Highland Nhs Board

Home , Melvaig, Ormiscaig, Raigmore

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 21 January 2011 www.nhshighland.scot.nhs.uk HIGHLAND NHS BOARD

MEETING OF BOARD

Tuesday 1 February 2011 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.

2 Minutes of Meetings of 7 and 16 December 2010 and Action Plan (attached)

The Board is asked to approve the Minutes.

2.1 Matters Arising

Review of Appointments – Position of Vice-Chair, CHP / Raigmore Committee Chairs and Committee Chairs Report by Garry Coutts, Chair, NHS Highland (attached)

The Board is asked to:

 Review the current membership of Committees.  Agree that Ian Gibson be re-appointed as Vice-Chair until 31/01/2013  Agree to the proposed membership for Community Health Partnerships / Raigmore Committees and that Chairs should be appointed / re-appointed until 31/01/2013.  Agree to the proposed appointment of Chairs for the main Governance Committees to 31/01/2013.

3 PART 1 – REPORTS BY GOVERNANCE COMMITTEES

3.1 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 22 December 2010 (attached)

3.2 Mid Highland CHP Committee – Draft Minute of rescheduled Meeting held on 12 January 2011 (attached)

3.3 North Highland CHP Committee – Draft Minute of Meeting held on 14 December 2010 (attached) 3.4 Raigmore Hospital Committee – Draft Minute of rescheduled Meeting held on 10 January 2011 (attached)

3.5 South East Highland CHP Committee – Note and Agenda of Meeting held on 20 January 2011 (attached)

The Board is asked to Note the Minutes.

3.6 Audit Committee – Draft Minute of Meeting held on 14 December 2010 (attached)

3.7 Staff Governance Committee Assurance Report and Draft Minute of Meeting held on 23 November 2010 (attached)

3.8 (a) Improvement Committee Assurance Report of 10 January 2011 and Balanced Scorecard (attached) (b) H4 – Alcohol Brief Interventions Update from Improvement Committee Report by Margaret Somerville, Director of Public Health and Health Policy

3.9 Area Clinical Forum – Draft Minute of Meeting of 25 November 2010 (attached)

3.10 Health & Safety Committee – Draft Minute of Meeting of 18 November 2010 (attached)

3.11 Pharmacy Practices Committee – Notes of Meetings (attached)  24 August 2010  26 October 2010  9 November 2010  2 December 2010

The Board is asked to: (a)  Note the Minutes. (b)  Note that the Staff Governance Committee met on 23 November 2010.  Note the minute of the meeting and the associated Assurance Report and agreed actions resulting from the consideration of the specific items detailed below. (c)  Note that the Improvement Committee met on 10 January 2011.  Note the Assurance Report and agreed actions resulting from the review of the specific topics detailed and the Balanced Scorecard.  Note the next meeting of the Improvement Committee will be held on 28 February 2011. (d)  Note the ABI delivery performance of NHS Highland against other Boards.  Endorse the importance of ABI delivery as a tool to combat excessive drinking in NHS Highland.  Sign up to review existing SLA and LES for the target period 2011/12.  Support shifting emphasis from training to delivery of ABIs by nurses and doctors. (e)  Note the meetings of the Pharmacy Practices Committee.

2 Council/Highland NHS Board Joint Committees

3.12 Highland Council Partnership – Joint Committee for Children and Young People – Minute of Meeting of 12 November 2010 (attached)

3.13 Highland Council Partnership – Joint Leadership and Performance Group – Minute of Meeting of 14 December 2010 (attached)

The Board is asked to note Minutes.

For Information

3.14 Endowment Funds Committee – Draft Minute of Meeting of 10 January 2011 (attached)

The Board is asked to note the Minute.

4 PART 2 – CORPORATE GOVERNANCE / ASSURANCE

4.1 NHS Highland Financial Position as at 31 December 2010 Report by Malcolm Iredale, Director of Finance (attached)

The Board is asked to:

 Note the continued projection of financial breakeven for 2010/11.  Note the improvement in the Operational Forecast, together with the ongoing work to deliver remaining savings and the continued management of emerging cost pressures.  Note the delivery of savings to date of £12.5m  Note the work underway on financial planning.

4.2 NHS Highland Draft Capital Plan 2011/12 Report by Malcolm Iredale, Director of Finance (attached)

The Capital Programme was discussed at the December Board Meeting, highlighting the reduction in the Board’s draft capital allocation and the potential impact on the current approved Capital Plan. This paper updates the process, recognising that the allocation is still draft pending agreement of the Scottish Government Budget later in the month, and also that it needs to reflect the final 2010/11 carry forward position on current capital schemes.

The Board is asked to:

 Note the anticipated level of capital resource for 2011/12 and the significant impact on the Board’s Capital Plan.  Note the committed projects to be undertaken in 2011/12  Agree the revised process to prepare and communicate the Capital Plan.  Note that a further Capital Paper will be submitted to the April Board.

3 4.3 Disposal of Surplus Property – Migdale Hospital Report by John Bogle, Acting Head of Capital & Property Planning on behalf of Malcolm Iredale, Director of Finance (attached)

It is a requirement that the Health Board officially declares properties/land which are no longer required, surplus to requirements. Migdale Hospital will become vacant when the new hospital opens and no other Health Service use has been identified for it, it has been declared surplus by the North Highland CHP and the Board is now asked to confirm this.

The Board is asked to Declare Migdale Hospital surplus to requirements and agree its disposal.

4.4 Infection Control Report Report by Liz McClurg, Temporary Infection Control Manager on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control (attached)

The Board is asked to:

 Note the contents of the Infection Control Report.

4.5 Scottish Patient Safety Programme (SPSP) Report by Maryanne Gillies, Clinical Governance Manager/SPSP Manager on behalf of Dr Ian Bashford, Board Medical Director (attached)

It was agreed by the Board in 2010 that there should be more regular reports to the Board on the SPSP. SPSP forms a key part of the NHS Highland Quality & Patient Safety Framework which was approved by the Board in April 2010. The aim of the Framework is to ensure that healthcare is personalised and made fairer, that there is access to the most effective treatments and that systems keep patients safe.

The Board is asked to note the progress of the Scottish Patient Safety Programme within NHS Highland as at January 2011 and in particular:

 The revised trajectory;  Actions planned to achieve trajectory;  The Hospital Standardised Mortality Ratios (HSMR) published on 30 November 2010.

4.6 “A Participation Standard for the NHS in Scotland” – Structure and Governance Arrangements Report by Gill Keel, Head of Public Engagement on behalf of Anne Gent, Director of Human Resources (attached)

The Board is asked to:

4  Note the work in progress to review the Board’s systems of governance for patient and public involvement across NHS Highland.  Note the attached appendix which presents a summary overview of existing patient and public involvement structures.

4.7 Chief Executive’s and Directors’ Report - Emerging Issues and Updates Report by Elaine Mead, Chief Executive (attached) This month’s report incorporates updates on:

 Autism Network  Freedom of Information (Scotland) Act 2002  Governance of Audit Scotland Reports  New Year Honours – Mid Highland CHP General Manager  NHS Blood and Transplant Organ Donation Report – 1 April – 30 September 2010  NHS Highland: Mid-Year Stocktake 2010-2011  NHS Highland Strategic Framework 2010/11 – Implementing the Vision  NHS Regional Planning – North of Scotland Planning Group and West of Scotland Planning Group  Volunteering Update  Winter Planning

The Board is asked to note the Emerging Issues and Updates Report.

5 PART 3 – STRATEGY AND POLICY

5.1 Community Care Plan Report by Jan Baird, Director of Community Care on behalf of Elaine Mead, Chief Executive (attached)

NHS Highland and The Highland Council have been consulting across the Partnership area on “Changing Community Care” – the Partnership Community Care Plan. The consultation process and earlier draft have previously been presented to NHS Highland and the attached document is the final version.

The Board is asked to:

 Endorse the final draft of the Community Care Plan to enable implementation to progress  Agree that the outstanding work required to complete the outcomes framework is progressed.

6 FOR INFORMATION

6.1 Date of next meeting The next meeting of the Board will be held on 5 April 2011 in the Board Room, Assynt House, Inverness.

6.2 Any Other Competent Business

7 Close of Meeting

5 Highland NHS Board 1 February 2011 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 7 December 2010 – 8 30 am Board Room, Assynt House, Beechwood Park, Inverness

Present Mr Garry Coutts, Chair Dr David Alston Mr Bill Brackenridge (by videoconference) Ms Pam Courcha (from 9.30 am) Mr Quentin Cox Mr Mike Evans Mr Ian Gibson Mr Okain McLennan Mr Colin Punler Cllr Elaine Robertson (by videoconference – until lunch) Mr Ray Stewart Ms Sarah Wedgwood Dr Roger Gibbins, Chief Executive, NHS Board Dr Ian Bashford, Board Medical Director Mrs Anne Gent, Director of Human Resources Mr Malcolm S Iredale, Director of Finance Ms Heidi May, Board Nurse Director Ms Elaine Mead, Chief Operating Officer Dr Margaret Somerville, Director of Public Health & Health Policy (from 9.50 am)

Also present Dr John Harvey, Consultant Rheumatologist (Item 169) Mr Derek Leslie, General Manager, Argyll & Bute CHP (until 12.10 pm) Mrs Gill McVicar, General Manager, Mid Highland CHP Mr Chris Meecham, Board Secretary Mr Kenny Oliver, Performance Manager (Item 176) Ms Moira Paton, Head of Community and Health Improvement Planning (Items 173 and 174) Mrs Lorraine Power, Board Services Assistant Mr Bill Reid, Head of eHealth (Item 175) Mrs Susan Rose, Communications Manager Mr Tom Slavin, Head of Finance, Mid Highland CHP (Item 171) Mrs Lynda Thompson, (Item 174)

Apologies – Apologies were received from Cllr Margaret Davidson, Mrs Gillian McCreath and Dr Vivian Shelley.

Prior to the commencement of business the Chair advised that Pam Courcha and Margaret Somerville were running late due to weather conditions and would join the Board meeting as soon as possible.

84 149 Declarations of Interest

Following her arrival at the meeting Ms Courcha declared a personal conflict of interest in relation to the item on Commissioning of Individual Advocacy, Collective Advocacy, Carers Centre and Community Development Services discussed at the Joint Leadership and Performance Group, and took no part in the discussion of this item. She also declared an interest in relation to the item on Advocacy Services as a member of her family used these services.

150 Minute of Meeting of 5 October 2010

The Chair advised that he had received a letter from Mr Douglas Hogg who had attended the last meeting, commenting on the minute and suggesting amendments. Mr Hogg had been advised that as it was a Board minute it was for the Board to approve or otherwise. He also highlighted that 10 letters had been received from individuals and a number of letters from MSPs regarding the item on Investing in Quality.

The minute of 5 October 2010 was approved.

151 Minute of Meeting of 2 November 2010

The minute of 2 November 2010 was approved. Dr Gibbins advised that following the meeting on 2 November, which had considered the business case in relation to Raigmore Day Services Centre and the Initial Agreement for the Redesign of Mental Health Services in Argyll & Bute CHP that the meeting of the Scottish Government Capital Investment Group (CIG) scheduled for 14 December had been postponed until February.

The Board a Approved the Minutes of Meetings held on 5 October and 2 November 2010. b Noted the position regarding the meeting of the Scottish Government Capital Investment Group.

152 Matters Arising

Members commented and updated on various actions in the Board Rolling Action Plan:

 In relation to the evaluation of Ward 2c it was noted that this had been completed and reported to the Raigmore Committee. A copy of the report would be circulated to Board members.  With regard to the action that there should be more regular Scottish Patient Safety Programme (SPSP) reports to the Board the Chief Executive confirmed that there would be a report to the next Board meeting, at which time the Board could decide on the future regularity of reports.  Mr Evans referred to the work following the report on Mid Staffordshire and it was noted that this would be reported to the next meeting of the Corporate Team with a report to the Board thereafter.

The Board a Agreed that the Board Rolling Action Plan be updated as discussed.

85 REPORTS BY GOVERNANCE COMMITTEES

153 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 27 October 2010

Mr Brackenridge, Chair of Argyll & Bute CHP updated on the meeting. The Board noted the performance of Argyll & Bute CHP in relation to delayed discharge figures, which had remained at zero for 8 months now.

In relation to the Vale of Leven Monitoring Group it was reported that the Vale of Leven Hospital would be delivering the services envisaged in the “Vision for the Vale” from 13 December 2010. The Chair welcomed the item on the Health Environment Inspectorate and it was noted that work was ongoing to ensure compliance with HEI Standards for the patients’ environment. It was noted that there would be greater use of unannounced inspections overall and less intensive inspections of those hospitals that had received five requirements or less during the first year of inspection. Mr Leslie also highlighted that the team involved in the mock inspection carried out at the Lorn and Islands Hospital on 22 September had included public representation. Mention was made of a potential financial risk regarding the SLA with NHS Greater Glasgow & Clyde.

154 Mid Highland CHP Committee – Draft Minute of Meeting held on 22 October 2010

Mr McLennan, Chair of Mid Highland CHP, updated on issues discussed by Mid Highland CHP Committee. He highlighted the Service Plan for Older Adults: Acute Rehabilitation Service Report which was part of the work on the clinical blue print for the Belford Hospital of the future. Mr McLennan also referred to the Hospital Travel Scheme Pilot which had been established in Fort William. Feedback on this initiative had been very positive and it was noted that this linked in with the item later on the Board agenda on Policies for Managing Access for Patients.

A question was raised in relation to dental access and the waiting list in the Dingwall area. It was recognised that many people on the waiting list did not take up places when offered them.

155 North Highland CHP Committee – Draft Minute of Meeting held on 12 October 2010

Mr Punler, Chair of North Highland CHP, updated on issues discussed by North Highland CHP Committee. He highlighted concerns in the Caithness area in relation to access to dental services and advised that Alex Fraser had reported to the last meeting of the Committee and would submit a further report to the next meeting. It was noted that the Emergency Medical Retrieval Service (EMRS) had been extended to cover the Caithness and Sutherland area from October and this service was welcomed by the Board.

156 Raigmore Hospital Committee – Draft Minute of Meeting held on 18 October 2010

In the absence of Ms Courcha, Mike Evans updated on the Raigmore Hospital Committee. It was noted that there had been changes to Organisational /Management Arrangements for Raigmore Hospital and that in future Raigmore Hospital would have 4 delivery units/divisions namely:  Surgical Specialties Division  Medical and Diagnostics Division  Patient Services Division  Hotel Services Division There were still a number of key posts to be filled in the new structure; however no additional management costs would be incurred in the new structure. Mr Evans highlighted work to develop a quality and performance Dashboard for Raigmore Hospital which would aim to pull together key performance indicators (KPIs) for the hospital. It was hoped that the Dashboard would help to clarify areas for improvement, which should be the focus for senior managers, and would be available for the next meeting of the Governance Committee.

86 There was some discussion around audible signage at the Raigmore Hospital site and when this would be operational again. Mr McLennan confirmed that this issue would be discussed by the Control of Infection Committee and it was suggested that a briefing could be provided for Board members.

157 South East Highland CHP Committee

It was noted the October meeting of the South East Highland CHP Committee had been cancelled and rescheduled for 23 November. The rescheduled meeting had also been cancelled as it would have been inquorate. The Board expressed disappointment at the low attendance at CHP and Raigmore Governance Committees, and the Chair requested that the Board Secretary prepare a report on attendance at CHP/Raigmore Committee meetings over the last year. He also requested that CHP/Raigmore Chairs ensure that all committee members had been issued with relevant guidance regarding their role.

The Board a Noted the minutes. b Noted that the issue relating to audible signage would be discussed at the next meeting of the Control of Infection Committee and that a briefing could be issued to Board members in due course. c Remitted to the Board Secretary to prepare a report on attendance at CHP/Raigmore Committee meetings over the last year. d Remitted to CHP/Raigmore Committee Chairs to ensure that all committee members had been issued with relevant guidance regarding their role.

158 Clinical Governance Committee Assurance Report and Draft Minute of Meeting held on 9 November 2010

In the absence of Dr Shelley, Sarah Wedgwood updated on the Clinical Governance Committee. In terms of the covering report for the meeting held on 9 November, it was noted that Dr Shelley had been present at the meeting rather than by videoconference and that Margaret Somerville was noted twice as being present while Margaret Davidson was present but not detailed as such. It was however noted that the minute reflected the correct attendance. Ms Wedgwood highlighted the discussions on Falls Prevention, Antimicrobial Prescribing in Primary Care and Tracheostomy Care. It was noted that interviews for patient representatives had been postponed due to adverse weather conditions. The Board Medical Director highlighted an issue around quality reporting and advised that the Datix system was poorly used by medical staff. Work was ongoing to look at policies and procedures to ensure more comprehensive reporting. Dr Bashford also mentioned the recent QIS report on Sexual Health and advised that there would be a report on the Radiology look back exercise to the next meeting of the Committee in February 2011.

159 Improvement Committee Assurance Report of 1 November 2010 and Balanced Scorecard

The Board noted the Improvement Committee Assurance Report of 1 November 2010 and Balanced Scorecard. The Chair advised that this had been a positive meeting and NHS Highland was doing well on most targets. It was noted, however, that eKSF remained an issue. There followed a detailed discussion on this issue and the Board reiterated the importance of staff development and eKSF and the need to embed this in the organisation.

87 A point was raised as to whether validated information or more recent unvalidated information should be used by the Committee and it was agreed that this should be considered further and reported to the January meeting of the Improvement Committee.

160 Area Clinical Forum – Draft Minute of Meeting of 30 September 2010

Mr Cox, Chair of the Area Clinical Forum, updated on the last meeting of the Area Clinical Forum. He referred to the Infection Control Update on page 3 of the minute and advised that the reference to “MRSA funding” in the third paragraph should in fact read “MRSA Screening funding”. It was agreed that the minute would be amended accordingly.

Mr Cox highlighted the ongoing work in relation to the NHS Highland Quality and Patient Safety Framework and advised that an Area Clinical Forum Development Day was planned which would explore further the issues raised at the Board Strategy Day. The Chair noted the improved attendance at the Forum and Mr Cox confirmed that an attendance record was now circulated at each meeting.

161 Endowment Funds Committee – Draft Minute of Meeting of 4 October 2010

Mr Gibson updated on the last meeting of the Committee. Cllr Robertson referred to the Financial Position reported on page 2 of the minute and the reference to some funds, which remained unspent. Mr Gibson advised that Endowment Fund allocations were much reduced and it was likely that all funds would be spent by the end of the financial year. Mr Gibson highlighted the need for use of restricted funds where possible, which had been allocated for a specific purpose. He also confirmed that there was scrutiny to ensure the appropriate use of funds.

The Board noted the important role of Endowments and the need to promote this area.

The Board a Noted the Minutes. b Noted:  that the Clinical Governance Committee met on 9 November 2010.  the Assurance Report and agreed actions resulting from the consideration of the specific items detailed.  the items for discussion at the next meeting to be held on 8 February 2011. b Noted:  that the Improvement Committee met on 1 November 2010.  the Assurance Report and agreed actions resulting from the review of the specific topics detailed and the Balanced Scorecard.  that the next meeting of the Improvement Committee will be held on 10 January 2011. d Agreed that further consideration should be given to the use of validated or unvalidated information in relation to eKSF reporting and this issue considered at the next meeting of the Improvement Committee. e Agreed to the minor amendment to the minute of the meeting of the Area Clinical Forum held on 30 September, as discussed.

88 Council/Highland NHS Board Joint Committees

162 Argyll & Bute Health & Care Strategic Partnership – Minute of Meeting of 29 September 2010

Mr Brackenridge, Chair of the Argyll & Bute Health & Social Care Strategic Partnership updated on the meeting. He advised that the meeting scheduled for 24 November had been cancelled. Mr Brackenridge gave an update on the eCare Pilot and advised that Bill Reid, Head of eHealth would be meeting with Jim Robb, Head of Service, Adult Care Services for Argyll & Bute Council, in January 2011 to progress.

163 Highland Council Partnership – Joint Committee for Children and Young People – Minute of Meeting of 1 October 2010

Mr Gibson, updated on the Committee, and highlighted measures to address the pressures on the Out of Authority Placements Budget. This included services such as the Northern Lights project which could accommodate five children at a time. It would initially be used to facilitate the return of children in out of authority placements to Highland but discussions were taking place with Barnardo’s regarding it becoming a service to prevent children being placed out of authority within the first two years of its operation.

164 Highland Council Partnership – Joint Leadership and Performance Group – Minute of Meeting of 12 October 2010

Garry Coutts, Chair, updated on the meeting and highlighted the Commissioning of Individual Advocacy, Collective Advocacy, Carers Centre and Community Development Services, advising that nominations were now underway for a preferred bidder. He also referred to the update on the Transformational Change Programme and the Joint Community Care Plan 2009/12.

The Board a Noted the minutes.

The Board adjourned at 10.00 am and resumed at 10.10 am.

CORPORATE GOVERNANCE / ASSURANCE

165 NHS Highland Annual Report 2009/10 Report by Susan Rose, Head of Communications on behalf of Anne Gent, Director of Human Resources

NHS Boards are required to publish an annual report conveying the activities of the NHS Board. The principal purpose of the local NHS annual report is to account to the local community and other local stakeholders for key aspects of its performance during the year, as part of public accountability. Mrs Gent, Director of Human Resources presented the report to the Board. It was felt that the new format was more user friendly and Mrs Gent sought comments from the Board prior to the printing of the report. The Board discussed the report in detail and a number of comments were made:

 There were a number of acronyms used throughout the document and it was requested that all acronyms in the document should also be given in full.  Page 13 the reference to Consultants travelling to Caithness should be reworded to reflect that there would be less travel than previously.  It was suggested that the slide used in the Annual Review to illustrate performance against the HEAT targets should be included.

89  There were a large number of pictures in the document and it was asked if these increased the overall cost.  This point was noted and it was also noted that not so many copies of the report were actually printed now as the report was also available electronically and online.  It was recognised that 90% of patient contact was in the community and it was suggested that this should be reflected more, if not in this year’s report then in future years.  Mention was made of the number of languages that the document could be made available in and that Gaelic was not listed. It was recommended that Gaelic should be included.  In relation to feedback on the report it was noted that there was a mechanism for feedback and it was suggested that this should be evaluated.  It was suggested that there should be more content in relation to Infection Control.  It was felt that the financial information detailed on pages 26 and 27 was not very user friendly.  A comment was made that the wording for Table 4 on page 7 did not correspond with the information in the chart.  The photograph used on page 19 had contact details for NHS Direct rather than NHS24 and should be changed.

It was agreed that the Chair, Sarah Wedgwood, Susan Rose and Anne Gent should discuss the issues raised at a reference group with the aim of incorporating the majority of comments made. It was recognised that due to the timescale that it might not be possible to address all issues in this year’s report but these would be picked up for future reports.

The Board a Noted the draft Annual Report for 2009/10. b Agreed that a number of amendments were required prior to publication and remitted to a reference group, as detailed above, to take this forward.

166 Director of Public Health and Health Policy – Annual Report 2009/10 Report by Margaret Somerville, Director of Public Health & Health Policy

The purpose of the report was to provide information and direction to service planning and to raise issues of public health importance to a wide audience. Dr Somerville spoke to the report and confirmed that she would also present the report to CHPs/Raigmore as well as our partner local authorities. The numbers of people aged 75 and above is set to increase substantially over the next decade and the associated increase in long-term conditions has major implications for the way in which we provide health care. There was plenty of good work in progress to reduce risk factor levels in the Highland population but we were still not seeing convincing reductions in alcohol consumption or rates of obesity. Pandemic Flu was successfully contained last year with an enormous amount of work by public health, health care and other staff, but we still needed to be as fully prepared as possible for future challenges such as climate change. The report also looked at the contribution and value of health improvement in reducing health care costs and activity, reinforcing the need to maintain this work long-term.

The Board welcomed the Annual Report by the Director of Public Health and Health Policy.

The Board a Noted the report and its recommendations.

90 167 NHS Highland Annual Accounts 2009/10 Report by Malcolm Iredale, Director of Finance

The 2009/10 Annual Accounts were considered by the Audit Committee on 29 June 2010 and subsequently approved by a special In Committee meeting of the Board on that day. Following this process, the Accounts were submitted to the Scottish Government, for onward submission to the Scottish Parliament, where the NHS Highland Accounts have now been approved.

The Board a Noted the 2009/10 year-end position for NHS Highland. b Noted the completion of the audit work and approval by the Board in Committee of the Accounts on 29 June 2010 and subsequent Parliamentary process.

168 NHS Highland Financial Position as at 31 October 2010 Report by Malcolm Iredale, Director of Finance

Mr Iredale updated on the financial position to 31 October 2010, which forecast a position at 31 March 2011 as financial breakeven. The underlying operational position was a £2.2m deficit, which had improved by £1.6m since the previous month, and maintained the progress towards the projected breakeven.

As previously reported, operational pressures arise for 2 major reasons:

 Emerging Cost Pressures (Net) - £0.5m  Efficiency Savings Programme - £1.7m

The major cost pressures, detailed in section 3, related to prescribing, medical locums and cost pressures and overspends which were emerging in a number of areas, including Out of Hours, Tertiary expenditure and the cost of oil.

Efficiency Savings were detailed in section 4 of the report and detailed in Table 3. The Table highlighted a planned achievement of £13.3m against the £15m target, albeit that some savings were non recurring in the current year. Some of these non recurring savings reflected the work of the Budget Review Group in the current year to develop a medium term Savings Plan which recognised the time needed to plan and deliver recurring savings, and the need to supplement these in the shorter term with non recurring initiatives. The work of the Budget Review Group was ongoing to ensure appropriate delivery of the savings programme, not only in 2011/12 but into forward years. This included the co-ordination of savings within individual Units as well as leading area wide initiatives.

The provisional Scottish Budget was published on 17 November, noting that this draft was pending discussion and agreement by the Scottish Parliament. In NHS terms for Boards, the indicated uplift was approximately 1% on a like for like basis, after taking account of central adjustments for the accounting treatment for Prescribing income, and the Change Fund established with Local Authorities. This overall indicative uplift would be subject to confirmation with individual Health Boards after agreement of the Scottish Budget into the New Year, and in the meantime the Board continued to plan on the basis of this indicative figure. As exact details will not be available during the next months, close contact will be maintained with Scottish Government to ensure that the assumptions and detailed calculations used by the Board are in line with latest Scottish Government Health Department guidance.

Ms Wedgwood sought further detail on how we were achieving saving and the impact on the organisation as a whole. Following discussion, Mr Iredale advised that he could produce a table of summarised savings by operational units to give added assurance in future reports.

91 The Chair also advised that CHP Chairs should be monitoring savings plans at their Governance Committees. In this respect Mr Brackenridge confirmed that this was evidenced by the recent minute of the Argyll & Bute CHP Committee.

The Board a Noted the continued projection of financial breakeven for 2010/11. b Noted the actions to deliver remaining savings and the continued management of emerging cost pressures. c Noted the work underway on financial planning. d Agreed that the Director of Finance produce an additional table summarising savings by operational units to give added assurance in future reports.

At this juncture the Chair agreed to consider the item on Rhuematology Services.

STRATEGY AND POLICY

169 Rheumatology Services for Northern NHS Highland Report by Dr John Harvie, Consultant Rheumatologist, Gill McVicar, General Manager, Mid Highland CHP and Alison Mackay, Rheumatology Project Manager on behalf of Elaine Mead, Chief Operating Officer

A review of NHS Highland rheumatology service was initiated in 2008 to cope with pressures resulting from new national standards of care including rapid access to specialist care for patients with suspected rheumatoid arthritis, to safely administer new ‘biologic’ treatments and to meet new waiting time targets. The Chair welcomed Dr John Harvie and Gill McVicar to present the report.

The review identified deficiencies and recommended the initial steps to develop a hub and spoke service emphasising quality and safety while encouraging self management, equity of access to appropriate levels of care and where appropriate to deliver care closer to patients’ homes

The key recommendations were:

 The continued availability of a seven day inpatient facility at Highland Rheumatology Unit and access to medical beds at Raigmore Hospital for complex cases.  Establishment of a rheumatology day case/ infusion service in a reduced complement of beds at the Highland Rheumatology Unit, Dingwall and a multi-specialty infusion service at Raigmore, with plans to set up further units across Highland where there is a recognised need.  To extend specialist multi-disciplinary care at Raigmore and peripheral out patient clinics  To develop structured education and training for arthritis patients and their families  To offer education and clinical skills training to clinicians in the primary care and community teams with a view to extending their role in the management of patients with chronic arthritis.  Integrated care pathways are being explored and developed to support appropriate and timely referrals.

Mrs McVicar updated on a recent meeting with Friends of the Highland Rheumatology Unit, hosted by the Consultants which had taken place on 2 December 2010. Positive feedback had been received on the proposals and the original working group would be invited to an event in January to ensure they have an opportunity to hear the outcomes of their early work and to comment on the Action Plan.

92 There followed a detailed discussion on the report and some concern was expressed that not everyone who had previously contacted NHS Highland regarding this issue would have an opportunity to provide feedback on the proposals. It was agreed that all those who had written to the Chair, Garry Coutts, regarding this issue would be sent a copy of the proposals, along with details on how they could feed back comments. It was agreed that no changes should be made to services until they had had an opportunity to feedback. Mention was made of the detailed Action Plan which had not been circulated with the paper and it was agreed that this could be circulated to Board members for information. It was noted that all proposals would be contained within existing financial resources. The Chief Executive felt there was a need to ensure that decisions such as these were made timeously by the Board and without delay. It was suggested that the Rheumatology Services work should be reviewed to ensure that a process was in place and the expectations of the Board were clearly understood and followed.

The Chair noted his appreciation for the work done to date, which would allow NHS Highland to provide the level of service we want to provide for patients. He also suggested that the review should be completed by the end of January 2011. In order to take this forward without further delay it was agreed to delegate to a number of Board members to undertake a review of the process so that the issue would not need to wait until the February meeting of the Board for a final decision. It was agreed that the Chair, Vice-Chair, Mr Okain McLennan and Ms Pam Courcha should participate in the review.

The Board agreed the proposals, subject to there being no significant new issues arising from the feedback.

The Board a Noted the redesign of Northern NHS Highland rheumatology services. b Approved the direction of rheumatology services for Northern NHS Highland. c Agreed the proposals, subject to there being no significant new issues arising from the feedback. d Delegated a number of Board members, as detailed above, to undertake a review of the process so there would be no further delay in implementation. e Recommended that the detailed Action Plan be circulated to Board members for information.

CORPORATE GOVERNANCE / ASSURANCE

170 Recommendation to approve Hub Private Sector Delivery Partner Report by John Bogle, Acting Head of Capital & Property Planning on behalf of Malcolm Iredale, Director of Finance

Hub is a procurement vehicle supporting a long term programme of investment in community infrastructure for local authorities, NHS Boards and other public sector bodies across Scotland. It will provide a mechanism for delivering assets more effectively through a single partner, with continuous improvement leading to better value for money. Mr Iredale updated on the report. It was noted that there had been a detailed session on this subject at the last Board Development Session.

The following were the key objectives of the hub initiative across Scotland:-

93 a) To provide enhanced local services by increasing the scale of joint service working and integration between Community Planning Partnerships across Scotland; b) to deliver a sustained programme of investment into community based facilities and developments so that more and more services are provided locally in communities through multi-disciplinary team working (wherever possible and appropriate) from single sites; c) to establish a more efficient and sustainable procurement methodology for public sector bodies that:- (i) reinforces joint strategic planning and delivery; (ii) is stable and long-term; (iii) delivers better value for money than current procurement arrangements; (iv) is flexible in its ability to respond to evolving service strategies and in being able to deliver through different contractual/ funding routes; and (v) is able to generate sufficient project size, volume and deal flow to attract private finance into the delivery and long-term management of the service; d) to share learning and improve the procurement process; e) to deliver facilities for Community Services that meet public sector policy objectives for design quality and sustainability; and f) to facilitate and improve the level of stakeholder engagement in the planning of services and development of facilities for Community Services.

John Matheson, Director, Health Finance Directorate wrote to all NHS Boards in June 2009 outlining that hub will take precedence over Frameworks Scotland for NHS Boards, with hub being the default model for the delivery of new build primary health care and community based premises. Exclusivity provisions with Hubco will apply to Health Boards for projects greater than £750,000 capital value for a period of 10 years.

Mr Gibson asked about potential risks and resource implications. It was noted that there would still be a three-stage process, which would aim to minimise fees. This would include the Initial Agreement, Outline Business Case and Final Business Case and costs would be reported at each stage of the process.

The Board Approved a The selection of Alba Community Partnerships Limited as the Private Sector Development Partner (PSDP) in Hubco as recommended by the North Territory Programme Board. b The establishment of Hubco, shareholding in Hubco and the provision of working capital of £270,000 between all participants (£15,000 each), all funding being provided from the Hub Programme’s Capital Enabling Funds not NHS Highland funds. c The entering into of the Territory Partnering Agreement, Shareholders Agreement and Participants Agreement with delegated authority to the Director of Finance to execute the same on behalf of the Board. d The appointment of Gerry Donald, Head of Physical Planning, NHS Grampian, as the B Shareholders’ Director on the Board of Hubco. e The appointment of Fraser Innes, North Territory hub Programme Director as the B Shareholders’ Representative and Participants’ Representative under and in terms of the Participants’ Agreement with delegated authority to take any action, grant any approval or consent or sign any notice required in terms of the Shareholders’ Agreement and Territory Partnering Agreement; in accordance with the terms of the Participants’ Agreement.

94 f The appointment of the Head of Capital and Property Planning as NHS Highland’s representative on the Territory Partnering Board with delegated authority to make any decisions on its behalf, which require to be taken by the Territory Partnering Board pursuant to its constitution.

171 Tain Health Centre – Outline Business Case Report by John Bogle, Acting Head of Capital & Property Planning on behalf of Malcolm Iredale, Director of Finance

Gill McVicar, General Manager, Mid Highland CHP and Tom Slavin, Head of Finance, Mid Highland CHP presented the report. Mrs McVicar updated on the background to the project. There were significant property issues around the current Tain Health Centre, which was over crowded and did not meet modern standards. General Dental Services in Tain were provided from inadequate premises above ground floor level with no disabled access. The Board approved an Initial Agreement (IA) for the project in October 2010; the Scottish Government Capital Investment Group (SGCIG) also approved the IA in September 2010.

Mr Slavin advised that the replacement of Tain Health Centre did not appear on the Board’s 5 year Capital Plan apart from £419,000 for dental fit out, therefore the preferred option was to have a revenue funded solution with the new Hubco providing a Design, Build, Finance and Maintain package.

The additional revenue costs of this option were estimated to be £559,095 per annum funded by:  £344,356 from CHP – covered through local redesign and cost improvement enabled in part by this development;  £147,494 from Dental, £20,000 from current funding and £127,494 from currently non cash limited GDS funding;  £67,245 from additional charges levied on the 2 GP practices.

As well as the additional non cash limited GDS spend identified above, the pay and non pay costs associated with the additional patient services would also be funded through non cash limited GDS. Although NHS Highland is aware that cash limiting of GDS funding is planned it has no knowledge of the timescale for this.

The Board was asked to approve the OBC and agree that the Project Team engage with the new Hubco which will be established to produce an FBC for the Board meeting in June 2011 and SGCIG meeting in July 2011. The cost of this would be met from capital enabling funding from Scottish Futures Trust (SFT). The Board was further asked to approve the use of these capital enabling funds to purchase the preferred site for the new health centre adjacent to Craighill Primary School, Tain.

There was some discussion around maintenance costs and the need for re-valuation of the site adjacent to Craighill Primary School by the District Valuer. The Board was advised that the new build would be fully maintained as full life cycle maintenance was included in the proposals.

The Board a Approved the Outline Business Case (OBC) for the replacement of Tain Health Centre. b Agreed that the Tain Health Centre Project Team engages with Hubco to produce a Full Business Case (FBC) for submission to NHS Highland Board in June 2011, with this work funded by capital enabling funds from Scottish Futures Trust (SFT). c Approved the purchase of a site adjacent to Craighill Primary School, Tain from Highland Council funded by capital enabling funds from SFT.

95 172 NHS Highland Capital Programme Report by Malcolm Iredale, Director of Finance

The NHS Highland Capital Plan was agreed by the Board in April 2010 and the 2010/11 element was in the process of being delivered. The Draft 2011/12 Scottish Government (SG) Budget was published on 17 November and, while it would not be finalised until February 2011, it was appropriate to review the impact that such a budget would have on the Capital Plans within NHS Highland. This report outlined the capital implications of the Draft Budget for the NHS, and highlighted the major issues for Highland. Mr Iredale advised that the SG Draft Budget Report reflected the reduced capital resources available as a result of the UK Comprehensive Spending Review (CSR), and the impact of strategic priorities within Scottish Government which included:

 Additional Forth Bridge crossing  Glasgow Southern General Hospital replacement  Ongoing work on the NHS Radiotherapy Programme  School modernisation programme

These national priorities impact on the capital allocations likely to be available to individual organisations, such as NHS Highland. The tables on page 2 of the report illustrated the draft NHS Highland resource based on NRAC Formula of £6.2m, however following adjustments for additional legal commitments and other capital spend the potential capital resource available was approximately £3.0m.

Detailed capital figures were only becoming available, and discussions were ongoing with SGHD to clarify the detailed issues. This would inform the revised local capital programme which was currently being considered by Operational Managers. The key aspects currently emerging were:

 Any moneys previously banked by NHS Highland with the Scottish Government to fund capital projects into the future are no longer available.  No further Business Case proposals, which involve capital expenditure, are being progressed through the national Capital Investment Group (GIG) until after finalisation of the Scottish Government Budget in February 2011. This means that consideration of the two cases submitted by NHS Highland (Day Case and Argyll and Bute Mental Health) will not be considered until the March Capital Investment Group.  The local capital resource should focus on the maintenance of the existing estate and equipment to ensure that the Board is able to continue to meet Statutory Compliance, replace appropriate equipment, and undertake the necessary level of backlog maintenance, etc.  Encouragement is being given to progressing other appropriate methods of progressing capital type spend – such as the Hub initiative described earlier on this agenda, or through stand alone procurements through revenue finance.

The application of these principles meant that progress on a number of Highland schemes would be deferred until after finalisation of the Government budget in February. Within the current NHS Highland Capital Plan this means deferring progress on the following schemes:

 Inverness Day Services  Argyll and Bute Mental Health Redesign  Skye Hospitals – MacKinnon  Dental – Portree  Dental - Oban

During discussion, concerns were expressed that the Board may not be able to address clinical needs which have been identified as priorities. It was agreed that the priorities should be reviewed, along with any potential revenue solutions, with a report to the next Board meeting.

96 The Board a Noted the significant reduction in capital resource likely to be available in 2011/12. b Noted the major impact on the current Capital Plan and Projects c Agreed the approach being adopted to amend the previous Capital Plan. d Noted that a report would be submitted to the Board in the New Year when further details are available. e Agreed that the priorities should be reviewed, along with any potential revenue solutions, and a report submitted to the next Board meeting.

173 Review of Equality and Diversity Impact Assessment Process Report by Esther Dickinson, Policy Development Manager & Moira Paton, Head of Community and Health Improvement Planning on behalf of Dr Roger Gibbins, Chief Executive

Moira Paton, Head of Community and Health Improvement Planning, presented the report. Equality Impact Assessment (EQIA) is designed to improve patient care, improve our status as an employer and ensure that we do not further disadvantage the most vulnerable in our community. EQIA encourages evidence based practice and prompts staff to involve the relevant communities in decision making. A full review of our process, mechanisms, support and paperwork for EQIA was undertaken to support improvement in our use of this key mechanism for ensuring and demonstrating a commitment to fairness and to addressing disadvantage and inequality. The report outlined the recommendations emerging from this review and the Board was asked to support these.

It was noted that, where done, impact assessments were commonly completed at the end of planning any given piece of work. This significantly increased the likelihood of staff seeing it as an end in itself and significantly decreased the benefits. It was proposed to re-brand EQIA as “Planning for Fairness”, offer guidance to senior staff, redevelop the paperwork required and keep the process and the paperwork under review. An update on progress would be submitted to a future meeting of the Board and exception reports would be submitted to the Improvement Committee.

During discussion the Director of Public Health emphasised the importance of monitoring inequalities and endorsed the scrutiny of “Planning for Fairness” by the Improvement Committee. Ms Paton confirmed that the team would work with Committee Chairs and staff involved so they were familiar with the process. The Director of Human Resources requested that in terms of the re-launch / re-branding process that the full term – “Planning for Fairness” be used rather than creating another acronym.

The Board a Endorsed the new system to embed EQIAs into the work of the organisation. b Noted that an update on progress would be submitted to a future meeting of the Board and exception reports would be submitted to the Improvement Committee.

97 STRATEGY AND POLICY

174 NHS Highland Advocacy Plan Report by Lynda Thomson, Policy Development Manager and Moira Paton, Head of Community and Health Improvement Planning on behalf of Roger Gibbins, Chief Executive

The Scottish Government require NHS Boards, in partnership with local authorities, to produce three-year Advocacy Plans which outline joint intentions for the provision of independent advocacy services in the Board area. This is the fourth plan that we have produced in partnership with Highland Council and our second such plan with Argyll and Bute Council. Moira Paton, Head of Community and Health Improvement Planning, presented the report. It was noted that there were different agreements with Highland Council and Argyll & Bute Council. The advocacy services currently provided within Argyll and Bute area still have a further year to run on current Service Level Agreements. At this stage it is planned to approach the current providers directly for a continuation of these services for a further three years.

The approach for Highland Council area was to retain current levels of funding for existing advocacy services, as reflected within the Advocacy Plan. Service specifications had been prepared for each of the advocacy services outlined and it was anticipated that negotiations would begin shortly. However, it was noted that since the issue of the report the Highland Community Care Forum (HCCF) had indicated that that they had not reached a decision on whether it would be possible for them to negotiate at the end of March and it was suggested that it might be possible to extend the facilities they provide. The Joint Leadership and Performance Group had also suggested a further change to the tender for carers’ services, to include carers’ advocacy.

The Advocacy Plan included a review of the current services in the area; an outline of assessed need for Independent Advocacy based on available research and data, and the outcome of our community consultation. It also details our legislative duties to ensure the provision of Independent Advocacy services.

The Board a Approved the Independent Advocacy Plan 2011 – 2014. b Noted the approach to procurement of independent advocacy services and the services to be procured.

175 NHS Highland eHealth Strategy Annual Refresh Report by Bill Reid, Head of eHealth on behalf of Roger Gibbins, Chief Executive

The NHS Highland eHealth Strategy was finalised in July 2009 and formally adopted at the August 2009 meeting of the Highland NHS Board. The current Strategy Refresh was presented to the eHealth Strategy Group on 8 September, and subsequently revised to reflect discussions and comments received. The document was then discussed by the Corporate Team at the meeting held on 30 September. The current Strategy document reflected the feedback received as a result of the respective meetings.

There followed a detailed discussion, during which the following points were raised:

 Mention was made of links with the seven characteristics of the Strategic Framework. Mr Reid confirmed that his intention was to meet with the relevant Executive Directors regarding this.  The changed situation regarding capital funding was also mentioned and how this might impact on the Strategy.

98  Long Term Conditions and Anticipatory Care Plans and the need for IT systems to be able to “speak to each other” across various locations and organisations.

It was agreed that the changed situation regarding capital funding would require an urgent review of the priorities. It was also felt that a more explicit timeline; a broader view of eHealth’s contribution to clinical services and the seven characteristics; and a clearer articulation of what can be delivered, and when, should be incorporated into the Strategy for further discussion at the February Board meeting. Bill Reid also agreed to provide Board members with a separate briefing on MiDAS.

The Board a Noted the background and consultation process leading to the final eHealth Strategy 2009 – 2012 and the associated commitment by the Head of eHealth to refresh the document on an annual basis. b Noted the substantially revised content of the attached document. c Noted in particular the ongoing work to ensure that the eHealth Strategy will support the implementation of the Strategic Framework. d Noted the availability of a more detailed Management Report referred to in the Strategy and available on request. e Agreed that the work identified should be progressed and incorporated into the Strategy, for further discussion at the February Board meeting. f Noted that the Head of eHealth would provide a separate briefing on MiDAS for Board members.

176 NHS Highland Updated Policies for Managing Access for Patients Report by Kenny Oliver, Performance Manager on behalf of Elaine Mead, Chief Operating Officer

The policy for Managing Access for Patients was approved by NHS Highland Board in June 2009. This paper outlined proposed updates to reflect changes in national policy and amendments identified since the implementation of the policy 18 months ago. Kenny Oliver updated on the report, which covered 5 key areas:

1. Admissions 2. Admit on Day of Surgery Policy (Appendix 1) – This policy had been developed for patients attending hospital for treatment, to improve the patient’s journey and help improve the utilisation of NHS resources. 3. National Patient Access Policy 4. Patient Rights (Scotland) Bill 5. Implementation of the policies developed through LEAN process.

The main focus of the current Managing Access for Patients policy was around attendance at outpatient appointments. As the 18 week Referral to Treatment Programme had progressed, there had been an increasing focus on patients being admitted to hospital for treatment. This had required the development of additional policies and procedures to improve the patient’s journey from the decision to admit the patient, to the patient being admitted, through to discharge. These amendments will need to be reflected in the revised Managing Access for Patients policy.

It was noted that the Admit on Day of Surgery Policy had been considered by the Improvement Committee. The principles of the Admit on Day of Surgery Policy were as follows:

99  Patients attending hospital for a surgical procedure should attend a pre operative assessment. Part of this assessment will determine whether a patient is suitable for admission on the day of surgery. Only if a patient is deemed not suitable for admission on the day of surgery should they be admitted to hospital the day before their surgery

 If a patient has been deemed suitable for admission on the day of surgery, is booked for an appointment before 10am and lives out with travel time zone from the hospital where their appointment is, then they are entitled to reclaim any expenses through the Highland and Islands Travel Scheme to cover an over night stay in a B&B or similar.

 NHS Highland is not responsible for the booking of any overnight accommodation out with NHS facilities.

 Patients should attend their agreed appointment and make every effort to arrive on time.

During discussion it was noted that Belford Hospital had been running this policy as a pilot for a number of months, and the evaluation so far had been very positive. Following discussion, the Board noted the revisions to date and the requirement to bring a revised policy back to the NHS Highland Board in April 2011 for approval.

The Board a Noted the revisions to date b Noted the requirement to bring a revised policy back to the NHS Highland Board in April 2011 for approval.

The Board adjourned at 1.10 pm for lunch and resumed at 1.40 pm.

177 Infection Control Report Report by Liz McClurg, Temporary Infection Control Manager on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control

Heidi May, Board Nurse Director updated on the Infection Control report. The position regarding Staph aureus bacteraemias (SAB) was that, due to low numbers of infection and multiple different causes, the SAB target continued to be challenging for the Board. All Boards have been asked to reduce SAB case numbers by an additional 15% by March 2011, which means the target for NHS Highland is no more than 46. Although the year-on-year improvement has been maintained, it is unlikely that NHS Highland will meet the target set for 2010/11. There have been 33 cases between April – October 2010, of which there were 3 MRSA and 30 MSSA. Despite the challenge of a difficult target, NHS Highland continues to have the lowest rate of SAB infection of all the Scottish territorial Boards.

The C. Difficile Infection (CDI) case numbers nationally are now at their lowest level and NHS Highland is well on track to meet the target. All Boards are now expected to achieve a minimum of 50% rate reduction among patients age 65 and over by 31 March 2011. In terms of numbers this means NHS Highland must not exceed 130 cases of CDI over the course of 2010/2011. From April to October 2010 there have been 50 cases.

NHS Highland had one of the lowest rates of antibiotic prescribing in Scotland and continued to be one of the highest users of recommended antibiotics, only overtaken by NHS Tayside in 2009/10. In addition, the use of antibiotics associated with an increased risk of infection with Clostridium difficile is falling and NHS Highland now has the 4th lowest prescribing rate of these drugs out of 14 NHS boards.

100 NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas. Compliance with taking opportunity for hand hygiene was 97% in September and October 2010. Compliance with technique for hand hygiene was 93% in September and 94% in October 2010. Cleaning compliance was 95% during September and 92% in October 2010. The target compliance is 90%.

During discussion a question was raised regarding dentists prescribing antibiotics and Ms May advised that she would look into this.

The Board a Noted the contents of the Report. b Noted that the Board Nurse Director would consider the issue of dentists prescribing antibiotics.

178 Mid Year Progress Report on the Implementation of the Annual Work Plan 2010/2011 Report by Liz McClurg, Temporary Infection Control Manager on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control

In 2003 the Chief Medical Officer identified the prevention and control of Hospital Associated Infection (HAI) as a high profile priority issue for NHS Scotland. This resulted in the development of the NHS Scotland Code of Practice for the Management of Hygiene and HAI. With effect from May 2004 all NHS Boards were instructed through SEHD/CMO (2004) 9 to implement the Code of Practice with immediate effect.

Section 7 of the Code of Practice - Compliance Management, requires Boards to develop an annual infection control and monitoring programme. This should include audit activity and seek to identify areas of deficiency. From the findings, a local Action Plan must be initiated.

The 2010-2011 Infection Control Work Plan was submitted to and approved by the Board in August 2010. The purpose of this report is to provide a progress update.

The Board a Noted the Infection Control Work Plan (2010–2011) Progress Report.

179 Constitution / Role & Remit of Area Nursing, Midwifery and Allied Health Professions (AHP) Committee Report by Helen Bryers, Head of Midwifery on behalf of Heidi May, Board Nurse Director

Highland NHS Board approved the disbandment of the Area Nursing and Midwifery Committee and the Allied Health Professional Committee in April 2010. At the same time, Highland NHS Board agreed to the formation of a Joint Nursing, Midwifery and AHP Committee. This committee was now formed and had agreed terms of reference and role and remit.

Ms May updated on the report and advised that this had been discussed in detail at the meeting of the Area Clinical Forum on 25 November. An issue was raised regarding membership which was currently stated as being at senior charge nurse level. It had been pointed out that there were competent nurses / staff nurses who could also contribute to the Committee and it was therefore agreed to amend the constitution to reflect this. Mr Cox also highlighted a sentence in the membership section of the constitution which stated “Membership vacancies shall be filled by nominees elected by the Committee on the basis of the above criteria”.

101 He was not entirely happy with the word “elected” and confirmed that he would agree an appropriate form of words with the Board Nurse Director. Sarah Wedgwood asked how the committee fitted into the clinical governance structure and Ms May agreed to re-circulate a copy of the diagram which had been included in the previous report to the Board.

The Board a Agreed the Terms of Reference for the Area Nursing, Midwifery & Allied Health Professions Professional Advisory Committee (NMAHP PAC), subject to the minor changes discussed. b Remitted to the Board Nurse Director to re-circulate a copy of the diagram which had been included in the previous report to the Board to Sarah Wedgwood.

180 Chief Executive’s and Directors’ Report – Emerging Issues and Updates Report by Roger Gibbins, Chief Executive

This month’s report incorporated updates on:  Children and Adolescent Mental Health Services (CAMHS)  Combined Assessment Unit, Belford Hospital  Mental Health Services – Adult Support and Protection  Mental Health Services for Older Adults in Ross and Cromarty  NHS Regional Planning – North of Scotland Planning Group  Raigmore and Caithness General Hospital Boiler plants – Biomass Fuel  Sale of Glencoe Hospital  Update on Actions – Annual Review

The Board expressed their thanks to staff who had continued to provide services throughout the period of severe weather. Staff had been getting to work and had ensured that there had only been minor disruption to services. It was noted that regular situation reports were being obtained from each operational unit and a regular situation report had been submitted to the Scottish Government.

Roger Gibbins, Chief Executive updated on the current position regarding the former Glencoe Hospital, which was due to go on sale on the open market after 23 December 2010, if members of the local community were unable to make a formal offer. The South Lochaber Community Group had previously used the Land Reform Act to gain exclusive right to bid on the property for six months. This ran out in June 2010 but Highland NHS Board granted the Group’s request for a six month extension which would run out on 23 December 2010. On the day on the Board meeting, in the early hours of the morning, NHS Highland had received a request from South Lochaber Community Group for a further extension. A copy of the relevant e-mail was tabled for information.

The request was considered by the Board. The Director of Finance advised that he had contacted the SG Property Directorate and had been advised that the Board was under no obligation to extend. It was also felt that the Board had a wider responsibility in terms of the disposal of the property. Following discussion Board members decided that they could no longer justify giving the Group exclusive right to bid, as they had been unable to raise the necessary funds in the year that they had had to do so.

The Board a Noted the emerging issues and updates report. b Noted the correspondence from South Lochaber Community Group requesting a further extension in relation to the former Glencoe Hospital.

102 c Agreed they could not offer a further extension to the South Lochaber Community Group.

181 Any other Competent Business

There was none.

182 Date of Next Meeting

The next meeting of the Board will be held on Tuesday 1 February 2011 at 8.30 am in the Board Room, Assynt House, Beechwood Park, Inverness.

The meeting concluded at 2.15 pm.

103 Highland NHS Board 1 February 2011 Item 2(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/

DRAFT MINUTE of the SPECIAL JOINT MEETING of the BOARD and THE 16 December 2010 – 10 00 am HIGHLAND COUNCIL Council Chamber, Council Headquarters, Glenurquhart Road, Inverness

Present: Highland NHS Board Mr Garry Coutts, Chair Dr David Alston Mr Bill Brackenridge Mr Quentin Cox Mr Mike Evans Mr Ian Gibson Mrs Gillian McCreath Mr Okain McLennan Mr Colin Punler Cllr Elaine Robertson Dr Vivian Shelley Mr Ray Stewart Ms Sarah Wedgwood Dr Roger Gibbins, Chief Executive, NHS Board Dr Ian Bashford, Board Medical Director Mrs Anne Gent, Director of Human Resources Mr Malcolm S Iredale, Director of Finance Ms Heidi May, Board Nurse Director Ms Elaine Mead, Chief Executive Designate Dr Margaret Somerville, Director of Public Health & Health Policy Present: Highland Council Dr D Alston Mr D Fallows Mr E Hunter Mr F Parr Mr R Balfour Mr G Farlow Mr D Kerr Mrs M Paterson Mr B Barclay Mr B Fernie Mr J Laing Mr R Pedersen Mr S Black Mr M Finlayson Mrs B McAllister Mr T Prag Mr I Brown Mr J Finnie Mrs I McCallum Mr I Renwick Mr P Cairns Mr D Flear Mrs L MacDonald Mr A Rhind Mr D Cameron Mr J Ford Mr J McGillivray Mr G Rimell Mrs I Campbell Dr M Foxley Mrs D Mackay Mr J Rosie Miss J Campbell Mr C Fraser Mr D Mackay Mr I Ross Mrs H Carmichael Mr H Fraser Mrs A MacLean Mr R Rowantree Mr D Chisholm Mr L Fraser Mr K MacLeod Mr A Sinclair Mr A Christie Mr A Graham Mrs K MacNab Mrs G Sinclair Mr B Clark Mr J Gray Mr G Marsden Mr G Smith Mr R Coghill Mr R Greene Mr D Millar Mrs M Smith Mr P Corbett Mr B Gormley Mrs L Munro Mr A Torrance Mr N Donald Mr D Henderson Mrs P Munro Mrs J Urquhart Ms J Douglas Mr D Hendry Mr B Murphy Mrs C Wilson Mr R Durham Mr J Holden Mr A S Park Mr H Wood Mr R Wynd

105 In Attendance Mr Bill Alexander, Director of Social Work, Highland Council Mrs Jan Baird, Director of Community Care Mr Alistair Dodds, Chief Executive, Highland Council Mrs Gill Keel, Head of Public Engagement Ms Julie MacLennan, Democratic Services Manager, Highland Council Mr Chris Meecham, Board Secretary Ms Michelle Morris, Assistant Chief Executive, Highland Council Ms Moira Paton, Head of Community & Health Improvement Planning Mrs Lorraine Power, Board Services Assistant Mr Simon Steer, Head of Community Care Integration

Mr Sandy Park and Mr Garry Coutts jointly chaired the meeting.

Apologies – Apologies were received from Ms Pam Courcha, Cllr Margaret Davidson, Dr Vivian Shelley, Mr David Bremner, Mr Jim Crawford, Mr Allan Henderson, Mr Willie Mackay, Mr Martin Rattray and Lady Marion Thurso on the Highland Council.

Prior to the commencement of business Mr Sandy Park, Convener of the Highland Council and Mr Alistair Dodds, Chief Executive, Highland Council welcomed the NHS Board and officials to the Highland Council Chamber for the Special Joint Meeting between Highland NHS Board and the Highland Council.

CORPORATE GOVERNANCE / ASSURANCE

185 Declarations of Interest

There were no declarations of interest by Highland NHS Board members. Mr S Black declared a financial interest in Item 186 on the grounds that his spouse was employed by NHS Highland and confirmed that, after consideration of the subject matter within the report; he would take part in the debate but would not participate in any voting.

186 Improving Joint Service Delivery – A New Partnership Model Joint Report by Chief Executive, The Highland Council and Chief Executive, NHS Highland

There had been previously circulated Joint Report No. HC/NHS/1/10 dated 8 December 2010 by the Chief Executive, Highland Council and the Chief Executive, NHS Highland, which outlined the shared values and principles underpinning our joint approach to service delivery for Adult Community Care and Children’s Services. Alistair Dodds, Chief Executive of The Highland Council, and Elaine Mead, Chief Executive Designate of NHS Highland, presented the Joint report. The report summarised the reasons why the leadership of the Highland partnership believed that a new model for service planning and delivery was needed, considered a variety of possible models, highlighted the preferred model and proposed further work to continue the momentum towards significantly improved arrangements to deliver better outcomes, increase effectiveness and achieve further efficiencies.

The recommended model involved single lead agency arrangements, and would leave both organisations jointly accountable for determining outcomes and the resources to be committed. The lead agency would assume responsibility for all aspects of business delivery strategy, internal governance and operational delivery or commissioning of services and would be fully accountable for the delivery of agreed outcomes. It was felt that the most appropriate single lead agency for the delivery of Adult Community Care Services was NHS Highland and that the most appropriate single lead agency for the provision of Children’s Services was The Highland Council.

The proposals would:  reduce bureaucracy,  ensure front-line services were efficient and cost effective by removing duplication and gaps,

106  make sense to the public and to service users, by having a single, lead organisation responsible for the management and organisation of services,  provide a clear framework for improved leadership and enhanced public accountability.

The changes would be significant as they would:  involve far reaching changes in organisational and management arrangements for the two largest employers in the Highland area.  provide a means of achieving what politicians, professionals, clinicians and the public have been seeking for many years, in both children’s and adult services – reduced bureaucracy and a real joined up approach to service delivery.  represent the most advanced plans in Scotland to achieve these aims.  demonstrate the significant trust and effective working relationships that have been developed by care and health professionals across Highland Council and NHS Highland.  deliver real improvements in services and outcomes for the users of health and social care services in the Highlands.

It was noted that North East Lincolnshire had introduced new arrangements which had provided valuable learning and they had agreed to visit Highland sometime in January / February 2011 to share this further. It was anticipated that some funding would be available from the Change Fund for Community Care with the possibility for additional transitional funding.

It was recognised that the proposals were still in the early stages of development and there was significant work still to be done, which would involve engagement with staff, services users and families. The decision requested at this stage was simply to agree in principle to undertake more detailed work to develop a formal Implementation Programme Plan. The Plan would then be brought back to the Council and the Health Board by May 2011, seeking formal endorsement and commitment to proceed.

Dr Foxley welcomed the joint meeting and endorsed the proposals, which would improve services in the Highlands. Mr Coutts also endorsed the proposals and while highlighting the enormity of the task ahead asked that this not hinder the potential benefits.

There followed a detailed discussion on the proposals by members of The Highland Council and NHS Highland, during which a number of points were raised:

 Transitional arrangements were key, as were the relationships that currently exist between The Highland Council and NHS Highland.  The need to keep the focus on the needs of Highland people.  The proposals were underpinned by the strategic direction of NHS Highland, including the Vision and Strategic Framework, the Quality and Patient Safety Strategy and shifting the balance of care. Quality care was paramount with appropriate clinical governance.  The need to not just consider changing the structure within the organisations, but to also consider the culture within the organisations.  Mention was made of Specialist Childcare Health Professionals and children with long-term complex needs, which was a specific area that would require further consideration.  The need to involve staff on the ground and recognition that there were different terms and conditions of service across the two organisations.  Whether the proposals for both Children’s Services and Adult Community Care Services needed to be progressed in tandem.  It was noted that Argyll & Bute CHP area and Argyll & Bute Council were not currently involved in the proposals, however they were interested in the model and the intention was to set up a project board in Argyll & Bute, which would follow the progress of the proposals.  The importance of people receiving services and delivering services to understand the proposed changes.  The need for clear governance and accountability arrangements, in relation to financial governance, clinical governance and staff governance.  The need to get the structures right and ensure that they are integrated.

107 Mr Coutts emphasised the focus on quality outcomes. He recognised that the detail still needed to be worked through and the timetable was very tight, although this could be reviewed if required. Staff involvement would also be key and he suggested that professional staff should be involved in the proposed event in January / February 2011 with North East Lincolnshire.

Dr Foxley advised that the Chair of the Social Work and Housing Committee. Margaret Davidson, who was currently on leave, had given her full support to the proposals. He felt that the issue around highly specialised care for children would require further consideration. In recognition of the fact that there had been more concerns around Children’s Services, he highlighted the close working relationship between Health Visitors and District Nurses and suggested that his could be extended to include School Nurses. It was suggested that there was a need for a Communications Strategy, which might address some of the issues raised.

Mr Park asked Highland Council members to agree the recommendations. Mr Coutts asked Highland NHS Board members to agree the recommendations. Both The Highland Council and NHS Highland unanimously agreed the recommendations in the report.

Council Members and the Board Agreed in Principle: a To commit to a pathway for integration of health and social care services that would provide both Authorities with the joint responsibility for specifying the outcomes to be achieved for service users, and the totality of resources to be allocated to each of the two service areas, and would put in place single lead agency arrangements for Adult Community Care Services and for Children’s Services. b That the most appropriate single lead agency for the delivery of Adult Community Care Services was NHS Highland and that the most appropriate single lead agency for the provision of Children’s Services was The Highland Council. c A formal Implementation Programme Plan be developed to progress detailed planning and implementation with a view to the new arrangements being fully in place by April 2012. d That this Plan is brought, by May 2011, to the Council and Health Board for formal endorsement and commitment to proceed. e To receive and consider further reports on progress, and participate in a special workshop in the new year to explore the issues in depth with input from Partnerships elsewhere who have developed and implemented similar proposals.

187 Any other Competent Business

Chief Executive – NHS Highland – Dr Foxley advised the meeting that this was Dr Gibbins last Board meeting as Chief Executive of NHS Highland. He highlighted the good working relationship they had had over the years, particularly referring to work in relation to remote and rural health and the relationship between NHS Highland and The Highland Council. Dr Foxley presented a gift to Dr Gibbins on behalf of The Highland Council. Dr Gibbins thanked the Council for the gift and said that he was privileged to have had the opportunity to work in the Highlands.

188 Date of Next Meeting

The next meeting of the Board will be held on Tuesday 1 February 2011 at 8.30 am in the Board Room, Assynt House, Beechwood Park, Inverness.

The meeting concluded at 11.20 am.

108 Highland NHS Board 1 February 2011 Item 2(c)

FOLLOW UP FROM BOARD ACTION PLANS – APRIL 2009 ONWARDS Those items shaded grey are due to be removed from the Action Plan as they have been completed, or will be considered at the next Board. Meeting Item Action / Progress Outcome

Board 07/04/09 NoSPG – Initial Agreement – The Board gave formal approval for the initial agreement to Has been put back from original date of Reprovision of a Regional Young enable the development of an outline business case for Tier 4 April 2010 and likely to be the autumn. People’s Unit services across the North of Scotland. Board 07/12/10 – Deferred Likely to be April 2011 Adult Support and Protection: The Adult Support and Protection Committees should submit a CEs Report – 07/12/10 Adult Protection Committees report to the Board every 2 years. Board 06/10/09 Disability Equality Scheme 2009/12 Noted the intention to develop a Single Equality Scheme in Board June 2010 2010, into which will be incorporated disability equality actions Deferred to early 2011 and would be submitted to the Board. Board 05/04/11 Board 01/12/09 Volunteering Policy The development of the Volunteering Strategy for NHS Board 07/12/10 – Deferred Highland will be progressed next year. CEs Report – Board 01/02/11 Mental Health Services A report would be submitted to the Board following the Future Board – work ongoing Psychological Therapies Review. Board 05/04/11 – Will be covered as part of Mental Health Work Plan.

Board 02/02/10 Raigmore Committee Circulate evaluation of Ward 2c to Board members. Evaluation of Ward 2c currently underway. Report circulated to Board members 16/12/10

Joint Leadership and Performance Reports from Stakeholder to be circulated to members. Chair to circulate to Board Members Group  Friday 26 February 2010 – Caithness 26 Feb and 28 May now circulated  Friday 28 May 2010 – Nairn/Badenoch  Friday 20 August 2010 – Fort William No reports produced by HC for these  Tuesday 23 November 2010 – Skye and Lochalsh events.

To consider prior to January 2011 the positions of Vice-Chair Board 01/02/11 and Chairs to the CHPs/Raigmore.

Board 01/06/10 Minute of 13 April 2010 – Healthy Agreed that there should be an update on the Healthy Weight Margaret Somerville – Future Board Weight Strategy Strategy to a future meeting of the Board. Board April 2011 Meeting Item Action / Progress Outcome

Board 01/06/10 Minute of 13 April 2010 A report on the care and provision for people with Autism Board 07/12/10 – Deferred Spectrum Disorder should be submitted to a future meeting of CEs Report – Board 01/02/11 the Board.

Control of Infection Report Further analysis of trends of the SAB cumulative chart to be Control of Infection Committee done by the Control of Infection Committee. Being progressed by Director of Medical Education Highland Compact with the Third The Chair suggested that it would be useful to have a wider Board Dev. Sector discussion on policy in relation to working with the third sector at CEs Report 01/02/11 a future Board Development Session, prior to the Volunteering Strategy being considered by the Board in December 2010.

Scottish Patient Safety Programme To include more regular SPSP reports to the Board. Board 01/02/11

Communications Framework Further Report on the implementation of the Framework to be Future Board - April 2011 submitted to the Board in due course.

North Highland CHP Committee To submit a future report to the Board on various initiatives to Margaret Somerville – Future Board encourage people to take exercise. Board April 2011

Board 10/08/10 Clinical Governance Committee Operational Units to consider the findings of the Better Together CHP / Raigmore Chairs & GMs to Patient Experience Programme and address any areas that progress could be addressed. Standing Orders To provide guidance for CHP/Raigmore Committees regarding Completed. New arrangements have to quarterly reports on patient and public involvement. be planned around the new Participation Standard for NHS Scotland (Part three, Corporate Governance of Participation). The core agendas of Operational Governance Committees and other key committees should be revised to include items on Engagement with Patients and Communities. This may be more effective as an element within each item or report, rather than as a separate item, e.g. within a standing item on actions to deliver the Strategic Framework.

2 Meeting Item Action / Progress Outcome

Board 10/08/10 Standing Orders To provide guidance for CHP/Raigmore Committees regarding Anne Gent and Gill Keel are quarterly reports on patient and public involvement. progressing, initially through dialogue with General Managers. A progress report will be presented to the Board in February 2011. Report on Participation Standard submitted to Board 01/02/1. Primary Care – 70% Group of GPs To explore further opportunities with the 70% Group to shift the Future Board – Summer 2011 balance of care in other specialties (e.g. Gynaecology, Orthopaedics and Rheumatology). Gender Equality Scheme To advise on the timescale for a Single Equality Scheme. Future Board – Feb 2011 Deferred – Board 05/04/11 North Highland CHP Committee The Staff Governance Committee to consider an appropriate Staff Governance Committee agenda for CHP/Raigmore Committees to cover relevant Staff Work in Progress. AG liaising with Governance issues. Head of Personnel and Employee Director. Health & Safety Committee CHP/Raigmore Chairs to progress the issue of Fire Safety CHP/Raigmore Chairs to progress. Officers in each building in their area.

Board 05/10/10 Board and Committee Calendar of NHS Highland to continue to invite the Councils to attend the Future NHS Board – To be agreed Meetings 2011 NHS Board at least once a year and that representatives from NHS Highland should attend the Council meetings at least once a year.

Maternity Services Committee A further update to be prepared for Board members on progress No progress yet. Being considered in relation to the position of Clinical Lead for maternity services. through the Maternity Services Coordinating Committee Control of Infection Report CHPs/Raigmore ensure that there had been walk rounds the CHP/Raigmore Chairs / GMs various hospitals with someone who had relevant experience, to ensure they were at the necessary standard.

The Control of Infection Committee to consider the trigger CoI Committee – still to be actioned thresholds in relation to the Control of Infection report.

Looked After and Accommodated A further report to be submitted to the Board in approximately 6 Board April 2011 Children months time, to focus on both Highland Council and Argyll & Bute Council areas and include the implementation of action plans to improve outcomes for Looked After Children both at home and out of area.

3 Meeting Item Action / Progress Outcome

Board 05/10/10 Chief Executive’s Report Corporate Team to consider the funding issue relating to Corporate Team Wheelchair Services and report back to the Board. Future Board

NHS Highland Strategic Framework This work would to be further progressed at the Board Strategy Board Dev. 02/11/10 2010/11 – NHS Highland Vision Session on 2 November, and a further report to be submitted to the December meeting of the Board. Board 07/12/10 – deferred Board 01/02/11 Investing for Quality To progress the work in relation to the Clinical Board. Board 07/12/10 – deferred Board Dev. 31/01/11 To issue of the Statement of Guiding Principles for Prescribing to all prescribers in NHS Highland as Board policy and agreed the contents of this guidance. Board 05/10/10 Emergency Response and SAS to liaise with the Chief Executive regarding the suggestions CE / SAS to progress Transport made, and agree with him a revised implementation plan. CEs Report – Board 07/12/10 – A further report would be submitted to the Board in relation to deferred monitoring performance in local areas. Board 01/02/11 A Participation Standard for the A further report on structure and governance would be CEs Report – 07/12/10 – deferred NHS in Scotland submitted to the next meeting of the Board. Board 01/02/11

Sarah Wedgwood should join the PFPI Group and Pam Courcha and Okain McLennan should also be involved in this work. Board 07/12/10 Matters Arising Raigmore Hospital - A copy of the report following the evaluation Completed of Ward 2c had been submitted to the Raigmore Committee and would be circulated to Board members.

Scottish Patient Safety Programme (SPSP) – the Chief Board 01/02/11 Executive confirmed that there would be a report to the next Board meeting, at which time the Board could decide on the future regularity of reports.

Mid Staffordshire – it was noted that this would be reported to Corporate Team – 27/01/11 the next meeting of the Corporate Team with a report to the Board 05/04/11 Board thereafter. Raigmore Hospital Committee Audible Signage at the Raigmore Hospital – a question was COI Committee 15/12/10 raised as to when this would be operational again. Mr McLennan confirmed that this issue would be discussed by the Briefing for Board Members Control of Infection Committee and it was suggested that a briefing could be provided for Board members.

4 Meeting Item Action / Progress Outcome

Board 07/12/10 CHP / Raigmore Committees Board Secretary to prepare a report on attendance at Board 05/04/11 CHP/Raigmore Committee meetings over the last year. CHP/Raigmore Committee Chairs to ensure that all committee CHP/Raigmore Chairs members had been issued with relevant guidance regarding their role.

Improvement Committee Further consideration to be given to the use of validated or Improvement Committee 10/01/11 unvalidated information in relation to eKSF reporting and this Completed issue considered at the next meeting of the Improvement Committee.

Area Clinical Forum To amend the minute of the Area Clinical Forum meeting held Completed on 30 September to read “MRSA Screening funding”.

NHS Highland Annual Report A number of amendments were required prior to publication and Amendments made – completed 2009/10 it was remitted to a reference group comprising Garry Coutts, Sarah Wedgwood, Susan Rose and Anne Gent to take this forward.

Area Finance Report Director of Finance to produce an additional table summarising Future Boards savings by operational units to give added assurance in future reports.

Rheumatology Services for Agreed the proposals, subject to there being no significant new Northern NHS Highland issues arising from the feedback.

Delegated to the Chair, Vice-Chair, Okain McLennan and Pam Courcha to undertake a review of the process so that the issue would not be delayed further.

Review to be undertaken to ensure that a process is in place and the expectations of the Board are clearly understood and followed.

Detailed Action Plan to be circulated to Board members for Circulated to Board members information. 20/01/11.

5 Meeting Item Action / Progress Outcome

Board 07/12/10 NHS Highland Capital Programme A report would be submitted to the Board in the New Year Board 01/02/11 when further details were available.

The Board agreed that the priorities should be reviewed, along with any potential revenue solutions, and a report submitted to the next Board meeting. Review of Equality and Diversity To take forward the new system to embed EQIAs into the work Impact Assessment Process of the organisation.

An update on progress would be submitted to a future meeting Board Aug / Oct 2011 of the Board and exception reports would be submitted to the Improvement Committee. NHS Highland eHealth Strategy The work identified should be progressed and incorporated into Board 01/02/11 – Deferred Annual Refresh the Strategy, for further discussion at the February Board Board 05/04/11 meeting. To provide a separate briefing on MiDAS for Board members. NHS Highland Updated Policies for To bring a revised policy back to the NHS Highland Board in Board 05/04/11 Managing Access for Patients April 2011 for approval.

Infection Control Report Board Nurse Director to consider the issue of dentists Briefing prepared by Antimicrobial prescribing antibiotics. Prescribing Team, will go to relevant committee Constitution / Role & Remit of Area To amend the constitution as agreed by the Board. ANM&AHP Committee Nursing, Midwifery and AHP Committee To re-circulate a copy of the diagram which had been included Nurse Director to meet with Sarah in the previous report to the Board to Sarah Wedgwood. Wedgwood.

Chief Executive’s Report To advise South Lochaber Community Group of the Board Completed decision regarding the former Glencoe Hospital.

6 Highland NHS Board 1 February 2011 Item 2.1

MEMBERSHIP OF COMMITTEES

Report by Garry Coutts, Chair, NHS Highland

The Board is asked to:

 Review the current membership and in so doing to consider forthcoming vacancies and appointments.  Agree that Ian Gibson be re-appointed as Vice-Chair until 31/01/13.  Agree to the proposed membership for Community Health Partnership/Raigmore Committees and that Chairs should be appointed / re-appointed until 31/01/13.  Agree to the proposed appointment of Chairs for the main Governance Committees to 31/01/2013.

1 Background and Summary

The following Chair appointments expire in January 2011:

 Gillian McCreath, Chair of South East Highland Community Health Partnership  Okain McLennan, Chair of Mid Highland Community Health Partnership  Colin Punler, Chair of North Highland Community Health Partnership  Bill Brackenridge, Chair of Argyll & Bute Community Health Partnership  Pamela Courcha, Chair of the Raigmore Committee

In addition, Ian Gibson’s appointment as Vice Chair expires in January 2011. The terms of office of Gillian McCreath and David Alston will also end on 31 January 2011 and 31 March 2011 respectively. Gillian McCreath is has been re-appointed for a further term and the recruitment process is underway for a new Non-Executive Board member to replace Dr Alston.

Following discussions, the following changes are proposed:

Vice Chair Appointment Propose that Ian Gibson be re-appointed as Vice-Chair until 31/01/2013

Community Health Partnerships and Raigmore Hospital Current Proposed

North Highland CHP Colin Punler – Chair Colin Punler – Chair David Alston – Member Ray Stewart – Member Mid Highland CHP Okain McLennan – Chair No Change Sarah Wedgwood - Member

South East Highland CHP Gillian McCreath – Chair Gillian McCreath – Chair Ian Gibson Margaret Davidson – Member Raigmore Hospital Pam Courcha – Chair Mike Evans – Chair Mike Evans – Member Pam Courcha – Member Argyll & Bute CHP Bill Brackenridge – Chair No Change Vivian Shelley – Member Elaine Robertson – LA Member Governance Committees Current Proposed

Audit Committee Okain McLennan – Chair Ian Gibson – Chair Margaret Davidson Margaret Davidson Mike Evans Mike Evans Ian Gibson Gillian McCreath Gillian McCreath Okain McLennan Clinical Governance Vivian Shelley – Chair Sarah Wedgwood – Chair Committee Quentin Cox Quentin Cox Margaret Davidson Margaret Davidson Ray Stewart Vivian Shelley Sarah Wedgwood Ray Stewart

Staff Governance David Alston – Chair Pam Courcha – Chair Committee Pam Courcha David Alston Ian Gibson Ian Gibson Colin Punler Colin Punler Ray Stewart Ray Stewart Endowment Funds Ian Gibson – Chair Committee Bill Brackenridge No Change Garry Coutts Okain McLennan Ray Stewart Lyn Wormald, Staffside Rep Remuneration Garry Coutts – Chair Garry Coutts – Chair Sub-Committee Ian Gibson – Vice-Chair Ian Gibson – Vice-Chair David Alston Bill Brackenridge Bill Brackenridge Pam Courcha Pam Courcha Mike Evans Gillian McCreath Gillian McCreath Okain McLennan Okain McLennan Colin Punler Colin Punler Ray Stewart Ray Stewart

Joint NHS Highland and Highland Council Committees Current Proposed

Joint Committee for Ian Gibson – Co-Chair Ian Gibson – Co-Chair Children and Young Pam Courcha Mike Evans People Gillian McCreath Gillian McCreath Okain McLennan Okain McLennan Colin Punler Colin Punler Sarah Wedgwood Joint Leadership & Garry Coutts – Co-Chair Performance Group Ian Gibson No Change a CHP Chair (TBA)

Joint NHS Highland and Argyll & Bute Council Committee Current Proposed

Argyll & Bute Health and Bill Brackenridge – Chair Care Strategic Partnership Vivian Shelley No Change Elaine Robertson – LA Member

2 Non-Executive Representation on other NHS Highland Committees Area Control of Infection Okain McLennan – Chair No Change Committee Gillian McCreath Health & Safety Committee Bill Brackenridge No Change

Pharmacy Practices Committee Bill Brackenridge No Change Ian Gibson Risk Management Steering Vivian Shelley No Change Group Spiritual Care Committee Garry Coutts No Change

Non-Executive Representation on other Committees/Groups National Appeal Panel for Entry to Vacancy Pharmaceutical Lists

2 Contribution to Board Objectives

Robust corporate governance arrangements are essential to the delivery of all of NHS Highland’s Corporate Objectives. This specifically contributes to “Better Value – All services are efficient and cost effective” – BV.1 Working systems and practices are redesigned to be fit for purpose.

3 Impact Assessment

Because of its nature this paper does not require to be impact assessed.

Garry Coutts Chair, NHS Highland

21 January 2011

3 Highland NHS Board 1 February 2011 Item 3.1 Argyll & Bute Community Health Partnership Aros DRAFT MINUTE OF MEETING OF Lochgilphead THE ARGYLL ARGYLL & BUTE CHP COMMITTEE PA31 8LB www.nhshighland.scot.nhs.uk/

Rooms J03-J07 Mid Argyll Community 22 December, 2010 at 1.00 pm Hospital and Integrated Care Centre, Lochgilphead

Present Mr Bill Brackenridge, Chairman, Argyll & Bute CHP Mr Derek Leslie, General Manager, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Mr John Herrick, Area Dental Committee Dr Alan Davidson, Consultant Rep Ms Elaine Garman, Public Health Rep. Cllr Elaine Robertson, Non Executive Director, NHS Highland Mr Duncan Martin, Chairman, Public Partnership Forum Ms Katy Murray, Deputy Chairperson, Public Partnership Forum Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Dr George Hannah, GP Rep Cllr George Freeman, Argyll & Bute Council Rep Ms Glenn Heritage, CVO Rep Ms Tricia Morrison, CVO Rep Ms Mary Wilson, AHP Rep, Argyll & Bute CHP (by VC)

In Attendance Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of Human Resources, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Mr Jim Robb, Argyll & Bute Council Mr Stephen Whiston, Head of Planning, Contracting & Performance, Argyll & Bute CHP Mrs Margaret Johnston, Admin Assistant – Minute Secretary

1 CHAIRMAN’S WELCOME

The Chairman opened the meeting by welcoming everyone to the Mid Argyll Community Hospital and Integrated Care Centre, Lochgilphead.

