ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 24 April ... · 4/24/2013 · ARGYLL & BUTE CHP...

ARGYLL & BUTE CHP COMMITTEE MEETING

Wednesday 24 April 2013 at 1pm

Guide Hall, Kinloch Road, Campbeltown

AGENDA

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

3. Conflicts of Interest Robin Creelman

4. Minutes from Previous Meeting 4.1 Minute –20 February 2013 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues

6.1 Highland NHS Board Media Briefing (attached) Robin Creelman 6.2 Director of Operations Report (attached) Derek Leslie 6.3 CHP Draft Annual Report (attached) Derek Leslie

7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 7.3 Health Improvement (attached) Elaine Garman 8. Financial Governance 8.1 Finance Report (attached) George Morrison 9. Staff Governance

9.1 PDP/R and eKSF Implementation (attached) David Logue 10. Partnership Working

10.1 Draft Minute of CPP Management Committee 06-02-13 (attached) Derek Leslie

11. Performance Management 11.1 Balanced Scorecard Summary (attached Derek Leslie 11.2 Delayed Discharge Update (verbal) Derek Leslie 11.3 Operational Delivery Plan (attached) Stephen Whiston

3.30pm : Public Session

12. Review and Redesign of Hospital, Community and Care Services in Kintyre (attached) Stephen Whiston 13. Mental Health Modernisation Update (attached) Derek Leslie 14. Papers for Noting: 14.1 Argyll & Bute CHP eHealth Steering Group Draft Minute 06-02-13 (attached) 15. AOCB*

16. Date, Time & Venue for Next Meeting

Wednesday 19 June 2013 at 10.30am J03-J07, Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead

* to be notified to Chairman in advance of meeting

The Committee meeting will be followed by:

Argyll & Bute CHP Committee Date of Meeting : 24 April 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/

J03-J07, Mid Argyll Hospital,

Lochgilphead

20 February 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 Elizabeth Reilly, Area Dental Committee Representative Ms Glenn Heritage, CVO Representative Mr Duncan Martin, Chairman, Public Partnership Forum Mr Michael Roberts, Vice Chair, Public Partnership Forum Councillor Elaine Robertson, Argyll & Bute Council Representative Councillor George Freeman, Argyll & Bute Council Representative

In Attendance Apologies

Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Ms Rose MacVicar, PA to Head of HR & Head of Planning Contracting & Performance Ms Tricia Morrison, CVO Representative, Argyll & Bute CHP Ms Dawn Gillies, Staffside Representative Ms Liz McMillan, Staffside Representative Jim Robb, Head of Service, Adult Care, Argyll & Bute Council

1. CHAIRMAN’S WELCOME The Chairman opened the meeting by welcoming everyone to the Mid Argyll Hospital and Integrated Care Centre. 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 4.1 Minute of Meeting held on 19 December 2012 Page 1 - It was noted that Raymond Stewart, NHS Highland Employee Director was not in attendance at the meeting. Page 14 – Mr Creelman reported on a communication received from Mr Law, Hunters Quay Community Council representative regarding the interpretation in the Minute of his comment in relation to the appropriateness of referrals to Inverclyde. Mr Law wished it to be clarified that this was not a complaint regarding GPs’ referrals to Inverclyde. The Committee: Approved the content of the Minute of the meeting on 19 December 2012, with the above amendment and clarification noted. 5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 19 December

2012 Aortic Abdominal Aneurysm Screening Mr Roberts raised concern about the uptake within the CHP not being accurately recorded. Ms Garman advised that this is a key performance indicator which has a 60% uptake target nationally. The national reporting will be on a yearly basis, however a request has been made for interim data. In the meantime speaking to local staff they estimate a 60% uptake within the CHP. Patient Management System (PMS) Mr Martin enquired if there had been further discussion with NHS Highland NHS Board regarding the implementation of PMS and the implications of this for Argyll & Bute patients. Mr Creelman gave assurance that this continues to be a focus of discussion in various forums and concerns were recently noted from the public health representative on the eHealth Group. Mr Leslie clarified that the specific concerns raised are in efforts to ensure that Argyll & Bute residents do not have equity of access to services compromised as a result of being managed through the Highland ‘instance’, whilst patient flows are, with very few exceptions, to NHS Greater Glasgow and Clyde and are being considered proactively. Mr Leslie stated that the CHP has acknowledged and will take responsibility for any resourcing issues which may arise. Mr Martin reiterated that equity of access for Argyll & Bute patients was non-negotiable.

