ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 23 … · 10/23/2013 · 13.1 Audit Scotland Report...

ARGYLL & BUTE CHP COMMITTEE MEETING

Wednesday 23 October 2013

J03-J07, Mid Argyll Community Hospital &

Integrated Care Centre, Lochgilphead

12.30pm – Lunch

1pm – Committee Meeting

1. Chairman’s Welcome Robin Creelman 2. Apologies Robin Creelman

3. Conflicts of Interest Robin Creelman

4. Minutes from Previous Meeting 4.1a Minute of 21 August 2013 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues

6.1 Minute of Highland NHS Board – 01-10-13 (verbal) Robin Creelman 6.2 NHS Highland Annual Review – Letter from Cabinet Secretary for Health & Wellbeing (attached) Derek Leslie 6.2 Director of Operations Report (to follow) Derek Leslie

7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Fiona Campbell 7.2 Infection Control Report (attached) Sheila Ogilvie 7.3 Health Improvement – Summary of Director of Public Health Annual Report (attached) Elaine Garman

10.30am - 12.30pm – Committee Members Development S ession

• Director of Public Health Annual Report – Children & Young People - Elaine Garman

• Service Options for Radiography Out of hours Servic e in Argyll and Bute Hospitals – Status update – Stephen Whiston/David Logue/Kristin Gillies

3.30pm : Public Session

8. Financial Governance 8.1 Finance Report (attached) George Morrison 9. Staff Governance

9.1 PDP/R and eKSF Implementation (attached) David Logue 9.2 Minute of Partnership Forum Meeting of 15-08-13 (attached) David Logue

10. Partnership Working

10.1 Children’s Services – Joint Pilot Inspection Report (attached) Derek Leslie 10.2 Change Fund 2013-2014 – Mid Year Review (attached) Derek Leslie

11. Performance Management 11.2 NHS GG&C Service Level Agreement (SLA) Update (attached) Stephen Whiston 11.3 Delayed Discharge Census at 15-09-13 (attached) Derek Leslie

12. Mental Health Modernisation Update (attached) Derek Leslie 13. Papers for Noting: 13.1 Audit Scotland Report – NHS Financial Performance 2013 (attached) 13.2 Argyll & Bute CHP eHealth Steering Group Draft Minute 14-08-13 (attached) 13.3 CHP Committee Meeting Dates 2014 (attached) 14. AOCB*

15. Date, Time & Venue for Next Meeting

Wednesday 18 December 2013, RSR Braeholm, Helensbur gh

* to be notified to Chairman in advance of meeting

The Committee meeting will be followed by:

Argyll & Bute CHP Committee 23 October 2013

Item : 4.1

MINUTE OF MEETING OF THE ARGYLL & BUTE CHP COMMITTEE

Argyll & Bute Community Health Partnership Aros Lochgilphead Argyll PA31 8LB www.nhshighland.scot.nhs.uk/

Lecture Room

Oban Community Fire Station

21 August 2013

Present

Mr Robin Creelman, Chairman, Argyll & Bute CHP Mr Derek Leslie, Director of Operations, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Ms Elaine Garman, Public Health Representative, Argyll & Bute CHP Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Ms Liz McMillan, Staffside Representative Mr Duncan Martin, Chairman, Public Partnership Forum Councillor Elaine Robertson, Argyll & Bute Council Representative Ms Glenn Heritage, CVO Representative Ms Elaine Wilkinson, Non-Executive Member

In Attendance Apologies

Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Ms Elizabeth Reilly, Area Dental Committee Representative Councillor George Freeman, Argyll & Bute Council Representative Jim Robb, Head of Service, Adult Care, Argyll & Bute Council Mr Michael Roberts, Vice Chair, Public Partnership Forum Ms Dawn Gillies, Staffside Representative

1. CHAIRMAN’S WELCOME The Chairman opened the meeting by welcoming everyone to Oban Community Fire Station. 2. APOLOGIES Apologies for absence were noted as above. 3. CONFLICTS OF INTEREST No conflicts of interest were declared.

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4. MINUTE FROM PREVIOUS MEETING 4.1a Minute of Meeting held on 19 June 2013 Item 7.2 – Infection Control Report – MRSA Screening – Ms Tyrrell requested an amendment to the Minute as follows : Mr Creelman asked if MRSA screening is undertaken in the CHP. Ms Tyrrell confirmed that screening has been implemented across all hospitals within the CHP; audit of compliance is also carried out in each hospital although national reports require information only from acute hospitals. The Committee: Approved the Minute with the above amendment noted. 5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 19 June 2013 There were no matters arising. 6. NHS Highland Organisational Issues 6.1 Highland NHS Board – 13 August 2013 Mr Creelman referred to the following agenda items discussed at the meeting : North of Scotland Planning Group Annual Report 2012/13 which summarised regional achievements across the range of project which NoSPG supports on behalf of North of Scotland Boards. Update report on the Highland Quality Approach (HQA). This is a significant piece of work which is still being ‘bedded in’ throughout NHS Highland. Mr Martin emphasised the importance of front line staff contributing to the outcome of the HQA work. Mr Leslie advised that there is evidence of progress being made by staff in the adoption of HQA. The Committee: Noted the above update. 6.2 Director of Operations Report Mr Leslie provided a summary of key points in the circulated report. Maternity Services Following the receipt of a complaint from a Mull maternity patient regarding her alleged early discharge from hospital following the birth of her baby and the follow-up advice given to her, a Significant Event Review (SER) was undertaken. This has resulted in changes to how the midwifery team engage and work with women from the islands in preparation for birth in Oban.

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A number of actions were identified and an action plan will be developed that will be monitored through the Maternity Services Group to ensure a positive experience for patients. NHS Highland will respond to the complainant through the normal channels. The notes of the meeting with the complainant will be written up and the report on the outcome of the full Sudden Unexpected Incident submitted to the Chief Executive. Ms Tyrell reiterated that the SER included engagement with Mull maternity patients and resulted in a comprehensive report. The discussions and outcomes are also viewed as a learning experience for staff. Councillor Robertson enquired about the maternity model for Mull in comparison to other areas of the CHP. Ms Tyrrell advised that the maternity model is the same across the CHP and was developed in collaboration with service users and providers and is due to be reviewed, as agreed, after a period of implementation. Stroke Services Lorn & Isles Hospital is looking to increase clinics to 2 per week. The availability of a protected stroke bed in ward I will result in the availability of a bed for stroke patients at all times. The improved discharge planning structure will result in more timeous discharge planning. Substitute Prescribing

At the present time there is no access to substitute prescribing in Kintyre. Those who require methadone or other heroin substitute medication travel to Dumbarton, if they are subject to a DTTO, or continue have it prescribed by their previous GP if they have moved into the area already on treatment. The working group continues to meet and has clear plans for the establishment of a service based on : • Salaried GPs prescribing with the support of a nurse prescriber from a weekly

addictions clinic in Campbeltown Hospital. • Support between clinics provided by the Argyll & Bute Addictions Team (Integrated

NHS/Social Work Team). • Additional psychosocial support provided by KADAS, the local 3rd sector provider. • Input from a Consultant Psychiatrist (Addictions) as required. A meeting of the Scottish Government Cabinet is due to be held in Campbeltown on 28 August when it is expected that substitute prescribing will be a topic for discussion at the public meeting. The Opiates Substitute Prescribing review report is due to be published. Mr Creelman voiced his support for a clear and implementable addictions strategy and the need for consistent partnership input to take this forward. Cowal 24/7 Implementation of Preferred Option. The implementation of the preferred option continues through the work of the Implementation Governance Group, the Operational Sub-group and the Communications and engagement sub-group. These groups have representation from Health, Scottish Health Council and the Public.

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Currently 2 Salaried GP posts have been advertised and are awaiting short listing and potential interview. Shifts continue to be covered by locum staff, with clinical supervision being provided by the clinical lead. Negotiations continue with HR and medical unions regarding the rural Out of Hours service. A locality based rota master is in post as an interim until the job description is agreed. A locality contingency has been agreed verbally with Scottish Ambulance Service (SAS.) Locality SAS currently operate treat and refer and Nurse Practitioners are currently working in casualty. The extended community care team is working to 20.00 hours to support care in the community, prevention of admissions and supported discharges from casualty. Islay Clinical Services Review Update An Integrated Nurses Workshop was held on 10 July 2013. A follow up education session with nurses was held Thursday 15 August to explain how the Competency Framework will be used to inform individual learning development plans for staff. Education sessions to be available in ward area every 4 weeks, supported by GPs. The Steering Group Meeting held on Friday 16 August endorsed recommendations from Clinical Workforce Group:

o 6 GPs needed with defined clinical skills to work across community hospital and primary care settings

o Hospital nursing establishment is due to be reviewed, led by Ms Tyrrell, and informed by clinical workforce recommendations and national workforce planning tools including clinical judgement.

o Clinical skills for nursing staff identified and included in Competency Framework o 10 in-patient beds with contingency plan for an additional bed to be developed

The Community and staff feedback report was tabled at Steering Group. Approximately 2000 feedback forms were distributed and 121 responses were received, with 9 key areas identified : � Fear that if 3 GP practices to integrate with a central pool of resources, premises

at Port Ellen and Port Charlotte will be lost. � Anxiety about losing medical cover OOHs and the impact on patient care. � People unlikely to use/do not use NHS 24, are more likely to turn up at casualty,

call the hospital or dial 999. � Support for more services available on Islay, fewer patients having to travel to

mainland. � Develop a more coherent and integrated way of working for all staff groups, not just

GPs. � More investment in front line staff (doctors, nurses), less “pen pushers”. � General lack of information about what services are currently available, how to

access services and what to do if there is no access to a GP after surgery hours. � Staff would like to see improvements to facilities in the hospital. � Dental services need to be reviewed, improved facilities.

GPs are meeting with an independent consultant who can offer contractual support on Wednesday 21 August, to discuss the support he can provide and potential contractual models. The CHP is funding the contractual support.

InPS who provide the VISION IT system attended Islay for meeting with clinicians and CHP IT staff on 29 July. Several actions are now being progressed. A Visioning Workshop is due to be held on Thursday 22 August. The Project meeting structure is to be reviewed following workshop.

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Kintyre Continuing Care Beds in Campbeltown Communi ty Hospital The CHP is reviewing its engagement procedures following discussions with the Scottish Health Council and subsequent receipt of extant engagement guidance. Mid Argyll Community Hospital & Integrated Care Cen tre (MACHICC) Builders started on site on 10 June to provide a day treatment unit and relatives room within MACHICC. Working in partnership with MacMillan Cancer this refurbishment will enhance the environment for patients by providing a dedicated treatment and relaxation space for three patients. A relative’s area will also be developed within the hospital, providing an area of privacy and relaxation for families to stay when relatives are receiving end of life care in the hospital. GP Vacancy –Furnace & Inveraray The Furnace and Inveraray community councils have established a marketing group to identify ways of advertising the current GP vacancy in creative and innovative ways. The group have contacted community councils in Jura and Arran who have recently had success using creative marketing techniques when advertising GP vacancies and are liaising with local managers. Patient Management System (PMS) Trakcare The implementation programme for the new patient management system commenced formally on 1 April 2013 and is now well advanced. In particular, the hardware configuration for the system has been installed and signed off by the supplier. An initial instance of PMS Scottish Edition has been taken by the supplier and will be used to initiate the Highland build in conjunction with the data configured for NHS Highland as a whole. The programme consists currently of three projects, technical, core patients administration system (PAS) and clinical. A significant amount of work and commitment has been evident on the part of health record staff across the NHS Highland area which is acknowledged as additional to the day job and is key to successful implementation. As intimated when the Board formally approved the business case in December 2013, particular challenges associated with Argyll & Bute’s acute specialist service patient referral pathway, almost wholly completely into NHS Greater Glasgow & Clyde, are being actively considered through an operational interface group. This is to ensure Argyll & Bute patients are not disadvantaged in terms of equity of access, prioritisation and waiting times as a result of pathways straddling two instances. A range of patient pathway scenarios has been identified to enable specific focus of those areas where functionality between the Highland and Greater Glasgow & Clyde instances present a challenge. This focus will include concentrated engagement between service planners, service providers and eHealth specialists from both Boards. The status of these discussions will be reported to the PMS Implementation Programme Board when it next meets in early September. The Committee: Noted the content of Director of Operations Report. 6.3 Feedback from NHS Highland Annual Review The Chief Executive report is awaited.

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The review undertook a revised format this year when the Cabinet Secretary for Health & Wellbeing met separately with public and patient representatives, followed by a meeting with NHS Highland Board. The initial feedback from the review has been positive. Mr Martin reported that the patients’ session provided the opportunity for the group to highlight and discuss any concerns. Referring to patient feedback, Ms Heritage reported on a GP Practice incident she had been made aware by a member of the public, and enquired about the process for investigating the incident. Dr Hall advised that there is a reporting process which GP Practices follow and, if required, an event review is undertaken. The outcome of any such reviews are reported and reviewed by the Clinical Governance and Risk Management Committee (CGRMC). It was agreed that Minutes of CGRMC meetings will be an agenda item for noting at CHP Committee meetings. Dr Hall stated that it is important to encourage patients to advise the NHS Highland Feedback team of any concerns or complaints they may have in relation to their care. 7. Clinical Governance 7.1 Clinical Governance & Risk Management Report Ms Tyrrell spoke to the circulated report and highlighted and summarised a number of items. Risk Management Incidents The data reported as at 22 July 2013 indicated that a total of 515 incidents were reported within Argyll & Bute during quarter 1. Cowal & Bute – 81 (15.7%) Helensburgh – 11 (2.1%) Mid Argyll & Kintyre – 257 (49.9%) Oban, Lorn & Isles – 158 (30.7%) Outwith – 8 (1.5%) Ms Tyrrell advised that the increase in incidents reported is being looked at in detail to establish if there is a sustained increase and the outcome will be provided at the next meeting. In the last financial quarter slips trips and falls remained in the highest category of incidents. The top category for each locality: Cowal & Bute – transfer / discharge (14) Helensburgh – violence and aggression (3) Mid Argyll & Kintyre – violence and aggression (53) Oban, Lorn & Isles – falls (56) Increase in number of incidents related to transfer and discharge is being investigated. During Quarter 1 the incidents reported in Argyll & Bute were graded as follows, with the remaining incidents yet to be graded:

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Low – 305 (59.2%) Medium – 139 (27.0%) High – 3 (0.6%) There were 2 incidents, reviewed by a manager and graded with a consequence of major or extreme. Mid Argyll, Kintyre and Islay- Suicide Oban, Lorn & Isles – SAB The overall outcome for Argyll & Bute is: No injury / harm – 307 (59.6%) Near Miss – 57 (11.1%) Injury / harm – 137 (26.6%) Death – 1 (0.2%) Property damage – 13 (2.52%) There were 2 RIDDOR incidents in Quarter 1 . 1 x >7 day absence – staff accident – resulting in an injury to thumb. 1 x major injury – staff fall resulting in a fractured patella. Pressure Ulcer Prevention Ms Tyrrell reported that work is continuing to show improvements for patients with a sustained overall reduction in Grades 3 and 4 ulcers. There has been recent increase in capacity of Tissue Viability specialist nursing support within NHS Highland; this will deliver additional support to the clinical staff in ensuring that adherence to standards for pressure ulcer prevention is maintained across all areas. Ms Tyrrell advised that if compliance with standards is reported as less than 90%, the model for compliance is reviewed and the area concerned re-audited. In addition, a short life group has been established to develop an action plan to raise awareness, and develop prevention strategies, across community and primary care settings. This will include working with carers and staff in Care Homes and Care at Home services. Councillor Robertson enquired if the work with carers and care home staff had commenced. Ms Tyrrell confirmed that there has been some approach across NHS Highland and she is currently working with the NHS Highland Tissue Viability Group to review the monitoring of pressure ulcer prevention by care providers and to identify training needs. All organisations contracted to provide care are required to comply with the guidelines and the contact person in Argyll & Bute Council is currently seeking clarification from care providers that this is the case in the CHP. It was agreed that this will also be discussed at the next Joint Management Team meeting in September. Falls Prevention A considerable amount of work is underway to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn and Islands Hospital in Oban.

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Disruptive, Violent & Aggressive Behaviour While incidents related to disruptive, violent and aggressive behaviour are the second highest category reported the numbers for Argyll and Bute are consistently lower than those of the other operational units as shown in the graph below. Training and support for staff is delivered throughout the year to ensure that staff have the right communication and management skills to deal effectively with potential incidents. Staff Availability The majority of incidents related to lack of staff availability are reported by hospital staff when there is shortage of nurses in clinical areas due to sickness absence. The number of incidents reported for Argyll and Bute is generally low. However each incident is scrutinised by local managers and the lead nurse to identify the causes, the trends and whether there has been any impact on patient care as a result. Nursing and Midwifery staffing establishments are agreed through a robust process which involves nursing and midwifery leads, managers, charge nurses and team leaders and staff side representatives. Due to the extent of service redesign within Argyll and Bute’s hospitals over the past two years, at its July meeting the CHP Core management Team agreed the process for carrying out Argyll and Bute wide review of existing establishments during September 2013. This is in line with NHS Highland policy. The process will include representatives from CHP management, Finance, HR and staffside as well as the Senior Charge Nurses and Team Leaders. It is anticipated that the revised establishments will be agreed and signed off in December/January Significant Event Reviews (SER) There have been four SERs since the last report. Each of these has been investigated with the staff who were involved and reports and action plans generated. SERs are an essential element of risk management and form an integral part of the improvement in the safety and quality culture. Feedback from staff about their experience of the SER process continues to inform developments and improvements in the way in which the need for SERs is identified, the way in which the reviews are conducted and in how the action plans are developed and monitored. Health Improvement Scotland Adverse Event Review Health Improvement Scotland (HIS) Adverse Event Management visit to review NHS Highland in relation to the management of adverse events took place on 7 August 2013. HIS are undertaking review visits to all Boards within NHS Scotland. There were a number of sessions included in the programme which allowed the visiting team to talk to various members of staff about adverse event arrangements within NHS Highland including:

• Discussion with Senior Managers • Demonstration of systems in place e.g. Datix, record storage, staff training • A visit to a clinical area in Raigmore to talk with front-line staff to understand their

perspective about the management of adverse incidents. • Discussion with staff involved in 4 selected incidents. One of these sessions was

with A&B CHP staff in relation to a incident which occurred in Argyll and Bute and which was subject to a Significant Event Review

A draft report will be provided by HIS with final report due to be published on 23 September 2013.

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Complaints Of the 7 complaints received in June 2013 the themes contained within complaints can be broadly categorised as follows:

Waiting Times 3 Access to Services 2 Care/Treatment 2

Ms Tyrrell stated that during the investigation of complaints there is communication with the complainants to keep them advised of the progress of the rigorous process. All responses are screened prior to the final version being submitted. External Review Joint Inspection of Children’s Services in Argyll and Bute The pilot inspection in Argyll and Bute was completed in April 2013. The draft report has been received and the final report is due to be published in September. Work is already underway to address the identified areas for improvement Quality and Safety Scottish Patient Safety Programme Acute Services: Detailed run charts for Lorn and Islands Hospital reported : INR: slightly raised due to one patient with a raised INR on admission. Spread across wards all sustaining improvement. Sepsis: data input from two wards now. VTE –to be taken forward when NHS Highland agree the appropriate tool. Mortality review – June–December 2012 looked at and report sent to Dr Bashford. All deaths reviewed and no adverse events identified. January–June 2013 to be audited. Mr Creelman requested that 3 monthly reviews of standardised morality figures and findings are reported to the next CHP Committee. Primary Care A local learning event for GPs, Practice Nurses and Practice Managers was held in Inveraray on 6 June 2013 with 24 of the 33 Argyll and Bute GP practices represented at the meeting (44 attendees) The training session was facilitated by Dr Kirsty Vickerstaff, Scottish Patient Safety Programme (SPSP) Primary Care GP Clinical Lead for NHS Highland, Dr Neil Houston, National Clinical Lead for Healthcare Improvement Scotland and Jill Gillies, SPSP-PC Programme Manager. The event provided information regarding the tools and resources of the primary care safety programme to improve patient safety and specifically supported practices with the two elements which have been included in the Quality and Outcomes framework this year;

• The Safety Climate Survey • Structured Case Note Review using the Primary Care Trigger Tool

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The NHS Highland SPSP-PC working group identified Warfarin Management as a key area of focus for NHS Highland. Argyll and Bute CHP is currently developing an enhanced service for anti-coagulation monitoring incorporating the SPSP-PC Warfarin Care Bundle for introduction across Argyll and Bute CHP from 1 April 2014. A care bundle is a structured way of improving processes of care to deliver enhanced patient safety and clinical outcomes. Dr John Lyon, Argyll and Bute SPSP-PC Clinical Lead and Joyce Robinson, Primary Care Manager are representing Argyll and Bute CHP at an NHS Highland site visit by Healthcare Improvement Scotland on 27 August in Inverness to agree an action plan for future activities, including further learning sessions (National and Local), IT and Data collection and enhanced service progress. It was agreed and noted that the Scottish Patient Safety Programme will be an item for discussion at a future CHP Committee development session. Health & Safety Revised Health & Safety Work Programme The NHS Highland work programme for Health and Safety 2013–2015 is being revised and updated. The programme will be split into corporate and operational work strands and each area of work will have targets and performance measures. The work programme is to be included as part of the Operational Units Delivery Plan and its implementation will be overseen by the Joint Chairs of the Operational Health and Safety Groups and monitored by the Health and Safety Committee. To avoid unnecessary duplication of effort each corporate work stream will have a NHSH Lead. The corporate work programme will be tabled for approval at the August NHSH H&S Committee. The CHP operational plan will contain all the work streams within the corporate plan plus areas of work to meet local concerns, identified e.g. through incident reporting or risk assessment. The A&B CHP Operational Plan will be tabled at the CHP Operational Health and Safety Group on 22 August 2013. Future reports to the CHP Committee will include performance related information in relation to achievement of the work plan Moving & Handling Audits The Moving and Handling Advisor along with the area co-ordinator/trainers in moving and handling have begun baseline audits for moving and handling. These baseline audits will be conducted within wards in each hospital. Items covered by the audit include: the level and frequency of training received by staff, the competence of individuals and the availability and quality of moving and handling risk assessments. These audits will help to determine any gaps in competence and written assessments. This will provide essential information as we make the transition from a prescribed frequency of moving and handling training to one based on the competence of individuals. Fire Safety Fire Risk Assessments Fire risk assessments carried out by the CHP Risk Advisor, Fire Safety, using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay, Lorn & Islands, Dunoon, Rothesay and Mid Argyll are now complete and have been issued. Action plans are being prioritised locally. The target for completion of the risk assessment for Mull and Iona Community Hospital is the end of August.

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Compartmentation Survey Recent fire service audits have highlighted the need for compartmentation work to be undertaken. Sub-compartmentation of wards is a key priority. Work is ongoing between the Fire Officer and the Estates Department. The fire alarm systems have been upgraded to L1 standard in Dunoon and Oban. Unwanted Fire Alarm Signals Two reported fires (actual) in Campbeltown and Lorn and Islands Hospital were as a result of overheating of equipment. Some unwanted signals were attributed to new alarm systems. Staff have been informed of the higher level of detection due to the new alarm systems and have been reminded to prevent unwanted calls by inappropriate actions e.g. using nebulisers, kettles or toaster in non designated areas or rooms. Six calls were due to works carried out by contractors. Procedures for the management of contractors need to reviewed by Estates to ensure they are fully implemented. Fire Service Audits The enforcing authority, Scottish Fire and Rescue Service (SFR), has now completed audits in Cowal, Rothesay, Islay, Campbeltown and Oban hospitals. Duty holders have received letters of recommendations; no formal action has been issued. Duty holders have responded by letter to the fire authority. Although SFR detail the full scope of works required, the letters indicate an immediate need for some interim works. These centre on the sub division of ward areas. All sites have Fire Safety Action Plans in place both as a result of the 3i risk assessments and the Fire Service Audits. Immediate actions are being progressed at all sites. Further funding is being sought to deal with some of the estates issues required. 7.2 Infection Control Report Ms Tyrrell referred to the circulated report which updated the CHP Committee of the current status of Healthcare Associated Infections and infection control measures in Argyll & Bute CHP and NHS Highland. Staphlococcus Aureus Baceraemia (SAB) (including MRSA) – the two previously reported cases of SAB which occurred in Lorn and Islands Hospital, Oban and have been scrutinised using the Root Cause Assessment tool. The first case appears to have been related to contaminated blood cultures and therefore not a true SAB. To ensure that correct aseptic technique is used when taking blood cultures, work is underway with medical staff at Lorn and Islands Hospital. The second case occurred in a patient with an invasive device (PICC Line) undergoing chemotherapy as a day case. As a result of the case analysis we are reviewing the need to undertake routine MRSA screening for all day case patients (not currently included in the guidance). Clostridium Difficile (CDI) Target There has been an increase in cases of CDI in Argyll and Bute since April 2013, with a total of 8 cases recorded - 6 in hospital and 2 in community. Of the 6 hospital cases, two

The Committee: Noted the content of the Clinical Governance & Risk Management Report

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of these were a recurrence of infection within the same two patients. There has been no epidemiological connection between the cases, no spread of infection within the wards in which the patients were being cared for and all patients have recovered. Point prevalence study of antimicrobial prescribing practice will take place across each hospital in September to identify how well we are complying with the guidance. In addition education sessions are being delivered in sites across the CHP for all prescribers to maintain the focus on appropriate prescribing of anti microbial agents. Hand Hygiene Hand hygiene audits continue to be undertaken monthly by all clinical areas, the results displayed and any non compliance addressed. All areas in Argyll and Bute continue to demonstrate compliance with the standards. Mr Creelman highlighted the previous suggestion for public engagement in compliance audits in hospital settings. Ms Tyrrell will discuss the proposal for with NHS Highland. Cleaning & Healthcare Environment The monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated 95% compliance in May and 94% in June 2013 for domestic monitoring and 97% for estates monitoring in May and 95% in June 2013. Outbreaks/Incidents There have been no outbreaks or incidents in Argyll and Bute since the last report. Education Following the findings of the HSE visit to Lochaber and the subsequent improvement work that was undertaken, NHS Highland has developed minimum standards for Infection Control education for community nurses. These require that all team members undertake the following:

- NHS Highland Hand Hygiene module - HAI Mandatory Induction Training Programme - Principles of Aseptic Technique

All teams in Argyll and Bute are currently progressing with these, with most expected to complete by the end of September 2013. In addition Team Leaders/ Case Load Holders are requested to undertake the Cleanliness Champion Programme by March 2014. Audit National audit tools have been developed in order to measure compliance with the national Infection Prevention and Control Manual Standard Infection Control Precautions. Baseline audits have been carried out in Lorn and Islands Hospital and Campbeltown Hospital. Plans are being progressed to implement a rolling audit plan within each hospital; when these have been implemented results from the audits, which will be reported monthly, will be utilised to identify areas of good practice and areas where improvement is required.

The Committee: Noted the content of the Infection Control Report

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7.3 Health Improvement Community Planning and Single Outcome Agreement Ms Garman referred to the circulated paper outlining details of the jointly issued Statement of Ambition by the Scottish Government and COSLA and their agreement that Community Planning Partnerships (CPPs) will be at the heart of public service reform. Ms Garman advised that it is expected that CPPs will : • strengthen their governance, accountability and operating arrangements; • ensure a greater pace of change and decisiveness in impact; • develop new and different ways of working and behaviour within and across partners; • take a more systematic and collaborative approach to performance improvement and

quality standards, including national requirements where appropriate, with robust self-assessment as a starting point.

• to report on progress and performance in ways that are clear to local elected members, CPP partners, local communities, the Scottish Government and audit and inspection bodies.

The paper emphasises that the development, delivery and performance management of Single Outcome Agreements (SOAs) are key to this. It is required that new SOAs are developed that:

• show a clear understanding of place. • plan and deliver for outcomes. • show how the total resource available to the CPP and partners has been

considered and deployed in support of the agreed outcomes. • focus on reducing outcome gaps within populations and between areas, i.e.

addressing and reducing inequalities. • promote early intervention and preventative approaches. • demonstrate genuine community engagement and evidence that the CPP is

planning, resourcing and integrating work to support communities to engage and deliver for themselves.

• focus on national policy priorities by aiming to achieve transformational, not incremental, performance improvement. The six priorities are: - Economic recovery and growth - Employment - Early years - Safer and stronger communities, and reducing offending - Health inequalities and physical activity - Outcome for older people

To ensure delivery of the required actions and outcomes, Argyll & Bute CPP has developed a draft SOA and has had a visit from a nationally organised ‘peer review scrutiny panel’ from which written feedback is awaited, although initial feedback has been received with regard to the draft SOA prior to the scrutiny visit. A form of self assessment against the Audit Scotland report and the national guidelines for CPPs and SOAs is being done following work on the SOA and this will also consider again the Audit Scotland Inequalities report response. An action plan to address the issues arising from the self assessment is required for each CPP. The final SOA is to be agreed and submitted to Scottish Government by 31 March 2014. In addition to contributing to the specific health components of the SOA, as part of the Local Delivery Plan (LDP) the CHP illustrated how it is contributing to the six national

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priorities to improve performance by providing some examples of their specific contributions to the SOAs for their area, demonstrating how they are contributing to better outcomes through collaborative gain. The LDP submission was to be with Government by the end of June, only part way through the national timetable set for SOA development, peer review and partnership improvement, so the CHP’s submission reflects an interim position. To date, no feedback has been received from Government. The next steps for the CHP are to ensure that plans are in place through the Health & Wellbeing Partnership, the public health team and locality clinical teams to deliver on all aspects of the SOA. The process for agreeing performance indicators has not yet been decided within the CPP but preparatory work for that can begin in the CHP. The Committee acknowledged that this is a complex and wide spectrum of work. Ms Garman will provide regular feedback to the meeting to give assurance and clarity relating to governance and accountability aspect of the work being undertaken. Ms Wilkinson enquired if the Pyramid system detailed the linkages of the work being undertaken by the CPP. Ms Garman replied that it did provide a degree of reassurance of a joined up approach in taking forward the work. 8. Financial Governance 8.1 Report Mr Morrison referred to the circulated paper and advised that for the four months ended 31 July 2013, Argyll & Bute CHP recorded an overspend of £274,000, which is an increase of £74,000 on the overspend reported at the end of June. The five main factors creating the overspend are;

• medical locum costs in Dunoon and Oban • nurse staffing costs in Ward B and A&E at Lorn & Islands Hospital • an overspend on the general medical services budget • an increase in individual care packages, especially referrals to Huntercombe • unachieved savings

Mr Morrison advised that the issue of locum costs is being reviewed NHS Highland wide. A detailed analysis of workforce establishments is currently being undertaken to look at nurse staffing levels. With regard to the Salaried Dental Service, it has been assumed that the service will be funded at cost and therefore a nil variance has been reported at month 4. A bid for funding of £4.3m has been with SGHD for several months now, however we are still awaiting confirmation of the level of funding that will be made available. Cost Improvement Programme 2013/14 The CHP’s savings plan for 2013/14 totals £2.4m. Savings in prescribing, commissioned services and depreciation look likely to be achieved. However the savings targets for Localities (totalling £1.05m) and management and corporate services remain challenging.

The Committee: Noted the content of the Health Improvement Report.