2 APOLOGIES

Apologies for absence were received from:

Mr Cleland Sneddon, Argyll & Bute Council Ms Dawn Gillies, Staffside Representative Ms Liz McMillan, Staffside Representative Mr Neil Robinson, Area Pharmaceutical Committee Rep Dr Vivian Shelley, Non Executive Director, NHS Highland Mr Donald Barr, Area Optical Committee Rep 3 CONFLICTS OF INTEREST

No conflicts of interest were declared.

4 MINUTE FROM PREVIOUS MEETING HELD ON 25 AUGUST 2010

4.1 Minute of Meeting held on 27 October 2010

The minute of the meeting on 25 August 2010 was accepted as a complete and accurate record of the meeting.

The Committee:

 Approved the content of the Minute

5 MATTERS ARISING

No matters arising.

6 HIGHLAND NHS ORGANISATIONAL ISSUES

Mr Brackenridge confirmed that Elaine Mead has been appointed as the new NHS Highland Chief Executive and will be taking up post at the end of January 2011. Mr Brackenridge asked that the Committee’s congratulations to Ms Mead be recorded.

Mr Brackenridge advised that a new ruling coalition is now in place at Argyll & Bute Council. Councillor Andrew Nisbet is now Spokesperson for Social Affairs and Councillor Elaine Robertson is Depute Spokesperson for Social Affairs. Mr Brackenridge confirmed that further changes will be advised in due course.

6.1 Minute of Highland NHS Board Meeting – 2 November, 2010

Mr Brackenridge highlighted Item 146 from the Minute on the Redesign of Mental Health Services in Argyll and Bute and confirmed the Board approved the initial agreement for submission to the Scottish Capital Investment Group.

The Committee:

 Noted the contents of the Minute of Highland NHS Board – 2 November 2010

6.2 Report of Highland NHS Board Meeting – 7 December, 2010

Mr Brackenridge drew attention to page two of the report and advised that the Board had expressed disappointment at the low attendance at CHP and Raigmore Governance Committees and confirmed the Board Secretary will be compiling a report on attendance covering the last 12 months.

The Committee:

 Noted the contents of the Minute of Highland NHS Board – 7 December 2010

2 6.3 Report of the Special Joint Meeting of Highland NHS Board and the Highland Council on 16 December 2010

Mr Brackenridge confirmed that a joint report was presented to the meeting which outlined the joint approach to service delivery for Adult Community Care and Children’s Services. Mr Brackenridge confirmed a detailed plan for service delivery will be drawn up jointly, however a lot of work will be required before complete agreement will be reached.

The Committee:

 Noted the contents of the report on the Special Joint Meeting of Highland NHS Board and Highland Council on 16 December 2010

7 CLINICAL GOVERNANCE

7.1 Clinical Governance & Risk Management Report

Ms Tyrrell spoke to the previously circulated papers and highlighted a number of areas from the report.

RISK MANAGEMENT

Incidents – Quarter Two: July 1st until September 30th 2010 Ms Tyrrell reported that during the period of 1 July to 30 September 2010 a total of 1,890 incidents and near misses were recorded NHS Highland wide.

During quarter two within Argyll & Bute CHP a total of 466 incidents and near misses were reported. The top three categories of incidents for the CHP were noted as:

 Slips trips and falls  Disruptive, violent and aggressive behaviour  Absconder / Missing Patient

CHP Risk Register Ms Tyrrell confirmed that a review of the CHP Risk Register was deferred from the October CHP Core Management Team until January 2011.

Mid Staffordshire Report In light of the very serious findings from the inquiry into the failings at Mid Staffordshire a gap analysis has been conducted in Argyll and Bute and an action plan has been developed focussing on addressing the areas identified for improvement. This will be monitored through the CHP Clinical Governance and Risk Management group.

COMPLAINTS

July – September 2010 Ms Tyrrell reported that during the period financial quarter 2 (FQ2) a total of 106 formal complaints were received Highland wide with 43% being responded to within the 20 day target.

Argyll & Bute CHP received a total of 15 formal complaints during the same period with 33% of complaints being responded to within 20 working days. Ms Tyrrell confirmed that complaints exceeding the 20 day timescale were due to the complexity of the clinical situation.

3 HEALTH AND SAFETY

Slip/Trip Flooring Risk Assessment Ms Tyrrell confirmed that the high slip risk areas identified in the Strategem report 2006 have been revisited and assessed again, for almost all locations. It was felt that the original Strategem work was of poor quality and resulted in a gross over estimate of risk in the vast majority of cases. It also became apparent that a significant number of the assessments were no longer valid due to changes to the flooring and/or room usage. The next phase is to create an action plan to re-assess the high risk areas of flooring and any areas of new flooring.

Health and Safety Policy and Strategy A Health and Safety Development Plan for the CHP is in the process of being produced, the aim of the plan is to ensure that the operational objectives from the NHS Highland Strategic Implementation Plan are achieved within the CHP.

QUALITY

NHS QIS Joint Advisory Group Visit Ms Tyrrell confirmed that the Pre-Joint Advisory Group assessment visit for endoscopy services at Lorn and Islands Hospital will take place the week beginning 29 August 2011.

NHS QIS Heart Disease Standards Argyll and Bute CHP contributed to the NHS Highland self assessment submission and associated action plan. The self assessment along with the associated evidence was submitted to NHS QIS on 22 November. No peer review visits are planned for these standards. Following a review of the submissions, teams may be invited to discuss their submission with NHS QIS.

Ms Tyrrell also advised that an HMIE inspection will be carried out at Argyll & Bute Hospital during May or June 2011.

Mr Brackenridge thanked Ms Tyrrell for her report.

The Committee:

 Noted the contents of the Clinical Governance and Risk Management Report

7.2 Cleanliness, Hygiene and Infection Control Report

Ms Tyrrell spoke to the previously circulated paper and highlighted a number of areas to the Committee.

Staphylococcus aureus bacteraemia (including MRSA) Ms Tyrrell confirmed all NHS Boards have been asked to reduce Staphylococcus aureus bacteraemia (SAB) case numbers by an additional 15% from April 2010 over and above the 30% baseline reduction which means the target for NHS Highland is no more than 46 cases by 31st March 2011. The NHS Highland SAB rate remains the lowest of the mainland Boards in Scotland. Ms Tyrrell reported that there have been 5 cases of SAB in Argyll and Bute between April and October 2010 with 3 in Lorn and Islands Hospital, one in Mid Argyll Hospital and one in Victoria Hospital, Isle of Bute. Ms Tyrrell confirmed the National SAB Action Group has been set up to review and discuss progress against delivery of the SAB HEAT target and is chaired by the Chief Nursing Officer. The priority areas continue to be

4  Optimising communication; the aim is all NHS Highland staff know how many SABs and what to do to avoid them by March 2011  Optimising invasive device use ( PVC, CVC, Urinary catheters); the aim is all Senior Charge Nurses in NHS Highland will understand the risks associated with and how to avoid them  Optimising Blood Culture taking; the aim is all staff who take blood cultures are trained and assessed competent by the end of December 2010, that within NHS Highland one standardised system is in place for taking blood cultures by December 2010.  Preventing soft tissue infections becoming SAB; the aim is for all Senior Charge Nurses to know how to access tissue viability support for at risk patients.

Clostridium Difficile Infection (CDI) Ms Tyrrell confirmed the reduction in CDI cases has been sustained in NHS Highland with CDI case numbers nationally now at their lowest level.

Mr Tyrrell reported that in Argyll and Bute 5 cases have been reported since April 2010; one case in hospital and four in the community. Advanced surveillance has been carried out in each case with enhanced surveillance being carried out on every CDI case with immediate feedback to staff concerned. Surveillance includes 30 day follow up from diagnosis for C.difficile. The Infection Control Team works closely with the Health Protection Team to ensure robust follow-up in the community. The following initiatives are taken to reduce CDI Cases

 Promotion of good hand hygiene across all staff groups and general public.  Attention to environmental cleanliness  Antimicrobial prescribing.

Hand Hygiene Ms Tyrrell confirmed that NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas. Compliance with taking opportunity for hand hygiene was 97% in September and October 2010. Compliance with technique for hand hygiene was 93% in September and 94% in October 2010. Ms Tyrrell also confirmed further training has been delivered to all medical staff in Lorn and Islands Hospital, Oban and compliance with the standards for hand hygiene is consistently above 90%.

Cleaning and the Healthcare Environment Ms Tyrrell reported that all hospitals in Argyll and Bute scored above the target compliance of 90% for cleaning. The October audit did highlight issues in Rothesay Victoria Hospital which led to reduction in their score and these issues are now being addressed by the Hotel Services manager.

Ms Tyrrell advised that estate problems are now being reported by cleaners on the new reporting system and confirmed she would bring a more detailed report to the next Committee

The Committee:

 Noted the contents of the Cleanliness, Hygiene and Infection Control Report

Admission, Transfer and Discharge Policy Ms Tyrrell spoke to the previously circulated paper and confirmed the policy was launched on 1 December 2010 to provide and improve information on patient pathways and discharge

5 planning. A monitoring tool will be followed to ensure implementation is followed and an audit will be carried out in June 2011 to evaluate the impact and policy implementation.

Mr Leslie confirmed this policy will be taken to the next Argyll & Bute Health and Strategic Partnership meeting in January 2011.

Dr Hannah asked who is responsible for completing the large admission, transfer and discharge checklist. Ms Tyrrell advised that ward staff will be responsible for completing this and confirmed that feedback will be obtained and monitored.

Mr Brackenridge commented that this was a good step forward in the management of admissions and discharges.

The Committee:

 Noted the contents of the Admission, Transfer and Discharge Policy

8 FINANCIAL GOVERNANCE

8.1 Finance Report

Mr Morrison spoke to a previously circulated paper and reported that for the seven month period ended 31st October 2010, Argyll & Bute CHP recorded an overspend of £488,000. This represents an increase of £90,000 on the overspend of £398,000 recorded at the end of September. Mr Morrison also confirmed that the overspend reported in November was £592,000

MAIN CAUSES OF THE YEAR-TO-DATE OVERSPEND OF £488K

Oban, Lorn & Isles Locality - £182k overspend  Medical locums - £99k  Laboratory pays & supplies - £64k  Unachieved savings - £145k

Mid Argyll, Kintyre & Islay Locality - £177k overspend  Mid Argyll Hospital, nursing pay costs - £86k  Muasdale GP surgery, medical locums - £76k  Islay Hospital, nursing pay costs - £42k

General Medical Services - £246k overspent  GP practice support payments - £221k

Commissioned Services - £407k overspent  Eating disorders referrals to the Priory and Huntercombe - £244k  Brain injury treatments - £59k  Thoracic referrals to the Golden Jubilee - £53k  Bariatric surgery referrals to the Golden Jubilee - £17k  Unachieved savings - £58k

COST IMPROVEMENT PROGRAMME – PROGRESS REPORT

Mr Morrison reported that several targets within the £4m Cost Improvement Plan are proving difficult to achieve which is creating significant pressure on the overall 10/11 financial

6 position and is a contributory factor to the year to date overspend. The forecast year-end shortfall of 0.75m will also impact on the 11/12 budget setting process.

GREATER GLASGOW & CLYDE SLA

Mr Morrison advised that NHS Greater Glasgow & Clyde have submitted a claim which is £2.2m higher than expected. Mr Morrison confirmed he will bring an update on the position to the next Committee meeting in March.

Mr Leslie commented that he would have expected NHS Greater Glasgow & Clyde to be pursuing a cost improvement plan and therefore efficiency savings, which the CHP ought to benefit from rather than facing such a significant increase. He confirmed that Mr Morrison’s team will be looking very closely at the accounting methodology used in the claim from NHS Greater Glasgow & Clyde.

2010/11 FORECAST OUTTURN

Mr Morrison confirmed that following a review of expected expenditure patterns the forecast outturn for Argyll & Bute CHP will be an overspend of £395k which is a significant reduction from the previous months forecast of a £650k overspend.

Mr Morrison advised that this is not an acceptable position and actions will be taken to achieve a year-end break-even position. Various measures, including bed number rationalisation and improved vacancy management controls are likely to yield benefits which will improve the financial situation. In addition, managers have been notified of target budget outturns which will need to be met if a year-end break even position is to be achieved.

Councillor Robertson asked if the re-design process will produce savings by the end of the year and also what will happen if the CHP overspends. Mr Morrison confirmed that if the Board overspends this will be deducted from the budget for the following year.

Councillor Robertson asked if the CHP will meet the efficiency savings target. Mr Leslie confirmed that the re-design processes have provided efficiency savings and these will be accelerated to meet the target.

Councillor Freeman referred to GP Support Payments and asked if the CHP can stop these payments. Mr Leslie confirmed that this efficiency saving had been taken out of the budget as these are traditional cost payments which the CHP cannot stop making. He also confirmed this has now been referred to internal audit.

The Committee:

 Noted the information contained in the Finance Report

8.2 Revenue Budget Report

Mr Morrison spoke to a previously circulated paper and advised that this was considered by the CHP Core Management Team at its meeting on 26th November 2010.

2011/12 REVENUE BUDGET DISCUSSION PAPER

National budget – key messages Mr Morrison highlighted a number of key headline messages for the NHS from the Scottish Government’s proposed revenue budget for 2011/12.

7  The overall uplift for the NHS is 3.2%; however this contains specific issues which need to be recognised.

 The full cost of removing prescription charges (£57m across the Scottish Health Service) is included in the uplift. This is not additional funding as it replaces lost income.

 The creation of a £70m fund to redesign services across health and social services is included in the uplift. It is not clear at this stage how this fund will be accessed.

 The remaining uplift equates to approximately 1% for territorial Health Boards before any adjustments for NRAC parity.

 On efficiency savings, there is an expectation that Health Boards will deliver a minimum of 3% which will be retained to support cost growth, increases in service demand, any service developments and improvements in quality.

Impact on Argyll & Bute CHP Mr Morrison confirmed that the CHP’s proposed revenue budget for 2011/12 is currently being produced. Preliminary work suggests that the savings target required to be delivered by Argyll & Bute CHP in 2011/12 will be at least £5.0m, which is approximately 3.5% of the budget.

The Committee:

 Noted this paper was considered by the CHP Core management Team at its meeting on 26 November 2010

8.3 Capital Report

Mr Morrison spoke to the previously circulated paper and confirmed the total value of the 2010/11 capital programme in Argyll & Bute is £7.5m. Mr Morrison confirmed schemes are progressing well and summarised the planned expenditure in this financial year on the following schemes:

 Campbeltown Dental Centre  Mull & Iona PCC  Rothesay Victoria Hospital upgrade  Decontamination works – several sites  HAI compliance works – several sites  Medical Equipment  eHealth investment  Mental Health Redesign

Mr Morrison confirmed availability of capital funds will be severely restricted in 2011/12 with significantly less that the £7.5m being available for investment in Argyll & Bute.

Mr Leslie advised that CHP key areas for capital funding in 2011/12 are Mental Health Redesign and Oban Dental Centre.

The Committee:

 Noted the information contained in the Capital Programme Progress Report

8 9 STAFF GOVERNANCE

9.1 Argyll & Bute Partnership Forum Minute – 14 October 2010

The Argyll & Bute Partnership Forum minute of 14 October, 2010 had been previously distributed and the contents were noted.

The Committee:

 Noted the Argyll & Bute Partnership Forum Minute of 14 October, 2010

9.2 PDP/R and e-KSF Implementation

Mr Logue spoke to a previously circulated paper and confirmed progress towards meeting the eKSF target is improving. Mr Logue confirmed that by November 32% of staff in the CHP had their personal development plan signed off on the eKSF system and the number had risen by over 10% during the month of December. Mr Logue confirmed initiatives are continuing to ensure the HEAT target of 80% will be achieved by March 2011.

The Committee:

 Noted the current position that 32% of staff in the CHP have a completed personal Development Plan on the eKSF system  Noted that the level of implementation is improving by 10% on the previous month.  Noted the continuing initiatives to ensure that the HEAT target of 80% is achieved by March 2011.

9.3 Workforce Monitoring Report

Mr Logue spoke to a previously circulated paper advising that the NHS Highland Workforce Report is produced bi-monthly and covers staff governance issues. Mr Logue highlighted the following items from the report.

Sickness Absence Mr Logue confirmed that sickness absence continues to be an area of concern as the CHP continues to maintain a higher level of absence than other areas in NHS Highland. Reduction in sickness absence remains a high profile initiative within the CHP with managers working in partnership with Staff Representatives, HR and Occupational Health to address areas of high absence.

Turnover and Stability Rate Mr Logue confirmed that figures indicate a very stable workforce within the CHP with low numbers moving on to other posts. While this retains skills and experience within the service, it also reduces opportunities to recruit staff who bring ideas and initiatives from other areas of employment.

Councillor Robertson referred to the sickness absence figures showing the CHP with an overall figure of 5.4% however Dental staffing figures show a rate of 8.24% and asked why this is so high. Mr Logue confirmed that percentage figures for Dental Services are skewed due to the low number of employees in this service.

9 The Committee:

 Noted the information provided within the workforce Report of September 2010

10 PARTNERSHIP WORKING

10.1 Argyll & Bute Public Partnership Forum Draft Notes – 16 November 2010

Mr Martin confirmed the meeting on 16 November had went well, with Mr Morrison giving an interesting and informative financial update presentation to the Forum.

The Committee:

 Noted the Argyll & Bute Public partnership Forum Draft Notes – 16 November 2010

10.2 Argyll & Bute Adult Protection Committee 1st Biennial Report April 2008 – March 2010

Mr Leslie spoke to the previously circulated report and referred to the adult protective statistical information for Argyll and Bute. Mr Leslie asked the committee to note the report.

The Committee:

 Noted the Argyll & Bute Adult protection Committee 1st Biennial Report April 2008 – March 2010

11 PERFORMANCE MANAGEMENT

11.1 Delayed Discharge/Joint Performance Report

Mr Robb spoke to a previously circulated report and confirmed the Scottish Government HEAT target of 0 delayed discharges against the target of 0 over six weeks which does not have an exception code had been met for the eighth month in a row and work will continue to ensure government targets are met. Mr Robb advised that although performance has been good improvements could still be made

The Committee:

 Noted the contents of the Delayed Discharge Report.

11.2 Better Health, Better Care, Better Value Project Board Update

Mr Whiston spoke to a previously circulated paper and provided a full update and summary on the work undertaken by the locality task groups in taking forward the aims and specific objectives agreed at the CHP conference in February 2010.

Mr Whiston confirmed the Better Health, Better Care, Better Value Project has made significant progress, particularly over the last 3 months, with intensive redesign activity and contingency and implementation action plans enacted.

10 Mr Whiston emphasised the importance of protecting front line services and confirmed the outcome of the work to date has not evidenced any negative impact on front line services or any detriment to patient care. There has been some slippage on timescales, although this is at present manageable.

Mr Leslie advised that there has been a substantial amount of work carried out across the CHP during which there has been widespread media coverage and ongoing significant engagement with the community throughout.

Mr Herrick advised that the new Dental Centre in Campbeltown was handed over on 14 November. Finishing works are nearly complete and the building will be ready for occupancy on 11 January 2011. The new Dental Tutor will be in place in April and will act as a practicing dentist until the students take up their places in August 2011.

The Committee:

 Noted the Better Health, Better Care, Better Value Project Board update

11.3 18 Week Referral to Treatment Status Report

Mr Whiston spoke to a previously circulated report produced by Kristin Gillies, Service Planning Manager and James Brass, E-Health Manager which gave an update on the main challenges and progress towards meeting the stage of treatment targets set to deliver the 18 week Referral to treatment target by the end of December 2011.

Targets for 2010/11 are:

 Outpatients 12 weeks,  Diagnostics 4 weeks  Inpatients/ Day Case 9 weeks.

Mr Whiston confirmed the main waiting time pressures for Argyll and Bute CHP remains Orthopaedics, Ophthalmology, ENT, Dermatology and Anaesthetics. All of these Specialities are undergoing redesign to improve the patient pathways and capacity within each Speciality.

Ophthalmology Over the last 10 months the CHP has been leading a redesign process to address problems with NHS Greater Glasgow & Clyde which has resulted in the CHP agreeing to fund additional clinics as an increase to the SLA on a recurring basis.

There is extreme pressure on the Ophthalmology service in Campbeltown and Oban. Currently Campbeltown is receiving a monthly clinic however the required increase to the SLA has not been implemented as yet due to operational issues. In Oban there has been little progress as Greater Glasgow & Clyde are struggling to find a Consultant to increase the SLA.

Mr Whiston confirmed the CHP has now formally received a status and service continuity update from NHS Greater Glasgow & Clyde together with their plans on how they will configure resources to cover the existing and new SLA commitments. In addition the CHP has asked NHS Greater Glasgow & Clyde to look at all options available to deliver and sustain the service.

ENT ENT in Oban is experiencing capacity issues at present and a demand capacity and queue analysis has shown that there is a shortfall of 7 clinics a year.

11 Waiting list initiatives are being used to maintain the waiting list but this is not sustainable. Discussions with NHS Greater Glasgow & Clyde are ongoing to discuss how this shortfall will be addressed.

Dermatology A new Consultant Dermatologist has started sessions in Campbeltown and Mid Argyll however it is clear that additional sessions in Campbeltown will be essential. In addition, the CHP is trying to set up a clinic using GPs from Campbeltown and Mid Argyll Practices to do one session alongside the Dermatologist and carry out biopsies and other minor surgical work. No decision about the quantity of extra sessions required will be made until this service is up and running.

Orthopaedics The CHP continues to explore the alternative provider for elective orthopaedics with the Golden Jubilee National Hospital initially covering Oban Lorn and Isles and the Mid Argyll, Kintyre and Islay catchment areas. Discussions are ongoing between the CHP, Greater Glasgow & Clyde and Golden Jubilee National Hospital regarding an elective pathway into the Golden Jubilee National Hospital.

Anaesthetics – Lorn and Islands Hospital Oban The CHP continues to report breaches of the waiting time guarantee in Anaesthetics due to an increase in new referrals causing the demand to exceed the capacity of the clinic. This service is led by a Consultant Anaesthetist in Oban, who is the only one able to deliver this service in the CHP. A number of actions have begun to address this:

 Introduction and training of a specialist pain nurse to deal with return patients, due to be fully trained by December  Looking at the possibility of using spare theatre capacity to do more clinics – post December 2010  E-vetting and prioritisation of all new patients.

Locality management are exploring further options, however at this time providing waiting list initiatives to clear the clinic is a possibility.

Unavailability Unavailability is defined as being a period of time when the patient is unavailable for treatment for either medical or social reasons. With the increased use of unavailability with patients opting to wait for a local appointment, it is vital that the CHP monitors the use and ensures it is used correctly.

With the increase of these numbers it was requested that all Medical Record Staff record “Local appointment requested” as a note to allow the CHP to monitor its use. In addition, it has been emphasised with Glasgow at the operational SLA meeting that Medical Records would be offering patients the opportunity to attend an appointment in Glasgow in the pressure specialties and this has been agreed as appropriate.

Did Not Attend (DNA’s) Mr Whiston confirmed the CHP must ensure maximising productivity at clinics to make sure no clinic appointment slots are lost.

As a result of this all Medical Records departments in the CHP have been asked to ensure that the CHP are:

 ringing patients to confirm their attendance,  ensure rigorous application of the patient access policy, applying unavailability or returning referrals back to GPs.

12  If a patient does DNA they are contacted afterwards to ask why they did not attend their appointment.

It is vital that the CHP maximise efficiency and the reduction of DNAs within the CHP

NHS Highland Patient Access Policy NHS Highland patient access policy was signed off by NHS Highland at its Board meeting in June 2009. All Medical Record staff have access to the patient access policy and are required to use it to ensure they follow the appropriate procedures when arranging appointments and managing waiting times.

Mr Whiston confirmed that it is essential that consistent management and procedures are followed in all the topics to ensure equity of access to services for patients. The CHP has focussed on applying and delivering on these specific topics within the constraints of its current decentralised Medical Record service.

Centralised Patient Appointing The CHP is in the process of scoping out how Centralised booking could assist it in achieving 18 weeks RTT target and has opened discussions with NHS Greater Glasgow & Clyde to understand what this type of process would look like and how it would work.

A centralised appointing system has been implemented in North Highland centred on Raigmore and NHS Greater Glasgow & Clyde are also rolling out this service for the whole of its Board, with enhanced referral administration utilising e-referrals and e-triage. The outcome of this scoping review is planned to be complete by the end of December and is to be presented to the Core Management Team in early January.

Measurement and Performance of 18 Weeks Referral to Treatment Mr Whiston gave an update on progress on 18 week compliance.

System Readiness Assessment to Deliver 18 Weeks RTT No systems are fully 18WRTT compliant until codification of what this means has been finalised by ISD and relevant system development completed. The current expectation is for the codification to be available by the end of this calendar year. However Helix can record some important elements of the 18 week RTT pathway and can store and generate UCPN.

Recording Clinic Outcomes Codes Clinic outcome codes are currently entered into the patient administration system and are used to identify significant 18week RTT waiting time pathway events. For the new 18 week RTT standard, commonality will be achieved across NHS Highland by the adoption of the outcomes codes as implemented within Raigmore hospital which are closely aligned with NHS Scotland Clinic Outcome Codes. The CHP is currently converting the clinic outcomes forms for consultant led out-patient clinics to include these NHS Highland outcome codes.

Generating and Holding UCPN The UCPN is the Unique Care Pathway Number and each patient has a single common unique number. Through the work being undertaken to achieve the Electronic Referral and eTriage target, in excess of 90% of referrals arrive at the CHP hospitals via SCI Gateway. SCI Gateway and the Helix patient administration system have been programmed and registered to generate UCPN numbers. Work has now started to identify processes to ensure that all new referrals have a UCPN.

It has been noted that the systems currently in use in NHS Greater Glasgow & Clyde are not UCPN compliant. Therefore the UCPN number cannot be included in inter board transfers and investigation has started to workaround this short-coming.

13 Pan Highland Reporting

Following the recent move to the Helix Outpatients system work has re-started on automatic transfer of data to the pan NHS Highland data repository from where reporting will be possible for the whole of the health board. Reporting will be available to appropriately authorised users via the Intranet.

In conclusion Mr Whiston advised that the CHP is experiencing greater pressure than ever before to meet the 18 week RTT targets and will continue to do so until more permanent measures can be implemented especially in Ophthalmology. With regard to measuring the 18 week RTT pathway, eHealth are progressing actions pending final pathway definitions.

The Committee:

 Considered the current challenges to ensure compliance to the 19 Week RTT target  Noted the e-health update re. Achievement of 18 week RTT pathway measurement.

12 VALE OF LEVEN MONITORING GROUP

12.1 Minute of the Vale of Leven Monitoring Group - 25 October 2010

The Vale of Leven Monitoring Group minute of 25 October 2010 had been previously distributed and the contents were noted.

The Committee:

 Noted the minute of the Vale of Leven Monitoring Group of 1 October, 2010.

12.2 Draft Minute of the Vale of Leven Monitoring Group – 28 November 2010

Mr Brackenridge spoke to the previously circulated minute and highlighted item 7 regarding the Acute Services update. Mr Brackenridge also confirmed that as Chairman of the Group he has been asked to write to the Cabinet Secretary for Health & Wellbeing regarding the reinstatement of Christie Ward and confirmed he had received a reply confirming that the Ward will not be reinstated.

The Committee:

 Noted the minute of the Vale of Leven Monitoring Group of 28 November, 2010.

13 FINAL REPORT OF THE REMOTE & RURAL IMPLEMENTATION GROUP OCTOBER 2010

Mr Leslie spoke briefly to this substantial report highlighting the summary of agreed actions. The Committee agreed this report should be brought back to a future Committee development session for further discussion

The Committee:

 Noted the noted the Final Report of the Remote & Rural Implementation Group October 2010

14  Agreed the report should be brought back to a future Committee development Session

14 MENTAL HEALTH SERVICES ARGYLL & BUTE 2012: EVERYONE’S BUSINESS UPDATE

14.1 Update Report

Mr Leslie spoke very briefly to the Mental Health Services update report and the paper was noted.

The Committee:

 Noted the contents of the Mental Health Services Update Report

15 PAPERS FOR NOTING

15.1 eHealth Steering Group Minute, 11 August, 2010

The Committee:

 Noted the eHealth Steering Group Minute of 10 November 2010.

16 AOCB

No other competent business highlighted.

17 DATE OF NEXT MEETING

The next meeting will take place at 1pm on Wednesday 2 March, 2011, Rooms J03-J07, Mid Argyll Community Hospital and Integrated Care Centre, Lochgilphead

15 Highland NHS Board 1 February 2011 Item 3.2 Mid Highland Community Health Partnership CHP General Manager’s Office Larachan House Docharty Road Dingwall IV15 9UG Telephone: 01349 869221 Fax: 01349 865870 www.nhshighland.scot.nhs.uk

DRAFT MINUTE OF MEETING MID HIGHLAND CHP GOVERNANCE COMMITTEE Wednesday 12 January 2011 Larachan House (10.00 am – 12.30 pm) Dochcarty Road Dingwall

With videoconference facilities at:

Highland Council HQ, Inverness Portree Hospital, Skye Fort William Health Centre

Present: Mr Okain McLennan (Chair) Non Executive Director, Highland NHS Board Mrs Gill McVicar CHP General Manager Mr Tom Slavin CHP Head of Finance Mrs Alison Hudson CHP Lead Nurse Mr Findlay Hickey CHP Lead Pharmacist Mrs Margaret Moss CHP Allied Health Professionals Lead Dr Dennis Tracey Public Health Consultant (from 11.30 am onwards) Mr Johnson Swinton Third Sector Representative Mr Michael Macmillan Public Partnership Forum Member, Ross & Cromarty Ms Sarah Wedgwood Non Executive Member, Highland NHS Board

In Mrs Alison Phimister Locality General Manager, Skye & Lochalsh, Ross, Attendance: Cromarty and West Ness Ms Jackie Jefferson Committee Administrator (Minutes)

By VC: Mr Bob Cameron Highland Council Corporate Manager Ross, Skye & Lochalsh Ms Mandy Sillars Area Partnership Forum Representative Mr Callum Macdonald Area Partnership Forum Representative

By Ms Margaret Fisk Interim Personnel Manager Invitation:

Apologies: Mrs Annie Macleod Public Partnership Forum Member (shared role) Skye & Lochalsh Mr Hamish Fraser Local Councillor, Skye Mr Bren Gormley Local Councillor, Fort William & Ardnamurchan Mrs Margaret Paterson Local Councillor, Dingwall & Seaforth Mr Brian Murphy Local Councillor, Lochaber Mrs Isabelle Campbell Local Councillor, Wester Ross, Strathpeffer & Lochalsh 1 WELCOME AND APOLOGIES

The Chairman confirmed that this meeting was to have taken place on 17 December but had been postponed due to adverse weather conditions. Unfortunately the revised date, which had been set at short notice, clashed with other Highland Council meetings. Local councillors had given their apologies and videoconference links were put in place to Highland Council Headquarters, Inverness in the event that any members were able to join the meeting. Other VC links were set up to Fort William Health Centre and Portree Hospital on Skye. Mr McLennan welcomed everyone and introductions were made round the table. Mrs McVicar extended a special welcome to Ms Margaret Fisk who was attending her first Governance Committee meeting in her role as Interim Personnel Manager.

There were no other apologies.

Mrs McVicar advised Committee of the death of Olwyn Macdonald at the weekend. Mrs Macdonald was a past member of the Mid CHP Governance Committee and a regular attendee at meetings. She also undertook an immense amount of work on behalf of her community and for Highland Council. Committee’s thoughts went to Olwyn’s family at this time.

2 DECLARATIONS OF INTEREST

None noted.

3 MINUTES

3.1 CHP Governance Committee Meeting – 22 October 2010 Mr Macmillan drew attention to Item 15.5, Suicide Prevention, on page 14 of the minute wherein it was stated that “Mr Macmillan queried whether NHS staff were authorised to offer the training to partner agencies …..” He wished to clarify that he was referring specifically to guidance teachers or those in schools dealing with young people. This was duly noted and Mrs McVicar confirmed that this training is offered to them.

The minutes were otherwise approved as an accurate record of the meeting.

3.2 CHP Clinical Governance & Risk Management Group Meeting – 1 December 2010 Minutes from the CHP Clinical Governance & Risk Management Group meeting on 1 December 2010 were not available but will be submitted to the next Governance Committee meeting on 18 February 2011.

3.3 NHS Highland Improvement Committee Assurance Report – 1 November 2010 The contents of the report were noted.

Governance Committee:

. Approved the minute of the CHP Governance Committee meeting dated 22 October 2010. . Noted that the minute of the CHP Clinical Governance & Risk Management Group meeting on 1 December 2010 will be submitted to the next Governance Committee meeting for noting. . Noted the contents of the NHS Highland Improvement Committee Assurance Report dated 1 November 2010.

2 4 MATTERS ARISING

4.1 Public Partnership Fora At a previous meeting it was agreed that three Locality Public Partnership Fora (PPF) would be created with workshop events in each of the Localities to allow any interested members of the public to learn more about PPF and join their local forum if they wish. Mrs McVicar indicated that it had not been possible to progress this work due to competing pressures and recent weather conditions. It is planned to take this forward in March/April. She reiterated her invitation for expressions of interest in being part of a small group to help set up Locality PPF workshops.

Governance Committee:

. Noted plans to take forward Locality PPF workshops during March/April. . Noted the General Manager’s invitation for expressions of interest in participating in small groups to assist with arrangements for Locality Public Partnership Fora workshops.

5 NHS HIGHLAND BOARD UPDATE

The Chairman highlighted the following issues from the Board meeting on 7 December 2010.

(i) Brief updates were provided from the minutes of each of the NHS Highland CHP Governance Committee meetings. Argyll & Bute’s plans for mock unannounced inspections at hospitals across the CHP were noted. Mrs McVicar confirmed that Mid CHP’s Lead Nurse and senior managers also undertook unannounced ward walk-rounds. A member of Argyll & Bute Patient Public Forum, who has had training with the Health care Environment Inspectorate, has offered be part of walk round teams in at Belford Hospital and Mackinnon Memorial Hospital (MMH), to offer advice and support.

(ii) An in-principle decision has been taken between NHS Highland and the Local Authority that the responsibility for Care of the Elderly and Adult Community Care Services will be transferring to the Health Board. Highland Council will be responsible for the provision of Children’s Services. Both organisations have agreed to further work being done on the detail of such an arrangement and to wider consultation with those affected. It is intended that the new arrangements will be fully in place by April 2012. Mr Cameron noted that this represents a significant change but one that was welcomed by the joint meeting of the Council and NHS Board. He emphasised that there is a great deal of work to be done but that the joint approach is the right way forward and will deliver better outcomes for service users. In response to a query by Mr Swinton, the Chairman confirmed that the intention is to transfer resources between the relevant agencies. Concerns have been raised by staff at both agencies and considerable work will be required to resolve the issues.

(iii) The Director of Finance presented a paper on the capital programme for NHS Highland. The capital plan was agreed by the Board in April 2009 but the draft 2011/12 Scottish Budget was published in November and although this will not be finalised until February 2011 it does have considerable implications for NHS Highland’s plans. £20m of capital funding which was banked by NHS Highland with the Scottish Government for projects that were not ready to proceed, has now been withdrawn. This means that no further business case proposals involving capital expenditure are being progressed through the National Capital Investment Group until the Scottish Government budget has been finalised in February 2011. A number of NHS Highland schemes which are not yet legally committed, are being deferred until after February. In Mid CHP environmental work at MMH, Broadford Practice premises and progress with the new dental facility at Portree are now on hold. The impact of this on the services provided by the CHP has been strongly emphasised to the Director of Finance, the Chief Executive and the Chair.

3 The Tain business case is progressing as this is not reliant upon capital funding. This was discussed in more detail later in the meeting (Item 14 of the agenda).

Mr Macdonald queried how it was possible for the £20m to be withdrawn. Mr Slavin indicated that the CHP had complied with all necessary regulations but that the £20m represented plans the CHP had in place to develop a number of capital projects such as MMH. It takes time to develop a project and in the interim the Scottish Government have reviewed their resources and decided they cannot afford to provide the banked funding and continue with the major capital projects already committed to.

Governance Committee:

. Noted the contents of the Chairman’s verbal update from the Board.

6 GENERAL MANAGER’S REPORT

Mrs McVicar spoke to her previously circulated report.

She first acknowledged the immense effort of all staff that had gone above and beyond the call of duty to deliver services during the continuing severe winter weather conditions. The response by staff has been exceptional and in some instances they put themselves at risk to continue to provide patient care. She also commended the work of partner agencies such as the Red Cross who have helped with staff transport and reaching patients in remote areas.

Committee members endorsed this wholeheartedly and the Chairman indicated his intention to write to staff on behalf of Governance Committee, thanking them for their efforts.

Mrs McVicar advised that a number of items scheduled for the 17 December meeting will be deferred until February to allow for more discussion. These include aspects of current activity, the Delivery Plan and how the CHP is responding to the Strategic Framework. She confirmed that she was happy to take questions on any of these issues however.

Mrs McVicar highlighted the following issues:

Waiting Times Proposals are being developed for the Endoscopy Solutions Group, presenting options to enable Belford Hospital to double its capacity for endoscopy work. This is to support the Board’s aspiration to utilise Belford capacity to provide an NHS Highland Bowel Screening facility. Patients from outwith the Lochaber area will be invited to attend.

Delayed Discharge This remains an area of great concern, particularly during the winter period when hospitals are busier. There are still a number of patients in a delayed discharge situation who are breaching the target set by Scottish Government. The CHP continues to work closely with Social Work colleagues but problems remain with home care packages in some areas, particularly with the Independent Living Service contract in Ross & Cromarty. Intensive discussions are ongoing with Social Work partners. Care Home places remain another cause for delay. In response to a query from Mr Swinton, Mrs McVicar confirmed that the financial cost of delayed discharges to the CHP can be (and is) calculated; of more concern is the human cost and risk of patients remaining in a hospital setting when they should be moved to a more homely environment as quickly as possible.

4 Alcohol Brief Interventions There is considerable concern about the CHP’s ability to meet the trajectory target for Alcohol Brief Interventions (ABI). GP practices are signed up to deliver ABI and have been trained to do so; however the interventions they say are taking place are not being recorded. Steps are now being taken to explore other ways to deliver the interventions and to record activity. It seems unlikely that the challenging target will be met quickly, despite strenuous efforts. Funding previously allocated to GP practices is to be reallocated to ABI specialists to work in the areas of most need. Retrospective work around the recording of ABI data is also ongoing and the CHP Health Improvement Group has been asked to re-focus its attention on this matter.

Day Case Rates Concern had been expressed that targets for day case activity were not being met, particularly at Belford Hospital. However day case activity there has now improved dramatically and continues to do so. The monthly day case activity percentage has risen from 45% in January 2010 to 90.2% in October 2010. She commended Belford staff for their immense efforts. Rates have improved to the extent that staff are asking for more dedicated day case beds which is extremely encouraging.

Standardised Morbidity Rate There were challenges around recording of Standardised Morbidity Rates (SMR) data, particularly on Skye. A huge amount of effort has been invested there and significant achievements have been made. There should be a return to target within the next two months.

Suicide Prevention Training There has been a significant improvement against trajectory and although considerable effort is being invested to ensure that as many staff as possible access the available training, there are still challenges around achieving GP targets. A validated shorter course is to be offered to GPs and it is hoped that further improvements will be seen. Responding to a point raised by Mr Macmillan, Mrs McVicar confirmed that the course co-ordinator is from the Education Department and the training is available to all staff from both Health and partner agencies. eKSF The CHP remains far short of its target to record Knowledge and Skills Framework (KSF) data electronically (eKSF). However, a concerted effort was made and managers ensured that all staff had review dates in place. These reviews are now taking place and the results are expected to be seen shortly, with target achieved by end March.

Sickness Absence The CHP’s sickness absence rate is very slightly above the 4% standard and is maintaining its improved position. The record for short term absence is extremely good although there are challenges around long term sickness. Every case is being managed appropriately by managers and Personnel.

Joint Equipment Store at Fort William Mrs McVicar highlighted the Joint Equipment Store which is now open at Fort William. All three Localities now have access to an integrated store.

Reablement - Lochaber Ms Wedgwood referred to the Reablement work in Lochaber and Mrs McVicar confirmed that mapping work has been carried out. Several meetings have taken place between the local authority and NHS Highland in Lochaber and it is hoped to have a joint presentation on this at the February Governance Committee meeting.

Belford Redesign The Pre-assessment Service is up and running and the impact of this is evident in the latest Day Case data. The need to move the Day Case service from its present location within the Combined Assessment Unit has been recognised and a cost-neutral plan will be developed to relocate the service to a larger area.

5 Belhaven Ward activity has now temporarily relocated to the annexe of the Step-down Ward at Belford Hospital. Although there were some initial challenges relating to patient flows and space utilisation, these have been addressed.

Skye & Lochalsh Reference Group A Skye & Lochalsh Reference Group meeting was held on 13 December. Mrs Phimister confirmed that this was very useful; there were three presentations on ongoing projects and a workshop event to prioritise the action plan which has been in development for the past six months. There is now a clear steer on the priorities from the Reference Group’s perspective.

Skye & Lochalsh Salaried Practices Working Group Mrs Phimister indicated that the Broadford & Sleat Collaborative Working Group held its final meeting on 19 November, having concluded the final item on the action plan. A report was made available at that meeting which identified the benefits for patients, including improved access to a wider range of clinicians, and savings in the order of £90k per annum. In addition, IT and telephone systems will be improved and Practice Nursing expertise will be shared between both sites. In response to a query from Ms Wedgwood, Mrs Phimister explained that the key lessons learned from the exercise related to the challenges around public/patient engagement, especially when a number of ideas are being generated. Engagement with the process must be encouraged whilst ensuring that people are secure in the understanding that services are being improved while lowering cost. She added that clarity was vital.

In response to a query from Mr Macmillan, Mrs McVicar confirmed that there were four salaried practices in Skye and Lochalsh, one in Drumnadrochit, one in Torridon and one in Ballachulish. These represent approximately 8% of total patient numbers. She advised that there is no pressure on practices to become salaried but some GPs, particularly in smaller rural practices, preferred to retain their clinical focus rather than become involved in the complex business aspects of running an independent practice.

Out of Hours Services In East Ross a pilot commenced on the first weekend of November led by a GP consortium working together with Unscheduled Care Practitioners and nurses. So far this is working well.

In West Ross there have been issues around locums not turning up for booked sessions which requires cover at very short notice and at very great expense. A contingency plan is currently out for consultation which offers a different mechanism for filling the weekend rota. The CHP is working with Scottish Ambulance Service to implement the Strategic Options Framework for Emergency and Urgent response and that West Ross, Skye and Lochalsh and Ardnamurchan had been identified as priority areas.

There are serious concerns about the Portree rota which relies upon GPs supported by Rural Practitioners (RPs). However fewer and fewer GPs are willing and able to work on the rota and pressure on RPs is increasing. Discussions around a contingency plan for OOH services on north Skye are planned.

Teleneurology The teleneurology clinics commenced in Portree at the beginning of November. Feedback from patients has been very positive and it is hoped to begin to develop this service in other remote areas.

Sexual Health Services A Quality Improvement Scotland (QIS) peer review in November and although the formal report has not yet been received the feedback has, on the whole, been positive. QIS commended the work taking place and highlighted some areas for improvement. Mrs McVicar congratulated the team for the enormous amount of effort invested in providing evidence before and during the visit and for their continuing commitment to improving and developing the service.

6 Governance Committee:

. Noted the contents of the General Manager’s report.

PERFORMANCE MANAGEMENT

7 BALANCED SCORECARD

This was circulated prior to the meeting.

7.1 Did Not Attend (DNA) Mrs McVicar emphasised that this referred to patients who did not attend appointments rather than could not attend. This has previously been discussed in detail and the suggestion for local work with media and patient groups is being progressed. Patient focussed booking (where patients have the opportunity to make an appointment that suits them from the outset) should help the situation although there are still issues around general surgery in Belford which need to be explored further. The Chairman felt that the message about the high cost of DNAs needed to be highlighted to the public and noted that patients had responsibilities too.

Mr Macmillan felt it would be useful if patients who did not attend appointments were asked the reason why. Mrs McVicar indicated that plans to do this are in progress, both by letter and by telephone. The central Patient Booking Service phones or texts patients 24 hours before an appointment but this is a fairly new service which will take a few months to evaluate.

7.2 Day Case Report and Action Plan As indicated in the General Manager’s Report the position is an improving one. The results of the Admit Day of Surgery (ADOS) audit is continuing and the results should be available soon.

7.3 Waiting Times Report The waiting times targets within the CHP’s control have been met. Mrs McVicar confirmed that where Endoscopy procedures at Belford Hospital are concerned there is considerable capacity. This is because, as a Rural General Hospital, consultants are on site there to deliver other services.

8 RISK MANAGEMENT

8.1 Health and Safety Report The Health & Safety Manager’s report was circulated prior to the meeting. Ms Wedgwood referred to Item 2.1 and enquired about the action plan. Mrs McVicar confirmed that this locally delivered plan would be overseen by the Health & Safety, Clinical Governance & Risk Management Group.

8.2 Incident Management Report Mr Shields submitted a comprehensive report on Incident Management following a request at the previous Governance Committee meeting for more detailed information on incidents relating to Slips, Trips & Falls and Violence & Aggression. Some in-depth analysis has been undertaken and the results referred back to the relevant clinical areas.

Mr Macmillan thanked Mr Shields for his report. He referred to incidents of Violence & Aggression where the highest number is in Fyrish Ward at County Community Hospital, Invergordon. This ward cares for the elderly with problems affecting their mental health. He queried why, out of a total of 89 incidents during the first six months of 2010/11, only 64 were identified. Mrs McVicar indicated that for confidentiality reasons patients were not identified when incidents were input to the DATIX reporting system, but that there were methods for tracking. Further work will be done on this.

7 Mr Macmillan commented that the DATIX Incident Reporting Form itself did not seem particularly satisfactory. He noted that the form was orientated towards NHS staff and made no attempt to elicit the outcome for the patient involved in the incident, showing little or no concern for their welfare. He indicated that this could be particularly relevant if the document should ever form part of a court case. Mrs McVicar noted that DATIX is an online reporting system and the printed version contained in the papers did not demonstrate its use particularly well. She confirmed that she would be happy to arrange an online demonstration for Mr Macmillan if he wished. Mr McLennan agreed that the form was not patient-focussed; he emphasised that it had been designed with the specific purpose of allowing NHS staff to report incidents. Mrs McVicar reassured Mr MacMillan that the narrative in the reports often did provide information on outcomes for the patient.

However, it was agreed that Mr Macmillan had raised a valid point and Mrs Hudson confirmed that she would provide him with access to a completed form on line; should he still have concerns, the matter could be explored further.

9 CLINICAL GOVERNANCE

9.1 Lead Pharmacist’s Report Mr Hickey spoke to his previously circulated report. Mr McLennan queried levels of compliance with antimicrobial prescribing; Mr Hickey indicated that this was difficult to determine because in primary care it was not actually known what prescriptions were being issued for. An audit of antibacterial prescribing nationally is planned for a few months’ time however. Mr Hickey emphasised that the use of antibacterials associated with Clostridium difficile infections is monitored closely and discussions take place with practices that have a high level of prescribing. He emphasised that sometimes use of these drugs is appropriate. He also drew attention to a recent Scottish Government communication concerning the emergence of resistant strains of antibacterials.

Ms Wedgwood raised a financial issue around the risks of forecasting substantial prescribing savings so early in the year (as highlighted on p3 of the Finance Report under Item 13). Mr Hickey advised that data for the costs of primary care prescribing are 2-3 months behind because of the system used to process prescription forms and payments. He acknowledged the risks but anticipates that a number of beneficial factors will come into play during the second half of the year.

Mrs McVicar highlighted that the CHP had already identified areas in prescribing it which it could improve and these formed part of the savings scheme. These included a review of polypharmacy, the introduction of ScriptSwitch to GP practices, ongoing review of prescribing by overspending practices, quality prescribing work and the work of the 70% Group (part of whose remit is to bring their prescribing back within budgets).

9.2 Complaints Report Mrs McVicar spoke to the previously circulated report, advising that the CHP is still not achieving its targets. She explained that the number of complaints involved is small but some individual complaints are highly complex, involving multiple organisations. She confirmed that the issue is receiving renewed focus with additional training being offered for managers.

9.3 Control of Infection and Hand Hygiene Mrs Hudson’s report was circulated prior to the meeting.

Mrs McVicar commended staff on the dramatic improvements around rates of Healthcare Associated Infection (HAI). This is a high priority issue for Governance Committee, CHP Management Team, Locality Management Teams and individual units. She emphasised that awareness of HAI is important to all staff.

Mrs Hudson advised that this time last year there were 21 cases of Clostridium difficile in the CHP compared to 14 so far this year. Only three of these were in Mid CHP hospitals: two at the Belford

8 and one at Portree. The remaining 11 were in the community. Norovirus has not affected Mid Highland unduly and all necessary preparations are in hand for any seasonal outbreaks.

Preparatory work for Healthcare Environment Inspectorate (HEI) visits is continuing, particularly at Mackinnon Memorial and Belford Hospitals. Gap analyses are being developed against the results of all HEI inspections undertaken at other hospitals. She indicated that the levels of preparedness in terms of environmental improvements are much improved at both MMH and Belford Hospital. Staff preparation and awareness has been a priority and prioritised action plans are being developed for all hospital sites, although inspections are only anticipated at MMH and Belford at present.

Monthly hand hygiene audits continue and high standards are being sustained with, on average, 95% compliance against opportunities taken.

Ms Wedgwood referred to Table 6 on p8 of the Highland HAI Report for October 2010. She queried why the October figure for Estates Monitoring Data for Ross Memorial Hospital was somewhat lower than for other sites. Mrs Hudson indicated that this was a reflection of major environmental works taking place at the time.

10 STAFF GOVERNANCE

10.1 Workforce Reporting Mrs McVicar spoke to the reports for Mid Highland and CHP and Services Overall. She highlighted the continuing reduction in bank usage and commended the efforts of individuals and teams.

11 HEALTH IMPROVEMENT

11.1 Alcohol Brief Interventions Mrs McVicar addressed this as part of her General Manager’s report at Item 6 above. There was a further brief discussion and she confirmed that there is a great deal of health improvement work taking place around hazardous drinking habits. She confirmed that the police have also indicated a willingness to work with the CHP on alcohol issues, with the possibility in the future of their officers undertaking ABI training.

11.2 Suicide Prevention This was also addressed in the General Manager’s report (Item 6 above).

12 PARTNERSHIP WORKING

12.1 Delayed Discharge This was addressed as part of Item 6 above. Mrs McVicar confirmed that Raigmore Hospital is under immense pressure at present, with medical patients currently occupying surgical beds. The ability of the CHP to assist is limited by the fact that our community hospitals have several people in a delayed discharge situation.

Mrs Phimister advised that the figures for December 2010 were marginally better than those for December 2009 and that there was a modest reduction in the most recent overall figures.

Mrs McVicar indicated that she intends to raise the issue at the Joint Community Care Management Team meeting later in the week to explore other options.

9 13 FINANCIAL GOVERNANCE

13.1 Financial Report Mr Slavin provided an update to his previously circulated report which was dated 31 October 2010. The CHP has identified schemes to achieve all Cash Releasing Savings target of £1.446m and this has been withdrawn from budgets. The biggest financial risk to the CHP relates to the ability of budget-holders to manage within this reduced financial environment, whilst still maintaining provision of quality and frontline services.

The CHP is reporting a year-end financial position of £300k overspent. However, this is not acceptable to NHS Highland who has indicated that it expects this to be brought back to breakeven. The CHP has a significant non-recurring overspend, particularly in OOH and pays. Mr Slavin indicated that he was reasonably confident that savings in the region of £266k could be achieved in Prescribing (as discussed under Item 9.1 above). Mrs McVicar emphasised that the overspend was extremely worrying and that a concerted effort is taking place to bring this back in. However there have been financial challenges such as the cost of HEI works and the replacement of vital equipment etc. Mrs McVicar also emphasised that it takes time to realise savings from service redesign.

Ms Wedgwood expressed concern about how quality of care would be impacted by the financial challenges. Mrs McVicar confirmed that risk and impact assessment is built into every redesign project. She also emphasised that by concentrating on quality and service improvement, very often cost savings will follow as waste and inefficiencies are reduced.

Responding to a query from Mr Macmillan about Dingwall Health Centre premises, Mr Slavin clarified that work on the proposed new site had been abandoned due to unexpected site costs. It was then agreed that a new health centre should be built on the existing site.

Mr McLennan confirmed that any overspend will be carried over to next year’s budget. He emphasised that it is NHS Highland’s expectation that there will be no overspend.

Governance Committee:

. Noted the contents of the Performance Management Reports.

During a short break in the meeting, the Chairman congratulated Mrs McVicar who was awarded an MBE in the 2011 New Year’s Honours List for services to the NHS in Scotland. He was delighted to present a gift to her from staff who agreed that this was extremely well deserved in the light of her hard work, commitment and enthusiasm. Mrs McVicar thanked everyone for their support and also thanked those who had nominated her. She indicated that, to her, this honour was a reflection on the wider NHS team.

14 TAIN HEALTH CENTRE OUTLINE BUSINESS CASE

The Tain Health Centre Outline Business Case (OBC) was submitted to the NHS Highland Board in December and approved. A copy of the document was circulated prior to this meeting. The existing health centre and dental practice are not fit for purpose, are over-crowded and the facilities do not meet modern standards.

The replacement of Tain Health Centre does not appear on the Board’s 5 Year Capital Plan (apart from £419k for dental fit out) therefore the preferred option was to have a revenue funded solution with the new Hubco providing a Design, Build, Finance and Maintain package.

10 The Board approved the OBC and it was agreed that the Project Team should engage with Hubco to produce a Full Business Case for the Board meeting in June 2011. The cost of this will be met from capital enabling funding from Scottish Futures Trust. The Board also approved the use of capital enabling funding to purchase the preferred site for the new health centre adjacent to Craighill Primary School in Tain.

Governance Committee:

. Noted progress on the new Tain Health Centre.

15 RHEUMATOLOGY SERVICES

A paper setting out proposals to redesign NHSH Rheumatology Services was submitted to the December NHSH Board meeting and approved in principle. All those who had submitted complaints were sent a letter and copy of the proposed action plan; only one response was received and this was favourable. A meeting of those who had been involved with the original workshops would be held on 18th January. The clinical vision will be presented and there will be an opportunity for discussion. Communication and further engagement with patients will also be a focus of the meeting.

Mrs McVicar emphasised that this was not specifically about the Highland Rheumatology Unit (HRU) but about Rheumatology Services across NHS Highland. The driving force for this was awareness in primary care of the need for early detection and intervention; clear clinical guidelines exist indicating that the sooner a condition is diagnosed and managed by a consultant, the better the outcome for the patient. The HRU forms part of the service although compared with the number of people living with these conditions in Highland, few patients actually access the Unit. The number of beds in the unit itself will reduce from 14 to 10 to allow the introduction of an infusion service due to commence this month. Initially this will look at biologic infusions for rheumatology conditions but, in time, will be expanded to benefit patients with other conditions.

The Chairman welcomed these proposals. He felt they represented the right direction for Rheumatology Services in Highland and also secured the future of the HRU in Dingwall.

Governance Committee:

. Noted developments in Rheumatology Services in NHS Highland.

16 BRIEF UPDATE ON STRATEGIC FRAMEWORK AND RELATED ISSUES

In the absence of key members of the Governance Committee it was agreed that this item would be deferred until the February meeting. This will include a development session for Committee members and an in-public development session.

SERVICE REPORTS

17 OUT OF HOURS SERVICES

An Out of Hours report will be submitted to February’s Governance Committee meeting.

11 SERVICE IMPROVEMENT

18.1 Skye & Lochalsh Service Review and Redesign Mrs Phimister confirmed that this refers to a paper originally submitted on 25 June relating to Out of Hours Services.

18.2 Linking Practices in Skye & Lochalsh Mrs Phimister updated Committee on collaborative working between Broadford and Sleat under Item 6, General Manager’s Report. She indicated that a workshop comprising representatives from all the salaried practices had taken place. This followed the Scottish Health Council workshop format and had some practice-based discussion linked with the quality strategy, the demographic challenges and the financial position. As a result of this the priorities have emerged and the work has been remitted back to practices. Practice managers will be establishing patient participation groups and will also take forward the priorities identified at that meeting.

18.3 Service Plan for Older Adults in Lochaber This item was addressed as part of Item 6, General Manager’s Report. Mrs McVicar has asked for a joint Health/Local Authority presentation to the February meeting of the Governance Committee.

19 PATHWAY TO INTEGRATION

The Highland Council/NHS Highland paper dated 16 December Improving Joint Service Delivery – A New Partnership Model was circulated prior to the meeting.

It was agreed that it would not be possible to have a full discussion without Local Authority partners present. This item will therefore be deferred until February’s Governance Committee meeting. Mrs McVicar highlighted professional concerns from Children’s Services staff (paediatricians, public health nurses, health visitors, school nurses and speech and language therapists). These responses have all been fed back to a central point and workshops with these staff are planned to help understand the key concerns. The first of these is scheduled for 17 January. Mrs Hudson confirmed that the Children’s Service Network is hosting a workshop on 18 January so the outputs from the workshop on 17th will feed into this.

It was agreed that this should be a standing Governance Committee agenda item.

Mr Macmillan referred to p19 of the paper, Regulations related to consultation. The statement that “there should be a consultation 8 weeks prior to the commencement of the proposed arrangement” suggested that the implementation date was already fixed. He indicated that there was little point in a consultation process if the decision had already been taken to implement the arrangement. Furthermore, a period of only 8 weeks could scarcely be called consultation. He suggested that those managing the PR aspects should give consideration to the possibility of making media announcements well before commencement of the basic statutory 8 weeks, particularly given that some of the views expressed could have a bearing on the final scheme.

Mr Macmillan indicated that there were a number of statutory provisions that could be affected by the proposal and he wondered if any consideration had been given to the proposition that there are likely to be different ages at which a person ceases to be a young person and becomes an adult. For example in one statutory area a person may be deemed to be an adult at 16, while in another the age may be 18. If this was the case, there would be a need for transitional arrangements.

Mr McLennan indicated that although the statutory consultation period was 8 weeks, there would in effect be a 12 month consultation period for this proposal. He agreed it was critical that discussion around the numerous and complex issues began as soon as possible.

12 STRATEGY AND PLANNING

20 PRIORITIES FOR 2011/12

It was agreed that this item should be deferred until the February meeting.

FOR NOTING

21.1 NHS Scotland Chief Executive’s Annual Report 2009/10 This was circulated prior to the meeting.

21.2 Scottish Government Chief Medical Officer and Public Health Directorate Letter This was circulated prior to the meeting.

22 AOB

The Chairman indicated that an issue had arisen around out of hours services on the Ardnamurchan Peninsula. Although emergency and urgent response is the responsibility of Scottish Ambulance Service, historically this has been provided by the local District Nurse. The situation is neither safe nor sustainable as it relies on two nurses in the main and they are not in place to provide a 999 response. Mr McLennan confirmed that the CHP will continue to work with SAS to try to resolve the issues. Mrs McVicar indicated that this is an anomalous situation and clearly unsustainable but she understood the concerns of the community who believed that nurses were required due to the fact that SAS is unable to respond to emergencies within their 30 minute standard. A First Responder scheme has been set up in Kilchoan as part of the response. Every attempt will be made to continue to provide an on call service whilst discussions with the local community and planning for a more robust service continue.

23 DATE OF NEXT MEETING

The next meeting of the Mid Highland CHP Governance Committee will take place on Friday 18 February 2010 (10.00 am – 4.00 pm) at County Community Hospital, Invergordon.

13 Highland NHS Board 1 February 2011 Item 3.3 Unconfirmed North Highland Community Health Partnership Caithness General Hospital Bankhead Road Wick KW1 5NS Telephone: 01955 605050 Fax: 01955 604606 www.nhshighland.scot.nhs.uk

MINUTE of MEETING of the NORTH HIGHLAND CHP COMMITTEE 14 December 2010– 2.00 pm The Marine Hotel, Brora

Present: Mr Colin Punler, Chairman, North Highland CHP Committee Mrs Sheena Macleod, General Manager, North Highland CHP Mr David Alston, Non-Executive Board Member, NHS Highland Dr Bobby Echavarren, Clinical Lead, Caithness LHP Cllr Bill Fernie, Highland Council, Wick, Caithness Mr Paul Fisher, Clinical Lead, Caithness General Hospital Cllr David Flear, Highland Council, Landward, Caithness (until 3.40pm) Dr Moray Fraser, Clinical Director, North Highland CHP Mr Ian Hargrave, Corporate Manager, Highland Council, Caithness, Sutherland and Easter Ross Mr Mark Kerr, Personnel Advisor, North Highland CHP Mrs Carena Macivor, Acting Lead Nurse, North Highland CHP Mrs Sylvia Mackay, Voluntary Sector Representative, North and West Sutherland Care Alliance Mr Ross Mackenzie, Head of Finance, North Highland CHP Cllr John Rosie, Highland Council, Thurso, Caithness (until 3.45pm) Dr Cameron Stark, Consultant in Public Health, NHS Highland Mr Allan Tubb, Deputy Public Partnership Forum Member Ms Claire Wood, Lead Allied Health Professional, North Highland CHP Dr Alan Woodall, Clinical Lead, East Sutherland LHP

In Attendance: Mrs Pauline Craw, Locality General Manager-Caithness, North Highland CHP Mrs Georgia Haire, Locality General Manager-Sutherland, North Highland CHP Mr Bob Silverwood, Community Care Manager, Highland Council – North Highland Mrs Mary Burnside, Lead Midwife/Manager, North Highland CHP Mrs Fiona Duff, Primary Care Manager, North Highland CHP Mrs Jennifer Bremner, Condition Management Practitioner Team Leader (shadowing Pauline Craw) Mrs Alison Meek, Local Officer for Scottish Health Council Ms Kay Oswald, CHP Support Manager (Minutes)

Vacancies: Dentist

Chairman’s Welcome

The Chairman, Colin Punler, welcomed everyone to the meeting.

Declaration of Interest

Mr Punler asked if anyone had any interests to declare – none were expressed. 1 APOLOGIES

Apologies had been received from Cllr George Farlow, Dr Andreas Herfurt, Mr Ranald MacAuslan, Cllr Deirdre Mackay, Mrs Janette McQuiston, Cllr Linda Munro and Mrs Elizabeth Smith.

2 MINUTE OF MEETING HELD ON 12 OCTOBER 2010

The minute of the meeting held on 12 October 2010 was approved as an accurate record.

3 MATTERS ARISING

Forward Planner

Cllr David Flear suggested that in view of the impending integration agenda of Highland Council and NHS Highland that perhaps a Development Session should be allocated to this topic and the impact which may arise.

It was noted that the topic for the next Development Session was Telemedicine and its use within the CHP.

Development Session

The key messages from the Development Session held prior to the previous Committee meeting had been distributed for information. Mrs Sheena Macleod confirmed that following on from the comments received she had reviewed the content of the presentation which will be used to deliver the key messages from the CHP to members of the public. Following discussion a few minor amendments were suggested and agreed. Any further feedback should be notified to Sheena Macleod.

Mrs Macleod indicated that a programme of events for rolling out the presentation will be arranged and support from the Committee would be appreciated. The first event is scheduled for 7 February at the Ward Forum meeting at Edderton. Mr Allan Tubb and Dr Alan Woodall offered to attend. It was acknowledged that the slides gave the basic key messages but that the script would vary depending on where the presentation was being delivered.

It was agreed that some of the messages may change as the integration agenda becomes more focussed and the presentation would be adjusted accordingly. In view of the integration agenda it was considered essential that Highland Council members were present, endorsing the message of working together. Bob Silverwood confirmed that he was happy to accompany the CHP members when required.

Feedback from Board Meeting

Colin Punler gave the following feedback from the Board Meeting held the previous week:-

1. Finance  Unconfirmed, but available capital funding for NHS Highland in 2011/12 forecast to reduce to £3m.  Unconfirmed budget shortfall for NHS Highland in 2011/12 is forecast to be approximately £20m.  Message from Board to CHPs – need to ensure that quality is being maintained in areas where costs are being reduced. 2. Rheumatology – redesign approved.

2 3. Director of Public Health annual report presented – Dr Margaret Somerville will be travelling around CHP Committees in the New Year. 4. CHP attendance register – Board Secretary to compile and maintain. 5. Access for Patients Policy approved – overnight accommodation costs will be met in cases where travelling time to hospital is greater than 90 minutes and appointment is before 10.00 hours.

4 FINANCE AND PERFORMANCE REPORTS

4.1 General Manager’s Report

A report by Sheena Macleod had been distributed for information. During discussion the following points were highlighted:

 Electronic Knowledge and Skills Framework (e-KSF) – David Alston confirmed that at the Staff Governance meeting he had received assurance that North CHP have plans in place to achieve the target set.  West Caithness Redesign Project:- o Ongoing discussions being held with the Scottish Government (SG) and asked to defer consideration of the paper until the Government are satisfied with the information provided to them. o Still unclear as to whether project would be deemed “major service change”. o Gap Analysis and an Equality and Diversity Impact Assessment has been completed and returned to the SG. o Communications Department are in constant contact with SG to ensure correct process is being followed. o Paper will come to the Committee for scrutiny and then go to the Board. The committee will decide whether to give support to the paper or not, giving consideration as to whether the process meets the standards as required for NHS Highland in terms of Clinical Governance, Public Involvement and Financial governance. o A suggestion that a meeting should be held prior to the Committee meeting to discuss the paper in private was rejected. It was agreed that members had already had ample opportunity to consider the options and give feedback as various papers had been presented throughout the engagement process. Instead, it was agreed that the paper should be a separate agenda item with ample time given to discuss it fully at the Committee meeting. o Queried whether other alternatives had been considered e.g. one large community hospital providing all services under one roof – confirmed that this had been one of the options considered by the original stakeholder group but discounted as there was no funding for additional capital projects. o Reminded that the original reason for looking at the West Caithness project was due to underutilised beds at Dunbar and staff not being used efficiently as well as the underutilisation of the PCEC. As time has moved on the need to make savings has also become an issue.

 Obstetric Service – queried whether a timescale had been given by the Board Medical Director as to reintroduction of low risk inductions to CGH. It was confirmed that awaiting results of comparison of data re outcomes of low risk inductions at CGH and Raigmore Hospital. It was indicated that the main consideration is for a safe service. It was noted that the post caesarean infection rates at CGH are lower than those at Raigmore but acknowledged that Raigmore has higher risk patients which would influence this data.

3 4.2 North Highland CHP Financial Position Report by Ross Mackenzie, Head of Finance

The Finance Report for the period to 31 October 2010 had been distributed for information. The forecasted year-end position for the CHP is an overspend of £716K. The following points were highlighted:-

 Improvement in position from previous month but CHP has been asked to reduce this overspend to £0.5 m by the year end.  Cash Releasing Savings (CRS) target of £1.3m – £372k remains outstanding. As the majority of the savings have been delivered on a non recurrent basis, £964k will be carried forward into 2011/12. Savings target for 2011/12 is expected to be in the region of £2m.  Prescribing forecast of £188k overspend is based on 5 months prescribing data but this position is expected to improve following reduction in drug tariffs.  GMS – Global Sum quarterly recalculation has resulted in £21k benefit to the CHP.  NHS Highland overall position is a forecasted overspend of £2.2m which after management action and delivery of outstanding CRS targets is expected to be brought back to breakeven in line with its Local Delivery Plan.

During discussion the following was raised:-

 David Alston intimated that the expected cutback on capital expenditure for 2011/12 from £20m to £3m will create an ongoing situation for NHS Highland with revenue solutions being sought for capital issues.  Queried what the CHP will do differently if unable to meet CRS of £1.3m this year and forecasted increase to £2m for next year. Acknowledged that CHP will incur difficulties as 70% of costs are staff and given the no compulsory redundancy policy then severely restricted in opportunities to make savings.  Suggested that perhaps there was an opportunity to share staff with Raigmore but advised that Raigmore were actually pulling back on outreach clinics in an attempt to avoid costs of clinicians travelling and productivity pressures.  Allan Tubb noted that the finance report had indicated various slippages in staffing, some due to recruitment issues, and suggested that this would result in a reduction in services to the public. It was indicated that some of the slippages were due to management taking the opportunity to do things differently with post vacancies. It was confirmed that there was a mechanism in place to risk assess vacant posts and monitor the positions. Georgia Haire confirmed that she would be happy to advise Mr Tubb of how the vacant posts were being managed.  Mr Punler indicated that there was a need to ensure that quality was being maintained in areas where costs have been reduced. It was acknowledged that it was difficult to evidence this but that the Scottish Patient Safety Programme, HEAT targets, QIS audits and patient feedback gave an indication of quality and should give the Committee some reassurance. It was agreed that the Quality Dashboard presentation being planned as a Development Session would be useful for the Committee.  It was queried how many staff were on temporary contracts and Mark Kerr agreed to provide this information.

Colin Punler concluded that it was recognised that:-  There were constraints on making savings  There were constraints outwith Management control  There was a need for quality indicators  There was a need for staff to recognise the patient experience  There was an ultimate need for a breakeven position.

4 The Committee:

 Noted the information provided  Agreed that information on temporary contracts be provided.

5. STAFF GOVERNANCE

5.1 Staff Governance Issues

A Staff Governance Report by Mark Kerr, Personnel Manager, had been distributed for information. The report outlined the CHP’s position against the Sickness Absence and electronic Knowledge and Skills Framework (eKSF) targets. There has been a steady downward trend in sickness absence although it was noted that there was a higher level of sickness absence within Hotel Services. Work is ongoing with managers to address this position. Concerns were expressed around the achievement of the eKSF target but it was indicated that there were a number of reviews which were in progress which only required to be signed off.

Colin Punler indicated that the Board were looking for reassurance that the five areas of Staff Governance were being met:-  well informed  appropriately trained  involved in decisions which affect them  treated fairly and consistently  provided with an improved and safe working environment.

Following discussion it was agreed that each of the themes should be taken and reported on in detail, concentrating on one theme per meeting.

The Committee:

 Noted the information provided.  Agreed that each area of Staff Governance be reported on, one per meeting.

6. CLINICAL GOVERNANCE

6.1 West Caithness Redesign Project

It was agreed that this item had been discussed in detail under agenda item 4.1. Additional points raised:-

 Hoped that increased working together between NHS and Highland Council would make discussions at public events more productive.  Acknowledged that position of Councillors was difficult as had to represent their constituents and balance with governance role on the CHP Committee.

The Committee:

 Noted the information provided  Noted that a paper giving Management Team recommendations would be presented following consideration by the Scottish Government.

5 6.2 Infection Control Progress Report

The Infection Control Report by Carena MacIvor, Acting Lead Nurse and the updated HEI action plan for CGH had been distributed for information. The following issues were highlighted:-  Training for Antimicrobial prescribers is reducing the rate of inappropriate prescribing and helping to reduce CDI cases.  Patient information about infection control is being made more widely available and has been uploaded to the North CHP section of the website. The Patient Information group which is being formed will also be used as a vehicle to increase public awareness regarding infection control.  Cdiff figures have reduced by 50% in the year.  Staff are prepared for the Norovirus season which has started.  HEI inspection gave CGH the opportunity to improve and tighten up procedures and now have to ensure the community hospitals are similarly prepared. Dunbar Hospital has an action plan and a risk prioritisation group has been formed to develop a tool which will identify issues and their impact.  A gap analysis is carried out for each HEI report.  Interviews for the Control of Infection Nursing post will take place in January.  The recent HEI report of Forth Park Maternity Hospital had indicated that whilst the building was due to be closed and services moved to another site, there was still a need to ensure the current facility met the required standards.

Mr Punler indicated that it was important that the Committee were assured that the facilities within this area are prepared for any unannounced visit by the HEI. Sheena Macleod confirmed that a series of pre inspection visits were being carried out with a view to gathering information as to actions required and associated costs. A risk prioritisation matrix is being planned and an internal team are doing their own unannounced inspections.

Other issues raised:-

 Confirmed that linoleum at entrance of Migdale Hospital was replaced with carpet as Health and Safety risk. Carpet was used as non-clinical area.  Queried whether there was a role for lay members to reinforce messages and work with team. Confirmed that Patients Council members assisted with audits and lay members were on the Control of Infection Group.

The Committee:

 Noted the information provided.

6.3 Clinical Governance and Risk Management Report

A report by Rachel Hill, Clinical Governance Manager, had been distributed for information. The high level of incidents relating to Disruptive, Violent, Aggressive Behaviour on page 3 of the report was highlighted and it was queried whether there was any connection with alcohol regarding this data. It was agreed that Rachel Hill would be asked if the system could be interrogated for more detail on this.

The Committee:

 Noted the information provided.  Agreed that Rachel Hill be asked to establish further information on Disruptive, Violent, Aggressive Behaviour incidents.

6 7. ENGAGING WITH PATIENTS AND COMMUNITIES

7.1 Issues from PPF Members

Allan Tubb raised the following:-  Suggested that issues from voluntary members on the Committee should also be considered under this agenda item. This was agreed.  Queried whether assurance could be given over the West Caithness Project that longer term, funding would be available to sustain proposed services. It was indicated that assurance could not be given for longer term but medium term, known factors have been taken into account by the Management Team.  A transport issue following Day Surgery was raised and it was agreed that this was not an issue for the Committee but should be raised with Georgia Haire, Locality General Manager for Sutherland.

The Committee:

 Agreed that issues from voluntary members should be included under this agenda item.

8. NORTH HIGHLAND CHP HEALTH AND WELLBEING PROFILES 2010

The North Highland CHP Health and Wellbeing Profiles 2010 had been distributed for information. It was agreed that some of the issues considered could be raised with Dr Somerville, Director of Public Health when she presents her Annual Report at the Committee meeting on 12 April 2011.

9 ANY OTHER COMPETENT BUSINESS

9.1 Winter Plans

Pauline Craw, Locality General Manager, Caithness, confirmed that the winter plans had been put into action following the adverse weather and that the Committee could be reassured over the results. Staff were to be commended for going the extra mile and council colleagues thanked for their assistance. Very little activity had been cancelled. The Committee asked that their thanks be conveyed to the staff.

The Committee:

 Noted the information provided.  Agreed that thanks should be conveyed to staff for their efforts.

10 DATE OF NEXT MEETING

The next meeting of the CHP Committee will be held on Tuesday 8 February 2011 at 2.00pm in the Seminar Room at Caithness General Hospital. Videoconferencing facilities will be made available at the Lawson Memorial Hospital for anyone wishing to join the meeting from there. (The Development Session will take place from 12.45 to 13.45. Please note that no lunch will be provided as there are canteen facilities at CGH).

The meeting closed at 4.00 pm.

7 Highland NHS Board 1 February 2011 Item 3.4

Raigmore Hospital Inverness MINUTE OF MEETING OF THE IV2 3UJ RAIGMORE GOVERNANCE Telephone 01463 704000 COMMITTEE www.nhshighland.scot.nhs.uk/

Multi-purpose Room, Centre for Health Science 10 January 2011

Present Mr M Evans, Non-Executive Director (Chair) Mr C Lyons, General Manager Dr R Harvey, Clinical Director Mrs M Morrison, Clinical Governance & Risk Manager Mrs P Dobbie, Patients Council Representative Mrs E MacKay, Partnership Forum Representative Mrs K Underwood, Head of Finance Mrs R McGee, Health & Safety Manager Mrs C Walker, Personnel Manager Ms L MacDonald, Highland Council Representative Mr C Munro, Voluntary Sector Representative

Apologies Mrs U Lyon, Lead Nurse Mr D Flear, Highland Council Representative Ms P Courcha, Non-Executive Director

In Attendance Ms L MacDonald Scottish Health Council Ms E Greig, Communications Manager Mr K Oliver, Performance Manager Mrs L Lawrence, Business Support Manager (Minutes)

1 Apologies, Welcome and Introductions

Mr Evans confirmed that he would be chairing the meeting due to Ms Courcha being unwell and welcomed everyone to the meeting, in particular Mr Kenny Oliver, Performance Manager who was attending to discuss Agenda Item 13. Apologies were also noted. Concern was raised that the “to follow” papers had not been received by members of the Committee. It was agreed that a full set of papers should be made available to all members prior to the meeting, as opposed to on the day to allow sufficient time for members to review papers.

Given the need for Mr Lyons to leave the meeting early, Mr Evans confirmed that the agenda items would be taken in a slightly different order, to that detailed in the agenda.

2 Conflicts of Interest

Mr Evans confirmed the instruction from the NHS Board that future agenda’s should include the above item, to allow the opportunity to declare any potential conflicts of interest. The following potential conflicts of interest were noted: 1. Mr Munro advised that his wife is an NHS member of staff, employed at Raigmore Hospital. 2. Mr Munro confirmed that he is employed by the Highland Children’s Forum who were actively involved in the recent Birnie Centre discussions. 3. Mr Evans confirmed his involvement in the audit for the Birnie Centre.

3 Minutes of Meeting held on 18 October 2010

The minutes of the meeting held on 18 October were approved as an accurate record.

4 Matters/Actions Arising not on the Agenda

All matters arising are covered in the content of the General Manager’s report (Agenda Item 7).

Mr Munro referred to the discussion in October 2010 around the reduction in Orthopaedic waiting times and how this added pressure would affect staff, in particular Ward 3C, in terms of the proposed reconfiguration of beds in the Hospital. Mr Lyons confirmed that Sheila Cascarino, Interim Directorate General Manager, Surgical Division, is leading a group comprising of all key stakeholders, including nursing, clinical staff and partnership forum representation to take this forward by the 31 March 2011. Mrs Mackay confirmed that partnership representation has been involved and discussions are going well. Members were advised that the group was an implementation group following the completion of the review which had already been undertaken prior to the media interest and involved orthopaedic nursing and consultant staff in this area. Mr Evans confirmed that the proposals had been discussed at the recent NHS Board meeting and regular updates on progress would be requested. Mr Munro confirmed that it was his understanding that some staff felt that they are not being kept informed and this was leading to anxiety for some members of staff. Mrs Walker provided reassurance that staff would be engaged with fully during the implementation phase and regularly informed of the progress being made. Mr Lyons added that as part of the process of engagement a meeting had been arranged to allow staff at all levels to be made aware of the proposals for reconfiguration of beds. In addition Mrs McGee confirmed that from a health and safety perspective, there was now involvement to consider the pressures both on individuals and the working environment.

Mr Evans referred to the current management changes and queried whether there would be any cost savings as a result. Mr Lyons confirmed that this would not be the case, as there is no intention to appoint additional staff, but to review current staffing arrangements and make changes that will ensure that the management team are used efficiently and effectively. Mr Lyons added that with the recent management changes, the team are already seeing the benefits of bed utilisation/escalation team meetings who have met twice per day since Wednesday of last week. Such meetings highlighted that the hospital was down a significant number of beds however careful planning ensured that 16 patients due to attend today for elective surgical procedures were protected and did not have to be cancelled at short notice as may have been the case previously.

Mr Lyons also added that if there were any particular groups of staff who do feel they are not being kept fully informed, the management team are happy to meet with staff at any stage in line with partnership working. Mrs Mackay added that in terms of partnership working Mr Lyons has been very clear in what is expected and confirmed that a further meeting has been arranged this week to further discuss. Mrs Walker also confirmed that a meeting to discuss the Local Partnership Forum role and remit has been arranged for next week with the intention that the Forum continues more effectively to provide a communication vehicle to feed out to the organisation on a partnership basis.

2 5 NHS Highland Board Feedback

Mr Evans provided members with an overview of the discussions held at the recent Board meeting and highlighted the following areas:

Scottish Government Budget News and the decision to postpone meantime, the Day Services Centre. It was noted that further updates were hoped to be available in March.

Mr Lyons referred to the Day Services Modular Unit currently being commissioned on site and confirmed that this had been delayed slightly due to the recent weather conditions. It was noted that the contractors were back on site today and it was hopeful that the facility would be available from 1st week in February with no patients affected as a result of the delay. The commissioning of this unit provides an introduction to day services in the true sense and provides an advance on the current situation.