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6. NHS Highland Organisational Issues 6.1 Meeting of Highland NHS Board Meeting – Action Plan – 5 February 2013 Mr Creelman reported that with the exception of the amendment noted in 4.1 above, there were no actions for Argyll & Bute CHP. The Committee: Noted the above comment. 6.2 Director of Operations Report Mr Leslie provided a summary of points in the circulated report. Islay The challenges of providing safe and sustainable services on Islay continue, which has resulted in significant political interest, and a review of services is due to commence on 1 March 2013. An Islay Clinical Services Review Steering Group has been established and will be chaired by Mr Robin Creelman, NHS Highland Non-Executive and Chair of the CHP, with support from Gordon Peterkin, independent clinical expert, who was appointed following an inclusive recruitment initiative, with input from the local community and GPs. The CHP has agreed a further 1 year transitional support with the three GP practices to underwrite their participation in the Review, as a result of which the GPs formally notified the CHP of the withdrawal of their out of hours opt out notice. The Islay review has been promoted as part of a fundamental piece of work being undertaken by NHS Highland following a request from the Cabinet Secretary for Health and Social Care to develop and submit a proposal that will explore the development and testing of models for the delivery of sustainable person-centred, safe and effective primary care in remote and rural areas. Mr Whiston has been actively liaising with Ms Gill McVicar, who is leading on this project for NHS Highland, to inform the proposal and a bid has now been submitted to the Scottish Government, the outcome of which is awaited. The building works in Islay hospital outpatients’ department are now completed. The dental van is scheduled to return to the hospital site at end March 2013. Actions are continuing to alleviate the problems with car parking and access to the site for public transport. Ms Heritage reported that the voluntary car scheme is underway but at present this service is being under utilised. Mull & Iona Progressive Care Centre A public meeting was recently held on Mull, chaired by the Council Leader, to discuss and address a number of integration issues, particularly associated with the allocation of extra care housing.

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Integrating Care in Argyll & Bute A paper was submitted for noting to the Highland NHS Board on 5 February 2013 to provide an update on the integration process and ongoing discussions between NHS Highland and Argyll & Bute Council. CHP Locality Updates Mid Argyll, Kintyre & Islay o At a recent bed modelling meeting agreement was reached that Campbeltown

Community Hospital will operate with a total of 21 beds with effect from 1 April 2013. A contingency plan will be in place for the availability at short notice of a further 3 beds if required. Concerns highlighted by the Community Council regarding public engagement in the exercise are being examined.

o The Board’s Director of Nursing recently visited Campbeltown Hospital and Mid

Argyll Hospital, with positive feedback being given to both sites that reflected the Healthcare Environment Inspectorate (HEI) approach.

o GP locum cover for Inveraray/Furnace practice has been secured for the period March-June 2013 to ensure service continuity. Dr Hall advised that the CHP are endeavouring to employ long term locums to ensure a consistent knowledge of the clinical systems in place within the practice and close monitoring of this is in place. He also advised that a local GP has been appointed as a locum to specifically oversee the review and updating of the current systems.

Oban, Lorn & Isles o The Raigmore Operational Unit has committed to supporting the CHP Urology

service at Lorn & Islands Hospital, Oban with the recruitment of an additional Urology Consultant to provide an outreach specialist service. The patient’s referral pathway to NHS Greater Glasgow and Clyde will remain unchanged.

o Further discussions have taken place with the Taynuilt Community Council in

relation to their interest in establishing a satellite hospital dialysis facility on Lorn & Isle Hospital. Mr Creelman gave a commitment that the CHP will continue to work with the community and to monitor hospital dialysis, and further review this and the potential location of a unit in 2015/2016.