15

A shortfall of £400k on the savings plan is currently forecast as some plans are not yet fully developed. Addressing this shortfall in the savings plan is included in the planned management action required to achieve a year-end break-even position. 2013/14 Year-end Forecast Outturn Argyll & Bute CHP is currently forecasting a year-end break-even position, however this is dependent on management action to achieve this outturn. Future Commitments The CHP is finding it challenging to deliver savings in the current financial year. Looking ahead, funding uplifts for the next few years are likely to remain low and the financial challenge is likely to be unrelenting. A number of commitments have been identified that will require to be underwritten by efficiencies made elsewhere in the CHP. The Core Team has considered and acknowledged the need for these service improvements, but there implementation must be considered and contained within the limits of affordability and will be revisited and risk assessed as the financial position develops. The Committee Noted the content of the report and the financial challenge facing the Argyll & Bute CHP in 2013/14. 9. Staff Governance 9.1 PDP/R and eKSF Implementation Mr Logue reported that at 30 June 2013 the CHP had 3.74% of all staff (5.05% excl bank) with reviews and personal development plans signed off in e-KSF for this year so far. Actions for 2013/14 continue to be taken forward in order to maintain progress and improve the proportion of staff that have an annual review, with a focus on the following:

• Continue to addressing issues of missing data re a number of staff, particularly Bank, who do not have one or more of the following: named manager, e-mail address, no KSF outline or no review.

• Local managers and team leads planning and spreading reviews throughout the

year The Workforce Development Facilitator will undertake a quality review through meetings with local management forums and by asking members of A&B CHP Partnership Forum to complete a short survey questionnaire. This feedback will then be used to identify ways to improve and develop the quality of the programme

The CHP Committee :

• Noted the position In June 2013. • Noted the trend to embed this in practice and use to support and direct staff.

development in line with CHP and NHS Highland objectives. • Noted the need to ensure bank staff have review. • Noted the actions in place to maintain and improve progress.

16

9.2 Minute of Partnership Forum (PF) Meeting of 4 J uly 2013 The draft minute was circulated for information. Staff Survey It was noted that 30% of staff completed the survey, which was discussed and debated at the PF meeting on 4 July. One area of concern highlighted is the implementation of the NHS Highland ‘Whistleblowing’ Policy. Mr Logue advised that Senior Managers and Staffside representative have reviewed policies from other trusts and identified actions required in the CHP. The implementation of the policy will be tested in the Oban, Lorn and Islands area, to provide training to staff and work with managers to raise awareness of the need to report poor standards and the support available to staff. Reshaping Care for Older People (RCOP) A workshop will be held in October to encourage leadership in taking forward the work of the RCOP. Integrated Equipment Store Discussions continue around the establishment of a single integrated equipment store, the required staff configuration and to address all governance issues. Councillor Robertson enquired about the proposed premises and the expected date of implementation of the service. Mr Morrison advised that discussions are ongoing with the Council regarding the possible purchase of a property in Helensburgh. The date of implementation of the service will clarified and advised to Councillor Robertson. 10. Partnership Working 10.1 Public Partnership Forum (PPF) Mr Martin reported that the initial Leadership meeting scheduled for last week was cancelled and a new date will be arranged for September. Mr Creelman suggested that the name of the meeting, i.e. Leadership, should be reviewed. Mr Martin agreed to discuss this at the forthcoming meeting. 11. Performance Management 11.1 Delayed Discharge Report The Delayed Discharge weekly briefing of 1 August 2013 was circulated for information.

The Committee: Noted the above verbal update and the content of the circulated draft Minute.

The Committee: Noted the verbal update.

17

The Committee : Noted the details of the circulated report.

12. Mental Health Modernisation Update Mr Leslie highlighted details of the circulated report which gave an update on the implementation of the modernisation of mental health services in Argyll & Bute. Inpatient Services The bed compliment remains at 28 plus 3 minimal supervision places in the refurbished Firgrove building. The target of 22 beds is on schedule to be achieved.

Upgrade works on the IPCU single rooms is due to commence within the next few weeks which will result in a temporary reduction to 4 beds and a permanent reduction to 5.

Occupational Therapy toilets and DSR refurbishment is complete as is the Physiotherapy department relocation which took place in June.

Plans to relocate the MAPS/Clinical Psychology/OPD from the portakabin to Cowal Ward are being finalised and work should commence in August/September. New Hospital Development The Bundle As reported in June it appears almost inevitable now that the new hospital project will not be considered viable as a stand alone project and will need to be bundled with another capital project from the North Scotland Hub area. As previously reported there are two projects; one in NHS Highland (Aviemore); and one in NHS Grampian (Inverurie) ; that appear to be of sufficient size and at a stage of development to meet the criteria to be consider as part of a bundle. The need to bundle should be confirmed following the key stage review currently being undertaken by the Scottish Futures Trust (SFT). A decision on which project we will be bundled with should follow soon after that.

At present it is unclear how much additional delay this will cause – but it is clear that both of the projects being considered for bundling are at an earlier stage of development, and that bundled projects need to have Outline Business Case and Financial Business Case approved, and achieve financial close, at the same time. Community Mental Health Service (CMHS) Team Base Both Kintyre and Dunoon CMHS bases are complete, which will result in improved integrated working. Delivery of furniture and installation of phones, etc is awaited to allow them to become operational. In Campbeltown there are some discussions with the Kintyre & Islay Addictions Service regarding the best use of the shared space. Supported Transfer of Detained Patients The CHP Core team approved the proposal to recruit to a number of posts to support this development at end of June. The posts are currently out to advert. Those posts which will

18

be recruited internally will be filled within the next few weeks, with external applicants being interviewed later in August. The Committee: Noted the current key issues and progress against the action plan. 13. Noting 13.1 Draft Minute of eHealth Group Meeting – 1 May 2013 The Draft Minute of eHealth Group Meeting of 1 May 2013 was circulated for information. Mr Leslie referred to the eHealth meeting held on 14 August 2013 where it was agreed to review the IT support currently provided to GP practices in the CHP. The Committee: Noted the content of the circulated draft Minute 14. AOCB Mobile Phone Coverage Mr Leslie highlighted current concerns regarding mobile phone coverage within Argyll & Bute CHP. It was noted that this is a national issue and sub-contracting of the services is currently taking place. 15. DATE, TIME & VENUE FOR NEXT MEETING: Wednes day 23 October 2013 J03-J07, Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead

Cabinet Secretary for Health and WellbeingAlex Neil MSP

T:0845 7741741E: [email protected]

The ScottishGovernment

Mr Garry CouttsChairNHS HighlandAssynt HouseBeechwood ParkInvernessIV23BW

n--LEGACY 2014XX COMMONWEALTH GAMES

GLASGOW

IC; September 2013

2~ d;t)NHS HIGHLAND: 2013 ANNUAL REVIEW

1. This letter summarises the main points discussed and actions arising from the AnnualReview and associated meetings in Inverness on 19 July 2013.

2. I would like to record my thanks to you and everyone who was involved in thepreparations for the day, and also to those who attended the various meetings. I found it avery informative day and hope everyone who participated also found it worthwhile.

Meeting with the Area Clinical Forum

3. I had a constructive discussion with the Area Clinical Forum. It was clear that theForum continues to make a meaningful contribution to the Board's work; that the group haseffective links to the senior management team; and that, in general, effective engagementand communication has improved in the last couple of years. It was reassuring to hear thatthe Forum has a determined focus on clinical engagement in the planning and delivery ofservices, utilising the Highland Quality Approach to secure efficiencies and improve quality.It was also reassuring to hear of the robust clinical governance arrangements which are keptunder review and the commitment to person centred, safe and effective services. TheForum is also clearly playing a key role in relation to the Integration of Health and SocialCare and Children's Services with the Board and Highland Council. I was also encouragedto hear about the forum's input to improving local access and patient experience throughPoint of Care Testing and the Community Hospital Strategy Refresh.

4. I acknowledged that the challenges of sustaining Rural General Hospitals continues tobe a key issue for the Board, evidenced by the significant recruitment and retentionchallenges in medical staffing. In addition there are workforce sustainability issues inGeneral Practice affecting the sustainability of some GP practices. Recruitment to newprofessional roles is also becoming more of a challenge. I agreed with a view that there wasa need for a rural recruitment strategy. I was grateful to the Forum members for taking timeout of their busy schedules to share their views with me.Taigh Naomh Anndrais, Rathad Regent, Dun Eideann EH1 3DGSt Andrew's House, Regent Road, Edinburgh EH1 3DGwww.scotland.gov.uk

Argyll & Bute CHP Committee23 October 2013

Item 6.2

mailto:[email protected]

http://www.scotland.gov.uk

Meeting With the Area Partnership Forum

5. I had an equally positive discussion with the Area Partnership Forum. It was clearfrom our discussion that local relationships remain strong and that mutual respect and trustunderpins those relationships. I was encouraged the views of members that the lead agencymodel for integration was working well. I heard that the Board was taking a consideredapproach to building staff confidence in the system. The Chief Executive acknowledged thesupport and commitment to partnership working across both systems and organisationswhich was making delivery possible. I was interested to hear from the three localpartnership forums and the commitment to improving quality of care and patient safety,within a widely dispersed geographical area and the important role that ever improvingtechnology could play. I was pleased to note that the wellbeing of staff remains a priority forthe Highland Partnership Forum and Board, and that this is the focus of the on-going work topromote attendance locally. The rate of sickness absence - particularly long-term sicknessabsence - had risen slightly over the last 12 months. Continuing efforts to reduce long termsickness absence are directed towards individual case management and supportingrehabilitation strategies. We will keep this under close review. I congratulated the Board ona strong performance on embedding KSF and on extending it to adult social care staff.

6. Not withstanding the challenges, I was assured by what I heard in both the ACF andAPF meetings - including the significant activities undertaken to engage and involve all staffin developing and agreeing a positive culture and set of agreed behaviours - that bothForums and the Board are well placed to address both current challenges and those that lieahead, in effective partnership.

Patients' Meeting

7. I would like to extend my sincere thanks to all the patients who took the time to comeand meet with me and I recognise that some had to travel very long distances. I very muchvalue the opportunity to meet with patients and firmly believe that listening and responding totheir feedback is a vital part of the process of improving health services. I greatlyappreciated the openness and willingness of the patients present to share their experiencesand noted the specific issues raised including: the long distances which patients have totravel for often short appointments; a desire to see greater integration between SAS andNHS Highland and I highlighted the planned closer working between SAS and NHS 24 fromSept 2013 which would also benefit patients in Highland; concerns about poorcommunications between practitioners involved in the delivery of home and community care;the perceived disconnect between services when children with on-going conditions leaveschool and require access to adult services; support for the value of peer support; the needfor the Board and other organisations to improve complaints handling and to use complaintsas learning opportunities (which I fed back to the Board); there was also support for theopportunity to meet more often as a group and I understand that the Board has agreed toconsider how to support on-going group discussions.

Annual Review Meetings - New Format

8. Ministers have listened to feedback from public attendees at Annual Reviews inrecent years who called for a more focussed public discussion of the key issues, ahead ofthe opportunity to ask questions. As such, Ministerial Reviews are now undertaken in twosessions - the first, in public, with the Minister setting the scene and context for thediscussion before the Board Chair delivers a short presentation on the key success andchallenges facing the local system under the Government's 3 Quality Ambitions: Safe,

Taigh Naomh Anndrais, Rathad Regent. Dun Eideann EHl 3DGSt Andrew's House, Regent Road, Edinburgh EHl 3DGwww.scotland.gov .uk


Item 6.2

http://www.scotland.gov

Patient-Centred and Effective. This is then followed by the opportunity for attendees to askquestions of the Minister and Health Board.

9. The second session is held in private between the Minister and the full Health Board.This is a more detailed discussion of local performance under the 6 Quality Outcomes andalso offers Ministers the opportunity to reflect on the experience of the day whilst testing howBoard Non-Executives are able to regularly hold the Executive team to account. This letterprovides a detailed summary of this discussion and the resulting action points.

Annual Review - Public Session

10. I was pleased to hear during the Chair's presentation you reiterate the Board's clearfocus on patient safety, effective governance and performance management; and on thedelivery of significant improvements in local health outcomes, alongside the provision of highquality, safe and sustainable healthcare services. A detailed account of the specificprogress the Board has made in a number of areas is available to members of the public inthe self-assessment paper which the Board prepared for the Annual Review. This has beenposted on the NHS Highland website.

11. We then took a number of questions from members of the public and this worked well.I am grateful to you and the Board team for your efforts in this respect, and to the audiencemembers for their attendance, enthusiasm and considered questions.

Annual Review - Private Session

Everyone has the best start in life and are able to live longer healthier lives

12. While I expressed disappointment that NHS Highland missed the March 2013 drugand alcohol treatment waiting time target, I acknowledged the significant progress the Boardhad made over the last 3 years. I was reassured that the Board is giving this a high priorityand a significant amount of work is being undertaken to ensure that 90% of clients referredto treatment will wait no longer than 3 weeks to access appropriate treatment. We will keepthis under review. I was reassured that the Board would meet the target and the smallnumbers involved to achieve this. While performance against the 31 day cancer waitingtime standard was above 95% in Q1 2013, performance against the 62-day Standard hasfallen below the expected 95% for the last 2 published quarters. You explained that you hadidentified some specific issues in breast and urology services and that you were directingservice redesign efforts and that this was already resulting in improved performance, whichyou were confident could be sustained. We also discussed the pressures that small clinicalteams are under when unavoidable absences occur.

Health care is safe for every person, every time

13. Rigorous clinical governance and robust risk management are fundamental activitiesfor any NHS Board, whilst the quality of care and patient safety are of paramount concern.Considerable work has been undertaken at all levels in recent years to ensure that Boardseffectively respond to the findings and lessons to emerge from numerous high profile reviewssuch as the Francis Inquiry and previous reports in relation to events at Mid-StaffordshireNHS Trust.

14. I am aware that there has been a lot of time and effort invested locally in effectivelytackling infection control; and this is reflected in the Board having exceeded national targetsfor MRSAlMSSA and C.diff. You also assured me that the Board remains fully committed toTaigh Naomh Anndrais, Rathad Regent, Dun Eideann EHl 3DGSt Andrew's House, Regent Road, Edinburgh EHl 3DGwww.scotland.gov.uk


Item 6.2


meeting the 2015 HEAT target for the reduction in incidence in Clostridium difficile, andefforts are being doubled to reduce preventable MRSAlMSSA cases. You reflected that thiswill be challenging in the face of small numbers. The Healthcare Environment Inspectorate(HEI) was set up by the former Cabinet Secretary with a remit to undertake a rigorousprogramme of inspection in acute hospitals. There have been a number of announced andunannounced HEI visits to NHS Highland hospitals in 2012/13 and you assured us that allrequirements and recommendations have been addressed in a timely manner.

Everyone has a positive experience of health care

15. We moved on to discuss stroke care and the reasons why in the year to March 201371% of patients were admitted to a stroke unit within one day of admission, falling short ofthe 90% stroke unit access HEAT target. You explained that work is underway to improvepatient flows through the system and you expect this work to deliver significant improvementover the coming months which would ensure compliance with the target.

16. The Minister for Public Health had expressed concern earlier in the year about NHSHighland's performance against the commitment to ensure that 25% of under 18s with type 1diabetes are provide with an insulin pump by March 2013. You explained that you are in theprocess of systematically reviewing all under 18s to assess their suitability for pump therapy.Additional staff have been recruited to provide education, training and support to anychildren coming forward to start pump therapy should they be suitable and wish to avail ofthat treatment.

17. We discussed NHS Highland's performance against the HEAT Standard for theearly diagnosis and treatment of Dementia, where the Board is currently performing belowStandard. You explained that measures to improve performance include the appointment ofan Alzheimer Scotland Dementia nurse and the appointment of a Dementia NursePractitioner at Raigmore. You assured me that the Board's emphasis on post diagnosticsupport would lead to meeting the Standard. I acknowledged your general comments onthe construct of some HEAT targets and Standards and we will consider such issues as wecontinue to develop them.

18. In terms of local performance against the HEAT access targets over the last year,NHS Highland successfully delivered against the 18 weeks referral to treatment target with acombined performance of 92% as at March 2013. Within the stage of treatment targets, theBoard has seen a number of patients exceed the 12 weeks outpatient Standard, howeverwork is in hand to address the position. You also assured me that work is underway locallyto ensure on-going local compliance with the legally binding 12-week Treatment TimeGuarantee target. A specific point was raised during the public session about a long waitfor a diagnostic result and you said that you were looking urgently at how to address a gap incapacity. We will keep in touch on this. A number of Health Boards across Scotland havestruggled to meet and maintain the 98% 4 hour A&E Waiting HEAT Standard over the lastyear. However, the position in NHS Highland has been particularly strong with the Boardconsistently performing at 98%. The recently announced additional national unscheduledcare funding should assist the Board in maintaining this position. We will look to all Boards tohave robust winter plans in place to effectively manage the expected upturn in demand,notably in unscheduled care.

19. I appreciate that a great deal of work has been undertaken by all Health Boards in lightof the issues experienced with NHS Lothian on the effective, appropriate and responsiblemanagement of waiting times. We took the opportunity to ask the Board's non-executivesTaigh Naomh Anndrais, Rathad Regent, Dun Eideann EHl 3DGSt Andrew's House, Regent Road, Edinburgh EHl 3DGwww.scotland.gov.uk


Item 6.2


about how comfortable they felt with the quality of information provided to hold the Executiveteam to account. I was assured by what I heard about the extent of challenge and scrutinyand members confirmed that they receive detailed and helpful information and data and sofelt fully informed and able to effectively scrutinise Board performance.

Staff feel supported and engaged

20. Effective attendance management is critical - not only in terms of efficiency but alsoto ensure good support mechanisms are in place for staff. NHS Highland's sicknessabsence rate for the period 1 April 2012 to 31 March 2013 was reported as 4.89%. Thiscompares with an average across NHS Scotland of 4.80%, against the national Standard of4%. The Board's approach to attendance management had been part of the discussion atthe morning meeting of the Area Partnership Forum and I was struck by the sense of jointownership on this issue; it is clearly regarded as not just a management responsibility but afirm, collective commitment to meeting and maintaining the Standard in full partnership. Ilook forward to seeing a sustained improvement in the local position in 2013 and beyond.

People are able to live well at home or in the community

21. I asked for an overview of the progress the Board and Highland Council is makingwith the critical health and social care integration agenda. You explained that the singlemanagement, governance and financial arrangements for health and social care services ineach organisation have been in place for more than a year. This is enabling bothorganisations to take forward plans for integrated front line delivery of services, which willachieve transformation in the way caring services are delivered. I had seen an example ofthis earlier when I briefly visited the Royal Northern Infirmary, York Day Hospital andMacKenzie Centre.

Best use is made of available resources

22. It is vital that NHS Boards achieve both financial stability and best value for theconsiderable taxpayer investment made in the NHS. I am therefore pleased to note thatNHS Highland met its financial targets for 2012/13 alongside the Efficient Government targetfor the year and, based on the current in-year position, remain in line with the Board'sfinancial plan in 2013/14. You explained that there are strong links between the Board'srecurrent efficiency programme and its planned service change programme and the Board istotally committed to its Quality Strategy and recognises that reducing harm, tackling wasteand managing variation leads to improved quality services as well as generatingopportunities to release savings. All efficiencies made through this programme arereinvested in health care.

23. It was disappointing that the level of recurring savings was lower than planned. Thefinancial plan for 2013/14 forecasts a steady reduction in the underlying deficit with a returnto recurring balance in 2016/17. It is very important that this commitment is met and financecolleagues will keep in close touch on this over the remainder of the year.

Conclusion

24. I want to recognise that there is considerable, extremely positive work going on inNHS Highland, for the benefit of local people. This is testament to the dedication andprofessionalism of local NHS staff, and I thank them for it.

Taigh Naomh Anndrais, Rathad Regent, Dun Eideann EHl 3DGSt Andrew's House, Regent Road, Edinburgh EHl 3DGwww.scotland.gov.uk INVESTOR II'; PEOPI.E


Item 6.2


25. I was encouraged by much that I saw and heard during the Annual Review. TheBoard has generally good relationships with its planning partners; is performing well againstthe majority of its performance targets; and is exercising sound financial control. Maintainingthis control and building on these effective relationships will be essential. I am confident thatthe Board understands the need to maintain the quality of frontline services whilstdemonstrating best value for taxpayers' investment. As I have said, we will keep progressunder close review and I have included a list of the main action points from the Review in theattached annex.

Alex Neil

Taigh Naomh Anndrais, Rathad Regent, Dun Eideann EHl 3DGSt Andrew's House, Regent Road, Edinburgh EHl 3DGwww.scotland.gov.uk INVESTOR IN PEOPLE


Item 6.2


ANNEX

NHS HIGHLAND ANNUAL REVIEW 2013

MAIN ACTION POINTS

The Board must:

• Continue to review, update and maintain robust arrangements for controllingHealthcare Associated Infection.

• Continue to deliver on its key responsibilities in terms of clinical governance, riskmanagement, quality of care and patient safety, including a prompt and effectiveresponse to the findings of HEI and Older People in Acute Hospitals inspections.

• Keep the Health Directorates informed on progress towards achieving all accesstargets, in particular the 4-hour A&E standard.

• Make sustained progress against the staff sickness absence standard.

• Continue to work with planning partners on the integration agenda, and to deliveragainst the delayed discharge target.

• Continue to achieve financial in-year and recurring financial balance, and keep theHealth Directorates informed of progress in implementing the local efficiencysavings programme.

Taigh Naomh Anndrais, Rathad Regent, Dun Eideann EHl 3DGSt Andrew's House, Regent Road, Edinburgh EHl 3DGwww.scotland.gov .uk

IfF -""I~ ~,

~ I:>~'"INVESTOR IN PEOPI.E


Item 6.2

http://www.scotland.gov


Item : 7.1 Argyll and Bute CHP Clinical Governance and Risk Ma nagement Report Report by Pat Tyrrell, Lead Nurse and Fiona Campbel l, Clinical Governance Manager

The CHP Committee is asked to:

• Note the contents of the Clinical Governance and Risk Management Report.

1. CONTRIBUTION TO THE BOARD’S CORPORATE OBJECTIVES The vision of the Highland Quality Approach is:

• Better Health – improving the health of the population • Better Care – enhancing the experience of care for individuals • Better Value – controlling the per capita cost of care

In order to achieve this the key elements of the Quality Strategy have been adopted: Person-Centred There will be mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. Safe There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times. Effective The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

2. RISK MANAGEMENT 2.1 Incidents The following data relates to incidents reported between July 1st to September 30th 2013. The data is correct as of October 10th 2013. FIGURE 1 Argyll and Bute Incidents Last 13 months

FIGURE 2 Incidents by Category

A total of 519 incidents were reported within Argyll & Bute during quarter 2. By locality Cowal & Bute – 80 (15.7%) Helensburgh – 12 (2.3%) Mid Argyll & Kintyre – 253 (48.7%) Oban, Lorn & Isles – 163 (31.4%) Outwith – 11 (2.1%)

In the last financial quarter slips trips and falls remained in the highest category of incidents. The top category for each locality: Cowal & Bute – transfer / discharge (15) Helensburgh – Communication&Confidentiality(2) Medication(2-2) Mid Argyll & Kintyre – falls(56) Oban, Lorn & Isles – falls (47)

FIGURE 3 Incident Grades by Locality

FIGURE 4 Incident with Major and Extreme Consequenc e

During Quarter 2 the incidents reported in Argyll & Bute were graded as follows: Low – 282 (54.3%) Medium – 191 (36.8%) High – 4 (0.7%) The remaining incidents have not yet been graded.

There were 6 incidents graded with a consequence of major or extreme. Mid Argyll, Kintyre and Islay- 3 Cowal & Bute – 3

FIGURE 5 Incidents by Locality and Outcome

FIGURE 6 RIDDOR Reportable Incidents

Overall outcome for Argyll & Bute: No injury / harm – 294 (56.6%) Near Miss – 44 (8.4%) Injury / harm – 154 (30%) Property damage – 27 (5.2%)

There have been no RIDDOR incidents since April 2013

5

2.1.1 Pressure Ulcer Prevention The graphs below illustrate the trends in Hospital Acquired Pressure Ulcers across NHS Highland. While the overall number remains fairly constant the reduction in Grades 3 and 4 ulcers is sustained. CQI scores for Pressure Ulcer Prevention for each ward in Argyll and Bute are shown in Appendix One. Run charts for individual hospitals in Argyll and Bute are included in Appendix Two There has been recent increase in capacity of Tissue Viability specialist nursing support within NHS Highland; this will deliver additional support to the clinical staff in ensuring that adherence to standards for pressure ulcer prevention is maintained across all areas. In addition, short life group has been established to develop an action plan to raise awareness, and develop prevention strategies, across community and primary care settings. This will include working with carers and staff in Care Homes and Care at Home services. FIGURE 7: NHS HIGHLAND HOSPITAL ACQUIRED PRESSURE U LCERS APRIL 2011- SEPT 2013

6

FIGURE 8: HOSPITAL ACQUIRED PRESSURE ULCERS APRIL 2 011 – SEPT 2013

FIGURE 9: GRADE 3 PRESSURE ULCERS DEVELOPED IN HOSP ITAL PER 1000 OBDS

FIGURE 10: GRADE 4 PRESSURE ULCERS DEVELOPED IN HOS PITAL PER 1000 OBDS

7

2.1.2 Falls Prevention As with Pressure Ulcer prevention considerable amount of work is underway to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn and Islands Hospital in Oban. The graphs below illustrate trends across NHS Highland. Audit of compliance with Clinical Quality Indicator Falls Prevention are carried out each month across all wards in Argyll and Bute. High percentage compliance with the standards for identifying and managing risk of falls is required in each ward. These scores are illustrated in the tables in Appendix One. Work is underway to align the approach to Falls Prevention using the SPSP Care Bundle and this will alter how performance is reported in the future. NHS Highland has established work group led by Associate Director for AHPs to progress this further. FIGURE 11: NHS HIGHLAND FALLS RATES PER 1000 OBDS F ROM 2011

FIGURE 12: NHS HIGHLAND FALLS RATES PER 1000 OBDS B Y OPERATIONAL UNIT FROM

2011

8

FIGURE 12: NHS HIGHLAND REPORTED FALLS PER 1000 OBD S BY HOSPITAL

2.1.3 Disruptive, Violent and Aggressive Behaviour While incidents related to disruptive, violent and aggressive behaviour are the second highest category reported the numbers for Argyll and Bute are consistently lower than those of the other operational units as shown in the graph below. Training and support for staff is delivered throughout the year to ensure that staff have the right communication and management skills to deal effectively with potential incidents. FIGURE 13: NUMBER OF V&A INCIDENTS BY OPERATIONAL U NIT SEPT 2012-SEPT 2013

9

2.2 Health Improvement Scotland Adverse Event Revie w On 23 September 2013, Health Improvement Scotland (HIS) published the NHS Highland report in relation to the management of adverse events review visit which took place on 07 August 2013. The following areas of good practice within NHS Highland were noted:

• consistent approach to patient, family and carer involvement • strong local governance structure with cohesive local teams, and • openness and transparency in sharing learning across the organisation.

A number of challenges in how adverse events are managed within NHS Highland were noted. The review team found that further improvements could be made in terms of assurance of consistency in the practice of managing adverse events across the four operational units, consistency in approach to investigations and the use of IT systems to their full potential. The following recommendations were made:

1. continue to implement a consistent process for involving patients, families and carers in the adverse review process

2. ensure a consistent process to recording the engagement with patients, families and carers, and

3. consistently provide timely and meaningful feedback to staff to encourage a reporting culture.

4. implement the training and education improvement plans and demonstrate a systematic approach to staff training, ensuring staff are appropriately trained, and

5. ensure staff involved in managing significant adverse incidents have a clear understanding of investigation methods and apply them to adverse event reviews and action planning.

6. clearly define roles and responsibilities for escalation and decision-making. 7. introduce a process to ensure that staff make full use of Datix for significant event

reviews, including its additional features, and consistently capture all documentation relating to each stage of the significant adverse event process, and

8. ensure that there is a single integrated approach to documentation management, monitoring, scrutiny and assurance across the NHS board.

9. implement a system to ensure consistency in decision-making for undertaking significant adverse event reviews across the NHS board.

10. ensure the timescales for various stages of the adverse event review process are met in line with the incident management policy and procedures

11. ensure there is a consistent process for developing and monitoring action plans and outcomes, and

12. ensure lessons learned from individual adverse events as well as thematic learning are captured, shared and implemented across the NHS board.

Actions to address some of the recommendations have already been implemented and further improvement work is underway.

Additionally, on 13 September 2013, HIS published: Learning from adverse events through reporting and review: A national framework for NHSScotland.

10

The aims of the national approach to learning from adverse events are to:

• Learn from adverse events locally and nationally so as to make service improvements that enhance the safety of our healthcare system for everyone.

• Support NHS boards to manage adverse events in a timely and effective manner. • Establish a standardised approach to adverse event management across

NHSScotland, including consistent definitions and the establishment of measures to monitor implementation.

• Ensure a consistent and coordinated approach to the identification, reporting and review of adverse events and allow best practice to be actively promoted across Scotland.

• Present an approach that allows reflective review of events and can be adapted to different settings.

• Provide national resources to develop the skills, culture and systems required to effectively learn from adverse events to improve services across NHSScotland.

The national approach seeks to ensure that no matter where an adverse event occurs in NHSScotland:

• the affected person receives the same high quality response • any staff involved are treated in a consistent manner • the event is reviewed in a similar way, and • learning is shared and implemented across the organisation and NHSScotland to

improve the quality of services.

Taking into account the HIS review report for NHSH, and the national framework for adverse event management, Argyll and Bute CHP continues to work to refine and improve processes. 3. COMPLAINTS TABLE 1 Argyll and Bute Complaint Performance repo rt

Target Amber Red June- 13

July- 13

Aug- 13

Number of complaints received 4 5 ~ 6 7 and over 7 10 9 Achievement against 20 day 80% 70 – 79% Under 69% 0% 20% 11% Number of complaints over 40 working days old * 0 ~ 1 or more 5 0 2 Number of further correspondence over 20 working days old * 0 ~ 1 or more 1 2 1 Number of complaints categorised as high risk 1 2 3 and over 2 3 1

11

Of the 9 complaints received in August 2013 the themes contained within complaints can be broadly categorised as follows:

Transfer 1 Dental Services: access/waiting times/treatment 5 Care / Treatment 3

4. EXTERNAL REVIEWS 4.1 Joint Inspection of Children’s Services in Argy ll and Bute The final report from the Care Inspectorate was received in September 2013. The inspection of services to children took place over 22 weeks earlier this year and involved inspections, reviews of case records, interviews of families and young people ,meetings with staff and elected members. They looked at the work of the Community Planning Partnership to improve the lives of children in Argyll and Bute and considered services to children and young people provided by NHS, Council, Police, Independent and Third Sectors. The inspectors recognised:

• The strong commitment to prevention and early intervention • A very positive culture of partnership working at all levels • The flexible approach to working with families to improve outcomes for children

and young people • Sound work to promote strong and resilient children, young people and families

The inspectors also highlighted three areas of good practice which are:

• Getting it right antenatal – our interagency approach to identifying and supporting vulnerable pregnant women, which is having a significant impact on giving unborn babies the best start in life

• Early intervention service –this service provides high quality intensive support to vulnerable children and young people

• Nurse coordinators – working to support children in care, families affected by homelessness and Gypsy traveller families

They identified areas for improvement as:

• Secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children

• Complete and implement the Integrated Children’s Services Plan • Continue to develop rigorous and systematic joint self-evaluation to improve

outcomes for children and young people • Ensure continued leadership and direction is provided to implement the planned

improvements for services for children, young people and families

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The overall inspection grades are as follows: Providing help at an early stage Very Good Impact on children and young people Good Assessing and responding to risks and needs Adequate Planning for individual children Adequate Planning and improving services Adequate Participation of children and young people Good Leadership of improvement and change Good Improving the wellbeing of children and young people Good 5 QUALITY AND SAFETY 5.1 Scottish Patient Safety Programme Acute Services: Detailed run charts for Lorn and Islands Hospital are included in Appendix Three. As part of the Scottish Patient Safety Programme (SPSP) Hospital Standardised Mortality Ratio (HSMR) data is published quarterly for acute hospitals to assess progress in reducing mortality over time.