Mr Evans also referred to the ongoing discussions in relation to Highland Council/NHS Highland agreement to work towards a different agenda in terms of social work services, with NHS Highland expected to take ownership of Adult Services and the Highland Council taking responsibility for Children’s services. Members were advised that at present, this remains a working plan. It was felt that it would be useful to extend the Governance Committee meeting scheduled for 14 February, to allow a “vision” day on this subject and the Boards strategy in general and to extend this invite to members of the management team at Raigmore and Councillor Margaret Davidson, Chair of Social Work and Housing Committee, and to be attended/facilitated perhaps by Elaine Mead, in her new role as Chief Executive.

In this respect the Governance Committee would take place until 12.30pm with the workshop from 1-3pm that afternoon. Members were asked to commit to this session and it was generally felt that this would be a worthwhile exercise.

6 Clinical Governance Report

Members noted the circulated report.

Mr Evans advised members that this would be the last report produced by Mirian Morrison, as it has been agreed that future reports will be the responsibility of the Quality and Patient Safety Management Team chaired by Dr Rod Harvey.

In relation to Clinical Incident reviews, Mrs Morrison confirmed that each Clinical Director for the CHP’s and Raigmore has been asked to present a recent complex complaint or serious incident at the Clinical Governance Forum scheduled to take place on Tuesday 12 January. This will provide colleagues with the opportunity to learn from the outcomes of the investigations.

In relation to root cause analysis, it was noted that an information leaflet for patients and relatives on the incident review process is currently being formalised. Ms Dobbie asked if this leaflet could be reviewed by the Patients Council to allow the opportunity to comment on the content.

In terms of Complaints, it was noted that the situation had improved slightly with 53% of complaints being answered within the 20 day target. The Clinical Governance Team continue to work closely with the General Managers and Directorate General Managers to improve this situation. To provide an indication of the number of complaints received, it was noted that in terms of the number of patients at Raigmore Hospital, complaints amount to 0.15% which are extremely small numbers with the main reasons being around lack of communication and attitude of staff. Members were advised that final responses are

3 routinely fedback to the individuals/departments concerned, with a view to use this as a vehicle to raise awareness and prevent recurrences in the future.

Dr Harvey added that there may be opportunities to raise further awareness through the Team Brief which would allow feedback to a wider audience. Mr Munro also queried whether the awareness/training sessions should be focussed on the individuals highlighted in such complaints. Dr Harvey added that the Quality & Patient Safety Management Team would be reviewing a number of the complaints coming through the system which would provide an increased opportunity to learn from the outcomes.

In terms of Better Together – Inpatient Results, it was noted that the circulated results had been published on the 27 October and the results were very positive in terms of Raigmore Hospital and highlighted that Raigmore was consistent with other hospitals. Members were advised that the 2nd round of the survey would commence this month.

Mrs Morrison added that the comments made by patients would be made available and shared with the management team. This would allow the opportunity to develop a plan based on the information from the patients.

Mr Evans thanked Mrs Morrison for her support to the Committee and looked forward to this continuing with the management team taken over the responsibility.

The Committee:

Noted the contents of the Clinical Governance & Risk Management Report. Noted that the Quality & Patient Safety Committee would be taking responsibility for reporting to the Governance Committee in the future.

7 General Manager’s Report

Members noted the circulated report.

Mr Lyons confirmed that the Quality & Patient Safety Management Team under the chairmanship of Dr Harvey would be 1 of 2 key meetings within Raigmore, the other being the Senior Management Team. The Quality & Patient Safety Group would be focussing on the quality issues and the Senior Management Team focussing on the operational issues within Raigmore Hospital.

In relation to the reduction in theatre use over the Christmas period, it was noted that this had not been possible and in fact additional lists had been arranged over the New Year period. Members noted that theatres were working a full capacity with the exception of Christmas and Boxing Day. This was largely due to the inability to close a surgical ward during this time to allow staff, within theatres to take annual leave and as a result no savings would be available to feedback into the savings plan.

In relation to the revised bed management arrangements for Raigmore Hospital, it was noted that key personnel were regularly attending the bed management and bed escalation meetings, including physicians, infection control colleagues, nursing and bed managers to ensure a joint approach. It was noted that 5 out of 7 beds in ITU are currently being used for flu cases although effective bed management has ensured that there is no cancellation of elective surgery this week.

Referring to the Hospital Environmental Inspections, it was noted that a number of internal inspections had taken place to ensure continuing preparation for the unannounced HEI visit which is imminent. The management team has inspected 4 wards to date, with some wards

4 identifying issues, which can and will be easily rectified. In terms of floor cleaning, Mr Lyons confirmed that £30K had been invested in 2 industrial floor cleaners which will make a huge difference in the communal areas of the hospital. It is also hoped to continue the work to maintain a clean area at the front entrance to the hospital and to ensure this, discussions are being held with Highland Council colleagues to utilise the specialist equipment used for cleaning the pavement areas. Ms Dobbie advised that as a member of the Patients Council and involved in the recent HEI internal visits, any matters which do arise are dealt with speedily.

Mr Lyons commented that in his view the ward areas were cleaned to an extremely high level, but it was his intention to ensure these standards were maintained.

Referring to an update on the Birnie Centre, Mr Munro advised that a meeting had taken place recently with parents, social work and early year’s colleagues and an arrangement has been reached with health colleagues which will meet the needs of all concerned. However it should not be underestimated that the general feeling was that there was a major lack of consultation and a failure on the part of NHS Highland to engage with the relevant stakeholders in discussions. Mr Munro confirmed that the parents group had not been involved in any of the discussions despite having raised in the region of £1.2M for the Birnie Centre and received 3 days notification of the proposed closure following discussion with the staff involved. Mr Munro added that the parents involved should receive a huge amount of credit, for their forbearance and dignity during this time and hoped that some lessons would be learned from the situation. This was echoed by Mrs MacDonald, Health Council.

Mr Evans concluded that a decent solution had been found, although this could have been very different and would perhaps have avoided the bad publicity which had occurred as a result. Mr Lyons advised that he would be keen to identify why this had happened and confirmed that this was the sort of discussion which should be taking place at the Senior Management Team. Mr Munro advised that members of the Senior Management Team had taken the time to correct the situation and they should be thanked and congratulated for their input.

In relation to the radiology review (appendix 1), Dr Harvey gave an extremely comprehensive overview of the incident, which resulted in the review being undertaken. The formal report will be shared with colleagues at the Clinical Governance Forum as a learning opportunity and a copy of the report will be circulated to members of the Governance Committee for their information.

Mr Evans acknowledged the amount of work undertaken, and advised that lessons had been learned as a result of this review. Dr Harvey confirmed that there are a number of measures which will now be put in place as a result, including a need for a Radiology Staff policy. In addition there has been discussion around an NHS Scotland Agency Bank which would allow a common information system. Mrs MacDonald, Highland Council commented that the amount of double work involved had been vast as a result. It was noted that the GMC had been advised of the issue and will be provided with a copy of the report and despite taking into account the 4% discrepancy rate the 1 to 2 errors had been identified as gross errors.

Dr Harvey reassured members that the patients involved had been kept fully informed at all stages during the review and around 10-15% had contacted the Helpline for advice following receipt of the initial letter. In addition copies of letters were sent to the patients GP for information.

The Committee:

Noted the General Manager’s report

5 Mr Lyons left the meeting to attend the NHS Highland Endowments Committee meeting.

8 Financial Governance Report

Members noted the circulated report. Mrs Underwood confirmed that the end of year position continued to indicate an overspend of £837K despite the figures shown only up until October 2010. There is slight change in the year to date position from £163K to £258K for November. Mr Evans referred to the end of December figures, not available at this time and queried the overspend in relation to NHS Highlands overall situation and confirmed that NHS Highland are not permitted to exceed their budget allocation and that there would be consequences as a result and requested a review prior to the next meeting. Mr Munro added that the reductions relate heavily on the management of vacancies and queried the pressures on patient care as a result. It was noted that the effects these changes have on individuals and the services are reviewed and although a very complex situation, the skill mix within each area is looked at. Mr Evans confirmed that whilst accepting that savings need to be made this needs to be undertaken without impact on patient safety and quality.

Mr Evans requested a clear report at the next meeting on how savings will be transacted and what the implications were likely to be as a result.

The Committee:

Noted the year to date position of £163K and forecast of £837K as at 31 October 2010. Noted the level of recurrent savings to be achieved in 2011/2012 of £5M. Noted the level of pressures and risks across the divisions. Agreed that a clear report be available at the next meeting in relation to savings and the likely implications.

9 Infection Control Report

Members noted the infection control report. Dr Harvey provided an overview and confirmed that in terms of Staph Aureus Bacteraemias there is a continued struggle to meet the target although there has been progressive improvement in this area. Work is ongoing to reduce the current numbers as NHS Highland cannot become complacent.

In relation to C-Difficile members were reassured that rates were within the trajectory targets although there appears to be a degree of clustering in some wards. The infection control team are reviewing this as there has been some concern around a slight increase.

The Committee:

Noted the contents of the Infection Control Report.

10 Health & Safety Report

Members noted the circulated report with Mrs McGee providing a comprehensive overview of the content.

In relation to evacuation training Mr Munro queried whether partners in the private sector i.e. Smithton Nursing Home had been contacted in relation to their evacuation procedures following the recent outbreak of fire and the successful evacuation of all residents and staff.

6 Mrs McGee confirmed that there is ongoing dialogue with external and internal agencies to ensure that good practice can be shared.

In terms of the recent HSE inspection, Mrs McGee confirmed that the HSE had requested an unaccompanied visit on this occasion, which effectively prevents the opportunity to address any points/issues raised at the time.

The Committee:

Noted the contents of the Health and Safety Report.

11 Staff Governance

Members noted the circulated report with Mrs Walker providing a comprehensive overview of the content.

In relation to the staff sickness rates, it was noted that the figures remain within the 4% target with 3.67% recorded for end October 2010.

In relation to the KSF/PDP target it was noted that this was ongoing although it was anticipated that all staff would eventually transfer to the electronic system, which allows individuals to update and control their own PDP’s and provide the necessary evidence. Latest figures indicate that 49.7% of staff do have a PDP reviews at various stages in place with the anticipation that these will be recorded on eKSF by end March 2011. Members were reassured that there is a huge amount of activity in undertaking these reviews and logging these on the system and that in relation to nursing staff, delegation of the responsibility has been passed to senior staff nurses to assist in this process. In response to a question from Mr Evans it was felt that the HEAT target should be achievable by 31 March.

The Committee:

Noted the staff governance report and the progress being made in relation to KSF.

12 HEAT Targets & Raigmore Hospital Dashboard

Mr Oliver provided an overview of the HEAT standards set up by the Scottish Government for each NHS Board. These standards contain a number of sections which include:

H – health improvement E - efficiency A – access T – treatment

In terms of the localised report, Mr Oliver advised that Mr Lyons had requested a quality and monitoring report for Raigmore Hospital based on the standards set by the Scottish Government. The document is a work in progress, which will continue to be developed and populated on a monthly basis. It was noted that Raigmore Hospital is a pilot site at present, with a view to the reporting system being rolled out to the other CHP’s if proved to be successful.

7 The Committee:

Noted the Monthly Quality and Performance Report and accepted that the document is currently a work in progress.

13 Partnership Working

Members noted Mrs Dobbie’s circulated report. In relation to communication it was noted that it was imperative to publicise positive stories as there is a tendency to accentuate negative stories in the media.

14 AOCB There was no other business.

15 Date of Next Meeting

14 February 2011 at 10am in the Centre for Health Science followed by workshop.

8 Highland NHS Board 1 February 2011 Item 3.5

South East Highland Community Health Partnership Alder House Cradlehall Business Park Inverness IV2 5GH Tel: 01463 – 706948 www.nhshighland.scot.nhs.uk

The meeting of South East Highland CHP Committee due to be held on 23 November 2010 was cancelled due to the number of apologies received, leading to the meeting not being quorate.

The meeting was not rescheduled as the first meeting of the 2011 calendar took place on 20 January 2011. It has not been possible to produce a minute of the meeting prior to issue of Board papers on 21 January 2011.

Accordingly a copy of the relevant agenda is attached, as well as a list of attendees. The CHP Chair will give a verbal update at the Board meeting.

Gillian McCreath, Chair South East Highland CHP Committee

21 January 2011 LIST OF ATTENDEES AT MEETING OF SOUTH EAST HIGHLAND CHP COMMITTEE HELD ON THURSDAY 20 JANUARY 2011

Present Mrs Gillian McCreath, Non-Executive Director, Chair Dr Kate Adamson, CHP Patient and Public Representative Dr Adrian Baker, GP & Clinical Lead, Nairn & Ardersier Locality Ms Marie Close, Local Officer, Scottish Health Council Councillor Jaci Douglas Mr Brian Downie, CHP Patient and Public Representative Ms Frances Gair, Acting Community Care Manager, The Highland Council Mr David Garden, Head of Financial Planning Mr William Gilfillan, Corporate Services, Highland Council Dr Robert Henderson, Consultant in Public Health Medicine Mrs Hilda Hope, CHP Lead Nurse Dr Iain Kennedy, GP & Clinical Lead, Inverness Locality Mrs Ailsa MacInnes, Optometry Representative Ms Emily Macintyre, Community Pharmacy Representative Mrs Margaret MacRae, RCN Staff Side Representative Dr Boyd Peters, GP & Clinical Lead, Badenoch & Strathspey Locality Ms Rhiannon Pitt, CHP Lead AHP Mr Thomas Ross, CHP Lead Pharmacist Dr Ian Scott, CHP Clinical Director Mr Nigel Small, CHP General Manager Mr Hamish Wood, CHP Patient and Public Representative

In Attendance Mrs Sue Blackhurst, CHP Committee Administrator

Apologies Ms Morag Bramwell, Service Planning Analyst Councillor Margaret Davidson Mr Ian Gibson, Non-Executive Director, Vice-Chair Mr Douglas Johnston, CHP Personnel Manager Councillor John Holden Mr Chris Lyons, General Manager, Raigmore Hospital Councillor Graham Marsden Mr Adam Palmer, UNISON Staff side Representative SOUTH EAST HIGHLAND CHP COMMITTEE

20 January 2011 at 2:00 pm

Meeting Room, Town & County Hospital, Cawdor Road, Nairn (Please arrive through the Main Doors at the GP Entrance) AGENDA

1 Welcome and Introductions

2 Apologies

3 Conflicts of Interest G McCreath

4 Minute of Previous Meeting G McCreath 19 August 2010 (attached)

5 Matters Arising

6 Polypharmacy T Ross Presentation by Thomas Ross, CHP Lead Pharmacist

7 Financial Governance 7.1 CHP Finance Report and CRS 2010/11 D Garden Finance Report by David Garden, Head of Financial Planning (attached)

8 Organisational Issues 8.1 Feedback from NHS Highland Board Meeting on G McCreath 7 December 2010 8.2 CHP Committee Meetings for 2011 G McCreath (List of Proposed Dates attached) 8.3 NHS Highland / The Highland Council : Joint Service Delivery N Small/ Summary Report of the Special Joint Meeting of NHS Highland W Gilfillan Board and The Highland Council on 16 December 2010 (attached) Members are advised that the full report of the meeting, by The Highland Council, is available from the CHP Committee Administrator upon request.

9 Partnership Working 9.1 Third Sector N Small 9.2 Public / Patient Involvement H Wood 10 Improving Services and Clinical Issues 10.1 CHP Prescribing and Pharmacy T Ross Report by Thomas Ross, CHP Lead Pharmacist (attached)

11 Performance Management 11.1 General Manager’s Report N Small Report by Nigel Small, CHP General Manager (attached) 11.2 Delayed Discharges N Small / Report by Frances Gair, Acting Area Manager (Community Care) F Gair and Jean Pierre Sieczkarek, Locality General Manager (to follow) 11.3 Balanced Scorecard N Small SE Highland CHP Heat Targets (attached)

12 Staff Governance 12.1 HR / Partnership Issues D Johnston / M MacRae 12.2 Workforce Report D Johnston SE CHP Sickness Absence Information to 31 October 2010 (attached)

13 Clinical Governance 13.1 CHP Infection Control H Hope Report by Hilda Hope, CHP Lead Nurse (attached) 13.2 CHP Clinical Governance & Risk Management Group N Small Minute of the meeting held on 2 December 2010 (attached)

14 AOCB

15 Date of Next Meeting The next meeting will take place on 7 April 2011 at 2:00 pm in the Board Room, Assynt House, Inverness. Highland NHS Board 1 February 2011 Item 3.6 Assynt House Beechwood Park Inverness IV2 3BW HIGHLAND NHS BOARD Tel: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk

MINUTE of MEETING of the NHS Board Audit Committee Tuesday 14 December 2010 – 10.00 am Board Room, Assynt House

Present: Mr Okain McLennan, Chairman Mr Mike Evans, NHS Board non-Executive Mrs Gillian McCreath, NHS Board Non-Executive

Also Present: Mr Ian Gibson, NHS Board Non-Executive Mr Garry Coutts, NHS Board Chair (from 10.30 am)

In Attendance: Mr Iain Addison, Head of Area Accounting Mr Grant Angus, Director, Deloitte LLP Mr Martin Doherty, Manager, Deloitte LLP Mr Malcolm Iredale, Director of Finance Ms Kay Jenks, Senior Auditor, Audit Scotland Mr Peter Lindsay, Audit Manager, Audit Scotland (Videoconference from 10.35 am) Miss Lisa MacDonald, Manager, Deloitte LLP Mr David McConnell, Assistant Director, Audit Services (Health), Audit Scotland (Videoconference from 10.35 am) Mr Brian Mitchell, Board Committee Administrator Mr Marius Rautenbach, Senior Auditor, Audit Scotland (Videoconference from 10.35 am) Mr Bill Reid, Head of eHealth (from 11.00 am)

1 WELCOME AND DECLARATION OF INTERESTS

Members were asked to consider whether they had an interest to declare in relation to any Item on the Agenda for this meeting. There were no declarations of interest made.

2 APOLOGIES

An apology for absence was received on behalf of Mrs Margaret Davidson.

3 MINUTE OF THE MEETING HELD ON 14 SEPTEMBER 2010

The Committee:

 Approved the Minute of the meeting held on 14 September 2010.  Noted the associated Action Plan, which would be updated for the next meeting, as per discussion. 4 MATTERS ARISING

4.1 Review of Bute Healthy Living Initiative (BHLI)

On the point raised by Mr M Evans it was confirmed that CHP General Managers had been requested to consider relevant issues at CHP Management Committees and that this would be included within the relevant Internal Audit follow-up report.

The Committee Noted the position.

4.2 Committee Assurance from Annual Reports

On the point raised by Mr I Gibson it was confirmed that further guidance on this issue was to be issued.

The Committee so Noted.

4.3 GP Practice Payments

Mr I Gibson raised the issue of GP Practice Payments in Argyll and Bute CHP and was advised that the issues concerned would be the subject of a future Internal Audit report.

The Committee so Noted.

5 INTERNAL AUDIT

5.1 Internal Audit Progress Report

There had been circulated a copy of the progress report, which summarised Internal Audit work undertaken up to 14 December 2010 including five reports. There was one Priority One recommendation identified, in relation to the review of Estates. The report indicated that 61% of the Internal Audit Plan for 2010/2011 had been completed. The report also indicated those Reviews in relation to which fieldwork was in progress or now complete.

The Committee then considered the report as follows:

Estates (2009/2010)

This Review was considered under Item 5.2 on the Agenda.

Patient Funds

Internal Audit concluded that the overall assessment is that the current design and operation of controls is limited. There were a number of issues highlighted with regard to overall patient funds systems and account management, activity at ward level including the holding of excessive funds, recording issues, and use of disclaimer forms. There were issues in relation to the Care and Custody of Patients’ Property Standing Financial Procedure (SFP), as well as awareness of the Procedure document itself. There were also issues relating to security of patient valuables, use of receipt books, and administration of patient funds.

2 During discussion, Mr I Addison advised that a recent move to a system of individual bank accounts had proved not as effective as had been hoped and consequently there would be a move to revert back to the previous system. He further advised that a letter would be issued to General Managers expressing concern relating to the non-completion of relevant records and offering training on relevant procedures where required. Mr O McLennan highlighted the importance of this area of activity and the need for control weaknesses to be addressed quickly, this point being echoed by Mr G Coutts. Mr M Iredale highlighted the role local finance teams could play in assisting in this area. After further discussion, Mr Coutts suggested that this area of activity be considered further by the Improvement Committee.

The Committee:

 Noted the position.  Agreed activity in relation to Patient Funds be considered by the Improvement Committee.

Review of Cowal Community Hospital

Internal Audit concluded that the controls over the key aspects of the management and administration process at Cowal Community Hospital offer scope for improvement, particularly in relation to the informal controls over the management and administration of accommodation. Other issues highlighted related to asset records, controlled drug reconciliation, pool car mileage records, purchase orders, income receipts, and patient fund administration.

The Committee Noted the position.

Review of Victoria Hospital

Internal Audit concluded that the controls over the key aspects of the management and administration process at Victoria Hospital offer scope for improvement, particularly in relation to the security arrangements in place and the management of patient funds. Other issues highlighted related to matters of security, the recording and management of controlled drugs, and asset reconciliation.

The Committee Noted the position.

Review of Incident Management

Internal Audit concluded that the current design and operation of controls over the control environment across Incident Management is limited. A number of areas for improvement were identified particularly around the analysis of incident data, and the implementation and follow up of corrective actions. Other issues highlighted related to incident category analysis; application of review, investigation and approval dates; sharing of best practice; DATIX system issues; responsibility for reviewing incidents retrospectively; cross-analysis of reported incidents from similar locations or departments; multiple recording of incidents; and formal closure arrangements for incidents following the investigation phase.

During discussion, Mr M Iredale advised that Executive walkrounds utilised DATIX reports and acknowledged the need for more formal arrangements for the sharing of data, especially where commonalities exist. On the issue of assurance in this regard, Dr R Gibbins stated that there was a need for the Clinical Governance Committee to consider a formal method of 3 shared learning. Miss L MacDonald advised that arrangements were in place to actively consider this point, that informal arrangements were in operation, and that relevant matters were discussed with the Clinical Governance Team. She stated that the main issues related to recording and assessment processes.

The Committee:

 Noted the position.  Agreed the Clinical Governance Committee consider issues relating to recording and assessment processes for the sharing of data, especially in relation to issues of commonality.

General Discussion

Mr M Evans referred to the issue of management responses to issues highlighted within general Progress Report reviews and was advised that detailed action plans were in place for all reviews. Mr G Angus suggested that future Progress Reports could be amended to include a summary of the relevant management response and this was welcomed by Committee members.

The Committee Agreed that future Progress Reports include summary management responses.

5.2 Review of Estates Services

Mr M Doherty spoke to the circulated report which concluded that the controls in place in respect of the audit areas offer scope for improvement, specifically there is a lack of a strategic direction for the development of the estate and there is no objective basis against which budgetary performance can be assessed. There was one Priority One recommendation relating to the need for the Property Strategy to be linked to organisational Clinical Strategies at an operational level.

During discussion, there was concern expressed relating to the management response to the issue raised in connection with the Estates reporting structure within Argyll and Bute CHP, in that this was considered to be lacking in detail and an agreed timeframe. Mr B Brackenridge emphasised the need for strong central oversight in this area, especially with a view to ensuring appropriate technical expertise. Mr I Addison advised that a new financial IT system for ordering and financial procedures would aid consistency in these areas.

The Committee:

 Noted the content of the report.  Agreed the Argyll and Bute CHP General Manager should further consider and assess the findings, recommendations and management responses contained in the report.

6 EXTERNAL AUDIT

6.1 External Audit Briefing Note – September 2010

There had been circulated Briefing Note advising as to External Audit activity in NHS Highland to December 2010. It was stated that the report, Service Management 4 Arrangements: ICT Review had been issued, completing the work on the 2009/2010 audit of NHS Highland, and this was circulated under Item 6.2 on the Agenda. The audit team had concluded their planning work for the 2010/2011 audit and the draft Annual Audit Plan for 2010/2011, excluding the audit fee for the year, had been circulated under Item 6.3 on the Agenda. There had been a review of the work carried out on the areas where external audit had planned to place reliance on the work of internal audit, a letter in relation to which had been circulated under Item 6.4 on the Agenda.

The Committee Noted the position.

6.2 NHS Highland ICT Service Delivery 2009/2010

Mr M Rautenbach spoke to the circulated report outlining the key findings on the NHS Board’s management arrangements for supporting information and communications technology (ICT) service delivery. The report concluded that NHS Highland continues to make progress to provide ‘the right information in the right place at the right time using the right ways, means and safeguards’. Existing work has yielded positive results such as increasing the availability of information to front line users. In addition, the ongoing consolidation of ICT systems will progressively make information readily available to a wider audience. At the same time this increases staff dependence on ICT and increases the impact of any disruption to ICT service delivery. Maintaining dialogue with front line users of the ICT service will become an increasing challenge, as meeting diverging demands from a variety of specialities will continue to challenge the eHealth department’s mission to provide organisation wide systems. The report included relevant management responses.

During discussion, there was concern expressed that the report was high level in nature and as such did not provide clear assurances in relation to the risk areas identified. It was stated that the level of detail referred to would be provided through Internal Audit and that the circulated report gave more of an overview of the relevant management and structure to help meet patient requirements. In response to the point raised by Mr O McLennan relating to the provision of advice on best practice that could be applied within NHS Highland, Mr M Iredale stated that Audit Scotland would be in a unique position to provide information in relation to benchmarking, best value etc given their involvement with a number of NHS Boards in Scotland. Mr D McConnell confirmed this point.

The Committee Noted the content of the report.

Mr B Reid left the meeting at 11.20 am

6.3 Draft External Audit Annual Audit Plan 2010/2011

Mr D McConnell spoke to the circulated draft Annual Audit Plan for financial year 2010/2011, which provided background on the overall approach and responsibilities of the External Auditor, as well as addressing particular issues within NHS Highland, including efficiency and budgets, Best Value, financial management and affordability, effective partnership working, performance management, service redesign and sustainability, scrutiny and governance, capacity to deliver, patient safety and clinical governance, and performance audit. The Plan also indicated that the relevant Audit Fee had yet to be agreed.

During discussion, Mr O McLennan referred to elements of the draft Plan relating to monitoring of delivery within NHS Highland and was advised that the Audit Scotland role was to provide an oversight of the relevant monitoring arrangements. He added that the draft Plan included a range of required statutory elements to enable appropriate comment on the NHS Highland Annual Accounts, but also consider a range of wider issues, with these being 5 subject to further discussion and agreement. Mr B Brackenridge emphasised the need to ensure best value from External Audit services, through discussion. Mr G Coutts welcomed the general overview of risks provided by External Audit, however expressed a degree of concern that there was a lack of detail provided on specific elements, and that not all relevant risks are identified during this process. Mr I Gibson echoed this point adding that he would welcome reference to particular issues affecting NHS Highland as well as in relation to such national issues as cash limited services. Dr R Gibbins highlighted future CNORIS payments and cash limited dental services as examples of issues that NHS Boards required to consider. On all these points, Mr D McConnell emphasised that the circulated document was a draft Plan and was to be subject to further discussion prior to agreement and finalisation.

After discussion, the Committee:

 Noted the draft Annual Audit Plan for financial year 2010/2011.  Noted the relevant audit fee had yet to be agreed.  Noted agreement on the Annual Audit Plan 2010/2011 was required by end January 2011.

6.4 Review of Internal Audit 2010/2011

Mr P Lindsay spoke to the circulated letter relating to the annual assessment of the adequacy of the internal audit function for NHS Highland. The letter indicated that Audit Scotland had concluded that the internal audit service operates in accordance with Government Internal Audit Standards and has sound documentation standards and reporting procedures in place. For the financial statements audit it was planned that formal reliance would be placed on internal audit’s work in relation to payroll, review of budgetary management, capital planning and asset management, and ordering and stock management practices. Reliance in these areas will allow resources to be directed to the financial systems and governance areas assessed as being of higher risk. Other areas of internal audit work planned for review and consideration included processes for management of savings plans, GP Practice payments, property transaction monitoring, and eHealth reviews. Audit Scotland would continue to monitor and review completed internal audit assignments to ensure that work on which reliance is placed has been delivered, and which would influence the relevant plan and agreed audit fee.

The Committee Noted the position.

7 CORPORATE GOVERNANCE AND RISK MANAGEMENT

7.1 Corporate Governance and Audit Group

Miss L MacDonald advised that recent discussion had included issues relating to Government Standards for the external review of Internal Audit services, especially where delivered in-house; and elements relating to Best Value such as areas of review focus and timescales for reviews.

The Committee so Noted.

6 8 FINANCIAL GOVERNANCE

8.1 Annual Accounts Process 2010/2011

Mr I Addison advised that there was continued discussion with Audit Scotland in relation to the 2010/2011 Annual Accounts process. Guidance was awaited in relation to the layout of accounts, which would again be subject to IFRS compliance.

The Committee Noted the position.

Mr M Rautenbach left the meeting at 11.55 am

9 COUNTER FRAUD

9.1 Update by Counter Fraud Champion

Mr O McLennan advised that he had recently attended a Counter Fraud Champions/ Fraud Liaison Officer meeting in Stirling, at which a range of issues had been discussed including best practice in deterring low level fraud, liaison with Procurators Fiscal in relation to bringing relevant cases, provision of guidance for Internal Auditors where fraud is encountered as part of their reviews, and the sharing of best practice across NHS Boards. It was stated that fraud would be included within a Development Session for the NHS Board in 2011 in relation to the application of Standing Financial Procedures, including consideration of the DVD resource received from Counter Fraud Services (CFS). It was further stated that the relevant Memorandum of Understanding between CFS and the Human Resources service was to be re-examined and issued early in 2011.

The Committee Noted the position.

10 AUDIT SCOTLAND

10.1 The Role of Boards

The Audit Scotland Report examined the role and work of boards in 106 public sector bodies as at 31 March 2009. The audit examined how these bodies are accountable to the Scottish Government; how people become members of boards and are supported to perform this role; and how the boards of public bodies operate. The report outlined key messages and a number of recommendations aimed at helping boards improve their practice in this area. It was advised that this report was being utilised as part of the current review of governance arrangements within NHS Highland.

10.2 Physical Recreation Services in Local Government

The Audit Scotland Report examined how Councils organise physical recreation services, how much is spent and impact of the services. The report states that regular exercise helps improve both physical and mental health and Councils have a major role in organising and providing physical recreation services. How that role is fulfilled varies considerably, and includes direct service provision and an increasingly common use of arms-length and external organisations. The report outlined key messages and a number of recommendations aimed at helping Councils improve.

During discussion, Mr M Iredale advised that this report, whilst primarily aimed at Local Government, was being actively considered by the NHS Highland Public Health service. Mr 7 M Iredale referred to the Referral to Exercise Scheme, advised that there was a mixed approach being adopted across Highland, and stated that this matter should also be considered by the Director of Public Health.

10.3 Getting it Right for Children in Residential Care

The Audit Scotland report examined how effectively Councils used their resources on residential placements for their looked after children and identified areas for improvement. Mr M Iredale advised that whilst the report was primarily aimed at Local Government it included a good practice checklist that may be useful in considering areas of activity where NHS Highland had an interest. Mr G Coutts referred to the position in Highland whereby a relatively high number of children were referred ‘out of area’ for placements and stated this affected the ability of NHS Highland to address, provide and monitor appropriateness etc of relevant health care elements.

10.4 Priorities and Risks Framework – A National Planning Tool for 2010/2011 NHS Scotland Audits

The Audit Scotland document included the 2010 edition of the Priorities and Risks Framework.

Mr G Coutts left the meeting at 12.10 pm

10.5 Improving Energy Efficiency – A Follow up Report

The Audit Scotland report re-evaluated the performance of the public sector in improving its energy efficiency. It followed up the key recommendations from the 2008 report, and looked at how prepared public bodies are for the CRC Energy Efficiency Scheme. The report looked at the performance of councils, the NHS and central government bodies. The report outlined key messages and recommendations aimed at helping public bodies improve their performance in this area. Mr M Iredale advised that the report would be considered by the Carbon Reduction Management Board in February 2011 and relevant actions taken forward.

The Committee otherwise Noted that copies of the relevant documents had been received and were available from the Corporate Services Committee Team.

11 ANY OTHER COMPETENT BUSINESS

11.1 Joint Approach to Service Delivery for Adult Community Care and Children’s Services in Highland

Mr M Iredale advised the Committee that there was a to be held a joint meeting with Highland Council to discuss a new partnership model for improving joint service delivery for Adult Community Care and Children’s Services and this would have a series of financial and audit repercussions. There had been circulated Briefing Note outlining National Audit Office recommendations relating to gaining relevant assurance during merger processes and members were encouraged to suggest other applicable resources in this regard. Mr G Angus advised that Deloitte LLP could provide project management information relating to private sector mergers that may be of assistance. The view was expressed that learning points that emerged from the dissolution of NHS Argyll and Clyde may be of assistance and all agreed that appropriate project management would be key in enabling the right issues to be identified and the right people assigned to address these.

8 The Committee Noted the position.

11.2 Contract for Internal Audit Services

Mr M Iredale advised there had been initial informal discussion with Highland Council relating to shared internal audit services and that a number of key risks had been identified. One area being examined related to the potential to access Highland Council internal audit capacity, with activity led by an appropriate professional audit organisation. The view was expressed that there were a number of commonalities between the audit functions for both organisations however there was a need to ensure that external knowledge and expertise was not lost from any agreed process.

The Committee:

 Noted the position.  Agreed that the quality of internal audit service provision required to be maintained and associated risks minimised.

12 DATE OF NEXT MEETING

The next scheduled meeting will be held on 15 March 2011 at 10.00 am, in the Board Room, Assynt House, Inverness.

The meeting closed at 12.35 pm.

9 NHS Highland Board 1 February 2011 Item 3.7

STAFF GOVERNANCE ASSURANCE REPORT

Report by Anne Gent, Director of Human Resources

The Board is asked to:

 Note that the Staff Governance Committee met on 23 November with attendance as listed below.  Note the minute of the meeting and the associated Assurance Report and agreed actions resulting from the consideration of the specific items detailed below.

Present: Dr David Alston, Non-Executive Director (Chair) Ms Pam Courcha, Non-Executive Director Mr Colin Punler, Non-Executive Director (by videoconference) Mr Ray Stewart, Employee Director Mr Ian Gibson, Non-Executive Director

In Attendance: Ms Elspeth Caithness, Staff Side Representative (RCN) Ms Sheena MacLeod, General Manager, North Highland CHP (by videoconference for item 15) Mrs Pamela Cremin, Workforce Planning & Development Manager Mrs Anne Gent, Director of Human Resources Dr Roger Gibbins, Chief Executive Ms Gill Keel, Head of Public Engagement Mr Derek Leslie, General Manager, Argyll and Bute CHP (by videoconference, for item15) Ms Judith McKelvie, Learning and Development Manager Ms Gill McVicar, General Manager, Mid Highland CHP (for item 15) Ms Lindsey Mitchell, Medical Workforce Redesign Manager Mr Ian Underwood, eHealth (for item 15) Mr Philip Walker, Head of Personnel Ms Alison Binns, Board Committee Administrator

1 Items for Discussion

The items discussed at the meeting are noted below:

 Reports from other Committees  Implementation of NHS Highland Strategic Framework and Board Vision o Workforce Programme Plan o Communications and Engagement Plan o Role of Highland Partnership Forum  NHS Highland Workforce Action Plan  NHS Board Workforce Plans and National Scrutiny Panel – Template  Hospital Locums  Rural Practitioner Support for Rural General Hospitals  Staff Governance Action Plan  Workforce Information Report (including Sickness Absence)  Implementation of Knowledge and Skills Framework  Staff Survey For Information

The items for information presented to the meeting are noted below:

 Counter Fraud Services Training DVD

2 Contribution to Corporate Objectives

This Assurance Report demonstrates how NHS Highland Workforce issues are being lead and managed in achievement of the Board’s Corporate Objectives.

3 Governance Implications

This Assurance Report has a direct impact on staff governance and workforce planning and demonstrates performance on the implementation of the Workforce Strategy and the HEAT Targets.

4 Impact Assessment

This report does not require impact assessment.

Anne Gent Director of Human Resources

21 January 2010

2 STAFF GOVERNANCE COMMITTEE – ASSURANCE REPORT Staff Governance Committee Meeting – 23 November 2010

ISSUE: REPORTS FROM SUB COMMITTEES

Issues/Risks Assurance Actions The Committee Role The Staff Governance Committee The Committee received Reports from  No specific actions and Remit includes requires to be advised of the the Remuneration Sub Committee on receiving Reports from issues discussed at the 29th June, the HPF on 13th August and Sub Groups. Remuneration Sub Committee, 17th September and the Health and the Highland Partnership Forum Safety Committee on 19th August. The (HPF) and the Health and Safety minutes were noted and no issues of Committee and ensure that any concern were raised. concerns are brought to its attention.

ISSUE: IMPLEMENTATION OF NHS HIGHLAND STRATEGIC FRAMEWORK AND BOARD VISION – WORKFORCE PROGRAMME PLAN

Issues / Risks Assurance Actions The Committee Role The Staff Governance Committee The Committee received a draft version  The Workforce Work Programme will be and Remit require that requires assurance that there is a of the Workforce Work Programme to developed further to include timescales there is a Workforce Workforce Work Programme to support the implementation of the and brought back to the next Staff Strategy/Work support the implementation of the Strategic Framework and Board Vision. Governance Committee Programme Strategic Framework and Board Vision. Action: Anne Gent, Director of Human Resources

ISSUE: IMPLEMENTATION OF NHS HIGHLAND STRATEGIC FRAMEWORK AND BOARD VISION – COMMUNICATIONS AND ENGAGEMENT PLAN

Issues / Risks Assurance Actions The Staff Governance The Staff Governance Committee The Committee were updated with  The Committee requested a Report on Standards requires that requires assurance that staff are regard to the Communication and the number and types of events held to staff are ‘Well Informed’ informed and engaged in the Engagement Plan and the work that promote Communications and and ‘Involved in implementation of the Strategic had been implemented to date. Engagement. decisions that affect Framework and Board Vision. them’. Action: Gill Keel, Head of Public Engagement

3 ISSUE: IMPLEMENTATION OF NHS HIGHLAND STRATEGIC FRAMEWORK AND BOARD VISION – ROLE OF HIGHLAND PARTNERSHIP FORUM

Issues / Risks Assurance Actions The Committee needs to The role of the HPF is being The Committee acknowledged the  The Committee requested that the ensure that the Highland reviewed, in relation to clarifying workshop discussion held to date and outcome of further discussions are fed Partnership Forum the role in relation to the the focus of HPF on the delivery of the back to the next meeting. (HPF) is fit for purpose, implementation of Board Strategic Workforce Work Programme. as the key operational Framework and Board Vision. Action: Ray Stewart, Employee Director group which implements Staff Governance and Workforce Planning.

ISSUE: NHS HIGHLAND WORKFORCE ACTION PLAN

Issues / Risks Assurance Actions The Committee Role The Committee requires The Workforce Plan Rolling Action Plan  The Committee requested that a further and Remit requires it to assurance that the Workforce Plan was provided for the Committee and update be brought to the next meeting. oversee Workforce for 2010/11 is being implemented. the positive progress noted. Planning Action: Pam Cremin, Workforce Planning and Development Manager

ISSUE: NHS BOARD WORKFORCE PLANS NATIONAL SCRUTINY GROUP - TEMPLATE

Issues / Risks Assurance Actions The Committee Role The National Scrutiny Group had The Committee were advised that NHS  A further update of the work of the and Remit requires it to requested that Board Area Highland had been actively involved in National Scrutiny Group was requested oversee Workforce Partnership Forums complete a the development of the Template and for the next meeting. Planning Template to cover staffside that NHS Highland’s completed engagement in Workforce Template had been positively received Action: Ray Stewart, Employee Director Planning and risk assessments on by the National Scrutiny Group. the quality of services where workforce reductions are planned.

4 ISSUE: HOSPITAL LOCUMS

Issues / Risks Assurance Actions The Committee Role The Committee requires The Committee received assurance  A further update on progress was and Remit requires to assurance that Workforce that the Action Plan to address the key requested for the next meeting. receive audit reports on Planning issues are being issues for NHS Highland, emerging workforce issues. progressed on the back of the from the Audit Report, were being Action: Lindsay Mitchell, Medical Audit Scotland Report on ‘Using progressed. Workforce Redesign Manager Locum Doctors in Hospitals’

ISSUE: RURAL PRACTITIONER SUPPORT FOR RURAL GENERAL HOSPITALS

Issues / Risks Assurance Actions The Committee Role On the back of work progressed The Committee received a Report  No specific actions. and Remit requires it to by the North of Scotland Planning regarding the work that had been oversee Workforce Group, in relation to the future progressed in relation to the 3 NHS Planning. sustainability of the Rural General Rural General Hospitals. The Hospitals, a model had been Committee supported the proposal to developed, which should ensure link this work with the NHS Highland services are sustainable into the and UHT Knowledge, Transfer and future, without having to rely on Partnership Project. Doctors in Training for service provision.

ISSUE: STAFF GOVERNANCE ACTION PLAN

Issues/Risks Assurance Actions The Committee Role A full report on progress against The Committee were advised that good  The Workforce Work Programme will be and Remit requires it to the Staff Governance Action Plan progress was being made in aligned to the Staff Governance Action oversee the will be brought to the Staff implementing the Action Plan. Plan. development and Governance Committee in May. implementation of the Staff Governance Action The Staff Governance Action Plan Plan. needs to be aligned with the Workforce Work Programme.

5 ISSUE: WORKFORCE INFORMATION REPORT (INCLUDING SICKNESS ABSENCE)

Issues / Risks Assurance Actions The Committee Role The Committee discussed The Committee were provided with  No specific actions. and Remit requires it to sickness absence and workforce assurance from the Workforce monitor Workforce establishment data as well as Information Report. Information and the employee relations data. Standard on sickness Improvements to the Report are made absence. on a regular basis.

ISSUE: IMPLEMENTATION OF KNOWLEDGE AND SKILLS FRAMEWORK

Issues / Risks Assurance Actions The Committee Role The Staff Governance The Committee received a Report on the  A more detailed Report from Raigmore and Remit requires it to Committee requires assurance overall position in relation to eKSF Hospital to be produced. monitor progress that KSF is fully implemented to HEAT Target, as well as detailed reports against the achievement realise the benefits of Agenda for from each CHP and Raigmore Hospital. Action: Chris Lyons, General Manager, of the KSF HEAT Change in line with the eKSF Raigmore Hospital Target. HEAT Target for March 2011. Assurance was provided that the CHPs had detailed plans to bring them back to  Further discussions would take place the trajectory and meet the Target. A regarding IT issues. more detailed report from Raigmore Hospital was requested. Action: Judith McKelvie, Head of Learning and Development and Bill Reid, Head of eHealth

 A further Report would be proved for the next meeting.

Action: Judith McKelvie, Head of Learning and Development

6 ISSUE: STAFF SURVEY

Issues / Risks Assurance Actions The Committee Role The 2010 Staff Survey had The Committee noted the position and  The Committee requested a further and Remit requires it to closed on 22 November. NHS the online nature of the Staff Survey. update at eh next meeting. oversee the Highland have a return rate of implementation of the 22% against a national average The Committee noted the results of the Action: Ray Stewart, Employee Director Staff Governance of 26%. Survey were expected in January. Standard.

7 Assynt House Beechwood Park Inverness, IV2 3BW Telephone: 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 STAFF GOVERNANCE COMMITTEE 23 November 2010 – 10:00 Board Room, Assynt House, Inverness

Present Dr David Alston, Non-Executive Director (Chair) Ms Pam Courcha, Non-Executive Director Mr Colin Punler, Non-Executive Director (by videoconference) Mr Ray Stewart, Employee Director Mr Ian Gibson, Non-Executive Director

In Attendance Ms Elspeth Caithness, Staff Side Representative (RCN) Ms Sheena MacLeod, General Manager, North Highland CHP (by videoconference, for item 15) Mrs Pamela Cremin, Workforce Planning & Development Manager Mrs Anne Gent, Director of Human Resources Dr Roger Gibbins, Chief Executive Ms Gill Keel, Head of Public Engagement Mr Derek Leslie, General Manager, Argyll & Bute CHP (by videoconference, for item 15) Ms Judith McKelvie, Head of Learning and Development Ms Gill McVicar, General Manager, Mid Highland CHP (for item 15) Ms Lindsey Mitchell, Medical Workforce Redesign Manager Mr Ian Underwood, eHealth (for item 15) Mr Philip Walker, Head of Personnel Ms Alison Binns, Board Committee Administrator

1 WELCOME AND APOLOGIES

Apologies were noted from Mr Garry Coutts, Mr Adam Palmer, Mr Nigel Small and Mr Chris Lyons.

2 CONFLICTS OF INTERESTS

At its meeting on 5 October 2010 the Board agreed, following a review of the Audit Scotland Report “The Role of Boards”, that “Conflicts of Interests” should be a standing item on all Governance Committee agendas. Members were required to formally declare any interests in the business to be transacted at that meeting.

There were no conflicts of interests declared.

3 MINUTE OF MEETING HELD ON 24 AUGUST 2010

The minute of the meeting held on 24 August 2010 was approved.

8 4 MATTERS ARISING

The meeting of the Highland Partnership Forum on 21 May 2010 had received a presentation in relation to extending Credit Union services in the Highlands to NHS Highland staff and families. Mr Stewart advised that this had been progressed and that the availability of these services had now been communicated to staff. Action in relation to this item was therefore complete.

In respect of the ongoing actions in relation to the Mid Staffordshire NHS Foundation Trust Inquiry, Mrs Gent advised that a report would be presented to Corporate Team later in the week.

The Committee Noted the position.

5 REPORTS FROM OTHER COMMITTEES

5.1 Minute of Meeting of the Remuneration Sub Committee held on 29 June 2010

The minute of the meeting of the Remuneration Sub Committee held on 29 June 2010 was noted.

5.2 Minute of Meeting of the NHS Highland Partnership Forum held on 13 August 2010

The minute of the meeting of the NHS Highland Partnership Forum held on 13 August 2010 was noted

5.3 Minute of Meeting of the NHS Highland Partnership Forum held on 17 September 2010

The minute of the meeting of the NHS Highland Partnership Forum held on 17 September 2010 was noted.

5.4 Draft Minute of Meeting of the Health and Safety Committee held on 19 August 2010

The minute of the meeting of the Health and Safety Committee held on 19 August 2010 was noted; this minute had been submitted to the NHS Highland Board on Tuesday 05 October 2010.

The Committee Noted the circulated minutes.

6 IMPLEMENTATION OF NHS HIGHLAND STRATEGIC FRAMEWORK AND BOARD VISION

6.1 Workforce Programme Plan

The Board Event, held at The Highland Council Headquarters on Tuesday 07 September 2010, and the subsequent Board Development Session on Tuesday 02 November 2010, had launched and further developed the revised Strategic Framework and NHS Highland Vision. The NHS Highland Board Vision aimed to:

 provide quality care at all times;

9  support people and communities to maximise their own health;  develop precision driven services so that when people need our care, they experience timely, focussed, effective services that minimise the duration and frequency of contact; and  ensure that every health pound spent delivers maximum health gain.

Mrs Gent advised that as part of the discussion, particularly that at the Development Session, the NHS Board had specifically considered the impact of the revised Strategic Framework and Vision on the workforce. The Workforce Work Programme, tabled at the meeting, had been produced as a result of these discussions. Mrs Gent advised, however, that the Work Programme was still very much work in progress and that whilst it had been considered by the Highland Partnership Forum at their meeting on Friday 12 November 2010, this discussion had not yet been reflected in the document or signed off by the Highland Partnership Forum, nor had it been consulted on more widely. The Workforce Work Programme tried to focus on the key workforce issues emerging from the NHS Highland Strategic Framework and Vision. It was noted that further work was required to consider the size and shape of the workforce going forward and to ensure consistency of application of policies already in place.

The Committee discussed the programme in some detail in particular possible workforce changes going forward and the importance of partnership working. Dr Gibbins suggested that clearer information might be provided in respect of governance as well as identifying key deliverables at key points in time. The Staff Governance Committee agreed that the Workforce Programme Plan would be included on the agenda for the February 2011 meeting.

6.2 Communication and Engagement Plan

Ms Gill Keel, Head of Public Engagement, spoke to the circulated paper and detailed the initial awareness raising campaign among staff for NHS Highland’s Vision and Strategic Framework. The aim of the campaign was to ensure that staff and other stakeholders understood the case for change, could influence the change process if necessary and contribute to shaping outcomes. The broad objective of the awareness campaign was to communicate with staff, patients, community / local political leaders, partners and the public to:

 raise awareness of the reasons behind the need for change  gain the active participation of staff, patients and others to facilitate realistic and achievable change based on experience  celebrate success and innovation and share positive experiences of change  challenge existing behaviours and attitudes.

Initially an event, aimed at NHS Highland clinical leaders and managers, had been planned for the following Monday based on the materials from the Board’s Annual Event. This event would include a session to look at internal methods of promoting staff awareness and dialogue. Further events would be arranged for other members of staff.

The Committee discussed the importance of the Board Vision, the key message from this and ensuring the consistency of that message. Mrs Gent referred to three key messages contained within the Board’s Vision; that demand for health services was increasing, that resources were constrained but that quality needed to be maintained and stated that the planned events would begin the process of enabling staff and stakeholders to internalise and understand these key messages. It was reported that every effort would be made to ensure that the right messages were cascaded through the organisation. A record would be kept of all sessions and feedback would be requested. Informal and anecdotal feedback would also be available through the Highland Partnership Forum and local partnership forums. The Staff Governance Committee agreed that this item be reviewed at the next meeting.

10 6.3 Role of the Highland Partnership Forum

Mr Stewart reported that at its last meeting, the NHS Highland Partnership Forum had held a short workshop. The Partnership Forum had been asked by Dr Gibbins to consider whether the existing mechanisms were sufficient to enable it to fulfil a delivery and governance role within the organisation moving forward. The changing role of the Partnership Forum in relation to the NHS Highland Strategic Framework and Board Vision, the consideration of the challenges facing the existing structure, the identification of actions, the measurement of the impact associated with change and consideration of the changes in the workforce and the effects of this for other areas all required further thought. Further suggestions had been made around a more delivery based approach rather than an advisory one, with Dr Gibbins suggesting the Partnership Forum could have oversight of the delivery of the Board Vision, translating this into local actions. Mr Stewart reported that colleagues on the Partnership Forum were generally keen to take on this role but were concerned to establish what actually needed to be progressed. It was likely that the role and remit of the Forum would change, however Mr Stewart did not feel it would be substantially different; the Staff Governance Committee would need to be sure it was comfortable with any new direction.

Mrs Gent advised that the Partnership Forum now had the opportunity to refocus its work and suggested that one area would be overseeing the delivery of the Workforce Work Programme. Mrs Gent agreed that it would be helpful if the Staff Governance Committee could endorse the new approach for the Partnership Forum and sign it off; as the Partnership Forum is a delivery arm of the Staff Governance Committee. The Committee were generally supportive of and encouraged by the developments within the Partnership Forum. It was noted that further discussion was required by the Partnership Forum both locally and nationally and with other Boards. It was agreed that this item be re-visited at the next meeting in February.

The Committee  Noted the development of the Workforce Work Programme as a result of discussions by the NHS Board and the Highland Partnership Forum.  Noted that further work was required to the Workforce Work Programme.  Agreed that clearer information be provided within the Workforce Work Programme in respect of governance and timescales for key deliverables.  Agreed that the Workforce Work Programme be included on the agenda for the next meeting.  Agreed that feedback from the events promoting awareness of the Board’s Vision and Strategic Framework be considered at the next meeting.  Agreed that the results of further discussion on the future role of the Highland Partnership Forum be considered at the next meeting.

7 NHS HIGHLAND WORKFORCE ACTION PLAN

Ms Pam Cremin, Workforce Planning & Development Manager spoke to the Workforce Plan Rolling Action Plan, November 2010 Update, which provided the Staff Governance Committee with an update on progress against actions on the NHS Highland Workforce Action Plan. Ms Cremin advised that many actions had been completed with those outstanding on track to be completed as detailed. The NHS Highland Workforce Plan had been developed in line with the Board’s Local Delivery Plan 2010 / 2011, Strategic Framework 2010 / 2011 and NHS Highland Corporate Objectives 2010 / 2011 and was well placed to support this activity going forward into 2011 / 2012 and beyond. Work had continued to develop the framework for scenario planning.

In respect of the current establishment level, Ms Cremin reported that as at 30 September 2010 this had been reduced by 91.25 whole time equivalent (wte) posts, representing good 11 progress toward the removal of the planned 108 wte posts. Processes were now in place that ensured a better understanding of the establishment level and consequently what workforce savings were required and how these could be achieved. It was noted that the range of options available to achieve these savings was unlikely to be the same in future years as this past year. During discussion, it was reported that the posts removed had not been concentrated in any one unit, job family or location but were generally the workforce changes that had been anticipated. Mr Stewart advised that at the start of the year, there had been reasonable confidence that the removal of the target 108 wte posts would be achieved however work was ongoing to ensure that this would be the case, especially once information from other areas, including waiting list initiatives and overtime had been considered. The Committee agreed that a further update be provided at the next meeting in February 2011.

The Committee  Noted the update.  Agreed that a further update be provided to the meeting in February 2011.

8 NHS BOARD WORKFORCE PLANS NATIONAL SCRUTINY PANEL - TEMPLATE

In June 2010, the Cabinet Secretary for Health & Wellbeing announced the development of a National Scrutiny Group comprising trade unions, NHS employers and the Scottish Government. The remit of the group was to scrutinise NHS Board Workforce Planning to ensure that these had been developed in partnership and did not impact adversely on the quality of patient care. A key aspect in the planning of future services would be taking an integrated planning approach which had quality and patient safety at its core, and working within an infrastructure that also assessed and mitigated any risks to service delivery caused by lack of capacity and capability in the workforce. NHS Board Partnership Forums were identified as key to providing this assurance at a local level and a self assessment audit tool was developed, piloted by Dumfries & Galloway and Lothian (NHS Highland had also been involved in a more limited way), which had been sent to all Partnership Forums for completion.

Mr Stewart advised the Staff Governance Committee that the NHS Highland response had recently been presented to the Cabinet Secretary and was well received. Members of the National Scrutiny Group had been asked whether they would wish to develop any themes within the audit further; it was generally felt that risk assessments should receive additional attention. Mr Stewart commented that the Cabinet Secretary seemed assured that the work of the group should continue, however no date had yet been set for the next meeting. During discussion, it was considered that a more consistent approach to risk assessment going forward was critical and suggested that this could be included locally within the quality framework / dashboard. It was also noted that the National Scrutiny Group would be able to focus on the work of Partnership Forums and how they could develop in the future.

The Committee Noted the position.

9 HOSPITAL LOCUMS

The Audit Scotland report “Using locum doctors in hospitals”, published in June 2010, analysed how efficiently and safely Boards used locum doctors and what the associated costs were. Following discussion of this report locally, it had been agreed that further analysis of the information should be undertaken to gain a clearer understanding of where locums were being used, at what grade, for what reason and the associated costs. Data relating to requests for locums within NHS Highland was collated centrally through Medical

12 Staffing (although this currently excluded Argyll & Bute, work was in hand to remedy this situation).

Ms Mitchell confirmed that a number of further actions had been identified including further cleansing and detailed analysis of the data, adding the data for Argyll & Bute and adding and matching financial information. An action plan was being developed which would be discussed by the Medical Workforce Planning Group which was due to meet in December. It was hoped that once agreement had been reached on the information required, this would be available on a monthly basis and reported on a unit basis. It was agreed that an update on progress would be provided to the next meeting of the Staff Governance Committee. Mr Stewart requested that the total cost of locums was included on the next report.

The Committee  Noted the position.  Agreed that an update on progress be provided to the next meeting.

10 RURAL PRACTITIONER SUPPORT FOR RURAL GENERAL HOSPITALS

Ms Mitchell, Medical Workforce Redesign Manager, spoke to the circulated paper. All three Rural General Hospitals (RGHs) in NHS Highland currently had a combination of Foundation Programme and GP trainees providing the most junior level of medical cover and supporting the medical workforce model of Consultant delivered services. In the last two to three years there had been significant recruitment difficulties to both Foundation Programme and GP training programmes. This has particularly impacted the RGH’s. An event in July, facilitated by the Remote and Rural Implementation Group, debated the challenges faced by the RGH’s and identified potential future workforce models. The event report suggested a model whereby the current level of Consultant cover was maintained with support from various disciplines including a new role which may or may not be a doctor.

Ms Mitchell and Ms Helen Morrison, Associate Director (NMAHP Workforce Planning and Development), with the assistance of Dr Emma Watson, Director of Medical Education, had been tasked to develop a workforce model based on that outlined in the report for discussion by the Corporate Team. Alternative models, possible challenges and potential solutions were to be included in this work. At meetings with RGH Consultants and Hospital Managers, a number of concerns had been highlighted including whether it was necessary to change the current reliance on junior doctors at all, the ability of non-doctors to ever achieve the competencies required to substitute for junior doctors and the ability of RGH’s to sustain Consultant-led services without junior doctors. Further discussion led to agreement that an observational study would be undertaken to develop a robust picture of the activity of junior doctors against which competencies could be articulated.

Ms Mitchell acknowledged that work in this area was closely aligned to the aims of the successful bid by NHS Highland and UHI for Knowledge Transfer Partnership Funding. This funding would support a 24 month ‘pilot’ involving three rural general hospitals, the Belford Hospital, Fort William, Caithness General Hospital, Wick and Lorn & Islands Hospital, Oban, to explore and implement new models of staffing to ensure future service delivery and meet future needs. At the Corporate Team in October 2010 it had been agreed that a new model would be developed, tested and refined through the KTP programme over the next two years.

In response to a question concerning the sustainability of the current model during this two year period, Ms Mitchell confirmed that the medical recruitment process remained a risk, considerable effort had been required to fill vacancies that year, as did the competency levels of junior doctors. However, with the support of General Managers and RGH Consultants it was noted that the agreed strategy was considered appropriate.

13 The Committee Noted the position.

11 STAFF GOVERNANCE ACTION PLAN

Mr Stewart provided a brief verbal update in relation to the Staff Governance Action Plan against each of the five component parts of the Staff Governance Standard. The importance of two standards, “Involved in decisions” and “Treated fairly and consistently” was highlighted, as the organisation moved into a period of redesign and change.

Mr Stewart advised that a more detailed report would be prepared for a future meeting and would consider the useful of the Self Assessment Audit Tool going forward. Mrs Gent further noted that work was required to match the Workforce Programme Plan with the Staff Governance Standard.

The Committee Noted the position.

12 WORKFORCE INFORMATION REPORT (INCLUDING SICKNESS ABSENCE)

Mr Walker spoke to the circulated Workforce Information Report. The sickness trend had plateaued at 4.8%, around 0.3% higher than the Scottish average. The in-month rise was almost entirely attributable to short term sickness absence with long term sickness remaining relatively constant at around 2.75% of total sickness absence. A fresh look was being taken at Promoting Attendance Policy implementation to see if an adjustment in activity in this area was required. Other work had been undertaken to reduce sickness absence further including conducting staff interviews / capability interviews and long term case management but further discussions were ongoing as to whether there was anything further that could be done to address this. Occupational Health had identified that the stress at work elements of staff sickness were quite high and were looking to see if any further intervention was possible. Current pressures on the workforce and those possible around the redesign programme suggested that close attention would need to be maintained in this area.

During discussion by the Committee, a number of queries were raised in relation to the report. The lack of clarity around the establishment monitoring table was discussed and Mr Walker advised that, going forward, the headcount in post line would be removed from the table. Ms Cremin advised that, following work with finance, the staff in post data would change as data became more robust. Information had recently come to light that a number of staff had been counted twice due to changes in job families in relation to agenda for change. It was noted that there were a number of quality issues still to resolve, including full alignment of the data with finance. Ms Courcha commented on the number of CBT referrals and the target for providing appointments with 60 working days. Mr Walker commented that whilst this seemed a long wait, this was generally not the first appointment, members of staff had already had initial interview/s with Occupational Health.

In respect of the tables giving information on Employee Relations, the Committee requested that further clarification be made. Mr Walker confirmed that generally Employee Conduct cases were completed within 18 week time frame however data gathering activity ongoing. He agreed to further review these tables to ensure that information was displayed as clearly as possible. September had seen a rise in capability issues to its highest level since May 2010. These cases could relate to a number of issues including quality of work or ill health. Mr Walker agreed to consider revising the table to show detail of the issues more clearly.

14 It was noted that the redeployment register currently contained around 200 members of staff. Of the 198 included as a result of organisational change, a substantial proportion were linked to the redesign of mental health services in Argyll & Bute. These members of staff were listed as being “at risk” from an employment perspective due to planned changes within the services. Once the new service had been fully developed it was likely that a large number of staff would be matched to the new posts.

The Committee  Noted the position.  Agreed that clarifications be made to the tables relating to establishment monitoring and employee relations as detailed above.

13 IMPLEMENTATION OF KNOWLEDGE AND SKILLS FRAMEWORK

Ms McKelvie, Head of Learning and Development, spoke to the circulated report which detailed the latest situation on the implementation of the knowledge and skills framework. The HEAT Target stated that 80% of all staff should have a development review completed and recorded on eKSF by March 2011. An update on the figures quoted in the circulated paper was provided. The position for NHS Highland, as at 23 November 2010, was that 2196 reviews were in progress, a total of 27.5%. With 1714 reviews, 21.5%, completed and signed off and 320 reviews, 4%, awaiting sign off, total activity stood at 53%.

Ms McKelvie advised that the KSF team were working to support staff across Highland to ensure that reviews were carried out. Guidance documents had been revised and updated, roadshows held across NHS Highland and, more generally, comprehensive support provided to both reviewers and reviewees. Telephone support had even been provided during reviews. A discussion had taken place at the Highland Partnership Forum on 12 November 2010 in relation to the “complete on paper function”, specifically about making this available to all staff. It had been agreed at that meeting that this was not required but that any manager could contact the e-KSF team to activate this facility, if it was deemed necessary. Mr Ian Underwood, attending the meeting representing the e-Health team, updated the Committee on both local and national connectivity issues. The number of NHS Mail accounts requested to enable staff access to e-KSF had resulted in a substantial backlog, that morning 145 new user requests were outstanding. Every effort was being made to address these issues. Ms McKelvie advised the Committee that some technical challenges remained. However it was likely that further requests for accounts would be made as more reviews were booked and access to machines and ability to use them were still problems. The KSF team requested that members of staff inform them of any technical issues as soon as possible.

The CHP General Managers had been asked to submit reports to the meeting to provide assurance on the ability of NHS Highland to return to the agreed trajectory and achieve the HEAT Target.

Mr Derek Leslie, General Manager, Argyll & Bute CHP, advised that the number of reviews had increased with instructions circulated that dates for reviews were to be arranged irrespective of any “e” problems, although he would rather reviewers avoided the “complete on paper option” unless absolutely necessary. Mr Leslie advised that he now had evidence that by the end of February 2011, around 75% to 80% of reviews would be underway, the outstanding 20% of staff who had not had reviews would be those with a variety of extenuating circumstances. It was noted that arranging reviews for members of staff in hotel services had proved especially problematic.

Ms Sheena MacLeod, General Manager, North Highland CHP confirmed that 60% of staff reviews were either underway or complete. North Highland CHP held weekly progress

15 meetings at which information received from all departments was reviewed. Two areas had been identified as “hotspots”, Medical Records and Hotel Services and work was ongoing to support these teams. Staff have been actively discouraged from using the “complete on paper option” which it was felt would increase the work.

Ms Gill McVicar, General Manager, Mid Highland CHP reported that every member of staff now had a date in the diary for the commencement of their review. Unlike the other CHP’s, she advised that Mid Highland CHP had encouraged the “complete on paper option” feeling it was more important that the reviews be carried out, rather than being held up by technical issues which could be addressed some time in the future. As with the other CHP’s, arranging and completing review for staff employed within hotel services had proved challenging. Mid Highland CHP was aiming to have reviews completed for nearly all staff by the end of February, leaving March free to look at those staff who were not so readily available whether due to hours worked or other extenuating circumstances.

Mr Nigel Small, General Manager, South East Highland CHP had sent his apologies. The Committee reviewed the SE Highland CHP report and considered that the detailed figures submitted provided sufficient assurance that the required level of completed reviews would be reached.

Mr Chris Lyons, General Manager, Raigmore Hospital had been unable to attend the meeting. Following a review of the report provided to the Staff Governance Committee it was agreed that more detailed information be requested to provide the required assurance that the HEAT Target would be met.

The Committee noted that issues with IT featured across all areas. It was agreed that Ms McKelvie would discuss the issues with Mr Bill Reid, Head of e-Health and report back to the Committee as necessary.

The Committee  Noted the position.  Agreed that sufficient assurance had been provided that the HEAT Target could be met by Argyll & Bute CHP, North Highland CHP, Mid Highland CHP and South East Highland CHP.  Agreed that a more detailed report be requested from Mr Chris Lyons, General Manager, Raigmore Hospital.  Agreed that Ms McKelvie and Mrs Gent discuss IT issues with Mr Bill Reid, Head of e-Health.  Agreed that a further update be provided to the next meeting.

14 STAFF SURVEY 2010

Mr Stewart advised the Staff Governance Committee that the 2010 Staff Survey had closed the previous day. This year, hard copies of the survey had not been circulated to all members of staff and the majority of forms had been completed online. In total, 22% of NHS Highland staff had responded compared to the national average of 26% for Scotland. Numerically, this equated to about 1800 staff members. Response rates to the survey had declined, for all mainland Scottish Boards. A number of reasons had been suggested for this, including the fact that the survey had only been progressed in the main online; concerns had been expressed around confidentiality of the online version which a number of staff had not felt comfortable with.

Whilst the number responding was disappointing, Mr Stewart felt that the views of 1800 members of staff was a useful pool of information. He advised the Committee that a commitment existed to continue the staff survey every two years despite the costs

16 associated with this exercise.

The Committee Noted the position.

15 COUNTER FRAUD SERVICES TRAINING

A copy of the Counter Fraud Services Training DVD was available, on loan, from the Board Committee Administrator.

The Committee Noted the position.

16 AOCB

There was no other business.

17 DATE OF NEXT MEETING

The next meeting was scheduled for Tuesday 22 February at 10.00am in the Board Room, Assynt House, Inverness.

The meeting closed at 1.00 pm.

17 Highland NHS Board 1 February 2011 Item 3.8 IMPROVEMENT COMMITTEE

Report by Elaine Mead, Chief Executive

The Board is asked to:

 Note that the Improvement Committee met on Monday 10 January 2011 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 Mr Quentin Cox, Non-Executive Director Ms Elaine Mead, Chief Operating Officer

In Attendance: Ms Margaret Brown, Head of Service Planning Mr Kenny Oliver, Performance Manager Ms Linda Kirkland, Business Transformation Manager Mrs Mairi Milne, Business Manager, Public Health (part meeting) Miss Irene Robertson, Board Committee Administrator Ms Alison Binns, Board Committee Administrator

Apologies: Mr Ian Gibson, Dr Ian Bashford, Ms Pam Courcha, Mr Okain McLennan, Mr Colin Punler, Mr Nigel Small Respondents: Mr Bill Brackenridge, Chair, Argyll & Bute CHP Mr Mike Evans, Member, Raigmore Hospital (on behalf of Ms P Courcha) Mrs Gillian McCreath, Chair, South East Highland CHP Dr Roderick Harvey, Clinical Director, Raigmore (part meeting) Mr Derek Leslie, General Manager, Argyll & Bute CHP (videoconference) Mr Chris Lyons, General Manager, Raigmore Hospital Mrs Sheena MacLeod, General Manager, North Highland CHP (videoconference) Mrs Gill McVicar, General Manager, Mid Highland CHP Dr Margaret Somerville, Director of Public Health (items 2.1.a, 2.1.h and 2.2.g ) Mrs Anne Gent, Director of Human Resources (item 1b) Ms Maimie Thompson, Programme Manager 18 Weeks Referral to Treatment (item 2.1.d) Mr Iain Ross, Head of e-Health Infrastructure Services (item 2.1.d) Ms Fiona Clarke, Senior Health Promotion Specialist (item 2.1.h (i)) Dr Ken Oates, Consultant, Public Health (item 2.2.g) Ms Cathy Lush, Clinical Dental Manager (item 3) Mr David Babb, Senior Dental Officer (item 3) Dr Dennis Tracey, Consultant in Public Health (item 5) Mr Malcolm Iredale, Director of Finance (item 7) Ms Heidi May, Board Nurse Director (item 10) TOPICS DISCUSSED

1. Review of Board Assurance Report Actions a. Day Case Rates b. eKSF / PDP c. Electronic Referrals d. CAMHS

2. Balanced Scorecard

Heat Targets a. ABI b. Suicide Prevention c. Reduce Pre-operative Stay d. 18 Weeks RTT e. Inpatient / Day Case Waiting Times – 9 Weeks f. Drug Treatment – Referral to Assessment g. Dementia h. New HEAT Targets (i) Healthy Weight of Children – Revised Target for 2011 – 2014 (ii) Smoking Cessation – New Target for 2011 / 12 – 2013 / 14

Standards a. SMR Return Rate b. Sickness Absence c. New Outpatient Waiting Times – 12 Weeks d. Maximum Cardiac Intervention Waiting Times (Angiography) e. A&E Waits – 4 Hours Maximum f. 8 Key Diagnostic Tests g. Immunisations h. Cervical Screening Rate

3. Dental Balanced Scorecard and Action Plan

4. DNAs

5. Hospital Admissions – Long Term Conditions

6. NHS Highland Annual Review Action Plan

7. 2010 – 2011 Financial Update – Month 8

8. Local Delivery Plan 2011 – 2012

DATE OF NEXT MEETING

The next meeting will be held on Monday 28 February 2011 in the Board Room, Assynt House, Inverness at 1.30pm.

2 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

The Committee’s role and remit is to scrutinise NHS Highland’s performance and ensure remedial action is taken, as required. 1 REVIEW OF BOARD ASSURANCE REPORT ACTIONS Issues/Risks Assurance Actions Day Case Rates: Mid CHP – issue around data Mid CHP – work ongoing to Link in with NHS Highland review of RGH surgical activity. recording. improve position including Action: I Bashford / L Kirkland addressing cultural issues.

Argyll & Bute CHP – capacity and Argyll & Bute CHP – Existing Update report to be provided to Improvement Committee following sustainability issues in respect of locum input extended for next 2/3 redesign workshop. urology service at Lorn and Isles. months. Locum assistance from Action: D Leslie NHS Lanarkshire anticipated. Redesign workshop planned with GG&C in February to develop sustainable solution to tie in with NHS Highland redesign work. eKSF / PDP: Completed eKSF reviews remain Significant improvements Reports currently sent to key Managers monthly to be sent weekly – Chair below agreed trajectory. achieved in most areas. / CHP Chairs to be included in circulation. Assurance provided by GMs to Action: A Gent Staff Governance Committee on 23 November 2010 that plans in Position to be reviewed at next Staff Governance Committee on 23 place to enable HEAT target to be February 2010. met. Action: A Gent

‘Complete on paper’ function extended. Electronic Referrals: Decision by Project Board not to The benefits identified in the Further clarification required on the direct electronic triage of referrals by progress with plan for direct administrative process of clinicians. electronic triage of referrals by managing electronic referrals will Action: E Mead / B Reid clinicians due to functionality issues be rolled out. with software.

3 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

CAMHS: Current 52 week waiting time Work ongoing to enable 39 week Update to be provided to Improvement Committee following meeting of developmental HEAT target to evolve target to be achieved and Joint Committee for Children and Young People. to a 39 week target from 01 April trajectory is being developed to Action: G McCreath 2011. enable monitoring. Progress to be reported to the Joint Committee for Children and Young People.

2.1 BALANCED SCORECARD – HEAT TARGETS Issues/Risks Assurance Actions ABI: Highland failed to meet trajectory Range of measures being ABI’s to be placed on the next Area Medical Committee agenda. figure in October 2010. Return to investigated / actioned to address Action: Q Cox trajectory by the end of the current the challenges. period unlikely. A range of further actions was suggested including fact finding from other Ongoing engagement with GPs to Boards who have successfully achieved the target, establishing links with Confirmation of HEAT Target for April encourage and facilitate activity in other public services e.g. police and the extension of alcohol screening. 2011 – March 2012 received this area including addressing Action: M Somerville / GMs requiring considerable improvement data recording issues (data in performance. Current forecast should be recorded through High level review of model for delivery of ABI’s to be provided to next target will not be met; existing model ESCRO rather than VISION). Board meeting. of delivery is not effective. Action: M Somerville Further extending training to Mid and North CHPs not meeting enable more staff to deliver ABIs. Update report to be submitted to Improvement Committee on 28 February trajectory. GP practice delivery 2011. remains poor in both areas. North CHP has delivered, and Action: M Somerville plans to extend, bespoke training to support A&E staff.

Mid CHP has extended training to community staff and midwives and accepts paper forms from

4 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

these groups for later entry on the database. Retrospective auditing and recording of ABI’s delivered by Sexual Health Services and CPN’s is underway.

Suicide Prevention: NHS Highland as a whole has met Raigmore had achieved the 50% The two remaining operational units are required to achieve the 50% the 50% target for training, two target. (Subsequent to the target for training as soon as possible. CHP’s are below 50% - Argyll & Bute meeting it was confirmed that the Action: C Lyons / D Leslie CHP and Raigmore. December position for Raigmore was 39%). Suicide prevention training target to be kept on Balanced Scorecard. Action: K Oliver Argyll & Bute CHP – difficulties Argyll & Bute CHP – meeting identified by managers in releasing arranged for February to discuss staff to attend training courses. training issues, scheduling difficulties and future training needs. Plan to meet target by March 2011.

Reduce Pre-operative Stay: Argyll & Bute CHP – current Argyll & Bute CHP – information Update report to be provided to Improvement Committee in May 2011. performance 0.87 days as opposed reports illustrating pre-operative Action: D Leslie to target of 0.61 days. stay profile and activity now produced. Redesign of services would likely see improvements in 2011 – 2012.

18 Weeks RTT: Tolerance for 18 Weeks RTT Continued focus on all elements 18 Weeks RTT trajectory to be agreed with each operational unit as part confirmed as 90% (as opposed to of 18 Weeks Work Programme of 2011 – 2012 LDP by mid February 2011. 95%). Boards will be assessed on a including actions which will Action: M Thompson / GMs combined tolerance. reduce waits and delays. Work underway as part of LDP process

5 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

Boards expected to measure all to agree new trajectory reflective Suite of management reports to be submitted to and discussed at a future pathways at speciality level. of agreed 90% tolerances and Board Development Session. current baseline position. Action: Chair / E Mead

IT systems not currently fully in place Ongoing implementation of to support measurement of 18 Weeks systems upgrades across RTT. Highland along with data cleansing and validating. Phased implementation of PAS to comment on 07 February 2011.

Audiology – action plan and trajectory developed and agreed Action plan and trajectory to be monitored through Improvement and submitted to Scottish Committee. Government. Action: M Thompson / L Mitchell

Orthopaedics – 18 Week RTT Orthopaedic Action Plan Action plan progress to be monitored through Improvement Committee. developed and agreed. Action: M Thompson / C Lyons

Argyll & Bute CHP - 18 Weeks RTT IT systems to be in place and producing data by March 2011.

Inpatient / Day Case Waiting Times Raigmore – significant – 9 Weeks: management attention given to Raigmore – standard not being met, micro managing 9 Week target All operational units should ensure that the Inpatient / Day Case Waiting 19 breaches in November, with the across hospital. Times target is being maintained. majority in Orthopaedics Significant progress has been Action: GMs made with Orthopaedic job plans. A further meeting was scheduled Job plans to be considered for a future Board Development session. to plan for the impact of the Action: Chair / E Mead retirement of an Associate Specialist in the next 6 months.

6 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

Drug Treatment – Referral to Assessment: North CHP – only 33% (target 90%) North CHP – the vacancy that No further action. of patients were assessed within the existed had now been filled and 4 week deadline in September. the 100% target is now being achieved.

Dementia: North CHP and Argyll & Bute CHP North CHP – extra support Position to continue to be monitored. were behind trajectory in relation to offered to GP’s to review patients Action: Sheena MacLeod / Derek Leslie registration of patients with dementia. whom likely to have dementia and by CPNs who are contacting Care North CHP – GPs reluctant to add Homes on their behalf. patients to the QOF unless a formal dementia diagnosis had been Options for VC consultations with received from a psychiatrist. psychiatrist in remote and rural areas being considered.

Position with North CHP improving, confident of getting back on trajectory by end March 2011.

Argyll & Bute CHP – a nurse specialist, seconded for 4 months, was providing extra support to GP practices to identify patients who should be registered. A work plan had been developed to reach the target by end March 2011; anticipated being on trajectory by end of January 2011.

7 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

New HEAT Target – Healthy Weight of Children: NHS Highland ahead of trajectory Convene short life working group to develop an action plan to meet the Revised HEAT target for 2011 – 2014 for current HEAT target, ending needs of the new target and address key challenges. announced by Scottish Government. March 2011, and will exceed Action: F Clarke New target more akin to full X- target for combined X and mini-X programme which has proved programmes. challenging for NHS Highland. Considerable difficulties experienced across Highland with full X-programme with several planned programmes cancelled due to lack of sign-up or attendance.

Full consideration of the issues, lessons learned from the current HEAT target and other Boards will inform development of the action plan for the next phase. Highland is seeking to work more closely with the local authority through the joint committee structure to tackle hard to reach groups.

New HEAT Target – Smoking Cessation: The new HEAT target requires the NHS Highland is on target to Report to the Improvement Committee meeting on 28 February 2011. Highland smoking cessation service meet the current HEAT target. Action: M Somerville to achieve at least 4,288 (7.5%) successful quits (at one month post Following a review of the quit) including 2,358 (55%) in the Smoking Cessation Service, and 40% most deprived within-Board overlaps with other services, e.g. SMD areas over the next three years healthy weight and ABI, a detailed ending March 2014. plan will be developed.

8 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

2.2 BALANCED SCORECARD – STANDARDS General Comment – the Improvement Committee has noted a continued decline in performance against standards. All services are required to ensure continuing focus on maintenance of performance to achieve standards. Action: GMs Issues/Risks Assurance Actions SMR Return Rate: Mid CHP – Despite the return rate for Mid CHP – additional Operational units to ensure adequate staffing / cover available within latest period increased from previous administrative support identified coding teams to ensure continuity of service. report – still not meeting the target. to assist with backlog and Action: GMs Staffing and coding issues. exploring options to have a pool of staff trained and skilled in coding. Return rate monitored on weekly basis.

South East CHP – failed to meet 95% South East CHP – a redesign of target due to staff capacity / sickness the administration team has issues. resolved staffing issues and the 95% target has now been met.

Raigmore – failed to meet 95% Raigmore – staffing issues have Referred to Raigmore Committee to ensure required updates are target; steady downward trend been addressed and, with the available on this matter. recorded since April 2010. change in management, a review Action: C Lyons / Raigmore Chair of the service has been undertaken. A return to planned performance is expected by March 2011.

Sickness Absence: Argyll & Bute CHP – absence rate of Argyll & Bute CHP – a range of Update report to be submitted to Improvement Committee on 28 February 5.58% recorded for October (a initiatives are in place. Extra 2011. reduction in long term absence and staffing resource has been Action: D Leslie increase in short term). identified for a specific project beginning at the end of January 2011 to address sickness issues.

9 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

New Outpatient Waiting Times – 12 Argyll & Bute CHP – all All operational units should ensure that the New Outpatient Waiting Times Weeks: specialities are currently target is being maintained. Argyll & Bute CHP – waiting time undergoing redesign to try and Action: GMs pressures remain in ophthalmology, improve patient pathways and orthopaedics, ENT, dermatology and capacity. The CHP has had Update report to be submitted to Improvement Committee on 28 February anaesthetics. verbal assurance that A&B 2011. patients are not treated any Action: D Leslie differently from GG&C patients; the outpatient target is 10 weeks Ensure quality of data to Service Planning is maintained. by 31 December 2010. Action: GMs

Raigmore – significant Raigmore – breaches recorded management effort put in place to during November in ophthalmology, pre-empt breaches in December. orthopaedics and restorative Although due to a cancelled clinic dentistry. from the visiting Restorative Dentistry Service, there were 12 breachers, with together with further 16 due to capacity issues within Orthopaedics.