Mr Whiston reported that letters have been issued to individual dialysis patients to encourage them to contact the CHP directly to discuss their individual transport needs.

Councillor Robertson expressed her thanks to Ms Kennedy and Mr Whiston for the considerable amount of work undertaken in reviewing the needs of dialysis patients.

Cowal & Bute Cowal 24/7 Review – community engagement process is continuing around the contingency plan which is now in place to support the implementation of a unified out of hours service for Cowal with a mix of on duty and on-call staff.

The Committee: Noted the content of Director of Operations tabled update.

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7. Clinical Governance Ms Tyrrell highlighted the recently published report following the Mid Staffordshire NHS Foundation Trust Public Inquiry and referred the Committee to the executive summary which details the 290 recommendations in the report. She commented that there is a significant amount of learning and actions required by organisational and regulatory bodies referred to in the report. Ms Tyrrell advised that the report has been considered at the Argyll & Bute CHP Clinical Governance Group and a number of actions have been identified to be taken forward locally. Ms Tyrrell also commented on the forthcoming Health Environment Inspectorate unannounced visits to community hospitals. The Argyll & Bute hospital has in particular been the subject of a focussed action plan, completed by the allocation of non-recurring funds to improve control of infection compliance. 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 A total of 438 incidents were reported during quarter 3, which is a slight decrease in the 442 incidents reported in quarter 2. Broken down in locality : Cowal & Bute – 115 (26.25%) Helensburgh – 10 (2.28%) Mid Argyll & Kintyre – 183 (41.78%) Oban Lorn & Isles - 112 (25.57%) Outwith NHS Highland – 18 (4.11%) (patients transferred in) Ms Tyrrell advised that 74 incidents are awaiting grading and any significant grades will be carried forward for reporting in the next quarter. Slips, trips and falls remain the highest reported category of incidents for Cowal & Bute (33), Mid Argyll, Kintyre & Islay (51) and Oban, Lorn & Isles (43). The top category for Helensburgh was medication (4). Three incidents which occurred in Mid Argyll/Kintyre resulted in Significant Event Reviews. The learning from these reviews will be applied throughout the CHP. There were no RIDDOR reportable incidents recorded for the CHP in quarter 3. Pressure Ulcer Prevention Implementation of the NHS Highland Zero Tolerance approach to preventable pressure ulcers is continuing with a number of measures being taken to improve the identification and management of those patients at risk of developing pressure ulcers in all settings.

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Ms Tyrrell stated that there is an increase in the number of frail and older people in the community and further work is planned to improve understanding and knowledge among carers and patients, as well as the wider community. Councillor Freeman queried if the reported incidents in Helensburgh were acquired in a hospital environment. Ms Tyrrell advised that they were community acquired and attempts are currently being made to obtain information from the Vale of Leven Hospital of any hospital acquired incidences of Argyll & Bute patients. Councillor Freeman asked if the CHP receives notification of patients with pressure ulcers prior to transfer from NHS Greater Glasgow & Clyde back to Argyll & Bute. Ms Tyrrell confirmed that details are incorporated in a patient’s care plan on transfer and there is regular liaison between the CHP Leads on pressure ulcer work and NHS Greater Glasgow & Clyde. Mr Creelman raised the issue of reporting of pressure ulcer incidents occurring in Care Homes. Ms Tyrrell advised that all incidences in residential homes, staffed by NHS staff, are reported on the NHS systems, with actions identified, i.e. risk assessment. There is also an ongoing focus on training of community carers, to include independent providers. Ms Garman asked what route of learning was in place following the investigation of incidents. Ms Tyrrell replied that investigations and outcomes are discussed by the Clinical Governance Group and outcomes and recommendations disseminated to managers and staff. She acknowledged the possible need to review this process to ensure adequate feedback and understanding of actions required. Councillor Robertson enquired about the overall training of Health Care Assistants and the process of liaison with different care providers. Ms Tyrell advised that this work is part of the Reshaping Care for Older People, which looks at :

o a mapped out workforce o the careers framework o registered and unregistered Health Care Assistants o joint training