A target of a 15 percent reduction in the HSMR by December 2012 was originally set by the SPSP. This has been extended to a 20 percent reduction by December 2015.

In Scotland HSMRs are calculated by dividing the actual number of deaths in hospital and up to 30 days following admission by the number that would be predicted, adjusting for the characteristics of the patients treated. The predicted probabilities of mortality are based upon national activity in the period October 2006 to September 2007. This adjustment involves factors such as severity of disease, age, sex admission types and other patient characteristics outside the hospitals’ control.

Higher or lower death rates do not automatically indicate deficits in care. Case mix adjustment is not perfect, and local issues such as coding, emergency admission practices and the use of hospitals for terminal care, can affect the findings. In particular it recognised that inaccurate recording of diagnosis can lead to overestimation (or underestimation) of the HSMR.

In smaller hospitals with a lower patient volumes and numbers of deaths, rates are more likely The principal purpose of the HSMR measure is the review of mortality data for an individual hospital over a period of time and it is currently not considered an appropriate measure for comparing hospitals or identifying outliers.1 Guidance on the interpretation of the HSMR indicator is again being reviewed by the Scottish Patient Safety Programme, Health Improvement Scotland and the National Service Agency2.

The ‘triggers’ that would prompt investigation of a local context focus upon HSMR data values that deviate significantly from the hospitals own average over time; exhibit sustained shifts in trend or identify a hospital as having values consistently above the Scottish average.

1 Information and Services Division. Quarterly Hospital Standardised Mortality Ratios. Available online at: http://www.indicators.scot.nhs.uk/HSMR/HSMR.htmll 2 Available online at: http://www.indicators.scot.nhs.uk/HSMR/HSMR.html (Accessed August 2012)

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Additionally, given that the purpose of the measure is to monitor a target reduction in patient mortality, a hospital showing no decrease in its HSMR trend would be expected to provoke interest.

In the latest period at Lorn & Islands RGH there were 29 deaths recorded at 30 days following admission and the HSMR was 0.99. This figure ended a period of four consecutive increases in the HSMR. A result of these recent trends is that the overall improvement rate of the HSMR at the hospital has been slowed down and currently stands at 12 percent.

In NHS Highland Raigmore Hospital and Caithness Rural General Hospital (RGH) both have HSMR trends showing rapid improvement. Raigmore Hospital has had a 20.6 percent reduction in its HSMR to date and has had fewer deaths than predicted in all of the periods under review. The consistently low ratios are unlikely to be due to chance, but it is not possible from this data alone to conclude that this is a result of better care.

Caithness General Hospital has a provisional HSMR of 0.85 (observed deaths = 29) in the latest reported period. The longer-term trend, monitored using linear regression, would suggest a 17.2 percent decrease in the HSMR from the start of target monitoring.

Belford Hospital had an HSMR of 0.89 (observed deaths = 17) in the latest reported quarter. The Belford Hospital has the smallest number of patient discharges of any of the participating NHS Highland hospitals and the HSMR data for this hospital shows considerable quarterly variation. Simple linear regression shows a.13.1 percent overall improvement to date in the HSMR, compared to an equivalent national reduction of 11.6 percent.

Further detail related to Lorn and Islands Hospital HSMR is highlighted in Appendix Four.

6. HEALTH AND SAFETY 6.1 NHS Lothian HSE Prosecution NHS Lothian was recently prosecuted by the Health and Safety Executive following an assault on a member of staff, the community psychiatric nurse was assaulted in the home of a patient that she was visiting. The court heard that in this instance Lothian had no risk assessments for staff working with violent or aggressive patients; that they had failed to provide sufficient information, instruction, training and supervision to the staff member; and that they had failed to provide a safe system of work for such visits.

In light of this incident the Health and Safety Team is progressing the following actions:.

• Identifying the numbers of lone workers in the CHP • Undertaking an audit of attendance at Management of Violence and Aggression

training • Auditing compliance with the Lone Working Policy • Providing support to managers in undertaking violence and aggression risk

assessments.

14

6.2 Moving and Handling Two streams of work in relation to moving and handling are being progressed:

1) Competency Model Agreement has been reached to progress towards a competency model of continuing education for moving and handling, the approach delivered in Northern Highland. The competency model will replace the annual classroom training. In the first instance this will be introduced for hospital staff. Essentially this means that instead of releasing staff to attend training, assessment by Key Workers will take place on an ongoing basis within the workplace.

A paper is in development which will provide detail about the implementation of the competency model e.g. the number of Key Workers required; training requirement for Key Workers. The overall costs for the competency model compared with the current model will reduce as a result of less staff having to be released from the workplace to attend training.

2) Integration of Moving and Handling A joint group was tasked to take forward work relating to the integration of moving and handling as part of Workstream 5: Reshaping Care for Older People

A working group comprising NHSH and A&B Council representatives has been progressing aspects of joint working relating to Moving and Handling. Key areas of work being progressed are: Joint Training in Competencies in Hoist and Sling Prescription; Risk Assessment and Shared Documentation

However, in relation to delivering joint training this has come to a stand still as NHSH and A&B Council deliver different training approaches:

• Argyll and Bute Council delivers a neuromuscular approach to training delivered by ‘MovES’, a company which validates their own moving and handling training.

• NHSH/ A&B CHP operates a self-validated system of training. Previously NHSH followed the MovES approach but this has not been the case for some years.

In order to fully integrate the moving and handling service a common approach to training needs to be agreed. Information is being gathered to inform an option appraisal to assist decision making.

7. FIRE SAFETY 7.1 Fire Risk Assessments

Fire risk assessments carried out by the CHP Risk Advisor, Fire Safety, using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay, Lorn & Islands, Dunoon, Rothesay, Mid Argyll and Mull and Iona Community Hospital are now complete and have been issued. Action plans are being prioritised locally. Assessment of Victoria Integrated Care Centre, Helensburgh is under way.

15

Some premises are now due an annual audit. Where there has been no material change to the building or the risk, the site duty holder will check the risk assessment against work completed in the action plan and report this back to the fire advisor who will update the 3i system. Where there have been material changes (e.g. extension work, change of use or risk) then the duty holder will inform the fire advisor so that an update of the risk assessment can be made. 7.2 Compartmentation Survey Part of the capital funding request has been released to start some of the much needed compartmentation works. Partial funding for Lorn & Isle and Cowal Community hospitals has been made available. Work will be prioritised in line with the recent Scottish Fire and Rescue Service audit letters. 7.3 Unwanted Fire Alarm Signals TABLE x: ARGYLL AND BUTE INCIDENTS CODED TO FIRE CA TGEORY July 2013- September 2013 A&B CHP Incidents coded to Category - FIRE 1.7.13-30.9.13 Sub Category

Count of incidents by Site and Sub category

Unwanted fire alarm signal (false alarm)

Hospital - Argyll & Bute 2

Hospital - Bute - Rothesay Victoria Hospital 1

Hospital - Dunoon - Cowal Community Hospital 4

Hospital - Mull - Mull & Iona Community Hospital (Bowman Court.) 1

Hospital - Oban - Lorn and Islands General Hospital 1

GP - Southend - Kintyre Medical Group 1

Total 10

Cause of incidents: 2 incorrect procedure, 2 smoke detected but no apparent fire 1 power failure, 3 steam from a kettle / inappropriate siting of kettles 1 steam from taps left running 1 accidental activation of an alarm by a resident in Bowman Court (outwith NHS remit). Of the 10 incidents, it is considered that 6 could have easily been avoided. All incidents are reviewed and advice provided to minimise the risk of reoccurrence. 7.4 Possible Fire Service Strike Action The Fire Service Union has initiated industrial action in England & Wales. Negotiations are still ongoing in Scotland. To ensure that the CHP is prepared for any possible action and consequential reduction in response from the Fire service all Locality Managers and Clinical Services Managers have been to asked to ensure that local plans are robust and tested and additional training for all in-patient areas with a particular focus on practical use of fire extinguishers has been offered.

16

APPENDIX ONE: CLINICAL QUALITY INDICATOR COMPLIANCE SCORES CQI Rates: % compliance with standards for Pressure Ulcer Prevention 2012 2013

SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUG SEPT COWAL AND BUTE Victoria Hospital

100 95 100 100 93 93 98 95 98 93 96 98 97

CCH Ward 1 98 96 96 98 96 100 100

CCH Ward 2

98 100 96

98

100

100

MID ARGYLL, KINTYRE AND ISLAY Glenaray 95 100 95 93 95 95 100 100 83 100 100 100 100

Glassary 100 100 100 100 100 100 Cara Knapdale

100 100 100

100 100

Campbeltown NR 97 95 100 100 100 100 98 98

100 100 100 98

Islay 90 90 90 90 92 95 100 100 100 100 100 100 100

OBAN, LORN AND ISLES Ward A 95 100 100 100 100 100 83 100 100 100 100 100 100

Ward B 100 100 98 100 93 95 100 100 95 98 100 85 Ward I 100 100 100 100 100 100 100 100 100 100 100 100 100

MICH 95 NR NR 78 100 NR 91 92 100 100 100 100

17

APPENDIX ONE: CLINICAL QUALITY INDICATOR COMPLIANCE SCORES CQI rates: % compliance with Standards for Falls Pr evention

SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUG SEPT COWAL AND BUTE Victoria Hospital

100 100 100 91 96 100 100 100 100 91 100 99 99

96 97 97 97 97 100 CCH Ward 1 AND 2

100 96 98

96

95

97 100

MID ARGYLL, KINTYRE AND ISLAY

Glenaray 100 100 100 100 100 100 100 100 100 100 100 100 100

Glassary 100 100 100 100 100 100

Cara

Knapdale

100 100 100

100

100

100 100

Campbeltown NR 100 94 100 96 76 89 100 96.3 100 98 100

Islay NR 87 90 90 93 67 96 84 82 100 96 100 OBAN, LORN AND ISLES Ward A 96 96 97 100 97 96 100 100 100 100 100 83 95

Ward B NR 100 98 98 87 100 100 100 97 98 100 100 98 Ward I 100 100 100 100 100 100 100 100 100 100 100 100 100

MICH 100 NR NR 61 94 NR 100 100 100 100 100 100 100

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APPENDIX ONE: CLINICAL QUALITY INDICATOR COMPLIANCE SCORES CQI Rates: %compliance with Standards for Food, Flu ids and Nutritional Care 2012 2013

SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUG SEPT COWAL AND BUTE

Victoria Hospital

99 97 93 NR NR 98 96 97 NR 97 98 99 98

92 96 95 95 97 100 CCH Ward 1 AND 2

97 99 100

98

100

100 100


Glenaray 67 89 100 100 99 100 94 100 91 100 97 100 100

Glassary 100 100 100 100 100 100

Cara

Knapdale

100 100 100

100

100

100 100

Campbeltown 96 94

Islay 100 100 OBAN, LORN AND ISLES

Ward A 100 100 100 100 100 100 100 100 100 100 100 100 100

Ward B 100 100 99 94 95 100 100 100 97 97 99 85

Ward I 100 93 100 100 100 100 100 100 100 100 100 100 100

MICH 100 95 100 100 100

- 19 -

APPENDIX TWO HOSPITAL ACQUIRED PRESSURE ULCERS PER 1000 OBDS BY HOSPITAL OBAN, LORN AND ISLES

APPENDIX TWO (CONT)

- 20 -

HOSPITAL ACQUIRED PRESSURE ULCERS PER 1000 OBDS BY HOSPITAL


- 21 -

APPENDIX TWO (Cont)

HOSPITAL ACQUIRED PRESSURE ULCERS PER 1000 OBDS BY HOSPITAL COWAL AND BUTE

- 22 -

APPENDIX THREE SCOTTISH PATIENT SAFETY PROGRAMME OUTCOME MEASURES FOR LORN AND ISLANDS HOSPITAL In Patient Mortality Adverse Events Average Length of Sta y in HDU

- 23 -

HDU Mortality Crash Call Rate SAB Rate

CDI RATE INR < 6

- 24 -

- 25 -

APPENDIX FOUR: HSMR IN LORN AND ISLANDS HOSPITAL Hospital Standardised Mortality Ratio in Lorn & Isl ands RGH with target reduction 1 and regression lines 2 ,Oct 2006 – Mar 2013 p

- 26 -

Local trends in HSMR: Lorn & Islands Rural General Hospital

• Figure 1: Quarterly Hospital Standardised Mortality Ratios in Lorn & Islands RGH

Lorn & Isles Hospital

Quarter Observed deaths (30 days) Predicted deaths (30 days)

Hospital Standardised Mortality Ratio

(HSMR) Number of patients Crude Mortality Rate

(%)

Oct-Dec 2006 36 29 1.22 834 4.3

Jan-Mar 2007 22 25 0.87 856 2.6

Apr-Jun 2007 20 26 0.76 946 2.1

Jul-Sep 2007 33 29 1.15 932 3.5

Oct-Dec 2007 24 25 0.97 914 2.6

Jan-Mar 2008 27 30 0.90 920 2.9

Apr-Jun 2008 27 31 0.87 984 2.7

Jul-Sep 2008 36 32 1.13 968 3.7

Oct-Dec 2008 25 25 1.00 867 2.9

Jan-Mar 2009 30 25 1.20 870 3.4

Apr-Jun 2009 21 23 0.91 946 2.2

Jul-Sep 2009 28 25 1.11 951 2.9

Oct-Dec 2009 22 25 0.87 973 2.3

Jan-Mar 2010 23 27 0.84 900 2.6

Apr-Jun 2010 28 30 0.95 1019 2.7

Jul-Sep 2010 23 26 0.87 980 2.3 Oct-Dec 2010 28 27 1.03 878 3.2 Jan-Mar 2011 24 27 0.89 868 2.8

Apr-Jun 2011 17 25 0.68 832 2.0

Jul-Sep 2011 19 25 0.75 801 2.4

Oct-Dec 2011 14 22 0.63 842 1.7

Jan-Mar 2012 20 27 0.75 881 2.3

Apr-Jun 2012 19 23 0.83 833 2.3

Jul-Sep 2012 23 26 0.89 882 2.6

Oct-Dec 2012 34 26 1.31 807 4.2

Jan-Mar 2013 p 29 29 0.99 832 3.5 Base year period shown in Italics P: Provisional data: reflects SMR01 completeness for individual hospitals at 29th June 2013 Source: ISD Scotland (SMR01) linked dataset


Item : 7.2

INFECTION CONTROL REPORT Report by Pat Tyrrell, Lead Nurse The CHP Committee is asked to: • Note the contents of the report.

1. Aim The purpose of this paper is to update CHP Committee members of the current status of Healthcare Associated Infections (HAI) and infection control measures in Argyll and Bute CHP and NHS Highland.

2. Contribution to Board Objectives One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. 3. Summary TABLE 1 SHOWS NHS HIGHLAND INFECTION PREVENTION & CONTROL TARGETS AND PERFORMANCE DATA Group Target NHS

Scotland NHS Highland

Clostridium difficile

Age 15 and over

New Target 32.0 (100,000 OBDs) to be achieved by 03/15

27.7 April – June 2013

Green

Staphylococcus aureus bacteraemia

Age 15 and over

24.0 (100,000) AOBDs

27.93 April –June 2013 (not validated)

Red for this quarter

Hand Hygiene 95% 95% 98% Green

Cleaning 90% 95%

96% Green

Estates

90% 97% 97%

Green

AMAU 95%

Green Antimicrobial prescribing

Hospital-based Empiric prescribing

95%

Ward 4A 96%

Green

2

Group Target NHS Scotland

NHS Highland

Surgical antibiotic prophylaxis

Compliant New audit process for Colorectal Surgery not fully compliant.

Amber

Primary Care empirical prescribing

Less than 5%

7%

Amber

Source: - Health Protection Scotland/ISD/Local data. 4. Achievements The fourth Consultant Microbiologist took up post on 2nd September 2013.

5. Challenges

• To influence the prevention and reduction of Clostridium difficile infections acquired in the community in the 15 – 64 age group.

• To reduce MSSA bacteraemias by engaging all clinical staff in hospitals and the community in initiatives to prevent and reduce invasive device/healthcare related infections.

• To deliver Infection Prevention & Control support and HAI education in care homes and adult social care settings.

• To address the need for risk assessment and screening for Multi-Drug Resistant bacteria (Carbapenemase producers) in light of recent Interim Guidance from Health Protection Scotland, and CMO/SGHD (2013)14 letter. Action plan to be in place by December 2013 (see Section 7)

6. Risks Achieving the Clostridium difficile and SAB HEAT targets

3

Argyll and Bute CHP Healthcare Associated Infection Report –

October 2013

Section 1 – NHS Highland Board Wide and Argyll and Bute Issues

1. Staphylococcus aureus (including MRSA)

1.1 Staphylococcus aureus bacteraemia target From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, Staphylococcus aureus bacteraemia (including MRSA) cases are 24.0 cases or less per 100,000 acute bed days. For NHS Highland this means no more than 60 cases. 1.2 Trends April – June 2013 rate was 27.93 per 100,000 acute bed days (18 SABs) which means that it is above the Local Delivery Plan trajectory of 24.0 per 100,000 bed days for this quarter. This may be due in part to seasonal variation. The rate for the same period last year was 30.3 per 100,000 acute bed days. HPS quarterly report will be published 02/10/2013. Within NHS Highland there were 5 MSSA and 1 MRSA SABs in July and 6 MSSA SABs in August 2013.

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

4

FIGURE 1 STAPHYLOCOCCUS AUREUS BACTERAEMIA (MRSA AN D MSSA) CASES PER 100,000 OCCUPIED BED DAYS ALL AGES JANUARY 2011 – S EPT 2013

FIGURE 2 STAPHYLOCOCCUS AUREUS BACTERAEMIA (MRSA AN D MSSA) CASES PER 100,000 OCCUPIED BED DAYS ALL AGES PER QUARTER FROM 2010 TO 2013

5

TABLE 2 SHOWS THE CUMULATIVE TOTALS FOR SAB WITHIN ARGYLL AND BUTE CHP FOR THE YEARS SINCE 2009-2010: Hospitals 09/10 10/11 11/12 12/13 13/14 Lorn and Islands, Oban 8 3 0 5 2 Victoria Hospital, Rothesay 1 1 0 0 0 Mid Argyll Hospital, Lochgilphead 0 1 0 0 0 Argyll & Bute Hospital, Lochgilphead 0 0 0 0 0 Campbeltown Hospital 0 0 0 0 0 Mull and Iona Community Hospital 0 0 0 0 0 Islay Hospital, Bowmore 0 0 0 0 0 Cowal Community Hospital, Dunoon 0 0 0 0 0 There have been no cases of SAB in Argyll and Bute since the last report. 1.3 Improving Patient Safety in Relation to SAB Audits of practice in relation to use of peripheral and central vascular catheters and urinary catheters were carried out during the site visits in May and June across all hospitals in Argyll and Bute. There are evidence based care bundles available through Scottish Patient Safety Programme to support staff to implement consistent good practice for every patient every time. These are available across all hospitals and staff are being supported to implement the standards to address the gaps identified through the audit process. Scottish Government has released funding to recruit to HAI Quality Improvement Facilitator (HAI QIF) posts from January 2014 until January 2016 with the aim of improving and embedding the integration of the Healthcare Associated Infection (HAI) and Safe agendas. The post holders will be based within local Infection Prevention and Control Teams (IPCT) within each NHS Board in order to work across the safety agenda focussing specifically on the HAI agenda with a view to build capacity and capability amongst all frontline staff and the members of the IPCT. NHS Highland has received funding for 2 posts – decisions how these posts will work across the Board area have still to be finalised. 2. Clostridium difficile

2.1 Clostridium Difficile Target

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 within the 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

6

A technical update to the Clostridium difficile HEAT target has been necessary as a result of revisions to bed day data which are used as a denominator to calculate rates. Revisions to the Clostridium difficile HEAT target were published on the 4th September 2013 by Health Protection Scotland (HPS), in response to the detection that the number of bed days used to calculate rates for Clostridium difficile infection in patients aged 65 years and over since the outset of the programme in 2006 was artificially high and which, once corrected, means that the published Clostridium difficile rate for all Health Boards will be higher than in previous reports. However, it is important to note that there are no changes to the number of cases identified and reported reductions in Clostridium difficile remain accurate. The target was agreed following discussion and recommendation by the HAI Task Force and was based on the rate of the best performing Board in the period year ending June 2012. Once the historical bed day data was corrected, the rate was identified as 32.0 cases per 100,000 total occupied bed days in the year ending June 2012 and therefore the HEAT target has been revised to reflect this updated rate. HPS is reviewing how it uses and processes data to ensure suitable systems are in place in order to make sure such mistakes will not occur in the future. From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, the rate of Clostridium difficile infections (CDI) in patients aged 15 and over is 32.0 cases or less per 100,000 total occupied bed days. For NHS Highland that means no more than 70 cases in the year ending March 2015. As a result of this, the Local Delivery Plan Trajectories which were submitted earlier this year have been revised and confirmation is awaited that the Clostridium difficile trajectory has been formally agreed. 2.2 Trends FIGURE 3 CLOSTRIDIUM DIFFICILE CASES PER 100,000 OCCUPIED BED DAYS

TABLE 3 SHOWS THE CUMULATIVE CD TOXIN POSITIVE CASE S IN EACH CHP HOSPITAL FOR THE YEARS SINCE 2009

7

Hospitals 09/10 10/11 11/12 12/13 13/14

Lorn and Islands Hospital, Oban 0 1 2 1 2

Cowal Community Hospital, Dunoon 3 1 2 2 3

Victoria Hospital, Rothesay 3 0 1 0 1

Mull and Iona Community Hospital 0 1 0 0 0

Argyll & Bute Hospital, Lochgilphead 0 0 0 0 1

Mid Argyll Hospital, Lochgilphead 0 0 1 0 0

Campbeltown Hospital 0 0 1 1 2

Islay Hospital, Bowmore 0 0 0 0 0

TABLE 4 SHOWS THE CUMULATIVE CD TOXIN POSITIVE CASE S IN COMMUNITY FOR THE YEARS SINCE 2009

09/10 10/11 11/12 12/13

13/14

North and West Unit 22 8

South and Mid Reported as CHPs 21 6

Argyll & Bute CHP 2 4 2 2 4

There have been a total of 9 cases of Clostridium difficile infection (CDI) detected in hospital settings in Argyll & Bute CHP since 1st April 2013. A further 4 patients have been diagnosed in the community setting. This represents an increase on the last 2 years. Initial examination of the data available does not appear to suggest cross infection has been a factor in the increased number of infections diagnosed. The 4 patients diagnosed in community settings were in different locations with no links related to hospitalisation or other healthcare intervention.. With the exception of Cowal Community Hospital, the hospital patients diagnosed were unrelated in terms of time and/or place. 3 patients in Cowal Community Hospital were diagnosed as having CDI in April, August and September respectively. No infection alert triggers have been breached and initial investigation does not suggest an outbreak situation. Nevertheless, the situation warrants further scrutiny to detect and rectify any preventable factors which may increase the risk of infection acquisition to current and future patients. Further review will be carried out on the epidemiology and clinical history on Cowal patients on 17th October 2013. 2.3 Improving Patient Safety in Relation to CDI The point prevalence study of antimicrobial prescribing practice took place across each hospital in September to identify how well we are complying with the guidance. The final report is being complied by the Lead Antimicrobial Pharmacists for NHS Highland; the

8

findings will inform further work to improve the knowledge and practice of all prescribers across Argyll and Bute. NHS Highland is one of the Boards participating in a pilot project for Surveillance of Community Clostridium difficile Infection. CDI is mainly associated with healthcare, but surveillance in Scotland does not distinguish between CDI cases from acute, non-acute hospitals, and the community. Studies undertaken within Scotland since 2008 have shown that community-associated CDI (defined as no history of healthcare admission in the 12 weeks prior to onset of symptoms) represents a significant proportion of all cases reported under the national surveillance programme. Any further reductions in the incidence rate of CDI in Scotland will also require a better understanding of community-associated CDI (CA-CDI) and its relationship with the acute sector. 3. Hand Hygiene

The current National Hand Hygiene Campaign, including the collection, analysis and publication of bi-monthly hand hygiene data by Health Protection Scotland (HPS), concluded on 25 September 2013 with the publication of the 27th bi-monthly Hand Hygiene Monitoring Audit Report. From 1st October 2013 individual Health Boards are responsible for monitoring and reporting hand hygiene compliance data. NHS Highland will continue to report compliance in the bi-monthly report to the Board. 3.2 Trends NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining 98% compliance in July and 99% in August 2013. All areas in Argyll and Bute continue to demonstrate compliance with the standards- the results for each hospital are included within the charts in section 2 of the report. 4. Cleaning and the Healthcare Environment

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

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The monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated 96% compliance in July and August 2013 for domestic monitoring and 97% for estates monitoring in July and August 2013.

The recently published NHS Scotland National Cleaning Compliance for Domestic & Estates Cleaning Services quarterly report April - June 2013 shows that NHS Scotland compliance for cleaning was 95.6% and 97.5% for Estates.

TABLE 5 SHOWS NHS SCOTLAND QUARTERLY REPORT APRIL - JUNE 2013 FOR NHS HIGHLAND.

Cleaning Result % Estates Result %

NHS Highland 95.6 97.1

A&B CHP 96.2 97.4

New Craigs 96.6 99.8

North & West 95.0 97.1

Raigmore 95.3 97.1

South & Mid 96.0 95.9

The results for each hospital in Argyll and Bute are included within the charts in section 2 of the report. Issues related to the Service Level Agreement with NHS Greater Glasgow and Clyde for the provision of cleaning services to the Helensburgh site are currently being addressed by the Locality Management Team. 5. Outbreaks/Incidents There have been no outbreaks or incidents in Argyll and Bute since the last report. 6. Standards for Healthcare Associated Infection (H AI) All hospitals in Argyll and Bute continue to work to implement the standards to prevent HAI. NHS Highland Nurse Director (Heidi May) and Lead Nurse for Mental Health (Mhairi Will) visited Argyll and Bute Hospital on September 13th to review the work that has been undertaken and to identify further requirements to ensure safe delivery of care in view of the extended timescale for completion of the new facility. As a result of this visit a number of areas for action were identified and these have been prioritised in the action plan the delivery

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

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of which will be overseen through the Hospital HAI Task Force Group, chaired by the Director of Operations. Healthcare Environment Inspectors made an unannounced visit to Belford Hospital, Fort William on 22nd August 2013. The Inspection team found that:

- staff demonstrated an awareness and understanding of their roles and responsibilities

- continual system of environmental audit in place which demonstrated a process of continual improvement pertaining to the prevention and control of infection

- action plans in place demonstrated responsibility and accountability where staff can clearly identify areas of high risk where additional resources are required

- standard of cleaning was good throughout the areas inspected. The report contained one requirement and two recommendations as follows:

Requirement:

• NHS Highland must ensure that all infection control manual policies outwith their review date are reviewed without delay. This will ensure that they reflect current best practice; that these reviews are in line with current national and local policy; and staff have access to the most up to date information at all times. All policies and procedures for the prevention and control of infection must be reviewed and updated on a regular basis in line with local governance structures.

Recommendations:

• NHS Highland should ensure that the new protocol for PVC is rolled out across Belford Hospital to ensure that staff are using the most up to date information

• NHS Highland should reinforce awareness among staff of the local policy for selection and use of colour coded aprons

Healthcare Environment Inspectors made an unannounced visit to Caithness General Hospital on 9th & 10th September 2013. The Inspectors found that staff were engaged with the inspection process, that they demonstrated a good awareness of key roles and responsibilities for infection prevention & control and had audit processes in place through Scottish Patient Safety Programme and environmental walk rounds. Some issues were found during the inspection, staff have already made good progress to address them. The final report will be published on Wednesday 6th November 2013.

7. Antimicrobial Resistance Extensive spread of organisms resistant to carbapenems (antibiotics usually of last resort) has occurred within a number of European countries, with some countries moving to an endemic situation. The number of carbapenemase-producing Enterobacteriaceae (CPEs) detected within the UK has also risen, with over 70 Trusts in England having isolated a carbapenemase producing organism. In Scotland there has been an increase in CPE detection, with 25 cases detected in 2012. A working Group has been set up to ensure the Board is compliant with the actions as described in the CMO/SGHD (2013)14 letter. It should be stressed that NHS Highland does not have any problems and will continue to ensure that all preventative, measures are in place to minimise the risk. The action plan will be monitored by the Infection Control Improvement Group.

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8. Flu Immunisation Programme

The annual flu immunisation programme has commenced with all those at high risk being immunised through their primary care services. The groups eligible to receive the vaccine this year include:

• Children aged 2 and 3 years • All patients aged 65 years and over • Chronic respiratory disease aged 6 months or older • Chronic heart disease aged 6 months or older • Chronic kidney disease aged 6 months or older • Chronic liver disease aged 6 months or older • Chronic neurological disease aged 6 months or older • Diabetes aged 6 months or older • Immunosuppression aged 6 months or older • Pregnant women • Those living in long-stay residential care homes or other long-stay care facilities

where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality

• Unpaid Carers and young carers In addition all health and social care staff in Argyll and Bute are being encouraged to take up the offer of free seasonal influenza immunisation in order to protect themselves and their patients. Low uptake of seasonal flu vaccination by health care workers continues to be an issue in Scotland and throughout the UK. While vaccination of NHS staff remains voluntary, all NHS Boards are encouraged to offer the vaccine in an accessible way, and all staff to seriously consider the benefits to themselves and their family contacts, their patients, and the NHS as a result accepting the offer of the vaccine. Flu outbreaks can arise in health and social care settings with both staff and their patients/clients being affected when flu is circulating in the community. It is important that health professionals protect themselves by having the flu vaccine, and, in doing so, they reduce the risk of spreading flu to their family members. Vaccination of healthcare workers against flu significantly lowers rates of flu-like illness, hospitalisation and mortality in the elderly in healthcare settings. Flu immunisation of healthcare workers with direct patient contact and social care staff may reduce the transmission of infection to vulnerable patients, some of whom may have impaired immunity that may not respond well to immunisation. Vaccination of frontline workers also helps reduce the level of sickness absences and can help ensure that the NHS and care services are able to continue operating over the winter period. This is particularly important when responding to winter pressures, and winter planning should seek to take account of the importance of staff vaccination across the NHS.

Healthcare Associated Infection Reporting Template (HAIRT) Section 2 – Healthcare Associated Infection Report Cards

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The following section is a series of ‘Report Cards’ which provide information on 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. This includes information for pan Highland, Lorn and Islands Hospital, Oban, Community Hospitals collectively for Argyll and Bute and NHS Highland out of hospital infections. 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 Num bers 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&sectionID=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&sectionID=1 For each acute hospital and community hospitals in the 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 Compl iance 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. Understanding the Report Cards – Cleaning Complianc e

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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.