A total of 35 outpatients breached the 12 week target in NHS Highland.

A&E Waits – 4 Hours Maximum: Raigmore – standard of 98% not met Work ongoing to identify Review previously developed action plans / good practice. in the past three months. Issues contributory factors however Action: C Lyons identified in relation to availability of range of measures already being AMAU beds, the management implemented including actions to Report figures on a regular basis to Chair of Raigmore Committee. escalation policy and breach due to minimise number of days on call Action: C Lyons awaiting results. for medical admissions and escalating to senior management cases where patients reach 180 minutes and may breach.

10 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

Immunisations (with particular reference to North and Mid Target remains challenging and Position to continue to be monitored. Highland CHP): further uptake difficult to Action: K Oates MMR uptake rate below 95% influence. Quarterly update standard. closely monitored and outlier practices identified to GMs / Primary Care Managers for discussion / action. Annual immunisation training provided to practice nurses. Contact with / reminders to parents at key stages to promote MMR vaccine.

Cervical Screening Rate: Argyll & Bute CHP – low uptake rate Work ongoing with locality health Action plan to be developed once issues identified following further of cervical screening. improvement leads to improve meetings. practice rates. Initial discussions Action: D Leslie with practices have raised number of issues, further discussions to take place.

3 TOPIC: DENTAL BALANCED SCORECARD AND ACTION PLAN Issues/Risks Assurance Actions Increase registrations in all age Dental Property Strategy – roll out Update required on areas of particular concern for the Improvement groups, specifically adult although of the NHS Highland premises Committee on 04 July 2011. still behind trajectory. programme continues.

Recruitment to SEDS identified as challenging in Skye, Kyle and Caithness.

Health improvement Data to be made available by Experience of decay data not CHP during 2010 / 2011. currently available at CHP level. Levels of performance relating to

11 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

Initial reporting for Children’s Fluoride Childsmile Programme expected Trajectory for delivery of HEAT Target to be developed as part of the Varnish low. to increase as six month reporting submission for the LDP. period comes to an end. Work Action: C Lush / M Brown has been done to raise awareness of the programme with independent dental practices. Scoping exercise underway to Access to dental care for vulnerable assist in prioritisation of patient groups. vulnerable patient groups. Range of actions ongoing Work required to improve percentage including local oral health of adults retaining their natural teeth awareness initiatives and (target 90%). increasing capacity for dental registration.

4 TOPIC: DNAs Issues/Risks Assurance Actions North CHP – improved position since Highland has one of the lowest Update report to be provided to a future meeting. July 2010 report however worsening DNA rates of the mainland Action: M Brown DNA rate in gynaecology. Boards and has met its March 2011 target of 6.9% since June Report requested for a future meeting on Patient Focused Booking Mid CHP – small improvement since 2010. Further improvements can process. July 2010, significant reduction be achieved, although there are Action: M Brown required if CHP target of 5.6% to be issues to be addressed. A achieved (current rate 7.4%). number of work streams are underway as part of the 18 South East CHP – only 0.1% behind Weeks RTT programme. Patient trajectory, significant improvement in Focused Booking process being psychiatry. extended.

Argyll & Bute CHP – continued Argyll & Bute CHP – current focus deterioration in DNA figures, highest on GG&C visiting services with of which is in General Psychiatry intensive redesign work

12 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

underway. Significant modernisation of General Surgery which has the highest volume of DNA’s. Scoping exercise for central appointment system also underway.

5 TOPIC: HOSPITAL ADMISSIONS – LONG TERM CONDITIONS Issues/Risks Assurance Actions Rise in OBD rate as a result of Short life working group Review activity related to cardiology changes with other Boards. changes in delivery of cardiology established by Raigmore Action: D Tracey services in Raigmore, including management to explore the inception of the PCI service in May issues associated with the Review of PCI activity and assessment of impact on other Raigmore 2010, and changes in diagnostic increase in activity and bed use services to be continued and reported, in first instance, to Corporate criteria. associated with cardiology Team. service. Action: D Tracey / C Lyons Threshold for PCI rates in Highland seems to be higher than elsewhere in Other workstreams to reduce Scotland. OBD’s for people with Long Term Conditions continue to indicate an North CHP – OBD rate considerably overall reduction. greater than other CHPs.

6 TOPIC: NHS HIGHLAND ANNUAL REVIEW ACTION PLAN Issues/Risks Assurance Actions The review took place in Oban on 22 Following the formal report a June 2010. An update on actions number of areas were identified arising from the review was for further work. Progress requested at the meeting in continues to be made in all areas. September 2010.

13 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

7 TOPIC: 2010 – 2011 FINANCIAL UPDATE – MONTH 8 Issues/Risks Assurance Actions The position at Month 8 remains Reasonable level of confidence Operational units to continue to develop / implement options for achieving challenging with a number of areas of that breakeven will be achieved improvements in order to deliver breakeven position. pressure identified including for 2010 / 2011. Operational Action: GMs prescribing, medical locums, Forecast has shown an cardiology, Raigmore surgical, Out of improvement since previous Paper to be developed detailing how NHS Highland has achieved Hours and hospital drugs. meeting, the majority of which financial savings during 2010 – 2011 for consideration by a future Board. was realised in month 7. Action: M Iredale Breakeven is dependent on operational units continuing to deliver further improvements as far as possible. North CHP – currently projecting increased deficit since November North CHP – Redesign projects 2010. continue to be implemented along with LEAN project in CGH. Mid CHP – predicted deficit remains unchanged. Detailed report requested by the Chair for further discussion as Argyll & Bute CHP – currently Argyll & Bute CHP – claim from appropriate. forecasting breakeven however GG&C against their SLA will be Action: D Leslie / M Brown significant claim from GG&C against disputed. their SLA has been received.

Raigmore – currently projecting increased deficit since November Raigmore – position remains 2010. Increased activity levels in challenging. cardiology.

14 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

8 TOPIC: LOCAL DELIVERY PLAN 2011 – 2012 Issues/Risks Assurance Actions Initial draft of Local Delivery Plan Number of HEAT Targets has Initial draft to be presented to Improvement Committee on 28 February 2011 – 2012 required by Scottish reduced from 31 to 20. A target 2011. Government by 18 February 2011, has been introduced around Action: K Oliver the final version is required by 18 Stroke Services. March 2011.

9 FUTURE AGENDA ITEMS

Meeting on 28 February 2011  Complaints – 20 day response target  Smoking Cessation  Sickness Absence – Argyll & Bute CHP  New Outpatient Waiting Times – 12 Weeks – Argyll & Bute CHP  Local Delivery Plan 2011 - 2012

Future meetings:  Living and Dying Well Action Plan  Day Case Rates – Argyll & Bute CHP  CAMHS  Reduce Pre-operative Stay – Argyll & Bute CHP (09 May 2011)  18 Weeks RTT  Dental Balanced Scorecard (04 July 2011)  DNAs  Patient Focused Booking process

15 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

10 AOCB Issues/Risks Assurance Actions The Healthcare Environment Considerable experience gained Operational units to continue focused preparations for unannounced Inspectorate has commenced from visits to Raigmore and inspections. unannounced hospital inspections. Caithness General Hospitals, Action: H May / GMs GMs were requested to provide along with that from other Boards, assurance as to the preparedness of and shared across Highland. each of their areas for an Number of areas where work has unannounced visit. been identified, this has been costed and planned appropriately.

All areas reported carrying out local unannounced inspections, gap analyses on other inspection reports and discussion as CHP Committee meetings.

North CHP – environmental audits have taken place in community hospitals along with mock inspections using staff from rival wards.

Mid CHP – working closely with estates to improve the environment and evidence folder available to show what action plans are currently in place along with time frames.

Argyll & Bute CHP – considerable activity and substantial item on CHP meeting agendas.

16 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 10 January 2011

Raigmore – unannounced visits had identified areas requiring further attention but also examples of good practice.

11 SCHEDULE OF IMPROVEMENT COMMITTEE MEETINGS IN 2011

All meetings take place on Mondays, commencing at 1.30pm, on the following dates:

 28 February 2011  09 May 2011  04 July 2011  05 September 2011  31 October 2011

17 Improvement Commitee 10 January 2011 NHS Highland - "At A Glance" HEAT Targets Item 3

Summary of the Operational Units performance as per the Balanced Scorecard reported to the Improvement Committee on 10th January 2011

Targets with a delivery date by the end of March 2011 e d n t e o u t e d i t r t d B n i a

o n a s d p l D a e

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g r

i g l h e i d l m h t H r v t y

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i l g d o i o a o r e E

B Target M R S M N A D ChildHealthyWeightInterventions Oct-10 N/A Mar-11 Alcohol\BriefInterventions Oct-10 N/A Mar-11 SuicidePreventionTraining(DueforDeliveryDec2010) Nov-10 Dec-10 SmokingCessation Oct-10N/A Mar-11 Breastfeedingat6-8weeks Mar-10 N/A Mar-11 InequalitiesTargetedCardiovascularHealthchecks Oct-10 N/A N/A N/A N/A Mar-11

Daycaserates Oct-10 N/A Mar-11 EmergencyInpatientsaveragelengthofstay Aug-10 Mar-11 Outpatients-DNArate Oct-10 Mar-11 FinancialPerformance Oct-10 Mar-11 CashEfficencies Oct-10 Mar-11 Electronicmanagementofreferrals(DueforDeliveryDec2010) Oct-10 N/A Dec-10 e-KSF/PDP Nov-10 Mar-11

Inpatient/DayCaseWaitingtimes-9weeks Nov-10 N/A Mar-11 Drug Treatment: Referral to assessment (Due for DeliveryDec10) Sep-10 N/A Dec-10 Drug Treatment: Assessment to treatment(Due for Delivery Dec10) Sep-10 N/A Dec-10

ReduceOccupiedBeddaysforlongtermconditions Jun-10 N/A Mar-11 BalanceofcareforOlderPeoplewithcomplexcareneed Mar-10Reported at Board Level only Mar-11 Dementia (Unvalidated -validatedpositionavailableannually) Nov-10 N/A Mar-11 RateofattendancesatA&E Nov-10Reported at Board Level only Mar-11 MRSA/MSSA Bacterium: 30% reduction Jun-10Reported at Board Level only Mar-11 C.DiffInfections:30%reduction Sep-10Reported at Board Level only Mar-11 ReductioninEmergencybeddaysforpatientsaged65+ Jun-09 N/A Mar-11

Targets with a delivery date beyond March 2011 e d n t e o u t e d i t r t d B n i a

o n a s d p l D a e

o l e r n h y r h P a o

g r

i g l h e i d l m h t H r v t y

H g i n a r

i l g d o i o a o r e E

B Target M R S M N A D ChildFluorideVarnishApplications Jun-10 N/A Mar-14

ReducePreOperativestay Oct-10 N/A Mar-13 ReduceCarbonemmissions Sep-10 Mar-15 ReduceEnergyConsumption Sep-10 Mar-15

AdvanceBooking-GP Mar-10No Update available until March 2011 Mar-11 Suspicionofcancerreferrals(62days) Sep-10Reported at Board Level only Dec-11 AllCancerTreatment(31days) Sep-10Reported at Board Level only Dec-11 18weeksReferraltoTreatment-admittedperformance Oct-10Currently reported at Board Level only Dec-11 18weeksReferraltoTreatment-admittedcompleteness Oct-10Currently reported at Board Level only Dec-11 18weeksReferraltoTreatment-nonadmittedperformance Oct-10Currently reported at Board Level only Dec-11 18weeksReferraltoTreatment-nonadmittedcompleteness Oct-10Currently reported at Board Level only Dec-11 No Trajectory AlcoholTreatment:ReferraltoTreatment N/ATarget in development Mar-13 No Trajectory FasterAccesstoSpecialistCAMHS Jun-10Trajectory in development Mar-13

NHS Highland - "At A Glance" Standards e d n t e o u t d i r t d B n i

o n a s d p l a e o l e r n h r h P a o

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H g n a r

i g d o i o a o r E

B Target M R S M N A MMRuptakerates-target95%at5yearsold Sep-10 N/A

SMR return rate - 90%of SMR1 returns received within 6 weeks Aug-10 Complaints-80%ofcomplaintscompletedwithin4weeks Oct-10 SicknessAbsence-4%target Oct-10 NewtoReturnOutpatientattendanceRatio Oct-10

CataractWaitingTimes-assessment-9weeks Nov-10 N/A N/A N/A NewOutpatientWaitingtimes-12weeks(allreferralsources) Nov-10 N/A Hipsurgery-98%ofpatientstreatedwithin24safeoperatinghrs Oct-10 N/A N/A N/A N/A Angiography-4weekwaitingtime Nov-10 N/A N/A N/A N/A A&EWaitingtimes-4hours Nov-10 Daignostictestswaitingtimes-4weeksfor8keytests Nov-10 N/A

DelayedDischarges-noclientswaitingover6weeks Nov-10 CervicalScreening-80%uptakeof 20-60yroldwomenscreened Sep-10 N/A PrescribingAntidepressants Aug-10 N/A ReductioninPsychiatricreadmissions Jun-09 N/A Improvement Committee 10 January 2011 Item 3

IMPROVEMENT COMMITTEE - JANUARY 2011 2010/11 BALANCED SCORECARD

Highland Sheets Raigmore Sheets North Highland CHP Mid Highland CHP South East Highland CHP Argyll & Bute CHP

Highland HEAT Raigmore HEAT North HEAT Mid HEAT South East HEAT A & B HEAT

Highland Cancer Raigmore Standards North Standards Mid Standards South East Standards A&B Standards

Highland Standards

Pharmacy

Facilities

Corporate HEAT

Dental eKSF

Trajectory Graphs (updated quartely once data becomes available)

Please click on the hyperlinks to be taken to each worksheet NHS HIGHLAND BALANCED SCORECARD 2010/11 TOTAL NHS HIGHLAND HEAT TARGETS

Achieve 484 interventions for child healthy weight intervention 9 2 2 4 0 1 6 Cumulative trajectory of 82 (65%) and 533 mini X against trajectory of H3.KPM1 programme by 2010/11, for the number of 5-15 year olds 2 4 5 7 3 8 8 Monthly 188 (284%) 221 Mar-10 2 2 4 4 5 5 5 Alcohol Brief Interventions 8 2 5 9 9 6 5

Achieve 8964 brief interventions in line with SIGN 74 guidelines by 7 4 8 3 4 8 3 Cumulative H4.KPM1 2010/11 Mar-10 4 6 8 0 2 5 8 Monthly Highland Trajectory for Oct = 6651 4066 4 4 4 5 5 5 5 Suicide Prevention

50% of key frontline staff educated & trained in using suicide % % % % % % % % Cumulative H5.KPM1 assessment tools/prevention training programmes by 2010 4 5 1 1 1 7 1 2 Monthly Highland Trajectory for Nov = 48% 34% Mar-10 3 3 4 4 4 4 5 5 Smoking Cessation 5 1 0 0 0 9 8

8% of smoking population successfully quitting (at one month post quit) 7 6 4 0 6 0 0 Cumulative H6.KPM1 from 2008/09 to 2010/11 - Equates to 4944 quits over the period 4 6 8 0 1 3 4 Monthly Highland Trajectory for Oct = 4223 3230 Mar-10 3 3 3 4 4 4 4 Breast Feeding at 6-8 Weeks New-born babies exclusively breastfed at 6-8 weeks review to increase Preceding 4 H7.KPM1 from 28.8% in 2006/07 to 36% in 2010/11 32.4% Jan-Mar 10 Quarters Awaiting data from ISD. June qtr due mid December Inequalities Targeted Cardiovascular Health Checks

Achieve 60 inequalities targeted cardiovascular Health Checks during 2 3 7 Cumulative H8.KPM1 2009/10 Mar-10 3 7 8 3 1 4 5 Monthly 189 1 3 6 9 1 1 1 Child Fluoride Varnish Applications Achieve at least 60% of 3 and 4 year old children in each SIMD quintile Reporting is on a quarterly basis and shows the worst to receive at least 2 applications of fluoride varnish per year by March performing quintile. The baseline data was received on

H9.KPM1 2014 Jan-Mar 10 % Quarterly 28.9.10 and a trajectory is now to be agreed

0.7% 0 Efficiency Efficiency Savings: Same Day Surgery Improved efficiencies by March 2011 to increase day case rate to % % % % % % % 8 3 0 3 3 2 9

78.9%. The number of BADS surgical procedures performed in a day ...... NOTE - THIS TARGET IS NOW MEASURED ON A E4.KPM1 case or outpatient setting Mar-10 7 7 9 6 1 2 1 Preceding Year MONTHLY BASIS NOT ROLLING YEAR 77.2% 7 7 7 7 8 8 8

Efficiency Savings: Emergency Inpatients Average Length of Stay Improved efficiencies by March 2011 to reduce non-routine inpatient 0 0 0 0 0 E4.KPM2 average length of stay to 4.0 Mar-10 . . . . . Preceding Year No updated data available from ISD 4.0 4 4 4 4 4

Efficiency Savings: New Outpatient Appointment DNA rates Note: This measure is now being measured on consultant

Improved efficiencies by March 2011 to reduce 1st outpatient % % % % % % % led activity only. Psychotherapy data for Argyll & Bute is 1 1 9 9 9 8 7 E4.KPM4 attendance DNA rate to 6.9% Mar-10 ...... Preceding Year now included. 7.0% 7 7 6 6 6 6 6

Reduce Pre-operative Stay 1 1 9 8 9 8 7 7 6 6 6 6

Improved efficiencies by March 2013 to reduce pre-operative stay by ...... 0 0 0 0 0 0 E4.KPM5 20% to 0.65 days for elective surgery Mar-10 Rolling year 0.72 1

Financial Performance 9 Operational forecast at 30th Sept 2010 is showing a £2m 3 Operate within agreed revenue resource and capital resource limits, , overspend continuing the move towards a breakeven 5 0 0 0 0 0 0 E5.KPM1 and meet cash requirement. Mar-10 £ Preceding Year position for the year end as per the LDP £79k - £ £ £ £ £ £

Savings to Nov 2010 are showing 100% achieved to date against trajectory. Plans being developed to ensure % % % % % %

Cash Efficiencies % 0 0 0 0 0 0 delivery of year end target, it is noted however that some of E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 3 0 0 0 0 0 0 Monthly the achieved savings will be non recurrent 93% 6 1 1 1 1 1 1

Electronic Management of Referrals % % % % % % % 2 9 2 7 1 3 8

Increase the % of new GP outpatient referrals into consultant led ...... Note that trajectory has been reprofiled for 2010/11. May E7.KPM1 secondary care services managed electronically to 90% from Dec 2010 Mar-10 6 2 0 8 2 9 0 Monthly figure adjusted - please refer to A&B Heat for further detail 65.1% 6 7 7 6 7 6 8 Progress with Biomass installations likely to almost achieve Reduce Carbon Emissions this year's target in full. Move to Gas from Oil immediately % % 3 0

To reduce CO2 for oil, gas, butane and propane usage by 3% each . . saves 25% o nemmissions - eg Nairn and Victoria R/say. 9 1

E8.KPM1 year to 22,875 tonnes by 2014/15. 1 1 Quarterly No concerns for this target.

No physical developments of a size to impact in-year to Reduce Energy Consumption: reduce consumption. Discussions ongoing re use and need % 8 %

To reduce energy consumption by 1% each year to 298,578kWhs by . for CEEF funds to pay for improvements. Current projection 3 E8.KPM2 2015-16. 0 . Quarterly is more complete than data used for Qtr 1 1 0

KSF and Personal Development Plan % % % % % % % % 9 8 5 7 0 5 7 5 2 6 6 7 4

80% of staff to have had a KSF/PDP review, completed and recorded . . . . . If all existing Review documents were signed off the figure 6 4 8 E10.KPM1 on E-KSF by March 2011 Mar-10 . . . 0 1 3 6 4 Monthly would be 57.07% (01/12/10)

4.59% 6 7 8 1 1 1 1 2 NHS HIGHLAND BALANCED SCORECARD 2010/11 TOTAL NHS HIGHLAND HEAT TARGETS

Date of Latest Reported Period Reporting Outturn Measure & DetailIndicator CommentsHEAT outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Access to Services Advance Booking - GP By 2010/11 at least 90% of patients are able to book a consultation with a GP or appropriate Healthcare Professional more than 2 working days NHS Highland is one of only 2 mainland NHS Boards to A8.KPM2 in advance 90% Mar-10 Preceding Year achieve the 90% target in 2009/10 Suspicion of cancer referrals (62 days) % % 4 7

For 95% of patients referred urgently with a suspicion of cancer, . . % Qtr 3 2010 (Jul-Sept) figures are unvalidated - screening A9.KPM1 maximum wait from referral to treatment is 62 days from Dec 2011 Oct-Dec 09 8 7 9 Quarterly included from Qtr 3 onwards 96.1% 9 9 9 All Cancer Treatment (31 days) % 5

For 95% of patients diagnosed with cancer, the maximum wait from first % . % Qtr 3 2010 (Jul-Sept) figures are unvalidated - screening A9.KPM2 decision to treat will be 31 days from Dec 2011 1 2 8 Quarterly included from Qtr 3 onwards 9 9 9 % % % % % % % 1 0 6 0 0 0 0

18 Weeks Referral to Treatment - Admitted Performance ...... Information relates to Northern Highland only - work 5 1 2 8 8 7 0

A10.KPM1a Deliver 18 week RTT from 31 December 2011. 8 8 8 7 7 7 8 Monthly ongoing to capture Argyll and Bute CHP data % % % % % % % 0 0 5 0 0 0 0

18 Weeks Referral to Treatment - Admitted Completeness ...... Information relates to Northern Highland only - work 8 1 7 1 1 8 8

A10.KPM1b Deliver 18 week RTT from 31 December 2011. 4 5 4 5 5 4 4 Monthly ongoing to capture Argyll and Bute CHP data % % % % % % % 3 0 8 0 0 0 0

18 Weeks Referral to Treatment - Non-admitted Performance ...... Information relates to Northern Highland only - work 2 0 3 3 3 2 3

A10.KPM1c Deliver 18 week RTT from 31 December 2011. 8 9 9 9 9 9 9 Monthly ongoing to capture Argyll and Bute CHP data % % % % % % % 0 0 0 0 0 0 0

18 Weeks Referral to Treatment - Non-admitted Completeness ...... Information relates to Northern Highland only - work 2 5 3 0 9 7 3

A10.KPM1d Deliver 18 week RTT from 31 December 2011. 8 6 8 8 7 7 7 Monthly ongoing to capture Argyll and Bute CHP data Inpatient/Day Cases Waiting Times: Maximum Wait 9 Weeks No patient to wait longer than 9 weeks from being placed on waiting list to admission for an inpatient or day case procedure from 31 March A10.KPM3 2011 Mar-10 6 3 0 1 Monthly September 2010 figures are provisional 16 1 1 1 8 1 0 1 2 Drug Treatment: Referral to Assessment. Please note the A&B data for Qtr 1 is unvalidated at

By Dec 2010, 90% of clients referred for treatment will receive a date % % present and excludes voluntary sectors/services. Qtr 2 4 2

A11.KPM1 for assessment that falls within 4 weeks of referral received . 9 9 Quarterly does not include A&B CHP data Drug Treatment: Assessment to Treatment Please note the A&B data for Qtr 1 is unvalidated at

By Dec 2010, 90% of clients will receive a date for treatment that falls % % present and excludes voluntary sectors/services. Qtr 2 8 6

A11.KPM2 within 4 weeks of their care plan being agreed. 9 9 Quarterly does not include A&B CHP data Alcohol Treatment: Referral to Treatment By Dec 2010 90% of clients referred for treatment will receive a date for A11.KPM3 treatment that falls within 4 weeks of their care plan being agreed No performance measure for this indicator in 2010/11 Faster access to Specialist Child & Adolescent Mental Health Services (CAMHS) By March 2013 no one will wait longer than 26 weeks from referral to A12.KPM1 treatment 6 5 1 9 3 2 Monthly 6 1 1 2 1 2 3 Trajectory for 2010/11 not yet established. Treatment Appropriate for Patient Hospital Admission For Long term Conditions Provisional figures due to under-reporting - ISD data 1

Reduce bed day rates (for COPD, Asthma, Diabetes, CHD) to 0 excludes current (longstay) inpatients. Continually revising T6.KPM1 9130/100,000 by Mar 2011. 1 Preceding Year the reporting method. 9,095 Apr-Mar 10 9 Balance of Care For Older People With Complex Care Needs Currently Working with ISD to develop local dataset for Increase the level of older people with complex care needs receiving monitoring. No. of ACPAs completed (to end of Oct 10): T8.KPM1 care at home to 30% by March 2011 25% Mar-10 Preceding Year 2767; 0.86% of total population

QOF Calculator figures now available. In Sept 6 practices didn't report (about 110 patients). In Oct 4 practices didn't Dementia report (about 150 patients). The November figure includes 6 2 9 5 0 1 6

Increase nos of patients' with an early diagnosis & management of 9 1 2 6 7 5 0 11 practices which didn't report. For these practices, the

T9.KPM1 dementia to 2659 by Mar 2011 Jan-Mar 10 0 3 3 3 2 2 4 Preceding Year October register has been reported.

2188 2 2 2 2 2 2 2 Rate of Attendance at A&E Note that from 1/4/10 only 4 A&E sites are included in the 6 5 9 9 7 5 4 1

Agreed reduction in number of attendances to A&E attendances by 8 0 0 4 2 5 3 7 measurement of this target - Raigmore, Belford, Caithness T10.KPM1 March 2011 to 1322 per 100,000pop'n Mar-10 3 6 6 5 6 4 3 1 Monthly General and Lorn & Isles 1 1 1 1 1 1 1 1 MRSA/MSSA Bacterium: 15% Reduction The most recent HPS figures are for period April-June Reduce all staphylococcus aureus bacteraemia (including MRSA) by 73 74 Preceding 4 2010. From April-November there have been 39 SABs. T11.KPM1 15% by March 2011 to 46 18 Jan-Mar 10 13 Quarters The target by the end of March is 46 The most recent HPS figures are for the period April-June 2010. NHS Highland is 0.4 above the national rate of 0.46 C. Diff Infections 30% Reduction in patients over 65. April-November 2010 there have been Reduce the bed day rate by 30% for age 65+ by March 2011 to 0.57 0.44 0.5 0.53 Rate/1000obd 55 Cdiff infections for 65+. The target is 130 by the end of T11.KPM2 per 1000 total OBD 25 Jan-Mar 10 25 25 Count March 2011 Reduction in Emergency Bed Days for Patients Aged 65+ Provisional figures due to under-reporting - ISD data Reduce emergency inpatient bed days for aged 65+ by Mar 2011 to 4

0 excludes current (longstay) inpatients. Continually revising

3238 per 1000 pop'n 1 Quarterly the reporting method.

T12.KPM1 3,234 Apr-Mar 09 3 NHS HIGHLAND BALANCED SCORECARD 2010/11

NHS HIGHLAND CANCER SHEET

Date of Latest Reported Period Reporting CommentsIndicator HEAT Measure & Detail Outturn outturn Mar APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB Period Health Improvement All Cancer treatment (31 Days) % 5

95% of cancer patients treated within 31 days of their decision to treat % . % Qtr 3 2010 (Jul-Sept) figures are unvalidated - screening 1 2 8

A9.KPM2 from December 2011 9 9 9 Quarterly included from Qtr 3 onwards Suspicion of cancer referrals (62 days) % % 4 7

All cancer sites combined. Target 95% of all urgent referrals included . . % Qtr 3 2010 (Jul-Sept) figures are unvalidated - screening 8 7 9

A9.KPM1 (not just GP) to be treated within 62 days of referral 96.1% Dec-09 9 9 9 Quarterly included from Qtr 3 onwards % % %

Breast Cancer 0 0 0 Qtr 3 2010 (Jul-Sept) figures are unvalidated - screening 0 0 0

100% Dec-09 1 1 1 Quarterly included from Qtr 3 onwards % 0 % . %

Urology (Prostate) Cancer 0 0 0 0 0 0

92.3% Dec-09 1 1 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % % %

Urology (Bladder) Cancer 0 0 0 0 0 0

100% Dec-09 1 1 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % % %

Urology (Other) Cancer 0 0 0 0 0 0

100% Dec-09 1 1 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % % 3

Lung Cancer 0 . % 0 6 7

100% Dec-09 1 9 9 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % % 4

Colorectal Cancer . 0 % Qtr 3 2010 (Jul-Sept) figures are unvalidated - screening 4 0 7

94.4% Dec-09 9 1 9 Quarterly included from Qtr 3 onwards % %

Head & Neck Cancer 0 0 a 0 / 0

n/a Dec-09 1 n 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % % %

Skin Cancer 0 0 0 0 0 0

80% Dec-09 1 1 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % % 0

Upper GI - OG Cancer . % 0 5 5 0

83.3% Dec-09 9 9 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % 0 . % %

Upper GI - HPB Cancer 0 0 0 0 0 0

100% Dec-09 1 1 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated New measure starting from Qtr 3. Qtr 3 2010 (Jul-Sept) %

Gynae - Cervical Cancer 0 figures are unvalidated - screening patients only from Qtr 3 0

Dec-09 1 Quarterly onwards % % %

Gynae - Ovarian Cancer 0 0 0 0 0 0

100% Dec-09 1 1 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated % % %

Haematology Lymphoma Cancer 0 0 0 0 0 0

100% Dec-09 1 1 1 Quarterly Qtr32010(Jul-Sept)figuresareunvalidated NHS HIGHLAND BALANCED SCORECARD 2010/11

TOTAL NHS HIGHLAND STANDARDS SHEET

Date of Latest Reported Period Reporting Comments Indicator HEAT Measure & Detail Outturn outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Health Improvement Immunisations - MMR1 % % 3 5

Monitor MMR1 uptake rates (% at 5 years old). Target 95% uptake . .

nationally Jan-Mar 10 5 4 Quarterly

91.7% 9 9 Efficiency SMR Return Rate Reporting run mid month with a 2 month lag averaging over Monitor % of SMR01 returns received (2 month lag averaging over 3 3 month period. Please note the target has been changed % % % % % 9 6 5 9 0

month period). National target is 95% complete in 6 wks from end of . . . . . from 90% to 95% after discussion with ISD. All previous discharge Mar-10 2 2 9 9 8 Monthly colour coding had been amended to reflect this change. 91.2% 9 9 8 8 8 Completed Complaints

50% ) ) ) ) ) ) ) Monitor % of completed complaints resolved within 4 weeks. % % % % % % % Information from the complaints database 30th November. 6 7 3 4 9 4 3 8 1 9 7 6 0 5 Target=80% of complaints responded to within 4 wks Mar-10 2 2 3 3 3 3 3 Monthly This information still has to be verified (38) 5 ( 4 ( 3 ( 4 ( 3 ( 5 ( 4 ( Sickness Absence 5.12% 4.86% 4.63% 4.57% 4.67% 4.70% 4.80% 4.55% Monthly Actual Achieve a sickness absence rate of 4% from 31 March 2009 4.81% Jan-10 4.86% 4.86% 4.87% 4.85% 4.86% 4.88% 4.86% Annual Rolling Efficiency Savings: Review to New Outpatient Attendance Ratio Note: This measure is now being measured on consultant

Improved efficiencies by March 2011 to reduce the ratio of return to 3 3 2 9 9 6 6 Preceding led activity only. Figures for July are provisional. 0 0 0 9 9 9 9 new outpatient attendances to 2.02 Mar-10 ...... Year Psychotherapy data for Argyll & Bute is now included.

2.04 2 2 2 1 1 1 1 Access to Services Cataract Waiting Times (Outpatient) Reduce nos of patients waiting over 9 weeks for outpatient treatment to Mar-10 0 by Dec 2007 1 0 0 0 0 0 0 0 0 Monthly New Outpatient Waiting Times: Maximum Wait 12 Weeks

No patient to wait longer than 12 weeks from referral from all sources to 0 1st outpatient appointment from 31 March 2010 Mar-10 2 7 9 5 4 0 8 0 Monthly Nov 2010 figures are provisional 29 2 3 3 5 2 3 3 7 Hip Surgery Waiting Times within 24hrs

Monitor % of hip fracture operations performed within 24 hours of % % % % % 0 % % 0 0 0 . . . . 3 3 8

admission to orthopaedics. % seen within 24 safe operating hours & . 0 . . 0 0 0 numbers who failed to achieve this. Target to be maintained=98% Mar-10 6 0 6 6 0 0 0 Monthly 100% 9 1 9 9 1 1 1 Maximum Cardiac Intervention Waiting Times (Angiography) Monitor number of inpatients/day cases waiting over 4 weeks Mar-10 0 0 1 3 7 7 0 0 1 Monthly A&E Waits To Be A Maximum of 4 Hours

Increase nos of patients waiting under 4 hours from arrival to treatment % % % % % % % % to 98% by March 2009. Mar-10 8 9 9 9 8 9 8 8 98% 9 9 9 9 9 9 9 9 Monthly 8 Key Diagnostic Tests No patients waiting over 4 weeks by March 2010. Mar-10 Monthly

0 0 0 0 0 6 7 3 5 Treatment Appropriate for Patient Delayed Discharges To have no clients waiting over 6 weeks by April 2010 Mar-10 4 6 4 Monthly 5 0 4 5 9 1 6 1 1 Cervical Screening rate Monitor % of 20-60 yr old women screened. Target is 80% Uptake as % % 8 5

per smear history within last 5 yrs for women aged 21-60 yrs no the . . LDP target of 5.5 yrs for women aged 20-60 yrs Jan-Mar 10 0 0 Quarterly 81.0% 8 8 Figures have been reworked on the basis of the most up-to- date CHI population (Sept 2009) which can be broken down to CHP level. Because CHI population is 10,497 Prescribing of Antidepressants greater than GRO population (used to calculate the HEAT 9 1 3 5 8

Reduce the prescribing rate (DDD per capita) of antidepressants to 30 . . . . . target), the apparent prescribing rate is less than previously by March 2010 Mar-10 0 1 1 1 1 Monthly shown. 30.7 3 3 3 3 3 Reduction in Psychiatric Readmissions

Reduce the number of readmissions (within 1 year of stay of at least 7 2 Preceding

days) to 289 by Dec 2009) Jan-Mar09 9 Year No updated data from ISD

213 1 NHS HIGHLAND BALANCED SCORECARD 2010/11 RAIGMORE HOSPITAL HEAT TARGETS

Date of Latest Reported Period Reporting Outturn Measure & DetailIndicator CommentsHEAT outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Health Improvement Suicide Prevention

50% of key frontline staff educated & trained in using suicide % % % % % % Cumulative

H5.KPM1 assessment tools/prevention training programmes by 2010 % % 2 2 2 9 9 9 Monthly Trajectory for Nov 45% 2 2 2 2 2 3 3 3 Efficiency Efficiency Savings: Same Day Surgery NOTE - THIS TARGET IS NOW MEASURED ON A Improved efficiencies by March 2011 to increase day case rate to MONTHLY BASIS NOT ROLLING YEAR % % % % % % % 6 6 3 0 1 0 7

82.7%. The number of BADS surgical procedures performed in a day ...... August and September figures are provisional and will E4.KPM1 case or outpatient setting Mar-10 0 9 1 9 3 4 3 Preceding Year change with updated coding 79.9% 8 7 8 7 8 8 8

Efficiency Savings: Emergency Inpatients Average Length of Stay Improved efficiencies by March 2011 to reduce non-routine inpatient 5 6 6 6 6 E4.KPM2 average length of stay to 2.5 Mar-10 . . . . . Preceding Year No update available from ISD 2.5 2 2 2 2 2 Efficiency Savings: New Outpatient Appointment DNA rates

Improved efficiencies by March 2011 to reduce 1st outpatient % % % % % % % Note: This measure is now being measured on consultant 4 4 3 2 1 0 9 E4.KPM4 attendance DNA rate to 6.6% Mar-10 ...... Preceding Year led activity only. 6.5% 6 6 6 6 6 6 5

Reduce Pre-operative Stay 1 2 1 0 9 8 7 7 7 7 6 6

Improved efficiencies by March 2013 to reduce pre-operative stay by ...... 0 0 0 0 0 0 E4.KPM5 20% to 0.67 days for elective surgery Mar-10 0.72 3 4 3 4 8

Financial Performance 3 3 8 3 4 7 3 5 4 3 0 0 Operate within agreed revenue resource and capital resource limits, , , , , , 3 3 Forecast position at 30th Nov 2010 continues to improve 1 1 1 1 1 8 8

E5.KPM1 and meet cash requirement. Mar-10 £ £ £ £ £ £ £ Preceding Year and is showing a £0.833m overspend for March 2011 -£897k ------Savings to Nov 2010 are showing 100% achieved to date % % % % % %

Cash Efficiencies 0 0 0 0 0 0 against trajectory with 1000% forecast to achieve although E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 % 0 0 0 0 0 0 Monthly some of the savings are non recurrent. 75% 7 1 1 1 1 1 1

Electronic Management of Referrals

Increase the % of new GP outpatient referrals into consultant led % % % % % % % E7.KPM1 secondary care services managed electronically to 90% from Dec 2010 Mar-10 7 6 6 3 6 3 7 Monthly Note that trajectory has been reprofiled for 2010/11 71% 6 6 6 6 6 6 7

KSF and Personal Development Plan % % % % % % % % 0 3 9 5 3 6 9 0 4 8

80% of staff to have had a KSF/PDP review, completed and recorded . . If all existing Review documents were signed off the figure 9 3 1 0 6 1 E10.KPM1 on E-KSF by March 2011 Mar-10 ...... 2 9 Monthly would be 49.70% (01/12/10)

3.47% 4 5 6 7 7 9 1 1

Access to Services 18 Weeks Referral to Treatment - Admitted Performance Of those admitted patients that can be measured what % were seen A10.KPM1a within18weeksfromReferraltoTreatment Monthly DataonlymonitoredatHighlandlevel 18 Weeks Referral to Treatment - Admitted Completeness % of admitted patients that we can measure on a 18 weeks referral to A10.KPM1b treatmentpathway Monthly DataonlymonitoredatHighlandlevel 18 Weeks Referral to Treatment - Non-admitted Performance Of those non-admitted patients that can be measured what % were A10.KPM1c seen within 18 weeks from Referral to Treatment Monthly Data only monitored at Highland level 18 Weeks Referral to Treatment - Non-admitted Completeness % of non admitted patients that we can measure on a 18 weeks referral A10.KPM1d totreatmentpathway Monthly DataonlymonitoredatHighlandlevel Inpatient/Day Cases Waiting Times: Maximum Wait 9 Weeks No patient to wait longer than 9 weeks from being placed on waiting list to admission for an inpatient or day case procedure from 31 March A10.KPM3 2011 Mar-10 3 0 9 Monthly November 2010 figures are provisional 11 8 1 1 5 1 0 1 1 Faster access to Specialist Child & Adolescent Mental Health Services (CAMHS) By March 2013 no one will wait longer than 26 weeks from referral to Trajectory for 2010/11 not yet established. Implementation A12.KPM1 treatment 0 2 7 5 3 3 Monthly of Isoft is planned. 3 1 1 1 1 1 2 NHS HIGHLAND BALANCED SCORECARD 2010/11

RAIGMORE HOSPITAL STANDARDS SHEET

Date of Latest Reported Period Reporting Indicator HEAT Measure & Detail Outturn Comments outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Health Improvement Efficiency Reporting monthly (run mid month) with a 2 month lag averaging over SMR Return Rate 3 month period. Please note the target has been changed from 90% % % % % % % 7 4 4 8 9 8

Monitor % of SMR01 returns received (2 month lag averaging over 3 month ...... to 95% after discussion with ISD. All previous colour coding has been 6 4 0 0 7 4

period). National target is 95% complete in 6 wks from end of discharge 95.5% Mar-10 9 9 9 9 8 8 Monthly amended to reflect this change Completed Complaints

41% ) ) ) ) ) ) ) Monitor % of completed complaints resolved within 4 weeks. % % % % % % % 8 3 6 6 4 7 3 7 6 1 8 2 9 8 1 1 1 1 2 1 2

Target=80% of complaints responded to within 4 wks (22) Mar-10 6 ( 4 ( 3 ( 3 ( 4 ( 2 ( 4 ( Monthly Information from the complaints database 30th November. Sickness Absence 4.25% 4.23% 3.85% 4.30% 4.37% 4.09% 4.13% 3.76% Monthly Actual Achieve a sickness absence rate of 4% from 31 March 2009 3.99% Mar-10 4.05% 4.03% 4.02% 4.00% 4.02% 4.02% 4.01% Annual Rolling Efficiency Savings: Review to New Outpatient Attendance Ratio

Improved efficiencies by March 2011 to reduce the ratio of return to new 1 9 7 4 2 9 8 Note: This measure is now being measured on consultant led activity 0 9 9 9 9 8 8 outpatient attendances to 2.05 Mar-10 ...... Preceding Year only. 2.06 2 1 1 1 1 1 1 Access to Services Cataract Waiting Times (Outpatient) Reduce nos of patients waiting over 9 weeks for outpatient treatment to 0 by

Dec 2007 1 Mar-10 0 0 0 0 0 0 0 0 Monthly November 2010 figures are provisional New Outpatient Waiting Times: Maximum Wait 12 Weeks

No patient to wait longer than 12 weeks from referral from all sources to 1st 5 2 2 9 4 3 8 9 9

outpatient appointment from 31 March 2010 29 Mar-10 2 3 3 5 2 1 2 6 Monthly November 2010 figures are provisional Hip Surgery Waiting Times within 24hrs Monitor % of hip fracture operations performed within 24 hours of admission to % % % % % % % 3 3 8

orthopaedics. % seen within 24 safe operating hours & numbers who failed to . 0 . . 0 0 0 6 0 6 6 0 0 0

achieve this. Target to be maintained=98% 100% Mar-10 9 1 9 9 1 1 1 Monthly Maximum Cardiac Intervention Waiting Times (Angiography)

Monitor number of inpatients/day cases waiting over 4 weeks 0 Mar-10 0 1 3 7 7 0 0 1 Monthly November 2010 figures are provisional A&E Waits To Be A Maximum of 4 Hours

Increase nos of patients waiting under 4 hours from arrival to treatment to 98% % % % % % % % % 7 8 8 9 7 8 6 6

by March 2009. 97% Mar-10 9 9 9 9 9 9 9 9 Monthly 8 Key Diagnostic Tests No patients waiting over 6 weeks by March 2009. Monthly November 2010 figures are provisional 0 Feb-10 0 0 0 0 0 7 1 2 Treatment Appropriate for Patient Delayed Discharges To have no clients waiting over 6 weeks by April 2010 Mar-10 Monthly 0 0 0 0 4 3 0 3 2 NHS HIGHLAND BALANCED SCORECARD 2010/11 NORTH HIGHLAND CHP HEAT TARGETS

Date of Latest Reported Period Reporting Outturn Measure & DetailIndicator CommentsHEAT outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Health Improvement Healthy Weight of Children Total figure equates to 21 Full X programmes against Achieve 83 interventions for child healthy weight intervention Cumulative trajectory of 32 (66%) and 55 mini X against trajectory of 23 H3.KPM1 programme by 2010/11, for the number of 5-15 year olds 7 7 6 6 6 6 6 Monthly (239%) 17 Mar-10 1 1 7 7 7 7 7 Alcohol Brief Interventions

Achieve 986 brief interventions in line with SIGN 74 guidelines by 7 8 0 9 7 3 0 Cumulative H4.KPM1 2010/11 Mar-10 8 9 1 1 2 6 7 Monthly Trajectory for Oct = 499 257 2 2 3 3 3 3 3 Suicide Prevention

50% of key frontline staff educated & trained in using suicide % % % % % % % % Cumulative H5.KPM1 assessment tools/prevention training programmes by 2010 1 5 4 4 4 4 9 2 Monthly Trajectory for Nov = 47% 31% Mar-10 3 3 4 4 4 4 4 5 Smoking Cessation

8% of smoking population successfully quitting (at one month post quit) 3 1 0 3 9 0 2 Cumulative H6.KPM1 from 2008/09 to 2010/11. Achieve 583 by Mar 2011 2 4 5 6 7 9 9 Monthly Trajectory for Oct = 498 387 Mar-10 4 4 4 4 4 4 4 Breast Feeding at 6-8 Weeks New-born babies exclusively breastfed at 6-8 weeks review to increase Preceding 4 H7.KPM1 from 28.8% in 2006/07 to 36% in 2010/11 28.6% Jan-Mar 10 Quarters Awaiting data from ISD. June qtr due mid December Inequalities Targeted Cardiovascular Health Checks

H9.KPM1 2014 Jan-Mar 10 % Quarterly 28.9.10 and a trajectory is now to be agreed

0% 0 Efficiency Efficiency Savings: Same Day Surgery Improved efficiencies by March 2011 to increase day case rate to % % % % % % % 0 4 9 0 3 5 4

72.7%. The number of BADS surgical procedures performed in a day ...... NOTE - THIS TARGET IS NOW MEASURED ON A E4.KPM1 case or outpatient setting Mar-10 0 5 2 0 7 5 1 Preceding Year MONTHLY BASIS NOT ROLLING YEAR 71.8% 6 6 6 5 6 6 7

Efficiency Savings: Emergency Inpatients Average Length of Stay Improved efficiencies by March 2011 to reduce non-routine inpatient 4 4 3 3 3 E4.KPM2 average length of stay to 5.0 Mar-10 . . . . . Preceding Year No update available from ISD 4.3 4 4 4 4 4 Efficiency Savings: New Outpatient Appointment DNA rates

Improved efficiencies by March 2011 to reduce 1st outpatient % % % % % % % Note: This measure is now being measured on consultant 5 4 4 0 1 8 9 E4.KPM4 attendance DNA rate to 6.7% Mar-10 ...... Preceding Year led activity only. 6.6% 6 6 6 6 6 5 5

Reduce Pre-operative Stay 8 9 7 7 7 9 1 1 1 1 1 1

Improved efficiencies by March 2013 to reduce pre-operative stay by ...... 0 0 0 0 0 0

E4.KPM5 20% to 0.20 days for elective surgery Mar-10 0.20 9

Financial Performance 7 8 8 8 4 6 5 0 Operate within agreed revenue resource and capital resource limits, , 4 4 2 2 1 9 Forecast position at 30th Nov 2010 continue to improve 1 9 9 8 8 7 6

E5.KPM1 and meet cash requirement. Mar-10 £ £ £ £ £ £ £ Preceding Year and is now showing a £0.695k overspend for March 2011 -£278k ------Savings to Nov 2010 are showing 100% achieved to date % % % % % %

Cash Efficiencies % 0 0 0 0 0 0 against trajectory. Plans being developed to find the as yet E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 3 0 0 0 0 0 0 Monthly unachieved savings 100% 6 1 1 1 1 1 1

Electronic Management of Referrals

Increase the % of new GP outpatient referrals into consultant led % % % % % % % E7.KPM1 secondary care services managed electronically to 90% from Dec 2010 Mar-10 3 8 2 9 6 6 9 Monthly Note that trajectory has been reprofiled for 2010/11 86% 8 8 8 7 8 9 9

KSF and Personal Development Plan % % % % % % % % 9 4 5 6 7 0 6 8 1 8 2 0 1 9 7

80% of staff to have had a KSF/PDP review, completed and recorded ...... If all existing Review documents were signed off the figure 0 E10.KPM1 on E-KSF by March 2011 Mar-10 . 0 3 6 8 9 2 0 Monthly would be 64.83% (01/12/10)

5.25% 8 1 1 1 1 1 2 3 NHS HIGHLAND BALANCED SCORECARD 2010/11 NORTH HIGHLAND CHP HEAT TARGETS

Date of Latest Reported Period Reporting Outturn Measure & DetailIndicator CommentsHEAT outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Access to Services 18 Weeks Referral to Treatment - Admitted Performance Of those admitted patients that can be measured what % were seen A10.KPM1a within18weeksfromReferraltoTreatment Monthly DataonlymonitoredatHighlandlevel 18 Weeks Referral to Treatment - Admitted Completeness % of admitted patients that we can measure on a 18 weeks referral to A10.KPM1b treatmentpathway Monthly DataonlymonitoredatHighlandlevel 18 Weeks Referral to Treatment - Non-admitted Performance Of those non-admitted patients that can be measured what % were A10.KPM1c seen within 18 weeks from Referral to Treatment Monthly Data only monitored at Highland level 18 Weeks Referral to Treatment - Non-admitted Completeness % of non admitted patients that we can measure on a 18 weeks referral A10.KPM1d totreatmentpathway Monthly DataonlymonitoredatHighlandlevel Inpatient/Day Cases Waiting Times: Maximum Wait 9 Weeks No patient to wait longer than 9 weeks from being placed on waiting list to admission for an inpatient or day case procedure from 31 March A10.KPM3 2011 Mar-10 Monthly November 2010 figures are provisional 0 0 0 0 0 0 0 0 1 Drug Treatment: Referral to Assessment.

By Dec 2010, 90% of clients referred for treatment will receive a date % % Sept 2010 figures represent very small numbers (3 0 3

A11.KPM1 for assessment that falls within 4 weeks of referral received . 5 3 Quarterly patients) Drug Treatment: Assessment to Treatment % %

By Dec 2010, 90% of clients will receive a date for treatment that falls 0 0 0 0

A11.KPM2 within 4 weeks of their care plan being agreed. 1 1 Quarterly Alcohol Treatment: Referral to Treatment By Dec 2010 90% of clients referred for treatment will receive a date for A11.KPM3 treatment that falls within 4 weeks of their care plan being agreed No performance measure for this indicator in 2010/11 Trajectory for 2010/11 not yet established. This CHP does Faster access to Specialist Child & Adolescent Mental Health not use iSoft for CAMHS, and figures may be being under- Services (CAMHS) reported at present. A robust reporting system requires to By March 2013 no one will wait longer than 26 weeks from referral to be put in place to enable accurate completion of Balanced A12.KPM1 treatment Monthly Scorecard. 0 0 0 0 0 0 0 Treatment Appropriate for Patient

Hospital Admission For Long term Conditions 2 Provisional figures due to under-reporting - ISD data 7

Reduce bed day rates (for COPD, Asthma, Diabetes, CHD) to 0 excludes current (longstay) inpatients. Continually revising T6.KPM1 9130/100,000 by Mar 2011. Apr-Mar 10 2 Preceding Year the reporting method. 11,445 1 QOF Calculator figures now available. In September 3 practices didn't report (about 48 patients). In October 1 Dementia practice didn't report (about 33 patients). The November

Increase nos of patients' with an early diagnosis & management of 6 8 8 5 4 1 1 figure includes 2 practices which didn't report - for these

T9.KPM1 dementia to 346 by Mar 2011 Jan-Mar 10 5 6 6 7 2 7 9 Preceding Year practices, the October register has been reported.

264 2 2 2 2 2 2 2 Reduction in Emergency Bed Days for Patients Aged 65+ Provisional figures due to under-reporting - ISD data Reduce emergency inpatient bed days for aged 65+ by Mar 2011 to 4

2 excludes current (longstay) inpatients. Continually revising

3238 per 1000 pop'n Apr-Mar 09 4 Quarterly the reporting method.

T12.KPM1 3,661 3 NHS HIGHLAND BALANCED SCORECARD 2010/11

NORTH HIGHLAND CHP STANDARDS SHEET

Date of Latest Reported Period Reporting Indicator HEAT Measure & Detail Outturn Comments outturn APR MAY JUN JUL AUG SEP OCT Nov DEC JAN FEB MAR Period Health Improvement % % 3 5

Immunisations - MMR1 . . 4 3

Monitor MMR1 uptake rates (% at 5 years old). Target 95% uptake nationally 93.7% Jan-Mar 10 9 9 Quarterly Efficiency Reporting monthly (run mid month) with a 2 month lag averaging over 3 month period. Please note the target has SMR Return Rate been changed from 90% to 95% after discussion with ISD. All % % % % % 5 5 4 1 3

Monitor % of SMR01 returns received (2 month lag averaging over 3 month . . . % . . previous colour coding has been amended to reflect this 6 3 3 4 6 4

period). National target is 95% complete in 6 wks from end of discharge 94.4% Mar-10 9 9 9 9 9 9 Monthly change

Completed Complaints % % % % %

Monitor % of completed complaints resolved within 4 weeks. 0 0 % 0 0 0 % ) ) ) ) ) ) ) 0 0 7 0 0 0 0 1 1 6 1 1 3 2

Target=80% of complaints responded to within 4 wks 75% (4) Mar-10 1 ( 1 ( 6 ( 1 ( 1 ( 1 ( 5 ( Monthly Information from the complaints database on 30T November. Sickness Absence 5.41% 4.90% 4.03% 4.28% 3.35% 3.24% 4.39% 4.08% Monthly Actual Achieve a sickness absence rate of 4% from 31 March 2009 5.28% Mar-10 5.00% 4.96% 4.95% 4.91% 4.89% 4.89% 4.89% Annual Rolling Efficiency Savings: Review to New Outpatient Attendance Ratio

Improved efficiencies by March 2011 to reduce the ratio of return to new 0 0 9 6 4 4 5 Preceding Note: This measure is now being measured on consultant led 2 2 1 1 1 1 1 ......

outpatient attendances to 1.14 1.21 Mar-10 1 1 1 1 1 1 1 Year activity only. Access to Services New Outpatient Waiting Times: Maximum Wait 12 Weeks No patient to wait longer than 12 weeks from referral from all sources to 1st

outpatient appointment from 31 March 2010 29 Mar-10 0 1 0 0 0 0 0 0 Monthly November 2010 figures are provisional A&E Waits To Be A Maximum of 4 Hours

Increase nos of patients waiting under 4 hours from arrival to treatment to % % % % % % % % 9 9 9 9 9 9 9 9

98% by March 2009. 99% Mar-10 9 9 9 9 9 9 9 9 Monthly 8 Key Diagnostic Tests

No patients waiting over 6 weeks by March 2009. 0 Mar-10 0 0 0 0 6 0 2 2 Monthly November 2010 figures are provisional Treatment Appropriate for Patient Delayed Discharges

To have no clients waiting over 6 weeks by April 2010 1 Mar-10 0 1 2 1 2 2 1 0 Monthly Cervical Screening rate Monitor % of 20-60 yr old women screened. Target is 80% Uptake as per % % 3 1

smear history within last 5 yrs for women aged 21-60 yrs no the LDP target of . . 2 2

5.5 yrs for women aged 20-60 yrs 82.6% Jan-Mar 10 8 8 Quarterly

Figures have been reworked on the basis of the most up-to- date CHI population (Sept 2009) which can be broken down Prescribing of Antidepressants to CHP level. Because CHI population is 10,497 greater 5 8 8 0 4

Reduce the prescribing rate (DDD per capita) of antidepressants to 36.1 by . . . . . than GRO population (used to calculate the HEAT target), 8 8 8 9 9

March 2010 38.253 Mar-10 3 3 3 3 3 Monthly the apparent prescribing rate is less than previously shown. Reduction in Psychiatric Readmissions Reduce the number of readmissions (within 1 year of stay of at least 7 days) to 29 by Preceding 1

Dec 2009) 26 Jan-Mar09 2 Year NHS HIGHLAND BALANCED SCORECARD 2010/11 MID HIGHLAND CHP HEAT TARGETS

Achieve 116 interventions for child healthy weight intervention 2 7 Cumulative trajectory of 14 (71%) and 107 mini X against trajectory of H3.KPM1 programme by 2010/11, for the number of 5-15 year olds 4 4 0 3 6 1 1 Monthly 40 (268%) 54 Mar-10 5 5 6 7 7 1 1 Alcohol Brief Interventions

Achieve 2322 brief interventions in line with SIGN 74 guidelines by 8 4 2 7 2 6 2 Cumulative H4.KPM1 2010/11 Mar-10 6 7 8 8 1 2 3 Monthly Trajectory for Oct = 1125 268 2 2 2 2 3 3 4 Suicide Prevention

50% of key frontline staff educated & trained in using suicide % % % % % % % % Cumulative H5.KPM1 assessment tools/prevention training programmes by 2010 3 3 9 9 9 4 8 0 Monthly Trajectory for Nov = 47% 23% Mar-10 2 2 2 2 2 4 4 5 Smoking Cessation 7 4 4 3

8% of smoking population successfully quitting (at one month post quit) 0 5 0 4 9 3 6 Cumulative H6.KPM1 from 2008/09 to 2010/11. Achieve 1369 by Mar 2011 3 0 8 0 0 1 1 Monthly Trajectory for Oct = 1069 757 Mar-10 8 9 9 1 1 1 1 Breast Feeding at 6-8 Weeks New-born babies exclusively breastfed at 6-8 weeks review to increase Preceding 4 H7.KPM1 from 28.8% in 2006/07 to 36% in 2010/11 34.1% Jan-Mar 10 Quarters Awaiting data from ISD. June qtr due mid December Child Fluoride Varnish Applications Achieve at least 60% of 3 and 4 year old children in each SIMD quintile Reporting is on a quarterly basis and shows the worst to receive at least 2 applications of fluoride varnish per year by March performing quintile. The baseline data was received on

H9.KPM1 2014 Jan-Mar 10 % Quarterly 28.9.10 and a trajectory is now to be agreed

2.1% 0 Efficiency Efficiency Savings: Same Day Surgery Improved efficiencies by March 2011 to increase day case rate to % % % % % % % 7 4 0 4 2 5 0

76.3%. The number of BADS surgical procedures performed in a day ...... NOTE - THIS TARGET IS NOW MEASURED ON A E4.KPM1 case or outpatient setting Mar-10 0 4 5 0 1 2 5 Preceding Year MONTHLY BASIS NOT ROLLING YEAR 53.7% 6 6 7 6 7 8 8

Efficiency Savings: Emergency Inpatients Average Length of Stay Improved efficiencies by March 2011 to reduce non-routine inpatient 7 8 7 6 6 E4.KPM2 average length of stay to 4.8 Mar-10 . . . . . Preceding Year No update available from ISD 4.9 4 4 4 4 4 Efficiency Savings: New Outpatient Appointment DNA rates

Improved efficiencies by March 2011 to reduce 1st outpatient % % % % % % % Note: This measure is now being measured on consultant 1 0 9 8 7 5 4 E4.KPM4 attendance DNA rate to 5.6% Mar-10 ...... Preceding Year led activity only. 7.7% 8 8 7 7 7 7 7

Reduce Pre-operative Stay 2 4 3 1 9 0 7 7 7 7 6 7

Improved efficiencies by March 2013 to reduce pre-operative stay by ...... 0 0 0 0 0 0

E4.KPM5 20% to 0.75 days for elective surgery Mar-10 0.72 Financial Performance 8 4 6 8 5 9 8

Operate within agreed revenue resource and capital resource limits, 7 2 2 4 2 9 9 Forecast position at 30th Nov 2010 continues to improve 5 5 5 5 5 2 2

E5.KPM1 and meet cash requirement. Mar-10 £ £ £ £ £ £ £ Preceding Year and is showing a £0.298m overspend for March 2011 -£331k ------% % % % % %

Cash Efficiencies % 0 0 0 0 0 0 Savings to Nov 2010 are showing 100% achieved to date E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 9 0 0 0 0 0 0 Monthly against trajectory with 100% forecast to achieve 87% 9 1 1 1 1 1 1

Electronic Management of Referrals %

Increase the % of new GP outpatient referrals into consultant led % % % % 0 % % E7.KPM1 secondary care services managed electronically to 90% from Dec 2010 Mar-10 0 6 6 0 0 7 1 Monthly Note that trajectory has been reprofiled for 2010/11 97% 9 8 8 8 1 7 9

KSF and Personal Development Plan % % % % % % % % 4 1 6 4 8 5 7 1 7

80% of staff to have had a KSF/PDP review, completed and recorded . If all existing Review documents were signed off the figure 6 1 1 8 4 1 6 E10.KPM1 on E-KSF by March 2011 Mar-10 ...... 1 Monthly would be 40.09% (01/12/10)

0.47% 1 2 3 3 4 6 7 1 NHS HIGHLAND BALANCED SCORECARD 2010/11 MID HIGHLAND CHP HEAT TARGETS

By Dec 2010, 90% of clients referred for treatment will receive a date % % 5 3

A11.KPM1 for assessment that falls within 4 weeks of referral received . 8 7 Quarterly Drug Treatment: Assessment to Treatment %

By Dec 2010, 90% of clients will receive a date for treatment that falls 0 % 0 5

A11.KPM2 within 4 weeks of their care plan being agreed. 1 9 Quarterly Alcohol Treatment: Referral to Treatment By Dec 2010 90% of clients referred for treatment will receive a date for A11.KPM3 treatment that falls within 4 weeks of their care plan being agreed No performance measure for this indicator in 2010/11 Trajectory for 2010/11 not yet established. This CHP does Faster access to Specialist Child & Adolescent Mental Health not use iSoft for CAMHS, and figures may be being under- Services (CAMHS) reported at present. A robust reporting system requires to By March 2013 no one will wait longer than 26 weeks from referral to be put in place to enable accurate completion of Balanced A12.KPM1 treatment Monthly Scorecard. 0 0 1 0 0 3 2

Hospital Admission For Long term Conditions Provisional figures due to under-reporting - ISD data 7

Reduce bed day rates (for COPD, Asthma, Diabetes, CHD) to 1 excludes current (longstay) inpatients. Continually revising T6.KPM1 8890/100,000 by Mar 2011. 0 Preceding Year the reporting method. 8112 Apr-Mar10 8 QOF Calculator figures now available. In Sept 3 practices didn't report (about 62 patients). In Oct 2 practices didn't Dementia report (about 51 patients). The November figure includes 3

Increase nos of patients' with an early diagnosis & management of 2 3 5 9 5 6 5 practices which didn't report - for these practices, the

T9.KPM1 dementia to 771 by Mar 2011 Jan-Mar 10 1 9 0 0 6 7 3 Preceding Year October register has been reported.

671 6 6 7 7 6 6 7 Reduction in Emergency Bed Days for Patients Aged 65+ Provisional figures due to under-reporting - ISD data Reduce emergency inpatient bed days for aged 65+ by Mar 2011 to 9

7 excludes current (longstay) inpatients. Continually revising

3102 per 1000 pop'n 6 Quarterly the reporting method.

T12.KPM1 2779 Apr-Mar09 2 NHS HIGHLAND BALANCED SCORECARD 2010/11

MID HIGHLAND CHP STANDARDS SHEET

Date of Latest Reported Period Reporting Indicator HEAT Measure & Detail Outturn Comments outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Health Improvement Immunisations - MMR1 % % 2 1

Monitor MMR1 uptake rates (% at 5 years old). Target 95% uptake . . nationally Jan-Mar 10 5 3 Quarterly 92.8% 9 9 Efficiency Reporting monthly (run mid month) with a 2 month lag SMR Return Rate averaging over 3 month period. Please note the target has Monitor % of SMR01 returns received (2 month lag averaging over 3 been changed from 90% to 95% after discussion with ISD. % % % % % % 8 2 6 1 9 5

month period). National target is 95% complete in 6 wks from end of ...... All previous colour coding has been amended to reflect this 6 4 5 4 0 1

discharge 78.4% Mar-10 7 8 8 8 9 9 Monthly change

Completed Complaints 0% % Monitor % of completed complaints resolved within 4 weeks. % % % 0 % % % Information from the complaints database on 30th ) ) ) ) ) ) ) 0 3 3 0 3 0 0 2 6 3 1 3 2 2 Target=80% of complaints responded to within 4 wks (4) Mar-10 5 ( 5.223 ( 4.453 ( 4.091 ( 4.673 ( 4.625 ( 4.625 ( Monthly November. Sickness Absence 4.68% 5.05 % % % % % % Monthly Actual Achieve a sickness absence rate of 4% from 31 March 2009 4.51% Mar-10 % 4.84 4.80 4.73 4.71 4.68 4.68 Annual Rolling Efficiency Savings: Review to New Outpatient Attendance Ratio 4.85

Improved efficiencies by March 2011 to reduce the ratio of return to new 9 9 2 4 4 2 3 Note: This measure is now being measured on consultant led 3 3 4 4 4 5 5 outpatient attendances to 1.56 Mar-10 ...... Preceding Year activity only. Figures for July are provisional. 1.35 1 1 1 1 1 1 1 Access to Services New Outpatient Waiting Times: Maximum Wait 12 Weeks No patient to wait longer than 12 weeks from referral from all sources to

1st outpatient appointment from 31 March 2010 29 Mar-10 0 4 0 1 0 0 1 0 Monthly November2010figuresareprovisional A&E Waits To Be A Maximum of 4 Hours %

Increase nos of patients waiting under 4 hours from arrival to treatment to % % % 0 % % % % 8 9 9 0 9 9 9 9

98% by March 2009. 98% Mar-10 9 9 9 1 9 9 9 9 Monthly 8 Key Diagnostic Tests No patients waiting over 6 weeks by March 2009. Mar-10 Monthly November2010figuresareprovisional 0 0 0 0 0 0 0 0 1

Delayed Discharges

To have no clients waiting over 6 weeks by April 2010 0 Mar-10 0 1 2 1 5 0 1 3 Monthly Cervical Screening rate Monitor % of 20-60 yr old women screened. Target is 80% Uptake as per % % 0 8

smear history within last 5 yrs for women aged 21-60 yrs no the LDP . . 1 0

target of 5.5 yrs for women aged 20-60 yrs 81.3% Jan-Mar 10 8 8 Quarterly

Reduce the prescribing rate (DDD per capita) of antidepressants to 26.9 . . . . . than GRO population (used to calculate the HEAT target), 6 6 7 7 7

by March 2010 26.5 Mar-10 2 2 2 2 2 Monthly the apparent prescribing rate is less than previously shown. Reduction in Psychiatric Readmissions Reduce the number of readmissions (within 1 year of stay of at least 7 days) to 57 by Dec 2009) Jan-Mar09 1 Preceding Year 50 4 NHS HIGHLAND BALANCED SCORECARD 2010/11 SOUTH EAST HIGHLAND CHP HEAT TARGETS

Achieve 120 interventions for child healthy weight intervention 0 3 6 6 6 Cumulative trajectory of 22 (55%) and 154 mini X against trajectory of H3.KPM1 programme by 2010/11, for the number of 5-15 year olds 2 5 1 1 6 6 6 Monthly 36 (428%) 8 Mar-10 1 2 1 1 1 1 1 Alcohol Brief Interventions 8 2 2 6 5 2 2

Achieve 2545 brief interventions in line with SIGN 74 guidelines by 6 5 1 5 2 6 4 Cumulative H4.KPM1 2010/11 Mar-10 2 3 4 4 5 6 7 Monthly Trajectory for Oct = 1748 945 1 1 1 1 2 1 1 Suicide Prevention

50% of key frontline staff educated & trained in using suicide % % % % % % % % Cumulative H5.KPM1 assessment tools/prevention training programmes by 2010 5 5 4 4 4 9 2 3 Monthly Trajectory for Nov = 55% 45% Mar-10 4 4 5 5 5 5 6 6 Smoking Cessation 1 2 7 9 8 9 1

8% of smoking population successfully quitting (at one month post quit) 2 7 2 6 2 7 1 Cumulative H6.KPM1 from 2008/09 to 2010/11. Achieve 1660 by Mar 2011 3 3 4 4 5 5 6 Monthly Trajectory for Oct = 1470 1256 Mar-10 1 1 1 1 1 1 1 Breast Feeding at 6-8 Weeks New-born babies exclusively breastfed at 6-8 weeks review to increase Preceding 4 H7.KPM1 from 28.8% in 2006/07 to 36% in 2010/11 34.7% Jan-Mar 10 Quarters Awaiting data from ISD. June qtr due mid December Child Fluoride Varnish Applications Achieve at least 60% of 3 and 4 year old children in each SIMD quintile Reporting is on a quarterly basis and shows the worst to receive at least 2 applications of fluoride varnish per year by March performing quintile. The baseline data was received on

H9.KPM1 2014 Jan-Mar 10 % Quarterly 28.9.10 and a trajectory is now to be agreed

0% 0 Efficiency

Efficiency Savings: Emergency Inpatients Average Length of Stay 8 9 8 6 1 9

Improved efficiencies by March 2011 to reduce non-routine inpatient ...... E4.KPM2 average length of stay to 15.3 Mar-10 5 8 8 8 8 7 Preceding Year No update available from ISD 16.5 1 1 1 1 1 1 Efficiency Savings: New Outpatient Appointment DNA rates % % % % % % % 7 9 0 8 3 0 0

Improved efficiencies by March 2011 to reduce 1st outpatient ...... Note: This measure is now being measured on consultant E4.KPM4 attendance DNA rate to 13.9% Mar-10 6 6 6 5 5 5 4 Preceding Year led activity only. Figures for July are provisional. 16.6% 1 1 1 1 1 1 1 Financial Performance 1 2 2 7 5

Operate within agreed revenue resource and capital resource limits, 7 7 7 8 8 Forecast position at 30th Nov 2010 is now to achieve the 8 7 7 4 3 0 0 E5.KPM1 and meet cash requirement. Mar-10 £ £ £ £ £ Preceding Year breakeven target for March 2011 £41k - - - - - £ £ Savings to Nov 2010 are showing 100% achieved to date % % % % % % %

Cash Efficiencies 0 0 0 0 0 0 0 against trajectory with 100% forecast to achieve although E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 0 0 0 0 0 0 0 Monthly some of the savings are non recurrent. 100% 1 1 1 1 1 1 1

KSF and Personal Development Plan % % % % % % % % 4 7 8 6 6 0 2 0 2 7 2

80% of staff to have had a KSF/PDP review, completed and recorded . . . If all existing Review documents were signed off the figure 2 7 4 3 2 E10.KPM1 on E-KSF by March 2011 Mar-10 . . . . . 0 4 4 Monthly would be 66.28% (01/12/10)

2.90% 3 3 4 6 8 1 1 2 NHS HIGHLAND BALANCED SCORECARD 2010/11 SOUTH EAST HIGHLAND CHP HEAT TARGETS

Date of Latest Reported Period Reporting Outturn Measure & DetailIndicator CommentsHEAT outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Access to Services Drug Treatment: Referral to Assessment.

By Dec 2010, 90% of clients referred for treatment will receive a date % % 6 7

A11.KPM1 for assessment that falls within 4 weeks of referral received . 9 9 Quarterly Drug Treatment: Assessment to Treatment

By Dec 2010, 90% of clients will receive a date for treatment that falls % % 7 7

A11.KPM2 within 4 weeks of their care plan being agreed. 9 9 Quarterly Alcohol Treatment: Referral to Treatment By Dec 2010 90% of clients referred for treatment will receive a date for A11.KPM3 treatment that falls within 4 weeks of their care plan being agreed No performance measure for this indicator in 2010/11 Trajectory for 2010/11 not yet established. This CHP does Faster access to Specialist Child & Adolescent Mental Health not use iSoft for CAMHS, and figures may be being under- Services (CAMHS) reported at present. A robust reporting system requires to By March 2013 no one will wait longer than 26 weeks from referral to be put in place to enable accurate completion of Balanced A12.KPM1 treatment Monthly Scorecard. 0 0 0 0 0 0 0 Treatment Appropriate for Patient Hospital Admission For Long term Conditions Provisional figures due to under-reporting - ISD data 8

Reduce bed day rates (for COPD, Asthma, Diabetes, CHD) to 3 excludes current (longstay) inpatients. Continually revising T6.KPM1 9130/100,000 by Mar 2011. 8 Preceding Year the reporting method. 9526 Apr-Mar10 9 QOF Calculator now in operation. All practices reported in September, but 3 practices missing from October report. Of these, one figure of about 67 is still unreported and not Dementia included in the October figure. The November figure

Increase nos of patients' with an early diagnosis & management of 3 6 4 5 0 5 2 includes 5 practices which didn't report - for these practices, T9.KPM1 dementia to 718 by Mar 2011 Jan-Mar 10 0 2 2 3 4 7 3 Preceding Year the October register has been reported. 676 7 7 7 7 7 6 7 Reduction in Emergency Bed Days for Patients Aged 65+ Provisional figures due to under-reporting - ISD data Reduce emergency inpatient bed days for aged 65+ by Mar 2011 to 2

9 excludes current (longstay) inpatients. Continually revising

3238 per 1000 pop'n 1 Quarterly the reporting method.

T12.KPM1 3313 Apr-Mar09 3 NHS HIGHLAND BALANCED SCORECARD 2010/11

SOUTH EAST HIGHLAND CHP STANDARDS SHEET

Monitor MMR1 uptake rates (% at 5 years old). Target 95% uptake . .

nationally. Jan-Mar 10 5 5 Quarterly

91.7% 9 9 Efficiency Reporting monthly (run mid month) with a 2 month lag averaging SMR Return Rate over 3 month period. Please note the target has been changed % % % % % % 6 4 2 5 7 6

Monitor % of SMR01 returns received (2 month lag averaging over 3 month ...... from 90% to 95% after discussion with ISD. All previous colour period). National target is 95% complete in 6 wks from end of discharge Mar-10 7 6 2 3 4 0 Monthly coding has been amended to reflect this change 99.3% 9 9 9 8 9 9

Completed Complaints

% % 100% Monitor % of completed complaints resolved within 4 weeks. % 0 % % 0 % ) ) ) ) ) ) ) 0 % 0 7 3 0 3 Target=80% of complaints responded to within 4 wks Mar-10 2 3 1 3 8 6 3 Monthly Information from the complaints database on the 30th November. (1) 5 ( 0 ( 1 ( 6 ( 1 ( 1 ( 3 ( Sickness Absence 5.15% 5.15% 4.90% 4.83% 4.14% 4.38% 4.90% 4.29% Monthly Actual Achieve a sickness absence rate of 4% from 31 March 2009 4.35% Mar-10 4.24% 4.27% 4.28% 4.30% 4.35% 4.42% 4.44% Annual Rolling Efficiency Savings: Review to New Outpatient Attendance Ratio

Improved efficiencies by March 2011 to reduce the ratio of return to new 8 2 6 2 1 4 6 Note: This measure is now being measured on consultant led 2 4 4 4 5 6 6 outpatient attendances to 6.13 Mar-10 ...... Preceding Year activity only. Figures for July are provisional.

7.18 7 7 7 7 7 7 7 Access to Services A&E Waits To Be A Maximum of 4 Hours % % % % % % %

Increase nos of patients waiting under 4 hours from arrival to treatment to % 0 0 0 0 0 0 0

98% by March 2009. Mar-10 9 0 0 0 0 0 0 0

100% 9 1 1 1 1 1 1 1 Monthly Treatment Appropriate for Patient Delayed Discharges To have no clients waiting over 6 weeks by April 2010 Mar-10 1 Monthly 3 0 2 1 3 4 4 1 9 Cervical Screening rate Monitor % of 20-60 yr old women screened. Target is 80% Uptake as per % % 1 8

smear history within last 5 yrs for women aged 21-60 yrs no the LDP target . . of 5.5 yrs for women aged 20-60 yrs Jan-Mar 10 1 0 Quarterly 81.3% 8 8 Figures have been reworked on the basis of the most up-to-date CHI population (Sept 2009) which can be broken down to CHP Prescribing of Antidepressants level. Because CHI population is 10,497 greater than GRO 9 3 5 8 0

Reduce the prescribing rate (DDD per capita) of antidepressants to 30.3 by . . . . . population (used to calculate the HEAT target), the apparent March 2010 Mar-10 9 0 0 0 1 Monthly prescribing rate is less than previously shown. 29.745 2 3 3 3 3 Reduction in Psychiatric Readmissions Reduce the number of readmissions (within 1 year of stay of at least 7 Figure given is for position as at 15 months previously, so June-

days) to 67 by Dec 2009) Jan-Mar09 8 Preceding Year 10 report gives Mar-09 position.

66 6 NHS HIGHLAND BALANCED SCORECARD 2010/11 ARGYLL & BUTE CHP HEAT TARGETS

Achieve 165 interventions for child healthy weight intervention 6 6 6 2 2 7 7 Cumulative trajectory of 14 (71%) and 217 mini X against trajectory of H3.KPM1 programme by 2010/11, for the number of 5-15 year olds 4 4 0 1 1 2 2 Monthly 89 (244%) 142 Mar-10 1 1 2 2 2 2 2 Alcohol Brief Interventions 6 8 1 7 5 5 1

Achieve 3691brief interventions in line with SIGN 74 guidelines by 5 1 5 7 8 3 9 Cumulative H4.KPM1 2010/11 Mar-10 6 7 8 9 0 2 2 Monthly Trajectory for Oct = 3279 459 2 2 2 2 3 3 3 Suicide Prevention

50% of key frontline staff educated & trained in using suicide % % % % % % % % Cumulative H5.KPM1 assessment tools/prevention training programmes by 2010 6 6 9 9 9 0 4 4 Monthly Trajectory for Nov = 43% 26% Mar-10 2 2 2 2 2 3 3 3 Smoking Cessation

8% of smoking population successfully quitting (at one month post quit) 1 7 9 4 0 8 6 Cumulative H6.KPM1 from 2008/09 to 2010/11. Achieve 1338 by Mar 2011 4 7 0 4 7 0 3 Monthly Trajectory for Oct = 1038 684 Mar-10 7 7 8 8 8 9 9 Breast Feeding at 6-8 Weeks New-born babies exclusively breastfed at 6-8 weeks review to increase Preceding 4 H7.KPM1 from 28.8% in 2006/07 to 36% in 2010/11 29.8% Jan-Mar 10 Quarters Awaiting data from ISD. June qtr due mid December Child Fluoride Varnish Applications Achieve at least 60% of 3 and 4 year old children in each SIMD quintile Reporting is on a quarterly basis and shows the worst to receive at least 2 applications of fluoride varnish per year by March performing quintile. The baseline data was received on

H9.KPM1 2014 % Quarterly 28.9.10 and a trajectory is now to be agreed

0% 0 Efficiency NOTE - THIS TARGET IS NOW MEASURED ON A Efficiency Savings: Same Day Surgery MONTHLY BASIS NOT ROLLING YEAR - Suspect Improved efficiencies by March 2011 to increase day case rate to significant reduction in day case rate is due to the fact that % % % % % % % 9 6 0 5 2 6 3

67.7%. The number of BADS surgical procedures performed in a day ...... now showing a monthly position emphasises the coding E4.KPM1 case or outpatient setting Mar-10 0 7 7 8 3 3 1 Preceding Year issues in Argyll and Bute CHP. 57.4% 6 5 5 5 7 6 6

Efficiency Savings: Emergency Inpatients Average Length of Stay Improved efficiencies by March 2011 to reduce non-routine inpatient 5 6 7 0 E4.KPM2 average length of stay to 6.1 Mar-10 . . . . Preceding Year No update available from ISD 6.4 6.4 6 6 6 7 Efficiency Savings: New Outpatient Appointment DNA rates

Improved efficiencies by March 2011 to reduce 1st outpatient % % % % % % % 3 3 2 2 6 9 9 E4.KPM4 attendance DNA rate to 7.4% Mar-10 ...... Preceding Year Note: Psychotherapy data is now included. 8.5% 9 9 9 9 9 9 9

Reduce Pre-operative Stay 9 9 6 5 9 7 9 9 9 9 8 8

Improved efficiencies by March 2013 to reduce pre-operative stay by ...... 0 0 0 0 0 0

E4.KPM5 20% to 0.61 days for elective surgery Mar-10 0.96 Financial Performance 0 0 0 0 0

Operate within agreed revenue resource and capital resource limits, 5 8 8 5 5 Forecast position at 30th Nov 2010 is now to achieve the 8 7 6 6 6 0 0 E5.KPM1 and meet cash requirement. Mar-10 £ £ £ £ £ Preceding Year breakeven target for March 2011 £0 - - - - - £ £ Savings to Nov 2010 are showing 76% achieved to date

Cash Efficiencies % % % % % % % against trajectory with 100% forecast to achieve although E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 3 6 8 3 5 0 6 Monthly some of the savings are non recurrent 100% 6 9 9 8 7 7 7

We are aware the the A&B figures are not reflective of the referrals with HEAT status, this is due to an issue with their SCI Outpatients and Gateway interface. Therefore referrals Electronic Management of Referrals have a status of Vetted Urgent, Vetted Routine and Vetted

Increase the % of new GP outpatient referrals into consultant led % % % % % % % which have not translated into HEAT statuses. This issue E7.KPM1 secondary care services managed electronically to 90% from Dec 2010 Mar-10 5 5 3 1 8 7 2 Monthly has now been resolved, May figure adjusted accordingly 22% 4 9 8 9 8 8 9

KSF and Personal Development Plan % % % % % % % % 1 8 2 5 3 5 2 8 1 1 4 4 1 0 3

80% of staff to have had a KSF/PDP review, completed and recorded ...... If all existing Review documents were signed off the figure 7 E10.KPM1 on E-KSF by March 2011 Mar-10 . 1 2 4 6 9 2 2 Monthly would be 62.94% (01/12/10)

5.37% 9 1 1 1 1 1 2 3 NHS HIGHLAND BALANCED SCORECARD 2010/11 ARGYLL & BUTE CHP HEAT TARGETS

Date of Latest Reported Period Reporting Outturn Measure & DetailIndicator CommentsHEAT outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Access to Services 18 Weeks Referral to Treatment - Admitted Performance Of those admitted patients that can be measured what % were seen A10.KPM1a within18weeksfromReferraltoTreatment Monthly DataonlymonitoredatHighlandlevel 18 Weeks Referral to Treatment - Admitted Completeness % of admitted patients that we can measure on a 18 weeks referral to A10.KPM1b treatmentpathway Monthly DataonlymonitoredatHighlandlevel 18 Weeks Referral to Treatment - Non-admitted Performance Of those non-admitted patients that can be measured what % were A10.KPM1c seen within 18 weeks from Referral to Treatment Monthly Data only monitored at Highland level 18 Weeks Referral to Treatment - Non-admitted Completeness % of non admitted patients that we can measure on a 18 weeks referral A10.KPM1d totreatmentpathway Monthly DataonlymonitoredatHighlandlevel Inpatient/Day Cases Waiting Times: Maximum Wait 9 Weeks No patient to wait longer than 9 weeks from being placed on waiting list to admission for an inpatient or day case procedure from 31 March A10.KPM3 2011 Mar-10 Monthly September 2010 figures are provisional 5 8 0 0 0 0 0 0 Drug Treatment: Referral to Assessment. Data for Qtr 1 is unvalidated at present. This data excludes

By Dec 2010, 99% of clients referred for treatment will receive a date % voluntary sector/services data. No data has been provided 6

A11.KPM1 for assessment that falls within 4 weeks of referral received . 9 Quarterly as yet for Qtr 2 Drug Treatment: Assessment to Treatment Data for Qtr 1 is unvalidated at present. This data excludes %

By Dec 2010, 90% of clients will receive a date for treatment that falls 0 voluntary sector/services data. No data has been provided 0

A11.KPM2 within 4 weeks of their care plan being agreed. 1 Quarterly as yet for Qtr 2 Alcohol Treatment: Referral to Treatment By Dec 2010 90% of clients referred for treatment will receive a date for A11.KPM3 treatment that falls within 4 weeks of their care plan being agreed No performance measure for this indicator in 2010/11 Faster access to Specialist Child & Adolescent Mental Health Services (CAMHS) By March 2013 no one will wait longer than 26 weeks from referral to A12.KPM1 treatment Monthly 3 3 2 4 4 7 7 Trajectory for 2010/11 not yet established. Treatment Appropriate for Patient Hospital Admission For Long term Conditions Provisional figures due to under-reporting - ISD data 7

Reduce bed day rates (for COPD, Asthma, Diabetes, CHD) to 6 excludes current (longstay) inpatients. Continually revising T6.KPM1 9130/100,000 by Mar 2011. Apr-Mar10 6 Preceding Year the reporting method. 8108 7 QOF Calculator figures now available - all A&B practices Dementia reported except in November. The November figure

Increase nos of patients' with an early diagnosis & management of 5 5 2 6 1 9 8 includes 1 practice which didn't report. For this practice, the

T9.KPM1 dementia to 825 by Mar 2011 Jan-Mar 10 2 2 3 4 4 2 4 Preceding Year October register has been reported.