Falls Prevention Ms Tyrrell reported that considerable work is ongoing to reduce the evidence 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 & Islands Hospital, Oban. Serious Untoward Incidents (SUI) Ms Tyrrell reported on one SUI occurred in relation to an unplanned discharge of a patient from hospital. The incident is being reviewed under the SUI management policy and a full report and action plan will be developed after the review meeting with staff involved due to take place in early March 2013. Complaints A review of overall performance in relation to complaints management is currently being undertaken in NHS Highland as part of the Highland Quality Approach. Ms Tyrrell reaffirmed the CHP process for conducting the investigation of complaints to ensure a full, accurate and informed response is provided to the complainant.

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External Reviews Joint Inspection of Children’s Services in Argyll & Bute Ms Tyrrell advised that a joint inspection is due to commence in early March 2013 which will focus on users and outcomes. As part of the inspection, the Inspectors will be looking for an evidence base of positive outcomes. Nine position statements which identify the CHP’s progress in improving outcomes for children and young people in Argyll & Bute across a range of indicators have been requested by the Care Inspectorate, with two statements already submitted. From the information on 450 children and young people submitted to the inspection team, the records of 90 children and young people have been selected by the inspection team as part of the inspection scoping. The Inspection Team intend to meet with young people and their families, as well as conducting a number of focus groups with both senior leaders, managers and professionals from across the agencies. Initial feedback of findings will be presented to the Community Planning Partnership on 1 May 2013, followed by a written public report at end May. Agencies involved in the inspection will received a more detailed report. HEI Inspection of Community Hospitals Ms Tyrrell highlighted that the HEI have announced that as part of their plans for 2013, there will be unannounced inspections of community hospitals starting from mid 2013. Mr Creelman referred to HDL (2005) 07, which informs that the Senior Charge Nurses are responsible for ensuring safe working conditions within their clinical areas. This includes all aspects of environmental cleanliness. Ms Tyrrell commented that within the CHP there is a daily process for recording the completion, or not, of tasks and any identified risks to patients are recorded on Datix. The daily schedules are reviewed and signed off by the Senior Charge Nurse/Nurse in Charge in collaboration with the Domestic Services Supervisors. Compliance with the system is evidenced by regular auditing. MHRA Inspection of Lorn & Islands Hospital Laboratories Councillor Robertson enquired about the MHRA follow-up inspection of Oban laboratories, which Ms Tyrrell confirmed is due to take place. She also advised that the initial inspection had received a positive outcome and satisfactory accreditation. 7.2 Infection Control Report Ms Tyrrell referred to the circulated report which provided an overview for the infection prevention and control across NHS Highland, together with the results from cleanliness monitoring, hand hygiene audit results and surgical site infections. It was reported that as at end September 2012 NHS Highland infection prevention and control targets and performance data recorded achievement of the national targets for :

o Clostridium difficile o Staphyloccoccus aureus bacteraemia

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

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o Hand hygiene o Cleaning o Estates o Antibacterial prescribing