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Abbreviations AMT Antimicrobial Prescribing Team

AMAU Acute Medical Admissions Unit

CHP Community Health Partnership

CDI Clostridium difficile Infection

CNO Chief Nursing Officer

CVC Central Venous Catheter

CSM Clinical Services Manager

ECDC European Centre for Disease Prevention & Control

GDP General Dental Practitioner

HAI Healthcare Associated Infection

HAIRT Healthcare Associated Infection Reporting Template

HEAT Health Improvement, Efficiency, Access, Treatment

HEI Healthcare Environment Inspectorate

Hemi arthroplasty An operation used to treat fractured hip similar to a total hip replacement, but involves only half of the hip.

ICU Intensive Care Unit

JAG Joint Advisory Group

MSSA Meticillin Sensitive Staphylococcus Aureus

MRSA Meticillin Resistant Staphylococcus Aureus

PICC Peripherally Inserted Central Catheter

PPI Proton Pump Inhibitor

PVC Peripheral Venous Catheter

QUAD Quality Assurance Document

RIDDOR Reporting of Injuries, Diseases and Dangerous Occupational Regulations 1995

SAB Staphylococcus aureus Bacteraemia

SCN Senior Charge Nurse

SHPN Scottish Health Planning note

SHTM 64 Scottish Health Technical Memoranda – Sanitary assemblies.

SPC Statistical Process Chart

SAPG Scottish Antimicrobial Prescribing Group

SICPs Standard Infection Control Precautions

SPSP Scottish Patient Safety Programme

VAP Ventilator Associated Pneumonia

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Staphylococcus Aureus Bacteraemia (SAB) criteria

Contaminated blood culture

• Staphylococcus aureus isolated from blood, and • SAB diagnosis incompatible with clinical picture, i.e. no or minimal

clinical signs and symptoms indicating SAB.

Hospital acquired infection

• Staphylococcus aureus isolated from blood cultures taken 48 hours after admission or within 48 hours of discharge, and,

• The presence of clinical signs and symptoms indicating SAB

Community onset-healthcare associated infection

• Staphylococcus aureus isolated from blood cultures taken <48 hours after admission, and

• The presence of clinical signs and symptoms indicating SAB, and • At least one of the following within the past 12 months:

o Hospitalisation or invasive device management as an outpatient / community patient, or dialysis as an outpatient / community patient.

True community infection

• Staphylococcus aureus isolated from blood, and • No hospitalisation within the past 12 months • No dialysis within the past 12 months • No community or outpatient healthcare for invasive device

management in the past 12 months

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APPENDIX ONE: NHS Highland Infection Prevention & Control Annual Work Plan 2013/2014 Argyll and Bute CHP

Objective

Activity Timescale Lead Officer

1.HEAT Targets

1.1 To continue to reduce the number of SAB cases to achieve the HEAT Target of 24 cases per 100,000 acute occupied beds days or lower by March 2015

a) By ensuring compliance with device related bundles – PVC, CVC, PICC, CAUTI b) By ensuring compliance with NHS Highland wound management guidelines & formulary. c) By reviewing the causes of community acquired SABs, to give an understanding of what preventable measures are required. d) By reviewing the causes of healthcare acquired SABs, to give an understanding of what preventable measures are required.

March 2015

Lead Nurse Supported by the Infection Prevention & Control Team

a) By monitoring the adherence to the Clostridium difficile policy – to highlight areas for improvement (compliance with hand hygiene, antimicrobial & proton pump inhibitor prescribing, environmental cleanliness & fabric maintenance, appropriate isolation)

March 2015

Lead Nurse Supported by the Infection Prevention & Control Team

1.2. To reduce the number of Clostridium difficile cases to achieve the HEAT Target of 25 cases per 100,000 occupied bed days in patient’s age 15 years and over by March 2015.

b)By ensuring the delivery of the most up to date testing

c)By the use of high quality local data to inform primary and secondary care

March 2014 Infection Control Doctor/Consultant Microbiologists

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2. Infection Prevention & Control is everyone’s business

2.1 Embed the importance of Infection Prevention & Control into everyday practice.

a) By ensuring that the ten elements of Standard Infection Control Precautions are implemented and audited to ensure compliant practice. b) By ensuring that there is Infection Prevention & Control input in all new builds/refurbishments as per HAI Scribe. c) By having risk assessed plans in place regarding non- compliant sinks & poor fabric maintenance. d) By ensuring there are systems in place to minimise the health & safety risks to staff using cleaning products e) By auditing compliance with NHS Scotland MRSA Screening policy. f) By ensuring that staff who are exposed to biological agents i.e. aerosol generating procedures, have access to and comply with wearing appropriate PPE.

March 2014 Lead Nurse Supported by the Infection Prevention & Control Team

3.HAI Standards 3.1 Embed the process and governance arrangements for HAI Standards Monitoring.

a) By ensuring there is a programme of HAI standards monitoring visits in each Operational Unit. b) By ensuring that there is a system in place to escalate any actions which cannot be progressed through the line management structure and if necessary to the Chief Operating Officer. c) By submitting quarterly reports to the Infection Control Improvement Group.

March 2014 Lead Nurse Supported by the Infection Prevention & Control Team

4.HAI Education 4.1 Ensure Patient/Service Users safety is achieved in relation to Infection Prevention & Control by standardising HAI education and training, targeted at different staff groups

a) Implement NHS Highland guidance on Infection Control training for all staff b) ensure that staff have HAI objective within their PDPs

March 2014 NHS Highland HAI Education Group

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across NHS Highland in • Hospitals • Community • Primary Care • Care Homes • Care at Home • Adult Day Care Centres • Learning Disability • Bank Staff • Social Work Staff • Volunteers and Contractors

c) ensure that Community Nurses complete the required modules and records of training are available

d) Identify what protected learning time is required for HAI training

e) Look at barriers preventing HAI training

f)Ensure that NHS Highland has a robust system of recording what training has been undertaken

5.Decontamination

5.1 Achieve compliance with all aspects of decontamination.

a) By ensuring that there are systems, processes and facilities for safe endoscopy decontamination. a) By putting systems in place around procurement of equipment to ensure effective decontamination. b) By ensuring that there are systems, processes and facilities for safe decontamination. c) By ensuring that there are plans in place for all (General Dental Practitioners) GDP independent contractors to be able to provide LDU facilities within their practices for the decontamination of instruments which are compliant with SHPN 13 Part 2.

March 2014 Head of dental Services/ Locality Managers/ Infection Control Nurses

6.Water Safety 8.1 Ensure Argyll and Bute has robust and consistent arrangements in place for the safety of the water systems in NHS Highland comply with legal duties and relevant guidance

a) By implementing NHS H procedures for the prevention of water-borne infection which include risk assessment, analysis and planned preventative maintenance.

b) By ensuring that daily water flushing is carried out to reduce the risk of water borne infection

March 2014 Estates Manager and Hotel services Managers

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7.Domestic Services

7.1 To support Domestic Services to achieve 90% Cleaning compliance.

a) By the development and implementation of Standard Operating Procedures (SOPs), including products used and reports to Senior Charge Nurses b) By the development and implementation of Domestic Services SOPs Training c) By the development and implementation of Domestic Services Standard Monitoring Procedures and Monitoring Training. d) By assessing Domestic Services staffing levels based on the agreed SOPs. e) By monitoring the implementation of COSHH procedures & Risk Assessments.

March 2014 Hotel Services Managers

8. Catering Services

8.1 To support Catering Services & Clinical Staff to ensure food safety from production to delivery.

a) Through education & training such as • Elementary Food Hygiene Certificate • Hazard Analysis and Critical Control Points

(HACCP) Training • Food Service at Ward Level

b) By monitoring compliance with food safety standards.

March 2014 Hotel Services Manager


Item : 7.3 The Annual Report of the Director of Public Health 2013 Report by : Elaine Garman, Public Health Specialist (Adapted from NHS Highland Board Paper by Dr Margaret Somerville) The Committee is asked to: • Note this paper.

1. Background and Summary The Director of Public Health is required to publish an annual report each year on the health of the Board’s population, or specific aspects of it. The 2013 report concentrates on children and young people in the Board area and makes recommendations for health and social care services to improve the health of this section of the population. Focussing on children and young people for this year’s report is timely for Argyll and Bute as the Community Planning Partnership has recently undergone a pilot joint inspection of children’s services by the Care Inspectorate. The Director of Public Health Annual Report can be found at: http://www.nhshighland.scot.nhs.uk/Meetings/BoardsMeetings/Documents/Board%20Meeting%201%20October%202013/5.1%20DPH%20Annual%20Report%202013-APP.pdf

2. Children and Young People in Argyll & Bute The report describes

• the demographic features of the population aged under 18 years in NHS Highland • key public health challenges that children and young people face as they grow and

develop • and the work that is in progress to support them to achieve their full potential the

issues affecting specific groups: o looked after children and other vulnerable groups o children and young people with long-term conditions

• some of the key service improvements that are taking place in o paediatric unscheduled care o child and adolescent mental health services o the Early Years Collaborative

• the consultations that have taken place with children and young people to inform service developments

The report makes recommendations for health and social care services.

3. Contribution to Board Objectives The Committee is committed to providing services based on evidence of need and effectiveness. This report summarises key information relevant to the planning of safe,

2

effective and efficient services which, if used, will lead to improvements in health for children and young people.

4. Governance Implications Staff Governance: no specific implications, but staff within children’s services will be involved in service improvement work, which should include considering recommendations from this report Patient and Public Involvement: children and young people have been extensively consulted during the preparation of this report and their views should be formally taken into account in the development and provision of services. Clinical Governance: the recommendations on revising and improving outcome measures and indicators and the provision of information systems will improve the quality of the information available for clinical governance and performance management. Financial Impact: not specifically quantified but much of the work described is already in progress.

5. Risk Assessment The NHS Highland Risk Register is currently being revised and the risks associated with some aspects of children’s services are being considered as part of this process.

6. Planning for Fairness No formal Planning for Fairness has been completed for this report, but implementation of the recommendations is expected to both improve health and reduce inequalities in health by supporting the most vulnerable children in society and ensuring effective services are available to all children and young people.

7. Engagement and Communication A wide range of people from various agencies and services have contributed to this report. The NHS Board will circulate the report widely to key individuals and agencies, post it on the website and will make it available to other groups on request. Elaine C Garman Public Health Specialist 14 October 2013


Item : 8.1

FINANCE REPORT REPORT BY GEORGE MORRISON The CHP Committee is asked to; • Note the financial position at month 6 • Note the requirement for management action to achieve a year-end break-even position 1. Argyll & Bute CHP - Month 6 Financial Position For the six months ended 30th September 2013, Argyll & Bute CHP recorded an overspend of £340,000. This is a slight increase of £21,000 on the overspend reported at the end of August. Table 1 below provides details of budgetary performance across the CHP at month 6.

Table 1: Financial performance by budget at 30 th September 2013 Year to Date

Budget Annual Budget Budget Actual Variance

Forecast Outturn

£’000 £’000 £’000 £’000 £’000 Oban, Lorn & Isles Locality 19,098 9,462 9,811 (349) (500) Mid Argyll, Kintyre & Islay Locality 17,106 8,424 8,412 12 (58) Mental Health In-Patient Services 7,455 3,571 3,520 51 100 Cowal & Bute Locality 12,649 6,294 6,401 (107) (200) Helensburgh & Lomond Locality 4,881 2,438 2,399 39 100 Salaried Dental Service 4,000 1,814 1,814 0 0 Other Clinical Services 4,942 2,265 2,286 (21) (15) General Medical Services 15,500 7,663 7,777 (114) (150) Prescribing 17,030 8,352 8,297 56 100 Dental, Ophthalmic & Pharmacy 7,782 4,052 4,052 0 0 Services from NHS GG & C 49,525 24,265 24,286 (21) (42) Commissioned Services 4,026 1,978 2,170 (192) (473) Resource Release 4,658 2,329 2,329 0 0 Depreciation 3,300 1,663 1,663 0 0 Management & Corporate 7,941 3,828 3,752 76 65 Budget Reserves 1,126 175 0 175 350 Total Expenditure 181,019 88,573 88,968 (395) (723) Income (1,394) (818) (873) 55 23 Net Budget Position 179,625 87,755 88,095 (340) (700) Planned Management Action 700 Forecast year-end outturn 0

The five main factors creating the overspend continue to be;

• medical locum costs in Dunoon and Oban • nurse staffing costs in Lorn & Islands Hospital • an increase in commissioned services costs • an overspend on the General Medical Services budget • unachieved savings

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2. Budget Variance Analysis

In more detail, the most significant budget overspends are; Oban, Lorn & Isles Locality - overspent £349k Unachieved savings - £167k shortfall at month 6 reflecting a low level of declared savings to date. Medical locums - £115k overspent due to a consultant physician vacancy. Ward B nursing pay costs - £45k overspent due to sickness absence, maternity leave and special care nursing requirements. Surgical locums - £36k overspent due to annual leave cover. Portering/Transport - £17k overspent due to additional staffing to support duties outwith normal shift rotas. ECG - £16k overspent due to the employment of agency staff to cover sickness absence. A&E nursing pay costs - £16k overspent due to sickness absence. Commissioned Services – overspent £192k A number of commissioned services budgets are overspent, including; Huntercombe - £132k overspent due to increased patient referrals. NHS Highland (north) - £65k overspent due to increased patient activity. NHS Lothian - £50k overspent due to an expensive patient referral. General Medical Services - overspent £114k Locums covering vacant small practices and maternity leave - £107k overspent. Minor Surgery - £13k overspent due to an increase in claims. Cowal & Bute Locality - overspent £108k Medical locums in Dunoon covering gaps in the casualty and out of hours rota - £174k overspent. Medical locums in Dunoon covering the hospital in-patient service - £51k overspent. Greater Glasgow & Clyde SLA - overspent £21k The reported overspend relates specifically to increased activity at WestMARC which is a variable charge related to activity levels. It is assumed that the main patients services SLA will be settled in line with budget (£47m) although agreement has still to be reached with GG&C on this. 3. Other Issues to note

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i) With regard to the Salaried Dental Service, it has been assumed that the service will be funded at cost and therefore a nil variance has been reported at month 6. SGHD has yet to announce the level of funding being made available for this service in 2013/14. ii) The CHPs savings plan in 2013/14 totals £2.4m. Savings in prescribing, commissioned services and depreciation look likely to be achieved. However the savings targets for Localities (totalling £1.05m) and management & corporate services look challenging.

Table 2: Argyll & Bute CHP Cost Improvement Plan 20 13/14

Recurring Savings Targets Responsible Manager

Target £' 000

DeclaredAchieved

£' 000 Outstanding

£’ 000

Forecast Achievement

£' 000

Likely Shortfall

£' 000 Oban, Lorn & Isles V Kennedy 365 31 334 200 165 Mid Argyll, Kintyre & Islay C West 331 173 158 271 60 Cowal & Bute V Smith 252 97 155 152 100 Helensburgh & Lomond V Smith 102 67 35 102 0 Unfunded Displaced Staff D Leslie 90 15 75 15 75 Prescribing F Thomson 1,000 787 213 1,000 0 Lead Nurse P Tyrell 20 0 20 20 0 Public Health E Garman 21 21 0 21 0 Management and Corporate D Leslie 76 16 60 76 0 Commissioned Services D Leslie 77 0 77 77 0 Depreciation G Morrison 66 66 0 66 0 Totals 2,400 1,273 1,127 2,000 400

4. Forecast Outturn Argyll & Bute CHP is continuing to forecast a year-end break-even position, however this is dependent on management action to achieve this outturn. If action is not taken to address cost pressures and unachieved savings, the CHP could overspend by £0.7m. The escalating overspends in Oban, Lorn & Isles Locality and Commissioned Services are causing particular concern. George Morrison Head of Finance Argyll & Bute CHP 16th October 2013


Item : 9.1

PDP/R AND e-KSF IMPLEMENTATION 2013/14 1. BACKGROUND AND SUMMARY The CHP has made considerable progress over current years in working towards achieving the NHS Highland target for 2012/13 that ALL Agenda for Change staff have a review against a Knowledge and Skills Framework (KSF) post outline, with at least 80% of reviews being carried out and recorded online using the web based system, e-KSF. This has provided a systematic way of knowing which staff have had a regular review. NHS Highland can report on the number of staff who have had reviews, that these follow the same process, and that staff are actively involved. This also supports Continuous Professional Development (CPD) and re-registration. In addition it allows for Mandatory and Statutory training to be included in every staff members’ PDP, which acts as a reminder and record. The ongoing target is remains that 80% of all staff have a KSF review completed and recorded on e-KSF at least annually. 2. MONITORING PROGRESS 2013/14 The position across NHS Highland at 30 September 2013 is as follows (Extract from e-KSF 30-09-13). Area All AfC

staff Reviews signed

off

% of AfC staff (all)

% of AfC staff (excl bank)

No of Reviews

completed within last 12 months

% Reviews

completed within last 12 months

(excl bank)

% Reviews

completed within last 12 months ( % of all

Staff)

September

% Reviews

completed within last 12 months ( % of all

Staff)

August Argyll and Bute CHP

1986 172 8.66 12.03 1229 85.94

61.88 64.21

Corporate Services

707 77 10.89 11.21 449 63.51 65.36

N/A

West 901 109 12.10 17.50 485 53.83 77.85 N/A Mid Highland

445 23 5.17 7.85 252 56.63 86.01 N/A

North Highland

950 73 7.68 11.34 441 46.42 68.48 N/A

Raigmore Hospital

3233 170 5.26 7.27 1648 50.97 70.52 N/A

South Highland

742 48 6.47 8.23 410 55.26 70.33

N/A

The CHP currently has 8.66% of all staff (12.03 % excl bank) with reviews and personal development plans signed off in e-KSF for this year so far. The total percentage for NHS Highland is 7.12% (9.54% excl bank posts).

The CHP Committee is asked to:

• Note the current position • Note the need to embed this in practice and use to support and direct staff

development in line with CHP and NHS Highland objectives • Note the need to ensure reviews and PDPs are planned for the next 6 mths • Note the need to ensure bank staff have review

2 Sally Munro Workforce Development Facilitator 11-10-13

This table now includes additional columns ( shaded) showing the number of reviews ( and %) completed in the previous 12 months ie 1 October 2012 to 30 September 2013. This is shown for both % of all staff and excl bank staff. This reporting is in line with the approach being taken nationally Comparison with last month shows a reduction which indicates that action is required by all involved to recover and retain our position 3. ACTIONS FOR 2013/14 In order to improve the proportion of staff that have an annual review, there needs to be a focus on the following :

• Addressing issues of missing data re a number of staff who do not have one or more of the following: named manager, e-mail address, no KSF outline or no review. Specific actions are being undertaken to address this and these will continue until completed. Actions by Workforce Development Facilitator and line managers

• Ongoing work in each area to ensure that all bank staff have an identified manager,

outline and review . Actions by Workforce Development Facilitator and line managers

• Planning and spreading reviews throughout the year

Actions by line managers

• Ensuring and improving quality of reviews and evidence Actions by line managers and staff.

The KSF Review and Development Process and use of e-KSF are well embedded into our culture and the focus now will be on managers/reviewers ensuring quality of reviews and evidence. This links directly to Professional leadership and registration and Health Care Support Workers (HCSW) Standards to ensure public protection and maintenance of professional standards within our workforce. 4 QUALITATIVE BENEFITS OF KSF Regular development reviews and agreeing personal development plans support service quality, improvement, staff and clinical governance. Examples are:

• E-KSF is used to support redesign and service improvement processes by using the KSF outlines to support staff in changing roles, and identifying differences in knowledge and skills required.

• The use of Foundation outlines for staff moving into new roles as part of service

change/redesign should ensure supported development into these roles leading to more confident staff more efficient and effective services.

In order to obtain feedback on the experience of using e-KSF, and the benefits or challenges, a review is being undertaken by the Workforce development facilitator involving meetings with local management forums and by asking a sample of staff to complete a short survey questionnaire. This feedback will then be used to identify any issues that need addressed. 6 CONTRIBUTION TO BOARD OBJECTIVES

3 Sally Munro Workforce Development Facilitator 11-10-13

The achievement of the target is in line with the NHS Highland Board objectives. 7 GOVERNANCE IMPLICATIONS Staff Governance KSF and e-KSF are vital components of meeting Staff Governance standards. Patient focus and public involvement The KSF process enables performance management to assist with improved patient focus and public involvement where appropriate for roles. Clinical Governance KSF process provides the opportunity to monitor development activities of staff including clinical skills and ensures that staff develop and apply the appropriate knowledge and skills in order to be effective in their work. Financial Governance This is part of normal management processes. In addition, workforce costs are a large proportion of the allocated budget. KSF PDP/R and e-KSF support the effective use of staff, in particular through service change and redesign. 8. IMPACT ASSESSMENT The KSF and e-KSF processes are impact assessed at National level and will be monitored as part of overall staff engagement measures. David Logue, Head of HR, Argyll and Bute CHP October 2013

e-KSF Reviews Report by Operational Unit For Period 01/04/2013 - 31/03/2014

All Staff Non Bank All Staff Non BankNHS Highland 9810 931 9.49% 112 1.14% 698 7.12% 9.54% 1741 17.75% 5452 55.58% 74.48%Argyll and Bute CHP 1986 216 10.88% 20 1.01% 172 8.66% 12.03% 408 20.54% 1229 61.88% 85.94%Corporate Services 707 92 13.01% 6 0.85% 77 10.89% 11.21% 175 24.75% 449 63.51% 65.36%Raigmore Hospital 3233 243 7.52% 30 0.93% 170 5.26% 7.27% 443 13.70% 1648 50.97% 70.52%West 901 79 8.77% 15 1.66% 109 12.10% 17.50% 203 22.53% 485 53.83% 77.85%Mid 445 26 5.84% 1 0.22% 23 5.17% 7.85% 50 11.24% 252 56.63% 86.01%North 950 96 10.11% 24 2.53% 73 7.68% 11.34% 193 20.32% 441 46.42% 68.48%Grouped Services (S & M) 846 86 10.17% 7 0.83% 26 3.07% 3.60% 119 14.07% 538 63.59% 74.41%South 742 93 12.53% 9 1.21% 48 6.47% 8.23% 150 20.22% 410 55.26% 70.33%Notes1 From e-KSF - does not include Adult Social Services dataCurrent position if Bank Posts are removed from 'Total Posts' - data from Workforce Information Staff ListThe accuracy of this report may be marginally affected by work on data links between e:ESS, SWISS and e-KSF systems If you notice an anomaly in the report please contact the L&D Systems Addministrator on 01463 706721

Reviews 'Completed & Signed Off'1 (12 month rolling)e-KSF Reviews 30th September

2013Total

Posts1 Reviews 'Started'1Reviews 'Completed & Not Signed Off'1

Reviews 'Completed & Signed Off'1 (01/04/2013-30/09/2013) Reviews at all stages1

Page 1 of 1 02/10/2013

Item : 9.1a

e-KSF Reviews Report by Operational Unit For Period 01/04/2013 - 31/03/2014

All Staff Non Bank All Staff Non BankNHS Highland 9810 931 9.49% 112 1.14% 698 7.12% 9.54% 1741 17.75% 5452 55.58% 74.48%

A&B Mental Health Services 179 5 2.79% 0 0.00% 24 13.41% 20.51% 29 16.20% 112 62.57% 95.73%Argyll & Bute Central Services 138 14 10.14% 4 2.90% 13 9.42% 9.77% 31 22.46% 88 63.77% 66.17%

Cowal and Bute Area 373 81 21.72% 8 2.14% 59 15.82% 20.70% 148 39.68% 261 69.97% 91.58%Dental Service (Argyll & Bute) 91 13 14.29% 2 2.20% 16 17.58% 23.53% 31 34.07% 55 60.44% 80.88%

Helensburgh and Lomond Area 85 13 15.29% 1 1.18% 10 11.76% 13.70% 24 28.24% 54 63.53% 73.97%Mid Argyll Kintyre & Islay 540 39 7.22% 4 0.74% 30 5.56% 8.50% 73 13.52% 290 53.70% 82.15%

Oban Lorn & Isles Area 580 51 8.79% 1 0.17% 20 3.45% 4.99% 72 12.41% 369 63.62% 92.02%Argyll and Bute CHP 1986 216 10.88% 20 1.01% 172 8.66% 12.03% 408 20.54% 1229 61.88% 85.94%Notes1 From e-KSF - does not include Adult Social Services data (unless Agenda for Change)Current position if Bank Posts are removed from 'Total Posts' - data from Workforce Information Staff ListThe accuracy of this report may be marginally affected by work on data links between e:ESS, SWISS and e-KSF systems If you notice an anomaly in the report please contact the L&D Systems Addministrator on 01463 706721

e-KSF Reviews 30th September 2013

Total Posts1 Reviews 'Started'1

Reviews 'Completed & Not Signed Off'1

Reviews 'Completed & Signed Off'1 (12 month rolling)Reviews at all stages1Reviews 'Completed & Signed

Off'1 (01/04/2013-30/09/2013)

Page 1 of 1 02/10/2013

Item : 9.1b


Item : 9.2

ARGYLL & BUTE CHP

ARGYLL & BUTE CHP PARTNERSHIP FORUM

MINUTE OF MEETING HELD on

15th AUGUST in Aros Boardroom

Present: David Logue (DLo) Head of HR Alastair Craig (AC) Senior Management Accountant Angela Dewsnap (AD) Personnel Officer Julian Gascoigne (JG) Risk/Health & Safety Manager, Clinical Governance & Health & Safety Team Elizabeth Cowan (EC) Royal College of Nurses John Dreghorn (JD) Mental Health Project Director - Mental Health Modernisation Louise Stanesby (LS) Staff Side Representative (RCN)

By VC Dawn Gillies (DG) Unison (Co-Chair) Elizabeth McMillan (EM) Unison (Co Chair) Viv Hamilton (VH) Locality Manager B &C and H & L Lorna Low (LL) Royal College of Midwives Donald Watt (DW) Clinical Services Manager OLI Apologies : Gaye Boyd (GB) Personnel Manager Pay Tyrrell (PT) CHP Lead Nurse Derek Leslie (DLe) Director of Operations Co-Chair Helen Duthie (HD) Unison Sally Munro (SM) Workforce Development Facilitator Colin Crawford (CC) British Dental Association Veronica Kennedy (VK) Acting Locality Manager OLI Douglas Niven (DN) Unison Kate McAulay (KM) Clinical Service Manager MAKI Bill Staley (BS) Information & Projects Manager George Morrison (GM) Head of Finance Fiona Broderick (FB) Unite Christina West (CW) Locality Manager MAKI Stephen Whiston (SW) Head of Planning, Contracting and Performance Alison Hudson (AH) Integrated Nurse Bank In Attendance by VC Ann Williamson (AW) Integrated Nurse Bank Minutes: Rose MacVicar (RM) HR & Planning Contracting & Performance Subject Action 1 Welcome and introductions

As DG and EM were VCing to the meeting it was agreed that DLo would Chair the meeting. For the benefit of all DLo asked for introductions. It was confirmed that the meeting is quorate.

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DLo advised that the meeting will be recorded using the digital recording system. This equipment is being used to assist with and to ensure an accurate account of the meeting.

Subject Action 2 Nurse Bank

a) AW presented an overview of the Integrated Staff Bank Report compiled by AW, AH and PT. Questions raised regarding equity of allocation of shifts were considered and addressed in the paper. (Copy of the report and comments received were circulated prior to the meeting.)

AW advised issues relating to the Integrated Staff Bank (ISB) are discussed at the Monitoring Group meetings which are held every 3 months to review progress against set key performance indicators. It was noted that the NHS Highland HUB began the process of collating information on Bank staff from 1st June 2012. By 31st May 2013 every area of NHS Highland was included thus giving one year’s data for analysis. An internal audit was undertaken to identify and address areas of concern. Analysis of the data indicated that the issues arising from Argyll & Bute are not unique. The key themes identified are noted within the report and the Partnership were asked to consider the recommendations included therein which included the set up of a Short Life Working Group (SLWG) to address specific issues which have been highlighted in the report. It is acknowledged that NHS Highland including Argyll & Bute, do not have sufficient bank staff on the system to be able to meet all the requirements and it would appear to be unlikely to have bank staff not working because of the lack of opportunity. As Raigmore Hospital was identified as the highest user of Bank Staff a pilot programme in one ward was implemented over a two week period. Precautions were put in place in advance to assure staff that requests would be dealt with appropriately and promptly by the Integrated Staff Bank)-(ISB).

In turn Bank Staff were actively encouraged to forward details of their availability to the ISB. It was emphasised that the ward would not be contacting them directly with available shifts as these would only be allocated via the ISB. It was a very useful exercise and lessons were learned both by the operational units and the ISB. To ensure communications between ISB and Bank staff the HUB recently carried out a mail shot to all Bank Nurses (currently about 1,900 – 2,000 bank nurses on the database for NHS Highland) requesting an update on personal information held e.g. address, telephone number, mandatory training completed, mobile phone etc. It was hoped that this would address the misapprehension regarding allocation of available work. It was noted that HUB had a 50 % response rate from the mail shot.

JD sought clarification on the following points:- • Is Argyll & Bute Mental Health Services represented in the SLWG? • AW advised that invitations to localities had been circulated recently and will

make enquiries to ensure Mental Health Services and staff side are included. • Are details of staff recently recruited automatically recorded on to the system?

AW

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• AW advised names, contact details and email addresses should be forwarded to the ISB. An email will then be sent to the Bank Staff from IBS which will include a form to be completed. On return this information will be stored on

Subject Action 2 Nurse Bank continued

the ISB database. • With regard to the number of shifts unfilled, what happens if bank staff cannot

be provided? Are they passed back to operational unit to find alternative? AW advised all necessary steps are taken by the ISB to identify staff coverage. Ideally the operational unit should pass any requests for staff to ISB at the earliest opportunity. The operational unit can then build in time to fill the request, e.g. at ward level, if the ISB are unable to do so. To avoid duplication the operational units should not be contacting potential staff directly. EC raised concerns regarding the potential impact to the operational unit when the ISB notify the operational unit that they are unable to fill the post. The time delay may result in “local staff” being unable to fill the post at short notice. AW reiterated the need for the ISB to be notified at the earliest opportunity of staff requirements. Information on any instances of unfilled cover should be forwarded to ISB for action.

b) DG sought clarification regarding letters which have been circulated to bank staff. The content of the letter advised those who had not been allocated work in the past 3 months were not eligible to be on Bank. This would appear to be unhelpful given there is a shortage of available bank staff in some areas. AW advised that no further letters to that effect have been issued since Oct/November 2012. ISB have reviewed the policy and indicated that a 6 month period of no work allocation is a more realistic figure Further concerns for the ISB are with regard to mandatory training for the bank staff and the possible costs of training staff that have not been available for work for a prolonged period. AW advised after consideration it was agreed that staff who have not been allocated work over a 2 year period would be advised by letter that they would be removed from the list.

c) For budget monitoring requirements AC asked for clarification on payment of any

outstanding annual leave for bank staff. AW advised the only outstanding payments will be for those staff who have lodged

appeals although was aware of one outstanding payment of 50 hours for A &B.

It was noted that bank staff are strongly encouraged to apply for leave accrued in the quarter they have worked and preferably used before the end of the following quarter. If bank staff fail to take their leave in this way the ISB will allocate a period of leave during which time the bank staff will be deemed unavailable.