577 5 6 6 6 6 6 6 Reduction in Emergency Bed Days for Patients Aged 65+ Provisional figures due to under-reporting - ISD data Reduce emergency inpatient bed days for aged 65+ by Mar 2011 to 5

9 excludes current (longstay) inpatients. Continually revising

3238 per 1000 pop'n 2 Quarterly the reporting method.

T12.KPM1 3411 Apr-Mar09 3 NHS HIGHLAND BALANCED SCORECARD 2010/11

ARGYLL & BUTE CHP STANDARDS SHEET

Monitor MMR1 uptake rates (% at 5 years old). Target 95% uptake . .

nationally Jan-Mar 10 4 6 Quarterly

91.3% 9 9 Efficiency SMR Return Rate Reporting monthly (run mid month) with a 2 month lag averaging over 3 month Monitor % of SMR01 returns received (2 month lag averaging over 3 period. Please note the target has been changed from 90% to 95% after % % % % % % 1 8 5 6 1 4

month period). National target is 95% complete in 6 wks from end of ...... discussion with ISD. All previous colour coding has been amended to reflect discharge Mar-10 1 8 4 8 8 7 Monthly this change 72.3% 8 8 8 8 8 9 Completed Complaints

71% Monitor % of completed complaints resolved within 4 weeks. % % % % % % ) ) ) ) ) ) ) % 7 9 3 3 3 3 Target=80% of complaints responded to within 4 wks Mar-10 2 3 7 6 3 6 3 Monthly Information from the complaints database on 30th November (7) 0 ( 6 ( 2 ( 3 ( 3 ( 3 ( 3 ( Sickness Absence 4.34% 5.04% 5.12% 4.65% 5.32% 5.69% 5.51% 5.58% Monthly Actual Achieve a sickness absence rate of 4% from 31 March 2009 5.08% Mar-10 5.11% 5.12% 5.10% 5.09% 5.10% 5.08% 5.09% Annual Rolling Efficiency Savings: Review to New Outpatient Attendance Ratio

Improved efficiencies by March 2011 to decrease return to new outpatient 1 2 4 3 5 5 7 Note: This measure is now being measured on consultant led activity only. 0 0 0 0 0 0 0 attendance to 1.72 by December 2010 Mar-10 ...... Preceding Year Psychotherapy data is now included.

1.74 2 2 2 2 2 2 2 Access to Services Cataract Waiting Times (Outpatient) Reduce nos of patients waiting over 9 weeks for outpatient treatment to 0 Mar-10 Monthly by Dec 2007 0 0 0 0 0 0 0 0 0 New Outpatient Waiting Times: Maximum Wait 12 Weeks No patient to wait longer than 12 weeks from referral from all sources to 1st outpatient appointment from 31 March 2010 Mar-10 2 Monthly September 2010 figures are provisional 29 0 0 0 3 5 1 8 3 A&E Waits To Be A Maximum of 4 Hours

Increase nos of patients waiting under 4 hours from arrival to treatment to % % % % % % % % 98% by March 2009. Mar-10 9 9 9 9 9 9 8 9 99% 9 9 9 9 9 9 9 9 Monthly 8 Key Diagnostic Tests No patients waiting over 6 weeks by March 2009. Mar-10 Monthly

0 0 0 0 0 0 0 0 0 Treatment Appropriate for Patient Delayed Discharges To have no clients waiting over 6 weeks by April 2010 Mar-10 Monthly 1 0 0 0 0 0 0 0 0 Cervical Screening rate Monitor % of 20-60 yr old women screened. Target is 80% Uptake as per % % 6 3

smear history within last 5 yrs for women aged 21-60 yrs no the LDP . . target of 5.5 yrs for women aged 20-60 yrs Jan-Mar 10 9 9 Quarterly 79.8% 7 7 Figures have been reworked on the basis of the most up-to-date CHI Prescribing of Antidepressants population (Sept 2009) which can be broken down to CHP level. Because CHI 0 1 3 5 7

Reduce the prescribing rate (DDD per capita) of antidepressants to 29.3 . . . . . population is 10,497 greater than GRO population (used to calculate the HEAT by March 2010 Mar-10 2 2 2 2 2 Monthly target), the apparent prescribing rate is less than previously shown. 32.0 3 3 3 3 3 Reduction in Psychiatric Readmissions Reduce the number of readmissions (within 1 year of stay of at least 7

days) to 68 by Dec 2009) Jan-Mar09 9 Preceding Year

68 5 NHS HIGHLAND BALANCED SCORECARD 2010/11

PHARMACY TARGETS

Date of Latest Reported Period Reporting Indicator HEAT Measure & Detail Outturn Comments outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Efficiency Financial Performance Forecast position at 31st Nov 2010 is now to achieve the k k 3 1 7 1 9

Operate within agreed revenue resource and capital resource limits, and meet cash 3 9 1 0 0 7 6 breakeven target for March 2011 with an underspend projected 3 1 1 1 1 1 1

E5.KPM1 requirement. £22k Mar-10 £ £ £ £ £ £ £ Monthly for the year end % % % % %

Cash Efficiencies 0 0 0 0 0 Savings to Nov 2010 are showing 100% achieved to date against E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 % % 0 0 0 0 0 Monthly trajectory with 100% forecast to achieve 100% 0 0 1 1 1 1 1 Standards )

Completed Complaints 1 ( Monitor % of completed complaints resolved within 4 weeks. % % % % % % %

Target=60% of complaints responded to within 4 wks 0% Mar-10 0 0 0 0 0 0 0 No complaints for October Sickness Absence 4.34% 3.67% 2.49% 3.48% 3.85% 3.66% 4.70% 3.18% Monthly Actual Achieve a sickness absence rate of 4% by 31 March 2009 4.03% Mar-10 4.10% 3.77% 3.82% 3.89% 3.87% 4.01% 4.05% Annual Rolling NHS HIGHLAND BALANCED SCORECARD 2010/11

FACILITIES TARGETS

Date of Latest Reported Period Reporting Indicator HEAT Measure & Detail Outturn Comments outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Efficiency

Financial Performance 3 4 3 0

Operate within agreed revenue resource and capital resource limits, and meet cash 5 5 5 6 Forecast at 30th Nov 2010 continues to show a £ 0.154m 1 1 1 1 0 0 0 £ £ £ £

E5.KPM1 requirement. £50k Mar-10 £ £ £ - - - - Monthly overspend for March 2011 % % % % % % %

Cash Efficiencies 0 0 0 0 0 0 0 Savings to Nov 2010 are showing 100% achieved to date against 0 0 0 0 0 0 0

E6.KPM1 Meet cash efficiency target. 2% per annum 100% Mar-10 1 1 1 1 1 1 1 Monthly trajectory with 100% forecast to achieve

KSF and Personal Development Plan % % % % % % % % 6 3 7 1 5 8 8 3 7 8 4 8 1 4 4 1

80% of staff to have had a KSF/PDP review, completed and recorded on E-KSF by ...... If all existing Review documents were signed off the figure would E10.KPM1 March 2011 Mar-10 5 5 8 7 8 8 8 1 Quarterly be 56.64% (01/12/10) 23.91% 2 2 2 2 2 2 2 3 Standards Completed Complaints Monitor % of completed complaints resolved within 4 weeks. % % % % % % %

Target=60% of complaints responded to within 4 wks 0% Mar-10 0 0 0 0 0 0 0 No complaints for October Sickness Absence 2.60% 2.41% 2.44% 3.56% 3.76% 3.14% 3.07% 3.43% Monthly Actual Achieve a sickness absence rate of 4% by 31 March 2009 3.27% Mar-10 3.21% 3.06% 3.07% 3.12% 3.18% 3.17% 3.20% Annual Rolling NHS HIGHLAND BALANCED SCORECARD 2010/11 CORPORATE SERVICES HEAT TARGETS

Date of Latest Reported Period Reporting Indicator HEAT Measure & Detail Outturn Comments outturn APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Period Efficiency Financial Performance 1

Operate within agreed revenue resource and capital resource limits, and meet 2 5 8 1 2 1 Forecast position at 30th Nov 2010 continues to improve and is E5.KPM1 cash requirement. Mar-10 0 5 5 5 6 6 1 Monthly showing a £ 0.111m underspend for March 2011 £149k £ £ £ £ £ £ £ Savings to Nov 2010 are showing 100% achieved to date % % % % % % %

Cash Efficiencies 0 0 0 0 0 0 0 against trajectory, with an over achievement forecast for year E6.KPM1 Meet cash efficiency target. 2% per annum Mar-10 0 0 0 0 0 0 0 Monthly end 100% 1 1 1 1 1 1 1

KSF and Personal Development Plan % % % % % % 5 % 8 0 9 6 2 1 4 8 2 4 0 1

80% of staff to have had a KSF/PDP review, completed and recorded on E-KSF . . % . . . . . If all existing Review documents were signed off the figure would

E10.KPM1 by March 2011 Mar-10 2 3 8 9 3 6 0 6 Quarterly be 68.06% (01/12/10)

12.24% 1 1 1 1 2 2 3 3 Standards Completed Complaints

Monitor % of completed complaints resolved within 4 weeks. % ) % % % 0 % % % Target=60% of complaints responded to within 4 wks Feb-10 2 There were no complaints for October 0% 0 0 0 5 ( 0 0 0 Sickness Absence 3.08% 1.93% 1.44% 2.30% 2.75% 2.88% 2.95% 2.95% Monthly Actual Achieve a sickness absence rate of 4% by 31 March 2009 3.44% Mar-10 3.75% 3.63% 3.55% 3.48% 3.46% 3.43% 3.36% Annual Rolling NHS Highland - Primary Care Dental Services 'Action Plan'

Summary of Primary Care Dental Services performance as per the Scottish Dental Action Plan 2005 d d n e n o t e d i r a t t d l n i o u n h D a s p l a B g o l N e i h r h P & A g H

g l L h i d l t h H r H

t y H n a r d g G o i o I o r Target E COMMENTS B M H S M N A H9 - FLUORIDE VARNISH Achieve at least 60% of 3 and 4yr olds in each SIMD quintile to receive at least 2 applications of fluoride per annum by March 2014 Aug-10 0% 0% 0% 0% 0% ORAL HEALTH IMPROVEMENT

60%of5-year-oldswithnoobviousdecayexperienceby2010 2010 63.7% Update not available by CHP 60%of11-year-oldswithnoobviousdecayexperienceby2010 2009 66.8% Update not available by CHP 90%ofadultstohavesomenaturalteethby2010 Jun-05 88% Not available at CHP level 100%ofNurserySchoolsparticipatingintoothbrushingschemesby2010 Jun-1093% 100% 100% of Primary Schools in most deprived SIMD quintile participating in tooth brushing schemes by 2010. Jun-10 100% 100% 100% Develop & deliver oral health care preventive support programmes for adults in most need, such as prisoners, dependant older people and people experiencing homelessness by March 2008, to be revised to reflect delay in launch of national programmes Children's Registration by 2010 based on Patient Postcode 0-2 yr olds 55% Sep-10 34.3% 34.1% 36.0% 35.1% 32.4% As of Qtr ending 30 June 2010 ISD are reporting registrations 3-5yr olds 80% - Old HEAT Target Sep-10 80.2% 78.1% 82.0% 72.4% 84.5% by patient postcode and as a percentage of the relevant 6-12 yr olds 90% Sep-10 91.1% 95.0% 89.5% 86.2% 90.6% geographies population 0-17 yr olds 85% Sep-10 79.9% 81.4% 80.0% 73.2% 81.0% Adult Registration by 2010 based on Patient Postcode 18-64 years to 65%. Sep-10 51.7% Update not available by CHP As of Qtr ending 30 June 2010 ISD are reporting registrations by patient postcode and as a percentage of the relevant 65+ years registered to 50%. Sep-10 42.5% Update not available by CHP geographies population Out of Hours (no target date set by SGHD) Percentage of the Highland population covered by Scottish Emergency Dental Service Nov-10 100% 100% 100% 100% 100% GDP Practice participation in Scottish Emergency Dental Service Nov-10 75% 60% 86% 50% 100% HEAT E-10 Report by Operational Unit (Monthly) For Period 01/04/2009 - 30/11/2010

HEAT E10 Agreed Trajectory Permanent HEAT E10 Month End KSF Review completed and Variation from Target for Reviews 'Started' on e- Reviews 'Completed & Not Reviews at all for end November 2010 = 55% Posts1 Target2 Target3 signed off on e-KSF4 Trajectory5 this month6 KSF4 Signed Off' on e-KSF4 stages4 NHS Highland 7974 6379 4386 1946 24.4% -2440 -55.6% 2838 2271 28.5% 334 4.2% 4551 57.1% Argyll and Bute CHP 1519 1215 835 491 32.3% -344 -41.2% 420 389 25.6% 76 5.0% 956 62.9% A&BMGM-CorpFunctions 103 82 57 47 45.6% -10 -17.0% 15 27 26.2% 7 6.8% 81 78.6% A&BOtherServices 22 18 12 5 22.7% -7 -58.7% 8 2 9.1% 0 0.0% 7 31.8% CowalandButeArea 316 253 174 58 18.4% -116 -66.6% 132 70 22.2% 35 11.1% 163 51.6% DentalService(Argyll&Bute) 52 42 29 33 63.5% 4 15.4% -2 7 13.5% 1 1.9% 41 78.8% HelensburghandLomondArea 71 57 39 35 49.3% -4 -10.4% 8 18 25.4% 6 8.5% 59 83.1% MidArgyllKintyre&Islay 542 434 298 156 28.8% -142 -47.7% 169 153 28.2% 18 3.3% 327 60.3% Oban Lorn & Isles Area 403 322 222 157 39.0% -65 -29.2% 85 112 27.8% 9 2.2% 278 69.0% Corporate Services 479 383 263 173 36.1% -90 -34.3% 114 130 27.1% 23 4.8% 326 68.1% ChiefExecutive 17 14 9 13 76.5% 4 39.0% -3 4 23.5% 0 0.0% 17100.0% Clinical Governance Team 17 14 9 5 29.4% -4 -46.5% 5 4 23.5% 0 0.0% 9 52.9% CommunityCare 3 2 2 3 100.0% 1 81.8% -1 0 0.0% 0 0.0% 3100.0% eHealthServices 125 100 69 12 9.6% -57 -82.5% 63 64 51.2% 3 2.4% 79 63.2% Finance 68 54 37 22 32.4% -15 -41.2% 19 25 36.8% 11 16.2% 58 85.3% HRServices 118 94 65 66 55.9% 1 1.7% 5 16 13.6% 6 5.1% 88 74.6% MedicalDirector 3 2 2 2 66.7% 0 21.2% 0 0 0.0% 0 0.0% 2 66.7% NursingMidwifery&AHPMgt 38 30 21 10 26.3% -11 -52.2% 13 11 28.9% 3 7.9% 24 63.2% Public Health 46 37 25 40 87.0% 15 58.1% -12 6 13.0% 0 0.0% 46 100.0% Mid Highland CHP 1090 872 600 128 11.7% -472 -78.6% 526 281 25.8% 28 2.6% 437 40.1% HighlandSexualHealth 14 11 8 3 21.4% -5 -61.0% 5 2 14.3% 0 0.0% 5 35.7% LochaberArea 321 257 177 23 7.2% -154 -87.0% 170 97 30.2% 8 2.5% 128 39.9% MidCHPHotelServices 130 104 72 18 13.8% -54 -74.8% 60 2 1.5% 0 0.0% 20 15.4% MidHighlandCHPManagement 36 29 20 14 38.9% -6 -29.3% 8 14 38.9% 2 5.6% 30 83.3% OutOfHoursService 55 44 30 13 23.6% -17 -57.0% 20 15 27.3% 6 10.9% 34 61.8% RossandCromartyArea 353 282 194 30 8.5% -164 -84.5% 182 103 29.2% 7 2.0% 140 39.7% Skye and Lochalsh Area 184 147 101 27 14.7% -74 -73.3% 83 48 26.1% 5 2.7% 80 43.5% North Highland CHP 725 580 399 223 30.8% -176 -44.1% 212 205 28.3% 42 5.8% 470 64.8% CaithnessArea 402 322 221 145 36.1% -76 -34.4% 96 108 26.9% 29 7.2% 282 70.1% NorthCHPHotelServices 119 95 65 15 12.6% -50 -77.1% 56 49 41.2% 5 4.2% 69 58.0% NorthCHPManagement 24 19 13 15 62.5% 2 13.6% -1 2 8.3% 0 0.0% 17 70.8% Sutherland Area 178 142 98 48 27.0% -50 -51.0% 59 46 25.8% 8 4.5% 102 57.3%

Page24of25 24/01/2011 HEAT E-10 Report by Operational Unit (Monthly) For Period 01/04/2009 - 30/11/2010

HEAT E10 Agreed Trajectory Permanent HEAT E10 Month End KSF Review completed and Variation from Target for Reviews 'Started' on e- Reviews 'Completed & Not Reviews at all for end November 2010 = 55% Posts1 Target2 Target3 signed off on e-KSF4 Trajectory5 this month6 KSF4 Signed Off' on e-KSF4 stages4 Operational Support Services 302 242 166 94 31.1% -72 -43.4% 87 64 21.2% 7 2.3% 165 54.6% Cancer Network 13 10 7 0 0.0% -7 -100.0% 8 8 61.5% 2 15.4% 10 76.9% Facilities-Community 86 69 47 30 34.9% -17 -36.6% 22 7 8.1% 3 3.5% 40 46.5% Facilities-Raigmore 93 74 51 42 45.2% -9 -17.9% 14 4 4.3% 0 0.0% 46 49.5% IntegratedPharmacy 88 70 48 18 20.5% -30 -62.8% 35 40 45.5% 2 2.3% 60 68.2% Operational Support - Other 20 16 11 4 20.0% -7 -63.6% 8 5 25.0% 0 0.0% 9 45.0% Raigmore Hospital 2491 1993 1370 494 19.8% -876 -63.9% 1001 654 26.3% 90 3.6% 1238 49.7% Medical & Diagnostics Division 1178 942 648 306 26.0% -342 -52.8% 401 330 28.0% 65 5.5% 701 59.5% PatientSupportDivision 136 109 75 66 48.5% -9 -11.8% 16 36 26.5% 5 3.7% 107 78.7% Quality&SafetyDivision 19 15 10 3 15.8% -7 -71.3% 8 6 31.6% 0 0.0% 9 47.4% RaigmoreCentral 36 29 20 4 11.1% -16 -79.8% 18 12 33.3% 1 2.8% 17 47.2% RaigmoreHotelServices 309 247 170 0 0.0% -170 -100.0% 185 3 1.0% 0 0.0% 3 1.0% Surgical & Anaesthetics Div 814 651 448 114 14.0% -334 -74.5% 374 264 32.4% 18 2.2% 396 48.6% South East Highland CHP 1293 1034 711 314 24.3% -397 -55.8% 462 489 37.8% 54 4.2% 857 66.3% BadenochandStrathspeyArea 119 95 65 45 37.8% -20 -31.2% 26 75 63.0% 6 5.0% 126 105.9% DentalService 265 212 146 100 37.7% -46 -31.4% 59 111 41.9% 15 5.7% 226 85.3% InvernessArea 248 198 136 51 20.6% -85 -62.6% 98 110 44.4% 9 3.6% 170 68.5% MHandLDServices 456 365 251 40 8.8% -211 -84.1% 234 139 30.5% 19 4.2% 198 43.4% NairnandArdersierArea 102 82 56 46 45.1% -10 -18.0% 15 39 38.2% 2 2.0% 87 85.3% SouthEastCHPCentral 35 28 19 19 54.3% 0 -1.3% 2 5 14.3% 2 5.7% 26 74.3% South East CHP Hotel Services 79 63 43 51 64.6% 8 17.4% -4 20 25.3% 5 6.3% 76 96.2%

Notes 1. Highland and CHP figures from SWISS (27/10/2010) detail from Staff List (04/11/2010) does not include Bank or Fixed Term 2. 80% of Permanent Posts 3. Based on November's planned trajectory percentage 4. From e-KSF 01/12/2010 Below agreed trajectory On agreed trajectory Exceeding agreed trajectory 5. Cumulative Trajectory minus KSF Review completed and signed off on e-KSF (01/11/2010) 6. No. of new 'Completed & Signed Off' reviews required to meet trajectory by end of December Indicates a 5% or greater increase in overall Review activity for the month of November

Page25of25 24/01/2011 Highland NHS Board 1 February 2011 Item 3.8(b)

H4 – ALCOHOL BRIEF INTERVENTIONS (ABI) UPDATE FROM IMPROVEMENT COMMITTEE

Report by Margaret Somerville, Director of Public Health and Health Policy

The Board is asked to:

 Note the ABI delivery performance of NHS Highland against other Boards.  Endorse the importance of ABI delivery as a tool to combat excessive drinking in NHS Highland.  Sign up to review existing Service Level Agreement (SLA) and Local Enhanced Service (LES) for the target period 2011/12.  Support shifting emphasis from training to delivery of ABIs by nurses and doctors.

1 Performance across Scotland

Using performance data as at September 2010 which differs from current published data, individual Board performance against target ranges from 30% to 182% achieved. NHS Highland is placed third from the bottom of this table at 60%. 8 of the 14 (57%) boards had achieved greater than 80% of their targets at that time.

At the end of the 08/09 reporting period NHS Highland were placed 5th on the table of performance. Since then we have only increased our performance against target from 25% to 60% over a 21 month period. Other Boards however have made much greater progress. Only two Boards have a smaller increase in performance than us.

Activity undertaken by the best performing Boards and those who have had the biggest increase in the percentages delivered varies but the majority of the top performing boards have good GP involvement and performance.

There are some general key points which have proven to be helpful in some areas  Champions – specific practitioner champions for peer training/refresher/engagement. E.g. having a GP champion who is actually delivering ABIs in their practice, can talk on the same level to other GPs and share experiences. This is the same in antenatal and A&E.  Local diagnosis of barriers – particularly in Primary Care, barriers to delivery can vary from practice to practice and even from GP to GP within the same practice. Finding out what each barrier is and trying to find individual solutions to this is labour intensive, but may result in better engagement.  Focus on the positive – Focus on the well performing areas and see what they are doing then try and spread that message around.  Backing up training – if training has been undertaken refresher sessions are important to reinforce what has been trained and to build the confidence of the practitioners to deliver.

Anonymised examples of individual Board performance data and good practices are detailed below.

Board with 104% H4 achieved and a 73% increase since 08/09 Good delivery among GP practices, although some issues with delivering but not reporting.

Board with 95% H4 Achieved and an increase of 79% since 08/09 GP’s very much on board and delivering well with additional practices signing up to LES. Funding used to buy GP sessions to provide GP to GP coaching support which has worked very well. Fairly robust system in A&E with patients self-screening then the outcome relayed to primary care via discharge letters. Pursuing ABI training to be included in staff induction and viewed as mandatory at board level. Senior Management involvement at steering group level and having tackling alcohol misuse a clear priority at board level has been very effective. Clear strategy and activity plan already in place for next two years informed by the health promotion change model. Good delivery among Genital Urinary Medicine sites. Utilised funding to employ/increase hours/ refocus remit of specific nursing staff in key settings to operationally progress the embedding of the approach.

Board with 52% Achieved but an increase of 41% since 08/09 GP’s are under performing as a result of time constraints. Endeavouring to communicate to practices that as an enhanced service some additional time is required hence the enhanced payment. Current delivery is via practice nurses. Considering requesting RCGP involvement to encourage delivery by GPs. Concerned that lack of delivery/reporting of ABIs will lead to a lack of evidence of hazardous/harmful drinking in board area and impact on future funding opportunities for alcohol related work.

Board with 94% H4 Achieved and an increase of 80% since 08/09 Majority of delivery by nursing staff employed on temporary contracts until March 2011 to deliver ABIs and progress embedding of approach. Staff surveyed to ascertain what support required to deliver ABIs. Held a conference to raise awareness of benefits of ABIs this was well attended and evaluated. Have started to include ABI training with staff induction.

Board with 65% H4 Achieved but with an increase of 60% since 08/09 Delivery among GP practices has increased substantially with 90% now signed to the LES despite very limited training resources. Communicating progress in comparison to other boards and between practices (not named), appears to have led to increases in delivery. Very good delivery among sexual health services.

Board with 64% H4 Achieved but only a 33% increase since 08/09 After a good start delivery among practices has now dropped off. Discussion with GPs suggests payment level does not provide an incentive for the time required to record. A plan (details of which are not known) has been put in place to engage with poorly performing practices. Remit of substance misuse midwives been broadened out to include preventative approaches including ABI delivery.

Board with 82% H4 Achieved and an increase of 82% since 08/09 75% sign-up to LES with good delivery via GP practices. Antenatal setting working extremely well due to funding utilised to employ specific midwives to deliver and embed ABI delivery.

Board with 81% H4 Achieved and an increase of 59% since 08/09 Good delivery numbers via GP practices despite low monetary reward for screening and ABI delivery. A&E Departments use a blanket FAST screening approach followed on by information in discharge letters which are now being followed up via primary care. ABI lead at management/team leader level in each CHP regularly attends GP forums and liaises with practices to encourage delivery. Addressing alcohol related issues a clear priority for board and staff. Reporting via GPAS and paper based claims.

2 Issues affecting performance in NHS Highland

The model of delivery adopted by the Board was that the majority of our Brief Interventions would be delivered in Primary care by our GPs. Significant resources have gone into training GPs across the Board area. To date the numbers of ABIs being delivered by GPs are not enough to meet trajectory. Over the last few months training has been rolled out to a wider range of Health Professionals whose delivery of ABIs can be counted towards the H4 target.

2 Only ABIs delivered by Doctors and Nurses in particular settings are eligible to be counted. This requirement has been retained in the reporting guidance for 2011/2012. Although widening the range of health professionals delivering ABIs has increased our numbers it is not as yet by a significant enough amount to meet our Board trajectory. However, retrospective audit is proving helpful in identifying ABIs delivered but not previously recorded in the information systems developed for the purpose.

Although sign up to the LES has been positive in most CHPs (77% across the Board) very few practices are delivering the aspirational figures they identified.

GPs identified that problems with the original LES and an over complicated recording system were identified as two of the main barriers to delivery. Action was taken to review the LES and the reporting screens last year, however, the expected up turn in delivery has not been realised. Issues with the LES are not unique to NHS Highland. Having spoken with Scottish Government it is clear that many Boards have experienced problems in agreeing a LES which met the needs of the practitioners and the organisation in terms of the target. Most have reworked and revised their LES and service level agreements during the course of the target.

3 Ongoing Activity in NHS Highland to Support Delivery

Primary Care  CHPs continue to liaise on a regular basis with GPs and practices to encourage delivery.  Representation made to the GP sub committee to gain support.  Alcohol Awareness Week in October utilised for delivery of ABIs, all practices sent a letter from the Director of Public Health encouraging ABI delivery.  Trained staff and their managers provided with a breakdown of the H4 target to locality, practice and individual staff level to aid monitoring of delivery and to communicate the target as achievable.  CHP Primary Care Advisers utilising breakdown of target to support discussions with practices.  Festive sensible drinking campaign organised in partnership with Highland Alcohol and Drugs Partnership. Every practice and member of trained staff received a letter urging them to deliver ABIs as part of the campaign. Resources such as a patient self-screening FAST to help reduce time required for delivery, sensible drinking posters to set the context for raising discussion, unit tumblers and leaflets were distributed to support delivery.  Group of ABI trainers conducted a series of lifestyle health checks for NHS and Highland Council staff to maximise opportunities for ABI delivery.  Screening/ABI week initiative will be repeated in late February.  Lifestyle health checks are being organised to maximise opportunities for proactive delivery  Currently exploring a potentially significant amount of activity being delivered by practices but not recorded via ESCRO.  Database to capture activity from non GP sources has been developed and went live in October 2010. Work is underway to input records retrospectively to the database and data capture forms have been distributed to all trained staff.  Negotiations with sexual health and Well North staff have resulted in agreement to report on ABIs  Initial discussions with Primary Care Advisers highlight the need to renegotiate the LES with GP’s if notification of ongoing funding from government is received.

A&E  Audit undertaken in Raigmore A&E department to identify any alcohol screening and brief intervention activity. The audit examined A&E admission documents from

3 November 2009 to February 2010. During this period the EDIS information system reported no alcohol screening and brief interventions. The audit applied the FAST alcohol screening tool criteria to information written in A&E admission notes. This found that A&E staff are screening patients for alcohol (although not using the recommended screening tool), but are not recording this on the EDIS information system.  Information has been fed back to clinicians and managers, and discussions have taken place with a CHP to explore options for the role of the hospital mental health liaison team in providing follow up for patients who screen positive.  All three main A&E sites took part in the festive campaign and agreed to encourage patients to self-screen and where appropriate deliver brief interventions if there was time available. The outcome of this initiative will not be fully known until later this month. However, early returns suggest A&E at Caithness General has progressed from delivering no ABIs to delivering in excess of 15 during the week of the festive campaign.  Discussions to encourage A&E departments to include screening and ABIs in their documentation.  Belford A&E has devised a very simple format for recording screening and ABIs in their patient documentation sent on to GP’s for action on discharge.  Attempts to replicate this care pathway in other A&E and minor injury sites are being made.  Despite concerted efforts to encourage A&E delivery, resistance in some sites continues to be challenging.

Antenatal  Almost all Highland midwives have now been trained.  Screening of all pregnant women is being encouraged; however initial feedback suggests there are very few positive screens.  Where women screen negative, midwives appear to be pursuing discussions about the benefits of abstinence as a good practice measure.  Reports from some midwifery sites suggest staff have been using the Scottish Birth Record (SBR) electronic reporting system to record ABI activity as opposed to the paper-based forms.  Progressing a retrospective audit of midwifery records.  Exploring potential for delivering ABIs via breastfeeding initiatives.

Retrospective data  Exercise to capture retrospective data is currently being undertaken. This is subject to operational units identifying resources to undertake this work.  Criteria for auditing records have been developed and CHP representatives have identified appropriate services to gather retrospective data from.  SE CHP have demonstrated a significant impact on delivery numbers through auditing records retrospectively, putting them almost back on trajectory.  Efforts will continue to encourage other CHPs to invest time and energy in auditing.

Future Priorities  An ABI working group meeting is due to take place on 8 February where planning for 2011/2012 will take place. Details of the plan have still to be worked out but there is recognition of a need to review the model being used in Highland in particular shifting focus from training to investing in delivery and revising the LES in partnership with GP representatives.

Margaret Somerville Director of Public Health and Health Policy

21 January 2011

4 Highland NHS Board 1 February 2011 Item 3.9 Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.show.scot.nhs.uk/nhshighland/

DRAFT MINUTE of MEETING of the AREA CLINICAL FORUM 2 December 2010 – 1:30 pm Board Room, Assynt House, Inverness

Present Mr Quentin Cox, Area Medical Committee, Chair Dr Moray Fraser, North Highland CHP, Professional Secretary (VC) Ms Pat Wells, Patient Representative Mr Duncan Martin, Patient Representative (VC) Dr Andrew Evennett, Area Medical Committee Mr Ian Rudd, Area Pharmaceutical Committee Mr Fraser Brunton, Healthcare Scientists Mr Ray Stewart, Employee Director Dr Iain Kennedy, SE Highland CHP Mr Adrian Hart, Area Dental Committee Ms Katrina Flannigan, Argyll & Bute CHP Ms Margaret Moss, Area Nursing, Midwifery and AHP Advisory Committee

In Attendance Ms Heidi May, Board Nurse Director Dr Margaret Somerville, Director of Public Health and Health Policy Ms Gill McVicar, General Manager, Mid Highland CHP (for item 10.3 and item 11) Ms Alison Binns, Board Committee Administrator

1 WELCOME AND APOLOGIES

Apologies were noted from Ms Chrissie Lane, Dr Anne Pollock, Ms Cathy Lush, Ms Catherine Beaton, Dr Roger Gibbins, and Dr Ian Bashford.

2 MINUTE OF MEETING HELD ON 30 SEPTEMBER 2010

The minute of the meeting held on 30 September 2010 was approved subject to the following amendments:

 Page 3, item 6.1, paragraph 2, first sentence replaced with “The Forum noted that MRSA funding for screening was due to end in March 2011.”

 Page 5, item 6.4, paragraph 1, sentence beginning “Mrs Wells suggested extending …” replaced with “Mrs Wells suggested extending the use of patient diaries, The Patients’ Council had been using these.” 3 MATTERS ARISING

3.1 Healthcare Scientists

Mr Fraser Brunton reported that a group of healthcare scientists had met for the first time on 19 November 2010. The meeting was chaired by Kenny Steele, Medical and Diagnostic Divisional General Manager, and also attended by Alison Farrell recently appointed development officer to support healthcare scientist groups in Highland and Grampian. An initial constitution for the Area Healthcare Scientists Forum had been discussed; a draft would be circulated prior to the next meeting, arranged for December. A Chair for the Forum had not, as yet, been identified and it was hoped that further interest in membership could be achieved from roadshow attendees. The Forum had discussed some initial thoughts with regard to a work plan.

Mr Stewart suggested that the Forum consider contacting the Board Services team to ascertain whether administrative support would be available for the Area Healthcare Scientists Forum, as a professional advisory committee to the Board; the Forum should be entitled to this. Mr Stewart also suggested that the national science and technology week in March may provide an opportunity to raise the profile of healthcare scientists and it may useful to consider requesting a slot on the Board Development meeting around that time to inform Board members. Mr Brunton agreed to take this back to Forum members.

3.2 Decontamination

Following Mr Seago’s verbal report to the meeting on 30 September 2010 outlining the difficulties facing dental practices in relation to new standards for decontamination, Mr Hart advised the Forum that implementation of these standards was proceeding throughout dental practices despite the fact that some issues remained unresolved. He reported that continually changing goalposts had not made the process any easier. Following a query as to whether patients had been placed at risk by any of the previously accepted decontamination practices, Mr Hart stated that he did not understand this to be the case, a fact which made any cost benefit analysis in relation to the extra equipment required very difficult. Mr Hart confirmed that he had written to the Chief Dental Officer on behalf of NHS Highland in relation to this matter seeking clarification. He reported that the standards were impacting small practices particularly, especially those in remote and rural areas, and it was possible the changes may result in some closures. Grants had been available to assist with equipment upgrades however, these were no longer available. The target date for all practices to be compliant was the end of 2010.

3.3 Investing for Quality – Clinical Board

Dr Margaret Somerville updated the Forum on activity in relation to the Clinical Board since the last Area Clinical Forum. Following acceptance by the Board of the last set of proposals, further discussions had taken place and work was now underway to identify a possible membership. A report had been planned for submission to the Board on 07 December 2010 but more discussion was required prior to any further formalisation. Discussion was required around a number of areas including the professional advisory structure, the role of Managed Clinical Networks, new technologies, clinical governance guidelines and out of area referrals to ensure that there was a detailed understanding of all the pieces and how these fit together. In advance of establishment of the full Clinical Board, a core group had been identified initially to review some of the tertiary referrals and consider the options prior to providing advice to the Board.

The Area Clinical Forum discussed in some detail the Clinical Board and where the work of the group most comfortably sat. Whilst it was generally agreed that there existed considerable expertise around the table, consideration was given to whether the “political” nature of the Area Clinical Forum made it a suitable place for the detailed analytical work required by the

2 Clinical Board. The ACF was seen more as a “sounding board” for ideas although it would continue to provide clinical advice. It was agreed that this item remain on the ACF agenda as a matter arising for the foreseeable future.

3.4 Waiting List Initiatives / Access Targets

The Chair advised the Forum that he had written to Ms Elaine Mead, Chief Operating Officer (copy attached), concerning the letter received from Dr Malcolm Steven (previously circulated) and his own involvement in a situation towards the end of October 2010. As yet, no response had been received. The Area Clinical Forum discussed the governance and quality issues associated with the use of short term locums to achieve waiting list initiatives and access targets and highlighted the main concern of the appropriate follow up of patients. Mr Hart reported that similar problems had also been experienced in dentistry with access targets met but other problems created further down the line.

The Forum agreed that the matter be discussed again once a response had been received from Ms Mead.

The Forum  Noted the establishment of the Area Healthcare Scientists Forum.  Noted developments in relation to dental decontamination.  Noted the update on the Clinical Board.  Noted the position in respect of Waiting List Initiatives / Access Targets.

4 CHAIR ATTENDANCE AT PROFESSIONAL ADVISORY COMMITTEES

The Chair reported that he had not attended any Professional Advisory Committee meetings since the last meeting but hoped to timetable these in the New Year.

The Forum Noted the position.

5 AREA CLINICAL FORUM CHAIRS GROUP

The Chair reported that he had attended a meeting of the Area Clinical Forum Chairs Group the previous day, 01 December 2010, and prior to this the Chairs Group had met with the Cabinet Secretary, Nicola Sturgeon. Copies of the two briefing papers, Efficiency and Productivity Delivery Framework and Quality Measurement Framework, were tabled at the meeting.

The Quality Measurement Framework had been identified as a structure for understanding and aligning the wide range of measurement across the NHS in Scotland for different purposes. As part of this, twelve potential Quality Outcome Measures had been identified and consulted on. The key areas in which Quality Outcome Measures are recommended by the Quality Measures Technical Group are:

 Care experience  Staff engagement and potential  Healthcare associated infection  Emergency admission rate / bed days  Adverse events  Hospital standardised mortality rate  Under 75 mortality rate

3  Patient reported outcome measures (PROMS)  Self-assessed general health  Percentage of time in the last 6 months of life spent at home or in a community setting.

Information sources had been identified for most of the measures however these were not available for either adverse events or PROMS. Considerable work was still required however the Forum noted that increasingly, more structure was developing in relation to the Quality Measurement Framework.

The Efficiency and Productivity Framework was initially published in June 2009, a revised Framework was in the process of being drafted with a proposed publication date at the end of December 2010. The revised Framework focussed on improving quality and reducing cost but had an explicit link to the Quality Strategy. Six productive workstreams had been identified as follows:

 Outpatients, Primary and Community Care  Acute Services and Patient Flow  Workforce Productivity  Evidence Based Care  Procurement, Prescribing, Shared / Support Services  Service Redesign and Innovation

An executive lead would be appointed for each area.

The Chair advised that the ACF Chairs Group meets every three months however; no further meeting would take place prior to the elections in May. Electronic copies of the tabled documents would be made available to Forum members for further discussion.

The Forum Noted the update.

6 AREA CLINICAL FORUM ANNUAL WORK PLAN

6.1 Infection Control Report and Mid Year Progress Report of the Implementation of the Annual Work Plan 2010 - 2011

Ms May gave the Infection Control Update that would be presented to the Board the following week. All Boards had been asked to reduce SAB case numbers by an additional 15% from April 2010 over and above the 30% baseline reduction which meant the target for NHS Highland was no more than 46 cases by 31 March 2011. Currently the number of cases stood at 41, it was therefore extremely unlikely that NHS Highland would be able to meet its target. However, NHS Highland was performing well and its SAB rate remained the lowest of the mainland Boards in Scotland. Further work was required and it was estimated that at least 50% of infections were preventable, for example, false positive blood cultures caused by poor technique.

In respect of Clostridium Difficile, NHS Highland was set to meet its target. NHS Highland’s anti microbial prescribing rate was one of the lowest in Scotland. Currently NHS Highland had the fourth lowest rate of CDiff in Scotland however; once again, there was still work to be done including obtaining accurate data from all GP’s. Other targets were also being achieved with hand hygiene sitting at 97% compliance and cleaning compliance at 92%. In terms of elective caesareans, Ms May reported that the action plan was finally seeing results and cases were showing a downward trend. Orthopaedic Surgical Site Infections were now under 1%.

4 In summary, Ms May advised that NHS Highland was performing well. Ms Wells was keen that this information be made available to patients and the public however the Forum was aware of the constraints of using the general press for this.

Mr Rudd advised that funding for the second anti-microbial post was due to end at the end of March 2011 and expressed his concern that a reduction in resources at this time may have a negative impact. Ms May agreed to review this.

6.2 Staphylococcus Aureus Bacteraemias

This item was deferred to the next meeting of the Area Clinical Forum on 27 January 2011.

6.3 Quality Implementation Plan Group

The Chair briefly updated the Forum on activity in this area. The last meeting of the Group had been dominated by a discussion on dashboards. The Primary Care dashboard was currently undergoing testing and it was hoped that this would be live in January 2011 although this may be a little ambitious.

The Forum  Noted the Infection Control update.  Agreed that Ms May investigate funding for the second anti-microbial post, due to end in March 2011.  Agreed that the Staphylococcus Aureus Bacteraemias presentation be deferred to the next meeting.

7 CONSTITUTION / ROLE AND REMIT OF NURSING, MIDWIFERY AND ALLIED HEALTH PROFESSIONAL COMMITTEE

Ms May spoke to the circulated paper which was to be presented to the NHS Board on 07 December 2011. It had been agreed at the NHS Board meeting in April 2010 that the Area Nursing and Midwifery Committee and Allied Health Professional Committee be disbanded and a joint committee formed. The purpose of the paper was to ask the NHS Highland Board to endorse the Terms of Reference December board to get agreement to written constitution. The paper had been brought to the Area Clinical Forum prior to presentation to the Board for its comments.

The changes were intended to enhance the advisory function of the Committee, promote joint working between nurses, midwives and allied health professionals and provide adequate representation at the Area Clinical Forum.

The Forum discussed membership of the Committee and Ms May advised that securing the range of representation required by the new Committee had taken rather longer than initially hoped. A query was raised over whether dental nurses and hygienists could or should be represented on the Committee but it was agreed that these staff would sit more comfortably with their dental colleagues. However, it did appear that there was an issue over the representation of some staff. Mr Rudd advised that the Area Pharmaceutical Committee had recently discussed a similar query in respect of pharmacy technicians. Following consultation with other pharmaceutical committees, it had been agreed that this would not be appropriate however, invitations would be extended to pharmacy technicians should issues arise on the agenda of particular interest to them. Mr Stewart added that the Highland Partnership Forum was intended to provide representation for those staff not included within the professional bodies.

In relation to representation on the Area Nursing, Midwifery and Allied Health Professions

5 Committee, Mr Stewart expressed his concern that membership seemed aimed at team leaders and charge nurses as he felt that many members of staff with considerable experience were employed at other grades. A further query was raised around the wording “Membership vacancies shall be filled by nominees elected by the Committee ..”. Ms May advised that revised wording would be considered in this regard where appropriate.

Dr Somerville queried whether all professional groups were represented on some level and whether some were more empowered than others to become part of the structure. It was important that all views were heard and all staff felt able to feed into the Board decision making process.

Ms May advised that the first meeting of the new partial Committee had taken place two months ago however the full Committee was yet to hold its first meeting. It was agreed that the Committee would be reviewed nine months after the first full meeting.

The Forum  Agreed that issues relating to staff not currently represented on professional advisory committees be considered under matters arising at the next meeting.  Agreed that the wording of the Constitution be reviewed as detailed above.  Agreed that a review of the new Committee take place nine months following the initial full meeting.

8 FUTURE APPROACH TO GOVERNANCE

A letter had been received from The Scottish Government in August 2010 requesting comments on the discussion paper “Future Approach to Governance”. A summary of the NHS Highland response was circulated with the Board papers. The Forum reviewed the response. Dr Kennedy referred to item 2 of NHS Highland’s response which he felt might cause some concern to GP’s who were open to being assessed and reviewed through the Quality Outcomes Framework. It was agreed that currently, whilst extensive governance arrangements were in place none were specifically directed at GP’s.

The Forum Noted the position.

9 CONSULTATION ON THE MEDICAL CERTIFICATE OF CAUSE OF DEATH

The General Register Office for Scotland had proposed a number of changes to the Medical Certificate Cause of Death form, the consultation for which was due to end on 04 January 2011. The Area Clinical Forum reviewed the consultation document and expressed most concern over some of the language that had been used both in terms of clarity and sensitivity. Specifically under “Time of Death” further clarity was required over whether it should be “appropriate” or “approximate” and whether the title “Disposal Hazard” should be used considering family members would see the form.

The Forum Agreed that comments be forwarded in response to the consultation.

6 10 BOARD MEETING – TUESDAY 07 DECEMBER 2010

10.1 NHS Highland Updated Policies for Managing Access for Patients

The Chair referred the Forum to the NHS Highland Board paper which proposed updates to the Managing Access for Patients policy originally approved by the Board in June 2009; the update reflected changes in national policy and amendments identified since the implementation of the policy. Whilst it was acknowledged that the Policy and suggested amendments provided clear principles for admittance on the day of surgery, it was agreed that this was a substantial change for patients and may require considerable explanation. Dr Kennedy expressed his concern that the new policy may cause considerable inconvenience for patients. Extra consideration was required for especially vulnerable patients, those who may find it difficult to pay for accommodation prior to claiming this back and whether other options could be explored. The Chair advised members to contact one of the Board attendees should they have any further concerns.

10.2 eHealth Strategy

The Committee noted the paper for discussion by the Board.

Ms Gill McVicar joined the meeting

10.3 Rheumatology Services for Northern NHS Highland

As previously discussed at the Area Clinical Forum, a review of the NHS Highland Rheumatology service had been undertaken in February 2009 by an independent consultant, the report for which had only been recently published. A paper had now been prepared by Mrs McVicar, to which Consultant Rheumatologists Dr Malcolm Steven and Dr John Harvie had also contributed, for the Board on Tuesday 07 December 2010.

Mrs McVicar advised that the initial review had been initiated to address pressures resulting from new national standards of care including rapid access to specialist care for patients with suspected rheumatoid arthritis, to safely administer new ‘biologic’ treatments and to meet new waiting time targets. The NHS Board paper made a number of key recommendations, central to these was the establishment of a rheumatology day case / infusion service in Dingwall and a multi-speciality infusion service at Raigmore, with plans to set up further units across Highland where a need had been identified. Mrs McVicar confirmed that the establishment of this service would incur some limited investment however, infusion skills were transferable and would benefit a range of conditions.

11 ACF DEVELOPMENT SESSION – 10 DECEMBER 2010

The Area Clinical Forum discussed the proposed development session the following week which was to be facilitated by Mrs McVicar. A decision was taken that the session would go ahead despite the fact that only a limited number of members could attend. The initial discussion focussed on possible areas for consideration with a number of suggestions including:

 clarity around what was expected from members of the Forum and how constituencies should best be represented  carry out a gap analysis in relation to CEL 16(2010)  encouraging involvement in the professional advisory committees and their role  reviewing the workplan  the role of the Area Clinical Forum and how proactive / reactive it should be.

7 Ms May suggested that the Area Clinical Forum may wish to consider its role in terms of clinical leadership. Whilst it was acknowledged that the reactive role of the Forum was important, and that the Forum did this well, further consideration was required as to how it could increase its visibility and establish more of a leadership role.

Consideration was given to what was expected from the development session. Ms McVicar suggested it would be useful to start the session with a review of the Strategic Framework and lay the foundation for future development of the Area Clinical Forum in line with this and CEL 16(2010). Members were asked to consider why they were involved in the Forum and what they hoped to achieve.

The Forum Noted the position.

Ms Gill McVicar and Ms Katrina Flannigan left the meeting

12 MINUTES / REPORTS FROM PROFESSIONAL COMMITTEES AND OTHER MEETINGS

12.1 Area Nursing, Midwifery and AHP Advisory Committee

Ms May referred to the Neurological Health Services QIS Standards Improvement Plan circulated with the Forum papers. A mapping process and gap analysis against the new standards was currently underway.

A copy of the Local Supervising Authority Midwifery Officer Annual Report had been circulated with Forum papers. Ms May reported that NHS Highland was making good progress however some concern remained around the ration of midwifery supervisors to midwives.

12.2 Area Dental Committee

Mr Hart advised the Forum that NHS Highland was currently unable to offer a restorative care service to patients; this had previously been provided by NHS Grampian but was no longer available. With the continuing development of the maxillo facial / oncology service, NHS Highland would like to offer a local service. Currently any patient requiring restorative care would need to be referred to either Dundee or Glasgow Dental Hospitals.

12.3 Area Medical Committee

Dr Evennett provided a brief summary of items discussed at the recent Area Medical Committee including:

 the gradual transfer of work from secondary to primary care and the usefulness of mapping this, Dr Ian Bashford would write to the Chair of the Area Clinical Forum concerning this matter  bereavement services and the fact that care should be taken not to over medicalise bereavement  the draft consultation on the NHS Highland Wound Management Guidelines and Product Formulary had been well received although a request for an electronic version and idiots guide would be made  lack of primary care input to the anti-coagulant monitoring service.

The Forum Noted the minutes of the various professional advisory committees and further updates provided.

8 13 FOR INFORMATION

13.1 Attendance Record

The Forum Noted the circulated document.

14 ANY OTHER COMPETENT BUSINESS

14.1 NHS Highland Wound Management Guidelines and Product Formulary – Revised Draft for Consultation

The Chair referred to the draft Wound Management Guidelines and Product Formulary, comments for which had been requested by 31 December 2010. Whilst he appreciated the considerable content of the document, he felt that there were a number of gaps and some areas that required further attention. Ms May advised that the information provided was the best usage information available both nationally and across Britain which had been collated by the Royal College of Nursing. One area discussed at some length by the Forum that had been omitted was nutrition. Ms May confirmed that comments would be forwarded and the appropriate changes made.

14.2 Other

The Chair advised members that, with the resignation of Mary Wilson, the Area Clinical Forum was currently without a Vice Chair. Members were asked to reflect on whether they would like to be considered for this position. Nominations should be provided to the Board Committee Administrator for consideration at the meeting on 27 January 2011.

The Forum  Agreed that comments on the Wound Management Guidelines forwarded as appropriate.  Agreed that members consider nominations for the position of Vice Chair.

15 DATE OF NEXT MEETING

The next meeting would be held on Thursday 27 January 2011 at 1.30pm in the Board Room, Assynt House, Inverness.

The meeting closed at 5.15 pm.

9 Highland NHS Board 1 February 2011 Item 3.10 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 HEALTH and SAFETY COMMITTEE 18 November 2010 – 10.30 am Board Room, Assynt House

Present Ms Elspeth Caithness, Joint Chair Ms Elaine Mead, Joint Chair Mr Bill Brackenridge, Non-Executive Director, NHS Highland Ms Lorraine Coe, North Highland CHP, deputising for Pauline Craw ( videoconference) Mr Stephen Don, UNITE – AMICUS Section, Raigmore Hospital Mrs Anne Gent, Director of Human Resources Mr Iain King, CSP Mr Derek Leslie, General Manager, Argyll & Bute CHP (videoconference) Mrs Janette McQuiston, UNISON Ms Caroline Parr, Partnership Support Officer Mr Colin Shields, Health and Safety Adviser, Mid Highland CHP

In attendance Mr Fraser Brunton, Radiation Protection Ms Fiona Campbell, Clinical Governance and Risk Management, Argyll & Bute CHP (videoconference) Mr Eric Green, Estates (videoconference) Mrs Mirian Morrison, Clinical Governance Development Manager Mrs Diane Stark, Infection Control Mr Bob Summers, Head of Health & Safety Miss Irene Robertson, Board Committee Administrator

1 WELCOME AND APOLOGIES

Welcoming everyone to the meeting, Elspeth Caithness advised that following the establishment of local Health and Safety Groups in the CHPs and Raigmore it was the intention that a representative from each of the operational units would attend the meetings of the Health and Safety Committee, to report on relevant issues emerging in their respective areas.

Apologies were received from David Babb, Trevor Bell, Pauline Craw, Gill McVicar, Ken Oates, Linda Rawlinson, Douglas Seago, Kenny Steele, Nicola Summers, Audrey Urquhart, and Jo Veasey.

2 MINUTE OF MEETING HELD ON 19 AUGUST 2010

The Minute of meeting held on 20 May 2010 was submitted. It was clarified that the Mid Highland CHP Health and Safety Groups would be meeting 10 times a year, the Lochaber Group holding four meetings and the Ross, Cromarty & West Ness/Skye & Lochalsh Group meeting six times per year. Subject to this amendment the Minute was Approved. 3 MATTERS ARISING NOT ON THE AGENDA

3.1 Release and Recruitment of Health and Safety Representatives

Elaine Mead confirmed that this issue had been raised at a recent meeting of the Highland Operational Group, when the statutory responsibilities of the organisation in relation to releasing staff to undertake their health and safety duties had been clarified. It was agreed to carry out an audit with a view to identifying the level and range of activity health and safety representatives are engaged in and quantifying the time required, and identifying challenges and barriers to releasing the representatives to enable them to fulfil their role.

The Committee:

 Remitted to Elspeth Caithness and Caroline Parr to take this work forward.  Noted that Ms Caithness would engage with colleagues who had expressed an interest in becoming health and safety representatives in order to encourage recruitment.

3.2 Fire Safety Policy – Appointment of Responsible Officers

Bill Brackenridge sought an update in relation to the appointment of responsible officers. It was agreed that a progress report would be prepared for the next meeting confirming the number of appointments made to this role and setting out plans to fill the remaining gaps.

The Committee Remitted to Bob Summers to arrange for a progress report to be submitted to the next meeting, from the Head of Facilities.

4 REPORTS BY OPERATIONAL UNITS

4.1 Verbal updates/minutes of last operational meetings a) Argyll & Bute CHP

There was circulated minute of the meeting of the Health and Safety Group held on 2 September 2010. The following points were highlighted:-

Flooring Assessment Following a re-assessment of areas previously identified as high risk, the CHP had agreed to develop a programme of flooring assessments. It was agreed that the lessons learned from this process should be shared with Health and Safety Managers in other operational units.

Mental Health in the Workplace (Stress) A stress questionnaire had been issued to staff in 2008 and the results, which had been inputted into the HSE’s assessment tool, had been used to inform the development of an action plan to address mental health issues in the workplace. The CHP proposed to repeat the exercise in order to update the data and accordingly the stress questionnaire would be re-issued to staff. The Committee agreed that the outcome of this work should be shared across the operational units.

Fiona Campbell confirmed that she would be seeking nominations for Health and Safety representatives for the Group through the Local Partnership Forum. Elspeth Caithness undertook to provide the CHP with a list of health and safety representatives. It was the intention that all the Health and Safety Groups should be jointly chaired. The Committee

2 reinforced the importance of identifying staff side representatives and facilitating their attendance at meetings. b) Mid Highland CHP

There were circulated the minute of meeting of the Lochaber Health and Safety Group held on 1 July 2010 with a copy of the Group’s workplan; and the minute of meeting of the Ross, Cromarty & West Ness/Skye & Lochalsh (RCWNS&L) Health and Safety Group held on 18 August 2010 along with the Group’s Terms of Reference.

As clarified at item 2 there were four meetings of the Lochaber Group and six meetings of the RCWNS&L Group held per year. Colin Shields explained the rationale for the difference was the size of each of the localities and the need to ensure more local issues were addressed as regularly as possible. c) North Highland CHP

The minutes of Caithness General Hospital Health and Safety Group of 23 June 2010 and the minute of the Community Health and Safety Group meeting held on 23 June 2010 were circulated. Lorraine Coe advised that discussions were ongoing regarding the arrangements for the two groups with a view to further refining the structure. d) Raigmore Hospital

The minute of the inaugural meeting of the Raigmore Health, Safety and Fire Group held on 29 September 2010 was tabled. The next meeting was planned for early December. A Joint Staff Side Chair had not yet been identified, Elspeth Caithness was undertaking this role in the interim. e) South East Highland CHP

It was noted that a Health and Safety Group had not yet been established in South East Highland CHP and that this had now been discussed with the CHP.

Discussion followed on the need to achieve a consistent approach across Highland to facilitate delivery of the health and safety agenda and enhance governance. Bob Summers advised that standard terms of reference for health and safety groups were set out in Appendix 4 of the Health and Safety Policy and Strategic Implementation Plan. He agreed to review the Appendix to ensure it provided appropriate guidance in terms of draft agendas for all the Health and Safety Groups to adopt. The Committee would also need to reflect on its agenda to ensure it was consistent with the aims of the Policy and Strategic Implementation Plan. The minutes of the meetings of the Health and Safety Groups would provide the Committee with assurance that core business was prominent on their agendas.

With regard to core business the operational units should report on any RIDDOR incidents occurring in their area. While his quarterly report to the Committee recorded any such incidents, Mr Summers suggested that he could perhaps expand this section of his report to provide more detail and ensure relevant issues were picked up. Mirian Morrison advised that the incident reports she prepared for the CHPs also identified RIDDOR reportable incidents.

4.1.1 Issues raised by Health and Safety Representatives

Elspeth Caithness advised that she had been actively seeking health and safety representatives, particularly for Mid Highland CHP. Some concern was expressed about the arrangements in this CHP regarding the number of meetings being held and the different locations and the difficulties this could pose for a joint chair and staff side representatives to attend. Colin Shields explained that the current arrangements pre-dated the new structure, and locality groups had already been established in Ross, Cromarty and Skye, however the

3 number and frequency of meetings could be reviewed. While it was felt the arrangements in Lochaber were appropriate, Elaine Mead recommended that there should be one overarching group to which the locality groups in Ross, Cromarty and Skye would report, and the minutes of this group would be submitted to the Committee. After discussion the Committee agreed that the structure in Ross, Cromarty and Skye should be reviewed and an overarching health and safety group established to provide oversight of the locality groups in that area. It was remitted to Alison Phimister, Locality General Manager, Ross, Cromarty and West Ness, to carry out this piece of work.

The Committee Agreed that a review of the structure in Ross, Cromarty and Skye be undertaken and an overarching group established to oversee the work of the locality groups in the area. This work to be carried out by Alison Phimister.

5 ADVISERS’ REPORTS

5.1 Health and Safety

Bob Summers spoke to his tabled report which detailed key developments and challenges during the period July – October 2010. Mr Summers highlighted the following points:-

Health and Safety Staffing An appointment had been made to the post of North Highland CP Health and Safety Manager. This post was shared between the CHP and the Estates Department.

South East Highland CHP remained without dedicated health and safety support, due to staff absence. Alternative support arrangements were in place in the meantime.

Compliance and Enforcement

(i) HSE Safety Management and COSHH Visit The HSE visits to Raigmore Hospital and Caithness General Hospital that took place during 9 – 12 November 2010 were discussed later in the meeting at item 6.1.

(ii) HSE RIDDOR Investigation, Raigmore Mr Summers reported on a significant incident that occurred at Raigmore in June 2010. The action plan developed to address the issues identified had been shared with the HSE who had intimated their intention to investigate the incident.

Discussion followed on the systems and processes in place to ensure significant incidents were promptly reported and investigated and appropriate action taken to ensure they did not recur. Mirian Morrison advised that the Clinical Governance Support Team was currently reviewing the Incident Management Policy and Procedures in order to further improve the process.

(iii) HSE Action Plan A rolling action plan had been drawn up to monitor progress against all outstanding HSE requirements. Mr Summers would update it on a quarterly basis for submission to the Committee. It was recommended that the Operational Units’ Health and Safety Groups should oversee progress against outstanding actions in their respective areas and notify Mr Summers of any issues or potential delays in implementation.

Iain King raised an issue regarding the distribution of HSE improvement notices to staff side representatives. Mr Summers advised that this was an organisational responsibility and he undertook to confirm that appropriate procedures were in place for disseminating this information to employees.

4 RIDDOR Incidents Mr Summers reported on a number of incidents noting that a significant number of days had been lost through sickness absence as a result of these events. Derek Leslie explained the different reporting arrangements in Argyll and Bute where locality managers reported incidents in their areas directly to HSE. He felt that having this direct link to HSE reinforced managers’ responsibility to timeously report incidents. The Committee felt that there needed to be one standard system in use and remitted to Mr Summers and Health and Safety Managers to consider and agree a procedure that would be applied across the whole of Highland.

Health and Safety Training and Competence

(i) Health and Safety Training Administration The changes to the administration arrangements had been successfully implemented. There was an issue around course availability which was being addressed.

(ii) Blended Learning Colin Shields updated the Committee on the position, noting the one outstanding issue was the potential integration of the LearnPro System with ATL. He was in discussion with both companies to progress this. A pilot would be run to test the operation of the system before rolling it out. It was acknowledged that access to computers could be an issue for some staff. A suggestion was put forward that staff could undertake the training at home as part of their normal working day. It was agreed that relevant officers would meet to discuss the issues and agree the way forward.

The Committee noted other training initiatives underway including the Passport Scheme and mandatory training being developed by NES.

(iii) Health and Safety Junior/Middle Manager Training An evaluation would be undertaken of the courses held to date with a view to their further roll out across the CHPs.

Display Screen Equipment (DSE) Assessments/Eye Care Scheme Update It was noted that the issues around the DSE software upgrade had been resolved.

First Aid (CEL43(2008) Nominations for first aiders were being sought from Raigmore, Dental Services and Estates, the nominees to attend local training at the earliest opportunity.

The Committee Noted the report and the actions being taken to address the issues identified.

5.2 Clinical Governance and Risk Management

Mirian Morrison spoke to her circulated report which detailed incident reporting activity across Highland during Quarter 2 July – September 2010. With regard to the data presented in the graphs, Mrs Morrison explained that a number of incidents were still being reviewed/awaiting final approval by the Clinical Governance Team and Health and Safety Managers. She undertook to amend the graphs to ensure clarity as to the number of incidents that had been finally approved and those awaiting sign off. She would also revisit the quality assurance process with a view to assisting managers to address issues and close off incidents in a timeous manner.

5 The Committee emphasised the importance of accurate and timely data and how it can be used to develop performance indicators and inform actions. Feedback on the impact of actions taken was also important to ensure appropriate areas were being targeted and that continuous improvement in performance was sustained.

5.3 Facilities

Eric Green reported on the development of a basic fire safety training system. A pilot was currently underway with colleagues in Argyll and Bute on the use of videoconferencing to deliver training.

In response to a query from Iain King regarding building maintenance, one of the areas highlighted by the HEI for attention, Mr Green confirmed that there was a budget for this purpose. However he acknowledged that it was challenging to maintain buildings, many of which were old, to the required standard within the limited resources available. Work was ongoing to review the Board’s assets which would inform the property strategy.

5.4 Infection Control Report

The Committee received Diane Stark’s report. It was noted that the recent HSE visit to Raigmore had identified a need to review the Needlestick Injury Policy.

5.5 Occupational Health

There was circulated report by Linda Rawlinson summarising progress in a number of areas and updating on the position regarding tendering and contract renewal.

5.6 Radiation Protection

Fraser Brunton spoke to his circulated report, noting progress made in a number of areas and detailing those areas requiring ongoing input from the Radiation Protection Service. Argyll and Bute CHP was receiving some support from NHS Greater Glasgow and Clyde in respect of radiation protection legislation.

The next statutory inspection of the Board’s compliance with IRMER in Radiology and Oncology was scheduled for 21/22 February 2011. Mr Brunton would bring any relevant issues relating to this and other visits to the Committee’s attention, as required.

A copy of the minute of meeting of the Radiation Safety Committee held on 22 March 2010 was circulated for the Committee’s information and noted.

The Committee Noted the reports, the issues identified and the actions being taken.

Mrs McQuiston left the meeting

6 TOPIC SPECIFIC ITEMS

6.1 Feedback from HSE Inspection November 2010

Mr Summers gave a brief report on the recent HSE inspection, noting in particular issues raised around compliance with COSHH, where improvement was indicated. A group was to be established, chaired by Dr Steven Ryder, Director of Occupational Health, to review the procurement and management of hazardous chemicals, and related educational and training needs.

6 Mr Summers wished to thank the staff at Raigmore and at the Caithness General Hospital for all their work in preparing for and participating in the visits. Elspeth Caithness advised that Health and Safety representatives had had an opportunity to meet with the HSE. It had been a very constructive meeting which had identified some areas where Health and Safety representatives might take a more active role.

The Committee Noted the update and would await the formal report of the HSE visits.

6.2 Health and Safety Policy and Strategic Implementation Plan

Bob Summers updated the Committee on progress with rolling out the Policy and Strategic Implementation Plan. He had already given presentations to some of the CHPs and Raigmore, and he would also be meeting with Health and Safety Managers to discuss operational aspects. A work plan was being developed, with key work streams to be identified in each area. Mr Summers proposed to bring the work plan to the next meeting with a view to identifying and agreeing priorities for action. The Committee would have oversight of the work plan and its implementation.

The Committee:

 Noted the development of a work plan to take forward the operational elements of the Policy and Strategic Implementation Plan.  Agreed to consider the draft work plan and identify priorities for action at its next meeting.  Agreed that the Committee would oversee the implementation of the work plan.

6.3 Hazard Specific Policies Update

6.3.1 Draft Policy on the Management and Control of Contractors in NHS Highland

There was tabled for the Committee’s consideration draft Policy on the Management and Control of Contractors in NHS Highland. Mr Summers highlighted the following points:-

 Page 7 Basic Health and Safety Responsibilities – NHS Contracting Managers This set out the responsibilities of, and steps to be taken by, managers to ensure that work to be done by contractors is carried out in a safe manner.

 Page 9 Induction This stated that all contractors working in any NHS location shall receive induction training appropriate to the level of work to be carried out, or the areas that will be worked on. All contractors are obliged to comply with any additional training sessions that may be offered by NHS Highland, as required.

Mr Summers advised the Committee of the need to have a pre-qualification scheme in place before the draft policy could be formally approved and rolled out. A meeting had been arranged with The Highland Council to consider options with a view to developing an accredited scheme to cover the Highland area. An approach might also be made to Argyll & Bute Council to widen out the range of opportunities in relation to the use of approved contractors. In the interim it was agreed that managers should be informed that the policy was in development and that they should follow the guidance set out in page 7 in relation to the use of contractors.

7 The Committee:

 Noted the draft Policy and the further pre-contract work that required to be done before its formal approval and roll out.  Agreed that managers should be informed of the position and advised in the meantime to adhere to the guidance as detailed in page 7 of the document regarding the use of contractors.

6.3.2 Fire Safety Policy

Eric Green advised that following its approval at the last meeting the Fire Safety Policy had been posted on the Intranet. The Committee noted that some further minor amendments required to be made to the document. It was agreed that Douglas Seago should have overall responsibility for control of the document, ensuring that it was updated as necessary.

The Committee Remitted to Douglas Seago to take responsibility for the Fire Safety Policy, ensuring that the document was updated as necessary and was accessible to staff.

6.4 Occupational Health and Safety Strategic Forum: A New Occupational Health and Safety Strategic Framework for NHSScotland

The Occupational Health and Safety Strategic Forum (OHSSFor) which was established earlier this year by the Scottish Government and the Management Steering Group of NHSScotland, was seeking feedback on the development of a new strategic framework for occupational health and safety provision for staff within NHSScotland, to replace the current strategy, ‘Towards a Safer, Healthier Workplace’, published in 1999.

Mrs Gent advised that the OHSSFor had sought input from Partnership Forums to assist with its work in developing the framework and she confirmed that the Highland Partnership Forum had discussed it at a recent meeting with a view to formulating a response on behalf of NHS Highland. Caroline Parr was leading on this piece of work. Mrs Gent felt it was also important that the Health and Safety Committee should have an opportunity to comment on the document.

In order for OHSSFor to gain effective feedback, a set of ten questions regarding the strategy had been compiled. These focussed on some key health and safety areas including violence and aggression, slips, trips and falls, musculoskeletal disorders, and mental health and well being. Mrs Gent suggested convening a small group of health professionals, managers and staff side representatives to collate views and comments and draft a response. In view of the tight timescale for submission of responses to the OHSSFor, members were asked to send their comments directly to Caroline Parr and Elspeth Caithness who would arrange for them to be considered by the group. Iain King advised that a review of musculoskeletal services was currently being undertaken and he would provide the group with feedback on this work.

The Committee:

 Noted the work ongoing to develop a new Occupational Health and Safety Strategic Framework for NHSScotland.  Remitted to its members to send their views and comments to Caroline Parr and Elspeth Caithness.

8 6.5 Horizon Scanning - Legislative Update

Mr Summers reported briefly on the topics covered in the latest Horizon Scanning Bulletin, highlighting in particular the findings of the health and safety review led by Lord Young.

The Committee Noted the issues identified.

7 ANY OTHER PREVIOUSLY NOTIFIED COMPETENT BUSINESS

7.1 NHS Highland Strategic Framework 2010/11 - NHS Highland Vision

The Strategic Framework 2010/11 was agreed at the October Board and work had begun on implementing the vision. The implementation process would have implications for the work force and the Committee was concerned that all relevant health and safety issues were captured in the work programme. It was therefore proposed that Ms Caithness and Mr Summers give some consideration to this aspect with a view to informing further discussion at the next meeting.

The Committee Agreed to give further consideration to the implications for the work force, specifically in relation to health and safety, of the implementation of the Strategic Framework and NHS Highland Vision at its next meeting.

7.2 Items for next agenda

The following items were proposed for inclusion in the agenda of the next meeting of the Committee:-

 Review of structure of Health & Safety Groups, including arrangements for and frequency of meetings  COSHH and PIN Policy related to COSHH  Strategic Framework and Vision for NHS Highland – Health & Safety issues  Occupational Health Services - Update

The Committee:

 Agreed the topics identified above for inclusion in the agenda of its next meeting.  Agreed to invite Dr Steven Ryder to speak to the Occupational Health Services update.

8 DATE AND VENUE OF NEXT MEETING

The next meeting of the Health and Safety Committee will be held on Thursday 17 February 2011 at 10.30am in the Board Room, Assynt House.

The meeting closed at 12.55 pm

9 Highland NHS Board 1 February 2011 Item 3.11 NHS Highland John Dewar Building Inverness Retail & Business Park PHARMACY PRACTICES COMMITTEE Highlander Way INVERNESS, IV2 7GE Tel: 01463 – 706814 24 August 2010 Fax: 01463 - 713844

NHS HIGHLAND - PHARMACEUTICAL LIST

Application by Gerard Samson-Dekker to provide pharmaceutical services at 30 Main Street, Newtonmore, PH20 1DA

NHS Highland’s Pharmacy Practices Committee (PPC) met on 24 August 2010 to hear the application from Gerard Samson-Dekker to provide pharmaceutical services at 30 Main Street, Newtonmore, PH20 1DA.

Decision The Committee having heard and discussed all the evidence agreed unanimously not to grant the application. The detail regarding the decision is noted below.

Neighbourhood The Applicant had presented a detailed description of the neighbourhood advising that this would commence at the “Welcome to Newtonmore” road sign on entering the village from the north and would be as the village borders Strathmashie, Laggan and Dalwhinnie.

The Committee supported the applicant’s definition of the neighbourhood and considered the detail of that neighbourhood and where the boundaries would lie. The Committee considered that the neighbourhood was defined as the settlements in the valley including Newtonmore, Laggan, Dalwhinnie and Strathmashie, which were surrounded by natural boundaries of hills and empty land between Newtonmore and Kingussie and the vacant land at Drumochter.

Adequacy It was noted that there was no pharmaceutical provision from within the defined neighbourhood. The committee then considered whether pharmaceutical services provided from outside the neighbourhood, which are currently utilised by residents of the defined neighbourhood, were adequate.

The Committee noted that since the previous pharmacy in Newtonmore had closed in 1985 the Kingussie pharmacy had been the sole provider of pharmaceutical services to the population of the neighbourhood. During that period complaints about the service had not been received by the Board. The Kingussie Pharmacy was observed to be a modern and well laid out pharmacy with a consultation room which, when the Committee visited, had not been crowded with patients waiting to collect prescriptions. The Committee noted that there are sometimes problems of unavailable stock to individual community pharmacy organisations; however, it noted that there are barriers to small pharmacies having more than one wholesaler.

The Committee noted that public transport provision was limited and the community car scheme may be unreliable but there were a slightly higher average number of cars or vans per household than the average for Highland. The committee considered how significant it would be to a rural population, used to travelling distances to access services, that existing pharmaceutical provision was three miles away from the neighbourhood. After discussion the Committee agreed that there was evidence that it was not unusual for patients to travel to access services in rural areas The population in the neighbourhood would be growing and ageing and that there was a higher than average proportion of elderly population in Newtonmore which may make it more difficult to travel, The Committee members agreed that the

PPC Decision 24 Aug 10.doc P1 Highland NHS Board 1 February 2011 Item 3.11 applicant had provided little evidence that the current level of provision of pharmaceutical services was inadequate - only anecdotal evidence that residents would like a pharmacy in Newtonmore.

The Committee also noted that the new community pharmacy contract enables the electronic transfer of information between the GP practice and the community pharmacy to reduce the requirement for the patient to visit both but does not require pharmacies to be closer to the patient than the GP practice.

Taking all these points together the Committee agreed that the defined neighbourhood population currently travelled to Kingussie to access pharmaceutical and other services and complaints had not highlighted any inadequacy. Possibly, current provision was not conveniently on the doorstep for the residents of Newtonmore but the provision of pharmaceutical services currently in place were adequate.

Necessary or Desirable The Committee, having agreed that current pharmaceutical services in the neighbourhood were adequate agreed that the application was not necessary to secure adequate services. They then considered whether the application was desirable to secure adequate services.

The Committee agreed that when the proposed housing developments go ahead there will be a significant increase in the Kingussie and Newtonmore populations. There would be scope for the current pharmacy to accommodate any subsequent increase in need for pharmaceutical services. Looking to the future as the population ages and the cost of travel increases it may become more desirable to have a pharmacy in Newtonmore.

The applicant offered to provide delivery and home visit services which whilst they may be desirable are not currently included in the contractual arrangements and could not form the basis of any decision in considering this application.

The Committee was unconvinced that the applicant had given proper thought to the sustainability of the pharmacy. It would not be in the interests of the public to open a pharmacy which could not secure, in the medium or longer term, the provision of pharmaceutical services to the population.

Any application in Newtonmore, in future, would need to present a more robust and explicit business plan, taking into account the specific needs of residents in a rural community.

Taking all these points together the Committee agreed that this application was not desirable

The Chair invited members of the Committee to vote on the application by Gerard Samson-Dekker to provide pharmaceutical services at the 30 Main Street, Newtonmore, PH20 1DA. The Committee unanimously agreed not to grant the application.

PPC Decision 24 Aug 10.doc P2 NHS Highland John Dewar Building Inverness Retail & Business Park PHARMACY PRACTICES COMMITTEE Highlander Way INVERNESS, IV2 7GE th Tel: 01463 – 706814 Tuesday, 26 October 2010 Fax: 01463 - 713844

NHS HIGHLAND - PHARMACEUTICAL LIST

Application by Community Pharmacies (UK) Limited to provide pharmaceutical services at Nairn Town & County Hospital and Primary Care Centre, Cawdor Road, NAIRN, IV12 5EE

NHS Highland’s Pharmacy Practices Committee (PPC) met on Tuesday, 26th October 2010 to hear the application from Community Pharmacies (UK) Limited to provide pharmaceutical services at Nairn Town & County Hospital and Primary Care Centre, Cawdor Road, NAIRN, IV12 5EE.

Decision The Committee having heard and discussed all the evidence agreed unanimously not to grant the application. The detail regarding the decision is noted below.

Neighbourhood

The Committee refuted the applicant’s definition of the neighbourhood as South Nairn as it did not contain within it premises such as a post office, bank, schools, council offices or church and there were only a small number of residential properties within the defined neighbourhood. They considered that the neighbourhood, as defined by the applicant, did not meet the legal test as it could not be considered as a neighbourhood for all purposes.

The Committee were in agreement that the neighbourhood was as delineated on the Nairn Framework Plan illustrated on Page 19 of the August 2009 copy of the Highland Wide Local Development Plan, a copy of which had been submitted by the applicant as evidence for the Committee in making their decision and as identified as the town of Nairn, bounded by countryside to the west, south and east and by the sea to the north of the town of Nairn.

Adequacy

The Committee, although noting that the surgery had longer weekday opening hours than existing pharmacies which were significant, felt they had not seen any substantial evidence submitted by the applicant to prove that the current provision of pharmaceutical services was inadequate but that they had seen clear evidence that the current range of existing services were satisfactory, including Saturday business opening hours and a full range of services being provided and delivered. The Committee considered the applicant’s submission of information regarding a reliant population for their defined neighbourhood, which included the practice list population for Ardersier Medical Practice. The reliant population was not resident in the defined neighbourhood but would access pharmaceutical services in the Nairn neighbourhood and it was felt that patients of the Ardersier Medical Practice were largely serviced by the Ardersier Pharmacy.

The Committee agreed that the current provision of pharmaceutical services in the neighbourhood was adequate.

PPC Decision 26 Oct 10 Nairn.doc P1 Necessary or Desirable

The Committee, having agreed that current pharmaceutical services in the neighbourhood were adequate and that the application was not necessary to secure adequate services then considered whether the application was desirable to secure adequate services.