Staphylococcus Aureus Bacteraemia (SAB) The reported annual rate, unvalidated by HPS, for NHS Highland to end December 2012 is 21.8 per 100,000 occupied bed days (OBD). The national target for March 2013 is 26 cases per 100,000 OBDs. There have been no new cases of SAB in Argyll & Bute since the last report. A small number (6, 19%) of line related SABs constitute a significant and potentially preventable proportion of all SABs, with 4 being associated with Peripherally Inserted Central Catheters. A group recently met to lead on the reliable implementation of the central line insertion and maintenance bundle and the reliable implementation of a PICC maintenance bundle. The Infection Control Team will monitor progress of the validation results around PVC insertion and maintenance. Clostridium Difficile Infection (CDI) in Patients 65 years and over The reported annual rate, unvalidated by HPS, for NHS Highland to end December 2012 is 29.2 per 100,000 OBDs. The national target for March 2013 is 39 cases per 100,000 OBDs. Clostridium Difficile Infection (CDI) in Patients 15-64 years The reported annual rate, unvalidated by HPS, for NHS Highland to end December 2012 is 57.1 per 100,000 OBDs. There is no national target for this age group. NHS Highland has a slightly higher rate than the national average but remains well within expected levels. There have been no new cases of CID in Argyll & Bute since the last report. HEI Inspections NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining an average of 98% compliance for November and December 2012. The November 2012 National Hand Hygiene Audit report shows NHS Highland compliance as 98%, National compliance was 95%. 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. Cleaning & the Healthcare Environment Domestic Service teams continue to carry out monthly cleaning and estates audits as per NHS Scotland National Cleaning Services Specification sustaining an average of 96% compliance in November and December 2012 for domestic monitoring; the average Estates compliance was 96% in November and 97% in December 2012

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In November 2012 Mid Argyll Hospital, Lochgilphead was below the target of 90% for Estates monitoring, 89.1%. In December 2012 Argyll & Bute Hospital, Lochgilphead was below the target of 90% for estates monitoring, 89.1%. Local action plans have been implemented in both areas. Outbreaks/Incidents

Norovirus is prevalent in the community, with a high risk of transmission to hospitals. There have been no ward closures since the last report. If an outbreak occurs in a Care Home, staff there are given support by the NHS Infection Control Team.

Unannounced HEI Inspection Visits

The Board Nurse Director, CHP Lead Nurse and Infection Control Nurses have recently carried out visits to each of the mainland Argyll & Bute Hospitals. The visits were viewed as positive and provided support to managers and staff in continuing the delivery of improvements in the environment and in practice.

Health & Safety Executive (HSE)

The HSE confirmed in December 2012 that NHS Highland have complied fully with the Improvement notice in respect to infection control in the community. Managers from Lochaber will attend the March meeting of Argyll and Bute Infection Control Group to discuss the findings from the visit and the actions that have been taken.

Healthcare Environment Inspectorate Annual Report

The HEI published their third annual report in February 2013. As a result of the anonymous information from the patient survey responses, the improvements which the HEI consider matter most to patients include :

� cleaner patient environments, for example wards � cleaner patient equipment � fewer maintenance, repairs and refurbishment issues � an increase in the number of staff complying with the national dress

code, and � better access to training and education in infection control for all

staff. Infection Control Risk Register

The CHP Risk Register is currently being updated, with the addition as a risk of the CHP’s ability to ensure compliance with HAI standards in Primary Care settings.

7.3 Health Improvement The circulated paper focussed on smoking cessation, child healthy weight and delivery of Keep Well.

The Committee: Noted the content of the Infection Control Report

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Smoking Cessation Ms Garman reported that performance to date for 2012/13 exceeded the targets set at end November 2012. As well as an agreed number of patients wishing to quit smoking, there has also been an agreed number from areas of socio-economic deprivation, although the recently reported figure for inequalities has shown a slight decline which is being reviewed by the Smoking Cessation Advisors. Child Healthy Weight The full X programme continues to be offered and run during 2012/13. During February and March 2013 swim passes will be given to those signing up for the X programme. Initiatives are in place to promote child healthy weight as part of healthy weight for all the family. Keep Well The CHP has undertaken a considerable programme of community development work to take forward the implementation of the Keep Well health checks in April/May 2013 in Campbeltown. The benefits of healthy eating are being promoted in collaboration with local food producers and events are being arranged to highlight the health benefits of good wholesome food. The aim is to tie in child health weight with adult healthy weight and the sign up to the X programme. 8. Financial Governance 8.1 Finance Report Mr Morrison spoke to the circulated report and advised that at end December 2012 the CHP recorded an underspend of £194,000, indicating that the CHP’s overall financial position is stabilising towards the end of the financial year. The budgetary analysis showed a number of overspends, in particular :

o Medical locum cover for vacancies and a suspension in Dunoon o Medical locum cover for a vacancy in Lorn & Islands hospital