To summarise the three main actions from the discussions:- 1) Operational Managers and staff reps to advise AW of instances where the ISB do

not advise that they are unable to supply staff cover within the 24 hours period as stipulated.

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2) Acknowledged the need to confirm the number of available bank staff for each area. Ideally the number of bank staff should match requirements of the operational units. An audit may be required to identify where the main gaps are.

Subject Action 2 Nurse Bank continued

3) Recruitment. From time to time Argyll & Bute CHP have advertised at a local level for bank staff and may now consider advertising posts to cover across the CHP. AW suggested localities look at their bank numbers and assess where there are gaps and whether they can do concerted effort to try and recruit.

4) SLWG is due to meeting on 30th August. DL requested report on discussions to the next Partnership meeting.

DL thanked AW for her input at the meeting.

DLo will contact PT

3 Minutes of meeting held on 4 th July Accepted.

4 Matters arising a) Mileage claims. As requested comments arising from the implementation of the

new policy were collated and circulated prior to the meeting.

DG will present at the Highland Partnership Forum meeting to be held on 16th August.

DLo advised the new rates become effective as from 1st July for own car users. It was agreed it would be helpful to discuss at HPF as it was felt these comments will echo other concerns raised.

JG raised concerns that staff may feel forced to use leased cars. As the threshold where employees should be considered for lease cars is reduced from 5,000 now to 3,500 cut off point for the high level mileage rate it will bring in more staff to the pool. It was noted that the NHS contribution has not increased for 7 years. As an action JG asked these points be included with the other points raised. DG requested details to be forward via email to ensure all points are covered.

b) Contact Officers

In previous years in Argyll & Bute and other areas of NHS Highland there were a number of staff who acted as Contact Officers. Over time these staff members have ceased to work in these roles leading to a gradual withdrawal of this service. A number of efforts were made and discussion had at HR subgroup and other forums to identify the best way forward to establish a network of Contact Officers. The decided outcome was that nominated staff within the HR department, who are not directly involved in Personnel procedures will be involved in this role. The identified staff for Argyll & Bute CHP are Helen Cameron and Tracey Smith who are based in Helensburgh. They will be provided with training in terms of policy and procedures. The role of the Contact Officer will be to provide direction and signpost staff on how best to progress their concerns.

The following comments were raised:- • EM raised concerns that only two members of staff would be recruited as

Contact Officers and she was uncertain that they would have the capacity to cover all of Argyll & Bute. Also there may be conflicts between their role as Contact Officer and that of HR within ER procedures.

DLo advised the workload will be monitored and reviewed when necessary.

• DG stated consideration will have to be given particularly with the role

DG JG to email DG

5

changing as Contact Officers are noted in a number of current policies. Staff need to be aware of the role of the Contact Officers and how it differs from what was offered in the past.

Subject Action 4 Matters arising

b) Contact Officers continued DLo advised for guidance a Role Descriptor can be issued with the information on Contact Officers.

c) Public Holiday in September

Following feedback from Operational Managers and staff side representatives and in view of the consideration given it was agreed to move the holiday from the 23rd to 30th September thus bringing the public holiday in line with GG&C and Argyll & Bute Council. This would facilitate GG&C outreach clinics and those with links to the Council.

There is a complication arising from the change of the date being the role provided by NHS 24 and NHSH HUB OOhrs service for GPs. In view of short notice they were unable to arrange cover for 23rd September. The decision regarding the date taken in practices has been left with the individual practices.

d) Children Services Update

In the absence of PT DLo presented a brief overview of the Children Services paper (copy of the paper was circulated prior to the meeting). DG – raised concerns on 2.4 of the paper “ Final paper being submitted to Core Team at end of August” “if approved it is anticipated that the changes in the teams can be delivered over the following six month period.” There may be Organisational Changes arising from the staffing proposals contained in the paper and if there are changes, how would this be managed? DL advised it would be more appropriate for these issues to be discussed at Locality level. It is not anticipated that there will be any major changes to the paper prior to submission to the Core Team. The CHP Organisational Change would only consider the paper if agreement cannot be made at a local level. VH stated the understanding being that if paper is approved at the Core Team the process would initiate an organisational change process. DL advised he will contact PT to arrange discussions the paper with DG and EM. Following the tabling of the paper at Core Team the Partnership can then revisit the paper. It was agreed that the item to be included in the agenda for the next Partnership meeting.

e) Datix

DLo apologised for the delay in responding to the request. The issues arose from concerns that staff where not receiving their feedback on their reports and, that having completing and submitting them, no feedback was received and were then unsure if the issues raised were being addressed.

An overview of the way the system operated was then given by JG. JG confirmed Datix are acted and reported on at Clinical Governance Group meetings, but there is no requirements within the process for a report to be forwarded to the initiator. Following Datix submission the initiator will receive an acknowledging email. There is no further access to the system as only Managers can log on to the system. Initiator cannot see the report again unless they are the Manager of that area. The only way to overcome this would be for every staff member to have a log in.

DLo CoChairs/RM

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Datix should not to be seen as a communication source as discussions on issues raised should go through existing channels within the day to day interactions.

Subject Action 4 Matters arising

e) Datix continued JC advised where necessary feedback more training can be arranged for staff and managers. DG stated although acknowledging something is being done, staff are under the impression that nothing is happening as they do not hear anything. Feedback would encourage use of system. DL stated it is accepted that there is a gap within the reporting process and are now looking at ways to ensure that staff are aware that Datix is being actioned and that dialogue between the manager and member of staff occurs. JG asdvised that issues raised at the Partnership Meeting can be further discussed at local Clinical Governance meetings.

DLo advised discussions will be included at the next Core Team meeting.

d) Stress at work

JC advised Focus Groups are being developed in all locations. Clinical Governance are revisiting the process as they have identified a number of issues with the system mainly around the slowness of the process. It was noted that there are differing areas where stress can be indentified:-

1) organisational stress 2) from the staff survey 3) though healthy working lives initiatives

NHS are moving towards the Healthy Living Lives process. The information and guidance is available online and Localities can sign up to on a local departmental or ward level. Date can be set for completion resulting in quicker feedback and action.

JG DLo

5 Finance AC presented an overview of the Finance Report (copy of the report was circulated prior to meeting). The report confirmed the CHP financial position for the three month ended 30th June 2013. It was noted that:- a) The Budget continues to show an overspend with a slight increase noted

during the period from the report tabled in May. Page 2 of the report outlines some of the budget pressures.

b) There is a significant move in having the dental service move from a non cash

limited to a cash limited budget for salaried dental service. We are awaiting confirmation of the funding allocation from the Scottish Government.

c) The cost improvement programme savings plan for 2013/14 shows possible

increasing shortfalls. Managers are continued to encourage to identify and effect any cost savings with their area without that unlikely to achieve a break even position at the end of the financial year. The CHP will continue to forecast a break even point at the end of the fiscal year but this remains contingent on robust management action to achieve a break even position.

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d) Reference was also made to the requirement to achieve recurring release of

50% of the current investment of the sums provided through the Change Subject Action 5 Finance continued

Fund. DG asked for clarification on the sums provided for investment in Bute and how this was being utilised. VH responded that this particular matter had been discussed through the Core Team. DG however, suggested that discussions of this nature should be undertaken in a forum which included staff representation. The Forum noted that the overall management of the Change Fund is undertaken by the RCOP programme Board which includes staff and public representation.”

At this point ER left the meeting.

6 Mental Health Redesign JD presented an overview of the report (copies were circulated prior to the meeting). a) A number of refurbishments are ongoing for the in-patient services. Cowal Ward

is currently being upgraded to provide office accommodation for Psychological services.

b) Staff redeployment

Interviews held yesterday at the Argyll & Bute of the 5 displaced HCSW, 2 have been offered a permanent contract, 2 fixed term contract and 1 is on secondment.

c) Budget. Bridging slippage has reduced the project management costs and can

now expect to be able to fund the two remaining Psychology posts which were on hold due to the funding availability.

d) CMHT upgrade to offices are both complete and office equipment has been

ordered. e) Supported transfer of detained patients. The service requires an additional 4

posts. Recruitment of two registered nurses and 2 HCSW required. It is hoped that these posts will be filled in the near future. The service will then have sufficient staff cover available.

f) Recovery

Three members of staff attend a one week course on Mental Health Recovery at Boston University. The staff have developed an action plan which will be presented at the next Programme Board for approval.

g) WRAP Four volunteers undertook training to become facilitators in Argyll & Bute. They are developing plans to rollout awareness raising sessions and workshops through Argyll & Bute.

h) Stage 1 proposal has gone out to advisors and SFT for consideration awaiting

formal response though it is thought it will be rejected as on basis of not good value for money and as it is below the Scottish Government threshold we may therefore, have to consider combining our bid with another project which will result in a further delay in the progress. This in turn leads to the need for further necessary upgrades and refurbishments to be carried out in the existing buildings.

7 Highland Partnership Forum a) DG advised the next meeting is due to be held on Friday 16th August. Further

update at next Partnership meeting.

b) DL advised that the meeting will be extended as there is a workshop on the staff experience project and the HQA.

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Unfortunately due to other commitments and unavailability of VC neither DG, EM

or DLo are able to join the meeting. Subject Action 8 NHS Highland Annual Review

The review took place three weeks ago and took the form of a range of meetings with the Cabinet secretary, Alex Neil. This included a meeting with partnership representatives from the HPF. Mr Neil had made it clear that he wanted to engage directly with patients, relatives, and front line staff to get idea of what was going on at a ground level. Short meetings were held during the day with a number of groups. Part of the discussions centred on the impacts of Integration of Adult Care and Children’s Services. There were meetings held also with the Medical Forum and with Highland Partnership Forum. A review and update report will be tabled at HPF and will be forwarded in due course.

9 Workforce Planning Development As SM is on annual leave overview of paper presented by DLo.

a) HCSW

25% of existing staff are still to sign off. Lists have been forwarded to Managers to action. Still slow uptake from managers of new staff to ensure that the staff go through the full induction programme

b) EKSF. DLo presented an overview of the report compiled by SM (copy was

circulated prior to the meeting) It is an ongoing requirement for staff and management to undertake PDP

discussions and record on EKSF system. It was noted that there is a slight dip in activity which is not unusual at this time of year. Managers continued to be encouraged to hold meetings throughout the year.

It was noted that there is a change in reporting which has been agreed nationally. Data will be analysed on a 12 month rolling year rather than on a cumulative monthly basis.

One additional point for information is the intention to try and get a more

qualitative measure of the benefits of the PDP process. Focus groups were considered but proved difficult to populate. SM proposes to attend existing locality meetings and team group meetings to promote and discuss problems or issues arising from PDPs.

c) The Staff survey group has undertaken all the identified actions and therefore the group has closed.

It is anticipated that issues will arise from the staff survey carried out this year and if necessary a new group will be formed. A further survey was carried out this year which closed in July. NHS Highland had achieved a total response rate of 30% which was an improvement on 2010. The NHS Scotland average was 27%. Of the mainland territorial health boards we are 6th out of 11. Our response rate equates to 2,984 staff having filled in the survey. The Argyll and Bute figure is 680 responses compared with your return figure was 422 in 2010. It is likely that final reports both locally and nationally will be issued in November this year.

SM will be contact Managers admin to arrange

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DG enquired if it would be possible to have a figure for the paper copies returned.

Subject Action 9 Workforce Planning

c) continued DLo advised 3,000 copies were circulated in Highland. Would be difficult to find

the number of paper copies returned for Argyll & Bute as all are anonymous. d) Redeployment.

DL presented an overview of the paper prepared by GB. (copy was circulated prior to the meeting) Minor changes from paper tabled being 2 HCSWs from A & B have now been removed from list.

DLo to contact Ray Stewart.

10 Organisational Change a) CHP Locality and Management Organisational Change Group.

DLo presented an overview of the Action Note of the meeting held on 8th August (copy was circulated prior to the meeting). The group are currently asked to consider proposals for Cowal & Bute Helensburgh & Lomond area. The view from the Group being there was more work required on the structure and job descriptions. As amendments to the original proposals have been proposed it was agreed that the Group could not progress until the amended paper be approved at Core Team . Following approval the amended paper will be returned to the Group for discussions.

b) Mental Health & MAKI

Overview of the minutes of the meeting held on 8th May 2013 was presented by JD (copy of the minute was circulated prior to the meeting). The content of the minute was noted. No comments were tabled.

c) Bute Cowal Helensburgh and Lomond

Overview of the minutes of the meeting held on 17th July 2013 were presented by VH (copy of the minute was circulated prior to the meeting). The content of the minute was noted. No comments were tabled.

d) Oban Lorn and the Isles

In the absence of VK DW presented an overview of the meeting held on 23rd May 2013 (copy of the minute was circulated prior to the meeting). The content of the minute was noted. No comments were tabled.

11 Integrated Equipment Store Unfortunately neither DR nor VK were able to attend the meeting. As there are a number of concerns arising from the proposed Integrated Store which needs to be discussed it was agreed that the item be carried to the next meeting of the Forum. DR to be invited to next meeting to provide feedback update on position.

RM

12 AOCB a) Maternity Leave

AC advised, as he has not seen any official documents, he is seeking clarification regarding backdating payment for Public Holidays for staff on Maternity leave.

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DG advised she received a copy of a letter to Chief Executive NHS Scotland from STAC on 24th December 2012. For the benefit of all DG read out to the meeting. It was agreed for the benefit of all DG will forward a copy of the letter to RM for

Subject Action 12 AOCB continued

onward circulation.

Item also to be included in the agenda for the next meeting.

b) Scottish Distant Island Allowance. DLo presented an overview of the paper circulated prior to the meeting. The content was noted and no comments were raised.

c) Parental leave

DLo presented an overview of the paper circulated prior to the meeting. The content was noted and no comments were raised.

d) Papers for meetings EM requested that all managers should submitted papers requested in time. Whilst acknowledging that all the papers were received and forwarded prior to meeting, the lateness of some of the papers meant that there was insufficient time to go over them or print them off. It was agreed that a reminder regarding submission of papers 7 days prior to the meetings be emailed to members.

e) EM advised that this is the last meeting for EC. On behalf of the Partnership EM

took the opportunity to wish EC well and extended thanks to EC for all the contributions she has made over the years.

CoChairs/RM RM

13 Meeting closed Date, time and venue of next meetings as follows:- 3rd October 14th November

All to be held in Aros Boardroom at 12.30 p.m. Please note there will be no meeting held in December. Dates for meeting in 2014 as follows 9th January 20th February 3rd April 15th May 26th June 14th August 25th September 6th November 18th December

All meetings to be held in Aros Boardroom commencing at 12.30 p.m.

Glossary HR Human Resources OLI Oban Lorn and Isles MAKI Mid Argyll Kintyre and Islay B &C Bute and Cowal H & L Helensburgh and Lomond CHP Community Health Partnership GG&C Greater Glasgow and Clyde ABC Argyll & Bute Council


Item : 10.1 Services for Children and Young People in Argyll an d Bute – Pilot Joint Inspection Report Report by Pat Tyrrell, Lead Nurse The CHP Committee is asked to: • Note the contents of the report and the actions being taken

1 Background and Summary

The Report of the Pilot Joint Inspection was published in September and is attached as Appendix One. The inspection of services to children took place over 22 weeks earlier this year and involved inspections, reviews of case records, interviews of families and young people,meetings with staff and elected members. They looked at the work of the Community Planning Partnership to improve the lives of children in Argyll and Bute and considered services to children and young people provided by NHS, Council, Police, Independent and Third Sector.

2 Findings

The inspection has highlighted a number of strengths which included:

• The strong commitment to prevention and early intervention • A very positive culture of partnership working at all levels • The flexible approach to working with families to improve outcomes for children

and young people • Sound work to promote strong and resilient children, young people and families

The inspectors also highlighted three areas of good practice which are:

• Getting it right antenatal – our interagency approach to identifying and supporting vulnerable pregnant women, which is having a significant impact on giving unborn babies the best start in life

• Early intervention service –this service provides high quality intensive support to vulnerable children and young people

• Nurse coordinators – working to support children in care, families affected by homelessness and Gypsy traveller families

The areas for improvement that were identified include:

• Secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children

• Complete and implement the Integrated Children’s Services Plan • Continue to develop rigorous and systematic joint self-evaluation to improve

outcomes for children and young people • Ensure continued leadership and direction is provided to implement the planned

improvements for services for children, young people and families

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The overall inspection grades are as follows: Providing help at an early stage Very Good Impact on children and young people Good Assessing and responding to risks and needs Adequate Planning for individual children Adequate Planning and improving services Adequate Participation of children and young people Good Leadership of improvement and change Good Improving the wellbeing of children and young people Good As a result of the inspection findings an action plan, focussed on the areas identified for improvement, has been developed, to be agreed by the Community Planning Partnership, prior to submission to Care Inspectorate. This will supplement the comprehensive Integrated Children’s Services Plan which, after extensive consultation, is due to be published in November 2013 3 Contribution to Board Objectives The ongoing evaluation and improvement of services delivered to children and young people in Argyll and Bute contributes to NHS Highland’s objectives to deliver Better Health (BH) – improving the health of the population and Better Care (BC) – enhancing the experience of care for individuals 4 Governance Implications

The findings of the inspection have been shared with staff across Argyll and Bute. Delivery of the resulting action plan to address areas for improvement will also involve the leadership and efforts of staff across all levels of the services. Wide consultation has also taken place to consult on the Integrated Children’s Services Plan with children, young people and staff. Monitoring of the delivery of the action plan will be through Argyll and Bute’s Children and Chief Officers Groups.

5 Risk Assessment

All risks that may affect delivery of the actions will be identified and managed through risk register.

6 Planning for Fairness Any policies that require to be developed will be assessed according to standards.

7 Engagement and Communication Engagement and communication of findings from Inspection have been delivered. Pat Tyrrell, Lead Nurse

Services for children and young people in Argyll and Bute

18 September 2013

Report of a pilot joint inspection

Argyl & Bute CHP Committee23 October 2013

Item : 10.1a

Services for children and young people in Argyll and Bute: report of a pilot inspection

Contents1. Introduction 1

2. Background 2

3. The Community Planning Partnership area 2 4. Particular strengths that are making a difference to children, young people and families 3

5. Examples of good practice 3

6. How well are the lives of children, young people and families improving? 4

7. How well are services working together to improve the lives of children, young people and families? 6

8. How well do services lead and improve the quality of work to achieve better outcomes for children and families? 8 9. Conclusion and areas for improvement 9

10. What happens next? 9

Appendix 1 Indicators of quality 10

Services for children and young people in Argyll and Bute: report of a pilot inspection 1

1. IntroductionAt the request of Scottish Ministers, the Care Inspectorate is leading joint inspections of services for children and young people across Scotland. When we say children and young people in this report we mean people under the age of 18 years or up to 21 years if they have been looked after.

These inspections will look at the difference services are making to the lives of children, young people and families. They take account of the full range of work within a community planning partnership area including services provided by health visitors, school nurses, teachers, doctors, social workers, police officers, and the voluntary sector.

The inspection teams are made up of inspectors from the Care Inspectorate, Education Scotland, Healthcare Improvement Scotland and Her Majesty’s Inspectorate of Constabulary for Scotland.

A draft framework of quality indicators was published by the Care Inspectorate in October 2012. The indicators in ‘How well are we improving the lives of children, young people and families? A guide to evaluating services for children and young people using quality indicators’ were used by the team of inspectors in their independent evaluation of the quality of services. We have covered all of the quality indicators in this report and reached evaluations for eight of them which are set out in the table in Appendix 1.

This report is published following a pilot joint inspection. This means that future inspections may be carried out differently and the reports we will publish at a later date may take a different format.

2. BackgroundThe pilot joint inspection of services for children and young people in the Argyll and Bute Community Planning Partnership area took place over three weeks in March 2013 and April 2013. It covered the range of services that had a role in providing services to benefit children, young people and families across the Argyll and Bute Community Planning Partnership area including the islands.

This pilot inspection also took a close look at how services had responded to the agreed priorities for action set out in the Care Inspectorate’s report on a joint inspection of services to protect children published in 2011.

Inspectors reviewed documents and spoke to staff with leadership and management responsibilities. They talked to staff who work directly with children, young people and families and observed some meetings. Inspectors reviewed practice through reading a sample of records held by services who work with children and young people. Some of these children, young people and families met with and talked to inspectors. Inspectors are very grateful to all of the people who talked to them as part of this pilot inspection.

Services for children and young people in Argyll and Bute: report of a pilot inspection2

As the findings in this joint inspection are based on a sample of children and young people inspectors cannot assure the quality of service received by every single child in the area.

3. The Community Planning Partnership area and the context for services for children and young people

Argyll and Bute has a population of over 89,500 and is Scotland’s second largest local authority by area. It has the third lowest population density, and has the most inhabited islands. The population is decreasing which is in contrast to Scotland as a whole. The number of children under the age of 16 is projected to fall by 8.7% by 2035.

The Argyll and Bute Community Planning Partnership has members from the public, private, voluntary and community sectors, and the Ministry of Defence. The Partnership has a new Community Plan and Single Outcome Agreement for the period 2013 to 2023, which sets out the vision for achieving improved long-term outcomes for communities in Argyll and Bute. This includes key priorities for children and young people. The partnership has overseen the development of a new vision for services for children and young people: Working together to achieve the best for children young people and families. The Child and Adult Protection Chief Officer Group oversees planning and continuous improvement and the Argyll and Bute Children’s Group is responsible for updating an integrated children’s services plan for 2013 to 2016. This new plan will set out what services will do to achieve the vision using the Getting it right for every child approach.

89,500Population of Argyll and Bute

Predicted population decrease of children under 16:

8.7% by 2035

A Single Outcome Agreement is an agreement between the Scottish Government and community planning partnerships which sets out how they will work towards improving outcomes for Scotland’s people in a way that reflects local circumstances and priorities.

The Integrated Children’s Services Plan is for services which work with children and young people. It sets out the priorities for achieving the vision for all children and young people and what services need to do together to achieve them.


4. Particular strengths that are making a difference to children, young people and families

• The strong commitment to prevention and early intervention.

• A very positive culture of partnership working at all levels.

• The flexible approach to working with families to improve outcomes for children and young people.

• Sound work to promote strong and resilient children, young people and families.

5. Examples of good practiceGetting It Right Antenatal Getting it Right Antenatal is having a significant impact on giving unborn babies the best start in life. It is a highly successful approach to identifying vulnerable pregnant women at an early stage and to providing coordinated support in partnership with other services to improve their parenting skills. This support includes the provision of suitable housing.

Early Intervention ServiceStaff deliver high quality intensive support to vulnerable young people and families. They work closely with other services to give flexible support that helps young people to remain in their own communities, improves their educational achievement and promotes stable caring relationships.

Nurse Co-ordinators Nurse co-ordinators work with children and young people who are looked after away from home, families affected by homelessness, and the gypsy traveller community. They coordinate and communicate information across services and enable families to access the help they need quickly. Their work is highly effective in helping children, young people and families to stay healthy and to be involved and included within their communities.

6. How well are the lives of children and young people improving?

Staff are very effective in recognising when children, young people and families need additional help. They provide flexible support and guidance at an early stage to stop difficulties getting worse. Multi-agency screening of incidents of domestic abuse is helping to ensure that children, young


people and families receive prompt and appropriate assistance. The Getting it right for every child approach is developing very well and most staff carry out their responsibilities with confidence and skill. Vulnerable pregnant women are identified quickly and provided with very effective support. Staff gather comprehensive information and share this appropriately to promote the well-being of children and young people. They maintain detailed and up-to-date records of observations and concerns.

The Getting it right for every child approach is being implemented successfully and staff are highly committed to working together. Children and young people are benefiting from effective collaborative work which promotes prevention and early intervention. Vulnerable children are getting the help they need at an earlier stage to improve their well-being.

Children and young people feel safe within their communities due to the proactive approaches services take to promote safer communities. Staff in education, youth services and police help children and young people to acquire the skills they need to keep themselves safe in a wide range of situations which may place them at risk. Young people living in residential units feel safe in their homes. Children and young people are safer and better protected from harm and abuse due to considerable improvements in the recognition and response to children and young people at risk. Staff work well together to consider all aspects of children’s and young people’s well-being when they respond to concerns. Where necessary, children are moved quickly to suitable accommodation in order to keep them safe.

The health of children and young people is improving. More babies are being breastfed and children have better dental health. Nurse co-ordinators ensure that the health needs of vulnerable children and young people are being met as quickly as possible. Early years services place a strong emphasis on improving healthy lifestyles through outdoor play, attention to hygiene and healthy eating. Social workers, health and education staff respond quickly to the early signs of emotional difficulty and are helping vulnerable young people to develop successful ways of managing anxiety and stress.

Children arrive in primary school better prepared for learning. Literacy rates in young children have improved. Most young people achieve well in schools and more are moving onto positive destinations. Children and young people’s educational progress is monitored carefully to identify potential barriers to their learning. More support is needed to help vulnerable children to achieve their academic potential. Most young people leaving care receive very effective support to develop the skills they need for independence. However, vulnerable young people would benefit from better access to meaningful and sustainable employment opportunities.

Children and young people living in kinship care receive helpful and responsive support. Increasingly, children and young people who are not able to remain at home are able to live in good quality family and residential placements. However, some are waiting too long before the plans for their future care are made permanent.

Getting it Right for Every Child is the Scottish Government’s approach to making sure that all children and young people get the help they need when they need it. For more information, search “GIRFEC” online.

A framework to assess risks and needs is an orderly way of exploring, understanding and recording what is happening in children’s lives.


Young people are very positive about the help they get to stay active, learn new skills and become more confident. However, some young people could miss out through limited access to affordable leisure and recreational activities. Young people benefit from a sense of belonging and positive attitudes within the wider community. Overall, children and young people feel included and listened to. Gypsy traveller children and young people are included and helped to overcome inequalities. Services are successfully preventing and diverting young people from anti-social activity.

Families and carers receive highly effective support from a range of services. There is a strong commitment to including fathers. Families are stronger and more resilient and this is enabling them to provide safer, more nurturing environments for their children and young people. Most families and carers are positive about the flexible help they receive. They feel valued, encouraged to be equal partners and enjoy improved experiences of parenting. They have someone whom they know, trust, and can contact when they need to. A small number of families with long-standing problems need more effective help to accept support and sustain improvements. Families, including kinship carers, would benefit from more opportunities to meet each other in suitable child-friendly places.

The diverse needs of widespread communities are considered carefully when services are being planned. Some local areas such as Tarbert benefit from a wide range of community organisations which very effectively promote health and well-being. This successful approach could be shared more widely in order to make best use of the opportunities offered by voluntary services. Members of the gypsy traveller community have been meaningfully involved in the development of services to meet their needs. Young people are involved in decision-making within their communities through youth forums and the youth bank project.

7. How well are services working together to improve the lives of children, young people and families?

The plan for integrated children’s services for the period 2009-12 has concluded. Partners have continued to work together on implementing Getting it right for every child and improving services for children in need of protection. The way in which the child protection committee carries out its work has been improved and its priorities for improvement are now much clearer and focused on outcomes. While this work is leading to positive improvements, partners have yet to set out a broader set of priorities, objectives and plans to improve services for all children, young people and families. A coherent plan was under development to shape the future of services for all children, young people and families and to meet the needs for public accountability.

The Child Protection Committee brings together all the organisations involved in protecting children in the area. Their purpose is to make sure local services work together to protect children from abuse and keep them safe.


Services are strongly committed to and use a variety of creative ways to consult and involve children, young people, families and other stakeholders when they use services. As a result, young people feel that they are listened to and their views taken into account. Vulnerable young people are benefiting from more effective opportunities to participate in service planning. There is scope to develop joint approaches to involve and consult stakeholders in designing services and shaping plans.

Partnership working is supported through respectful, open communication, and challenge. The Child and Adult Protection Chief Officers Group provides effective strategic direction and governance to the work of the Child Protection Committee and Argyll and Bute’s Children’s Group. Partners are delivering improvements in systems, processes, and practice and have made significant progress in implementing Getting it right for every child. Services are in a positive position to provide increasingly integrated and more effective services for children and young people. Increasingly, partners are making evidence based decisions about the allocation of resources towards early intervention and prevention. There is still much to do to streamline and share resources. A joint strategic approach to resource planning and commissioning is under development to manage resources more effectively.

Services are reviewing and developing their policies, procedures and guidance with the aim of improving services to protect children and support the implementation of Getting it right for every child. A helpful start has been made to developing shared policies and procedures. Staff are asked for their views and the consistent application of policies and procedures is improving. Managers in social work are committed to adhering to statutory timescales for reviewing and making plans for children.

There is a genuine commitment to improving performance and standards with a focus on outcomes. Audit activity is mainly carried out by individual services and there is a growing appreciation of the benefit of jointly assuring quality. Managers are keen to embrace new ways of working and are demonstrating a willingness to do this together through review, audit and governance groups. Services now need to develop a systematic approach to quality assurance across services. Arrangements for supporting and managing staff in health and social work services have been strengthened. Managers are aware of where they need to provide additional support and guidance to help staff raise standards.

Overall, staff recognise circumstances when children might be at risk of harm and usually take prompt action to protect them. Suitable accommodation is found for children and young people who need to be cared for in a safe place. Staff keep helpful chronologies of significant events, however, they need to improve how they use these to identify concerning patterns and risks to children and young people. Health assessments of young children carefully identify additional health needs and any support that is needed. The quality of assessment of risks and needs has improved but is still too variable. A few children experiencing neglect are not getting the help they need soon enough and a shared understanding of neglect is needed across services.

Staff generally work well together to plan for individual children and young people. Further work is needed to reduce the number of different plans and planning. Most vulnerable children and young people have a care or child protection

A personal plan or child’s plan lays out exactly what support will be provided, and in what way, to meet the child’s needs. The plan also records their views and wishes.


plan. The quality of these plans is variable and they do not always set out all the actions needed to keep children and young people safe or improve their wellbeing. Services are working more effectively together to provide young people with a disability with the right level of support to help them move into adulthood. Independent Reviewing Officers provide effective support and challenge to staff to ensure that plans lead to action and that children and young people experience positive change. Services are improving planning for children and young people who are unable to return home but the full impact of this has yet to be realised.

Staff across services listen carefully to the views of children, young people and families. They treat them with respect and take their views in to account when making decisions. They help families understand what needs to happen to make positive improvements in their lives. High quality independent advocacy support is available to children who are looked after away from home or whose names are on the child protection register. More children and young people could benefit from this. Children and families are kept well informed even when they are mistrustful of services. Complaints about services are addressed effectively.

The Getting it right for every child approach has improved joint working across services. This and multi-agency training is contributing to a strong culture of trust and working together. There are examples of creative and flexible deployment of staff to intervene early and deliver better outcomes for children, young people and families. There is scope to introduce joint approaches to workforce planning, training and development aligned to the new integrated children’s services plan. Overall, staff receive support and challenge to help them improve their work. They are valued and highly motivated and making a positive contribution to improving the well-being of children and families.

8. How well do services lead and improve the quality of work to achieve better outcomes for children and families?

The Community Planning Partnership has overseen the development of a new vision for children’s services. Leaders have engaged staff and young people very effectively in developing this vision, which is uniting staff around a common purpose and shared values. A recently formed corporate parenting board is at an early stage in defining its responsibilities. Leaders demonstrate a strong commitment to promoting equality and inclusion and this is shared by staff.