The Committee considered that the Nairn: Enquiry by Design report presented as evidence by the applicant was still in draft form and, while development was probable there was not a sufficient increase in population to make this application desirable. Taking this into consideration and the potential for delay to development due to the current economic climate the Committee did not consider that this application was desirable.

Furthermore, the Committee noted that although access to the proposed premises was not as good as it could be that it had not been any better prior to the GP surgery moving to that site from the Lodgehill site. It was noted that a regular non-contract collection and delivery service was available from both local pharmacies. In addition the new Community Pharmacy Contract core services of Acute Medication Service and Chronic Medication Service have introduced electronic transfer of prescriptions (from practices to pharmacies) and formalised recording of the pharmacy element of the integrated care pathway. The Committee considered that the pharmacy provision in the neighbourhood reflects the approach put forward by the Scottish Government that the pharmacy profession should provide services within communities and separate from the general medical practices.

The committee noted the evidence of good working communications between the Primary Care Centre and the two existing pharmacies.

Taking all these points together the Committee agreed that this application was not desirable.

The Chair invited members of the Committee to vote on the application by Community Pharmacies (UK) Limited to provide pharmaceutical services at the Nairn Town and County Hospital and Primary Care Centre, Cawdor Road, Nairn, IV12 5EE. The Committee unanimously agreed not to grant the application.

PPC Decision 26 Oct 10 Nairn.doc P2 NHS Highland John Dewar Building Inverness Retail & Business Park PHARMACY PRACTICES COMMITTEE Highlander Way INVERNESS, IV2 7GE th Tel: 01463 – 706814 Tuesday, 9 November 2010 Fax: 01463 - 713844

NHS HIGHLAND - PHARMACEUTICAL LIST

Application by Two Lochs Dispensing Limited to provide pharmaceutical services at The Old Bakery, Strath, Gairloch, Ross-shire, IV21 2BT.

NHS Highland’s Pharmacy Practices Committee (PPC) met on Tuesday, 9th November 2010 to hear the application from Two Lochs Dispensing Limited to provide pharmaceutical services at The Old Bakery, Strath, Gairloch, Ross-shire, IV21 2BT.

Decision The Committee having heard and discussed all the evidence agreed unanimously to grant the application. The detail regarding the decision is noted below.

Neighbourhood

The Committee agreed that the neighbourhood had been clearly defined by the applicant and supported the applicant’s definition of the neighbourhood and considered the detail of that neighbourhood and where the boundaries would lie.

The Committee considered that the neighbourhood was defined as the greater Gairloch area including the settlements to the north and south of the loch and between the Poolewe, Aultbea and Laide areas, bounded by the A832, enclosing within it the area known as “The Last Great Wilderness” and very long cul-de-sac type roads leading from the A832 to Melvaig, Cove Rubha na Susan, Ormiscaig, Opinan and Mungasdale in the North West and Redpoint in the South but excluding Kinlochewe and Scoraig.

Adequacy

The Committee considered that, within the neighbourhood just agreed, there were no general pharmaceutical services, only GP dispensing services and, although it had been acknowledged that this had been adequately provided, it was not a substitute for general pharmaceutical services.

As a result, the Committee considered that the application was necessary to ensure the adequate provision of pharmaceutical services.

Necessary or Desirable

The Committee further considered whether the application was desirable. In this regard, the Committee recognised that Gairloch was a tourist area with a large number of visitors every year, though mostly in the period from about Easter time to October. In addition, a pharmacy was desirable to increase access to healthcare services and provide an additional source of information on medicines and health promotion.

The Chair invited members of the Committee to vote on the application by Two Lochs Dispensing Limited to provide pharmaceutical services at The Old Bakery, Strath, Gairloch, Ross-shire, IV21 2BT. The Committee unanimously agreed to grant the application.

PPC Decision 9 Nov 10.doc P1 NHS Highland John Dewar Building Inverness Retail & Business Park PHARMACY PRACTICES COMMITTEE Highlander Way INVERNESS, IV2 7GE nd Tel: 01463 – 706814 Thursday, 2 December, 2010 Fax: 01463 - 713844

NHS HIGHLAND - PHARMACEUTICAL LIST

Application by APPLE HEALTHCARE LIMITED to provide pharmaceutical services at Unit 1C, District Centre, Milton of Leys, INVERNESS, IV2 6GP

NHS Highland’s Pharmacy Practices Committee (PPC) met on Thursday, 2nd December, 2010 to hear the application from Apple Healthcare Limited to provide pharmaceutical services at Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP.

Decision The Committee having heard and discussed all the evidence agreed unanimously to grant the application. The detail regarding the decision is noted below.

Neighbourhood

The Committee agreed that the neighbourhood had been clearly defined by the applicant and noted that The Highland Council were building a new primary school in that area and there were plans for further development of a range of commercial units. The Committee did not believe that Inverness could be deemed as a neighbourhood as it was a city with a large population accessing a considerable range of facilities. The committee agreed that the city consisted of a number of defined neighbourhoods. It was recognised that patients would travel from across Inverness to access pharmaceutical services at whichever pharmacy most suited individuals. The Committee supported the applicant’s definition of the neighbourhood.

The Committee considered that the neighbourhood was defined from the north, the junction of the A9 and Sir Walter Scott Drive where it exits, from the southwest, going down Sir Walter Scott Drive, from the north to west going down Sir Walter Scott Drive, until reaching Leys roundabout, which cuts into Culduthel Road, turning left heading south on the B861, heading south, taking a left line onto farmland taking in Slackbuie which meets with lower Milton of Leys to which south of which is farmland and following the line to the roundabout at the B9177 which links back onto the A9.

Adequacy

The Committee considered that although current pharmaceutical services were being delivered to residents in the agreed neighbourhood, from both within the neighbourhood and from outside it. However residents had to travel quite a distance in order to access these. In addition the population was growing and, taking into account the probable future developments, the Committee were of the view that at some point in the near future pharmaceutical services would clearly become inadequate due to the increasing numbers of people resident some distance from a pharmacy and the ability of the number of local pharmacies to deliver the requirements of the new contract services to the increased numbers requiring them.

Necessary/

PPC Decision 2 Dec 10.doc P1 Contd…./

Necessary or Desirable

Consequently, the Committee considered that the application was necessary to ensure the adequate provision of pharmaceutical services into the future.

The Committee further considered whether the application was desirable. In this regard, the Committee recognised that the applicant had presented a robust business plan and that the Milton of Leys neighbourhood was an area of significant growth which was set to continue, therefore making it desirable in order to increase access to healthcare services, in the absence of any other local healthcare services e.g. medical practice by providing a source of information on medicines, healthcare advice and health promotion services.

The Chair invited members of the Committee to vote on the application by Apple Healthcare Limited to provide pharmaceutical services at Unit 1C, District Centre, Milton of Leys, Inverness, IV3 5SB. The Committee unanimously agreed to grant the application.

PPC Decision 2 Dec 10.doc P2 Highland NHS Board 1 February 2011 Item 3.12 The Highland Council and NHS Highland

Minutes of the Meeting of the Joint Committee on Children and Young People held at Badaguish Outdoor Centre, Glenmore, Aviemore on Friday 12 November 2010 at 11.30 am.

Present:

Members:

Ms P Courcha ) Mr I Gibson ) Mrs G McCreath ) NHS Highland Mr O McLennan ) Mr C Punler ) Mrs J Baird )

Mrs M C Davidson (in the Chair) ) Mr W Fernie ) Highland Council Mr D Fallows )

Officers:

Mr P Mascarenhas, Youth Development Officer, Education Culture ) and Sport Service Ms M Kinsella, Integrated Services Co-ordinator, Education, Culture ) and Sport Service Mr J McTaggart, Educational Psychologist, Education, Culture and ) HC Sport Service Ms M Forsyth, More Choices, More Chances Lead Office, Education, ) Culture and Sport Service Miss J Maclennan, Principal Administrator, Chief Executive’s Office ) Miss M Murray, Committee Administrator, Chief Executive’s Office )

Mr J King, Head of Integrated Children’s Services ) HC/NHS

Ms S Amor, Child Health Commissioner/Public Health Specialist )NHS

In attendance:

Mrs L Munro, Children’s Champion Mrs M Paterson, Children’s Champion Mrs J Douglas, Children’s Champion Mr C Munro, Highland Children’s Forum Ms F Nixseaman, Highland Children’s Forum Mrs A Brady, Care and Learning Alliance Ms A Darlington, Action for Children Ms C MacLean, Children in the Highlands Information Point + (CHIP+) Ms N Grant, Who Cares? Scotland 1. Apologies for Absence

Apologies for absence were intimated on behalf of Dr M E M Foxley, Mr A M Millar, Mrs E McAllister, Ms E MacDonald, Dr M Somerville, Mr B Alexander, Mrs R Morrison, Mr H Fraser, Ms M Paton, Mr A Geddes and Ms R Sime.

2. Declarations of Interest

There were no Declarations of Interest.

3. Minutes of Meetings

NOTED the following Minutes of Meetings:-

i. Joint Committee on Children and Young People held on 1 October 2010; ii. Child Protection Committee held on 24 September 2010; and iii. Youth Justice Strategy Group held on 6 September 2010.

Also NOTED the following in relation to the Minutes:-

Joint Committee on Children and Young People

Item 3 – Minutes of Meetings – in relation to the Play Strategy, the process for engaging third sector partners to carry out the consultation and evaluation had been agreed by the Social Work Contracts Unit and invitations to tender would now be issued. The tender documentation would invite organisations to set out the detail of the consultation process and the timeframe within which it would be carried out and that would be taken into account when evaluating the bids, with Members of the Joint Committee being kept informed; Item 5 – Measures to Address the Pressure on the Out of Authority Placements Budget – in relation to the Northern Lights project, a meeting had been arranged to discuss the outstanding fire safety issues at Neath Birches. It was anticipated that the service would come on stream in January 2011 and Members of the Joint Committee would be kept informed of progress; Item 6 – The Governance Arrangements of the Joint Committee on Children and Young People –

 a report on third sector representation on the Joint Committee would be submitted to the Committee on 21 January 2011;  discussions had taken place and work was now underway with a view to the community child health and health improvement budgets being included within the Terms of Reference of the Joint Committee;

d. Item 9 – FHC3 Action Plan – Sensory Need –

 the populated Vision Services Action Plan would be available for distribution to Members of the Joint Committee on 15 November 2010;  no decision had been made regarding the continuation of British Sign Language as a mainstream subject at Dingwall Academy and Councillor Davidson would raise the issue, and its evaluation, with the Education, Culture and Sport Service;

2 Child Protection Committee

e. Item 6 c) – Serious Case Reviews – the case of Kristofer Blatt was a non- Highland Review which was now in the public domain; and

Youth Justice Strategy Group

f. Councillor Davidson would discuss the format of the Youth Justice Strategy Group Minutes with the Chairman of the Group.

4. Revenue Budget 2010/11 – Monitoring Report

There had been circulated Report No CYP/36/10 by Jonathan King, Head of Integrated Children’s Services detailing the position of the Joint Committee for Children and Young People budget as at 1 October 2010 which continued to show a projected overspend on placements for accommodated Looked After Children and a small increase in anticipated underspends against other headings.

The current estimated year-end outturn position was an overspend of £1.431m, a slight reduction on the figure reported to the Joint Committee on 1 October 2010. The main issue was the continuing significant overspend on the Out of Authority Placements budget and urgent work was ongoing to reduce the number of placements. The projected underspends on other budget headings were predominantly as a result of unfilled vacancies and a summary of current vacancies was provided. The highest turnover was in frontline services; however, three professional posts had also become vacant. With regard to the vacant Children’s Services Worker posts, there had been a disproportionate impact in part of Inverness and a meeting had been arranged with the Integrated Services Manager and the Area Children’s Services Manager to discuss how that would be addressed.

During discussion, the following comments were made:-

 concern was expressed regarding the potential risk to children and young people as a result of holding frontline vacancies and the importance of measuring the impact on services was emphasised;  an update was sought on the educational outcomes of Looked After Children and whether improvements were being made;  the importance of setting a realistic budget for Out of Authority Placements for the next financial year was emphasised, however, it should not be to the detriment of local investment; and  the budget setting process should be based on need as opposed to demand.

In response to questions, it was explained that:-

 it was not anticipated that there would be a significant negative impact on the education of Looked After Children as a result of the two vacant Education Link Worker posts. The posts had been created prior to the implementation of Getting It Right For Every Child when the majority of Looked After Children were not in mainstream education. That was no longer the case and all Looked After Children had a Child’s Plan which specifically addressed educational need. It was therefore considered that a monitoring and performance driving role, possibly

3 within the remit of the Integrated Service Co-ordinators, would be appropriate and the posts were currently under review; and  in relation to the Surestart budget, the underspend was a combination of unfilled vacancies, reduced demand and reconfiguration of services. With regard to the figures which were produced on Surestart, there was an anomaly in that they included children attending toddler groups, not all of which were from vulnerable families. In addition, as toddler groups tended to close during the summer months, there was an apparent dip in performance which was unrelated to the delivery of services to children in vulnerable families. This was an example of why performance reporting required to be reviewed and would be discussed in detail under the following item on the agenda.

NOTED the revenue monitoring position and the management actions being taken to improve the projected outturn.

5. Proposed Quality Assurance and Audit Measures in relation to the delivery of Children’s Services

There had been circulated report No CYP/37/10 by Jonathan King, Head of Integrated Children’s Services setting out the proposed performance reporting framework and format to be used for reports to future meetings of the Joint Committee and the complex processes within the partnership which sat behind the framework. The report also proposed a performance reporting schedule linked to specified meetings of the Joint Committee.

To date, the Joint Committee had periodically received reports on the performance of various aspects of children’s services and overall performance against the Children’s Service Plan. The reports were a mixture of new information and information which had been reported elsewhere, for example, in a Balanced Scorecard to NHS Boards or Quarterly Performance Reports to the Council’s Housing and Social Work Committee. The proposed expansion of the Joint Committee’s remit and the requirement for the Committee to drive rather than monitor performance in increasingly challenging financial circumstances had encouraged a thorough review of what was recorded and how it was reported. The report summarised the findings of the review and recommended the way forward.

In response to questions, it was explained that:-

 in relation to the proposed new reporting arrangements, where performance against a target was declining, an exception report and a management action report would be produced to explain the reasons for the decline and how it was proposed to address it; and  the Statistical Analysis Group (SAG) and Quality Assurance Group (QAG) were multi-agency and would examine not only the information relating to the Joint Committee targets but all of the data being gathered by the partner agencies to ensure better connectivity and minimise duplication.

During further discussion, the following comments were made:-

 in terms of the information being sought by the Joint Committee, an objective approach was necessary to ensure the best use of time and resources and that the data being gathered was meaningful;

4  it was suggested that the proposed quarterly “dashboard” report be circulated electronically in advance of the Joint Committee so that Members could access the detailed source data hyperlinked to the report;  the shift in focus from inputs to outcomes was welcomed and would demonstrate whether or not services were operating effectively;  it was important to create a reporting framework that would feed into those which were already in place, such as Her Majesty’s Inspectorate of Education’s (HMle) Quality Assurance Framework;  more outcome measures were required in relation to children with disabilities;  the proposed reporting framework should be taken forward in conjunction with the Community Planning Partnership;  the SAG and QAG should be asked to consider setting targets;  an exception report should be produced if a performance score remained static for more than two months;  children and young people were the service users and it was important to consult with them at regular intervals regarding their experiences, needs and aspirations and whether services were improving;  HMle’s “triangulation” model, which involved comparing one source of evidence with a second and third source, was a good method of assessing the quality of a service;  it was important to indicate where performance measures contributed to, for example, the Single Outcome Agreement;  the Logic Modelling approach, which had been used by Safer Highland, helped to provide focus when dealing with a vast amount of information and it was suggested that a similar approach be adopted in relation to the proposed reporting framework; and  the proposed reporting framework would shape the Joint Committee’s discussions over time and the importance of allowing sufficient time to discuss issues fully was emphasised.

The Head of Integrated Children’s Services encouraged Members to raise any further issues, for inclusion in the proposed report to the Joint Committee on 21 January 2011, by email.

i. APPROVED the proposed reporting arrangements, the presentation format and the timetable of quarterly reports set out in the report; ii. AGREED that the quarterly “dashboard” reports be circulated electronically in advance of the Joint Committee so that Members could access the source data; and iii. AGREED that an exception report be produced if a performance score remained static for more than two quarters.

6. “I used to be cheeky but then I grew up” – Young People’s Reflections on Leaving School

The Educational Psychologist and the More Choices, More Chances Lead Officer undertook a presentation during which the background to the research initiative on young people’s reflections on leaving school was explained. The aim of the research had been to find out how ready young people felt for life after school, how school had helped prepare them and what needed to change. Young people who were on the cusp of leaving school had been randomly selected from eight secondary schools throughout Highland and focus groups of four to nine people had been established. 5 In addition, a group of young people from the Calman Trust, who had already left school, had been involved.

There had been two elements to the research. Firstly, a quantitative questionnaire containing a list of items that might be important for a healthy and happy life which the young people had been asked to rate according to importance and how confident they felt about them. Secondly, there had been focus group discussions on a number of topics relating to leaving school and plans for the future. The five key themes which had emerged from the research were Curriculum; Learning Environments; Advice and Information; Planning and Options; and Experiencing the Future. The findings in relation to each theme were summarised and a handout containing the detailed information was provided. Following on from the research, it was considered that there was a need for dialogue between young people and those designing and delivering services and the curriculum. There was also further work to be carried out in relation to vulnerable groups, early intervention and tracking the destinations of school leavers. In conclusion, Members of the Joint Committee were invited to provide feedback on the data and what other services and agencies could use it.

During discussion, the following comments were made:-

 the research was welcomed and it was important that the findings were distributed as widely as possible;  it would be interesting to return to the same group of young people in a year’s time to find out whether their destinations were as expected;  teachers could have a significant impact on a young person’s life and it was essential to recruit people with the right attributes and skills;  the importance of consulting with children and young people was reiterated and it was suggested that the findings could be used to encourage other services and organisations to carry out research;  early intervention was key in securing positive destinations for children and young people;  Looked After Children’s experiences of education were often very different;  it would be helpful to know if the importance and confidence ratings differed for Looked After Children and whether there were any implications in terms of training and support for children’s services workers;  the importance of cross-service and agency working in implementing the lessons arising from the research was emphasised;  the Council’s Community Learning and Leisure Services were experienced in communicating with children and young people in an effective and respectful way and would be well placed to take this forward; and  it was suggested that a report reflecting on the issues raised be presented to a future meeting of the Joint Committee.

In response to questions, it was confirmed that the findings would be fed back to the young people who had been involved in the research. In relation to the comments regarding Looked After Children, it was explained that the young people who took part in the research had not been asked whether they had been in care. i. NOTED the presentation; and ii. AGREED that a report be submitted to a future meeting of the Joint Committee reflecting on the issues raised. 6 7. Future Business of Joint Committee for Children and Young People

There had been circulated Report No CYP/38/10 by Jonathan King, Head of Integrated Children’s Services setting out a proposed list of reports to be considered at future meetings of the Joint Committee on Children and Young People.

NOTED the proposed list of reports and AGREED:-

i. that the schedule be amended to accommodate the significant reports which required to be presented to the Committee on 21 January 2011; and ii. in addition to the reports requested during discussion of earlier items, that a report on the Joint Committee Budget Structure be presented to the Committee on 21 January 2011.

8. Date of Next Meeting

NOTED that the next meeting of the Joint Committee would be held on 21 January 2011 at 2.15 pm in the Council Chamber, Highland Council Headquarters, Inverness.

The meeting ended at 1.20 pm.

7 Highland NHS Board 1 February 2011 Item 3.13 HIGHLAND COUNCIL/NHS HIGHLAND LEADERSHIP AND PERFORMANCE GROUP

Minutes of the Meeting of the Highland Council/NHS Highland Leadership and Performance Group held in Committee Room 2, Council Headquarters, Glenurquhart Road, Inverness on Tuesday 14 December 2010 at 2.00 p.m.

Present:- NHS HIGHLAND HIGHLAND COUNCIL

Mr G Coutts Dr M E M Foxley (late arrival – Item 6 onwards) Mr I Gibson Mr A S Park Mr R Gibbins Mr J Finnie Mr J S Gray Mr A B Dodds

Present / For Action Mr A Geddes, Depute Chief Executive and Director of Finance, The Highland Council (AG) Mr B Alexander, Chief Operating Officer, The Highland Council (BA) Ms E Mead, Chief Operating Officer, NHS Highland (EM) Mrs J Baird, Director of Community Care, NHS Highland (JB) Ms M Paton, Head of Community & Health Improvement Planning, NHS Highland (MP) Mr S Steer, Head of Community Care Integration, NHS Highland, (SS) Mr B Robertson, Acting Head of Operations (Community Care), The Highland Council (BR) Mrs L Dunn, Principal Administrator, The Highland Council (LD)

Mr G Coutts in the Chair

Item Subject/Decision Action

The Group AGREED that items on the agenda be taken out of sequence and consequently were discussed in the following order.

1. Apologies for Absence No Action Necessary An apology for absence was intimated on behalf of Mrs M C Davidson.

2. Declarations of Interest No Action Necessary There were no declarations of interest.

3. Minutes of Previous Meeting No Action Necessary There was circulated Minutes of Meeting of the Leadership and Performance Group held on 12 October 2010, the terms of which were APPROVED.

1 4. Commissioning of a Carers’ Centre and Extension to Existing Contractual BA/JB Arrangements

There was circulated Joint Report No LP/27/10 by the Highland Council Director of Social Work and NHS Highland Director of Community Care which set out proposals for the commissioning of a Highland-wide Carers’ Centre service to provide advice and support to carers as well as a dedicated advocacy service. It also set out proposals to extend parts of the existing contract with HCCF and sought approval for these.

The report explained that the Group had previously agreed that Partners jointly commission a range of services including a Carers’ Centre service and that two separate services were required under this area of activity, namely an information, advice, training and support service for carers and a carers’ issue based individual advocacy service. In order to avoid any conflict of interest, the need for a firewall to be put in place between these services was emphasised.

Two separate service specifications had been developed in view of the two distinct elements to this contract and copies of these had been appended to the report. The report recommended commissioning of services on the basis of the funding currently available (£200,000) with the proviso that any additional Scottish Government monies, once available, be channelled into the contract to enable the successful bidder to augment service provision.

The report proposed that a tender be progressed for the Carers’ Centre which stipulated that a maximum price or indicative budget approach be adopted; bidders would submit proposals for achieving required outcomes. In addition, bidders would also be asked to highlight the added value and community benefits they would be able to deliver. It was proposed that the tender be issued in January 2011 with a view to the process being concluded by the end of May 2011 and the new arrangements in place by 1 September 2011.

Formal contractual arrangements were in place with Highland Community Care Forum (HCCF) until 31 March 2011 for a number of services which included collective advocacy for mental health and learning disability; individual advocacy for carers; service user and carer involvement, engagement and consultation and young carer involvement, engagement and consultation. However, there was a need to ensure smooth transition to the new arrangements and to allow sufficient time for the competitive process to be completed. Therefore, in line with the Highland Council’s Contract Standing Orders, the report recommended that the existing arrangements with HCCF be extended at the 2010/11 costs. In addition, the report also recommended that the existing contract with HCCF in respect of Mental Health and Learning Disability (contract Parts 1, 2 and 3) be extended, if necessary, to 31 August 2011 as well as the Individual Advocacy for Carers (contract Part 4) .

The report highlighted that it had already been agreed that Part 5 of the HCCF contract, Service User and Carer Involvement, Engagement and Consultation, would be extended to 30 June 2011 to allow a tapering off of this work. The report also advised that as the contract for the new Carers’ Centre would provide a range of services for young carers, the current contract in respect of Young Carer Involvement, Engagement and Consultation (Part 6) would be continued until 31 August 2011.

2 During discussion, it was suggested that the terminology used within the service specifications appended to the report was too general and concern was expressed that a Health and Safety policy had not been listed as an ‘Essential Requirement’, particularly as it was felt that this should be a fundamental part of any contractual arrangement. It was further recommended that a standard ethnicity form should be used.

In response, the Director of Social Work explained that a fully comprehensive Service Level Agreement (SLA) had been developed which contained a standard level of routine information, including health and safety, and this had then been further tailored with specific details in regard to this particular contract. He also advised that, once the service specifications had been approved, work would commence on developing a fully detailed tender pack.

Responding to a concern, the Director of Social Work further advised that in order to ensure there was no gap in service, the report sought approval to extend the relevant aspects of the HCCF contract for which services would be provided in future, i.e. to extend the current contractual arrangements in respect of carers services and potentially collective advocacy. However, he explained that at the recent Group workshop held on 26 November 2010, it had been agreed to take a break from the current model of community development and rather than tendering for a community development umbrella service, to commission further work to identify a future model and a report was presented at item 5 of the agenda to reflect this proposal. Therefore, local HCCF workers would finish at the end of June 2011 and it had been acknowledged at the workshop that this decision would attract adverse publicity and lobbying of elected Members. The Group had clear reasons for wishing to take stock and commission this further work and the importance of conveying this decision had been addressed within the Communications Strategy.

In relation to commissioning a carers’ centre and extension to existing contractual arrangements, the Chairman reiterated the importance of ensuring that the tender documentation was absolutely specific and to develop SMART objectives where possible.

Following discussion, the Leadership and Performance Group AGREED that the:-

i. tender for the Carers’ Centre be progressed on the basis of the two attached service specifications and timescales indicated in paragraph 3.2 of the report;

ii. existing contracts with Highland Community Care Forum be extended in respect of the provisions and the proposals as set out in paragraphs 4.4, 4.5, 4.6 and 4.7 of the report; and

iii existing contracts with Alzheimer Scotland and Support in Mind (formerly National Schizophrenia Fellowship) were, as set out at paragraph 4.8.2 of the report, to be extended to 31 August 2011, to allow for the conclusion of a tender process for the Carers’ Centre.

3 5. Promoting and Supporting Community Development and Volunteering BA/MP

There was circulated Report No LP/28/10 by the Highland Council Director of Social Work and NHS Highland Head of Community Health and Improvement Planning advising that the Leadership and Performance Group had discussed Community Development at an informal workshop meeting held on 26 November 2010, where officers had been remitted to set out proposals to commission the development of strategies and business plans for Community Development and Volunteering activity. The report summarised the background and set out these proposals.

The report explained that a number of high level outcomes had been identified within the draft Highland Joint Community Care Plan 2010–2013 and to achieve these, and to ensure services could be both sustainable and delivered as locally as possible, there was a need to work in partnership with service providers, voluntary organisations, community groups and communities.

The following draft frameworks had been appended to the report in respect of:-

 the development of a strategy for promoting and supporting community development; and  a strategy to promote and support volunteering.

The report advised that there was likely to be budget provision of up to £119,000 for Community Development and Volunteering during 2011-2012 and recommended that a budget limit of £45,000 be set for the commissioning of the two strategies and business plans. This would allow up to £74,000 for the part year implementation of the agreed recommendations from these pieces of work.

It was anticipated that the cost to develop each strategy/plan would be between £3,000 and £25,000 and, although seeking a minimum of three quotations would be sufficient within the terms of the Contract Standing Orders, it was recommended that a full tender, using Public Contracts Scotland, be conducted instead as well as any other advertising that might be considered appropriate to facilitate a wider reach. Given the small value involved and likely limited interest, the tender could be conducted within short timescales.

During discussion, concern was expressed regarding the potential difficulty in defining communities, particularly in urban areas, and it was suggested that existing structures, such as social and lunch clubs, be identified with a view to providing them with additional support. The Chairman explained that he anticipated that work would be undertaken to identify existing structures but emphasised that this initiative was not just about supporting already established and successful community development organisations. He explained that there was a need to achieve equity and therefore assistance would need to be provided to help set-up and develop community development activities across the Highlands and a further report on how to achieve this was requested.

With regard to volunteering, it was highlighted that this service would not replace but enhance and add value for users to existing services and that this would be a two-way support mechanism running in parallel.

4 It was highlighted that a statutory framework for volunteering already existed and it was suggested that contact be made with the Scottish Police Federation with a view to obtaining further information regarding the tensions that could arise from the deployment of volunteering and the potential perception of deskilling and devaluing professionals.

The Chairman also recommended that a volunteering strategy be developed that would provide both stimulating and fulfilling volunteering opportunities similar to that provided for youth services in respect of sports. The need to encourage businesses to support voluntary organisations as part of their corporate social responsibility strategy was also highlighted.

The Chairman requested that the two specifications be further developed to a higher level, that officers consider the range of potential partners, and the importance of ensuring that the partner could provide experience and examples from which to benefit and use as learning points.

Following discussion, the Leadership and Performance Group:-

i. APPROVED the draft framework for the development of a strategy for promoting and supporting community development;

ii. APPROVED the draft framework for the development of a volunteering strategy;

iii. AGREED the next steps in progressing these pieces of work and that the two specifications be further developed to a higher level, to consider the range of potential partners that would also provide experience and examples; and

iv. AGREED the resources to be attached to each piece of work.

9. Joint CommunityCare Plan 2009/12 BA/JB

There was circulated Report No LP/32/10 by the Director of Social Work and Director of Community Care which contained the final draft of the Joint Community Care Plan 2011-2014 and set out proposals to complete an Outcomes Framework, the development of detailed action plans and the identification of outcome measures. A draft Communications Strategy had also been appended to the report.

A draft of the Joint Community Care Plan had been circulated at the last meeting of the Leadership and Performance Group on 12 October 2010, but to allow more detailed scrutiny of the document and to enable discussion, a workshop had been held on 26 November 2010. Although feedback had been positive, a copy of the proposed final draft of the Plan, incorporating suggested amendments had been appended to report.

The report also advised that work continued on the development of the Outcomes Framework for Community Care which was linked to the Single Outcome Agreement (SOA) objectives, particularly on the delivery outcomes.

5 To sit alongside the new Joint Community Care Plan, a draft Communications Strategy had also been developed, a copy of which had been appended to the report, which would be key to ensuring that the Partnership achieved its objectives. A detailed work plan would be developed to support the implementation of the Strategy.

During discussion, the Chairman explained that although he supported the high level messages within the Communications Strategy, he felt that the key messages in respect internal and external audiences needed to be more clearly defined. He suggested that a similar approach be taken to that used with Highland’s Children, to target internal audiences to ensure that community care staff understood the key messages in relation to how community care services would be provided in future. In terms of external audiences, he felt that further work was required to clearly identify the high level messages and how these would be conveyed.

It was highlighted that it was very important that communities understood the significance of the issues relating to older people but that this was a difficult message to convey as only those that were in need of the services were interested. It was explained that one of the key messages to be communicated was that strengthening communities to support their own older people was a proactive and preventative approach that would help them to reduce their need for formal health and care services.

It was suggested that there were two sets of messages to be communicated, namely one generic message in relation to the overall direction of travel in respect of community care and secondly, a local message which could be tailored to address specific area issues on which local action plans could be developed to underpin the generic message.

It was also explained that the emphasis had changed from getting the Joint Community Care Plan and brand promoted to a process of engagement with communities and groups as a part of implementation of the Joint Community Care Plan. In addition, staff would also be responsible for communicating key messages to external audiences.

The Director of Social Work sought guidance on the continuation of the local stakeholder events during which the Group advised that they felt that the stakeholder events had been very valuable and felt that it would not be beneficial to withdraw this process as stakeholder engagement was essential. It was further recommended that a briefing note be prepared on local forums if required for Members on this issue.

Following discussion, the Leadership and Performance Group AGREED:-

i. the final draft of the Joint Community Care Plan;

ii. that the outstanding work required in completing the Outcomes Framework be undertaken in accordance with the timescales indicated in Section 3 of the report,

6 iii. the draft Communications Strategy in readiness for a plan for its implementation be developed and actioned; and

iv. that a briefing note be prepared on local forums.

10. Community Care Performance BA/EM

There was circulated a copy of the Community Care Performance Balanced Scorecard 2010/11, the terms of which were NOTED.

11. Possible Future Items No Action Necessary The Group NOTED that no additional reports had been proposed other than those which had already been requested during discussion of individual items on the agenda.

12. Future Meeting Dates: 2011 No Action Necessary The Group NOTED the following meeting dates for 2011, all to take place in Council HQ, Inverness:-

 15 February 2011 at 3.00 pm in Committee Room 1  12 April 2011 at 3.00 pm in Committee Room 1  28 June 2011 at 2.00 pm in Committee Room 2  16 August 2011 at 3.30 pm in Committee Room 2  18 October 2011 at 3.30 pm in Committee Room 2  13 December 2011 at 3.30 pm in Committee Room 2

6. Pathway to Integration AD/RG

There was circulated Report No LP/29/10 by the Chief Executive, Highland Council and the Chief Executive, NHS Highland which set out broad proposals for the management of the development of the Implementation Plan for a new partnership model to deliver health and social care, which would be presented to the Highland Council and NHS Highland in May 2011.

The Highland Council and NHS Highland were considering proposals for a new partnership model to deliver health and social care, at a special joint meeting on 16 December 2010. The Leadership & Performance Group were involved in the preparation of the report, Improving Joint Service Delivery: A New Partnership Model, which had now been published and a copy of which had been tabled at the meeting.

This report set out broad proposals for the management of the development of the Implementation Plan, which was to be presented in May 2011, and many details had yet to be developed and worked out, including in relation to governance systems, service delivery, organisational and professional structures, administrative functions, legal and financial matters, property management, information systems, human resources and business continuity. These issues also affected various support services within NHS Highland and Highland Council.

7 Therefore, it would be necessary to recruit a small team of people to provide dedicated support for the development of the implementation plan, and to work alongside the Council and NHS Highland officers. It was suggested that this team should be led by someone with significant experience of senior management responsibilities in health or local government and the report proposed that the Chief Executives be tasked to identify the team leader, who should then be involved in the recruitment of other members of the team.

The Scottish Government had indicated informally that it would be willing to provide funding for this team, and for the work, consultation and associated activities to prepare and take forward the implementation plan during 2010/11 and 2011/12.

This work would require a programme management approach and it was proposed that a Programme Board, meeting monthly until May 2011, be established comprising of:-

 Chief Executives of Highland Council and NHS Highland (joint chairs)  The Leader of the Administration of the Highland Council  The Chair of NHS Highland  The Depute Chief Executive (THC)  The Director of Finance (NHSH)  The Director of Community Care (NHSH)  The Director of Education, Culture & Sport  The Director of Social Work  Scottish Government representative  Other external person re public sector reform?  The support team leader

It was further proposed that a Programme Team be established, meeting weekly, to monitor the preparation and delivery of the implementation plan and should comprise:-

 The Assistant Chief Executive (THC)  NHS and THC Finance Managers  Appropriate senior managers from ECS, Social Work and NHS Highland  The support team leader

It was highlighted that the Transformational Change Plan, Integrated Resource Framework and Change Plan for Reshaping Care of Older People should be fully integrated into this process. However, in order not to dilute focus of the Pathway to Integration, the actual co-ordination of such change activity should be brought together under single leadership aligned via the Community Care Chief Officers Group rather than through the Programme Board or Team.

The Director of Social Work advised the Group that representatives from North East Lincolnshire, who had set-up a similar partnership, had indicated their willingness to attend a workshop in late January or early February 2011 to share their experiences and provide valuable learning opportunities.

8 On behalf of the Group the Chairman expressed his appreciation to the Chief Executives of both Highland Council and NHS Highland for bringing the proposals to fruition within a short period of time. The Group acknowledged that a number of the more detailed issues had yet to be worked through and work should be undertaken to dispel any notion that this was a centralisation of services. It was felt that it was important to continue to work through and explore the proposals with a view to providing more efficient and effective services for the people of the Highlands.

During discussion, it was felt important that the Group remained enthusiastic and positive and the following key points/recommendations were made:-

 the key role of Education, as well as Social Work, was highlighted in terms of Children’s Services;  a mechanism in which to involve the voluntary sector should be developed and also to ensure involvement and support of the professional organisations;  a catch, manage and respond system should be developed to address issues as they arose;  concern was expressed regarding the frequency of meetings which involved a significant time commitment, particularly for those officers on both the Programme Board and Team, and it was suggested that this be given further consideration to ensure that this was both feasible and efficient;  involvement/representation should be sought from the clinical profession and trade unions; and  consideration be given to ensuring that there was patient and public involvement in regard to major service changes.

The Chairman recommended that authority be delegated to the joint Chairmen to approve the Team Leader Job Description with a view to making an appointment as soon as possible. He further proposed that a programme, identifying key tasks, be submitted to a future meeting of the Programme Board to be scheduled in January 2011 and an update report be submitted to the next meeting of the Leadership Group scheduled to be held on 15 February 2011.

Following discussion, the Leadership and Performance Group:-

i. NOTED the report tabled at the meeting, Improving Joint Service Delivery: A New Partnership Model, which would be considered at the joint Highland Council/NHS Highland meeting on 16 December 2010;

ii. APPROVED the various proposals for programme management of the pathway to integration, as set out in section 3 of the report;

iii. AGREED that authority be delegated to the joint Chairmen to approve the Team Leader Job Description with a view to making an appointment as soon as possible;

9 iv. AGREED that a programme be developed and submitted to a future meeting of the Programme Board to be scheduled in January 2011 with an update report thereafter submitted to the next meeting of the Leadership Group on 15 February 2011; and

v. AGREED that a seminar be held with representatives from North East Lincolnshire in late January or early February 2011.

Mr G Coutts left the meeting at this point (3.50 pm) and Dr M E M Foxley took over the position of Chair for the remainder of the meeting.

7. Reshaping Care for Older People: Change Fund BA

There was circulated Report No LP/30/10 by the Director of Social Work and Chief Operating Officer which set out the Change Plan for Reshaping Care for Older People.

The report explained that the Scottish Government had established a Change Fund of £70m for 2011/12 to enable health and social care partners to implement local plans for making better use of their combined resources for older people’s services.

In order to access the Change Fund, each community planning partnership was required to produce a short Change Plan that had been agreed by all partners and the Highland Community Planning Partnership had agreed to hold a stakeholder event on 21 December 2010 to achieve third and independent sector involvement in this process. Once signed by all the partners, the Plan would be submitted to the Scottish Government for approval by the Ministerial Strategic Group for Health and Community Care. A copy of the draft plan template had been appended to the report.

It was highlighted that, in view of the work that had already been undertaken in ‘Reshaping Care’ objectives, and accordingly the Community Care Plan which had ‘shifting the balance of care and older people’s services’ as one of the central themes, Chief Officers had indicated to the Scottish Government that the compilation of Highland’s Change Plan would be firmly based on implementation of the strategy to achieve the outcomes set out in the joint Community Care Plan.

The report confirmed that the Plan would be taken forward in association with the central plan for the ‘pathway to integration’ by April 2012, and in line with ongoing transformational change plan and IRF activity, including with single leadership across these aligned strands. The key management milestones over the forthcoming weeks had been set out in the report.

The report also suggested that, in line with one of the key elements of the Joint Community Care Plan, a small core multi-disciplinary strategic group for older people should be formed to support this activity.

10 In response to a question regarding the £70m Change Fund, the Director of Social Work explained that there was Ministerial support for additional funding for the Pathway to Integration. To achieve this, further detailed information needed to be set out indicating the methodology and what the additional funding would provide and match funding also had to be provided, which could include Change Fund and Integrated Resource Framework monies. In terms of the £70m funding, it was explained that this was top sliced funding from the additional NHS allocation that had been received from the UK Government and, although it was suggested that the funding would continue into the future, it was unclear at present how this would be continued. He further explained that this funding was not to be used for ongoing service delivery but to provide additional capacity within community based services to allow institutional and acute services to be reduced. Therefore, both organisations would be required to make changes and implement innovative and creative ideas that focussed on rapid delivery of care for older people.

The Board was informed that it was anticipated that NHS Highland would receive approximately £4.4m which would include provision for Argyll and Bute, and this would equate to around £3m for Highland.

Thereafter, the Leadership and Performance Group APPROVED the process and milestones for the development and agreement of Highland’s Change Plan for Reshaping Care for Older People.

8. Transformational Change Programme

8.1 Summary of Workstreams and Progress BA

There was circulated an update on the Transformational Change Programme.

The Director of Social Work explained that work would continue on the workstreams identified within the report as well as managing the Pathway to Integration planning; the IRF; and the Change Plan for Reshaping Care for Older People.

Responding to concerns in respect of large care packages, the Director of Social Work explained that the size and cost of a number of care packages had been reduced following needs assessments to establish the required level of support. In addition, for some individuals, the model of care and support was also being examined to assess if this could be changed from an individual package to a group model. Overall, work to achieve savings was ongoing and assessed needs were being met.

Following discussion, the Group NOTED the report.

8.2 Integrated Resource Framework SS

There was tabled Report No LP/31/10 by the Highland Integrated Resource Framework Project Board which outlined the changing context surrounding the Integrated Resource Framework (IRF) and reflected on the initiative’s place within the emerging Pathway to Integration (PTI).

11 In presenting the report on behalf of the Project Board, the Head of Community Care Integration advised that the IRF had provided the basis from which the organisation could consider PTI. The role of the IRF work had been crucial in bringing forth the current integration proposals and the core work within IRF was integral to the delivery of PTI. He further explained that the PTI was a natural extension of the IRF work and that the need for mapping had not changed. Therefore, the report recommended that the refinement of the mapping work that had been initiated to date, particularly in terms of strategic level understanding, should be continued.

Continuing, he explained that the Strategic Level work was even more important within PTI and needed to be prioritised as this would determine the resource commitment of the partners to achieve the outcomes and standards from the Lead Authority. It was crucial that this work was undertaken, the product was transparent, and that Authorities made the explicit resource commitment for the full period of the arrangement (4 years). It was suggested that a detailed work plan for this work stream be developed.

The small examples of change (virtual ward) etc., related to those innovative service changes that were being trialled to bring about reductions in admissions, improve discharges and shifts in the balance of care. This work remained relevant and it was recommended that this became a focus for acceleration within the Change Fund considerations.

The district level work had been designed to take the whole budget for an area, lose the origins of that budget and in so doing develop and understand the management and governance arrangements that needed to be developed to retain financial accountability. However, the PTI approach removed the need for complex operational governance of finances between authorities but understanding the professional, managerial and cultural barriers to ‘virtuous’ use of resource remained relevant and the district level work could refocus on the softer, cultural aspect of effective decision making within and between agencies. The Project Board therefore recommended that the idea of progression on the basis of two districts be superseded by the broader integration of decision making and resource use as the implementation of the change plan took place across Highland.

With regard to the integration of Occupational Therapy (OC), the report explained that this could continue to be advanced, on a smaller scale, without detriment to the overall PTI work and might enable issues to be identified and resolved earlier. However, it was felt that there was little value in progressing the Mental Health service area as a separate initiative with a different timescale, and it was suggested that this work be consumed within the overall PTI plan.

In conclusion, the report explained that the final work stream within the IRF related to NHS specific actions and the interaction between the communities (CHPs) that assessed need and referring for services needed to be made more explicit through costed capacity plans. It was explained that this work remained imperative under PTI and should therefore be continued.

12 The Group NOTED the role of the IRF work in bringing forth the current integration proposals and the value of it’s continued contribution in this respect and AGREED that:-

i. the refinement of mapping work initiated to date, particularly in terms of strategic level understanding, be continued;

ii. the following proposals in relation to the component parts of the Integrated Resource Framework:

 The Strategic work stream (Level 1) was even more important under PTI and needed to be prioritised and a detailed work plan for this stream of activity be developed;

 Small steps of change (Level 2) remained very relevant and be a focus for acceleration within the Change Fund considerations;

 The District Plans (Level 3) focused on issues of technical financial governance and accountability related to the knitting together of two organisations at a local level; cease to be as directly relevant given the changing context of integration. Therefore, the idea of progression on the basis of two districts be superseded by the broader integration of decision making and resource use as the implementation of the change plan took place across Highland;

iii. work continue on the integration of Occupational Therapy services but that work in relation to Mental Health be subsumed within the overall Pathway to Integration; and

iv. NHS specific work continued as described within the report.

The meeting was concluded at 4.15 pm.

13 Highland NHS Board 1 February 2011 Item 3.14 Assynt House Beechwood Park Inverness IV2 3BW HIGHLAND NHS BOARD 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 ENDOWMENT FUNDS COMMITTEE 10 January 2011 – 11.05 am Board Room, Assynt House, Inverness

Present Mr Ray Stewart, Employee Director (In the Chair) Mr Bill Brackenridge, Non Executive Director Mr Malcolm Iredale, Director of Finance Mrs Lyn Wormald, Staffside Representative

Also Present Mrs Gillian McCreath, Non Executive Director

In Attendance Mr Iain Addison, Head of Area Accounting Mr Brian Beattie, Portering and Operational Security Manager, Raigmore Hospital (from 11.40 am) Mrs Kelly Dallas, Endowments Support Officer Ms Erin Greig, Communications Manager (from 11.40 am) Mr Chris Lyons, General Manager, Raigmore Hospital (from 11.40 am) Ms Iona Mcgauran, Nurse Manager, Raigmore Hospital (from 11.40 am) Mr Brian Mitchell, Board Committee Administrator

1 APOLOGIES

Apologies for absence were received from Mr I Gibson and Mr O McLennan.

2 MINUTE OF MEETING HELD ON 4 OCTOBER 2010

The Committee Approved the Minute of the Meeting held on 4 October 2010.

3 MATTERS ARISING

3.1 Videoconference Equipment – Occupational Health Service

At their last meeting the Committee had agreed to defer consideration of an application for the purchase of video-conference equipment for the Occupational Health Department at Raigmore Hospital pending receipt of relevant background information previously requested. Mr I Addison advised that there had been no further information received.

During discussion, there was reference to the monitoring of use of all NHS Highland Videoconference equipment. Mr M Iredale advised that an inventory of equipment was held and agreed to raise the issue of monitoring of use with the Head of eHealth. The Committee:

 Agreed to Reject the application due to a lack of relevant information.  Noted monitoring of use of existing Videoconference equipment would be raised with the Head of eHealth.

3.2 Argyll and Bute CHP Staff Lottery Fund

Mrs K Dallas advised that the local Committee were to meet shortly to consider bids against the outstanding resource. Mr R Stewart advised that he had also spoken to the Argyll and Bute CHP General Manager on this issue.

The Committee Noted the position.

The Committee agreed to re-order the agenda at this point in the meeting.

4 INVESTMENT FUNDS

Mr I Addison spoke to the circulated report indicating that as at 30 November 2010 the NHS Highland Endowment Funds portfolio value stood at approximately £8,191,000, and stated that after taking into account relevant withdrawals the overall trend showed positive movement well in excess of the values in March 2008. It was stated that the increase in the position since the lowest point, achieved in March 2009, was the equivalent of a 39% rise in portfolio value since that time. Mr I Addison advised that there was a requirement to withdraw approximately £525,000 to cover expenditure up to December 2010, and further advised that, if approved, the proposals for the use of specific funds at Raigmore Hospital in the sum of approximately £250,000 would also require to be covered.

During discussion, there was reference to concern previously expressed by a number of Fund Managers in relation to the potential risk associated with investment of resources. It was suggested that the current strong financial position offered a good opportunity to engage with Fund Managers on plans for utilisation of resources. Fund Managers should be given an indication of the positive long term return on investment at this time.

The Committee:

 Noted the position in relation to Investment Funds.  Agreed that managers of Restricted Funds be advised as to the current strong financial position with regard to investments and be encouraged to bring forward plans for utilisation of existing resources.

5 FINANCIAL REPORTS

5.1 Financial Position to 30 November 2010

There had been circulated Financial Report outlining that the balance of the Unrestricted Funds as at 30 November was £4,573,190.75 and that for 2010/2011 Budget Funds, some £177,846.85 remained unspent. Mr I Addison advised that income indicated for Non-Core Learning reflected a return of allocated funds that had subsequently not been utilised. A report on expenditure in year on this activity would be submitted to a future meeting. On the point raised by Mrs G McCreath, it was advised that annual administrative costs for Endowment Funds totalled approximately £80,000.

2 Discussion moved on to those Restricted Funds where there was little or no movement in year with the exception of income and expenditure relating to dividends accrued and admin costs incurred. Mr M Iredale confirmed that a report indicating those Funds could be prepared for future meetings. Mr B Brackenridge raised the issue of process for Fund consolidation and it was confirmed that General Managers were, on an annual basis, advised as to those Funds where little or no movement is evident in year and instructed to either bring forward plans for spend or consolidate these into General Funds as appropriate. Mr I Addison reminded members that factors such as basis for donation and subsequent spend could influence consolidation of individual Funds, in some cases requiring appropriate legal opinion to be sought. Mrs G McCreath raised the issue of donations, and the encouragement of benefactors to make these on a general, as opposed to more specific basis. It was stated that there was an education element involved in this for both those making and receiving donations, as well as further consideration of the terminology included in relevant literature.

The Committee:

 Noted the financial position.  Noted a report on Non-Core Learning expenditure would be submitted to a future meeting.  Agreed that Funds where there was little or no movement in year be identified and a report brought to a future meeting.  Noted further consideration would be given to issues relating to minimising potential restriction of use of donations upon receipt.

5.2 Exception Report

There had been circulated report detailing expenditure from Endowment Funds in excess of £5,000 to 30 November 2010.

The Committee Noted the report.

The Committee reverted to the original Agenda at this point in the meeting.

6 APPLICATIONS FOR APPROVAL

6.1(a) Purchase of Bed Lockers, Overbed Tables and Footstools for Raigmore Hospital

Mr C Lyons spoke to the circulated application in relation to the proposed entire replacement of all lockers, over bed tables and some footstools for all wards on the Raigmore Hospital site. It was stated that the existing stock was in relatively poor condition, being over 20 years old and subject to constant use. Mr C Lyons advised that, if approved, the purchase of this stock would be used to create a positive Public Relations exercise, which if managed well could maximise donations for Raigmore Hospital and help establish a strong legacy moving forward. Given the number of units involved, and the likely final total cost, there would be a requirement to utilise tender processes for procurement. There had been circulated a report on the indicative breakdown of proposed spend through relevant Raigmore Hospital Specific and General Funds, as well as letters of support from Senior Charge Nurses and the Patients Council. In addition, there had also been circulated an outline of the suggested media/PR campaign, and Ms E Greig indicated how this would be used to highlight how members of the public can donate to the Endowment Fund to improve the patient experience, as well as publicise the purchase of the new equipment. On the point raised, with regard to other NHS Highland sites, it was stated that this would be an issue for General Managers to consider.

3 There was discussion as to the appropriateness of using Endowment Funds for the purchase of such equipment and it was acknowledged that this would undoubtedly enhance the patient experience within Raigmore as well as improve overall control of infection on wards given relevant construction materials. Concern was expressed that purchase of such equipment through Endowment Funds may attract criticism that this had not been funded from core/exchequer resource, especially given the infection control element. It was noted that there was support for this approach from a range of sources and Mr M Iredale stated there was a risk that an overly prescriptive restriction of spend from Endowment Funds may eventually lead to a position whereby such resource was only utilised for ‘extras and frills’. Mr B Brackenridge stated that he favoured a spend policy that enabled such an approach to be taken that allowed for a consolidation of Fund resources as planned, and enabled the purchase of equipment that represented an enhancement of the patient experience. Mr C Lyons stated that such spend on aesthetic considerations represented an important element of patient welfare, aspects of which had possibly been overlooked on the Raigmore site. He added that in association with the proposed media/PR campaign it was anticipated that this proposal would generate significant income into Endowment Funds given that members of the public could witness the positive benefits for patients that donations can achieve.

With regard to the split of funding through the various Funds involved, Mr I Addison stated that relevant managers would require to be advised as to the position, and their agreement obtained for the approach being taken. Mr R Stewart emphasised that Funds designated for staff should not be utilised. Mr C Lyons advised that a number of Funds would effectively receive a net benefit in terms of the purchase of a number of pieces of equipment that were in excess of the total Fund resource available for a particular area. Mr C Lyons advised that he favoured a greater move toward a General Fund position as opposed to a range of individual Funds. On the issue of procurement, the process involved could take up to three months to complete, and on the point raised by Mr M Iredale, it was confirmed that there would be investigation as to whether there was an existing procurement process underway in Scotland that NHS Highland could tie into. In addition, General Managers should be canvassed as to whether they would wish to take advantage of the opportunity to participate in the process and benefit from any associated economies of scale on unit price. Discussion moved on to the proposed media campaign, and Mr C Lyons stated that this would, in addition to publicising the purchase of new equipment, help publicise the benefits accrued to patients through donations to Endowment Funds and also assist in moving to a General Fund position, with the assistance of the Friends of Raigmore.

After discussion, the Committee:

 Approved the application and the initiation of relevant tender processes.  Agreed that the approach adopted in relation to this application be highlighted to General Managers, including in relation to the type of spend involved.  Agreed that individual Fund Managers be advised as to the relevant proposed spend profile and their agreement obtained to this approach being taken.  Agreed that investigation be carried out into whether there was an existing procurement process underway that NHS Highland could tie into.  Agreed General Managers be canvassed on participation in the procurement process.

6.1(b) Revised Authorisation Levels Proposed for Raigmore Hospital Funds

The Committee were advised that the General Manager for Raigmore Hospital had requested that he be given responsibility for authorisation of all expenditure over £500 from Endowment Funds. Under existing authorisation levels, spend over £1,000 can be authorised by Directorate General Managers, and for over £10,000 this required the approval of the General Manager. Mr C Lyons advised that this approach would allow for greater managerial awareness of overall expenditure in this area. During discussion, there was a

4 view expressed that this would be an appropriate approach to be taken across operational areas and as such should be highlighted as an option to all General Managers.

The Committee:

 Agreed that expenditure over £500 from Raigmore Hospital Endowment Funds require authorisation by the General Manager.  Agreed that this change in authorisation level for expenditure be highlighted to all operational area General Managers.

Mr B Beattie, Ms E Greig, Mr C Lyons, and Ms I Mcgauran left the meeting at 12.30 pm

7 ENDOWMENT BUDGET FUNDS 2011/2012

Mr I Addison spoke to the circulated report proposing that the distribution to Budget Funds for 2011/2012 remain at £180,000. It was proposed that the basis of re-apportioning Funds in Patient Areas be the same as that adopted for 2010/2011, involving a 50% historic proportion and 50% to compensate for the lack of availability of Specific Funds. In this area there was discussion around outstanding balances for 2010/2011 and it was agreed that Fund Managers be requested to indicate plans for spend, with appropriate timescales given, for the next Committee meeting otherwise relevant resource would be returned to the General Fund. For Non-Patient areas, the level of unused funds in the Facilities budget was considered sufficient and as such no further apportionment was recommended. For Other Areas, the Non-Core Learning, Research and Development, and Valuing Service Awards levels would remain as per 2010/2011, and the Committee Discretionary Fund would comprise the balance of the original £180,000 figure. The unused balance from the 2010/2011 Discretionary Fund would be returned to the General Fund.

During discussion, it was stated that NHS Highland may be requested to make a proportionate one-off Endowment Fund contribution in relation to the Medium Secure Unit in Perth, this to be made on an Arbuthnott share approach and based on ‘old Highland’ levels.

The Committee:

 Agreed that Budget Funds for 2011/2012 be set at £180,000.  Agreed that Patient Area Budget Managers be requested to provide spending plans for outstanding resource from 2010/2011 budgets to the next meeting.  Agreed there be no further allocation to the Facilities budget in 2011/2012.  Agreed the balance of funds be allocated to the Committee Discretionary Budget.  Agreed that the unused balance of the Committee Discretionary Budget in 2010/2011 be returned to the General Fund.  Noted the position in relation to the Medium Secure Unit in Perth.

8 GUIDANCE

8.1 Use of Endowment Funds

Mr I Addison spoke to the circulated report incorporating an extract from the Guidance for Managers on the use of Endowment Funds. It was stated that in order to supplement existing Guidance, and as a result of increased pressure on Endowment Fund Managers to contribute to expenditure that had previously been classified as Core or Exchequer funded, more specific Guidance had been requested. Mr Addison took members through the circulated flow chart document illustrating the steps a Fund Manager should follow in

5 determining the appropriateness of funding expenditure from their Fund. There was also circulated a number of examples of the types of expenditure that can clearly be funded from endowments and a list of some items also deemed appropriate to be funded from Endowments. It was proposed to distribute the circulated documents to all Fund Managers.

During discussion, there was reference to the question of availability of revenue funding and the need for Fund Managers to be able to determine if this was the case. Mr B Brackenridge requested that the Guidance process reflect the issues debated earlier in the meeting in that improved patient experience etc was a legitimate area for spend and that Funds may be pooled where appropriate. CHP General Managers should be encouraged to use the updated Guidance to prepare plans for spend of outstanding General Fund resource in 2010/2011.

The Committee:

 Noted the Guidance, Flow Chart and examples of appropriate/inappropriate spend.  Agreed that CHP General Managers be encouraged to use the circulated documentation to prepare plans for spend of outstanding General Fund resource in 2010/2011.

8.2 Charitable Status of NHS Endowment Funds

There had been circulated report relating to a review of the NHS Lothian Endowment Fund, by the Office of the Scottish Charities Register (OSCR), to decide on the issue of charitable status. It was stated that the NHS Highland Fund is operated in a similar way and it would be reasonable to expect that the recommendations and outcomes from the Lothian review would apply equally to NHS Highland. It was indicated that OSCR had had given notice that the NHS Lothian Endowment Fund meets the charity test set out in the 2005 Act and would therefore continue to be registered as a charity in Scotland. It was stated that the main issues raised from the review were that Charity Trustees must act in the interests of the charity and be able to demonstrate this when dealing with issues relating to the interest of the Health Board and avoiding associated conflicts of interest, and that Trustees have the ultimate responsibility for ensuring expenditure within Funds furthers the specific purposes of each Fund.

The Committee were advised that although NHS Lothian was able to demonstrate that neither of these points undermined the charitable status there were a number of areas requiring review and improvement. For NHS Highland the areas for consideration related to overall governance and accountability, including a review of the constitutional structure to allow Trustees to demonstrate that any conflicts of interest can be dealt with in a way that demonstrates that the decision taken is in the interest of the Funds. There was a need to review the arrangements for the recruitment of Charity Trustees to ensure that this role is made explicit and fully considered as part of the recruitment process. Mr R Stewart advised this could be addressed through appropriate induction for Executive and Non-Executive Board members. On the issue of accountability it was stated that a full year Fund Summary Analysis, including details of Fund use for all Funds, would be included within the NHS Highland Annual Accounts.

The Committee:

 Noted the outcome of the OSCR review of the NHS Lothian Endowment Fund.  Noted the issues applicable to NHS Highland.  Agreed proposals to address the issues raised be submitted to the next meeting.

6 9 ANY OTHER COMPETENT BUSINESS

Mr I Addison advised that issues discussed at previous meetings of the Committee, over promotion and publicity relating to Endowment Funds were to be discussed with the Communications Team.

The Committee Noted a report would be submitted to the next meeting.

10 DATE OF NEXT MEETING

The next scheduled meeting of the Committee will be held on Monday 4 April 2011 at 10.00am in the Board Room, Assynt House.

The meeting closed at 1.10 pm

7 Highland NHS Board 1 February 2011 Item 4.1

AREA FINANCE REPORT

Report by Malcolm Iredale, Director of Finance

The Board is asked to:

1 INTRODUCTION

The Report is based on Financial data for the ¾ year position – to the end of December (Month 9), with a continued projection of a breakeven at the end of 2010/11. The underlying operational position (£1.47m deficit) has improved by £0.65m since the previous Board Report, and maintains the progress towards the projected breakeven.

The report is in the usual format, which includes detailed narrative for emerging cost pressures, the delivery of efficiency savings – both subjectively and organisationally - and other detailed operational issues. The report also highlights progress on the Financial Plan, together with the risks and opportunities available to the Board. In addition to covering the revenue position, the paper also notes the capital position. Following the narrative comment, the usual Tables are included to provide further detail.

2 FINANCIAL POSITION OVERVIEW

Based on the position at the end of December 2010 (Month 9), the forecast position at 31 March 2011 is financial breakeven, recognising the continued delivery of the savings, together with successful management of emerging cost pressures are both maintained.

As noted above, the operational position is a forecast deficit of £1.47m, which represents an improvement of £0.65m since the forecast for the previous Report. This improvement is the result of ongoing work across Units through:

 The delivery of further savings within the Efficiency Savings Programme  The achievement of further Non recurring Benefits  Improvement in the prescribing position

These benefits are partially off-set by additional cost pressures across a number of operational Units, particularly North Highland CHP and Raigmore. The importance of ongoing attention to the financial position throughout the Board is important, and all Teams are continuing to progress this to maintain progress in the delivery of Efficiency Savings, and close monitoring and control of all budgets, particularly those currently experiencing additional costs pressures. 3 COST PRESSURES AND OPERATIONAL PERFORMANCE

The major cost pressures to date are similar to those previously reported to the Board, noting the improvement in prescribing which had been anticipated in general terms as a result of the initiatives being undertaken throughout the area. The other, previously highlighted pressures continue as:

 Medical Locums – locum costs continue to be a pressure in Raigmore and the North CHP, with particular pressures in the latter area in relative terms.

 Cost pressures and overspends continue in a number of areas, including Out of Hours, Tertiary expenditure and the cost of fuel oil.

Detailed Financial variations within Operational Units are reported to the relevant Governance Committees who are in the best position to investigate and secure the necessary actions at local level to minimise the impact of such pressures.

3.1 North Highland CHP – £0.55m overspend

The forecast year end overspend, which represents an improvement of just over £141,000 on the previously reported position, is largely the combination of unachieved efficiency savings, and cost pressures. In terms of the latter, these include locum costs at Caithness General Hospital (£315,000) and Out of Hours in East Sutherland (£103,000).

3.2 Mid Highland CHP – £0.15m overspend

The forecast year overspend represents an improvement of £150,000 on the previous forecast, and is the result of improvements in prescribing, further cost containment within the CHP.

3.3 South East Highland CHP – £0.1m under spend

The forecast £102,000 under spend represents an improvement of £98,000 on the previously reported figure, and is the result of improvements in the prescribing position.

3.4 Argyll & Bute CHP – Breakeven

The CHP forecast remains at breakeven, but continuing to recognise as always that the agreement and settlement of the healthcare contract with Greater Glasgow and Clyde Health Board is a critical factor for the CHP.

3.5 Raigmore – £0.6m overspend

The forecast position shows an improvement in month of £232,000, with significant cost pressures still being experienced over a number of areas, including Theatres (£766,000), Day Case (£247,000) and Oral Surgery (£387,000).

3.6 Facilities – £0.21 overspend

The forecast overspend has increased by just over £50,000, largely as a result of increased heating oil costs / usage. While steps are being taken to try and minimise the short term pressures through effective energy management it is important to recognise that longer term benefit may require investment in alternative technologies, such as bio mass heating.

2 3.7 Pharmacy – Integrated Pharmacy – £0.18m under spend

Continued under spend with a further improvement in month of £15,000.

3.8 Other Healthcare Purchases – £0.31m overspend

The forecast overspend has decreased by £88,000 from last month, due to an increase in expected SLA income.

3.9 Corporate Services – £0.11m under spend

Forecast under spend has held from previous month

3.10 Central Services/Reserves – £0.04m overspend

Central services forecast overspend has marginally increased by £23,000 from last month due to a number of minor adjustments; potential pressures around the national risk share scheme (CNORIS) are yet to be quantified.

4 EFFICIENCY SAVINGS

As reflected in the performance of Individual Operational Units highlighted above, there has been further progress in delivering the agreed Efficiency Savings Programme and this is detailed in Table 3 and summarised in the Table below.

Non Rec Rec Total Efficiency Savings £000's £000's £000's

Target 15,018 15,018

Achieved to Date 4,119 8,369 12,488

Forecast to Achieve 192 383 575 Achievement 4,311 8,752 13,063

Balance still to achieve 1,955

The Table highlights a planned achievement of £13m against the £15m target, albeit that some savings are non recurring in the current year. Some of these non recurring savings reflect the work of the Budget Review Group in the current year to develop a medium term Savings Plan which recognises the time needed to plan and deliver recurring savings – and the need to supplement these in the shorter term with non recurring initiatives. The delivery of savings remains a focus, not just for the current year, but also for future periods and this is highlighted in Section 5 below.

Previous Financial Reports to the NHS Board on the Financial Position have detailed the delivery of savings both by Operational Unit, and, as above in overall terms to summarise the area wide position. During discussions, the issue of the delivery of savings over subjective headings has been highlighted and the Table below provides details of areas in which savings have already been delivered – i.e. the £12.5m highlighted in the Summary Table above. This type of information is included within the monthly Monitoring Return to the Scottish Government Health Department and shows that savings to date have been delivered over a number of areas with Workforce Efficiency / Productivity and Service Review / Variation being the most significant.

3 NHSH Total Cat Recurrent Savings Achieved to date Savings No £000's 1 Corporate Service Redesign 852 2 Improve & develop use of Technology 317 3 Prescribing/drugs 362 4 Maximise use of Current bed Stock 133 5 Review of core services/Clinical variation 1,311

6 Tertiary.- minimise referrals/maximise income 95 7 Nursing & AHP contribution to LTC 135 8 Workforce efficiency and productivity 2,533 9 Estates Facililities & Energy 165 Sub Total 5,902 Other Other not specified above - 2,467 TOTAL REC SAVINGS 8,369 NON RECURRENT £000's Savings Achieved Non Recurrently to Date 4,119 Total savings AS AT MTH 9 12,489

Within the current year, every opportunity is being taken not only to deliver agreed savings targets, but also to achieve any further savings beyond these targets in some areas where original targets may already have been delivered; examples include Pharmacy and Corporate Services.

5 IMPACT ON 2011/12 AND BEYOND

As previously reported, the indicative Board uplift for next year is around 1%, and this will be confirmed following agreement of the Scottish Budget by the Scottish Parliament later in the month.

In the meantime, work is ongoing to work towards the 2011/12 Board Budget based on previous planning assumptions which are broadly in line with the indicative Board allocation. An essential part of this is the identification of a Savings Programme of £20m – around 3.5% of the Revenue Budget - in order that the Board can achieve the statutory target of financial break even, and this is being taken forward at area level to ensure that plans by individual Operational Units are both consistent and in line with delivery of the NHS Highland Strategic Vision. The significant reduction in Capital Allocation for 2011/12 – considered separately on the Agenda under Item 4.2 - will also have an impact on the revenue position and it is important to maintain a close link between these two areas to ensure that the Board adopts a comprehensive budgetary approach.

The work on the 2011/12 Budget, includes recognition of the longer term to ensure that assumptions and plans for the coming year are in line with longer term financial guidance, and continue to provide the longer term planning required for delivery of the Highland Strategic Vision over coming years., including recognition of the changes arising from the Integration Work with Highland Council.

4 6 CAPITAL

Table 4 highlights the capital spend noting that actual spend to the end of December is £15.3m, against a budget of £29.9m. Close work is underway throughout the Board to ensure that this position will be delivered, and confirmation continues to be provided by the respective Project Teams that spend will be in line with budgets. It should be noted that some major contracts, started only recently involved spend over the next few months – eg the Cath Lab at Raigmore and the Mull & Iona Progressive Care Unit, some contracts are already well underway – eg Migdale, and that other items of equipment and estates work are in process of being delivered.

7 CONCLUSION

Significant progress has been made in the continued move towards delivery of financial breakeven at the end of the year. This is being undertaken throughout the Board and attention to detail will be maintained for the remainder of the Financial Year to ensure that the necessary financial targets are achieved.

8 CONTRIBUTION TO BOARD OBJECTIVES

The delivery of a balanced financial position contributes to the Board objectives to ensure that there is maximum benefit for every patient from every public pound, and to help maximise patient care resources through the reduction of waste and inefficiency

9 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

10 RISK ASSESSMENT

Financial risks, including the potential failure to deliver the necessary Financial Targets are included on the Corporate Risk register and managed accordingly

11 IMPACT ASSESSMENT

The Area Finance Report summarises the financial position of the Board which reflects the delivery of the full range of services throughout the area, with these individual services having been subject to equality impact assessment.

Malcolm Iredale Director of Finance

21 January 2011

5 . TABLE1 Income & Expenditure to 31st December 2010

Annual Plan Position to Date Forecast Outturn Prev month Current Plan Actual Variance Forecast Variance from Forecast Movement Plan Summary Funding & Expenditure to Date to Date to Date Outturn Current Plan Variance in month £000 £000 £000 £000 £000 £000 £000 £000

470,819SEHD-BaselineFunding 353,114 353,114 0 470,819 0 0 0 14,466 -RecurringSupplementalAllocations 10,850 10,850 0 14,466 0 0 0 (12,779) - Non Recurring Supplemental Allocations (9,584) (9,584) 0 (12,779) 0 0 0 472,506 Sub total - SEHD Core RRL 354,379 354,379 0 472,506 0 0 0

22,384 -NonCoreFunding 16,788 16,788 0 22,384 0 0 0

494,890 SEHD Funding as at Nov 2010 371,167 371,167 0 494,890 0 0 0

42,680 -FHSNonDiscretionary 32,010 32,010 0 42,680 0 0 0 55,088 -FHSGMSAllocation 41,316 41,316 0 55,088 0 0 0 3,303 -RecurringPendingallocations 2,477 2,477 0 3,303 0 0 0 1,173 -NonRecurringPendingallocations 880 880 0 1,173 0 0 0

597,134 Total SEHD Funding 447,851 447,851 0 597,134 0 0 0 Expenditure

Direct Health Services

43,117CHP'sinclHostedServices -NorthHighland 30,789 30,819 (30) 43,671 (554) (695) 141 70,267 -MidHighland 52,622 52,873 (252) 70,413 (146) (298) 152 87,505 -SouthEastHighland 64,241 64,059 182 87,403 102 4 98 171,640 -Argyll&Bute 127,237 127,758 (522) 171,640 (0) 0 (1) 129,402Raigmore 96,383 96,789 (405) 130,005 (603) (835) 232 20,878Facilities 15,423 15,730 (306) 21,091 (213) (160) (53) 5,208IntegratedPharmacy 3,799 3,576 224 5,024 184 169 15 18,542HealthCarePurchases 13,906 13,912 (5) 18,854 (312) (326) 14 15,253ResourceTransfer&VoluntaryOrganisations 11,447 11,363 84 15,146 107 121 (14) (12,485) Income SLA's NCA's etc (8,930) (8,787) (143) (12,379) (106) (194) 88 11,831CostofCapital 7,874 7,882 (8) 11,831 0 0 0 13,807 Central Costs/Reserves 5,772 5,685 87 13,846 (39) (16) (23)

574,965 TOTAL DHS SERVICES 420,563 421,659 (1,096) 576,545 (1,580) (2,230) 649

22,170 Corporate Services 16,122 15,878 245 22,059 111 111 (0)

597,134 Total Expenditure 436,685 437,536 (851) 598,604 (1,470) (2,119) 649

Manangement Planned Actions 0 (1,470) 1,470 2,119 (649)

0 Surplus/Deficit Mth 9 (11,165) (10,315) (851) 597,134 0 0 0

Finance-Monitoring 4.1AreaFinanceReport-APP1-4.xlsTotalSummary 24/01/201109:40 Income & Expenditure to 31st December 2010 Table 2 Annual Plan Final Position Forecast Outturn Prev month Current Plan Actual Variance Forecast Var From Forecast Movement Plan Detailed Expenditure to Date to Date to Date Outturn Current Plan Variance in month £000 £000 £000 £000 £000 £000 £000 £000

17,798 A & B CHP- Oban, Lorn & Isles 13,346 13,502 (156) 17,979 (181) (232) 51 23,381 Mid Argyll, Kintyre & Islay 17,524 17,658 (133) 23,473 (92) (124) 32 12,507 Cowal & Bute 9,277 9,180 97 12,355 152 119 33 4,935 Helensburgh & Lomond 3,678 3,652 26 4,898 37 27 10 3,197 Other clinical services 2,216 2,206 10 3,177 20 37 (17) 15,390 GMS 11,474 11,825 (351) 15,890 (500) (472) (28) 17,649 Prescribing 13,295 13,454 (160) 17,769 (120) (160) 40 12,259 FHS Non Discretionary Services 8,719 8,719 (0) 12,259 0 0 0 46,016 HCP - Glasgow & Clyde 34,497 34,507 (10) 46,034 (18) (18) 0 3,604 HCP - Other 2,514 2,883 (369) 3,922 (318) (307) (11) 4,182 Resource Transfer 3,116 3,095 20 4,155 27 27 0 10,722 Central & Corporate 7,583 7,079 504 9,729 993 1,104 (111) 171,640 Total A&B CHP 127,237 127,758 (522) 171,640 (0) 0 (1)

24,174 North CHP - Caithness 18,215 18,766 (552) 24,864 (690) (793) 103 9,139 East Sutherland 6,890 6,544 346 8,688 451 461 (9) 3,155 North West Sutherland 2,404 2,198 206 2,942 213 190 23 6,648 North CHP Management/HS/OOH 3,280 3,311 (31) 7,177 (529) (554) 24 43,117 Total North Highland CHP 30,789 30,819 (30) 43,671 (554) (695) 141

31,642 Mid CHP- Ross & Cromarty 24,041 24,336 (295) 31,888 (246) (257) 12 20,930 Lochaber 15,885 16,207 (322) 21,060 (130) (192) 63 11,533 Skye & Lochalsh 8,777 8,878 (101) 11,592 (59) (95) 36 1,932 Hotel Services 1,450 1,366 83 1,869 63 42 21 2,754 Mid CHP Management 1,361 894 467 2,437 317 297 20 68,792 Sub Total Mid CHP 51,513 51,681 (168) 68,846 (54) (206) 152 1,000 Sexual Health 753 779 (26) 1,048 (48) (48) 0 475 Highland HUB/NHS 24 355 413 (58) 519 (44) (44) 0 1,475 Sub Total Mid CHP Hosted services 1,108 1,192 (84) 1,567 (92) (92) 0 70,267 Total Mid Highland CHP/Hosted services 52,622 52,873 (252) 70,413 (146) (298) 152

8,686 SE CHP - Nairn/Ardersier 6,473 6,566 (93) 8,746 (60) (27) (33) 8,999 Badenoch & Strathspey 6,789 6,775 14 9,030 (31) (50) 19 27,874 Inverness 20,875 21,024 (149) 28,103 (229) (372) 144 2,741 SE CHP Central/Hotel Services 1,757 1,414 343 2,371 370 403 (33) 48,300 Sub Total SE CHP 35,893 35,779 115 48,250 50 (46) 97 19,497 Mental Health 14,227 14,198 29 19,463 34 32 2 1,282 Learning Disabilities 962 931 31 1,264 18 19 (1) 18,426 Dental 13,159 13,152 7 18,426 0 0 0 39,205 Sub Total SE CHP Hosted services 28,348 28,281 67 39,153 52 50 1 87,505 Total SE Highland CHP 64,241 64,059 182 87,403 102 4 98

46,275 RAIGMORE- Surgical & Anaesth. Divison 35,292 36,646 (1,353) 48,671 (2,396) (2,396) 0 70,831 Medical & Diagnostics Division 52,754 52,761 (8) 70,690 141 230 (89) 4,268 Raigmore Hotel Services 3,066 3,062 4 4,243 25 (1) 26 769 Quality & Safety Division 571 525 46 698 71 62 9 3,632 Patient Support Division 2,701 2,677 24 3,607 25 5 20 3,626 Central Costs & Provisons 2,000 1,117 883 2,096 1,530 1,265 265 129,402 Total Raigmore 96,383 96,789 (405) 130,005 (603) (835) 232

Other DHS Services 20,878 Facilities 15,423 15,730 (306) 21,091 (213) (160) (53) 5,208 Integrated Pharmacy 3,799 3,576 224 5,024 184 169 15 18,542 Health Care Purchases 13,906 13,912 (5) 18,854 (312) (326) 14 15,253 Resource Transfer & Voluntary Organisations 11,447 11,363 84 15,146 107 121 (14) (12,485) Income SLA's NCA's etc (8,930) (8,787) (143) (12,379) (106) (194) 88 11,831 Cost of Capital 7,874 7,882 (8) 11,831 0 0 0 13,807 Central Costs/Reserves 5,772 5,685 87 13,846 (39) (16) (23) 73,034 Total Other DHS Services - North Highland 49,292 49,360 (68) 73,413 (379) (406) 27

574,965 Total DHS Services 420,563 421,659 (1,096) 576,545 (1,580) (2,230) 649

22,170 Corporate Services 16,122 15,878 245 22,059 111 111 (0)

597,134 Total Net Expenditure 436,685 437,536 (851) 598,604 (1,470) (2,119) 649 Highland NHS Board Savings Targets Mth 9 December 2010 Table 3

Target Position to Date Forecast plan to achieve Year End Outturn Achieved YTD Achieved YTD Forecast Forecast Unachieved B/fwd 2009/10 2010/11 Total Operational CRS REC Non Rec REC Non Rec REC £000 £000 £000 £000 £000 £000 £000 £000 CHP's

712 611 1,323 NorthHighlandCHP 359 601 0 0 363 439 1,007 1,446 MidHighlandCHP 1,446 0 570 1,658 2,228 SEHighlandCHP 817 1,411 0 719 3,281 4,000 Argyll&ButeCHP 1,660 758 351 192 1,039 70 514 584 OtherHealthCarePurchases 584

2,510 7,071 9,581 Total CHP CRS 4,282 2,770 351 192 1,986

889 2,888 3,777 Raigmore 2,517 1,260 0 86 86 IntegratedPharmacy 86 0 145 348 493 Facilities 461 32 0

3,544 10,393 13,937 Total DHS Services 7,346 4,030 383 192 1,986

363 418 781 CorporateServices 723 89 (31) 300 300 Technology/eHealth 300 0

4,207 10,811 15,018 Total CRS 8,369 4,119 383 192 1,955 83%

SUMMARY £000's £000's £000's Rec Non Rec Total CRS REC Target 15,018 0 15,018

Achieved YTD 8,369 4,119 12,488

Balance to Achieve 6,649 (4,119) 2,530

Forecast to Achieve 383 192 575

Forecast Out-turn 6,266 (4,311) 1,955

Rec to LDP trajectory to date LDPAgreementtomth8 11264

Over/(under) achievement 1,224

Finance-Monitoring 4.1AreaFinanceReport-APP1-4.xlsCRS 24/01/201109:40 Highland Health Board Table 4

Capital - Monitoring Statement - 31st Dec 2010

Summary

Prev Mnth Actual Curr Mnth Forecast Year to date Forecast Variance NHS Highland £000's £000's £000's £000's Funding: CRL (Formula) (16,014) (16,014) (16,014) 0 PCCPMP (4,510) 0 (4,510) 0 Other SG Funding 2,794 (1,206) 2,759 35 Return of SG Brokerage (11,802) 0 (11,802) 0 Disposals (410) (157) (308) (102)

Total funding available (29,942) (17,377) (29,875) (67)

Expenditure: All approved Schemes 28,174 14,516 28,371 (197) Unallocated 862 0 598 264 Total Capital Expenditure 29,036 14,516 28,969 67

Capital Grants Committed 906 788 906 0 Total approved expenditure 29,942 15,304 29,875 67

Percentage of Budget Spent Month 9 0.51 Uncommitted Budget 598 Highland NHS Board 1 February 2011 Item 4.2

NHS HIGHLAND CAPITAL PLAN

Report by Malcolm Iredale, Director of Finance

The Board is asked to:

1 INTRODUCTION

The Capital Programme was discussed at the December Board Meeting (Item 5.5), highlighting the reduction in the Board’s draft capital allocation and the potential impact on the current approved Capital Plan. This paper updates the process, recognising that the allocation is still draft pending agreement of the Scottish Government Budget later in the month, and also that it needs to reflect the final 2010/11 carry forward position on current capital schemes.

It is however important that the Board understands the magnitude of change in the capital resources likely to be available for 2011/12 –in terms of the reduced capital allocation, the inability to access the “banked” money previously left with SGHID at this time, and the impact of any slippage on capital projects in the current year. The change in capital resources available not only requires a revised Capital Plan, but also an updated approach which recognises this reduction, while at the same time progressing the Board’s Strategic Vision which includes effective use of its asset base.

2 CURRENT POSITION

In 2010/11, NHS Highland has a Capital Programme of £29.9m which is a mixture of large schemes, smaller capital schemes and relevant asset/equipment replacement. This is funded by a mixture of Scottish Government capital allocations and application of reserves previously banked with the Scottish Government Health Department.