Mr Morrison advised that the above overspends present an ongoing risk and the issue needs to be managed by the CHP.

o Increased drugs costs at Lorn & Isles hospital o Overspend on hospital and community nursing pay costs on Bute o GMS budget overspend due to GP vacancies in Bowmore, Jura and Inveraray o Commissioned services overspend relating to increased referrals to Raigmore

and Belford

The Committee: Noted the content of the Health Improvement Report

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The cost pressures of all the above overspends are being offset by the benefits of the reduced prescribing costs. Cost Improvement Programme 2012/13 Mr Morrison indicated that based on the current information, there is likely to be a shortfall against the savings targets. To avoid a recurring deficit being carried forward to 2013/14, action is required by managers to address any shortfalls. Forecast Outturn 20/12/13 Mr Morrison reported that a year-end underspend of £200,000 for the CHP is forecast. It is anticipated that the benefits from the prescribing cost reductions will be sufficient to compensate for the in-year cost pressures and any shortfall against savings targets.

8.2 2013/14 Revenue Budget Mr Morrison summarised the budget setting process as detailed in the circulated paper. The proposed revenue budget relates to base recurring funding only, with the SGHD releasing a number of funding allocations during the course of 2013/14, most of which are non-recurring. These are outwith the scope of the CHP’s base revenue budget proposal. Mr Morrison commented that although the budget setting exercise is intended to be comprehensive, it should be noted that risks will exist within the budget setting, i.e. potential locum costs, individual patient treatment referrals, which may have a financial impact and will be reported as a cost pressure in finance reports during 2013/14. NHS Highland will receive a funding uplift from SGHD in 2013/14 of 2.8%, with the CHP receiving a share amounting to £4.072m. Any excess costs beyond the level of funding uplift provided will require to be met by the CHP from internal savings. Table 1 of the paper itemised the various provisions and challenges which are proposed for inclusion in the 2013/14 budget, totalling £6.472m, the detail of which has been previously debated at the CHP Core Team and Management Team meetings. Mr Morrison advised that if the forecast cost growth is agreed, a proposed savings plan of £2.4m, as detailed in Table 2, would also need to be agreed for 2013/14 in order to achieve a balanced budget. The savings targets will be owned by the budget managers who will report ways of delivering the proposed savings allocated to them. Councillor Freeman asked for clarification in relation to the prescribing budget. Mr Morrison advised that for Prescribing, the forecast growth has been set at £529k and a required savings target of £1m and acknowledged that in real terms this reflected a £½m reduction in the budget. The Committee Approved the provisions for the cost increases to b e included in the 2013/14 revenue budget (table 1) Approved the savings plan for 2013/14 to achieve a balanced budget (table 2)

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8.3 Highlands & Islands Travel Scheme – Changes to Earmarked Funding Arrangements

SGHD have now advised that the transfer of HITS from reimbursement to baseline funding has been delayed until 2015/16. From 1 April 2015 the CHP will be required to manage the costs of the HITS scheme and be accountable for any overspend on this budget. It is intended to carry out a redesign of services within the CHP to ensure best use of HITS funding.

9. Staff Governance 9.1 PDP/R and eKSF Implementation Mr Logue reported that the CHP is making considerable progress in working towards achieving the NHS Highland target for 2012/13 that all Agenda for Change staff reviewed against a KSF post outline, with at least 80% of reviews being carried out and recorded online using e-KSF. Mr Logue commented that while the figures continue to be below the planned trajectory, they have significantly improved, reflecting the expected pattern of more reviews being carried out in the latter half of the year. This increased level of activity will need to be sustained, and accelerated, to ensure achievement of the end of year target. The e-KSF Lead is meeting Locality Managers to discuss the figures and particular issues in their areas to review progress and address any outstanding issues or difficulties and is available to answer questions from any member of staff or manager on the e-Ksf process. The CHP position at 2 February 2013 was reported as : (bracketed figures are those reported to previous CHP Committee meeting on 19 December 2012)

o All AfC staff - 2043 o Review signed off - 814 (500) o % of AfC staff (all) - 39.84 (24.14) o % of AfC staff (excl Bank) - 54.74 (32.72