Strategic direction has been focused appropriately on improving services to protect children and young people and in implementing Getting it right for every child. Partners have shared responsibility for addressing areas of weakness and building sustainable strengths. Leaders should now ensure the new integrated children’s services plan is completed and published. This will provide an opportunity to jointly agree how recent service reviews and plans for restructuring services can ensure that the right services are in the right places.

Leaders have been influential in promoting positive working relationships and an ethos of teamwork


at all levels. Leaders and senior managers are becoming more visible and responsive to staff. Staff are confident about the future of services. Partners are taking steps to strengthen the capacity of leadership at all levels. Services have taken collective ownership of the findings from inspection and reviews, and have taken positive steps to make the necessary improvements to ensure children in need of protection are kept safe. Leaders now need to build on this to ensure continuous improvement in the quality of services for children, young people and families.

Leaders have made a promising start to introducing a systematic approach to joint self-evaluation and should build on the skills and knowledge that already exist to take this forward. This has been enhanced by the experience of the validated self-evaluation exercise carried out in conjunction with Education Scotland. A new culture of respect and openness to challenge is developing well. Services are becoming more self-aware and understand the areas that require further improvement. Leaders are motivated to learn and test out new ways of working. Staff would benefit from more opportunities to share best practice and benchmark against others. Services are at an early stage in developing children, young people and families in self-evaluation.

The Single Outcome Agreement features a number of key performance indicators for children and young people, and improving trends are reported for most. There are steady and improving trends in child health, educational achievement and in positive destinations for young people as they leave school. Partners are reducing outcome gaps for children and young people whose life chances are at risk and are clear about outcomes that require further improvement and are taking appropriate steps to do so. Partners now need to measure the key outcomes being achieved through early intervention and preventive approaches.

9. Conclusion and areas for improvement Services are working very well together in partnership which is underpinned by a positive culture of respect and openness. Strong leadership and direction is supporting successful collaborative working. Staff are united with a common purpose within the Getting it right for every child approach which in turn is having a positive impact on the well-being of children, young people and their families. Considerable improvements have been made in the immediate response to children in need of protection and providing help and support to children, young people and families at an early stage. Leaders are highly committed to consolidating these improvements and are clear about where to focus their work to build capacity and consistency. Together, services have made a positive start to leading and directing resources towards prevention and early intervention. Steady progress is being made against most performance indicators for children and services are highly committed to measuring the impact of their work together. There are plans to introduce systematic joint self-evaluation to support improvement.

Self-evaluation means taking a close look at what services have done and how well they have done it. It is important because it helps people to see clearly where they need to make improvements.

A Single Outcome Agreement is an agreement between the Scottish Government and Community Planning Partnerships which sets out how each will work towards improving outcomes for local people.


Inspectors are confident that services will be able to make the necessary improvements in the light of the inspection findings. In doing so the Argyll and Bute Community Planning Partnership should take account of the need to:

• secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children

• complete and implement the integrated children’s services plan• continue to develop rigorous and systematic joint self-evaluation to improve outcomes for

children and young people• ensure continued leadership and direction is provided to implement the planned improvements

for services for children, young people and families.

10. What happens next?The Care Inspectorate will ask the Argyll and Bute Community Planning Partnership to publish a joint action plan detailing how it intends to make any improvements identified as a result of the inspection.

The Care Inspectorate and other bodies taking part in this inspection will monitor progress and continue to offer support for improvement through their linking arrangements.

Judith TaitInspection LeadSeptember 2013


Appendix 1: Indicators of quality Quality indicators help services and inspectors to judge what is good and what needs to be improved. In this pilot inspection we used a draft framework of quality indicators that was published by the Care Inspectorate in October 2012 called ‘How well are we improving the lives of children, young people and families? A guide to evaluating services for children and young people using quality indicators’. This document is available on the Care Inspectorate website.

Here are the evaluations for eight of the quality indictors.

How well are the lives of children and young people improving?

Providing help and support at an early stage Very good

Impact on children and young people Good

Assessing and responding to risks and needs Adequate

Planning for individual children Adequate

How well are services working together to improve the lives of children, young people and families?

Planning and improving services Adequate

Participation of children, young people, families and other stakeholders Good

How good is the leadership and direction of services for children and young people?

Leadership of improvement and change Good

Improving the well-being of children and young people Good

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This report uses the following word scale to make clear the judgements made by inspectors.

Excellent outstanding, sector leadingVery good major strengthsGood important strengths with some areas for improvementAdequate strengths just outweigh weaknessesWeak important weaknessesUnsatisfactory major weaknesses

To find out more about our inspections go to www.careinspectorate.com

If you wish to comment about any of our inspections, contact us at [email protected] or alternatively you should write in the first instance to the Care Inspectorate, Compass House, 11 Riverside Drive, Dundee, DD1 4NY.

Our complaints procedure is available from our website www.careinspectorate.com or alternatively you can write to our Complaints Team, at the address above or by telephoning 0845 600 9527.

If you are not satisfied with the action we have taken at the end of our complaints procedure, you can raise your complaint with the Scottish Public Services Ombudsman (SPSO). The SPSO is fully independent and has powers to investigate complaints about government departments and agencies.

You should write to SPSO, Freepost EH641, Edinburgh EH3 0BR. You can also telephone 0800 377 7330, fax 0800 377 7331 or e-mail: [email protected]

More information about the Ombudsman’s office can be obtained from the website at www.spso.org.uk

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We have offices across Scotland. To find your nearest office, visit our website or call our Care Inspectorate enquiries line.

HeadquartersCare InspectorateCompass House11 Riverside DriveDundeeDD1 4NYTel: 01382 207100Fax: 01382 207289

Website: www.careinspectorate.comEmail: [email protected] Inspectorate Enquiries: 0845 600 9527

This publication is available in other formats and other languages on request.

Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile manithear iarrtas.

© Care Inspectorate 2013Published by: Communications


Item : 10.2

Contact Details Strategic Lead Name Derek Leslie Job Title Director of Operations, Argyll & Bute CHP Email Address [email protected] Telephone # 01546 605646 Name Sally Loudon Job Title Chief Executive, Argyll & Bute Council Email Address [email protected] Telephone # 01546 605522 Operational Lead Name Pat Tyrrell Job Title Lead Nurse, Argyll & Bute CHP Email Address [email protected] Telephone # 01546 605645 Name James Robb Job Title Head of Adult Care/CSWO, Argyll & Bute Council Email Address [email protected] Telephone # 01369-708627 Third Sector Lead Name Glenn Heritage Job Title Chief Executive Officer, Argyll Voluntary Action Email Address [email protected] Telephone # 01631 564839 Independent Sector Lead(s) Name Anna Houston Job Title Scottish Care Email Address [email protected] Telephone # 07733 432373

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Other Key Contacts Name Fiona Sharples Job Title Acting Project Manager Email Address [email protected] Telephone # 07717 430 273 Partnership Argyll and Bute Contact Name(s) & Job Title(s)

Pat Tyrrell Lead Nurse

Email Address [email protected] Telephone # 01546605645 Date of Completion

September 27 th 2013

1. Examples of impact Please complete a case study template (Annex 1) describing at least one achievement that your partnership has made through use of the Change Fund for each of the Reshaping Care Pathway workstreams (i.e. we would like at least 5 in total to be submitted):

• Preventative and Anticipatory Care; Proactive Care and Support at Home; Effective Care at Times of Transition; Hospital and Care Home(s); Enablers.

Each case study should be no more than one page long, with at least one of the case studies highlighting either a direct or an indirect impact on carers . Question 7 below contains short descriptors of interventions in the pathway. 2. Learning from what hasn’t worked as well as anti cipated The Change Fund has been an opportunity for Partnerships to explore innovations that are ‘Proof of Concept’ or ‘Tests of Change’. Please describe any shareable learning gained from initiatives where a decision not to continue has been taken – e.g. where barriers to progress were encountered or the initiative was not found to be effective. It is still early in the change process to identify the impact of all the areas in which we have invested Change Fund money. Areas of investment which we are revisiting to ensure that we do achieve the required outcomes include the: - Approach to Reablement. - Partnership with Independent Sector - Scaling up of telehealthcare

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3. Option Appraisal Please describe any option appraisal approaches used to decide Change Fund investment priorities – e.g. whether applied to all / only selected initiatives and who was involved.

• An option appraisal approach has been used for £120,000 of the Change Fund. The 4 localities (Cowal and Bute, Helensburgh and Lomond, Mid Argyll, Kintyre and Islay, and Oban, Lorn and Isles) were each allocated £30,000 to decide how best to utilise this investment. They were given a framework to support their decision making, adapted from a JIT tool.

• The framework requires partners from all sectors (NHS, Council, Third and Independent sectors, service users and carers) to have been involved in the local decision making process at the RCOP Locality Implementation Group, as well as sign off by them and the sector leads. In one area this led to a decision to use some of the investment to support the increase of the level of Anticipatory Care Plans.

• In another area the decision was made to support a Befriending Scheme to support older people and volunteer scheme to support hospital discharge, and a small amount was used to support Team Dances events for older people and carers.

4. Use of Data and Information Please describe your local progress and any barriers to effective use of data and information between partners (both within and out with the statutory sector). Progress

• The Joint Strategic Health Needs Assessment has been completed and is informing the development of the Joint Commissioning plan

• Outcomes framework has been developed on Argyll and Bute Council’s Performance Management system, Pyramid – this includes both national and local data

• Work is ongoing currently to review the proposed reporting framework in line with recent changes to the number of performance measures

• The Performance Management Group has been established to review and redesign the current framework of measures

• MiDIS is being implemented across all NHS community services (including community hospitals). This will work alongside the Carefirst system used in social work to provide joint data on key performance measures.

• Currently both systems remain separate in relation to joint staff accessibility. The agreed use of the electronic Personal Outcome Plan (POP) assessment across the partnership, provides the data link between these systems and it is expected that data from both Carefirst and MIDIS will be available to populate the joint RCOP measures

• Within community resilience data is and has been tracked from the outset and much is shared with older people when discussing need for future development / initiative in turn supporting co-production – this has been particular case for the Men’s Shed in Oban which has now come to fruition and had the evidence of type of work /

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practical support and considerations which would help form this project; also shared with Salvation Army who have partnered with AVA to establish the resource.

Barriers

• Problems relating to the lack of an integrated IT system, and access to single health or social care systems is seen by many staff as a significant barrier to effective joint working. This currently leads to wasted staff time finding and accessing data and information.

• Different collecting systems are not able to communicate with each other.

5. Improvement support Please provide details of any support you would welcome.

• Webex sessions to share progress and challenges in maintaining the momentum and commitment for change would be helpful especially with focus on self directed support, reablement, self management, anticipatory care, telehealthcare, community development and cross sector commissioning

• Learning sessions on commissioning • Ongoing support to ensure continued involvement for older people via the reference

group – in which ever format is decided by service users. There may be for example, links which could be made in other areas to support continued profile.

• National social marketing campaign about RCOP. Public acceptance and buy in is at

the heart of what we are trying to achieve and so it would be good to see some national work on this.

• Virtual link up with the RCOP Managers on a regular basis might also help with the

sharing of improvement stories and promote a collaborative approach and sharing across Scotland.

• Practitioners’ forums at Team Leader level to share developments and to develop

skills and enthusiasm for managing change at local levels.

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6. Budget 2013/14 Please insert details of your 2013/14 Change Fund budget and the proportion of spend aligned to each of these 5 workstreams:

2011/12 2012/13 2013/14 SG Allocation £1,710,00 £1,954,000 £1,954,000 Additional Local Resources (if any)

£0 £0 £0

Carry Forward N/A £1,000,000 £1,000,000 Total Allocation £1,710,000 £2,954,000 £2,954,000 Year-end Spend £710,000 £1,954,000 £2,454,000

(anticipated)

Anticipated Carry Forward to 2014/15 £500,000

Direct spend on carers (year-end spend)

N/A £300,000 £300,000 (anticipated)

Indirect spend on carers (year-end spend)

N/A £300,000 £300,000 (anticipated)

Preventative and Anticipatory Care

Proactive Care and Support at Home

Effective Care at Times of Transition

Hospital and Care Home(s)

Enablers

Total (should equal 100%)

2011/12 (year-end spend)

% % % % % %

2012/13 (year-end spend)

33% 30% 24% 2% 11% 100%

2013/14 (anticipated year end spend)

32% 55% 5%

0% 8% 100%

7. Assessment of Spread The Reshaping Care Pathway represents 4 ‘bundles’ of interventions, approaches or actions and the related enablers which collectively improve outcomes for older people. As you take forward Joint Commissioning, it is important to understand the extent to which you have spread new approaches and improvements so that you can understand where and when future gains can be anticipated. Therefore we invite Partnerships to complete a self-assessment of spread as at September 2013 by assigning a position statement 0-5 to each approach or intervention in the pathway.

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Spread Value

Self-Assessment Position Statement

0 No agreed plan to implement the approach / intervention / improvement action

1 Agreed plan to take forward the approach / intervention / improvement action but not yet began to implement

2 Testing / implementing the approach / intervention / improvement action in a minority of localities / sites / teams / older people / carers

3 The approach / intervention / improvement action has spread to most localities / sites / teams / older people / carers

4 The approach / intervention / improvement action has spread to all localities / sites / teams / older people / carers but is not yet fully embedded in routine practice

5 The approach / intervention / improvement action is fully embedded in all localities / sites / teams / older people / carers and there is an agreed plan to sustain this

Preventative and Anticipatory Care Value (0-5)

Build social networks and opportunities for participation

We are mobilising community support through volunteering, building community capacity, collaborations and social enterprises that promote participation and meaningful activity for older people living at home and in care homes.

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Early diagnosis of dementia

We continue to work to increase the number of people with dementia who have a diagnosis as this improves access to support and services for the family.

4

Prevention of Falls and Fractures

The Partnership is implementing the recommendations of Up and About: a whole system pathway for the prevention and management of falls and fragility fractures.

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Information & Support for Self-Management & Self-Directed Support

Practitioners and services signpost older people towards community and third sector resources that help them to stay well, to manage their conditions and provide useful and accessible information and advice on the choices they have about their future care, support and housing. This includes post diagnostic support for people affected by dementia and information and support required to adopt personal budgets.

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Prediction of risk of recurrent admissions

Community health and social care teams routinely use a risk prediction tool (e.g. SPARRA) and local health and social care data and intelligence to identify older people who are frail and at greatest risk of emergency admission to hospital or care home.

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Anticipatory Care Planning

Care providers support frail older people and their carers to develop Anticipatory Care Plans (ACPs): a summary or shared record of the preferred actions, interventions and responses in the event of an anticipated deterioration in the health of the person or their carer.

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Support for carers

Our health and care staff routinely identify carers and are able to signpost them to information, advice and support from social work, carers centres and other agencies to help them to stay well and be supported to continue in their role.

4

Suitable and varied housing and housing support

We are investing in handyperson services, housing support, making better use of our existing stock of sheltered housing and developing new specialist provision to help older people maintain their independence and reduce the risk of accidents at home.

4

7

Proactive Care and Support at Home Value (0-5)

Responsive flexible, self-directed home care

All providers of care and support at home adopt a “doing with” approach and formulate packages of care and support around the individual’s personal goals. This includes the opportunity to adopt personal budgets for care and support.

3

Integrated Case/Care Management

Multi-disciplinary community health and social care teams adopt an integrated case / care management approach to monitor and proactively support frail older people with complex and changing needs at greatest risk of emergency admission to hospital or care home.

3

Carer Support and Respite

We provide opportunities for short breaks to help carers continue to provide care, helping reduce isolation, providing a better quality of life and maintaining carers’ health and wellbeing.

3

Rapid access to equipment

There is effective and timely access to health and social care equipment and adaptations and this is an integral part of mainstream community care assessment and service provision.

4

Timely adaptations, including housing adaptations

We have streamlined access to adaptations and alterations which help older people to maintain their independence at home.

3

Telehealthcare

The partnership provides remote monitoring and assistive technology for older people with complex care and support needs who require this technology to remain supported in their own home.

3

Effective Care at Times of Transition Value (0-5)

Reablement & Rehabilitation

Health and care practitioners adopt an enabling approach and all providers have a focus on maintaining independence, recovery, rehabilitation and re-ablement.

2

Specialist clinical advice for community teams

Primary and community health and care staff, including voluntary and independent sector partners, are supported by access to a range of specialist practitioners for advice on common important conditions in older people such as dementia, continence, nutrition and tissue viability.

3

NHS24, SAS and Out of Hours access ACPs

Community teams share essential information from ACPs (e.g. electronic Key Information Summary) with local emergency and out of hours services and with SAS and NHS24.

3

Range of Intermediate Care alternatives to emergency admission

Working alongside NHS24, SAS and Out of Hours services we provide rapid access to a range of enabling assessment and treatment services at home, in minor injuries units, day hospitals, community hospitals and care homes as safe and effective alternatives to acute hospital admissions and to support timely discharge.

3

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Effective Care at Times of Transition Value (0-5)

Responsive and flexible palliative care

We provide timely access to community based support for palliative and end of life care to increase the proportion of older people who are able to die at home or in their preferred place of care.

4

Support for carers

We promote shared decision making and make sure that carers are informed and supported to help them continue in their role when the health of the person they care for deteriorates or they move to another care setting.

4

Medicines Management

Joint working between GPs, community pharmacists, mental health teams and geriatricians reduces polypharmacy for older people through mindful prescribing, review and reconciliation of medicines and use of pharmaceutical care plans. We support older people and their carers to administer and take medication safely.

2

Access to range of housing options

The range of intermediate care services provided includes timely accessible housing options for people whose functional ability has acutely declined.

2

Hospital and Care Home(s) Value (0-5)

Urgent triage to identify frail older people

Pathways through A&E and admissions wards are configured to identify frail older people with physical, functional and cognitive impairments who will benefit from coordinated comprehensive geriatric assessment.

2

Early assessment and rehab in appropriate specialist unit

Frail older people with physical, functional and cognitive impairments and those who have fallen are ‘pulled’ to access multi-professional Comprehensive Geriatric Assessment within 24 hours of emergency admission to hospital.

3

Prevention and treatment of delirium

Pathways through acute hospitals minimise boarding for frail older people and care staff are trained to prevent, detect and effectively manage delirium.

3

Effective and timely discharge home or to intermediate care

All partners work together and with Scottish Ambulance Service to optimise use of estimated date of discharge, improve discharge planning and eradicate delayed discharges, including delays in short stay specialty beds and for Adults with Incapacity.

3

Medicine reconciliation and reviews

Medicine reconciliation is routinely undertaken for older people on admission and at discharge from hospital and care homes, and antipsychotic prescribing is minimised.

3

Carers as equal partners

We identify the carer at an early stage when the person is admitted to hospital and ensure that the carer is involved in the care, rehabilitation and discharge planning.

3

Specialist clinical support for care homes

We provide specialist clinical support to enable care homes to have a greater role in intermediate care and to support staff to care for older people with dementia and palliative / end of life care needs.

3

Enablers Value

(0-5)

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Enablers Value (0-5)

Outcomes-focussed assessment

Our providers of care and support deliver personalised care through assessments which focus on personal outcomes and goals agreed with the older person (and their unpaid carer).

3

Co-production Services are planned and delivered in an equal and reciprocal relationship between professionals, people using services, their families and the community.

3

Technology/eHealth/Data Sharing

We routinely share information across professionals and teams in line with agreed data sharing protocols and using the capability of emerging technology.

2

Workforce Development/Skill Mix/Integrated Working

We are developing a multi-professional workforce that is integrated, capable and fit for the future with core generic skills and appropriate specialist competencies.

3

Organisational Development and Improvement Support

We engage and communicate effectively with all partners, with our workforce and the public, and collaborate across professions and sectors to strengthen strategic leadership for change and to build improvement capacity and capability.

3

Information and Evaluation

We routinely use measurement for improvement and feedback performance measures to our staff and to the public to lever and assure quality.

3

Commissioning and Integrated Resource Framework

Statutory, community, third and independent sectors, users, carers, providers and commissioners of care come together to agree long term service development and investment proposals including where and how resources should shift from current services and care models to new arrangements. We are using the Integrated Resource Framework to lever a shift in the totality of the partnership spend on service and support for older people.

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8. Any additional comments? The format of this Mid Year review is helpful to facilitate reflection on progress made, spread so far and where to focus future work. The Improvement Stories are also concise and will help to capture the myriad of work going on across Argyll & Bute and across Scotland and facilitate the sharing of the learning from this. Thank you for taking the time to complete this mid-year review. Please return this template, along with at least 5 case studies using the pro-forma in Annex 1, to [email protected] by Friday 27 September 2013.

Annex 1 – Examples of Impact

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As per Question 1, please complete the following template for each example of achievement your partnership has made through use of the Change Fund for each of the Reshaping Care Pathway workstreams. We would like at least one example for each workstream, with at least one of the case studies highlighting either a direct or an indirect impact on carers . Note – This paper is designed to show highlights and not a full case study and should be no more than one page long, allowing readers to have access to further information, if helpful. Please remember to ‘tag’ the case study appropriately on the next page. Submitted case studies will be published on the JIT website.

Reshaping Care and Integration Improvement Network

Partnership Argyll & Bute Name of Initiative Highlighted ‘Moving, for indepen dence’ Date of Submission 27-09-13 Primary Contact Glenn Heritage Email [email protected] Telephone # 01631-564839 Pathway: Preventative and Anticipatory Care 1. Summary Please summarise the case study in one paragraph of no more than 100 words.

• Wrap around support provided by timebank volunteers to enable a safe move from one accommodation to a better suited, safer home; retaining independent living and enabling the older person to control and choose the actual move itself.

• Maintaining that independence, enabling a move at nil cost, enabling the pace to be suited overcame the anxieties and fears which were overshadowing need to move house and made settling in supported by volunteers a comfortable and safe process. It also removed the need to move into a care home as the easiest option and family preference.

2. What was the issue you were addressing or workin g on?

1. Client accommodation was unsuited for older person safe independent living (first floor, no lift, many steps, poor layout)

2. Person was frightened by thought of moving; family has pressed to ‘go into a home’ – clearly not older person’s preference.

3. GP confirmed suitable ground floor accommodation meant no need for move to care home or similar

4. Greatest barrier was older persons fears – how could I manage to move, how can I afford to move, how do I deal with everyone (who?), how do I pack / unpack. Do I have to give up independence because I am too old to cope.


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3. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement)

• An older person (Jean) had been introduced to timebank earlier in year. When location and stairs were threatening independence, this was talked over with the Community resilience and timebank volunteer co-ordinator from Argyll Voluntary Action.

• After discussing and talking about Jeans situation both Jean and the co-ordinator were convinced that an independent move was what she person wanted, and not a move into a care home which seemed the option her family felt was inevitable.

• The worker set about sourcing everything and all people who could be mobilised to source property and facilitate a move. Volunteer driver and support assisted with accommodation to be identified. That done, support with landlords was made available.

• Volunteers cooked in advance, packed, talked through process with Jean – always ensuring that she stayed in control and made her own choices.

• Entirely through the timebank and peer support, the packing and unpacking was completed, the house being left was cleaned, transport by trailers and van carried all possessions, the new home was also cleaned and food and meal ready.

• An entire house move was made possible and, more importantly, Jean can look forward to some more years living independently whilst not feeling her family are constantly worried that she will fall or that it ‘will all be too much’. With smaller, well arranged ground floor accommodation and a visit from timebank volunteers, Jean hopes to enjoy her new home for as long as possible.

4. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?)

1. Choice was maintained with client at the centre of service 2. Independence is protected and maintained for possibly some years 3. Impact of cost was reduced utilising peer support networks and timebank volunteers 4. Wellbeing is reinforced and measures taken to safeguard this (e.g. safety, meals,

contact) 5. Need for provision through residential care is removed and family reassured parent is

safe (and they do not have to do anything) 6. Ongoing contact support is in place and access to social networks 7.

Timeline from start to completion was 2 months. This is the fourth move which has been entirely completed through timebank. What has been learned is the fear of coping with move is a major factor for older people – anecdotally, it is reported that moving to a care home ‘is the easier option, not the same as the preferred option’ from a family perspective.

5. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Glenn Heritage – Argyll Voluntary Action [email protected] Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g.


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Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

Preventative and

Anticipatory Care

Case Study

Proactive Care and Support at

Home

Case Study


Case Study


Case Study


Y


Reablement & Rehabilitation Y







Y Carer Support and Respite




Y Rapid access to equipment








Telehealthcare Support for carers


Support for carers




Y


Enablers

Outcomes-focussed assessment Y Co-production Y Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework Note – This paper is designed to show highlights and not a full case study and should be no more than one page long, allowing readers to have access to further information, if helpful. Please remember to ‘tag’ the case study appropriately on the next page. Submitted case studies will be published on the JIT website.


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Partnership Argyll & Bute Name of Initiative Highlighted Third sector promoti ng self management in

falls prevention Date of Submission 27-09-13 Primary Contact Christine McArthur Email [email protected] Telephone # 01700501549 Pathway: Preventative and Anticipatory Care 6. Summary Please summarise the case study in one paragraph of no more than 100 words.

• A focus group with older people was conducted with Argyll Voluntary Action and the falls prevention workstream to modify the language and messages in a falls prevention ‘lunchbox’ resource developed and presented at a JIT workshop by Dr Heather Hall for use by Sheltered Housing wardens.

• The ‘third sector box’ is delivered by Argyll Voluntary Action at present but the plan is to train volunteers to deliver it to their peers to raise awareness of modifiable falls risks across Argyll and Bute. The interactive resource contains key messages and is designed to engage older people. The box contains examples of a good shoe, a crunchie and aero (to demonstrate the differences between osteoporotic and normal bone) and wipes to clean glasses.

7. What was the issue you were addressing or workin g on? Falls in older people are common and lead to increased anxiety and depression, reduced activity, mobility and social contact and greater dependence on health and social services. There are many risk factors that can be altered to reduce the risk of falls and raising awareness can resulting behaviour change however older people are often resistant to public health messages on falls. Communicating messages in a way that’s acceptable to older people is challenging (Age UK, 2012). 8. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement)

• Educational resources were developed in Argyll and Bute by the falls workstream on modifiable falls risk for health and social care and independent sector workers. Third sector partners were also keen to be involved. The ‘lunchbox’ resource from the JIT workshop was identified by the falls prevention coordinator and permission was granted by Dr Heather Hall to modify it for delivery by the third sector. Delivery notes were developed by the falls workstream to ensure it is delivered in a consistent way. Argyll Voluntary Action (AVA) were involved in the development of the notes and in trialling the resource. A focus group of older people provided feedback and wording was changed to provide key messages on modifiable risk. Leaflets from Age UK


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were sourced based on feedback from AVA that this would allow the best advice to be passed on to people for them to act on. AVA have cascaded the resource across Argyll and Bute and plan to train volunteers to deliver it to their peers in a variety of settings to groups of older people. The resource encourages group discussion and debate.

• The Change Fund has funded this work in Argyll and Bute. The resource was

demonstrated previously at a JIT workshop and adapted to suit community delivery by volunteers with minimal training. Funding for printing of the resource has been allocated from the falls workstream to make 50 boxes available for dissemination across Argyll and Bute.

9. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) Argyll Voluntary Action have requested that the third sector box should be easily available and printed in a similar way to the other high quality resources that were developed in the falls workstream. At present AVA have to print the slides and laminate them and gather the contents for the box. A number of the resources will be printed and made available across the area. AVA will cascade the resource and its delivery through using volunteers in peer delivery to older people and collate data on the number of people reached. The printed versions will be available by Dec 2013.

10. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Gwen Harrison [email protected] Christine McArthur Falls prevention coordinator [email protected] Stephanie Hay - Resource Developer [email protected] Once submitted, this case study will be published to the JIT website. We would also like to put the example on the RCOP website locally so we can share the learning. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care)


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In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

Preventative and

Anticipatory Care

Case Study


Home

Case Study


Case Study


Case Study


y









Y Carer Support and Respite














Support for carers

y Medicines Management




Enablers

Outcomes-focussed assessment Co-production Y Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working Y OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework


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Partnership Argyll & Bute Reshaping Care Partnershi p Name of Initiative Highlighted Visiting Friends sup port Date of Submission 27-09-13 Primary Contact Glenn Heritage Email [email protected] Telephone # 01631564839 Pathway: Preventative and Anticipatory Care. 11. Summary Please summarise the case study in one paragraph of no more than 100 words. This initiative tackles social isolation and support to maintain independence through a blend of timebank support, befriending and a focus on person centred outcomes. 12. What was the issue you were addressing or worki ng on? Person of 90, isolated within her community since the death of husband, struggling with long term and deteriorating condition; feeling lonely and unable to cope with her garden yet resistant to ‘giving up’ and moving into care. 13. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement)

• As a 90 year-old, life-long resident of Helensburgh and a former school dinner lady, M.M raised her and own family whilst caring for generations of primary school kids. M.M. had been a very active member of the community and spent many happy years with her husband in Helensburgh. This year, after 60 years of marriage she lost her husband. He had helped her a great deal in the house as in recent years she was diagnosed with macular degeneration, a condition which is severe and worsening. Her husband was also the gardener, and MM loved her garden and the smell of flowers.

• Alone in the house every day and unable to get out, occupational therapy referred M.M. to Visiting Friends. The Visiting Friends co-ordinator met with M.M. and her daughter and all agreed to start a befriending relationship. Meeting to identify the outcomes MM hoped for it became clear that not only did MM feel lonely but was upset and distressed at the state of her beloved garden, which had huge emotional significance for her. She said it had been a source of pride for her and her husband and that he had won local awards for the garden. Although it was going to take a little time to implement befriending, assisting with the now neglected garden was somewhere we could make an immediate start. Gardening volunteers from AVA were working in M.M’s garden within a week.

• After months of neglect, M.M’s garden was once again taking shape and a buzz of activity. The overgrown bushes in front of her door was pruned back so M.M. could see if anyone was approaching. ‘It’s been sounding like the United Nations in my back garden…they have been wonderful. It is so good to hear laughter again’ M.M’s


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daughter said having the volunteers in the garden was a huge help for her too and really helped to lift her mom’s spirit. Soon after the gardening work, M.M had an initial friendly visit from her befriending volunteer. ‘It’s the happiest I’ve seen my mum in a long time.’ Said her daughter. M.M would eventually like go to a group for the partially-sighted in a nearby local church. Her befriender can now help to make this possible. ‘I am so grateful for all you have done for me.’ MM has said she cannot believe how her life has changed and the new opportunities now available.


1. Isolation and loneliness is reduced with befriending 2. Emotional well being is improved; a garden can be a physical reflection of how

someone feels. Neglected, it was as lonely as MM herself. 3. Peer support and contacts through timebank volunteers 4. Practical support and help around the home 5. Independence is maintained 6. Further support, and social contact is available

15. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Glenn Heritage, Argyll Voluntary Action [email protected] Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

Preventative and

Anticipatory Care

Case Study


Home

Case Study


Case Study


Case Study


Y


Y Reablement & Rehabilitation Y















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Y







Support for carers





Enablers

Outcomes-focussed assessment Y Co-production Y Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working OD and Improvement Support Information and Evaluation Y Commissioning and Integrated Resource Framework


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Reshaping Care and Integration Improvement Network Partnership Argyll & Bute Name of Initiative Highlighted Information for All Date of Submission 27-09-13 Primary Contact Gwen Harrison Email [email protected] Telephone # 01369 700100 Pathway: Preventative and Anticipatory Care. 16. Summary Please summarise the case study in one paragraph of no more than 100 words.