In terms of allocations, the Health Board received these under a number of headings, such as –

DETAIL 2010/11 2011/12 DRAFT £m £m Allocation - Formula Capital 12.0 5.0 Allocation - Primary Care Practice Modernisation Programme 4.5 1.9 Allocation - Medical Equipment 1.9 - Allocation - Specific Projects - 6.8

Allocation - Total 18.4 13.7 Access to Banked Resource 11.8 - Other Adjustments (0.3) -

TOTAL Resource Available 29.9 13.7 The Table highlights not only the funding of the 2010/11 Capital Programme of £29.9m, but also indicates the indicative capital resources that will be available in 2011/12.

At the start of 2010/11, NHS Highland had some £24m of banked resource with SGHD, together with an expectation of a further £4m of capital resource deferred from 2010/11 into future years. At the same time, the Capital Plan for the current year includes application of £11m of banked money – thereby leaving a balance of about £17m currently with SGHD. There is no access to banked money at this time, but SGHD have advised that projects which had been planned to be funded by a combination of formula capital and banked funds will be funded 100% by specific allocation subject to approval of the appropriate business case when capital resources allow.

In the meantime, the Board must prioritise, and commit capital spend for 2011/12 from the indicative resource accepting that:

 the figures are draft until after the Scottish Government Budget later in February  the exact impact of any slippage or carry forward into 2011/12 is not finalised at this stage  the 2010/11 allocation is a one year allocation with no indicative amount for future periods

3 2011/12 PLANS

The significant reduction in capital allocation has a marked impact on the 2011/12 Capital Plan, recognising that projects at legal commitment stage will be progressed through to appropriate conclusion. Some of this completion will be funded by SGHD from specific capital allocations in addition to the general capital formula, but other elements will require to be met by the Board from the formula allocation. It is also relevant to review if “legal commitments” can be broken down into smaller units. For example, it may be possible to complete part of the scheme (e.g. land purchase or design), but to defer other aspects (e.g. construct or fit out) until further capital resources become available.

This is summarised in the small Table below which in turn is supported by the detailed Table attached. These tables highlight the original 2011/12 Capital Plans (Left Hand Column), the Revised Plans and Funding (Columns 2 & 3), followed by Revised 11/12 Commitment (Column 4):

Detail 2011/12 2011/12 2011/12 2011/12 Original Plan Revised Plan Revised Commitment £m £m Funding £m £m Committed/Approved 10.1 10.1 7.4 (2.7) Schemes

Formula Funding 5.0 5.0 (DRAFT) Less Commitments (2.7)

Available Funding 2.3 (DRAFT) Less Rolling Programmes 5.7 0.3 (0.3) Other Programmes 22.3 - -

Remaining Resource 2.0 (DRAFT)

The Table highlights both the significantly reduced Capital Allocation and the impact of carried forward schemes where specific allocations in 2011/12 will not cover the totality of expenditure on these committed schemes.

2 This means that some of the Formula Allocation – still draft at this stage pending finalisation of the Scottish Government Budget – will be required to cover legal commitments, leaving approximately £2.3m to address the remainder of the previous Capital Plan which is detailed in the attached Table. The Board may be able to consider alternative funding methodologies for some schemes, but this would carry a revenue impact which is not currently reflected in the draft 2011/12 revenue budget.

It will therefore require very careful planning and prioritisation to ensure that the Board deploys its limited capital resources to maximum effect, including meeting any statutory / compliance maintenance or appropriate replacement of existing equipment.

4 CAPITAL PLANNING PROCESS

The current capital planning process has been progressed over the last few years when there had been an emphasis on capital investment. The position is significantly different now and the Board must establish a revised methodology which reflects this, while at the same time allowing progress to be made against delivery of the Board’s Strategic Vision which recognises the important role of modern, efficient and effective assets to help deliver this.

After approval by the Board of the overall Capital Plan, details are taken through the Asset Management Group who agree and monitor progress within individual spend areas – such as specific projects, ehealth, medical equipment, etc. The current allocation is likely to focus on estate and equipment spend – but given previous spend levels, demands in these areas exceeds resource available leading to a need to prioritise spend within individual programmes.

There are draft prioritisation models within the Board, but these have hitherto been used to choose items within individual programmes of spend, rather than between programmes. An example would be that it may be possible to choose between different items of medical equipment or different estate improvements – but harder to prioritise over the two areas – let alone adding Primary Care Premises, etc. The methodology has been reviewed by the Asset Management Group and a revised approach suggested which is being finalised / tested prior to being applied.

The Board’s Strategic Vision focuses on the delivery of clinical services and it is appropriate therefore to re-fresh clinical input to the Capital Planning process, particularly given the need to fully integrate the process with other relevant areas of Board work – such as the Property Strategy, Transformational Change, etc. This may best be achieved in the short term by presenting the results of the prioritisation model to a small Capital Group – such as the Chief Executive, Service Transformation and Finance, who can then direct the process through and augmented Asset Management Group which includes additional representatives, particularly clinicians, in the Asset Management process.

It is also important to ensure appropriate knowledge and understanding of the Board’s Capital position by key groups and staff within the Board, and it is suggested that this is achieved through cascade of a summarised version of this report which highlights the key issues.

5 CONCLUSIONS

NHS Highland, like all other NHS Boards, faces a significantly different capital position both in terms of anticipated allocations and the short term application of banked resources. The paper above describes both the impact of this on planned Capital Schemes, and a revised process to prioritise, plan and communicate the position.

3 6 CONTRIBUTION TO BOARD OBJECTIVES

The Capital Plan is an integral part of the Board’s LDP and facilitates achievement of the HEAT targets and delivery of Better Care through the provision of quality healthcare services in new or improved premises and equipment.

7 GOVERNANCE IMPLICATIONS

As part of the discharge of Financial Governance the Board must consider and agree the approach and guidelines to preparation and delivery of the Capital Plan.

8 IMPACT ASSESSMENT

The Capital Plan summarises the overall expenditure and funding of capital projects and reflects the delivery of the full range of services throughout the area, with these individual services having been subject to equality impact assessment.

Malcolm Iredale Director of Finance

21 January 2011

4 Comparison of Expected Capital Spend 2011/12

2011/2012 2011/2012 2011/2012 2011/2012 Original Plan Revised Plan Revised Funding Comittment Committed & Approved £000's £000's £000's £000's ARGYLL & BUTE Mid Argyll PFI Lifecycle Costs 13 13 13 0 Mull & Iona PCC 2,485 2,485 2,585 100 MID CHP ERPCC Life Cycle Costs 205 205 205 0 NORTH CHP Care of Elderly Sutherland 1,689 1,689 991 (698) RAIGMORE Masterplan Raigmore 130 130 100 (30) Angio Cath Lab Raigmore 1,342 1,342 (1,342) Lin Acc Raigmore 2,823 2,823 2,949 126 Sub Total Committed Schemes 8,687 8,687 6,843 (1,844) PCCPMP Dental Portree 1,285 1,285 392 (893) PCCPMP Dental Dingwall 200 200 Other 150 150 (150) Total Committed & Approved 10,122 10,122 7,435 (2,687)

Formula funding 2011/12 5,000 5,000 Less Use for Committed programme as above (2,687) (2,687) Available Formula Funding 2,313 2,313

Remainder of Plan requiring funding Rolling programmes EQUIPMENT Lab Equipment - Cyclical replacement 36 0 Medical Equipment - Cyclical replacement 1,262 0 Radiology Equipment - Cyclical replacement 485 0 Community Equipment - Cyclical replacement 29 0 HS Equipment - Cyclical replacement 29 0 1,841 IM&T 0 E Health schemes NH 1,270 0 E Health schemes A&B 250 0 1,520 ESTATES 0 CGH Heating Upgrade 170 0 Estates Infrastructure 50 0 Estates Minor Schemes A&B 551 0 Estates risk 1000 0 Primary Care Premises 185 0 Salaries 100 0 2056 OTHER 0 Voltage Infrastructure Upgrade Raigmore 200 200 (200) One Stop Cadiology Clinics 60 60 (60) Sub Total Rolling programmes 5,677 260 0 (260) Other ARGYLL & BUTE MID CHP Skye Hospitals MacKinnon /Broadford 1521 0 SE CHP PCCPMP Inverness Community Resource 655 0 DENTAL(Funded by PCCPMP) Dental Decontamination A&B 89 0 Dental Access Centres Oban 1487 1,286 Note EQUIPMENT Medical Equipment - Centrally Funded 0 0 Medical Equipment - Centrally Funded A&B 0 0 MID CHP Tain RAIGMORE Day Services Centre (Incl Renal & Endoscopy) 16,989 0 ARGYLL & BUTE Mental Health Service Redesign 915 0 HAI Compliance Work 200 0 LIH - Fluoroscopy and Plain film Radiology equip 445 0 ESTATES Carbon Emissions Sub Total Other 22,301 0 1,286 0

Sub Total Remaining plan 27,978 260 2,313 2,053

TOTAL 38,100 10,382 13,721 2,053

Note - No commitment to this scheme at this stage as as no final proposal and , significant costs beyond 11/12 with no current funding information Highland NHS Board 1 February 2011 Item 4.3

DISPOSAL OF PROPERTIES/LAND – SURPLUS TO REQUIREMENTS

Report by John Bogle, Acting Head of Capital & Property Planning

The Board is asked to Declare Migdale Hospital surplus to requirements and agree its disposal.

1 Background and Summary

It is a requirement that the Health Board officially declares properties/land which are no longer required, surplus to requirements. Property transactions are audited and this declaration is part of the checklist.

The property listed below will become vacant when the new hospital opens and no other Health Service use has been identified for it, it has been declared surplus by the North CHP and the Board is now asked to confirm this.

2 Proposed Disposal

2.1 Migdale Hospital, Bonar Bridge The current Migdale Hospital building is not fit for purpose. It does not comply with the Disability Discrimination Act requirements and there are health and safety issues associated with the layout and physical constraints of the building. The present site has problems with access, parking and on-going maintenance of an old building. Work is in progress on a replacement hospital nearby. It is anticipated that the present hospital will be vacated in summer 2011.

The North CHP have no plans to use the current building once it is vacated. The building will be secured and the site sealed off. The building is ‘B’ listed by Historic Scotland.

3 Contribution to Board Objectives

This proposal will contribute towards the following Board Objectives:

 Better Value – a considerable maintenance liability will be removed.

4 Governance Implications

Clinical governance will be improved when the new facility opens. Staff currently employed in the hospital will be offered posts in the new hospital. There is one long term resident in the staff accommodation in the present hospital who has been given notice that his tenancy will be terminated as there is no staff residential accommodation in the new hospital. The resident is being supported in his efforts to find alternative accommodation.

5 Impact Assessment

An EQIA has not been carried out on the disposal of the current building. An EQIA has been carried out for the new hospital.

John Bogle Acting Head of Capital & Property Planning

21 January 2011 Highland NHS Board 1 February 2011 Item 4.4

INFECTION CONTROL REPORT

Report by Liz McClurg, Interim Infection Control Manager on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control

The Board is asked to:

 Note the contents of the report.

1 Background and Summary

In August 2008 the Scottish Government published the Independent Review of Clostridium difficile Associated Diseases at the Vale of Leven Hospital (December 2007 – June 2008). This report raised a number of infection control-related issues which may be applicable to other NHS Boards in Scotland. To ensure a consistent approach was adopted nationally, the Scottish Government Health Directorates issued a ‘Healthcare Associated Infection (HAI) General Action Plan’.

Item 1.2 of the Action Plan – Governance, required all NHS Boards to implement a nationally agreed reporting template, to be used as the framework to report progress against the Hospital Associated Infection Agenda to Board meetings on a two-monthly basis. The implementation date for this reporting process was January 2009.

The key purpose of this report is to:

 Ensure visibility of HAI data and issues for Board members, facilitating awareness and action where indicated.  Assist in creating and populating a routine NHS Board HAI data set to facilitate assurance, awareness and national reporting for various levels within the organisation.  Place more detailed local information on HAIs in the public domain in the context of an open Board meeting and on the Board website.

2 HAI Reporting Template – NHS Highland Activity

The revised Healthcare Associated Infection Reporting Template (HAIRT) is now used by all Boards. It is in two sections.

 Section 1 covers Board-wide infection prevention and control activity and actions. A report card summarising Board-wide statistics can be found at the end of Section 1.

 Section 2 is a series of “Report Cards” which provide information for each acute hospital in the Board and for the community hospitals within each Community Health Partnership (CHP) 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.

For each hospital the total 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.

1 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. 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 report contains the following subject areas:

 Staphylococcus Aureus Bacteraemias (SAB)  Clostridium difficile  Hand Hygiene  Cleaning and the Healthcare Environment  Significant HAI incidents / outbreaks, emerging threats  Antimicrobial Prescribing  Other HAI Related Activity taking place in the Board.

3 Contribution to Board Objectives

Our key objective is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board.

4 Governance Implications

4.1 Staff Governance

 As additional information is distributed more widely it will ensure staff are better informed in respect of current issues relating to Infection Control and the management of HAI in our healthcare premises - “HAI is Everybody’s Business”.

4.2 Patient and Public Involvement

 The distribution of regular information to the patient/public sector will increase awareness and facilitate increased participation of patient/public representatives in the Infection Control agenda.

4.3 Clinical Governance

 By improving infection control practices, we will endeavour to provide a healthcare environment for patients that minimises the risk of HAI.

4.4 Financial Impact

 By reducing the incidence of HAI in our healthcare premises, financial savings could be achieved through lower rates of infection.

4.5 Better Health, Better Care, Better Value

 By improving infection control practices, we will endeavour to provide a healthcare environment for patients that minimises the risk of HAI.

2 5 Risk Assessment

By risk assessing infection control practices, we will endeavour to minimise the risk of HAI to patients in the healthcare environment.

6 Impact Assessment

As Infection Control policies are updated they are impact-assessed for equality and diversity.

Liz McClurg Interim Infection Control Manager Corporate Services

21 January 2011

3 NHS Highland Healthcare Associated Infection Report – February 2011 Section 1 – NHS Highland Board Wide Issues

Key Healthcare Associated Infection Headlines

 SAB HEAT target Support Initiative 30 November 2010  Planning for Aseptic technique pilot project December 2010

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

Current HEAT status All Boards have been asked to reduce SAB case numbers by an additional 15% from April 2010 over and above the 30% baseline reduction which means the target for NHS Highland is no more than 46 cases by 31st March 2011. NHS Highland has a low infection rate despite the challenge of the Staphylococcus aureus bacteraemia (SAB) target. (please see page 8 for more details). Although the year-on-year improvement has been maintained, NHS Highland will not meet the target set for 2010/11. There have been 44 cases between April – December 2010 of which there were 4 MRSA and 40 MSSA. The most common infections are those associated with skin and soft tissue infections, chest infections, indwelling devices (peripheral venous cannulae and central lines) and false positive blood cultures caused by poor technique. All staff who take blood cultures are now trained and assessed competent in carrying out the procedure and only take samples when there is clinical indication. A standard operating procedure for taking blood cultures has been disseminated throughout NHS Highland. An alternative method of obtaining blood cultures using a Vacutainer system is currently on trial in AMAU in Raigmore Hospital, to see if contamination rates reduce.

4 Initiatives to reduce SAB Infections During October and November 2010 the Infection Control Team monitored the number of blood cultures processed through the Microbiology laboratory at Raigmore Hospital to check whether the number of contaminants had reduced with improved technique. Of the 516 blood cultures processed in October, 22 samples (4.3%) were contaminated, in November, 591 were processed of which 13 samples were contaminated (2.2%). Although this has been audited for only two months there has been a decrease of 2.1% in the number of contaminants. If contaminants (which are currently included in the infection rate) are eliminated, NHS Highland would achieve its SAB target. A quality improvement pilot project, in conjunction with the University of Stirling, will commence in January 2011. The aim of the project is not only to improve aseptic technique with regard to urinary catheter insertion, cannulae insertion and care of wounds but also to further support a multidisciplinary team culture putting the patient at the centre of care. A beacon ward has been identified. Staff, including student nurses, will be identified as “Aseptic Ambassadors”, whose role will be to undertake an improvement methodology course and to demonstrate and promote good practice in aseptic technique. Local Clinical Educators/Nurse Practitioners supported by Practice Development and Infection Prevention Control staff will provide training and support. Practice Education Facilitator (PEF) staff will support mentors/students and Lecturers. The working group will monitor progress of the roll out, share the learning and extend this across NHS Highland.

Figure 1 shows the Cumulative SAB Rate against Target.

NHS Highland Staph aureus Bacteraemia: Cumulative Chart

100

70 s e d 60 o s i p E

e 50 v i t a l u

m 40 u C

0 April May June July August September October November December January February March

Target 2007-08 2008-09 2009-10 2010-11

5 Figure 2 NHS Highland Staph aureus bacteraemia SPC Chart

NHS Highland Staph aureus Bacteraemia SPC Chart

10 s e d o s i

p 8 E

. o N 6

7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 - - l- - - -0 ------l- - - -0 ------l- - - -0 ------l- - - -1 - - y n u g p t v c n b r r y n u g p t v c n b r r y n u g p t v c n b r r y n u g p t v c a u J u e c o e a e a p a u J u e c o e a e a p a u J u e c o e a e a p a u J u e c o e M J A S O N D J F M A M J A S O N D J F M A M J A S O N D J F M A M J A S O N D

Target SAB Trigger UCL Mean 4.1 up until April 10, then changed to 3.8.

Figure 3 shows the sources of infection together with the number of each MSSA SAB sources.

NHS Highland MSSA Primary Source Apr '10 - Dec '10 (40)

12 120.0

10 100.0 s t

8 80.0 n e s v B E

A f S o

f SAB o %

6 60.0 r e

e Cum % v i b t a m l u u N

4 40.0 m u C

2 20.0

0 0.0

I s r I e n n ) n la T s s e S u io io n w u U ie e t S s t t lo o t c e is c a f n is m b th T fe in n k F to A a t n e n s C f I m (v U o o t ta r r /S s n e h s e o t p ti h C e e li C th N lu a l C e s /C u r o e n lc e V U l ra e h ip e P Primary Source

6 There have been 4 MRSA SABs between April–December 2010, of which the primary sources were a PEG site, an Ulcer/Soft tissue, a surgical site infection and a chest infection.

Figure 4 NHS Highland SAB HEAT target

HEAT tgt NHS Highland SAB HEAT target Mthly DO NOT EXCEED 46 Cum Tot Avg Monthly: 3.8 Cum traj

40 November: CNO SAB Event on 30th 35 Continuing all efforts to reduce

t SABs e g r

a 30 HPS/QIS visit October: T 25/8

& Continuing with all the actions as

l outlined in the SAB action plan but

h 25

t there is no specific action. n o M 20 September: m

u Full action plan received including actions to: build

C improvement capacity, optimise invasive device management, 15 prevent soft tissue infections becoming SABs, optimising blood culture process, improving education and training and improving communications 10

0 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

National Context The NHS Highland SAB rate remains the lowest of the mainland Boards in Scotland. The overall Staphylococcus aureus bacteraemia rate for Scotland for the period July 2009–June 2010 was 0.362 per 1000 AOBDs. NHS Highland rate for the same period was 0.237 per 1000 AOBDs. With effect from April, 2011 all Boards are expected to achieve a rate of 0.26 cases per 1000 AOBDs or lower by year ending March 2013. The rate of 0.26 cases or less per 1000 AOBDs is based on the best performing Board as measured in year ending March 2010. NHS Highland is the best performing Board. The target may be revised should it be demonstrated that a lower rate is sustainable.

7 Table 1. Total number of S. aureus bacteraemia cases July–September 2010 and the annual rates of S aureus bacteraemia July 2009–June 2010 in the 15 Boards in Scotland

Figure 5 The SAB rate per 1000 acute occupied bed days for NHS Highland.

8 The National SAB Action Group, chaired by the Chief Nursing Officer, continues to review and discuss progress against delivery of the SAB HEAT target. The NHS Highland SAB action plan update is submitted to the National Group monthly. The National SAB HEAT event on 30/11/2010 was held by national video conferencing with all Scottish Health Boards participating. It was a useful session and it confirmed that NHS Highland is tackling the issues and continues the work to reduce SABs. It was useful to share information with other Boards and learn from each other. MRSA Screening The implementation of the current policy on MRSA screening continues until March 2011. An announcement of future policy direction is awaited. 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 and community hospitals within each CHP 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

Clostridium Difficile Infection (CDI)

The reduction in CDI cases has been sustained in NHS Highland. With effect from April 2010 all Boards are expected to achieve a minimum of 50% rate reduction among patients age 65 and over by 31st March 2011. In terms of numbers this means NHS Highland must not exceed 130 cases of CDI over the course of 2010/2011. From April to December 2010 there have been 60 cases and NHS Highland is well on track to meet and exceed the target.

Figure 7 shows the cumulative CDI episodes (age 65 and over) against the new target.

NHS Highland: Cumulative Clostridium difficile Toxin Positive Episodes (age 65 and over)

140

120

100 s e d o

s 80 i p e e v i t a l u 60 m u C

0 April May June July August September October November December January February March

Target 2010-2011

9 During July and August there was an increase in CDI cases noted in patients ages 20-58 years. There does not appear to be any geographical linkage and the cases are from across the whole of NHS Highland. The majority of cases were acquired in the community and have been reviewed in terms of causes which are multiple. No further increase has been seen in the following months.

Figure 8 NHS Highland Cumulative Clostridium Difficile Toxin Positive Episodes April to December 2010

NHS Highland: Cumulative Clostridium difficile Toxin Positive Episodes

350

300

250 s e d o

s 200 i p e

e v i t a l

u 150 m u C

100

0 April May June July August September October November December January February March

2007-2008 2008-2009 2009-2010 2010-2011

Initiatives to reduce CDI Cases

 Promotion of good hand hygiene across all staff groups and general public.  Attention to environmental cleanliness  Antimicrobial prescribing.

Enhanced surveillance is carried out on every CDI case with immediate feedback to staff concerned. Surveillance includes 30 day follow up from diagnosis for C.difficile. The Infection Control Team works closely with the Health Protection Team to ensure robust follow-up in the community.

National Context

The overall annual CDI rate for NHS Highland is lower (0.53 per 1000 AOBD) than the Scottish average (0.71 per 1000 AOBD). The NHS Highland Clostridium difficile rate in patients aged 65 and over for the period July – September 2010 was lower than the Scottish average at 0.25 per 1000 AOBD. The Scottish average was 0.47 per 1000 AOBD. In patients age group 15-64, NHS Highland rate for the period July - September was higher at 0.89 per 1000 AOBD. The Scottish average was 0.54 per 1000 AOBD. With effect from April 2011 all Boards are expected to achieve a rate of 0.39 cases per 1000 AOBD or lower by year ending March 2013. The rate of 0.39 cases or less per 1000 AOBD is based on the best performing Board as measured in year ending March 2010. NHS Highland’s rate year ending March 2010 was 0.49.

10 Table 2 shows the total number of cases in both age groups 65 and over and 15 - 64 in the period July – September 2010 and quarterly vs. annual rates of CDI in 14 NHS Boards in Scotland.

Antimicrobial Prescribing Antimicrobial Quality Prescribing Indictors.

Empiric Antibiotic Prescribing in Admission Areas Data on hospital-based empiric prescribing of antibiotics continues to be collected in the Acute Medical Admissions Unit and Ward 4A (Surgical Emergency Receiving Ward) in Raigmore Hospital. SPSP methodology is used, sampling five patients each week and auditing compliance with empiric prescribing guidelines in these areas with a target of 95% overall compliance to be achieved by the end of March 2011. Data to the end of December 2010 shows an increase in overall compliance to 90%. As part of this measure compliance with guideline recommendations improved to 95% for the first time since the audit commenced. Feedback on areas for improvement continues to be shared with clinical teams on a regular basis. The achievement of 95% compliance with guideline recommendations is an excellent reflection of the good prescribing practices by clinical teams within Raigmore.

Antibiotic Surgical Prophylaxis

Data on antibiotic prescribing for surgical prophylaxis for orthopaedic trauma shows overall compliance is being maintained at 94%. In vascular surgery, overall compliance has now been 100% for the past three months. The target for both areas is 95% compliance with antibiotic choice and duration of therapy less than 24 hours.

Antimicrobial Utilisation Data

Data covering hospital use of antibiotics is now available. In Raigmore, the use of antibiotics associated with a higher risk of infection with Clostridium difficile is falling (as a percentage of total antibiotic use). Data from Belford, Caithness General and MacKinnon Memorial

11 hospitals is subject to much fluctuation due to smaller numbers of patients. Review of drug issues in Lorn & Islands does not highlight any cause for concern in the use of CDI antibiotics. The content of regular reports on primary care prescribing is currently under discussion.

Management of Infection Guidance

Since the last Board report, no further sections have been reviewed.

Prudent Antibiotic Prescribing in Dentistry

A letter on prudent antibiotic prescribing in dental infections has recently been sent to salaried and independent dentists in NHS Highland. Discussion on reviewing antibiotic prescribing by dentists is underway.

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 and community hospitals within each CHP in section 2. Information on national hand hygiene monitoring can be found at: http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas. Compliance with taking opportunity for hand hygiene was 97% in November and 98% in October 2010. Compliance with technique for hand hygiene was 96% in November and 97% in December 2010.

The NHS Hand Hygiene Campaign 10th Bi-Monthly Audit was carried out in November 2010. Nationally compliance with taking opportunity for hand hygiene is 95%, compliance with taking opportunity in NHS Highland is 97%.

For the purposes of training staff in Hand Hygiene, the 6-step technique is used to teach staff to cover all parts of their hands. Great emphasis is placed on compliance with the 5 key moments which are: - before touching a patient - before clean/aseptic procedure - after body fluid exposure risk - after touching a patient - after touching a patient’s surroundings.

For the purpose of auditing hand washing 5 steps must be used: 1. Bare below the elbows 2. Wet hands and apply liquid soap 3. Ensure soap covers all surfaces of hands including wrists 4. Rinse and dry hands using a paper towel 5. Dispose of paper towel in a foot-operated bin using a method which does not re-contaminate hands.

12 For the purpose of auditing hand rubbing with gel: 1. Bare below the elbows 2. Apply the alcohol-based hand gel 3. Rub hands together, ensuring that the alcohol gel covers all surfaces of the hands.

With effect from April 2011 the audit tool will merge the outcomes of the opportunities taken with the technique used. This should give further confidence that not only are the correct opportunities taken but hands are washed thoroughly.

Table 3 compares the percentage compliance with opportunities with the combined percentage compliance with opportunities and technique in NHS Highland in November and December 2010.

November November December December 2010 2010 2010 2010 Compliance Compliance with Compliance Compliance with with opportunities with opportunities opportunities and Technique opportunities and technique (%) (%) (%) (%) Raigmore 98 96 98 96 CGH 98 98 99 99 Belford 98 95 98 95 Lorn & Isles 92 92 97 96 Mid Highland 96 94 99 96 CHP South East 100 97 98 96 Highland CHP A & B CHP 95 94 99 97 North Highland 100 99 100 98 CHP

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 and community hospitals within each CHP 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

Cleaning compliance was 94% during November and 94% in December 2010. The target compliance is 90%.

13 Further training has been given to ensure that auditing methods in both Domestic and Estates monitoring accurately reflects the cleaning standards and the state of the fabric of the buildings.

Current initiatives to improve cleaning

The domestic work books have been revised nationally and both Domestic supervisors and staff are working through them. The Cleanliness Champion Programme is being undertaken by Domestic supervisors.

HEI Inspection

The HEI Inspectorate made an unannounced visit to Lorn and Islands Hospital on 13/01/2011. Initial feedback was positive. The Inspectorate commented that they had been well received by staff who had engaged with the team. Standards of cleaning were consistently good throughout the hospital. Antimicrobial prescribing, empirical guidelines were present in laminated form in each ward. The Inspectorate found some pan Highland policy review dates had passed and this will be a required action to get these policies reviewed.

Outbreaks/Incidents There have been no outbreaks in November 2010. In December 2010, there were 13 cases of diarrhoea and vomiting in Rosebank Ward, Caithness General including 5 staff. There was difficulty in obtaining samples to send to the laboratory; therefore, it could not confirmed that this was due to Norovirus. In January a total of 27 patients and 23 staff in various wards had diarrhoea and vomiting, which again sufficient samples were not obtained to confirm that this was due to Norovirus. Table 4 shows the affected hospitals Hospital Patients Staff Month Caithness General 8 5 December Town & County Wick 1 5 January Dunbar Thurso 5 4 January Caithness General 13 9 January

H1N1 Between 22/12/2010 and 10/01/2011 a total of 56 patients were admitted to hospital with flu, 45 of which were H1N1. There were 8 Flu B and 2 Flu A.

HAI Related Deaths As part of our quality assurance in the management of HAI related cases, we are reviewing how care of Clostridium difficile cases between September - November 2010 was managed to ensure local guidelines were followed. NES have recently released a Clostridium Difficile training package to be undertaken by medical and nursing staff.

14 Other HAI Related Activity Surgical Site Infections (SSI) Caesarean Section Surgical Site Infections The infection rates of surgical site infection (SSI) in Caesarean section wounds continues to improve with focus on the following areas of practice: 1. Environment: the recent audit of the theatre environment showed a very high standard of practice in the theatre and the theatre temperature compliant with guidance. 2. All cases undergo root cause analysis. This recently highlighted some non- compliance with skin care preparation prior to admission. To address this, a new leaflet has been sent directly to all women booked for elective Caesarean sections. 3. Following surgery, the wound is covered with a waterproof dressing that remains in place for 48hrs - this ensures that we are now compliant with NICE guidelines for post-operative wound management. 4. Associated audit work supports the process by: a. investigation into adherence to the surgical site infection prevention bundle; b. skin preparation and cleansing; c. The distribution of appropriate information leaflets to women prior to the procedure.

Orthopaedic Surgical Site infections In September 2010 there was 1 fractured neck of femur infection from 30 operations and 1 infection in October 2010 from 29 operations. A root cause analysis has been carried out on each infection. There have been no infections from total hip replacement operations in September and October 2010.

Staff training Work is ongoing with the Learning and Development Team to increase the use of e-learning packages to deliver infection prevention and control training across Highland, freeing time for the Infection Control Nurses to focus on prevention of infection.

Decontamination Endoscopy Following the recent visit by the Joint Advisory Group (JAG), issues were identified regarding the decontamination of flexible endoscopes. A short life working group is working through the subsequent action plan. Progress will be reviewed by the Infection Control Improvement Group with reports submitted to the Control of Infection Committee.

15 Healthcare Associated Infection Reporting Template (HAIRT) Section 2 – Healthcare Associated Infection Report Cards

The following section is a series of ‘Report Cards’ which provide information for each acute hospital (Raigmore, Caithness General, Belford and Lorn & Islands), and the community hospitals within each CHP. The information includes the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections. Hand hygiene and cleaning compliance completes the report card.

The out-of-hospital infections report card identifies infections 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 and the community hospitals within each CHP. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data is presented as both a graph and a table giving case numbers. 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 acute hospital and community hospitals in each CHP, the total 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.

Understanding the Report Cards – Hand Hygiene Compliance Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website: http://www.washyourhandsofthem.com/

Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital/CHP report card presents the percentage of hand hygiene compliance for all staff in both graph and table form.

16 Understanding the Report Cards – Cleaning Compliance

Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning 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/

The Report Cards show the hospitals’ cleaning compliance percentage in both graph and table form.

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, care homes and the community itself. 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. Given the complex variety of sources for these infections it is not possible to break this data down in any more detail.

17 Abbreviations

HAI Healthcare Associated Infection

HAIRT Healthcare Associated Infection Reporting Template

CHP Community Health Partnership

SAB Staphylococcus Aureus Bacteraemias

MSSA Meticillin Sensitive Staphylococcus Aureus

MRSA Meticillin Resistant Staphylococcus Aureus

CDI Clostridium difficile

CNO Chief Nursing Officer

SPC Statistical Process Chart

HEAT Health Improvement, Efficiency, Access, Treatment

18 Quarterly rolling year Clostridium difficile Infection Cases per 1000 total occupied bed days for HEAT Target Measurement

1.4

1.2

0.8 Actual Performance

0.6 Target

0.4

0.2

0 Apr 07 - Jul 07 - Oct 07 - Jan 08 - Apr 08 - Jul 08 - Oct 08 - Jan 09 - Apr 09 - Jul 09 - Oct 09 - Jan 10 - Apr 10 - Mar 08 Jun 08 Sept 08 Dec 08 Mar 09 Jun 09 Sept 09 Dec 09 Mar 10 Jun 10 Sept 10 Dec 10 Mar 11

Apr 07 - Jul 07 - Oct 07 - Jan 08 - Apr 08 - Jul 08 - Oct 08 - Jan 09 - Apr 09 - Jul 09 - Oct 09 - Jan 10 - Apr 10 - Mar 08 Jun 08 Sept 08 Dec 08 Mar 09 Jun 09 Sept 09 Dec 09 Mar 10 Jun 10 Sept 10 Dec 10 Mar 11 Actual Performance 1.10 1.08 0.85 0.66 0.67 0.61 0.61 0.53 0.49 0.50 0.50 Target 1.32 1.27 1.21 1.16 1.10 1.05 0.99 0.94 0.88 0.83 0.77 0.72 0.66

Quarterly rolling year Staphylococcus aureus Bacteraemia Cases for HEAT Target Measurement

120

100

Actual Performance 60 Target

0 Apr 05 - Jul 05 - Oct 05 - Jan 05 - Apr 06 - Jul 06 - Oct 06 - Jan 07 - Apr 07 - Jul 07 - Oct 07 - Jan 08 - Apr 08 - Jul 08 - Oct 08 - Jan 09 - Apr 09 - Jul 09 - Oct 09 - Jan 10 - Apr 10 - Mar 06 Jun 06 Sept 06 Dec06 Mar 07 Jun 07 Sept 07 Dec 07 Mar 08 Jun 08 Sept 08 Dec 08 Mar 09 Jun 09 Sept 09 Dec 09 Mar 10 Jun 10 Sept 10 Dec 10 Mar 11

Apr 05 - Jul 05 - Oct 05 - Jan 05 - Apr 06 - Jul 06 - Oct 06 - Jan 07 - Apr 07 - Jul 07 - Oct 07 - Jan 08 - Apr 08 - Jul 08 - Oct 08 - Jan 09 - Apr 09 - Jul 09 - Oct 09 - Jan 10 - Apr 10 - Mar 06 Jun 06 Sept 06 Dec06 Mar 07 Jun 07 Sept 07 Dec 07 Mar 08 Jun 08 Sept 08 Dec 08 Mar 09 Jun 09 Sept 09 Dec 09 Mar 10 Jun 10 Sept 10 Dec 10 Mar 11 Actual Performance 79 69 76 67 69 80 88 99 97 95 88 89 84 84 72 69 74 70 63 62 Target 79 78 76 75 73 75 70 69 67 66 64 63 61 60 58 57 55 53 51 49 46 Pan Highland Clostridium difficile Infection Cases

18 16 14 12 10 8 6 4 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 11 11 13 10 14 8 9 12 5 9 6 6

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 1 7 5 2 7 5 2 3 4 8 9 2 1 2 2 0 1 0 1 0 0 1 0 1

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 96 96 97 96 95 96 97 96 96 98 97 98 93.2 93 85.5 93.3 92.8 91.7 94 94.7 95 92 94 94 Raigmore Hospital Clostridium difficile Infection Cases

18 16 14 12 10 8 6 4 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 3 2 7 4 4 2 1 4 1 2 2 4

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 1 2 0 3 1 0 1 0 2 2 0 1 2 1 0 1 0 0 0 0 0 0 1

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 98 96 97 96 95 96 97 96 96 100 98 98 93.2 93 85.5 93.3 92.8 91.7 94 94.7 94.5 94.1 93.9 93.7 Caithness General Hospital Clostridium difficile Infection Cases

18 16 14 12 10 8 6 4 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 1 2 0 1 1 0 0 0 1 0 0

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 99 99 99 98 98 99 98 98 100 99 98 99 96.6 95.5 94.1 95.3 96.9 95.2 96.8 96.5 94.5 91.1 94.3 93.2 Belford Hospital Clostridium difficile Infection Cases

18 16 14 12 10 8 6 4 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 1 0 0 0 0 0 0 0 1 0 0

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 98 99 100 94 93 100 96 98 93 98 98 98 93 95.3 89.7 93.3 96.2 93.4 96.2 93.5 94.6 89.1 93.8 97 Lorn & Islands Hospital Clostridium difficile Infection Cases

18 16 14 12 10 8 6 4 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 June-1- Jul-10 Aug-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 0 0 0 0 0 0 0 0 0 0 0

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 011000000010 0 0 0 0 0 0 0 0 0 0 0 0

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 96 94 99 97 92 94 92 94 92 92 92 97 93.5 93.7 95.6 93.6 94.9 96 96.4 96.4 95.7 96 95.6 93.7 Mid CHP Community Hospitals Clostridium difficile Infection Cases

18 16 14 12 10 Mid CHP Community Hospitals include Ross Memorial Hospital Dingwall, County 8 Community Hospital Invergordon, MacKinnon memorial Hospital, Broadford & 6 Portree Hospital Isle of Skye. 4 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 3 0 0 0 0 0 1 0 0 0 0

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 98 99 100 95 199 100 97 96 97 99 96 99 94 97 93 95 94 94 95 94 94 89 93 94 South East CHP Community Hospitals Clostridium difficile Infection Cases

18 16 14 12 For the purposes of monitoring New Craigs Psychiatric Hospital is included in this 10 report card. Other hospitals included are RNI Community Hospital Inverness, 8 6 Town & County Hospital Nairn, Ian Charles Community Hospital Grantown on 4 Spey, St. Vincents Hospital Kingussie. 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 1 0 0 0 2 0 1 0 0 0 0 1

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 June-1- Jul-10 Aug-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 99 97 98 99 99 99 100 100 97 98 100 98 96 96 94 97 96 96 95 96 95 89 92 94 Argyll & Bute CHP Community Hospitals Clostridium difficile Infection Cases

18 16 14 12 Argyll & Bute Community Hospitals include Argyll & Bute Hospital, Lochgilphead, 10 Campbeltown Hospital, Cowal Community Hospital Dunoon, Dunaros Community 8 6 Hospital, Isle of Mull, Islay Hospital, Mid Argyll Community Hospital & Integrated 4 Care Centre Lochgilphead, Victoria Hospital & Annex Rothesay 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 1 0 1 0 0 1 0 0 0 0 0 0

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 98 95 98 97 98 98 97 98 96 96 95 99 94 95 95 95 94 95 95 96 96 95 95 95 North CHP Clostridium difficile Infection Cases

18 16 14 12 10 North CHP Community Hospitals include Dunbar Hospital, Thurso; Town & County 8 6 Wick; Lawson Memorial Hospital, Golspie; Migdale Hospital, Bonar Bridge. 4 2 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 0 0 0 0 1 0 1 0 0 0 0 0

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Hand Hygiene Compliance Cleaning Compliance

100 100

80 80

60 60

40 40

20 20

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 98 99 100 100 97 100 100 199 100 98 100 100 97 97 95 97 97 97 93 96 96 91 95 94 Out of Hospital Infections Clostridium difficile Infection Cases

0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 4 3 6 6 4 7 7 3 2 5 3 2

MSSA Bacteraemia Cases MRSA Bacteraemia Cases

12 12

10 10

8 8

6 6

4 4

2 2

0 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

SCOTTISH PATIENT SAFETY PROGRAMME Progress as at January 2011

Report by Maryanne Gillies, Clinical Governance Manager/SPSP Manager on behalf of Dr Ian Bashford, Board Medical Director

The Board is asked to Note the progress of the Scottish Patient Safety Programme within NHS Highland as at January 2011 and in particular:

 The revised trajectory;  Actions planned to achieve trajectory;  The Hospital Standardised Mortality Ratios (HSMR) published on 30 November 2010.

1.0 INTRODUCTION

1.1 The Board last received a report on progress of the Scottish Patient Safety Programme (SPSP) in May 2010. That report provided detailed background information on the programme, the current and planned trajectory and examples of the work being carried out by the front line teams

1.2 SPSP forms a key part of the NHS Highland Quality & Patient Safety Framework which was approved by the Board in April 2010. The aim of the Framework is to ensure that healthcare is personalised and made fairer, that there is access to the most effective treatments and that systems keep patients safe.

1.3 In NHS Highland we believe that patients should be cared for in a safe environment that minimises risk. This means that we must continually and systematically review and improve our health care processes and working practices to prevent or reduce the risk of harm. In order to demonstrate that we are delivering on these aims we must have measurable objectives in place. It is important that these aims are achievable, yet ambitious and that they focus our attention on delivering improvement.

1.4 The two high level objectives of the programme are:

 Reduce mortality by 15% by end of 2012  Reduce adverse events by 30% by end of 2012

1.5 NHS Highland has committed to achieving the objectives of the Scottish Patient Safety Programme (SPSP) initially within pilot sites in the four acute hospital settings (Belford, Caithness, Lorn & Isles and Raigmore). Each hospital site delivers within five separate work streams (Leadership, Medicines Management, Critical Care, General Ward and Perioperative) Examples of the work being undertaken is detailed in Appendix A

1.6 A glossary of the terms used in this report is detailed in Appendix B

2.0 CURRENT POSITION

2.1 The Board is required to assess progress against the National IHI (Institute of Healthcare Improvement) assessment scale. This is applied to each hospital site and whole NHS Highland.

1 2.2 The projected IHI Trajectory for NHS Highland for January 2010 was 3.5. The Board Trajectory was 3.0 for Raigmore and 3.5 for the Rural General Hospitals. NHS Highland was 2.0 in January 2010 and achieved a 2.5 in February 2010.

2.3 NHS Highland had self- assessed themselves at a level 3.0 for their October report however confirmation was IHI gave an assessment of 2.5. From the feedback from IHI they were concerned that Medicines Management did not have sufficient documentation and data to indicate that all the key changes had been fully implemented. Action is now being taken to address these issues and the Boards reports to IHI for November and December will be amended to reflect this. It should be noted that IHI are currently reporting 3 months in arrears.

2.4 NHS Highland has recently reviewed their trajectory for whole NHS Highland as shown in figure below. NHS Highland is committed to drawing back in line with the IHI trajectory by end 2011.

IHI NHSH Actual Score Definition Trajectory Revised Status Trajectory Achieved

2.0 Improvement noted (using run chart rules) in process Jan 2009 Jan January and/or outcome measures for pilot populations in three 2009 2010 or more work streams. 2.5 Improvement noted (using run chart rules) in process April 2009 April March and/or outcome measures for pilot populations in all five 2009 2010 work streams. 3.0 All key changes in all five work streams have been July January implemented in the pilot populations. Sustained 2009 2011 improvement noted (using run chart rules) in related process and outcome measures in one to three pilot populations. 3.5 Sustained improvement (three months without sliding January April 2011 backwards) is noted in process and outcome measures 2010 for pilot populations in all five work streams. Spread (including testing, training, communication, etc.) of all key changes is underway beyond the pilot populations. 4.0 Spread (including testing, training, communication, etc.) Jan 2011 August of all key changes has been achieved in one to three 2011 (breadth) work streams with at least 50% penetration (depth) into other applicable patient populations and areas 4.5 Spread (including testing, training, communication, etc.) Jan2012 December of all key changes has been achieved in all (breadth) 2011 work streams with at least 50% penetration (depth) into other applicable patient populations and areas. 5.0 Spread has been achieved in all five (breadth) work Dec2012 December streams with 100% penetration (depth) into the 2012 applicable clinical areas and has been sustained (no backward slipping in the outcome measures) for a minimum of three months.

2.5 The Senior Leadership Team is responsible for monitoring the progress against the assessment scale and over the past year it has spend a considerable amount of time identifying and removing barriers for improvement. The pilot sites across all hospitals have been scrutinised a month to month basis to ensure progress is achieved and maintained.

2.6 Spread plans are being prepared for all clinical areas in the four hospitals. This involves identification of all relevant bundles, providing support and education to the clinical teams and ensuring data capture to demonstrate improvement. It has been agreed that progress of spread will be monitored by the Improvement Committee.

2 2.6 Challenges surrounding the delivery of the programme are:  Capacity issues surrounding competing priorities at the frontline and middle management  Capability issues; the conceptual difficulty between the ‘old methods’ of collecting large amounts of data to build confidence in interpretation v ‘new methods’ of very small sample sizes with constant close examination for improvement.

2.7 These are being address by supporting staff and working collaboratively with Stirling University and NES to produce a range of education material. A two day event is being held at the end of January, targeted at those in a education role. In addition the SPSP team is working with Practice Development Department to assess the level of competence and education requirement for all staff groups on a business transformation model.

3.0 QUARTERLY HOSPITAL STANDARDISED MORTALITY RATIO (HSMR)

3.1 Introduction The Scottish Patient Safety Programme (SPSP) was set a target of achieving a 15% reduction in hospital mortality by December 2011. To monitor this measure the Quality Improvement Programme at the Information Services Division (ISD) has developed a case-mix adjustment method for Hospital Standardised Mortality Ratios (HSMR). A quarterly cycle of updates has been established to provide HSMR’s to all hospitals in the SPSP. HSMR data was published for the first time on the 30th November and provides data for the period October 2006 to June 2010.

3.2 Measuring hospital mortality using HSMR The rationale for measuring hospital mortality is to reduce death rates, improve patient safety and reduce avoidable variation in care and outcomes. Using absolute numbers of deaths to support these aims would tell us very little as the numbers of people hospitalised changes over time, the hospital population may be getting healthier or the hospital safer. Calculating a crude hospital death rate by dividing the number of deaths by the number of people discharged within a time period would not add to this picture in that it fails to account for the chance of dying being closely related to factors such as age, sex, severity of illness and diagnoses. The HSMR approach, calculated using indirect standardisation, attempts to adjust for such factors that influence deaths rates and are outside the control of a hospital.

3.3 Key Points in interpretation of HSMRs  HSMRs are calculated by dividing the actual number of deaths in a hospital in a time period by the number that would be predicted, adjusting for the characteristics of the patients treated  If an HSMR is greater than 1 the number of deaths for a hospital is more than predicted relative to the Scottish base period. This does not necessarily mean that these were avoidable deaths, or that they were unexpected, or attributable to failings in the quality of care.  A consistently high (or low) HSMR over a period of time may signal a cause for concern, but there are dangers in misinterpreting a single value  HSMRs can fluctuate over time within hospitals – variation will be greater when the number of deaths is smaller  HSMRs are a high level measure that cannot be used on their own to assess the quality of care without other data and specialist audit  The HSMR method used by ISD allows individual hospitals to monitor themselves over time and was not created to compare hospitals or identify outliers

3 3.4 Local Trends in HSMR in Board Hospitals

The HSMR data for each of the four hospital is shown delow:-

3.5 Belford Hospital

o 2.0 i t

a Base year R y t i l a

t 1.5 r o M d e s i 1.0 d r a d n a t

S 0.5 l a t i p s o

H 0.0 Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun 2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010p

Standardised Mortality Ratio (SMR) Regression line Regression start

3.6 The number of observed deaths connected with Belford Hospital in each quarter period is small averaging about 21 in a quarter. Unsurprisingly, there is considerable random quarterly variation about the baseline and the regression line shows no evidence of trend. 3.7 Caithness General Hospital o i

t 2.0 a R

y t i l a

t 1.5 r o M

d e s

i 1.0 d r a d n a t 0.5 S

l a t i p s

o 0.0 H Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun 2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010p

Standardised Mortality Ratio (SMR) Baseline Scottish HSMR

3.8 The last six successive quarters of data have been consistently higher than the Scottish HSMR baseline. This pattern of data is unlikely to have occurred by chance alone. This suggests that over this 18 month period 180 deaths would have been predicted - 216 were observed. To put this in context, this would amount to an additional 2 deaths a month occurring than predicted over the period. As above there should be no assumption that any of these deaths were preventable. Even thought the additional number of deaths may be small a precautionary approach is being taken and a mortality case note review is taking place to examine in detail possible reasons: Has there been redesign of service that has perhaps resulted in changes of coding (including admission type codes)?

4 This might include changes in patterns of transfer admissions. Has there been a change to end of life care both in the hospital and the community. Have there been changes in other key safety measures such as HAI, SSI, readmissions or patient complaints?

3.9 Raigmore Hospital

o 2.0 i t a

R Base year

y t i l a

t 1.5 r o M

d e s

i 1.0 d r a d n a t

S 0.5

l a t i p s o

Standardised Mortality Ratio (SMR) Regression line Regression start

3.10 The HSMR trend at Raigmore has been below the baseline in all fifteen quarters of reported data. This in itself is a very unusual pattern. There may be case for citing Raigmore as an example of good practice, but additional evidence would be required.

3.11 An overall hospital HSMR can conceal variation in care across areas of hospital activity. Additional standardised data, perhaps specialty specific or based upon care for stroke, fractured neck of femur etc is required for larger hospitals to understand what is happening beneath the surface in larger hospitals.

3.12 It is possible to speculate that the lower HSMR at Raigmore may have something to do with patient care pathways in Highland that see stepped down care to local hospitals. The HSMR here may be influenced by the use of the last stay in hospital in any quarter as the trigger event for the calculation. 3.13 Currently the position suggests that Raigmore has around 22 percent fewer deaths than predicted than the base period. However, it should be remembered that the HSMR is a relative measure and the Scottish picture as a whole has improved over time. Rebasing to the national figure in the same quarter of 2010 would suggest that Raigmore has about 15 percent fewer deaths than Scotland. 3.14 Lorn and Islands Hospital Base year

o 2.0 i t a R

y t i l a

t 1.5 r o M

d e s

i 1.0 d r a d n a t

S 0.5

l a t i p s o

Standardised Mortality Ratio (SMR) Regression line Regression start

5 3.15 The number of observed deaths connected with Lorn & Islands RGH in each quarter period is small averaging about 22 in a quarter. Unsurprisingly, there is considerable random quarterly variation about the baseline and the regression line shows no evidence of trend.

4.0 FUTURE ACTIONS

4.1 The main priorities for NHS Highland over the next year are:

 To support capacity with frontline staff to examine process interventions and systems to ensure staff work smarter, not harder when ever possible  To maintain focus on pilot sites to achieve sustained improvement  To continue the development of the Quality Improvement and Patient Safety Team to increase capability by aligning with the Central Team, Stirling University, Practice Development, Clinical Governance and Frontline teams in the delivery of wide ranging education materials, presentations and ward based support.  To progress the Spread Plans at each hospital to ensure progress against assessment scale is achieved  To support the integration with other improvement programmes and ensure appropriate engagement and support from ‘middle management’.  To continue to develop robust data management and reporting to leadership teams.  To translate current data management system to dashboard style reports.  To implement to Heart Failure and Paediatric Bundles  To participate in the Safety Improvement in Primary Care Programme

5.0 CONTRIBUTION TO CORPORATE OBJECTIVES

This progress report demonstrates how NHS Highland is achieving its corporate objective of ensuring that services delivered are of high quality and clinically safe.

6.0. GOVERNANCE IMPLICATIONS

This progress report has a direct impact on clinical governance and demonstrates the approach to managing patient safety within the organisation.

7.0 IMPACT ASSESSMENT

This report does not require impact assessment.

Maryanne Gillies Clinical Governance Manager/SPSP Manager

21 January 2011

6 Appendix A

1.0 FRONTLINE TEAM ACTIVITY

As pervious mentioned the Board is committed to achieving the objectives of the Scottish Patient Safety Programme (SPSP). Detailed below are examples of progress being made across the four acute hospital sites.

2.0 Leadership

The Scottish Patient Safety Walk round process is now well established across all four sites. Safety walk rounds take place to a separate clinical area on a weekly basis at Raigmore Hospital. The team includes a Senior Executive, a Hospital Manager, a Clinical Governance Representative and a SPSP Facilitator. SPSP Actions are recorded and target date set for completion. Non SPSP actions are also recorded and escalated through to Hospital Quality and Patient Safety Group.. Senior leaders schedule a Walk round on planned visits to RGH’s and otherwise the walk rounds take place with local management teams.

3.0 Critical Care:

Objective Status Ventilator associated pneumonia: 0 or 300 days between Achieved Central Line CR-BSI: 0 or 300 days between Achieved Blood sugars w/in range (ITU/HDU): 80% or > w/in range Achieved

3.1 Process Compliance with Ventilator associated pneumonia showing sustained improvement at 100% as shown below:

CCP2 Preventing VAP Care Bundle Compliance

100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 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 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 / / / / / / / / / / / / / / / / / / / / / / / / / 7 7 7 8 8 8 8 9 9 9 9 0 0 0 0 0 1 1 1 1 2 2 2 2 2 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / 4 2 9 3 0 9 4 1 7 9 4 1 5 5 2 8 3 1 9 5 2 7 6 1 9 1 2 2 0 1 1 2 0 0 1 2 0 0 1 2 2 0 1 1 2 0 0 1 2 2

Reliability Target Who received all 4 components of the bundle

Team have achieved 370 days between Ventilator associated pneumonia

7 “For a long time the team felt that this measure was unachievable; but now we no longer view Ventilator Associated Pneumonia as an inevitable complication” Charge Nurse, Critical Care

3.2 The Critical care team have also implemented the Peripheral Vascular Catheter (PVC) Bundle, Multi-disciplinary Ward Rounds with Daily Goal Sheets. They have also introduced other elements from other work streams that are relevant e.g Safety Brief and SBAR (Situation, Background, Assessment, and Recommendation). They are using the methodology to produce further Bundles of care e.g Arterial Line Insertion and Maintenance Bundle.

4.0 General Ward:

Teams are achieving good progress across all four sites. There is reliable implementation of PVC Bundle, Safety Briefs and SBAR taking place. Daily Safety Briefs and the use of the SBAR communication tool are now part of the cultural norm. SEWs charts are in place across all clinical areas – teams have been challenged to achieve compliance with appropriate action being recorded. This is now showing improvement as teams consider system change e.g SEWS score being recorded on Safety Brief. General ward teams are also welcoming other Bundles e.g Central Line Bundles, Medicines Management and Periop Bundles as spread starts. The Belford Hospital has been challenged to achieve reliability and consistent data reporting due to the re-design of hospital and two ward amalgamating. The team are now receiving support from their management teams and senior leadership team. All teams are currently examining their process for early rescue and each hospital site is deploying Rapid Response Teams/Medical Emergency Teams to ensure early rescue of the deteriorating patient.

CCP8 PVC Bundle Compliance - Number of times where PVC care was optimal

100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 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 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 / / / / / / / / / / / / / / / / / / / / / / / / / 7 7 8 8 8 8 8 9 9 9 9 0 0 0 0 1 1 1 1 1 2 2 2 2 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 / / / / / / / / / / / / / / / / / / / / / / / / / 9 6 2 9 6 3 0 6 3 0 7 4 1 8 5 3 8 6 2 9 6 3 0 7 4 1 2 0 0 1 2 3 0 1 2 2 0 1 1 2 0 0 1 2 2 0 1 2 2 0

Reliability Target 1st Goal Line Number of times where PVC care was optimal Caithness General Hospital PVC compliance at 100%

8 GWP 1, 2 & 3 - SEWS compliance - Respiratory rate clearly recorded (%)

100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 9 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 / / / / / / / / / / / / / / / / 8 9 0 1 2 1 2 3 5 6 7 8 9 0 1 2 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 1 / / / / / / / / / / / / / / / / 1 0 1 0 1 1 8 1 6 8 6 0 4 9 5 0 3 3 3 3 3 3 2 3 2 2 2 3 2 2 2 3

Reliability Target 1st Goal Line Respiratory rate clearly recorded (%) Lorn & Isles SEWS compliance RR – compliance at 100%

5.0 Perioperative: The team are making excellent progress with implementing the surgical Pause across all four sites. There have been some challenges surrounding the reliable implementation of surgical brief – which are currently being addressed. The periop team in Raigmore have produced DVT Prophylactic assessments but there have been challenges in the implementation of these. A Pan Highland meeting has now been arranged for end January to agree a Venous Throm-embolism Policy and agree Pan Highland Venous thromoembolism. The SPSP team will move forwards with the reliable implementation using the Model for Improvement and documentation change. Considerable work has taken place testing a newly designed pre- operative checklist and care plan – this is currently reaching the final stages of testing and will be shared pan Highland. The perioperative team are challenged in providing an outcome measure in relation to the reliable implementation of the Surgical Site Infection Bundle, as currently there is no surveillance on the general surgical side. HPS and the infection control team have plans to provide some surveillance in colorectal surgery at the start of this year.

POP7 % of patients with surgical pause

100% 95% 90% 85% 80% 75% 70% 65% 60% 55% % Compliance 50% Reliability Target 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 / / / / / / / / / / / / / / / / 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 / / / / / / / / / / / / / / / / 0 1 0 1 1 8 1 0 1 0 1 1 0 1 0 1 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3 3 Belford Hospital Surgical Pause > 95% compliance

9 6.0 Medicines Management: The Medicines Management Team has been focusing on two significant areas of work: Medicines Reconciliation on admission and Anti-coagulant management (particularly Warfarin).

6.1 Medicines Reconciliation: A standardised form has been developed in all 4 hospitals. The team are achieving regular reliability of over 90% and occasionally over 95% - however maintaining reliability proves a challenge. This is due to constant change of junior doctors and pressures of work at the frontline. The team plan to provide a contingency ward round checklist. The medicines reconciliation form is being introduced as part of the roll out of the Commons Admission Document in surgical wards from January 17. This will enable spread of medicines reconciliation to take place. The team need to identify who will check compliance and report outcome data.

6.2 Decreasing INRs >6. A new Anti-coagulation protocol has been developed through tests of change and a Anti-coagulation prescription form has been developed, tested and implemented. The outcome measure is to reduce the number of INRs >6 below the baseline measure. Both Caithness and Raigmore are showing sustained improvement.

6.3 The IDL system has been upgraded by e-health and this system change has facilitated improvement in medicines reconciliation and anti-coagulation management. Pharmacy will reject all IDL discharge prescriptions where the reason for medication change in hospital or indication for initiation in hospital fields is not completed.

6.4 Failure Modes Effect Analysis - 50% reduction in FMEA The team at Raigmore have achieved a reduction in aggregate Risk Priority Number of 44% and 84% at single highest RPN – this was achieved through the implementation of the new Immediate Discharge Letter Anticoagulant Module and new Prescribing Charts. Belford Hospital, Caithness and Lorn& Isles have recently started using FMEA

6.5 Following further tests of change the warfarin and heparin infusion charts have been redesigned and implementation is in progress. The team are currently testing a shift to 2pm warfarin dosing and delivery – this will enable any problems with warfarin dosing to be addressed with the patient’s own clinical team and within regular working hours. A copy of current warfarin chart sent to GP and letter from pharmacy to GP attached to prescription

7.0 ADVERSE EVENT RATE

7.1 Traditional efforts to detect adverse events have focused on voluntary reporting and tracking of errors. The Global Trigger Tool produced by IHI for measuring adverse events provides an easy-to-use method for accurately identifying adverse events (harm) and measuring the rate of adverse events over time. Tracking adverse events over time is a useful way to tell if changes being made are improving the safety of the care processes.

7.2 The Trigger Tool methodology is a retrospective review of a random sample of inpatient hospital records using “triggers” (or clues) to identify possible adverse events. The process is not meant to identify every single adverse event in an inpatient record but to identify trends and system related issues.

7.3 Each hospital has a team who carry out this case note review on 20 case notes per month and results are recorded on a monthly basis.

7.4 The ‘expected’ adverse event rate is in the region of 30% and the overall aim is to reduce the rate by 30% by the end of December 2012.

10 7.5 Although Belford, Caithness, Raigmore have all shown sustained improvement – this would not be expected until spread has occurred. It has therefore been agreed that each team reviews their process and system of sampling and performing their review in order to assess whether the data is a true reflection of position.

11 APPENDIX B

GLOSSARY

Term Definition SEWS chart A patient observation chart designed to assist in the early detection and initiation of treatment in severe illness. Scottish Early Warning Score Chart

PVC A device inserted into a vein and then attached to intravenous infusion. Peripheral Vascular Catheter - commonly known as ‘Venflon’

Bundle A collection of processes needed to effectively care for patients undergoing particular treatments with inherent risks. The idea is to bundle together several scientifically grounded elements essential to improving clinical outcomes. A bundle should be relatively small and straightforward − a set of three to five practices or precautionary steps is ideal. SBAR A framework for communication between members of the health care team about a patient's condition. SBAR is an Situation, Background, easy-to-remember, concrete mechanism useful for framing Assessment, Recommendation any conversation, especially critical ones, requiring a clinician’s immediate attention and action. Safety Briefing A tool which incorporates discussions of safety into the daily routine, 24 hours a day, 7 days a week in order to increase safety awareness among front-line staff and to help develop a culture of safety. Should be carried out by front line staff at the start of each shift change. Rapid Response Team Sometimes known as the Medical Emergency Team — is a team of clinicians who bring critical care expertise to the bedside (or wherever it’s needed) in response to a deterioration in the patient’s condition. Surgical Pause A protocol to prevent wrong site, wrong procedure, and wrong person surgery. The pause requires the entire medical team to agree on the patient’s identity and all of the required elements of the impending procedure by using verbal and consulting supporting documents, such as test results, if applicable. If any member of the team does not agree on the relevant information, the procedure does not go forward. FMEA A systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the Failure Modes Effect Analysis relative impact of different failures in order to identify the parts of the process that are most in need of change. Daily Goal Sheets A form that states the tasks to be completed, care plan, and communication plan (discussions with patient/family or other care givers). Designed to facilitate communication by requiring the care team to define explicitly the goals for the day.

12 Highland NHS Board 1 February 2011 Item 4.6

A PARTICIPATION STANDARD FOR THE NHS IN SCOTLAND

Report by Gill Keel, Head of Public Engagement on behalf of Anne Gent, Director of Human Resources / Designated Director for Patient Focus and Public Involvement

The Board is asked to:

 Note the timescale for completing the self assessment against the Participation Standard for the NHS in Scotland, and agree to delegate approval of the final self assessment report to the Board’s Patient Focus and Public Involvement Leadership Group.  Note the work in progress to review the Board’s systems of governance for patient and public involvement across NHS Highland.  Note the attached appendix which presents a summary overview of existing patient and public involvement structures.

1 Background and Summary

The Participation Standard for the NHS in Scotland was issued in August 2010, and was introduced to the Board at the meeting in September 2010. The first Board self assessments are due to be presented to the Scottish Health Council on 11 March 2011. In order to meet the timeline set nationally, the Board is asked to delegate authority to approve the final NHS Highland self assessment report to the Board’s Patient Focus and Public Involvement Leadership Group.

The Standard is in three sections – 1) Patient Focus, 2) Involving People in service planning and development, and 3) Corporate Governance of Participation. Although each NHS Board will submit evidence against all three sections, it is understood that the final performance scores published will relate to the third section, Corporate Governance only.

Within NHS Highland, the Board has recognised the critical importance of participation in relation to our vision for services, and our aims for patients. The participation of patients in their own healthcare is fundamental to meeting our aim of continually improving the quality of patient care and experience. Supporting people to improve their own health and wellbeing is strongly dependent on our ability to engage with them in a positive way. The future of local healthcare services demands significant change across the whole of NHS Highland, so the need to engage service users and other local people in planning for the future of their local services has never been greater.

Attached to this paper at Appendix 1 is a brief update on existing patient and public involvement structures within NHS Highland.

2 The Participation Standard

Assessment Process The NHS Board was briefed on the Participation Standard in September 2010. For ease of reference, a summary of the Standard Statements, rationale and criteria is attached as Appendix 2 to this paper.

NHS Boards are required to prepare a self assessment report in accordance with national guidance, and submit by 11 March 2011. The timeline will not allow the completed NHS Highland self assessment report to be considered at a full Board meeting, so it is recommended that the final report is considered and approved by the Board’s Patient Focus and Public Involvement Leadership Group.

1 For ease of reference, the membership and role of this group is attached as Appendix 3 to this paper.

It is understood that Boards will receive final feedback and an assessed score during May 2011. This is an annual assessment, and Boards expect to be involved in reviewing the Standard and the assessment processes used during 2010-2011.

Corporate Governance The third section of the Participation Standard refers to the role of NHS Boards in relation to the overall governance of participation. The term “participation” in the context of NHS Scotland refers to a broad spectrum of activities, responsibilities and statutory duties. It is a challenge to define governance systems which cover the relevant aspects of performance through arrangements which are effective, manageable and proportionate. Within NHS Highland, we have taken the arrival of the Standard as an opportunity to reflect on internal governance arrangements, through the Patient Focus and Public Involvement Leadership Group.

In particular, the Leadership Group will review the ways in which operational units and services report their actions on participation through existing governance systems. For example, through applying greater rigour to the completion of Board papers, so that each paper provides the Board with assurance under the heading “Patient and Public Involvement” which sits within the section “Governance Implications”. As this work progresses, other recommendations may emerge for further discussion with the Board.

3 Contribution to Board Objectives

Compliance with the Participation Standard is a requirement of the Scottish Government. For the NHS Boards, it is an opportunity to reflect on aspects of working practice in relation to the participation of patients and carers in their own care, and more broadly in services. In NHS Highland, it is clearly understood that participation is fundamental to the delivery of our triple aims of improving health, improving the quality of patients’ experiences, and achieving good value for money across our services.

4 Governance Implications

The Participation Standard is strongly linked to supporting effective governance of patient and public involvement.

5 Risk Assessment

At this stage, no risks have been identified, although some additional recommendations to support good practice and effective governance may emerge.

6 Impact Assessment

The Participation Standard has been subjected to impact assessment at national level, during its development. This paper is for information so impact assessment is not relevant.

Gill Keel Head of Public Engagement Directorate of Human Resources

21 January 2011

2 APPENDIX 1

PARTICIPATION IN NHS HIGHLAND - UPDATE ON PATIENT AND PUBLIC INVOLVEMENT STRUCTURES Gill Keel, Head of Public Engagement

Introduction There is a broad range of ways in which NHS Highland leaders, managers and staff engage with our patients, carers and other people in local communities. The local guidance “Participation in Service Improvement, Redesign and Change” (NHS Highland, updated September 2010) states that every situation needs a planned approach to participation, individual to the specific circumstances and designed around the needs of participants.

There are however, a variety of mechanisms which support ongoing dialogue between parts of NHS Highland and the local communities we serve. The Designated Director for PFPI has recently led a series of meetings with the five operational units in connection with work in progress aimed at strengthening our approaches to participation. This paper provides a brief overview of the key participation structures.

Public Partnership Forums (PPFs) The concept of PPFs was introduced to NHS Scotland in December 20041 linked to the statutory guidance for the establishment of Community Health Partnerships2 (CHPs). Although the picture of patient and public involvement in the NHS has changed over recent years, PPFs continue to occupy a central position in terms of national policy.

CHPs must meet the statutory requirements to have a PPF from which at least one member is involved in the CHP Committee. In NHS Highland, this approach was applied across all five of our Operational Units. There are at least two PPF members on each of the CHP Governance Committees, and Raigmore has a number of public members drawn from the PPF, Patients’ Council, and other voluntary groups.

At present there are two PPFs in NHS Highland - the Highland HealthVoices Network (HHVN) which is NHS Highland-wide, and the Argyll and Bute PPF (A&B CHP area). At present they have 151 and 167 members respectively. There are some very committed and experienced members of both PPFs who make a huge, personal contribution to the work of NHS Highland. However, in common with PPFs across Scotland, the active members are a very small proportion of local people and the demographic profile of members is narrow.

Although research into PPFs across Scotland3 in 2008 was unable to demonstrate clear evidence of their effectiveness, experience within NHS Highland indicates that both PPFs have a valid role which is valued by members and by the organisation. As the landscape of participation in NHS Scotland continues to evolve, the Highland CHPs have been reflecting on the existing arrangements - for PPFs and for other forms of local engagement / participation – as part of an ongoing review aimed at ensuring that current systems are fit for purpose, and are making a positive contribution to local healthcare services.

Locally, some of the CHPs have been working towards developing a stronger, locality focus as part of the ongoing development of PPFs. In Argyll & Bute CHP, the CHP wide PPF has been supportive in developing locality based groups (PPFs), some of which are now well established. North and Mid Highland CHPs are also moving towards locality based structures, such as local Reference Groups. There is no “right way” of establishing or running a PPF so there are opportunities for local arrangements to adapt and evolve to suit the local situation. This work is ongoing.

1 Community Health Partnerships: Involving People Advice Notes (SEHD, December 2004). 2 CHPs Statutory Guidance (SEHD, October 2004). 3 “PPFs: What direction and support is needed for the future” (Scottish Health Council, February 2008). 3 Transitional Participation Advisory Group This is a new group which is currently being established following the termination of the former Highland HealthVOICES Network Steering Group. It involves leading members of the two PPFs, drawn from each CHP area, and a range of NHS Highland leaders / managers. The role is to advise and support NHS Highland leaders in the development and implementation of policies and practice aimed at promoting the participation of patients, carers and other local people in service design and delivery.

This group will have a close relationship with the Board’s Patient Focus and Public Involvement (PFPI) Leadership Group which brings together key Executive, Non Executive and operational leads. One key objective for the Leadership Group is to promote synergy between a range of separate but complementary strands of work which underpin achievement of the Board’s aims for patients and service delivery (including topics relating to participation in services, equality and diversity, quality and patient experience).

The PFPI Leadership Group will review and respond to issues raised by members of the Transitional Participation Advisory Group, through notes of meetings, and by direct request.

Locality and Service Planning Groups NHS Highland leaders / managers have ongoing engagement with local people through a range of established mechanisms. These local arrangements vary across the CHPs, and have evolved over time in response to a combination of the pre-existing infrastructure, priority local health topics, and the local needs.

For example, in some localities there are Local Health Partnership (LHP) groups. These groups involve a range of service providers (NHS, social work, voluntary sector) along with members of local communities. They consider a wide range of topics and issues which affect local services.

Other localities have established local Reference Groups. These differ from the LHPs in that the majority of members are drawn from the public, although they also involve staff from local service providers. They may be focussed on a specific service or group of services.

In addition to these geographically aligned groupings, there is a number of topic specific groups which support service planning. For example, there are Local Implementation Groups, some of which are leading local planning for mental health services, others leading on services for people with a learning disability. These groups involve service users, carers, and staff / service providers. Similarly, there are locally based health improvement groups which bring together a wide range of interests and expertise including public members, and which aim to promote synergy across activities which contribute to the broad agenda of promoting better health amongst local people.

At a very local level, a few GP practices have a Practice Participation Group (PPG), where people who use the services of the practice have a forum for regular dialogue with the GPs and the practice team. Although the primary focus of the PPGs is their local GP service, members can and do generate interest in broader issues of heath and health services, and develop links with other parts of NHS Highland.

Community Planning NHS Highland managers are involved in the Community Planning Partnerships led by our two local authority partners. Each of the Partnerships has a different approach to community planning, but they both have mechanisms designed to support engagement with local people. The CHP General Managers and other NHS Highland leaders / managers participate in the Community Planning Partnership Locality Groups in Argyll and Bute, and in the Ward Forums within the Highland Council area according to the agenda.

4 Patients’ Councils Patients’ Councils are groups of people who take an active interest in a specific hospital. There are three active groups in NHS Highland associated with Raigmore, Caithness General, and Belford. They provide an important route for ongoing communication between hospital managers / clinical leads and local people. Members also get involved in any of a wide range of activities aimed at improving the quality of care experience for patients. Activities include direct participation in local working groups or clinical audit / effectiveness initiatives, contributing to service review or redesign projects. In addition, some members are actively involved in other activities within NHS Highland so have considerable experience and skills which they bring to multiple strands of work.

Participation The paragraphs above outline the key structures which support ongoing dialogue about health and health services with local people. These structures and mechanisms are hugely important to the work of NHS Highland, but they do not themselves reflect the range of day to day participation of patients, carers and other members of the public in NHS Highland services.

Across NHS Highland, many approaches are used to seek and support active participation. For example, from simple actions such as promoting feedback from patients on their experiences of care, through methods of involving patients or service users in service evaluation and review (e.g. through questionnaires, discussion groups), through the active involvement of patients or others in the work of Project or Working Groups, and a range of methods which help people to contribute ideas aimed at improving aspects of quality (e.g. helping to design written information for patients, through to contributing to the development of local policy or practice).

5 APPENDIX 2 NHS HIGHLAND

A PARTICIPATION STANDARD FOR THE NHS IN SCOTLAND, AUGUST 2010

SUMMARY OF STANDARD STATEMENTS, RATIONALE, AND CRITERIA

Standard One – Patient Focus Standard Statement Care and services are provided in partnership with patients, treating individuals with dignity and respect, and are responsive to age, disability, gender, race, religion or belief, sexual orientation, and transgender status.

Rationale Understanding the wishes and needs of patients will lead to more effective and high quality healthcare.

The active participation of patients and where appropriate, their carers, in care and treatment planning makes a positive contribution to health outcomes and to their experience of care. Services are more responsive to the diverse needs of patients or service users when service planning is informed by their experiences and insights.

Equality Impact Assessments are carried out to ensure there is no adverse impact on particular groups of people and that everyone has equal opportunities to participate.

Criteria

1.1 NHS staff provide information and advice to patients in response to individual needs and preferences throughout the journey of care enabling and supporting informed patient choice and shared decision making.

1.2 Processes are in place to capture comments and complaints and include arrangements for ensuring feedback has an impact on service improvement.

1.3 People are able to access independent advice to support them in making a comment or complaint or obtaining information about health services.

1.4 Independent advocacy services are provided and developed in partnership with other agencies and the people who need them.

1.5 Individual need for independent advocacy is assessed, recorded and provided where necessary.

1.6 Support is in place to meet the needs of carers.

1.7 The NHS Board provides information about services in a range of formats, and has clear systems for responding to the specific communications needs of individuals.

1.8 People are treated with dignity and respect, in ways which recognise and respond to diverse cultural and social values.

6 Criteria for assessment 2010 / 2011 – 1.1, 1.7, 1.8

Standard Two – Involving People in service planning and improvement

Standard Statement There is supported and effective involvement of people in service planning and improvement. Rationale The delivery of ongoing improvements in the quality of healthcare services is greatly enhanced by the active involvement of patients or service users, carers, and others, including feedback on their experiences of the service.

Some people are unable to participate in service planning and delivery unless they have additional support. This may include people who have the greatest need of a service, but whose circumstances prevent them from making effective use of the service.

Equality impact assessment helps to identify the range of potential barriers across the groups of people affected by a service or service change. People need support to describe the barriers to their active participation, and to be involved in identifying measures to overcome them.

Positive experience of involvement in NHS services helps to create greater public confidence in the NHS Boards and in NHS Scotland.

Criteria

The six elements of the Informing, Engaging, and Consulting Guidance are covered by the criteria: planning; informing; engaging; consulting; feedback; evaluation.

2.1 The people who may be affected by the proposed service development or change are identified and their support needs assessed (planning).

2.2 The people who may be affected by the proposed service development or change are provided with relevant information and other appropriate communication aids that meets identified support needs (informing).

2.3 The people who may be affected by the proposed service development or change take part in developing, and appraising options, and are consulted appropriately (engaging and consulting).

2.4 Feedback is provided to the people involved on decisions made and how their views are taken into account (feedback).

2.5 Evaluation of the involvement is planned and carried out on an ongoing basis (evaluation).

All five criteria included in assessment 2010 / 2011.

7 Standard Three – Corporate Governance of Participation

Standard Statement

Robust corporate governance arrangements are in place for involving people, founded on mutuality, equality, diversity and human rights principles.

Rationale

NHS Board members have overall responsibility for the quality of the Board’s services, and for the quality of participation in service design and delivery.

NHS Board members are responsible for ensuring that their organisation meets statutory duties in relation to Participation and Equalities and for promoting good practice by providing leadership as well as challenge.

NHS Boards are required to have in place structures and systems which manage performance across their organisation, and which provide assurance to Board members of the quality of participation in services.

The actions of NHS Boards are open to public scrutiny. Demonstrating a culture in which participation is encouraged, supported, and valued can be a positive way of developing or reinforcing public confidence in the Board’s staff and services.

Criteria

3.1 The NHS Board is assured that systems and processes are in place to enable it to meet its statutory requirements in relation to the participation agenda.

3.2 The public feed into governance and decision-making arrangements.

3.3 The NHS Board is assured that a culture is encouraged throughout the organisation where participation forms part of the day to day planning and delivery of services.

All three criteria included in assessment 2010 / 2011.

8 Participation Standard assessment process and timeline 2010 / 2011

Each NHS Board self assessment drafted in partnership with and approved by patient groups/Public Partnership Forums prior to submission

Self assessment signed off by the NHS Board’s governance committee

All NHS Boards submit self assessments to allocated Scottish Health Council central email address with evidence by Friday 11th March 2011 covering year 1 relevant areas

Local Scottish Health Council offices review self assessment and submit initial commentary for performance analysts together with overview report of local issues (time allocated1 week)

Performance analysts review the self assessment evidence and local office comments (time allocated1 week)

Self assessed level provisionally agreed Self assessment returned to NHS Board with If no agreement on self assessed level, comments panel convened with performance analysts, peer and lay reviewers and local office to reach final agreement on self assessment level (1 week preparation time) NHS Board responds to comments made, providing further evidence where necessary (time allocated 2 weeks) Panel comments returned to the NHS Board

Comments resolved and version agreed between NHS Board and SHC NHS Board responds to comments made (time allocated1 week) providing further evidence where necessary (time allocated 2 weeks)

Panel reviews NHS Board comments and further evidence and comes to final decision on level reached electronically (time allocated1 week)

Self assessment with comments submitted to the Scottish Government Health Directorate and used to inform NHS Boards’ Annual Review Process

9 APPENDIX 3 NHS HIGHLAND PATIENT FOCUS AND PUBLIC INVOLVEMENT LEADERSHIP GROUP TERMS OF REFERENCE, APRIL 2010

Introduction There is a broad range of responsibilities and public duties which are summarised under the broad heading of Patient Focus and Public Involvement (PFPI). Within NHS Highland there are defined leadership roles which relate to specific parts of this broad agenda. The NHS Highland PFPI Leadership Group brings together a number of Board and operational leads, and provides a forum for consideration of key topics of evolving national policy and requirements of PFPI.

Role and Purpose The PFPI Leadership Group is operating in times of significant change across NHS services. The core function is to lead the development and oversee implementation of a strategic approach to Participation in the work and services of NHS Highland.

The main functions of the PFPI Leadership Group are:  To monitor national policy, and other emerging initiatives and to assess the implications for NHS Highland  To provide leadership and support in the planning and implementation locally of national policy or other requirements  To identify opportunities to maximise the synergy between different initiatives, programmes or policies, seeking the optimum benefit to our patients  To advise the NHS Board, and / or Operational Units, services, and functions as required  To assess whether current PFPI reporting and accountability arrangements are sufficient

Membership Anne Gent, Executive Director of Human Resources, and Designated Director for PFPI Viv Shelley, Non Executive Director Sarah Wedgwood, Non Executive Director Caroline Champion, Planning and Public Involvement Manager (Argyll and Bute CHP) Gill Keel, Head of Public Engagement Karen Burnett, HealthVOICES Coordinator Mirian Morrison, Clinical Governance Manager Moira Paton, Head of Community and Health Improvement Planning Stephen Whiston, Head of Planning (Argyll and Bute CHP)

Other members will be invited to join the Group either as ad hoc subject experts, or as full members.

Membership last updated 24 November 2010.

Responsibilities, Accountability, Governance The NHS Highland Board has overall accountability for NHS Highland’s performance on PFPI. Operational responsibility and accountability for the broad range of duties and activities under the heading of PFPI rests with each of NHS Highland’s Operational Units, services and functions. These are subject to performance monitoring and internal governance arrangements, and report to the Board through existing systems.

The PFPI Leadership Group is an informal group, not a formal sub committee of the NHS Board, and does not have a route of reporting to the Board. All matters which require the Board’s attention will be raised by the relevant lead either informally as part of the discussion on any matter of Board business, or formally as an agenda item on a specific topic at a Board meeting. The role of this group, and the membership will be reviewed and adapt according to changing needs.