• How to try and promote awareness and a greater understanding of the 3rd and independent sector to health and council staff.

• Promoting the services that third sector and independent sector can and do already provide for older people and how they can prevent avoidable admissions and delayed discharges. Also how to access the organisations and services their, referral systems, costs etc

17. What was the issue you were addressing or worki ng on? To promote NHS & council staff to start to think about what’s available out with the services that they normally use, there are a lot of smaller services that could be better utilised to ensure people don’t have to stay in hospital if medically they don’t require treatment there.


• Information day at Cowal community hospital – Two fold. Where 3rd & independent had information stalls to network with each other and promote what they do and staff from hospital and council would visit and also find out whats available.

• They were all given case studies of an instance where an older person needed some

assistance in some way and by speaking to the exhibitors they had to complete the case study.

• There was a small allocation of money to provide a lunch so staff could make better

use of the time by having lunch at the same time.


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• The exhibitors and the staff gained a great deal from the event, they all fed back that the case studies made them think and engage more. They learned from organisations that they had dealt with before some other services they provided that they were unaware of. They also learnt about some that they had not encountered before as well as how best to access and refer into in the future as well as waiting lists, costs etc.

• There is planned to be a follow up event later this year or early next, and there have

been enquires from other areas to replicate there as it went a big step in providing information in regards to third sector services and building community capacity.

20. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Once submitted, this case study will be published to the JIT website. We would also like to put the example on the RCOP website locally so we can share the learning. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care)


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In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

Preventative and

Anticipatory Care

Case Study


Home

Case Study


Case Study


Case Study


Y


Y Reablement & Rehabilitation Y





Y



Carer Support and Respite Y




Y Rapid access to equipment Y


Y


Y



Y Responsive and flexible palliative care



Y Telehealthcare Y Support for carers

Y Carers as equal partners

Support for carers

Y Medicines Management



Y


Y

Enablers

Outcomes-focussed assessment Co-production Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework


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Reshaping Care and Integration Improvement Network Partnership Argyll & Bute Name of Initiative Highlighted Training resources f or all partners : Modifiable

falls risks and Multifactorial Screening Date of Submission 27-09-13 Primary Contact Christine McArthur Email [email protected] Telephone # 01700501549 Pathway: Preventative and Anticipatory Care. 21. Summary Please summarise the case study in one paragraph of no more than 100 words.

• Training resources for falls prevention were developed in Argyll and Bute to raise awareness of modifiable falls risk factors with all staff working with older people. The training for care staff supporting older people at home was developed in partnership with independent sector providers.

• Falls in older people are common and are associated with increased rates of hospitalisation, increased dependency, restriction of daily living activities and higher rates of institutionalisation among older people. Reducing falls is a key focus of Reshaping Care for Older People and reablement after a fall is vital to enable people to regain maximal function.

22. What was the issue you were addressing or worki ng on? Fall related injuries in older people are a major public health challenge and an unnecessary cause of ill health and mortality. It is estimated that one in every three people over the age of 65 years and one in two people over the age of 80 years fall every year. Staff had identified that there was a lack of awareness that falls could be prevented and action wasn’t taken until after a fall had occurred. The role of exercise was often overlooked and although staff could identify who was unsteady on their feet they were not aware that this could be improved through specific exercises to improve strength and balance.


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• Educational tools were developed to encourage interaction during training as this facilitates learning. Scottish Care, NHS Highland and Argyll and Bute Council staff and the national falls programme manager were consulted in developing the training.

• There are two resources – one for staff caring for people in their own homes and one on multifactorial screening for falls risks and onward referral to evidence based interventions. Printed workbooks are provided for both training sessions for staff to be able to reference the information as required.

• Training is delivered in face to face sessions by physiotherapists across Argyll and Bute to independent sector carers, care home staff, Health and Social Care Support Workers and Health and Social Care staff on a rolling programme. This embeds the approach and learning locally. Costs of developing and delivering the training and costs of the printed resources are covered by the Change Fund.


• In NHS Highland multifactorial screening to identify modifiable falls risk to reduce falls is part of the community falls prevention pathway. Community based interventions can lead to reductions of 30% reduction in falls however consistency and equity in delivery of such interventions is a key factor.

• Implementing screening for modifiable falls risks and the provision of evidence based interventions will result in a consistent approach to reduce falls in those at high risk across the Highland area. Previous work has indicated that the evidence base for prevention of falls was not well understood. Training and educational needs were identified for staff and other agencies who would be carrying out Multifactorial Falls Risk Screening and working with older people at high risk of falls. Independent sector providers also identified training needs around falls and have been involved in the development for training to address modifiable falls risk and support of evidence based balance and strength exercises (individually prescribed by a physiotherapist).

• Through Reshaping Care for Older People development, funding and face to face delivery of the training has been possible in each locality in Argyll and Bute.

A key learning point is

• attendance is enhanced when the Team Leader for Older People who is responsible for commissioning services liaises directly with independent care providers and requests their full support

25. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Christine McArthur, NHS Highland Co-ordinator for Prevention and Management of Falls [email protected] Steph Hay, Resource Developer [email protected] Mary Wilson, Lead AHP A&B, [email protected] Catherine McLoone, Team Leader for Older People catherine.mcloone@argyll-


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bute.gov.uk Partnership Argyll & Bute Name of Initiative Highlighted Such a thing as a fr ee lunch Date of Submission 27-09-13 Primary Contact Glenn Heritage Email [email protected] Telephone # 01631 564839 Pathway: Preventative and anticipatory care. 26. Summary Please summarise the case study in one paragraph of no more than 100 words.

• People were clearly expressing a need for social interactions and a meal, which was not regimented, which was open to all, and which was fun.

• There were very few ‘lunch clubs’ in Argyll and in some areas none. Some were well funded, most for older people only and there was no funding to staff others. We needed solutions which met peoples needs more closely, preserved dignity, and did not require additional funding to be sought.

• We ultimately established seven lunch cafes, or music and lunch groups, mixing social interaction, nourishing food, volunteer support, transport and equitable access within the remits of the existing community resilience work.

27. What was the issue you were addressing or worki ng on?

• People were telling us how they enjoyed coming together over a meal but either could not get out on their own (mobility factor), could not afford to visit a café or restaurant (income / poverty factor), and did not want to feel they were the recipients of ‘charity’ (independence and dignity factor). People were clear they did not want a solely ‘old peoples lunch’ at a set time and where they could not meet and share with anyone, whatever age.

• So, we needed flexible times – an open café approach; lunch or soup and sandwiches but also social activity; transport to enable access for those who could not get out on their own; accessible premises; and a huge amount of volunteer support coupled with older people themselves to shape the service they wanted.

• This, then was to address social isolation, poor nutrition, building peer networks, and supporting independence.


• Initially, we listened to what people were telling us. We then sought further views from potential service users so each area – and this encompasses Oban, Mull, Lorn, Lochgilphead, Dunoon – had slightly different aspirations.

• We sought volunteers who would help cook, bake, support community resilience staff (who also cook and bake), assist at premises, and others who could offer transport.


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• Then we sought ‘free’ or almost free premises – and found them with support from local council, from Community Centres, various church premises, and within sheltered housing where we could open up to the wider community.

• In Lochgilphead for example, it is a lunch café – open for a few hours and open to all. Older people are joined by those from other organisations such as MS Centre or Dochas and by all ages. People can drop in or make their own arrangements and time to meet as we all would do at any café. Volunteers prepare, cook, serve and wash up. This led to a second group and to support to a group in Tarbert extending the services.

• In Oban, the group has a different clientele and they meet over soup and sandwiches with music, sometimes dancing and other occasional activities. Other organisations such as Carers and Alzheimers have service users who attend and everything from food to music to transport is provided voluntarily. This has now extended to Lorn and to Mull.


• In each are social isolation is reduced. • People have access to home cooked nutritious food • Peer networks and friendships are formed in an informal setting • The services are non discriminatory • Volunteers and older people shape the service, and have a sense of ownership • Dignity is something highly regarded in our evaluations – almost no one wanted ‘an

old persons lunch club’ – people did not want to be treated differently, they just wanted to access social activities, meet friends over tea or coffee and a meal.

• There is also an opportunity to comment on services, to be involved in developments and to discuss topics if people wish to do so.

• Because the activities are not funded separately, they are simply an add on, then they can continue for as long as there is a community resilience worker to organise and support volunteers; people themselves contribute to cost of meals although only if they are able to afford – no one is turned away. This was at the explicit request of older people – the desire not to be seen as ‘charity’. However, this is minimal and our volunteers supplement with their donations (as well as some shops and supermarkets).

30. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available)


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Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

Preventative and

Anticipatory Care

Case Study


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Case Study


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Y Carer Support and Respite Y














Support for carers





Enablers

Outcomes-focussed assessment Co-production Y Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework


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Reshaping Care and Integration Improvement Network Partnership Argyll & Bute Name of Initiative Highlighted Improving access for carers to services enabling

carers to adopt a self management approach to health improvement through skill development

Date of Submission 27-09-13 Primary Contact Christine Bell Co-Ordinator Crossroads,

Crossroads Caring for Carers SCIO Cowal &Bute Email Telephone # 01369 707700 Pathway: Proactive Care and Support at Home •Summary Please summarise the case study in one paragraph of no more than 100 words. To Improve access for all carers throughout Cowal &Bute to services which enable carers to adopt a self management approach to health improvement through skill development. Provide information and access to services which will support the carer to achieve and sustain the model of health promotion. What was the issue you were addressing or working o n?

• Building on and improving pre-existing support structures for carers particularly those in rural locations improving access to services. Improving access to information. Building strong relationships with partner organisations to continue to develop joint working opportunities to ensure the carer has the ability to make informed choices and decisions in future care planning. Developing a planned approach for ongoing development of self management skills.

What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement)

• Through the outreach project and development of carers centre services Crossroads focused on planning and delivering opportunities to develop skills relating to the self management approach to health promotion and highlighted the positive outcomes that can be achieved though engagement in the interventions. We provided 12 carers training places in the Mindfulness Based Approaches to Stress Reduction (MBSR) course with a planned staying mindful group. This also provided an opportunity to develop peer support and socialisation opportunities and some of the carers who attended continued to meet out with the training sessions and also went on holiday together.

• Through partnership with the NHS developing exercise groups for carers to promote

health and wellbeing /self management. Developed and run support group and drop in session for carers throughout Cowal & Bute. Dementia Group continue to promote the guide for families living with dementia in Cowal & Bute and have established a strong working relationship with the Alzheimer’s Link Workers to ensure carers have


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access to a holistic approach of support. Ongoing projects have also included joint working with Argyll Voluntary Action and the Rotary club to develop memory cafes and memory boxes. Started a group for carers supporting those with a mental health diagnosis. Directive working with carers through home visits from outreach worker to ensure the carer is well informed and supported.

• Set up a weekly carers club where carers can meet up over lunch and develop strong

peer support relationships. • Access to holistic therapies at the carers’ centre and outreach project as part of a self

management programme. • Education and promotion of relation techniques and how to adapt them into the every

day life of a carer. • Organised and ran health and wellbeing promotion events focusing on healthy

eating. Provision of health promotion and self management materials and carers were able to enjoy pamper sessions including hair and makeup and massage of choice.

• Provided over 50 health promotion and self management packs to carers throughout Cowal and Bute containing vital information on health improvement strategies.

• Improved Carers opportunities and access to social events by respite provision to allow carers to attend a number of outing such as lunch at Portavadie, theatre trips and other social events.

• Promoted the need and benefits to carers of short breaks in the self management approach to improved health and wellbeing and assisted many carers to secure and enjoy a short break through funding applications and organising the break with reported benefits in the well-being of the carers documented through carers’ evaluations.

• Assisted a family to attend conference specifically related to improving knowledge and understanding of the cared for persons with long term conditions.

• Carers centre now has installed a Carers pod which has been programmed to promote a variety of self management and health promotion tools specifically tailored to carers needs where carers can work through a programme of prompts raising awareness of vital health matters and can have blood pressure taken and weight recorded independently with the pod and will be prompted to focus on health improvement strategies as appropriate. This project is a joint partnership with the NHS.

• Crossroads is working on a further project in partnership with the NHS in providing training for staff to complete the counterweight management programme and aims to offer opportunities to carers throughout Cowal & Bute to engage in this health improvement programme accessed through the outreach project.

• Crossroads is working alongside the NHS to offer Keep Well Health Checks to all carers in the target age group through the outreach project and at the carers centre this is a further joint working project to promote health and wellbeing for carers.

What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?)

• Through carers’ evaluation of outreach project and all other events the overall feeling was that carers feel better informed and better supported to continue in there caring role. Carers’ awareness of the need to focus on self health improvement and self management skills has been increased and many carers stated that they have adopted these strategies into the everyday life as a carer but many continue to need encouragement and support to do so. This is an ongoing project which will continue through the change funding programme of the outreach worker and is reviewed


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through evaluation annually.

Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Maggie Clarke – living it up ( Dallas project manager) Alison Hardiman – Senior Health Promotion Specialist Dorothy Gordon – Alzheimer’s Scotland link Worker Kerry Noor – Alzheimer Scotland link Worker Gwen Harrison – Community Resilience Worker Once submitted, this case study will be published to the JIT website. We would also like to put the example on the RCOP website locally so we can share the learning. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

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Outcomes-focussed assessment Co-production Y Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework


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Partnership Argyll & Bute Reshaping Care Name of Initiative Highlighted ‘Training built arou nd us’ Date of Submission 27-09-13 Primary Contact Glenn Heritage Email [email protected] Telephone # 01631-564839 Pathway: Choose an item.

Proactive Care and Support at Home 31. Summary Please summarise the case study in one paragraph of no more than 100 words. For the first time a training package has been entirely co-produced locally by older people, volunteers, Alzheimer Scotland Resource Centre and Argyll Voluntary Action; designed, produced and road tested with older people at the centre of development. 32. What was the issue you were addressing or worki ng on? The need for training that was merged and developed, if you will, to find the right balance between the needs of our clients and the needs of our volunteers. Existing training for befrienders was felt too ‘cold’ and failed to take into account the range of needs and aspirations of older people themselves – and the relationships which develop from such initiatives. Older people and volunteers were unimpressed with existing training, and had viewed several packages; this was a truly co-productive approach. 33. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement)

• Argyll Voluntary Action Community Resilience Staff worked with Alzheimer Scotland, initially to review the befriending training as based on the national Befrienders' Network. This was discussed with older people and with volunteers who wished to become befrienders and found to be wanting; it did not cover those aspects older people felt were most important and although not unusable there was agreement between older people, volunteers and the two organisations AVA and Alzheimer that this could be made much more relevant and appropriate if time were taken to co-design and co-produce a training toolkit and course which had input from all stakeholders. From using the Resource Centre over a period of meetings the essence of the course was discussed, amendments made were these met the demands and needs of local people resulting in a revised training course for volunteers which has been entirely co-produced from start to finish. Clearly, it was helpful to have a starting point but importantly, a range of views were incorporated including volunteers who would be the befrienders. By joint working between Alzheimer Scotland and AVA no costs were attached to this exercise and befrienders feel more confident with the training received.


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1. Co-production is seen as more than a principle; it is a reality with organisations supporting the principle into practice.

2. Volunteers are confident they have skills which are not only appropriate, but which meet the needs and demands of older people

3. Older people have been involved and have ownership of the training which underpins a volunteer run service

4. Older people originally were clear that befriending should be volunteer run and being involved in this development has strengthened that view

5. The exercise was carried out over just 4 weeks, the benefits are a service which matches and meets demand and need and the cost is minimal.

6. This also reduces any need to purchase expensive training from a national network 7. Integrity and safety are in built and relevant checks are made; there is no loss of

value or relevance in the support and training offered.

35. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Argyll Voluntary Action. [email protected] Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

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Prediction of risk of recurrent

Timely adaptations,

Responsive and flexible palliative

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admissions including housing adaptations

care reviews




Support for carers





Enablers

Outcomes-focussed assessment Co-production Y Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working Y OD and Improvement Support Information and Evaluation Y Commissioning and Integrated Resource Framework


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Reshaping Care and Integration Improvement Network Partnership Argyll & Bute Name of Initiative Highlighted North Argyll Carers Centre – Outreach Service Date of Submission 27-09-13 Primary Contact Morag MacLean Email [email protected] Telephone # 01631 564422 Pathway: Proactive care and support at home 36. Summary Please summarise the case study in one paragraph of no more than 100 words. Self referral prompted by information from GP. Carer A struggled with being classed as ‘a carer’ and took some time before she felt able to access our support. Carer A living in rural area who had to move to another rural area due to progressive long term condition of their partner. Carer A felt isolated and despondent about the future. Concerned about the viability of living in area and also had to give up work. Through engagement with the Outreach Support Worker and wider team carer A is now accessing therapies, training, a condition specific carer support group and a will access a rural support group in October. Carer A has recently offered to volunteer in the centre. “If it wasn’t for you guys I would be stuck in the house, not seeing anyone” 37. What was the issue you were addressing or worki ng on? Carer isolation and confidence in caring role. 38. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement) On registration carer A was introduced to a designated Outreach Support Worker and time was spent building the relationship. Issues were addressed and signposting to other areas of the organisation and to external support occurred. Carer A was encouraged to become part of a condition specific peer support group in the centre and introduced to other carers in her locality who were instrumental in supporting Carer A and partner accept their new location. Carer A also has accessed, craft activities and carer training including relaxation and wellbeing sessions. The Change fund has enabled us to have a designated worker supporting rural carers and is enabling us to start new peer support groups in remote and islands areas. One such is starting in Carer A’s in October.


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39. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) Outcomes : Carer feels more confident and able to cope with caring situation, carer able to access support relevant to personal situation, carer fulfilment in volunteering and contributing to the local community.

40. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Once submitted, this case study will be published to the JIT website. We would also like to put the example on the RCOP website locally so we can share the learning. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

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Reshaping Care and Integration Improvement Network Partnership Argyll & Bute Name of Initiative Highlighted Delivering Choice Pr ogramme Date of Submission 27-09-13 Primary Contact Jen Layden Email [email protected] Telephone # 0141 557 7538 Pathway: Effective care at times of transition 41. Summary Please summarise the case study in one paragraph of no more than 100 words. The Marie Curie Delivering Choice Programme (DCP) was commissioned by Argyll and Bute via the Change Fund. The DCP programme focuses on service redesign of palliative and end of life care. The Programme has three phases:

1. Needs and gaps analysis of current service provision 2. Identification and development of services and initiatives 3. Implementation of services and initiatives.

42. What was the issue you were addressing or worki ng on? To identify palliative and end of life care needs in Argyll and Bute

1. To understand the gaps in the delivery of palliative and end of life care 2. To develop and support cross partnership working in the area of palliative and end of

life care. 3. To develop new services and initiatives to improve palliative and end of life care

43. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement) Using a whole systems programme management approach, the DCP programme to date has been successful in identifying local palliative and end of life care needs. The mapping of existing services for palliative and end of life care was undertaken between September 2012 and May 2013, culminating in a Phase 1 review report. The review report identified perceived gaps in the provision of palliative and end of life care, and a number of themes were identified for further solutions. The following areas were highlighted as key themes to develop services and initiatives:

1. Improving the culture of death, dying and bereavement through health promoting palliative care

2. Improving support for carers of people with palliative and end of life care needs 3. Improving access to transportation for palliative and end of life care patients and their

carers 4. Improving access to out of hours support and services for palliative and end of life


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care 5. Reassessing the role of care homes in palliative and end of life care.

Four stakeholder workshops were held to discuss these themes. The attendee list below shows the range of stakeholders present. Sector Staff groups/organisations NHS GP; Occupational therapy; community nursing team (nursing and

HCA); clinical services managers; Macmillan nurses; Marie Curie nurses; Dementia link workers; Health Improvement staff; pharmacist; physiotherapist; Respiratory specialist

Social work Performance Management Assistant; Service Co-ordinator (Health and Social Care)

Independent sector

Allied healthcare; Argyll Community Housing Association; Carewatch; Scottish Care; Carrgomm; Clydeview Care home; Ardfenaig Care Home; Struan Lodge; Thompson Court residential home

Third Sector Oban hospice community services; Red Cross; Alzheimer’s Scotland; Argyll Voluntary Action; Dochas Centre; Interloch Transport; North Argyll Carers Centre

Other representatives

Public Partnership Forum; Volunteers/carers; Oban Hospice Board; Cowal Palliative Care Implementation group; Kilfinan Community Council

Following the workshops, the following service options and initiatives are being developed into full business cases including; a new model for 24/7 integrated home support for palliative and end of life care patient; training and education; developing best practice guidance for remote rural patients travelling outwith Argyll and Bute for health appointments; raising awareness campaign around death, dying and bereavement. Implementation for new services and initiatives will begin in Autumn 2013. 44. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) The full benefits of the programme will be realised following the implementation phase. The programme has been successful in fostering ownership and partnership working between all sectors involved in palliative and end of life care. The outcomes we envisage from the DCP are as follows:

• Increase home support for palliative and end of life care • Increase awareness of death, dying and bereavement • Increase the numbers of palliative and end of life care patients dying in the preferred

place of death • Reduction in avoidable admissions in last 6 months of life from all community settings


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• Building support and confidence in carers of palliative and end of life care patients.

45. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) http://www.mariecurie.org.uk/en-GB/Commissioners-and-referrers/Commissioning-our-services/pilot-projects/Argyll-and-Bute-project/ Once submitted, this case study will be published to the JIT website. We would also like to put the example on the RCOP website locally so we can share the learning. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

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Y Medicine reconciliation and reviews


Y Telehealthcare Support for carers

Y Carers as equal partners

Support for carers

Y Medicines Management


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Enablers

Outcomes-focussed assessment Co-production


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Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework


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Note – This paper is designed to show highlights and not a full case study and should be no more than one page long, allowing readers to have access to further information, if helpful. Please remember to ‘tag’ the case study appropriately on the next page. Submitted case studies will be published on the JIT website.


Partnership Argyll and Bute Name of Initiative Highlighted Reducing Emergency A dmissions to Hospital Date of Submission 27-09-13 Primary Contact Pat Tyrrell Email [email protected] Telephone # 01546605645 Pathway: Hospital and Care Home 46. Summary Please summarise the case study in one paragraph of no more than 100 words. Multi disciplinary group established in each area to meet on weekly basis to review each person who has been admitted to hospital as emergency in preceding 7 days. With engagement of hospital and community nurses, social work and AHP staff (as well as consultant/GPs) and local managers the group use set of prepared questions to interrogate the reasons for admission and to identify what work could have been done a) further upstream to prevent the crisis and b) at time of crisis to prevent admission. 47. What was the issue you were addressing or worki ng on? We knew that more older people were being admitted to hospital as emergency than was desirable and we wanted to identify how we could avoid these crises in people’s lives from occurring 48. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement)

• Established weekly scrutiny meetings in each hospital • Prepared and adapted question set for use in each area • Collated the findings to inform local and area wide planning • Fortnightly telephone conference calls set up for the leads in each hospital


• Reduction in number of emergency hospital admissions across 5 sites • Improved, more joined up approach across care pathways • Better understanding by professionals in all settings of services available in local


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areas • Identification of gaps and local solutions • Implementation of Virtual Ward to support management of those at higher risk of

hospital readmission • We need to aggregate the information from each hospital to identify further areas for

development

50. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Pat Tyrrell, Lead Nurse, Argyll and Bute CHP Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies plea se enter a Y into each and every box you think this applies to, being cognisant of the prima ry pathway chosen on the previous page:

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Partnership Argyll & Bute Name of Initiative Highlighted Workforce Developmen t Passport Date of Submission Primary Contact Mary Wilson Email [email protected] Telephone # Pathway: Enabler – Workforce Development 51. Summary Please summarise the case study in one paragraph of no more than 100 words.

• The RCOP programme board had several workstreams taking forward different aspects of the full programme across the partnership.

• Many of these workstreams identified training and learning needs to support staff at all levels across all sectors to deliver against the service outcomes the partnership identified as required for the delivery of the new model of care.

• An event supported by the board illustrated the availability of 108 such sessions making it very difficult for teams and managers to know who and what to prioritise within this.

• To address these concerns a Cross Sectoral Workforce Development Group was set up to review all development activity for the partnership.

52. What was the issue you were addressing or worki ng on? Having identified 108 sessions that were available for staff across the partnership to attend teams and managers were struggling to understand what was ‘must dos’ for the team and what would support staff development but not necessarily support delivery of the new model of care. There was a lack of clarity about the work of the programme board and what actual outcomes were expected or why. 53. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement) The Workforce Development group has membership from each sector across the partnership and we reviewed the original list of 108 events. Three priorities were agreed as below –

1. Core requirement to ensure implementation of the Mo del of Care – essential to all groups identified

2. Will support the embedding of the Model of Care and /or CPD opportunity – essential to all teams but can be address individual eventually

3. Enhance community resilience and/or CPD opportunity or clarity required – excellent for team but generally personal development

The group populated new lists for each of these priorities with a total of 21 sessions being agreed from the original 108. A workforce development passport was developed around these that outlined who these sessions were targeted at and what the organisational and


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service outcomes were being addressed by each session. This passport has now been agreed and circulated across the partnership to be used in conjunction with the usual partnership frameworks/policies for development. 54. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) Much more clarity for leads and managers as well as for staff across the partnership about the development opportunities available and required for the delivery of the new model of care. The passport was designed to offer information on the work of the programme board and explain how everyone in the partnership links into this work on a day to day basis.

55. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Jean Armitage – Alzheimer Scotland. Anna Houston – Independent Sector Julie Thomson – Independent Sector Glenn Heritage – Argyll Voluntary Action Jayne Lawrence-Winch – council Area Manager Jennifer Swanson – OD Council Linda Skrastin – Clinical Service manager Sally Munro – OD Health


Item : 11.1

Service Level Agreement Status Report Report by Stephen Whiston, Head of Planning Contrac ting & Performance The CHP Committee is asked to:

• Note the status of SLA’s with NHS Greater Glasgow & Clyde, other Health Boards & providers and for services purchased from the CHP

• Note the progress of updating the Acute SLA in line with the Audit Committees recommendations on quality standards

• Note the progress of ongoing monitoring and review procedures

•

1 Background

The purpose of this paper is to update the CHP Committee on progress with regard to Service Level Agreements (SLA’s) for services provided to the Argyll and Bute population for 2013/14.

2 Introduction

SLA’s are required to ensure access to specialist health services for the residents of Argyll and Bute and to account for the expenditure incurred as a result. Most of these services are provided by NHS Greater Glasgow and Clyde (GG&C). Agreements are also in place with other bodies including other NHS Boards and increasingly with other statutory and voluntary organisations. 3 NHS Greater Glasgow & Clyde – Acute SLA

3.1 Value The roll forward value of the Acute SLA, based on the 2012/13 payment, has been agreed at £44,740,715 to which there will be an inflationary uplift of 2.76%. Discussions concerning the additional £5 million sought by GG&C are continuing. The funding gap is attributed to the Cross Boundary Flow Model which GG&C wish to adopt in preference to the Tribal Model currently in use. The funding shortfall identified by the Cross Boundary Flow model can be attributed to activity growth, changes in service provision and changes in the model itself. 3.2 SLA Documentation The Acute SLA agreement with GG&C is in the process of being reviewed and refreshed to reflect updated legislation and guidance as well as the current service profile. Although GG&C will not formally sign off the SLA due to the funding issues it is anticipated that this will be a working document by November. 3.3 Quality Standards As part of a recommendation arising from an internal audit report the NHS Highland Board Audit Committee requested that a set of quality indicators be established for inclusion within SLA’s. The purpose of these indicators is to provide a mechanism for reviewing the quality of care provided by other health boards so that formal regular assurance is received to ensure that services provided by other NHS Boards are meeting the specified quality standards. It was agreed with NHS Highland’s Clinical Governance Team and NHS Highland’s Planning Department that the National Standards for Clinical Governance and Risk Management,

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October 2005 should be used as appropriate quality standards within SLA’s with other NHS Boards as there is no updated guidance from Healthcare Improvement Scotland at present. The CHP has also developed a list of reports which are required in order to provide regular assurance against these quality standards (see Appendix 1). The CHP is currently going through an iteration process with GG&C to establish which performance reports are available aligned with GG&C governance and performance processes and which ones require to be developed over an agreed timeline. The proposals were endorsed by NHS Highland’s Audit Committee in September 2013 and will now be included in the revised Acute SLA documentation as well as any other SLA’s being developed or renewed with other NHS Boards. 3.4 Monitoring The CHP continues to meet with senior management of NHS GG&C to consider and address operational and financial issues pertaining to the services it commissions. The 2 sets of meetings are:

i. SLA Finance Group (membership detailed in Appendix 2) The group continues to meet on quarterly basis to oversee the SLA financial arrangements including agreeing costs, variations and exclusions, managing financial risks between both organisations, taking account of West of Scotland Regional Planning arrangements as well as monitoring financial and activity performance. Discussions at forthcoming meetings will focus on addressing:

o The shortfall between the 2013/14 rates according to the Tribal Model and Cross Boundary Flow Model

o The increasing range and cost of services excluded from the Acute SLA o The development of separate SLA’s and subsequent activity schedules &

costs for Laboratories, Radiology & Mental Health o Consultant Outreach service profiles, variations & cancellations

ii. SLA Operational Review Group (membership detailed in Appendix 2)

The group continues to meet on a quarterly basis to review and monitor the operational delivery of services against the SLA, addressing issues and progress against action agreed. There is also an emphasis on ensuring equitable access for Argyll and Bute patients to GG&C services by having these formal arrangements.