Gill Keel Head of Public Engagement 10 Highland NHS Board 1 February 2011 Item 4.7 CHIEF EXECUTIVE’S AND DIRECTORS’ REPORT EMERGING ISSUES AND UPDATES

1 AUTISM NETWORK

In the Spring of 2010 a new network was established to consider existing services to adults with Autistic Spectrum Condition (ASC) across the Highland Partnership. This was particularly timely as the Scottish Government was developing – Towards an Autism Strategy for Scotland; work locally on transitions was highlighting areas for improvement; and there was a need to further enhance the integrated working with the younger adult teams in the Social Work Service. The role of the Network is primarily to support the staff across agencies and services working in this field, provide a forum for users, carers and professionals to meet and share issues and develop and implement a quality framework. The role also extends to raising awareness of ASC in adult services; ensuring training is available and sustaining services needed by this client group. To date the network has been looking at the feasibility of pooling existing services into a more formal diagnostic and advisory service with considerable support from the Younger adult teams in Social Work and Community Health services. Training, awareness materials and screening tools have been shared from other parts of the country and similarly, service models have been evaluated and explored as options to improve the services in Highland. The engagement of local and National user groups in the Network has been most welcomed. Progress reporting will continue through the Board’s operational structure.

2 FREEDOM OF INFORMATION (SCOTLAND) ACT 2002

Chris Meecham, Board Secretary, acts as the Freedom of Information Officer for NHS Highland. A total of 377 requests were received under the Freedom of Information (Scotland) Act 2002 (FOISA) during the period 1 January to 31 December 2010. This shows a small increase on previous years, with 350 requests having been received during 2009, 275 received in 2008, and 148 received in 2007. Of these 377 requests (2009 figures in brackets):

o 211 (185) or 56% (53%) of requests resulted in Full Release o 85 (99) or 23% (28%) of requests resulted in Partial Release o 13 (19) or 3% (5%) of requests were in relation to information not held. o 29 (30) or 8% (9%) of requests resulted in Refusal o 12 (2) or 3% (1%) of requests were withdrawn or abandoned o 27 (15) or 7% (4%) of requests were still to be answered at the point of reporting

The requests were (as far as be ascertained) made by the following categories of requestors:

2010 2009 o Media 116 (31%) 117 (33%) o MSPs/MSPs’Researchers 91(24%) 50(14%) o Public 82(22%) 76(22%) o Commercial Companies 40 (11%) 24 (7%) o Voluntary Organisations 12 (3%) 14 (4%) o Unions 11(3%) 5 (1%) o Staff or ex staff or their family 10 (2%) 51 (15%) o OtherResearcher 7(2%) 5(1%) o GP 5 (1%) 0 o Solicitors 3(1%) 6(2%) o Students or academics 0 2 (1%) Of the 29 requests refused, the most common reason for the refusals was Section 12 (where the information requested would cost over £600 to produce). The number of requests from staff has reduced from 51 in 2009 to 10 in 2010. Many of these requests in 2009 related to staff who wished to receive further information about their assimilation onto Agenda for Change grades.

A report summarising the requests has been circulated separately to Board Members.

A staff familiarisation and training programme has been ongoing since September 2004. This has included articles in the Team Update, a leaflet introducing FOISA which was circulated to all staff, and a rolling programme of training events. A workbook on FOISA is also included in the Induction Training Programme. These materials are freely available on the NHS Highland website.

Reviews and Appeals to the Scottish Information Commissioner During 2010 there were no cases where the requestor asked for a review of the way in which their request had been handled under the Freedom of Information (Scotland) Act 2002. There were also no appeals to the Scottish Information Commissioner in 2010.

3 GOVERNANCE OF AUDIT SCOTLAND REPORTS

It is important to ensure that timely and appropriate action is taken on relevant Audit Scotland Reports – in terms of any separate response from Highland, to action or apply more general findings, or to reflect the experience of other NHS Boards. Audit Scotland Reports are already reported to, and discussed at the Audit Committee and this approach will be strengthened by revising the approach as follows:

(i) Audit Scotland Reports will be considered by the Director of Finance and the Chair of the Audit Committee to highlight:  the key messages for NHS Highland  the key actions required by NHS Highland  the Lead Officer within NHS Highland to action the report  whether the report needs formal consideration by a Committee of the Board

(ii) The Director of Finance will notify the Lead Officer / Committee of key issues and actions required.

(iii) The Audit Committee discussion and reporting will include not only review of the Audit Scotland Report, but also detail the specific work being undertaken within NHS Highland in response.

This approach will cover normal Audit Scotland Reports, but should an upgraded response be required – such as major mention of NHS Highland – then this will be referred to the Board or Improvement Committee at the first available opportunity.

4 NEW YEAR HONOURS – MID HIGHLAND CHP GENERAL MANAGER

The General Manager of Mid Highland Community Health Partnership (CHP) has been made an MBE for her services to the NHS in the Queen’s New Year Honours list. Gill McVicar, 52, of Fearn, who has worked for the NHS for more than 30 years and has been Mid Highland CHP General Manager since April 2004, comes from a clinical background having trained as a nurse in Ayrshire and then as a midwife in Renfrewshire. She worked in both of those areas, Argyll

2 and Clyde and Glasgow, before moving to Highland in 1990. Mrs McVicar gained a degree in Community Health Nursing at Robert Gordon University and worked as a district nurse and community midwife, before leaving clinical practice to take up a Quality Facilitator post so she could follow her passion for continuous improvement, learning and development. She also undertook further post graduate study in Health Economics at Aberdeen University. Mrs McVicar has a keen interest in watching and learning from developments nationally and until recently was Chairman of the Association of Community Health Partnerships, which brings together CHPs from across the country.

5 NHS BLOOD AND TRANSPLANT ORGAN DONATION REPORT – 1 APRIL – 30 SEPTEMBER 2010

National Picture

Over the past year, Clinical Leads for Organ Donation, Specialist Nurses for Organ Donation and Donation Committees have been established across Scotland and there is now evidence of increased activity with more referrals of potential donors to the organ donor and transplant team. In Scotland last year, more transplants than ever before were carried out, and across the United Kingdom, there was an increase of 7% in the number of deceased organ donors and a 10% increase in the number of living donors.

At the beginning of November 2010, there were 654 Scottish residents awaiting a transplant with a further 163 patients suspended from the list, and since April, at least 18 people have died whilst waiting for an organ to become available.

NHS Highland

NHS Highland continues to be active in the organ donation and retrieval process. The Specialist Nurse Organ Donation, together with an active network of volunteers, has been very successful in recruiting people to the Organ Donation Register - 45.6% of our population are registered, giving us the highest % of population registered in Scotland. Progress has also been made locally with promoting the referral and successful conversion of potential organ donors.

Organ donation activity is monitored by central collation of audit data. The data demonstrate effective activity in Raigmore Hospital, for example, the following charts show potential donors after brain death (DBD) and donors after cardiac death (DCD) for NHS Highland compared to national data for the UK from the Potential Donor Audit. The DBD chart shows the percentage of patients tested for neurological death (ND), while both charts also give referral rates, approach rates, adjusted authorisation rates and conversion rates.

(NB: “organisation” is Raigmore)

3 However, challenges remain; promoting referral from acute areas both within Raigmore and particularly in the rural general hospitals will continue to be a focus for our efforts over the next twelve months.

6 NHS HIGHLAND: MID-YEAR STOCKTAKE 2010-2011

There is attached as Supplementary Paper 1, letter dated 6 January 2011 from John Connaghan, Director of Health Delivery, Scottish Government to the Chief Executive, NHS Highland which records the main points of discussion at the NHS Highland Mid-Year Stocktake for 2010/11 which was held on 15 November 2010.

7 NHS HIGHLAND STRATEGIC FRAMEWORK 2010/11 – IMPLEMENTING THE VISION

The Executives, as part of the wider leadership team along with General Managers, continue to lead the implementation of the Vision and have further refined the messages to help communicate the Strategic Framework to a wider community. A generic presentation has been adapted and been used in both Argyll and Bute and North Highland CHPs with a positive response.

In addition a dedicated whole day seminar on ‘Stepping up the Pace of Change’ took place In Inverness on 14 January 2011 with an invited audience of over 80 senior leaders from across the whole organisation. Evaluation of the day demonstrates an enthusiasm and willingness to work differently to lead the necessary change. Delegates valued the interactive approach with direct access to question the leadership group.

A further session is planned for 21 February 2011 for clinical leaders taking the same format and also including a wider discussion focussed around quality and patient safety.

8 NHS REGIONAL PLANNING – NORTH OF SCOTLAND PLANNING GROUP AND WEST OF SCOTLAND PLANNING GROUP

A copy of the Briefing from the North of Scotland Planning Group for December 2010 is circulated as Supplementary Paper 2 to this update. A copy of the Briefing from the West of Scotland Planning Group for December 2010 is circulated as Supplementary Paper 3 to this update.

9 VOLUNTEERING UPDATE

‘The Refreshed Strategy for Volunteering in the NHS in Scotland’ was issued in October 2008. A key part of the work to be progressed was for NHS Boards to achieve the ‘Investing in Volunteers’ Standard by March 2011. The majority of NHS Boards have now achieved the award and in NHS Highland, it was confirmed that we had been successful in achieving the ‘Investing in Volunteers Standard’ in October last year. The Operational Units have now been asked to hold a celebratory Event in their local areas, to mark the achievement of the Standard and to thank local volunteers and the staff who manage and support them.

4 The Standard however focuses very much of those volunteers who are ‘directly managed’ by NHS Highland and whilst a comprehensive Volunteering Policy has been developed, with various supporting documentation for volunteers and their supervisors, the focus has been very much on managing, supporting and developing the Volunteers we currently have, rather than expanding Volunteering opportunities, within NHS Highland. In addition, the work commissioned and undertaken by other Voluntary Organisations, who work with Volunteers, was not included as part of the work for the Standard.

However, it has been widely recognised that there are considerable opportunities to work with local partners in developing a more comprehensive approach to Volunteering and that it would be more appropriate to progress the development of a strategic approach to promoting and supporting Volunteering in health and community care in partnership. The Highland Council Partnership - Joint Leadership and Performance Group, have therefore developed a proposal and an associated specification, to commission a piece of work to develop a Strategy for Volunteering across the Partnership. It is anticipated that this work will commence in the spring with the expectation that a Strategy will be developed by the autumn. A number of the members of the NHS Highland Volunteering Steering Group are engaged in progressing this and there is much support for this joint approach. It is anticipated that this development will also be shared and discussed with the Argyll and Bute Health and Strategic Care Partnership, in the near future.

10 WINTER PLANNING

10.1 Background Winter brings with it a number of challenges that may affect service delivery, including severe weather, seasonal flu, norovirus and the festive public holidays. Last year, in spite of the most severe winter weather for 30 years, H1N1 pandemic flu and increased levels of norovirus circulating in the community, NHSScotland performed well, with performance levels for key indicators comparable with previous years, and in many areas exceeding previous years’ performance. Effective winter planning ensured that appropriate treatments, interventions, support and services were maintained across the winter period for all patient groups, including those dependant upon Out of Hours (OOH), Mental Health and Community Health services.

The 2009/10 NHSScotland Winter Review built upon that of the previous year and confirmed that the recommendations made by Dr Daniel Beckett had been widely implemented across NHS Boards and had led to improved service delivery in a number of areas. In 2010/11 it was expected that boards ensure that the 2008/09 recommendations were fully implemented again to ensure the integrity of NHSScotland services.

Plans for winter 2010/11 focused on the following key areas that NHS Boards identified for further improvement:

o Reducing levels of boarding o Increasing the effectiveness of escalation planning o Improving patient discharge levels over the 4 day festive public holidays o Improving management of norovirus outbreaks

10.2 Implementation As in previous years, CHPs and Raigmore were asked to identify Winter Planning leads and to progress work to review and update local winter plans. Planning also included Mental Health and Primary care and Dental Out of Hours provision and was linked to NHS24, Social Work and

5 Scottish Ambulance Service planning. Areas were asked to specifically focus on the following areas of service delivery in addition to the improvement areas noted above:

 Escalation plans increase link with community hospitals bed usage  SPARRA and ACPAs re vulnerable patients at risk of admission  Partnership working  Two 4 day holiday periods  Staff flu vaccinations increase, especially A & E, ITU, HDU  Exception reporting  98% 4 hour A & E waits to be maintained  Mortuary business continuity and capacity  Whole system business continuity

10.3 Winter Reporting Due to severe weather experienced at the end of November, Severe Weather situation reporting (SITREPs) was implemented by Scottish Government from 27 November 2010, continuing on a daily basis throughout the festive period and including information on heating fuel supplies and Flu cases as well as pressures in service delivery arising from severe weather. From 7 January 2011 daily reporting for severe weather was stood down. However daily SITREPs for Flu cases in ITU were implemented and continues to date. Throughout this period the annual process of exception reporting for true exceptions was in place with areas reporting immediately any of the following:

o closure of a hospital to emergencies for any reason, o unplanned closure of a ward or a number of beds, o cancellation of elective procedures because of a lack of capacity, o trolley waits exceeding 12 hours, o significant outbreak of infection, or significant increase in expected demand

10.4 Local Highlights Reports received from CHPs/services highlight the following:  NHS24 activity was 18% higher over the Festive four day holiday period in 2010/11 than for the same period in 2009/10.  High levels of OOH patients with flu like symptoms over the festive period.  OOH Advice GP operational in Highland Hub supported during busy periods and minimised issues arising from small number of vacant shifts in Raigmore (caused by severe weather/sickness).  The Top 5 categories of call for Highland Hub were upper respiratory tract infection, lower respiratory tract infection; cystitis; viral infection; abdominal pain.  In the last calendar quarter of 2010 Raigmore Hospital has failed to reach the 98% compliance (being 96% in October/November, rising to 97% in December.) Analysis of the data has identified that medically receiving through Emergency Department as having a significant impact on the 4 hour target. Steps have been taken to address this matter, including alteration to the escalation process.  A Norovirus outbreak during December in Caithness General Hospital was quickly contained, allowing the ward to re-open prior to Christmas.  There were higher than normal levels of staff sickness, and some unavailability due to severe weather conditions across all areas of service delivery. However it should be noted that staff made considerable efforts to ensure availability and continuation of service delivery, including staying overnight in hospital/local accommodation to ensure availability.

6  Staff coped well in hospital and community during severe weather with support from volunteer drivers for staff transport and visiting patients in the community.  The Red Cross assisted with staff transport in severe weather in Skye.  The OOH (4x4) vehicle and Coastguard vehicle were used to support staff transport and patient visits in the community during severe weather in Lochaber.  Belford Combined Assessment Unit (CAU) was busy but manageable, with higher than normal staff sickness due to the prevalence of flu like illness in the community but no significant issues or exceptions were experienced.  In CHPs, community hospitals were running at high occupancy levels with little additional capacity available.  Patient discharge was expedited to support increased bed availability where possible.  In Argyll & Bute 11 patients waited longer than the 4hr target wait in A&E. The majority relating to patient transfer delays, due to transport difficulties  Some community services were disrupted as a result of the severe weather conditions, including outpatient clinics due to consultant unavailability.

10.5 Learning Points/Areas for Improvement in 2011/12  Ensure further integration of winter planning with whole system planning – integration with Emergency planning was in place this year. However further work is required to ensure full integration with Business Continuity planning in NHS Highland  Further development of Highland Wide Escalation plan, in the context of Business Continuity planning, is required  Further work required to manage/reduce impact of significant reduction of Social Work availability for a two week period over Christmas and New Year.  Ensure proactive planning is in place for heightened levels of reporting to Scottish Government. We should assume that daily reporting will be the norm for winter 2011/12 and should identify responsible managers as part of the early winter planning process, in line with the Exception Reporting process.  Note the need for local areas to continue to plan for difficulties filling OOH GP rotas and to ensure contingency and sustainability plans are developed throughout 2011.

Chief Executive’s Office Assynt House

21 January 2011

7 Health Delivery Directorate John Connaghan, Director

T: 0131-244 3480 F: 0131-244 2042 E: [email protected] 

Mr Roger Gibbins Chief Executive NHS Highland Assynt House Beechwood Park Inverness IV2 3BW

___ 6 January 2011

Dear Roger

NHS HIGHLAND: MID-YEAR STOCKTAKE 2010-2011

1. I am writing to record the main points of the discussion with yourself, Elaine Mead, Malcolm Iredale and Anne Gent via video conference on 15 November 2010. The purpose of the meeting was to look at progress in 2010-11 and at your preparations for 2011-12.

Finance and Efficiency

2. John Matheson welcomed your reassurance that the Board are on target to deliver against the end-year position of breakeven, as agreed in your LDP for 2010/11. You explained that the Board has experienced an in-year £3m operational overspend which you have, to date, successfully reduced to £2.4m. We were pleased to note that the Board’s general approach to planning for and prioritising efficiency savings seems to be fully consistent with the redesigned, national Efficiency and Productivity Framework, which is scheduled to be issued in early December. You confirmed that the Board is on track to deliver its Efficient Government target for 2010/11. However, we noted that a significant element of these savings are non-recurring and you confirmed that, going forward, the Board is fully focused on establishing recurring efficiency savings. We discussed prepardness for delivery of £22m (4%) of efficiency savings in 2011/12 and we heard that the Board is focussed on developing plans to deliver the required level of efficiency savings within the Board’s Strategic Framework. Nonetheless, we recognised that delivery of the plan in 2011/12 will be challenging.

3. John Matheson made reference to the Comprehensive Spending Review (CSR) announcement that was made on 20 October by UK Government. The implications of this announcement are currently being considered by the Scottish Government. A Budget was introduced to the Scottish Parliament on 17 November and is scheduled to complete its passage in February 2011. It was recognised that the impact of the CSR would impact significantly on the capital programme across the Scottish Government including Health. We confirmed that detailed discussions will take place with all Boards including NHS Highland to

St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.scotland.gov.uk  1. ensure that there is a clear understanding of the implications of the reduced capital envelope across all 4 years of the Spending Review.

Workforce

4. Ingrid Clayden led the discussion on workforce issues. You confirmed that while the Board was below trajectory on the eKSF target you explained that there was significant remedial activity in train and you expected to see a steep increase in the remaining months to March 2011. We were also interested to hear what the Board was doing to improve attendance at work to sustain the 4% sickness absence rate. You had identified that the Argyll and Bute area to be an outlier and management attention was being directed here. You were also looking at successful programmes elsewhere and in particular how the benefits from EASY initiative from Lanarkshire, might be implemented across NHS Highland. You confirmed that on workforce projections for 2010/11 the number of permanent posts had been reduced but the position was complicated by additional posts funded by SGHD and other external funding sources. You were planning to discuss the complexity issues with representatives from the National Scrutiny Group. In terms of 2011/12, you explained that the Board has a reasonable turnover at present and continues to work on plans with the full involvement of the staff-side and unions. We agreed that continued robust and effective partnership working will be critical in the demanding period ahead.

HEAT

5. We moved on to discuss performance against other HEAT targets. We recognise the considerable work undertaken locally to improve performance in the priority policy area of infection control; in particular, the sustained and encouraging progress NHS Highland is making in relation to the incidence of C-Diff and SABS.

Service Redesign

6. We started this section by receiving a helpful update on the review of services in the Caithness area, including those provided from Dunbar Hospital in Thurso. You confirmed that a paper was in the process of being finalised setting out the approach to date and the emerging conclusions. You would submit this to the Delivery Directorate in order that we could carefully consider the scale of change proposed.

7. You went on to assure us that both the review of services in Skye and Lochalsh and the review of services provided on the Isle of Bute are being actively progressed in full partnership with local stakeholders. Significant work is underway to develop an integrated model of care to deliver a modern standard of care at Victoria Hospital and wider provision of care in the community on Bute. The Review of Services on Skye and Lochalsh continues to be progressed within the Skye and Lochalsh Health Services Reference Group to consider the health needs of the community and you will keep the Delivery Directorate informed of progress. Finally, you confirmed that the Review of Rheumatology Services was complete and the main recommendations supported the continued availability of an inpatient facility at the Highland Rheumatology Unit at Dingwall and the establishment of a rheumatology day infusion service at the Unit. We welcomed this outcome.

St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.scotland.gov.uk  2. Conclusion

8. We are grateful to you and your team for meeting with us. It is clear that NHS Highland continues to make progress across the range of national and local priorities and that you are confident of meeting key performance targets, for the benefit of local people. However, you are not complacent about the challenges ahead and assured us that strong leadership and management focus would continue to be maintained over the coming year.

Yours sincerely

JOHN CONNAGHAN Director of Health Delivery

St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.scotland.gov.uk  3. NORTH OF SCOTLAND PLANNING GROUP

NHS Board Briefing December 2010

A meeting of the NoSPG Executive was held on 1 st December 2010. The following briefing has been prepared to update the North NHS Boards on the outcome of the meeting.

NoSPG Projects

CAMHS

A number of workstreams have been completed or an ongoing, such as: completion of a Needs Assessment, organisational visits to other countries and areas, development of an integrated care pathway and obligate network for Tier 4 CAMHS, and a site option appraisal.

A revised timetable for the project was agreed which would see Boards approve the Outline Business Case August/September next year and submission to the Scottish Government Capital Investment Group in November 2011.

It was agreed that the Clinical Lead will continue for a further year.

Cancer

It was agreed that NOSCAN should strengthen the alignment with and work under the auspice of NoSPG, the RCAG structure will be revised and develop a more focussed workplan, and links to nationally driven locally implemented work will continue.

Child Health

A short presentation was given on the implementation of the National Delivery Plan (NDP) for Children’s Specialist Services and the development of the ‘Logic Model’ used to evaluate the added benefit gained from the investment.

Oral Health & Dentistry

A revised action plan for Orthodontics was approved. A report on Restorative Dentistry will be considered by NoSPG at its meeting on 23 rd February 2011.

Weight Management

This work was commissioned in March 2010, following identification of significant capacity challenges in the regional SLA for Bariatric Surgery. A final report will be considered by NoSPG at its meeting on 23r d February 2011. eHealth

A proposal from the eHealth Directors to investigate shared eHealth services was approved, particularly in relation to the work of NoSPG.

North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles Mutual Aid

A form of words was agreed for inclusion in Board Emergency Plans. hub initiative

Alba Community Partnerships consortia has been appointed and have set up an office in Summerfield House, Aberdeen. The process for approvals of all partners is underway and financial close will be achieved on 20 th December 2010.

National Work Streams

TAGRA

There has been extensive dialogue with the Chair of the Technical Advisory Group on Resource Allocation (TAGRA) in relation to the impact of the NHSScotland Resource Allocation Committee (NRAC) formula on remote and rural areas of Scotland. Further dialogue is ongoing.

Remote & Rural Implementation Group

The final report of RRIG was submitted in October and a positive formal response has been received from the Cabinet Secretary. Work is underway to review how this will link with the Quality Strategy.

NoSPG Business Management

NoSPG Reorganisation

In June 2010, Chief Executives had asked for a review of NoSPG staffing to be undertaken, given the current financial situation. The proposal agreed will see a reduction in the current five Project Managers to two; one substantive post covering Child Health & CAMHS and the other fixed term post covering Acute services and Workforce. The new structure will be operational from 1 st April 2011 and a review of the workplan will be undertaken in the summer.

NoSPG Membership

Mrs Justine Westwood, Head of Planning, NHS 24 and Mr Milne Weir, Divisional General Manager (North), Scottish Ambulance Service have been nominated as members of the NoSPG Executive Group by their respective Chief Executives.

Date and time of next meeting

The next meeting will be held on 23r d February 2010 at 10:30 am. The meeting will be virtual.

Dr Annie Ingram Director of Regional Planning & Workforce Development North of Scotland Planning Group

North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles SUPPLEMENTARY PAPER 3

WEST OF SCOTLAND REGIONAL PLANNING GROUP

Briefing Paper

The following in a resume of the outcomes of the West of Scotland Regional Planning Group Meeting held on the 17th December 2010

1 Integrated Regional Services

At the RPG development session on 29th October Chief Executives from West of Scotland Boards agreed that there is a requirement to ensure support services are provided as efficiently and effectively as possible, remits and chars of the work steams have now been identified. The 6 key priority areas identified were:

1. Recruitment: Chair Patricia Leiser 2. Audit (internal): Chair Jeff Ace 3. Public Health: Chair Fiona Mackenzie 4. Procurement: Chair Allan Gunning 5. Payroll – e-Payroll rollout working: Chair Ian Reid 6. Remote Working –telehealth links, to support radiology reporting and /or relieve pressured medical staffing rotas: Chair Heather Knox

In developing the priority areas west of Scotland Boards agreed the following key principles

• Proposals need to be cash releasing at a level which is greater than that which is achievable through independent Board working. • The task is to redesign the service within a 25% reduction of the cost base • This should be implemented over 3 years (sooner if possible). • Proposals can be delivered region-wide or through groupings of Boards within the West region. Boards may also choose to work with Local Authorities in preference to health on some of these areas.

2 Regional E-Health- proposed shared services initiatives

The key objective of the programme is to provide standardised and upgraded infrastructure along with inter-Board network connectivity to support regional clinical systems. A number of eHealth functions are in the process of being reviewed to determine where reduced support costs and contribution to CRES could be achieved.

WoS Networking to Enable Shared Services: Fundamental to the sharing of eHealth services and also in relation to the sharing of corporate services is the implementation of a West of Scotland network.

o Rationalisation of Data Centres: Sharing of data centre facilities is a key objective within the scope of the WoS eHealth programme

o Single eMail Service: It is proposed that the WoS should procure and implement a single secure email service which links to Local Authority partners where necessary. o Shared Platform for IT Security: Work has commenced to review the current status of IT security contracts for anti-virus software and associated services.

o Rationalisation of common applications and systems: Following the procurement of the new Patient Management System and other national/regional systems such as Theatres and CEPAS

o Shared Service Desk and Support Services: The implementation of the proposed WoS regional network

o Implementation of Enhanced Communication Tools for MDT meetings: Work has recently completed to review requirements for communication at regional MDT meetings.

3 National Risk Share Schemes

The RPG considered a paper on national risk share arrangements. The paper provided background information and details of recent discussion and analysis, in particular in relation to orphan drugs and recombinants.

There are now 4 national risk share schemes, each of which has a different mechanism to provide guidance to NSD to help ensure the consistent and fair delivery of the related service or care. The paper sought NHS Board CEs decisions on:

 Whether in principle, NHS Boards wish to continue to pool funds in the national risk share schemes: If so o The range of medicines they would wish to see included in the Orphan Drugs financial risk share arrangement in 2011/12; o The method for calculation of contributions from individual NHS Boards (e.g. whether to use NRAC or another model); o The amounts to be top sliced for 2011/12 for the three existing risk share schemes o It was agreed that a 3 year rolling average risk share be incorporate into the paper for the Board CEs January meeting o It was also agreed that it would be unhelpful to unpick the basis of the Forensic Medium Secure Learning Disability risk share. Nor was there an appetite to fund specialist services in England through a west risk share.

4. National Spinal Surgery

The group considered and noted the project brief for the National Spinal Surgery Review Group which has been formed to:

o Determine appropriate intervention thresholds and review clinical referral pathways in light of these o In conjunction with Board and Regional Planners, consider provision of service across Scotland, looking at ‘need’ together with capacity and demand on a local, regional and national basis as appropriate o All spinal workload from Neurosurgery and Orthopaedics referrals will be considered, other than scoliosis referrals to the national spinal deformity service (the national service deals with spinal deformity patients up to skeletal maturity). o Through the Orthopaedic Task & Finish Group and the Operational Delivery Team, produce a CEL for NHS Boards on the delivery and risk management of the spinal services component of the 18 weeks RTT.

2 o Produce a final report of key recommendations signed off by the Operational Delivery Team by Spring 2011.

5 Optimal Reperfusion Service Report- Activity 2009/10

In 2008 the West of Scotland Regional Planning Group agreed to fund the establishment of a regional Optimal Reperfusion Service (ORS), which would serve the population of the following Health Boards, NHS Ayrshire & Arran, NHS Dumfries & Galloway, NHS Forth Valley, NHS Highland (Argyll & Bute), NHS Greater Glasgow & Clyde, NHS Lanarkshire and NHS Western Isles and was in collaboration with the Scottish Ambulance Service (SAS).

The numbers treated are almost exactly as predicted and the costs are also consistent with the planning assumptions. The overwhelming view is that the introduction of the service has been highly beneficial to patients but there remain opportunities for further improvements. 1418 patients have benefited from the service since it began with a significant reduction in lengths of stay however there remain challenges and the RPG needs to ensure the benefits of the investment are fully realised. . The Cardiac Planning Group will continue to monitor this regional service and strive to maximise the return on this regional investment both financially and in terms of patient care benefits.

The report made several recommendations:

 The SAS to improve the efficiency of activity carried out from the point of taking the diagnostic ECG to leaving the scene.  The need to improve the identification of appropriate patients and ensuring direct transfer to the intervention centre rather than via the Accident & Emergency department. This includes continuing to strive to improve the communication between the SAS and the Intervention Centres and vice versa.  Further consideration needs to be given to having a definitive agreement regarding at what point a patient should be thrombolysed. Should this occur for all patients who are taken to A&E by the SAS?  Reduce DES usage in this service to be in line with the agreed usage contained in the original business case.  Ensuring the administration of Thrombolysis to appropriately identified patients and better stock control across the region of these drugs.  Being able to more robustly track patients through the whole pathway.  Review of the 90 minute timeline to extend to 120 minute- noted this would not increase activity, but implications needed to be assessed by the Regional Cardiac Planning Group

The report and recommendations were endorsed by the RPG.

6 Strategic Change Update from Boards

NHS Ayrshire & Arran NHS Ayrshire & Arran Board had approved two Outline Business Cases for the North Ayrshire Community Hospital/adult mental health inpatients service and front door services at Ayr and Crosshouse. This would now need to be approved at national level.

Scottish Ambulance Service The service was updating their clinical strategy with an increased focus on patient safety. The Air Ambulance tender had been signed off at the Programme Board.

3 NHS Highland Report on the new partnership arrangement between NHS Highland and Highland Council. This would impact primarily on two key services i.e. Adult Elderly, Learning disability and Mental Health and Community Care Services and Children’s Services. Agreement had been reached in principle for one or other of the organisations to host these services and be solely responsible and accountable for them.

NHS Lanarkshire NHS Lanarkshire Board would be moving to new premises at Kirkland Hospital.

NHS Greater Glasgow & Clyde  Vale of Leven had now implemented new unscheduled care medical admissions model as per the “Vale Vision” all major emergency surgical & medical services would now go to Paisley  Both Vascular and Renal services had moved from Stobhill Hospital to the Western Infirmary  Stobhill Hospital in its present form would close in March 2011 with the transfer of 300 beds to the Glasgow Royal Infirmary site. The main focus of the Stobhill site would now be the Ambulatory Care Hospital  290 new beds had been created at Glasgow Royal Infirmary.  Final approval had been given for the new build at the Southern General Hospital and work was due to commence on 6th January 2011 with a completion date of 2015  It was anticipated that the new Children’s Hospital would open in the autumn of 2014  The consultation period on the future of Lightburn Hospital had finished. More work would be required. A paper would be going to NHS GG&C Board in February 2011.

NHS Forth Valley  The second phase of the move to the new Forth Valley Royal Hospital was now complete, the third phase would take place in Summer 2011  Forth Valley was currently addressing the retained elements of the sites at Stirling and Falkirk  Work was ongoing on partnership arrangements between Stirling Council and Clackmannananshire Council and NHS Forth Valley.

NHS Dumfries & Galloway  The OBC for Dumfries & Galloway Royal Infirmary had been approved by the Board and was now awaiting an invitation to submit to the National Capital Investment Group  There were a number of outstanding critical estate issues including a backlog of maintenance work  Work was ongoing with the local authority to progress the Health and Wellbeing agenda.

Stephen Whiston Head of Planning, Contracting and Performance Argyll & Bute CHP 24th December 2010

4 Highland NHS Board 1 February 2011 Item 5.1

COMMUNITY CARE PLAN

Report by Jan Baird, Director of Community Care on behalf of Elaine Mead, Chief Executive

The Board is asked to:

 Endorse the final draft of the Community Care Plan to enable implementation to progress.  Agree that the outstanding work required to complete the outcomes framework is progressed.

1 Background and Summary

2 Process to Date

A broad range of stakeholders were consulted on the proposed outcomes, issues and areas for development. The consultation followed a number of formats –  Distribution of consultation documents directly to stakeholders  Access to documents through public buildings on request  Online survey  Public events  Semi-structured interviews and group work sessions targeted at ‘harder to reach’ groups  Through networks of the Highland Community Care Forum.

This period of consultation ran from 5 April to 15 June 2010. Alongside this a number of Stakeholder Forums were held covering Thurso, Kingussie and Fort William and feedback from Council Ward forums was also collated.

Next Steps: Work is now ongoing to develop a framework which reflects the outcomes in the Single Outcome Agreement (SOA) and expresses outcomes at all levels of strategy and delivery.

On the basis of the consultation, a tiered model has been developed and a set of eight key themed outcomes have been developed as below:

1. People are healthy and have a good quality of life 2. People are supported and protected to stay safe 3. People are supported to maximise their independence 4. People retain dignity and are free from stigma and discrimination 5. People and their carers are informed and in control of their care 6. People are supported to realise their potential 7. People are socially and geographically connected; and 8. Community Care services are delivered effectively, efficiently and jointly This will lead to detailed implementation plans which will evidence progress across the wide range of community care groups and provide monitoring information to the Leadership and Performance Group.

A communication Strategy is also being developed which is underpinned by a set of principles which includes a commitment to using ‘plain English’ and avoidance of jargon.

Summary NHS Highland is asked to endorse this Community Care Plan which has been through extensive public and stakeholder consultation to enable implementation to progress.

3 Contribution to Board Objectives

This plan and its implementation contribute to the NHS Highland Strategic Framework demonstrating our integrated approach to achieving joint outcomes.

4 Governance Implications

Progress against the outcomes in the Community Care Plan will be monitored through the Leadership and Performance Group, the minutes of which are reported through Highland Health Board.

5 Impact Assessment

All actions will be impact assessed as they are developed.

Jan Baird Director of Community Care

21 January 2011

2 Appendix A

Highland Joint Community Care Plan

2010-13

FINAL DRAFT 2 Preface 1. Introduction...... 5

2. Community Care in Highland ...... 5 2.1 Making the Difference………………………………………………………… 5 2.2 The Challenges We face ...... 6 2.3 Consulting Service Users, Carers and Stakeholders...... 6

3 Changing Community Care ...... 8 3.1 The Outcomes People Seek...... 8 3.2 What People Have Told Us...... 8 3.3 Areas for Change and Improvement...... 10

4 A New Model for Community Care Services ...... 15

5 The Community Care Outcomes Framework...... 18 5.1 The Community Care Outcomes triangle...... 18 5.2 Implementing the Joint Community Care Plan...... 20

6 Delivering the Outcomes People Seek ...... 21 6.1 People are Healthy and Have a Good Quality of Life ...... 21 6.2 People are Supported and Protected to Stay Safe ...... 23 6.3 People are Supported to Maximise their Independence ...... 24 6.4 People Retain Dignity and are Free from Stigma and Discrimination .....26 6.5 People and their Carers are Informed and In Control of their Care...... 28 6.6 Peopkle are Supported to Realise their Potential ...... 30 6.7 People are Socially and Geographically Connected...... 31 6.8 Community Care Services are Delivered Effectively, Efficiently and Jointly...... 33

3 4 Preface

(NOTE: insert brief statement from the respective Chairs in endorsement of Plan.)

1 Introduction

This new Joint Community Care Plan has been developed by the Highland Community Care Partnership and is designed to be the blueprint for how the Highland Council, NHS Highland and our third sector partners will provide Community Care services in the future.

The Plan is result of a major consultation process across Highland during which we have listened very carefully to what people have told us is important to them.

The feedback1 we have received has been hugely helpful to us in developing this Plan and we are reassured that the people who responded to our Changing Community Care consultation were positive about the outcomes we had identified as being the important ones2.

2 Community Care in Highland

2.1 Making the Difference Community Care is the way we give care and support to adults who need extra help to live their day-to-day lives and their unpaid carers. Usually people who use community care services have special needs arising from some form of disability, either physical or mental, from mental health problems and/or alcohol and substance misuse issues, or as a result of advancing age. Examples of care and support are:  the community nurse who takes someone’s blood pressure, heart-rate or asks them about their mood so they can control their medication to stay independently at home;  the support worker who joins up with someone with a learning disability so they can go safely to social events like football matches or discos; or  the care attendant who helps someone with washing and dressing so their regular, unpaid carer can take a break.

1 The Changing Community Care: Summary of feedback document is available at: www.fhcommunities.org 2 For example 88% of people who responded to our booklets said, yes, they are the important outcomes

5 We try to provide care that meets people’s needs. We want to help the people we work with overcome whatever challenges they have so they can live the lives they want. This plan, therefore, will look at how our services can improve the lives of the people who use them. Our focus will be on the outcomes of our efforts – the ability to live independently at home; the opportunity to go to the football, the chance to take a break from caring – for this is the difference we seek to make.

2.2 The Challenges We Face The overall care needs of adults living in the Highlands are changing. Figures show that the number of people who are 75 or over in the Highlands will more than double between 2008 and 2033. That people in Highland are living longer is a fact that should surely be celebrated by us all. However we know also that the demand on community care services grows markedly in the over-75s. It also looks likely that numbers of people needing help because of a learning disability, autism or mental health problem will continue to rise and their needs become more complex. The demand for help from those with a long term and/or lifestyle related health condition also seems set to increase. Combine these increases in demand with a financial future where real cuts in public spending seem certain and it is clear to see the challenges that Community Care services face. In addition, we believe we have an expensive over-reliance on institutional care to meet the needs of the Highland population. For example we have a higher percentage or our older people in care homes in the Highlands than in other parts of Scotland. People are going into care homes younger than they are in other parts of the country and they are staying longer.

2.3 Consulting Service Users, Carers and Stakeholders Given the demographic and financial factors which face community care there has been a strong desire by policy-makers in Highland to develop a new and effective approach to meeting future challenges and to delivering the outcomes people seek. Therefore, in developing any new approach, the views of service users and carers are of critical importance to partners. We want to be sure our efforts are properly aligned to the delivering they outcomes people say they want. We want also to engage service users, carers and other stakeholders as active participants in meeting the challenges which lie ahead. In summer 2009 the Highland Community Care Forum (HCCF) carried out a consultation on partners’ behalf. They talked to a cross-section of nearly 400 community care users and their carers. Their discussions focused on what being independent meant, what people had found helpful or difficult in maintaining their independence and what changes or improvements would

6 help them remain at home3. This work has been used to help us develop our approach to meeting the future needs of community care groups. In 2010 a set of Changing Community Care consultation documents4 were prepared and disseminated which summarised our developing approach and aimed to give interested people the chance to feedback their views (the consultation period for these was April to June 2010). These documents set out . The outcomes we seek; . The challenges we face . What people had told us (a summary of HCCF’s first consultation); and . Our areas for change and improvement. In parallel with the distribution of the consultation documents Highland Community Care Forum (HCCF) carried out a second even more extensive consultation with ‘harder to reach groups’. These included interviews with over 600 people from the range of service user, carer and equalities groups. HCCF’s involvement turned out to be a significant source of evidence for this report; and underlines the importance of making sure that ‘harder to reach’ people are properly supported to have a voice. It was pleasing therefore that we received over 300 returned consultation documents, including online versions; to compliment the views given to HCCF. The engagement was also supplemented by officers attending meetings of Ward Forums and Community Councils to explain our plans and listen to feedback; and by our engaging with stakeholders in three planned events.

2.4 Incorporating Feedback The information we received told us we were on the right lines, but also deepened our understanding of the outcomes that people really want from our services. It has also shaped our understanding as to how we should go about meeting those outcomes in community care – and, in describing our delivery outcomes, the level of detail provided to us sharpened our focus on what we know is effective and on the activities which people tell us have the biggest positive impact on their lives. We also received a great deal of information with respect to the ‘Areas for change and improvement’ which were described in the original Changing Community Care documents. People were positive about each of the changes identified in the documents5. However people, both in responding to the documents and in face-to-face discussions, took the opportunity to add their comments and perspectives. This information has added significant detail to our understanding of the

3 Link to HCCF Part One report 4 The original Changing Community Care consultation documents are available at: www.fhcommunities.org 5 For example 78% of people who responded to our booklets said, yes, these are the improvements we need to make.

7 changes we need to make and has highlighted other important areas for improvement. We have amended our list of strategic priorities to reflect and highlight the feedback of users and carers.

3 Changing Community Care

3.1 The Outcomes People Seek Community Care is the term used to describe how we support adults who need extra help to live their day-to-day lives. It involves services provided by Health, Housing and Social Work. It involves people working in the private and voluntary sectors too. As we have stated above, our focus is on the outcomes of that support – the positive differences we can make to people’s lives. Therefore we have developed a set of themes to describe and guide the intended outcomes of our interventions - to ensure that we contribute to a position where: . People are healthy and have a good quality of life; . People are supported and protected to stay safe; . People are supported to maximise their independence; . People retain dignity and are free from stigma and discrimination; . People and their carers are informed and in control of their care; . People are supported to realise their potential; . People are socially and geographically connected; and . Community Care services are delivered effectively, efficiently and jointly. We use these themes to structure the translation of our action planning processes into meeting the high level outcomes that people tell us they want.

3.2 What People Have Told Us In developing this Plan we have made determined efforts to gather the views of users, carers and other community care stakeholders (see section 1.3 above). We have gathered user and carers’ views on what factors support adults in need to retain and regain their independence, and we have also sought people’s views on whether there are other issues we need to consider in shaping a Community Care Plan. Many people placed a very high value on independence and being able to remain at or return home. For most, it did not mean ‘going it alone’ but having access to the right level of help and community support. Some described “interdependence” as a more helpful way to think about how people support each other. Some of the things people told us that helped them retain independence were: . Clear communication by service providers so that people know who to speak to, what services are available and how to access them;

8 . Caring and understanding attitudes from service providers (being treated with respect and dignity and as individuals); . Living in a caring community where they have strong connections with family and supportive friends; . Being involved in a support group where people can relate to and support each other; . Appropriate and individual support services so that people can remain at home; . Preventative care and earlier help can delay or avoid the need for crisis intervention later on (e.g. suitable home adaptations fitted quickly and prompt access to physiotherapy etc); . Good respite care opportunities for the individual and their carer; . Adequate financial support to relieve the pressure many people experience; . Good access to transport and personal mobility. This enables people to have the freedom to do what they want when they want to; . The opportunity to maintain important relationships and be or become socially active was key to people retaining their independence and confidence to live at home; . Access to meaningful and flexible training, employment or voluntary opportunities enables people to feel more confident and widen their own expectations of living independently. The response to the Changing Community Care consultation demonstrated that there was wide agreement that the issues identified, above, were important. However people identified a range of other issues which they thought should be considered in shaping a new plan were. These included: . Taking a proactive approach: finding better ways of monitoring people's changing needs and reviewing their support appropriately. . Investment in quick access to low level supports: to support people to maintain their capabilities and avoid crises. . Having somewhere to go was a key issue to a range of vulnerable people in times of crisis. . Consistency and continuity of service was highlighted with many people saying they had experienced ‘Stop/Start services’ or that those who supported them changed too frequently to build proper relationships. . Reintegration of isolated people: developing more opportunities, to allow isolated people to mix with a wider range of people in everyday situations; and . Taking a holistic approach was seen as important when caring for the mental and physical well being particularly of older people and people with mental ill health people.

9 3.3 Key Areas for Change and Improvement

To meet the challenges we face in providing care, and to do it in a way which both reflects what people have told us and helps us develop a model for services necessary to meet future challenges, we recognise that our services to adults in need must change and must improve. A list of our key areas for improvement is given here:

Helping to Quickly Restore People’s Skills and Confidence Our community services play an invaluable role in helping people to live where they want - at home in their community. However bouts of ill health can result in people being taken to hospital and admitted to care homes for help; and we know that this can be linked to people quickly losing the skills they need for independent living. We want to help people who have had a crisis or a bout of poor health to regain as much independence as quickly as possible. We will seek to refocus our services so they target help to people to quickly regain lost skills. To do this we need build the capacity across our services to act proactively and to intervene quickly. Our work must therefore focus on developing the skills and knowledge of our staff to bring a clear re-ablement focus to their work; we must also aim to bring health and social work professionals much closer together at District levels, streamlining our helping and personal planning processes to co-ordinate closer joint-working and speedier responses to need.

Housing and Support Solutions Greater availability of affordable housing with the right level of help on hand is the key to many people living successfully in the community. The need for flexible responses of this type was highlighted by a range of groups during the consultation: people said that not everyone wants to live by themselves, but with flexible home-based support for older people or shared accommodation for people with learning disabilities, people could be enabled to live as independently as possible. We believe it is important to plan any new housing so that it is suitable for changing need and with support in mind. By enhancing Care at Home services and other home based supports we aim to provide more and more flexible help to support people to live at home for longer. Our care homes will provide accommodation for older people who have the highest level of need and who are no longer able to remain in their own home. Using a reablement approach whereby intensive levels of intervention are used to help people to regain their confidence through relearning and learning new skills we can help prevent hospital admissions and support the efforts of people to re-establish community living.

10 Better Joint Working between the Key Agencies We aim to join up health, housing and social work help so we can be more than the sum of our parts. One of the main things we will do is to have one single helping process that all professionals use. This has to be simpler, with less bureaucracy, and give more freedom to professionals to bring resources to bear. This should mean earlier help, and more people getting the right help at the right time. In doing this we aim to address the need to act more preventatively that people reiterated throughout our consultations - in that there needs to be sufficient investment in prevention, particularly low level support early on. Broader engagement with the widest range of partners within the universal, community, voluntary and commercial sectors has also been pointed to in consultation as an area for development: people said this was also necessary for better coordination of information, services and opportunities. In developing a comprehensive “outcomes framework” for Community Care (see sections 3 and 4) we have sought to ensure that the outcomes people seek are supported within a logical model for delivery that includes the full range of potential partners, focusing on the ways to create the conditions for adults with support needs to achieve sustainable community living.

Helping People and Communities to Better Help Themselves Across the country it is understood that sometimes services can create dependency. Also people seem to think that communities have been becoming less supportive – not looking after their neediest members. Where people and communities can accept more of the responsibility for their own care and support we believe they should. People have told us that they would welcome more preventative and proactive supports in their communities. Through a review of day and community services we will seek to co-ordinate the opportunities available for people to ensure there is a broad spectrum of community based supports for independent living – supports which mitigate social isolation and increase the opportunities for people to contribute and participate in stimulating, social settings. We will seek to target formal services’ efforts at those with the highest and most complex and, by streamlining our role and recycling resources, support community-based and voluntary effort. In the consultation people also talked about the importance of transport. This was often seen as a key underpinning factor in addressing isolation and enabling access to services. People said there is a need for equitable, accessible and flexible provision of transport across the Highlands. Transport is a wider, Council issue. However we will work together with our partners in an effort to improve the transport opportunities that adults with support needs can access.

11 Better Information and Better Communication Service users and carers have told us that providing clear and accessible information and advice is essential to ensure that they know who to speak to, what services are available and how to access them. We think that by providing good information at the right time we can also help people help themselves. This could be information about ways to manage a medical condition or about financial and welfare benefits they may be entitled to. We believe providing good information is fundamental to people becoming more active in their care. In consultation we also heard that the tenor of professionals’ communication is extremely important in building relationships and trust with service users and carers. People have told us about the importance of the skills and knowledge that professionals bring to their role, and people have stressed how the quality of listening, valuing and empathy in professionals’ work affects adults in need. Highlighted to be of particular importance were the communication skills of those working with people with dementia, autism and sensory impairment. We will therefore seek to ensure that improving these skills and competencies remain at the heart of the professional skill set.

Carers as our Partners Unpaid carers are our partners in providing community care. They are the people who provide help and support to relatives, partners, friends or neighbours without financial remuneration. The work done by carers is immense and this informal support helps many people stay at home when they might otherwise have to go into a care home. It also helps prevent emergencies and stops people from needing other specialist services. The importance of supporting carers was underlined in consultation process. People told us that carers need to be supported with appropriate information, equipment, and training and to be monitored so that they do not hit a crisis. The availability of appropriate and local short respite breaks as a key resource in helping people manage in their caring role was also pointed to. We want to make sure we do all we can to support adult carers and will seek to continue to ensure that they are respected and valued for the task they perform.

Young Carers One of three main outcomes of For Highlands Young Carers 2008-20116 is to “reduce the number of inappropriate caring roles taken on by young carers.” To help achieve this requires community care professionals identifying where parents are relying on children and young people to provide their care and to include that young carer in care planning processes. To protect that child or young person requires professionals to ensure that they are not taking on an

6 Available at www.forhighlandsyoungcarers.co.uk

12 inappropriate level of caring – one which will prevent them from achieving their potential to be safe, healthy, achieving, nurtured, active, respected and responsible and included.

Using New Assistive Technologies Telehealth is equipment that monitors a person’s health and Telecare is equipment that monitors social care needs can give early warning that things are not quite as they should be. Staff can intervene earlier to prevent someone becoming so ill that they eventually need emergency care in a hospital or care home. Technology can also help carers to continue to perform the caring role by providing a little extra assistance that in turn gives them confidence that the person they care for is safe. People have told us that technology can never be a substitute for hands-on care – that is of course correct, but we believe it does still have an important role to play. We will seek to increase our use of these technologies; we believe they will allow us to offer help when it’s actually needed – not just in case it is.

Being in Control It is becoming widely accepted that people should play as full a role as possible in shaping and delivering their own care, together with their paid and unpaid carers. In the consultation, people told us they wanted to be treated holistically as individuals, not simply seen as a collection of needs waiting to be met. By engaging people actively and being clear about the intended outcomes of any intervention, we aim to ensure that the help people get is closely tailored to meeting their individual needs and wants. We are also working to ensure people can access a range of flexible, personalised supports through the provision of self directed support – sometimes in the form of a direct payment. This should mean that people not only feel more in control of the decisions which affect their care and their life, but also that there is a wider range of potential supports for them to choose from to help them achieve the outcomes they seek. Whether or not people want to play a big role in directing their own care, for example using a direct payment, we think they should feel in control of the decisions which affect their care and their lives.

Creating Local, Specialised Services At the moment there are not enough services in Highland for people who have the most difficult to meet needs. Many people are placed in very specialist facilities, often in other parts of the country. This can make it hard for them to keep in contact with their families and friends. It can also be very expensive to pay for the most specialist care. We believe we must support more people to be cared for closer to their families and communities and in order to achieve this, we aim to develop new, cost effective local services. In a difficult financial climate where there are no new resources, we will need to ensure that the largest and most complex packages of care both deliver their intended outcomes as efficiently as

13 possible and that resources are recycled where high levels of support are in effect acting counterproductively. To do this, we need to form close partnerships between professionals, service users and their carers to look closely at how we currently do things and at how we might do things differently in the future to provide support proactively and manage risk creatively and appropriately.

Making Clearer Links between Needs and Resources Community Care has grown up in such a way that different groups of people – for example older people and adults with learning disabilities - who seem to have similar levels of need appear to get very different levels and types of service. This doesn’t seem fair. In consultation people have told us that within groups people with similar needs can also have very different levels of services provided. People have also wanted us to ensure that there is equity across Highland with respect to the distribution of services and resources. We will aim to make the links between the needs people have and the resources they receive much clearer – both at a personal and at a planning level (see Community Care services are delivered effectively, efficiently and jointly). This should also help us allocate our resources more fairly and more affordably into the future.

Embarking on a Road to Recovery People’s lives can be affected by a range of ongoing challenges to their health and well-being. This may, for example, be as a result of an enduring mental health problem, or it may be as a result of an addiction to alcohol or drugs. However people can and do recover control in their lives, even where they may continue to live with ongoing symptoms and difficulties. We propose that our mental health and substance misuse services should focus on the areas which have been shown to help people recover, for example: hope; purpose; relationship-building; and developing self- management. If recovery is a journey, then the role of our staff can be to provide a route map and signposts on that journey, without taking control away from the service user they travel alongside.

Working in a More Targeted Way As an aid to improving joint working, services in Highland for mental health and substance misuse are using clear targets to measure their performance. During the consultation we heard that people were concerned that targets might mean that certain activities and priorities are favoured ahead of others, and that our interventions needed to be balanced ones based on a holistic understanding of the individual and their circumstances. We agree with that point of view, and would aim to use interventions of just such a type to produce reductions in the suicide rate; reductions in the number of readmissions to psychiatric hospital; and provide quicker help for those with dementia. Talking therapies such as cognitive behavioural therapy

14 have been shown to help people with some mental health conditions. Whilst understanding the critical role that the right medication can play, we aim to increase the access people have to these talking therapies and reduce the number of people who are prescribed anti-depressants Focusing on these tangible results for people can, we believe, provide real momentum for improving the help we offer.

4 A New Model for Community Care Services Given the challenges we face, and the breadth of our areas for change and improvement, we believe we need new model for service delivery in community care: this will be aimed at both clarifying the roles we undertake and ensuring we engage with the broadest range of partners to help us deliver the outcomes people seek. In common with similar work being undertaken across Scotland and reflecting what we have heard in consultation, our services need to be modernised and reshaped so they can effect a shift in the balance of care to support earlier intervention and community-based support, together with the provision of more intensive services for those who require them. It is already the case that in many areas of Scotland, local authorities and NHS Boards have been moving towards much more closely integrated health and social care services; this work is being used to inform our integrated model based on a set of sustainable activities which both deliver a range of important outcomes for people and support a number of important partnership relationships with those in the universal, voluntary and community-based sectors. The proposed model is based on an integrated, tiered model of intervention and Chart 1, below, illustrates a service delivery model that is relevant across community care client groups. It shows how formal, statutory activity (or activity funded by statutory partners) will be targeted at people who have the highest and most complex levels of need and who are at greatest risk. The inverted triangle is embedded in a range of other activities, which are shown to either side of the triangle. This represents the increasing importance of activity in the voluntary and community sectors and services provided by universal and partnership providers to meet lower levels of need for community care client groups.

15 Role for Statutory Community Care Services (directly provided and commissioned) ‘Universal’ & other Partnership Services Tier 3 Hospital based care Flexible and integrated interventions aimed at: managing risk and protecting & rehabilitation those at risk of harm; maintaining community living for those with ongoing Community, complex needs; supporting people to re-establish the skills and confidence Police & Criminal commercial and necessary for community living after periods of ill health; and supporting Justice System voluntary supports carers whose ability to cope is most challenged interventions Tier 2 Accessible community-based Work in partnership to advise, support and initiatives aimed at providing: Targeted activities, initiatives and develop a broad range of community-based social and developmental information from the range of initiatives and ‘preventative’ supports which opportunities. Outcomes of universal providers which are are accessible by adults in need and their reduced isolation; increased orientated at meeting the needs of carers. Development of strong links to these participation and stimulation; and community care groups activities to support proactive monitoring greater resilience for community and information-sharing living

Tier 1 Informal groups; clubs & societies; range of The range of accessible, universal services: this Community community based opportunities to will include activities across Health and The mapping; participate. Council including, for example, a full a range of signposting; sporting, health and cultural opportunities Commercial services which support encouraging (Exercise classes, Men’s Health groups, community living. access educational courses and classes etc)

Chart 1 Tier 3: Formal, Targeted Services for Adults in Need are a set of integrated services that support people with the most complex needs and risks. Services aim to support people to manage, wherever possible, at home and in the community instead of in institutional care. People have told us that our inputs need to be targeted to prevent people’s needs quickly escalating. Services will be provided at this level where they are necessary to ensure that support is in place to: . manage risk and protect those at risk of harm; . maintain those with high, ongoing needs in the community; . carry out a reablement plan aimed at re-establishing as much independence as possible with people after a period of ill-health; and . support carers whose ability to cope is most challenged. Services will provide focussed and targeted supports aimed at preventing unscheduled admissions to hospital and promoting early discharge. It will be important to ensure that joint working between social care and allied health professionals is maximised, particularly in the area of reablement, rehabilitation and recovery. It is anticipated that service users will be involved in appropriate personal planning processes which will agree a clear set of intended outcomes for the person, with timescales clearly specified and the success of those outcomes monitored and measured. Tier 2: Community-based Supports for Community Care Groups are provided in partnership with a broad range of voluntary, community-based, commercial and universal efforts which are aimed at providing opportunities and activities that support the sustainability of community living for adults with support needs in our communities. This represents a great deal of preventative activity which often maintains people’s social connectedness and functioning and bolsters their capacity for more robust community living. Encompassing the broadest range of supports to adults with support needs and their carers – and including activities such as peer support, supported social gatherings, exercise and fitness classes, health awareness sessions, courses, classes, community transport schemes, volunteering opportunities, social enterprises, handyperson schemes and befriending - the role for the statutory sector will be to work to stimulate, support and partner this broad range of activity. This will include a co-ordinating role for health and social care staff to ensure that partnership provision links into these activities, for example, ensuring information about self-care, falls prevention etc. is properly shared, and that those who may benefit from formal provision at an early stage are identified. Tier 1: Information to Facilitate Access to Appropriate Supports focuses on information-giving and signposting, making people aware of the full range of support activities and facilities that are available to adults with support needs and their carers in our communities. Wherever possible, people prefer to meet others in informal settings, and being interested and involved in groups or societies is positively associated with personal well-being. However, simply not knowing that they exist can often be the stumbling block which prevents people getting involved. The existence of appropriate activities and supports – be they universal-, voluntary-, commercial- or community-run - need to be signposted wherever possible. Together statutory partners need to work to develop better, simpler routes for sharing information of this sort to encourage active community living for all adults.

5 The Community Care Outcomes Framework

5.1 The Community Care Outcomes Triangle In common with much practice in this field, work has been undertaken to develop an Outcomes Framework for Community Care which is clearly linked to the Single Outcome Agreement objectives. We have constructed a tiered model that aims to logically integrate the outcomes which we are aiming to achieve at each level. That is, by demonstrating that we are achieving outcomes at a lower level, we can be clear that we are contributing to the achievement of the higher level outcomes (see Chart 2 below). As stated above, the information we received from the Changing Community Care consultation deepened our understanding of the outcomes that people want from our services. It has also shaped our understanding as to how we should go about meeting those outcomes in community care – and, in describing our delivery outcomes, the level of detail provided to us sharpened our focus on what we know is effective and on the activities which people tell us have the biggest positive impact on their lives

COMMUNITY CARE OUTCOMES FRAMEWORK

SOA

HIGH LEVEL COMMUNITY CARE OUTCOMES - Set of strategic outcomes - Themed - Linked to SOA

DELIVERY OUTCOMES - Set of outcomes objectives supported by action planning - Owned by specific strategy groups - Clearly linked to achieving strategic outcomes

Chart 2

18 Top Level Outcomes: these are the Single Outcome Agreement Outcomes which we seek to contribute to in Community Care: A. People across the Highlands have access to the services they need B. People are, and feel, safe from crime, disorder and danger C. Our communities take a greater role in shaping their future D. Public services are delivered effectively, efficiently and jointly E. More people are supported into employment F. Healthy life expectancy is improved especially for the most disadvantaged G. The health and independence of older people is maximised H. Attitudes and behaviours towards alcohol and other drugs are changed and those in need are supported by better prevention and treatment services I. The impact of poverty and disadvantage is reduced

Middle Level Outcomes are high level outcomes for Community Care across all adult groups. The achievement of these outcomes will describe and promote the broad strategic direction of travel for Community Care. It is intended that these outcomes will be themed to communicate the focus of our work. These themes reflect the feedback we received from the Changing Community Care consultation: 1. People are healthy and have a good quality of life; 2. People are supported and protected to stay safe; 3. People are supported to maximise their independence; 4. People retain dignity and are free from stigma and discrimination; 5. People and their carers are informed and in control of their care; 6. People are supported to realise their potential; 7. People are socially and geographically connected; and 8. We deliver Community Care services effectively, efficiently and jointly.

Lower Level Outcomes: the bottom level of the triangle is a set of outcomes that services are currently working to directly deliver. The achievement of these outcomes will demonstrate that we are meeting the higher level outcomes: they will also often impact directly on the quality of service users’ and carers’ lives.

These outcomes identify what the strategic partnership groups are seeking to achieve for the relevant client groups, or area of operation, and will often be linked to specific performance indicators or targets. The clear expectation is

19 that there will be action plans associated with the achievement of each of these delivery outcomes.

5.2 Implementing the Joint Community Care Plan In order to deliver the range of outcomes that are set out within our Framework, we need a number of properly aligned multi-agency strategic planning groups, each with a supporting delivery group to ensure that there work is planned and effectively taken forward. These strategic planning groups are fully integrated within a joint governance structure to ensure the required actions are implemented at an operational level. Strategic Planning Groups are currently proposed as follows:

Strategic Planning Groups Adult Support and Protection Carers Housing and Homelessness Learning Disability Mental Health Brain-affected conditions Older People Physical Disability Sensory Impairment Substance Misuse Transitions

Some of these strategic groupings are already established with outcomes clearly worked up and outcome measures identified. However, others are in the process of being established with outcomes still to be finalised. It should be noted that this is not an exhaustive list and over time, there may possibly be changes and additions. The recent announcement by the Scottish Government to invest in the Reshaping Care for Older People agenda now means that Highland’s strategy for older people’s service will be more ambitious and this will now be taken account of in setting up the new strategic planning group for this important area of work.

20 6 Delivering the Outcomes that People Seek

6.1 People are Healthy and have a Good Quality of Life The aim for Highland’s Community Care services will be to promote the quality of life of the people we work with, and for them to live as long, healthy and active lives as they can. To achieve this as far as possible will mean making sure people know how they can stay fit and healthy and ensuring that the services which prevent difficulties and promote independence are in place. Therefore we need to give the right help quickly when people need it so that their health does not deteriorate. When people do have longer-term problems we must plan in advance what might go wrong, how services can work jointly to help, and what steps people themselves can take in managing their own conditions. We also want to help people who have had ongoing challenges to their health and well-being, maybe from an enduring mental health problem or as a result of an addiction to alcohol or drugs, to recover. We know medication can help, but services should also focus on the other areas which have been shown to make a difference, for example, helping people develop hope, purpose, relationship-building, and their ability to manage their own lives. In our consultation:  Many people felt that the best way of finding out what individuals need to remain independent and identify potential problems and solutions is at the local level.  Many people felt that anticipatory care together with health promotion can prevent people losing their confidence and independence. It is also

21 essential to help prevent a crisis that might be very difficult for someone to recover from.  People stressed the importance of preventive services whereby people could be helped to maintain their independence and any problems picked up and responded to at an early stage.

The outcomes that people seek: People's health needs are met at the earliest stage and at the most local level possible. People's health needs are anticipated and planned for. People are supported to recover from ongoing and enduring illness, mental illness and drug dependency.

People's health needs are met at the earliest stage and at the most local level possible People with alcohol and substance misuse problems benefit from an appropriate ‘brief intervention’ approach People are able to access local community care services through District Teams People with a mental illness receive early and aggressive intervention using psychological as well as pharmacological treatments People with a mental illness are able to access safe and supportive environments outwith a hospital setting to promote recovery and reablement Carers receive good medical information for themselves and the person they care for People benefit from accessing high quality public health, safety and welfare advice

People's health needs are anticipated and planned for People with a long term condition are supported proactively by co-ordinated services People who have potentially high needs are supported with anticipatory care plans People with learning disabilities receive regular proactive health screening Carers are offered training in the management of disability and potential conflict with self determination of client

22 People are supported to recover from ongoing and enduring illness, mental illness and drug dependency People with a mental illness receive help from services that have a clear recovery ethos People who have substance misuse issues receive help from services that have a clear recovery ethos People with a degenerative condition and their families are able to access appropriate psychological support

6.2 Adults in Need are Supported and Protected to Stay Safe Those who provide support to people in need must often help them to assess and mange the risks that they take – allowing people to live the lives they want to live without being unnecessarily restricted. To do this successfully often requires working with people to gain and retain the skills and confidence they need to keep themselves safe – and this can be particularly important after a period of ill health, crisis or hospitalisation. Our supports must also try to ensure that people and their carers, have the opportunity to create or access the safe and secure environments they would wish to live in. The quality of the Community Care services we provide in Highland has an important role in contributing to availability of those environments. Furthermore, we aim to support more people with the most challenging needs locally. However a number of people in our communities remain less able to protect themselves from risks than others. Some adults who have learning disabilities, mental health problems or who are frail, for example, can be at risk of harm from others. This may be from others who deliberately seek to harm them; or occasionally from those who can no longer cope with the burden of their care. It is important therefore that professionals who work with adults at risk of harm are alert to the potential dangers of harm in all its guises and that they are available to respond speedily, effectively and jointly to protect adults from harm when it is suspected. In Highland, there is a multi-agency Adult Support and Protection Committee that oversees policy and practice in this area. In our consultation:  People said that services, such as physiotherapy, that enable people to regain and retain mobility need to be in place much faster for people who can quickly lose their confidence.  People said that service providers need to communicate between themselves to prevent people getting into difficulties.  People felt that being bored and having nothing to do is very destructive to people’s wellbeing. The outcomes people seek: People gain and retain the skills which keep them safe at home and in the community. People are supported to stay safe through the operation of our policies and procedures.

23 People with complex and challenging needs are supported to stay safe To deliver on each one of these key outcomes we have identified a set delivery outcomes (listed below) that are owned by one of the Community Care Strategy Groups. These have yet to be fully fleshed out and will be supported by clear action planning processes:

People gain and retain the skills which keep them safe at home and in the community Risk enablement is the basis of transition planning Rehabilitative and reablement intensive supports are available to respond to urgent need People are supported by services that have a clear reablement ethos Adults at risk of harm are empowered to protect themselves Use of Telehealth solutions is increased Telecare response options are enhanced

People are supported to stay safe through the operation of our policies and procedures Systems and processes are in place to protect adults at risk of harm All relevant staff are appropriately trained in Adult Support and Protection processes People who are in urgent need are able access 24x7 monitoring and response co-ordination through the NHS Highland’s Out of Hours Hub Hearing impaired and visually impaired people are supported to ensure appropriate safety and warning equipment is fitted in their homes Effective integrated care pathways offer a flexible range of services from assessment to recovery for those with alcohol and drug dependencies People with an acute mental illness receive appropriate support from trained workers

People with complex and challenging needs are supported to stay safe Adults with Challenging Behaviour are supported in environments which are safe and as unrestrictive as possible New models of sustainable community living are established

6.3 People are Supported to Maximise their Independence Nobody wants to become ill or dependent on others and those who require our support tell us loudly that they would like to be able to use the skills they have as much as possible. Therefore we must target our efforts to make sure that:  People benefit as much as possible from the existing range of community-based services and activities which provide the foundation for community living. In particular we recognise the critical importance

24 of having access to appropriate housing - housing which compliments people’s abilities and promotes their potential for independent living.  We provide the right help at the right time to prevent difficulties becoming worse and people’s capacity for community living becoming compromised. In this we recognise that the speed of our delivery of preventative help is often a key factor in whether people can live at home or need to be looked after in hospitals or care homes.  We retain a strong focus on the outcomes of our support. We need to know that our work is appropriately targeted and having a real, positive impact on the lives of service users and carers and that service users are active participants in that endeavour. In all of the above, we recognise the huge role that carers play in supporting community living for adults in need in Highland. We see adult carers as our partners in Community Care and understand the imperative of valuing and listening to their opinions, and supporting them to cope with their caring role. In our consultation, people said:  Early advice and support can prevent people losing their homes or having to go into hospital.  There should be more information about what to expect to happen after a diagnosis of a long term condition such as dementia.  Carers’ ability to care needs to be monitored to ensure that they are coping and do not hit a crisis.  Lack of affordable housing is a major issue and it is important to plan any new housing so that it is suitable for changing need and with support in mind. The outcomes people seek: People stay or return home with the appropriate support Carers feel able to continue in their caring role. People have access to appropriate housing which maximises their independence and well-being People are active participants in meeting their own care needs

To deliver on each one of these key outcomes we have identified a set delivery outcomes (listed below) that are owned by one of the Community Care Strategy Groups. These have yet to be fully fleshed out and will be supported by clear action planning processes: People stay or return home with the appropriate support People with a physical disability receive focused environmental assessment and appropriate and timely adaptation, equipment or Telecare services Older people receiving a Care at Home service will from a greater focus on rehabilitation and enablement Older people receiving a Care at Home service benefit from a greater range of

25 flexible supports The purpose and functions of Care Homes are reviewed and a programme of modernisation implemented New models of sustainable community living are established that enable people to return to Highland

Carers feel able to continue in their caring role Carers’ ability to provide care is assessed and supported Carers, and the people they care for, are able to access planned and regular short respite breaks Carers have the opportunity to learn skills to enable them to fulfil their caring role Carers have the opportunity to learn self-help skills An assessment of the health and capacity of carers is included as part of the wider service user assessment

People have access to appropriate housing which maximises their independence and well-being People benefit from a range of appropriate housing and support solutions, including having greater access to ‘mainstream’ housing Housing is available that is suitable for changing mobility and provides flexible use of space for the changing needs of older people and those with physical disabilities People are able to access a range of care and repair and handyperson services that support them to live at home House moves are well informed and planned and support access to services were necessary Land allocation and planning processes help to ensure that housing suitable for those with support needs are located close to services and families

People are active participants in meeting their own care needs Self management of people who have long term conditions is supported by staff with appropriate knowledge and skills Partnership working is developed between health, social care and voluntary organisations to support the self management of those with long term conditions People with dementia will receive an early diagnosis and are engaged in the management of their condition Young people and their families benefit from effective transitions processes

6.4 People Retain Dignity and are Free from Stigma and Discrimination We know that discrimination and inequality can damage people’s health, wellbeing and confidence and must be tackled if we are to make a difference to the health and wellbeing of people in Highland. Equality is not about treating everyone the same but it is about treating everyone with the due dignity and respect that they deserve. It is also about

26 making sure that, as far as possible, everyone has the same opportunities in day-to-day life. High levels of inequality are also reflected in the impact that poverty has for a number of disadvantaged groups. Increasing the resources people have at their disposal is associated with better well-being and increases the opportunities they have to participate in the life of their communities. In our consultation people said:  There is a need to make sure that everyone knows they can have a voice and be equal. People should be encouraged to speak up and feel positive about themselves.  In order for communities to be free from discrimination, staff need to be trained appropriately to deliver services in a caring way and feel confident to challenge discrimination and report any discomfort to those in charge to appropriately deal with it.  Lack of money is a barrier to living independently.  For everyone to be treated with dignity, respect and to be valued, this needs to one of the main outcomes the plan. The outcomes people seek: People are supported to tackle stigma and discrimination. Our services and those we commission actively promote equality. People's incomes are maximised People receive the supports which allow them to retain their dignity

People are supported to tackle stigma and discrimination Anti-discriminatory practice is actively promoted through quality staff training and development People and groups have the opportunity to identify their own issues and take action, accessing independent and collective advocacy as appropriate

Our services and those we commission actively promote equality The effects of our services are routinely assessed for differential impact with respect to equalities groups Commissioned services are monitored for their ability to provide an equitable service to all equalities groups Reasonable adjustments are made in providing care to meet the needs of people with a learning disability Staff receive training around rights and needs of people with a learning

27 disability

People's incomes are maximised People are signposted to and supported to access income maximisation information and advice Carers get good information about financial and welfare benefits Benefits checks are routinely undertaken as part of the assessment process

People receive the supports which allow them to retain their dignity Best practice in Adult Support and Protection is supported by policies and procedures Staff are appropriately trained to ensure best practice in relation to Adult Support and Protection services Best practice is supported by quality staff training and development Carers are listened to by professionals and their knowledge about the person they care for is respected

6.5 People and their Carers are Informed and in Control of their Care Information seems to be the key to many aspects of life these days and this is true of Community Care too. Our consultation with service users and carers pointed to the high importance they placed on clear communication by service providers so that people know who to speak to, what services are available and how to access them. This seems to make eminent sense; and we believe there is a link between service users and carers having good quality information and them making the choices that are right for them about lifestyle, self-care and any support they are entitled to. We have a long history of providing the services we think people want and need. We haven’t always got that right. In future we want the people who use Community Care services and their carers know their options and to be able to choose what services they use and how they are delivered. This will mean: . giving people support to use a direct payment (money the Council can give them to pay for their own care if that’s what they want to do); . using Personal Planning to help people to draw their own plans for support; and . making sure the people who use Community Care services and their carers are involved in all the decisions that need to be made, whether that’s at a personal level or is about planning how we provide services more generally In our consultation people said:  More information about what to expect to happen to their health and support available after a diagnosis of a long term condition such as dementia would help them cope and plan much better.

28  In terms of risk management, there needs to be a more flexible and common sense approach to people living their own lives and making their own decisions.  People do not know what services are available and how to access them. Service providers are often not aware also, which means that they are not able to sign post people to the help and support they need. The outcomes people seek: People know how to stay as healthy and fit as possible. People are in control of decisions that are made about their care and the care they receive. People know about the services we provide and how to access them

Adults in need know how to stay as healthy and fit as possible People with a long-term condition are able to access to information about their condition Communities feel engaged and empowered to make healthier choices, including choice that relate to alcohol and drugs A programme of public awareness work is delivered around Adults Support and Protection principles Older people are well informed about opportunities in retirement Older people are informed on how to minimise the risk of a fall

People are in control of decisions that are made about their care and the care they receive Carers receive clear information from professionals about the matters that affect them Individuals and carers have access to advocacy services People with learning disabilities are actively involved in personal planning processes Citizen advocacy services are developed Assessment and intervention processes facilitate and reflects the management of risk by the service user and their carer People who are assessed as needing services have the opportunity to access a range of self-directed support options Carers are involved in shaping polices and the services we collectively deliver

People know about the services we provide and how to access them Young adults, their carers and families are confident that there is a robust plan

29 for future needs Information about Community Care services is broadly disseminated through a broad range of media Information about transport schemes and opportunities are made accessible to ‘harder to reach groups’ Information about the opportunities which exist for community members to participate in a range of community initiatives is actively promoted People are signposted and supported to access information technology and/or the internet to obtain relevant information about the services that are available to them

6.6 People are Supported to Realise their Potential The consultation on this plan has recorded that people think there is a danger that they can be simply seen by service providers as a bundle of personal care and medical needs waiting to be met. Rather people want to be seen and listened to as the individuals they are – holistically. As people make plans for their lives ahead with the assistance of a community care professional they often want to address all the components of a successful and fulfilling life. Invariably this will mean thinking about having something interesting to do, and seeking to achieve their potential in particular areas of importance to them. In many of the current support services we provide there is work done on a day-today basis to support people with emotional and social development. We want to make sure that that help is targeted at making as positive an impact as possible on people’s lives – ensuring people are as active participants as possible in the world around them – and we want to know that the identified outcomes for the work relate to increased self-sufficiency and the achievement of personal goals In the area of skills development we recognise the need to bring together a flexible framework which will allow people of different abilities to translate their efforts to develop personal and social skills into the achievement of a set of competencies associated with self-reliance, participation and, ultimately, employment. In our consultation people said:  Being supported to realise their potential is essential to people progressing and living fulfilled and healthy lives. However, there were very few appropriate opportunities available to people needing support to get them started.  There is a need to develop mentoring and befriending schemes to give people the support they need to get started and continue.  There is a lack of promoted information about community activities available and that service providers are not aware themselves what is available.  Service providers could have a key role in sign posting people to activities.

30 The outcomes people seek: People have access to training, employment and volunteering opportunities. People have access to the range of community-based development opportunities.

People have access to training, employment and volunteering opportunities Young people and their families benefit from the implementation of MC2 and Self Directed Support. Young adults ‘in transition’ have access to supported planning processes People with Learning Disabilities will have access to tailored education opportunities to develop skills, confidence and self esteem People with a physical disability have support to engage in training, employment or voluntary work Community Care service users have access to structured, modular training programmes to achieve competencies associated with occupational activities and participation

People have access to the range of community-based development opportunities Effective integrated care pathways offering a flexible range of services from assessment to recovery People have access to a wider range of transport that meet their needs Opportunities for health promotion, self management, ongoing rehabilitation and development are maximised through community centres and other leisure facilities Older people have access to life-long learning opportunities, including courses and classes

6.7 People are Socially and Geographically Connected Highland is a huge area with a very low population density. Yet the people who live there have just the same need to meet others and get out and about as people living anywhere else. Indeed many have told us that the opportunity to be socially active is a key to them retaining their independence and confidence to live at home. Transport has always been a challenge. Anyone living outside Inverness who can’t afford a car, or whose condition means they can’t drive will find it very difficult to get to community services such as the doctor or pharmacist. Day- to-day tasks like shopping for food can also be very difficult.

31 However we do not believe it is a sustainable role for Community Care services to provide social opportunities in themselves or to provide transport for the countless potentially beneficial journeys people make. Rather we see it as our role to support and stimulate a range of voluntary and community-based efforts aimed at providing accessible social opportunities and interesting activities for people living in the community; and to work more closely with our community transport partners to make best use of our combined resources to strengthen the network of routes and resources available to them. There is also a co-ordinating role for our professional staff to ensure that other provision is linked into these activities, for example, to ensure information about self-care or health promotion is properly disseminated or information about opportunities for social interaction and stimulation through courses and classes run by the Council’s Education, Culture and Sport Service are made known. In our consultation people said:  That communities could do more to help but only if they get the help and support they need when they request it.  The need for equitable access to transport is a key issue across Highland.  Lunch clubs and other places that offer opportunities for social interaction can make a great difference to the lives of older people. The outcomes people seek: Voluntary and community effort contributes to more supportive communities. People have access to a range of transport to maintain their networks People do not become socially isolated

Voluntary and community effort contributes to more supportive communities Community capacity building and community development is actively supported People are able to participate in a range of activities that they find enjoyable and personally fulfilling

People have access to a range of transport to maintain their networks Community Transport Groups and Schemes are appropriately developed and

32 supported The possibilities of Council run demand-led transport and Community Transport Schemes entering into reciprocal relationships to increase efficiency and flexibility are explored The opportunities to transform Council run demand-led transport into accessible scheduled services are fully explored The availability of information as to how to use existing public and community transport networks is fully disseminated to people with support needs

People do not become socially isolated The appropriateness of all out of area placements is reviewed and locally based services developed Carers have the opportunity to talk to other carers People and their carers have opportunities to use the internet, teleconferencing and other information technology systems to facilitate local and national networking Older people have opportunities to maintain and create new relationships through a range of community based and voluntary sector led social networking activities

6.8 Community Care Services are Delivered Effectively, Efficiently and Jointly To deliver the outcomes people seek requires staff from the Highland Council and NHS Highland to work closely together. Professionals have different skills and abilities, and different ways of working: but to be truly effective they need to be part of a single and co-ordinated helping effort which brings with it less bureaucracy and more freedom to get on with helping people who need community care services. Local joint decision-making should mean that resources can be brought to bear more quickly and ensure that more people get the right help at the right time. The make-up of local supports – including family, neighbours, health, social work and housing services – and the way these work together play a key role in helping people stay in their own homes for longer. Highland as a whole needs to understand that by spending money in the way it currently does means that it misses the opportunities to do other things that might work out better in the longer term. Work is underway to give partners a much clearer idea of what their choices are, and how they could jointly realign their budgets to improve the care of individuals and of the whole population. The aim will be to increase outcomes, efficiency and equity across areas.

33 In our consultation people said:  Better ways of identifying who needs help in communities need to be developed in partnership with all services, the voluntary sector and communities.  Communication is key between Highland Council and NHS Highland to ensue continuity of care and anticipating changing needs of people who use community care services.  Closer, more meaningful working, including representation from communities in decision-making bodies is needed. The outcomes people seek: Care is delivered using a joined up core processes. Resources are accessed quickly and equitably. Decisions about the allocation of resources are made jointly.

Care is delivered using a joined up core processes The transitions bridge and interactive guide are further developed Staff are competent and confident in supporting people with alcohol and drug dependencies The Care Management Approach for people with complex needs is developed and implemented Health and social care plans are available electronically Evidence-based staff training is promoted to support rehabilitation services Up to date patient pathways are in place for each Long Term Condition A single pathway and single point of access is created for rehabilitation services Care is delivered from within a single pathway across Community Care. Reviewing processes are streamlined Information systems are developed and maintained around interventions under adult support and protection legislation.

Resources are accessed quickly and equitably Equitable weighted per capita resources are identified for each care group Clinical guidelines are implemented and take account of the needs of people with learning disabilities The Integrated Resource Framework is implemented across Community Care Resource allocation processes are streamlined

34 Decisions about the allocation of resources are made jointly Financial resources for health and social care are devolved where possible to district level Extended Community Care teams are developed and working