These regular meetings have ensured that there is an excellent working relationship with Glasgow colleagues and has highlighted where focused work has been required. The meetings also provide a useful platform to discuss and address any issues experienced by locality managers/operational managers and to work with GG&C colleagues to resolve these. Discussions at forthcoming meetings will focus on addressing:-

o The implications of NHS GG&C’s Clinical Services Review for Argyll and Bute patients.

o The roll out of Trackcare in Argyll and Bute and the interface with the GG&C Trackcare system

o The output from the Radiography Review in Argyll and Bute o The development of SLA’s for Laboratories & Radiology o The update of the Acute SLA o Any Outreach SLA Operational Issues

4 Service Input SLA’s (Community and Non-Clinical S ervices):

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These are SLAs for individual clinical or support services delivered by NHS GG&C and are detailed in Appendix 3. 4.1 Review Meetings Responsibility for these SLAs sits with operational managers who should be regularly meeting with NHS GG&C colleagues to review the services being delivered in line with the specification, standards and key performance indicators set out in the SLA. The contracting department is available to support these reviews as required, however operational managers have the responsibility of ensuring that these reviews take place on a regular basis and that there is up to date activity information to aid the discussions. It has been agreed by the CHP Core Team that should reviews not be taking place, despite attempts from the responsible officers from Argyll and Bute CHP, the provider will be notified at the beginning of each year that there will be a reduced payment in the SLA unless a satisfactory review meeting is concluded. This notification will be made by the Head of Planning, Contracting and Performance at the formal SLA Finance meeting with providers. A number of review meetings have taken place in 2013-14 as detailed in Appendix 3. 4.2 Outreach Consultant Services

Finance and planning managers meet with locality management, clinical services managers and medical records officers on a six monthly basis to monitor the delivery of outreach services to each locality. The meetings focus on clinic provision in line with service need, waiting times and any clinic cancellation issues. The total baseline value of the outreach SLA is £821,114 and the value of variations and clinic cancellations across localities reported in the year to date is estimated at £2884. Any issues arising should be addressed by locality management with the relevant GG&C operational manager and escalated to the planning department should any significant issues arise and fail to be addressed between the operational managers. All formal variations to clinics are issued by the planning department. 4.3 Sign off 2013/14 Values As in previous years, values for both service input and outreach SLA’s will be uplifted to the basis of actual cost, the 2013/14 value has therefore yet to be finalised. The 2012/13 value of these agreements was £5,478,365 (see details in Appendix 3). 4.4 New SLA’s Work is underway to develop separate SLA’s with GG&C for Laboratories, Radiology and Mental Health which were previously components of the Acute SLA. Having separate SLA’s and activity schedules for these services will allow the operational managers and clinicians involved to have more ownership of the SLA’s, a better understanding of the services included in the SLA and closer scrutiny of the activity and associated costs. The 2013/14 Laboratories proposal from GG&C based on current identified activity shows a £53,566 funding shortfall whilst the Radiology proposal shows a funding gap of £46,034. GG&C have confirmed that they will be looking for the additional funding within this financial year. The CHP Head of Finance and Head of Planning Contracting and Performance will be reviewing the costs of these and the Mental Health SLA with GG&C colleagues throughout the remainder of this year. 4.5 SLA Terminations The CHP has served notice on the following SLA’s which will terminate on 31st March 2014:-

Table 1 – Service Input SLA Terminations

SLA No. SLA 2012/13

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Value £ 5 Estates Services – Helensburgh & Lomond 45,583 31 Public Health Information Services 22,050

Estates services for Helensbrugh & Lomond will be provided in house with additional term contracts following the termination of the SLA. Alternative arrangements have been made with colleagues in Inverness to provide public health information materials following the termination of the SLA. 5 Other Providers In addition to purchasing services from GG&C, the CHP also purchases services from other providers, including other Scottish Health Boards and voluntary organisations. The CHP also commissions services jointly with Argyll & Bute Council. The tables 2 & 3 below lists these SLA’s

Table 2: SLA’s – Other Health Boards

2012/13 Provider (Service)

Value £ Ayrshire & Arran 114,765 Borders 1,817 Wos Cardiac Consortium - Golden Jubilee 783,490 Golden Jubilee - Drug Eluting Stents 70,950 Childrens Hospice 12,159 Implantable CV Defibrillators - Golden Jubilee 90,025 Dumfries & Galloway 12,851 Fife 9,861 Forth Valley 36,261 Interventional Cardiology - Golden Jubilee 194,163 Grampian Acute Services 32,937 Grampian Telecardiology Outreach to Oban 3,000 Highland Renal Dialysis - Belford & Raigmore 101,889 Highland Acute Service 267,532 Highland New Craigs (Mental Health Inpatients) 100,740 Cardiac Resynchronisation Therapy - Golden Jubilee 101,880 Lanarkshire 52,721 Lothian Activity Excluded from SLA 62,632 Lothian 212,568 Neo-Natal Transport 49,912 Wos Reperfusion Service 84,744 Regional Services SLA - Golden Jubilee 10,854 Tayside 63,373 Thoriac Services - Golden Jubilee 200,829 Western Isles HB 307 Wos Sexual Health Service - Forth Valley 4,137

TOTAL 2,676,397 Table 3: SLA’s & Contracts – Other Providers

2012/13 Provider (Service)

Value £ Lomond & Argyll Advocacy Service * 91,464 Alzheimer Scotland - Action on Dementia ** 74,905 Argyll Voluntary Action (Guided Self-Help Workers) *** 46,735 Arthritis Care Scotland 11,546 Scottish Ambulance Service (Inter-Hospital Transfer, Cowal & Bute) 142,016

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Independent Optometrists (Diabetic Retinopathy Screening Programme)

38,123

TOTAL 404,789

* This figure is the CHP’s contribution only. The total annual contract value is £174,682

** This figure is the CHP’s contribution only and is a Part Year Effect. The total contract value for 2012/13 was £84,495 and for 2013/14 is £129,490 of which the CHP’s contribution will be £119,900. Argyll and Bute Council are the lead agency for this contract.

*** The 2012/13 payment was Part Year Effect. The Full Year Effect for 2013/14 is £95,182. 5.1 New SLA’s & Contracts In 2013 SLA’s and Contracts have been signed off with the following:-

• Nine GP’s to provide a Medical Incident Officer Service throughout Argyll & Bute, the 2013/14 value of these is expected to be £2,700 with additional payments in line with call out activity, training requirements and the purchase of equipment

• Seven independent general dental practices across Argyll and Bute to provide clinical dental services for the emergency dental service, the value of the contracts in 2013/14 will be on an activity/call out basis

• Buchanan’s to deliver an Orthotics service across Argyll & Bute CHP, the expected cost of this for 2013/14 is £51,480 with additional costs for supplies

Work is also underway or planned to develop SLA’s and Contracts with the following:-

• Cowal Hospice Trust for the provision of Palliative Care Services in Cowal Locality • Two independent optometrists to provide Optical Coherence Topography Scans in

the Campbeltown and Oban areas • An independent optometrist to provide a hospital based optometry service in Lorn and

Isles Hospital to support the Ophthalmology clinics • Argyll and Bute Council for the provision of domestic and catering services in Mull

and Iona Community Hospital 6 Services provided by Argyll & Bute CHP under SLAs to other commissioners

The table below lists these SLA’s

Table 4: Services Purchased from CHP

2012/13 Issue/Provider

Value £

NHS Education for Scotland (Dental Outreach at Campbeltown Dental Centre)

207,188

Argyll & Bute Council (Choose Life) 83,000

Argyll & Bute Council (Speech and Language Therapy) 119,757

TOTAL

409,945 In addition to the above work is underway to develop SLA’s & Contracts with the following:-

• An independent dental practice for the lease of Campbeltown Dental Centre which is expected to commence by November 2013

• An independent dental practice for the lease of Oban Dental Centre which is expected to commence by November 2013

• An independent dental practice for the purchase of domestic services and access to a Local Decontamination Unit in Oban Dental Centre

• Argyll and Bute Council for the purchase of domestic, cleaning & catering services at Gortonvogie Residential Home on Islay

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7 Contribution to Board Objectives This work directly contributes to the Health Boards corporate objectives and local delivery plan regarding finance, quality and redesign. 8 Governance Implications • Staff Governance

Not applicable

• Patient and Public Involvement

Applicable with regard to service review or redesign

• Clinical Governance

In line with the NHS Highland Board Audit Committee’s recommendations on quality standards.

• Financial Governance Aligned with financial management plan. Financial risks noted.

• Risk Assessment

Key financial risks documented

• Planning for Fairness

In line with current equality legislation

Report prepared by: Kirstin Parker

Service Planning & Contracts Manager 24th September 2013

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Appendix 1 - Information Requirements/Standards of Practice & Quality

(Excerpt from Argyll & Bute CHP Draft Acute Patient SLA 2013/16) Annual Review

Report

Frequency Date Received

Annual Report Annually

In advance of review meetings

Local Strategic Plan Annually


Local Delivery Plan

(including progress in meeting targets

& trajectories set for reduction of

Waiting Times and abolition of Activity

Status Codes)

Annually


Where this information is provided to the relevant West of Scotland Regional Planning Consortia, the

Consortia will assume the role of Commissioner in this respect. It is the responsibility of the CHP to

participate actively in all relevant consortia.

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Standards of Practice and Quality

Standard

Report Frequency Date

Received

HEI Reports & Completed Action

Plans

As issued by HIS

action plans Quarterly

OPAC Reports and Action Plans As issued by HIS

action plans Quarterly

Infection Surveillance Reports

Quarterly

Datix Reports

Quarterly

Pressure Ulcer Rates

Quarterly

Falls Rates

Quarterly

SPSP Reports

Quarterly

Standard 1 –

Safe and effective care and

services

• Risk management

• Emergency and

continuity planning

• Clinical

effectiveness and

quality

improvement

CQI Reports

Quarterly

Patient Survey Reports

Six Monthly

Complaints Reports

Six Monthly

Staff Survey Reports

Annually

Standard 2 –

The health, wellbeing and

care experience

• Access, referral,

treatment and

discharge

• Equality and

diversity

• Communication

Performance Report

Annually

Referrals to Professional Bodies Annually

Standard 3 –

Assurance and

accountability

• Clinical Governance

and quality

assurance

• Fitness to practice

• External

communication

• Performance

management

• Information

governance

Standards defined in Clinical Governance & Risk Management National Standards 2005

Activity

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Report

Data Frequency Date

Received

Number of people seen in the

previous month

Categories of Patients – i.e.

inpatient elective; day case etc

Speciality and sub speciality

Reason for admission

Expenditure

Patients postcode

Patients CHI Number

Patients Date of Birth

Patients GP

Monthly Activity Report

(Note A&B SLAs with NHS

GG&C due to scale of

activity report profile will

be summarised and

frequency will range from

quarterly to annual)

Referring agency if not GP

Monthly

Numbers of procedure/tests

conducted in previous month

Categories of Patients i.e.

Laboratory, Radiology

Speciality and sub speciality i.e.

Radiology – CT, Barium etc

Expenditure

Patients Postcode

Patients CHI Number

Patients Date of Birth

Patients GP

Monthly Data Set of Direct

Referral Activity

(Note A&B SLAs with NHS

GG&C due to scale of

activity report profile will

be summarised and

frequency will range from

quarterly to annual)

Referring agency if not GP

Monthly

Waiting Times

Report Data Frequency Date

Received

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Comparison of actual time for

patients on the waiting list to

agreed national waiting time

targets (highlighting all Patients

who are in breach of target)

Waiting times for patients

awaiting first outpatient

appointment analysed by

speciality and time period on

waiting list

Details of the waiting times for

patients awaiting combined for

outpatient appointment and

diagnostic pathway target,

analysed by speciality and time

period on waiting list

Details of the waiting times for

patients on the waiting list for

inpatient and day case treatment

analysed by specialty and time

period on waiting list

Monthly Waiting Times

Report

Relevant information on all

patients affected by “New Ways”

rules

Monthly

Appendix 2 – NHS Greater Glasgow & Clyde SLA Review Meeting Membership SLA Finance Review Group Argyll & Bute CHP George Morrison Head of Finance (chair)

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Morven Moir Commissioning Accountant Kirstin Parker Service Planning & Contracts Manager Stephen Whiston Head of Planning Contracting & Performance NHS Greater Glasgow & Clyde Jonathan Best Director of Regional Services Andrew Daly Head of Financial Management Marjorie Johns Planning Manager Jim Muir Finance Manager Operational SLA Review Meeting Argyll & Bute CHP Stephen Whiston Head of Planning Contracting & Performance Kristin Gillies Service Planning & Performance Manager Veronica Kennedy Locality Manager, Oban Lorn & the Isles Kirstin Parker Service Planning & Contracts Manager NHS Greater Glasgow & Clyde Jonathan Best Director of Regional Services Marjorie Johns Planning Manager In attendance as necessary - General Managers and Clinical Directorate Managers

Appendix 3 - Service Input and Outreach SLA’s with NHS Greater Glasgow & Clyde

SLA No. SLA CHP Operational

Lead

Agreed Values

2012/13 £

Review Meetings 2013/14

5 Estates Services - Helensburgh & Lomond locality Viv Hamilton 45,584 ongoing in advance of termination

6 Hotel Services for Helensburgh & Lomond locality Viv Hamilton 35,020

7 Laundry Jim Dempsey 182,386 April 2013

8 Telecommunications James Brass 85,637 ongoing meetings regarding specific issues, formal review to be arranged

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9 Transport Jim Dempsey 128,509 ongoing meetings regarding specific issues, formal review to be arranged

10 TSSU & CSSD Veronica Kennedy 47,300

13 Pharmacy Management Fiona Thomson 162,132 20/09/13

18 Out-of-Hours for Helensburgh & Lochside Viv Hamilton 665,514

19 IM&T James Brass 70,729 17/05/13 02/08/13

24 Procurement George Morrison 22,050 02/10/13

31 Public Health - Health Information Services Elaine Garman 22,050 ongoing in advance of termination

32a CHD Managed Care Networks Elaine Garman 13,300 25/09/13

32b Stroke Managed Care Networks Elaine Garman 16,600 01/10/13

35a WDCHP - Children's Physiotherapy Viv Hamilton 35,750 23/09/13

35b WDCHP - Speech and Language Services Viv Hamilton 114,320 23/09/13

35c WDCHP - Hospital at Home Viv Hamilton 50,180 23/09/13

35d WDCHP - Paediatric Medical Viv Hamilton 192,540 23/09/13

35e WDCHP - Children's OT Service Viv Hamilton 96,240 23/09/13

35f WDCHP - Child and Adolescent MH Service Viv Hamilton 14,925 06/09/13

35g WDCHP - Childrens Services Manager Viv Hamilton 14,280 23/09/13

35h WDCHP - Childrens Services Admin Viv Hamilton 18,820 23/09/13

37 Out of Hours Nursing Service WDCHP to Hel & Lom Viv Hamilton 80,403 June 2013

38 Physiotherapy Services from WDCHP to Hel & Lom Viv Hamilton 161,100 Feb 2014

40a Community Mental Health Services Hel & Lomond Viv Hamilton 584,620 Nov 2013

40b Psychology Services Viv Hamilton 65,335 Nov 2013

40c WD CHP - MH Crisis Service, Hel & Lom Viv Hamilton 110,280 Nov 2013

40d WD CHP - MH Primary Care Service, Hel & Lom Viv Hamilton 24,945 Nov 2013

42 Dementia CMHT services to the Hel & Lom Viv Hamilton 182,580 Nov 2013

45a Sexual Health Services - Dunoon Viv Hamilton & Christine Wills 22/04/13 18/09/13

45b Sexual Health Services - Helensburgh Viv Hamilton & Christine Wills

54,020 22/04/13 18/09/13

58 Audiology Services in Cowal & Bute Viv Hamilton 22,941

60 Orthoptic Services in Cowal & Bute Viv Hamilton 7,943

72 CAMHS - Cowal & Bute Viv Hamilton 21,900 06/09/13

80 Outreach Clinics Locality Managers 795,100 Ongoing

94 Public Health Screening Elaine Garman 64,500 12/09/13

95 Laboratory Services Stephen Whiston 1,022,092 23/08/13

96 Radiology Services Veronica Kennedy 197,910 23/08/13

98 Heartstart Elaine Garman 13,935 22/04/13

61 Cancer Services to West Dunbartonshire (A. Ferguson?)

Viv Hamilton (19,320)

73 Community Paediatric Services to Inverclyde (C. Clark)

Viv Hamilton (59,314)


Item : 11.2


Item : 12

Modernisation of Mental Health Services Update Repo rt (October 2013) (1) Report by John Dreghorn 1. Background

The following report provides an update on the implementation of the modernisation of mental health services in Argyll & Bute.

2. Progress Report

� Project Governance The Programme Board and Capital Project Board are due to meet on 18th October.

� Project/Service Management A paper is currently being developed which proposes a change in the management arrangements for community mental health services. The paper will be taken to the CHP Core Team in October for approval. In summary the proposal if approved would result in the Programme Director having a more direct role in the management of the CMHTs through the Locality CSMs, thereby bring community mental health services and hospital services under the same management and governance arrangements.

� Capital Project Stage 1 Approvals No further progress due to the need to bundle the project with another capital project.

� Inpatient Services The bed compliment is currently 27 plus 3 minimal supervision places in the refurbished Firgrove building. Upgrade works on the IPCU single rooms has commenced resulting in a temporary reduction to 4 beds and a permanent reduction to 5. Plans to relocate the MAPS/Clinical Psychology/OPD from the portakabin to Cowal Ward are being finalised and work has commenced. Further alterations and upgrade works are being considered by the HEI & Risk working group following the recent visit by the Director of Nursing, including the closure of the Lee Centre and the relocation of the ehealth training room.

� Staff Redeployment 2 of the 5 inpatient HCAs that remained displaced after the redeployment exercise last year have now been redeployed into permanent posts.

� New Posts A temporary increase in the nursing establishment has been agreed to support the patient transfer service. This will result in an additional 4 staff being appointed on fixed term contracts. It is anticipated that recruitment to the remaining clinical psychology posts will commence in November 2013. These are the last remaining community posts which have yet to be recruited.

� Budget

Bridging: The bridging allocation for the project during 2013/14 remains unchanged at £500k as set by the CHP management team.

The meeting is asked to: � Note current key issues and progress against the action plan

12 MH Services Modernisation Update Report October 2013 (1)

04/10/2013

J. Dreghorn Page 2 of 2

� Resettlement Group Work on establishing the group home in the Oban area for 2 patients is being progressed.

� New Hospital Development � “The Bundle”: As previously reported there are two projects; one in NHS Highland (Aviemore); and one in NHS Grampian (Inverurie); that are of sufficient size and at a stage of development to meet the criteria to be consider as part of a bundle. This will be discussed at the next Capital Project Board.

� Site Visit: A visit to A&B Hospital by Mike Baxter (Scottish Government Officer with responsibility for capital projects) has been arranged for mid November. Elaine Mead will accompany Mr Baxter on the visit. Derek Leslie invited Mr Baxter as it was felt that the uncertainty regarding the “bundle” was further delaying and already delayed project, and it is hoped that the evident need to replace the existing buildings will help to accelerate the process.

� Enabling Funds: We have been successful in securing project enabling funding totalling £191k to support works which require to be undertaken before the new hospital is built. These include: demolition of some existing building; widening of the access road to the new hospital site; completion of the site master plan; and relocation of the Blarbuie Woodland work area to another part of the site.

� Site Master Plan: We have commissioned MACMON Architects to undertake this work which is now progressing.

� CMHS Team Base Both Kintyre and Dunoon CMHS bases should be operational by the end of October.

� Supported Transfer of Detained Patients

Some of the new posts required to establish this service have been appointed to, however, due to other staff leaving we remain 3 posts short of what is required to commence the service. Interviews are due to take place towards the end of October. Likely start date is now Mid November.

� Recovery � Wellness Recovery Action Plans (WRAP)

Plans are being developed to roll out awareness raising sessions and WRAP workshops across Argyll & Bute. First two workshops are taking place at Argyll & Bute Hospital on 1st and 28th November.

3. Summary

After a period where the capital project appeared to have stalled there are signs that the project will begin to move forward again. In particular the availability of enabling funding will allow us to start to develop the site in preparation for the new build. This will be the 1st clear evidence to service users, staff and the wider community that the building project is moving closer to commencement. As reported last month a key focus for the wider MH modernisation project over the coming months is to roll out and embed “recovery” in all aspects of our work. The planned workshops are the 1st stage of that roll out programme. John Dreghorn Programme Director – Mental Health Modernisation


Item No : 13.1

1

AUDIT SCOTLAND – NHS FINANCIAL PERFORMANCE 2012/13 REPORT BY GEORGE MORRISON The CHP Committee is asked to; • Note the report and the summary of key messages

Audit Scotland has produced its annual report on financial performance in the NHS. The full report and the summary of key messages document are attached to this paper. The key messages made by Audit Scotland include; • NHS Boards tend to focus on breaking even each year. Longer term financial planning

needs to improve. • All NHS Boards achieved their financial targets in 2012/13. • Although savings targets were largely achieved, there was an overreliance on non-recurring

savings. This will increase the financial challenge in 2013/14. • Demand for healthcare is rising and good progress has been made in improving outcomes

for patients. • Vacancy rates in medicine and nursing have increased resulting in more use of agency and

bank staff and increased spending on private sector healthcare. While the whole report makes interesting reading, I would perhaps recommend the following paragraphs as of particular interest to members of the committee; 29, 35, 41, 83, 84 and also case study 5 on page 38. The committee is asked to note the report and the summary of key messages. George Morrison Head of Finance Argyll & Bute CHP 17th October 2013


Item : 13.2

eHealth Department Aros Lochgilphead Argyll PA31 8LB

Minute of Meeting of the Argyll & Bute CHP eHealth Group

14 August 2013 JO5/JO7

J05/J07,Lochgilphead, Talisman Room, Helensburgh, LM office, Oban,

Present: Pat Tyrrell, Chair John Dreghorn, Implementation Director, Mental Health Redesign

Dr Richard Sloan, MAKI Locality Representative George Morrison, Head of Finance, (via VC) Kathleen Young, Medical Records Officer Moira Newiss, Business Manager (via VC) Veronica Kennedy, Locality Manager Representative(via VC) Ken Barr, Patient Representative, Dunoon Mary Wilson, AHP Lead (via VC) Elizabeth Reilly, Community Dental Services (via VC) Derek Leslie, Director of Operations Bill Reid, Head of eHealth, NHS Highland James Brass, eHealth Manager Bill Staley, Information and Projects Manager In Attendance: Lhara Stevenson, PA (via VC) Item 1 Apologies Apologies were noted from the following:

Dr Michael Hall, Clinical Director Dr John Lyon, Locality Clinical Director

Dr Grace Ferguson, Clinical Director/Consultant Psychiatrist Kristin Gillies, Planning Manager Dr Brian McLachlan, Locality Clinical Director Catherine O’Hanlon, Practice Manager Representative Stephen Morrow, IT Development Manager Robin Wright, GG&C Representative John McVey ICT Project & Liaison Manager Please note that Item 8 GMS Support was moved up the Agenda and as such was taken after Agenda item 5 followed by the Dental Update. Item 2 Minute of Previous Meeting The minute of 1st May 2013 was accepted as a true record of the meeting. Item 3 Matters Arising

• ICNET supplier in discussion with relevant staff in GG&C. Pat & James to meet with Emma Watson: James & Pat to take this item forward.

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• MiDIS as A&E System. Bill Reid has not had sight of the Business Case currently in circulation due to annual leave. Bill Staley will arrange to have this sent to him. Bute has a form that captures basic A&E activity. James will see if the Bute form captures the data that ISD require. Trakcare A&E is not imminent and as such further discussion with Allan Jenkins is required and this item should remain open for discussion at this group.

• Bill R provided an update on the integration experience. Phase 1 of integration was Children and Adult services. Phase 2 of integration is in its early stages. It is a combination of support services between NHSH and Highland Council. Workshops have been set up. Council ICT services are contracted out until 2015, after which NSS will get involved with the procurement process. NHSH eHealth may provide some technical services to Highland Council after 2015. Bill R has agreed to give a presentation on the integration experience at the next A&B eHealth group meeting scheduled for November 2013.

• Argyll & Bute will be included in the GG&C laboratory system consolidation onto a single instance of Telepath for all GG&C lab results. GG&C will provide training for Telepath for the laboratory users in LIH. Practices will continue to receive microbiology results electronically and ICNET will be interfaced for its microbiology requirement.

• Bill R is speaking at a meeting with clinician’s in attendance and will encourage them to embrace Trakcare and hopes that along with Pat, Mary and Dr Hall’s encouragement a suitable clinical representation will be found to attend and represent A&B at future meetings of the PMS Clinical Project Board.

• Bill S informed the group that he did not know the actual percentage of returned referrals however GP’s have to actively look in SCI gateway for them. GG&C Staffnet should now be available to the GP practices where referral guidance can be viewed.

• Scott Henry is the GG&C clinical portal contact. • Representation to the National PMS Operation Review Group is ongoing.

Item 4 Activity Highlights/Management Report 4.1. eHealth Activity and Strategy Implementation Update James Brass/Bill Staley spoke to the paper, providing updates as per the handout with discussions that focussed on:-

• OneSign/Single Sign: Operational within eHealth Department as trial. Will then be rolled out with additional applications such as Helix, Sci Store, Vision, etc

• Migration to AB.nhsh.scot.nhs.uk domain: Wireless network is available at Oban & Lochgilphead with the exception of laptops. Awaiting suppliers to install equipment at the remaining sites. Mary noted a problem with access to AWT reports via the intranet on the AB domain. James asked Mary to log a call with the helpdesk.

• elmmediate Discharge Letters: IDL software will be in Oban by October to manage letters.

James & Pat to progress with ICNET.

Bill S to send Bill R MiDIS Business Case.

Bill R review Business Case.

James will view the Bute A&E data collection form to see if it captures what ISD require.

Bill R will give a presentation on the integration experience at the November meeting of the group.

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• EDT: discharge letters from GG&C to the Highland Hub and then out to practice electronically being piloted in Helensburgh. Upon completion of pilot it will be rolled out the other GP Practices.

• 18 Week RTT/TTG: Standardise letter templates onto Helix. Awaiting confirmation of format for NHS Highland to do this.

• Telecoms SLA Review: DNA aspect to be revisited through the use of the patient reminder system RemindPlus. Ken requested to know the actual DNA rate in A&B. Kristin has been tasked with providing this information to Ken.

• Lab Links: Awaiting 2 practices giving the go-ahead for work to be carried out in their practice. It was noted that clinical text on the label is not currently put into SCI Store and therefore onto the electronic results - a resolution to this is required.

Item 5 Finance Report George provided a verbal update to the group. IT Departmental Budget is £1.14m and is within spend. The GMS ehealth budget has been restricted to £275,000. This is £25K less than in the previous year. James to ensure that action is taken to contain ehealth costs within this budget. George asked Bill R to confirm how much of the £600K National Strategy funding for discretionary spend will be allocated to A&B. Bill said he would report back to George the amount as he had yet to get clarification. Ken informed the group that there was a possibility that the Argyll Street Practice in Dunoon would be demolished. The GPs own the building but not the land.

Item 6 TrakCare implantation Update (i) Update from Programme Board: Bill R provided a verbal update. Bill Reid will be attending

the Programme Board meeting on 6 Sept. He will be requesting Programme Board approval for the project to slip to a 3rd March 2014 go live date, previously November. This is due to the complexity of data migration. The Programme Board are aware of the slippage and would like the project to go live in November 2013. This is unlikely as the original Project Plan was just too ambitious even though it was put together in agreement from the supplier. We do not have the same depth of in house experience/knowledge as GG&C and will have to look to engage some specialist help with data migration.

(ii) Implementation Update: Derek provided a verbal overview of Bill S’s paper. He spoke briefly

of the background to the project and the consequence of A&B CHP not being part of the GG&C instance of Trakcare. He touched upon how the interface with GG&C re clinics in A&B meant clinicians were unable to view patient details while in A&B and that clinicians viewed this as risk to patients. The hope was that Healthshare would eliminate some of the problems but Healthshare was a false hope. Another difficulty has been GG&C lack of capacity to engage with the CHP to find a pragmatic solution to the difficulties and a change over of staff. With the delay to Trakcare Bill S’s paper asks the question on whether it is possible to have a re-think on how the CHP proceeds with Trakcare – will it really be any better for the CHP than the current PAS system which the MRO’s are familiar with and have

Mary to log call with helpdesk re problems with accessing AWT via the intranet on the A&B Domain Kristin to provide Ken with A&B DNA rate.

Bill R to confirm A&B allocation of the £600K National Strategy Fund to George.

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expertise in ? Derek made it clear that the original decision for the CHP to be part of the North Highland instance was a corporate decision and as such it would have to be discussed at that level. It is not a decision this group can make but he would take all the concerns raised (i.e. patient safety & processes) to a corporate level for further discussion. Bill R noted that we are contractually bound to Intersystems. There is a meeting taking place in Lanarkshire to show how its cross border interface with Glasgow works. James would like the details of the meeting as it may be beneficial for him to attend. John D asked if there was a Mental Health inclusion in our instance of Trakcare. Bill R said that would be some time yet and as such should proceed with MiDIS.

(iii) Operational Interface Group Update:

James advised that the Operational Interface Group has provided Bill R with documentation outlining the cross border difficulties in readiness for his meeting with Robin Wright for GG&C to suggest the most appropriate representation in assisting NHS Highland to mitigate these difficulties. Bill R has a meeting scheduled.

Item 7 MiDIS Update James spoke to the MiDIS implementation update providing an overview of the national review which is recommending a change to the manner in which MiDIS is hosted and supported and then covered the Highlight Report which was presented to the 13th August MiDIS Project Board. It was requested that the Addiction Team be included in the project. Item 8 GMS Support James spoke to the paper. James thanked Moira for her support to Dr Lyon re the email that was sent to the GPs asking them for their comments in regard to IT support in North Argyll. The paper summarised the comments which included recurring niggles but also compliments for IT Support. Argyll & Bute do not have a permanently manned helpdesk, the simplest means of requesting help being logged as work orders via the intranet. Some analysis of call information on the helpdesk software was undertaken to review response times although it became apparent that the information was less useful than hoped due to poor quality of information regarding call closure. eHealth Staff have been reminded of the importance of accurate recording of information and to ensure ‘ad-hoc’ requests received for instance when passing in corridors are recorded. Some complaints were Vision related and some of those complaints came down to levels of training on the Vision system. Argyll & Bute CHP has 0.4 WTE GP facilitator for 33 practices compared to 4.4 WTE in North Highland for 68 practices. The group discussed ways to redress the imbalance. Moira suggested that appropriate staff at some of the larger GP practices be trained in basic IT support skills. George mentioned that GP practices receive £373k per year in the form of HCHS practice support payments and perhaps the GPs could look to diverting some of that money into GP Facilitation support. A&B eHealth are to be invited to attend future Practice Managers meetings. Moira has agreed to circulate/discuss James’ GMS Support paper at the next Practice Managers meeting. James and Derek will meet to discuss options on how supplement the GP Facilitator role with a view to writing to the GPs and enquire about reprioritisation of the £373k from the HCHS funds.

Derek will raise Trakcare issues with patient safety and process at Corporate Level Bill R to provide James with details of the Lanarkshire meeting.

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Item 9 Dental System Update A new business request has been submitted in Raigmore requesting A&B Software of Excellence Health system be migrated onto R4 which is hosted at Raigmore. The expectation is that this will soon begin commencement. Once migration onto R4 has taken place then the current Senior IT support Officer (Dental) can be moved into the empty Senior IT Support Officer post and an IT Support Officer recruited to support less demanding dental role post migration.. Item 10 GG&C Update Apologies had been received from Robin Wright but contact details for clinical portal and the HI&T SLA Account Manager replacement had been provided as requested. Item 11 A&B Council Update. There was no representative from A&B Council thus no update available. Item 12 Paper for Noting As per previous discussions above. Item 13 Any Other Competent Business 14 Date and Venue of Next Meeting: 6th November 10:30-13:00 hrs, JO5/JO7 MACHICC & the Victoria Room, Helensburgh

Moira to circulate/discuss the GMS Support paper at the next Practice Managers meeting and ensure an

eHealth representative is invited to future Practice Managers meetings.

Derek & James to meet to discuss options on how to supplement the GP Facilitator role and bring it in line

with Highland.


Item : 13.3

Argyll & Bute CHP Committee - 2014

Committee Date Development Session

Lunch Time

Location

Wednesday

19 February 2014

10.30 - 12.15

12:15 – 13.00

13.00 – 16.00

Mid Argyll Community Hospital & Integrated

Care Centre, Lochgilphead

Wednesday

23 April 2014

10.30 - 12.15

12:15 – 13.00

13.00 – 16.00

tba

Wednesday

18 June 2014

10.30 - 12.15

12:15 – 13.00

13.00 – 16.00



Wednesday

20 August 2014

10.30 - 12.15

12:15 – 13.00

13.00 – 16.00

tba

Wednesday

22 October 2014

10.30 - 12.15

12:15 – 13.00

13.00 – 16.00



Wednesday

17 December 2014

10.30 - 12.15

12:15 – 13.00

13.00 – 16.00

tba

ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 23 … · 10/23/2013 · 13.1 Audit Scotland Report...

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