Mr Logue highlighted the qualitative benefits of eKSF to staff, who regularly receive development reviews and agreeing personal development plans supports service quality, improvement, staff and clinical governance and advised on the need for a systematic approach by Managers in carrying out the reviews. Mr Creelman asked for confirmation that the views of staff on the eKSF process are acknowledged and form part of the focus group discussions. Mr Logue reported that discussions within the NHS Highland focus group had been positive and acknowledged that further work was needed with the CHP focus group to provide assurance around the process. Mr Creelman commented on the reported number of 135 posts without outlines. Mr Logue advised that the CHP Lead for eKSF is currently reviewing the list. Ms Heritage enquired if there would be any impact from the implementation of the Change Fund work, and the fact that people will be working differently, and whether or not this would slow the process. Mr Logue acknowledged that this would provide a further challenge but that eKSF should support the process.

The Committee:

• Noted the current progress against trajectory • Noted the actions being undertaken to monitor and a chieve progress

against trajectory • Noted the qualitative aspects of e -KSF implementation

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10. Partnership Working Mr Martin reported that representatives from NHS Greater Glasgow & Clyde (GG&C) attended a recent Partnership Forum (PF) meeting to advise on the Clinical Services Review currently being undertaken in Glasgow. This resulted in a good, informative and detailed discussion between the PF members and GG&C representatives. 10.1 Draft Minutes of Community Planning Partnershi p (CPP) - Full Partnership

Meeting – 28-11-12 10.2 Draft Minutes of Community Planning Partnershi p (CPP) Management

Committee Meeting– 12-12-12

Mr Leslie advised that the Minutes of the above Groups will now be included as a routine agenda item to provide an overview of the business of the Community Planning Partnership. The Scottish Government are promoting cross partnership working across all Boards and Council areas, with a focus on the requirement for shared views and discussions. The Committee: Noted the content of the of the circulated Community Planning Partnership minutes 11. PERFORMANCE MANAGEMENT 11.1 Balanced Scorecard Summary Mr Leslie drew attention to the circulated document which provided the CHP with the opportunity to review the CHP’s performance against the Board position and the Scottish Government’s targets. He highlighted complaint responses as an area of concern but provided reassurance that the CHP carries out a thorough investigation of all complaints and the CHP Clinical Governance Manager scrutinises the level of openness in our responses. Councillor Freeman expressed disappointment in the short coming in performance against the breastfeeding target. Councillor Robertson commented on the CHP’s performance against DNA rates and was assured that two of the localities are meeting the target and steps are being taken for all localities to share good practice in an attempt to reduce DNAs. Press statements are regularly issued which highlight to the public the impact of DNAs on the appointing system and the cost implications. On completion of British Telecom taking over the contract for the CHP communications system, the CHP will consider the process for installing a patient phone reminder system. The Committee: Noted the content of the of the circulated Balanced Scorecard Summary 11.2 Joint Performance Report The circulated report provided an overall picture of the joint working between the CHP and Argyll & Bute Council.

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Mr Leslie reported that the January delayed discharge census recorded 7 patients <4 weeks, 3 patients were coded 9/51 (adults with incapacity) all delayed >6 weeks and 3 patients had exemption code 100, requiring discharge to a specialist facility. The CHP met the national target of zero delays for non-exempt patients at 6 weeks. The Committee: Noted the content of the of the circulated Joint Performance Report 11.3 Operational Delivery Plan (ODP) Mr Leslie advised that each CHP Operational Unit had been requested to produce and submit an operational unit delivery plan which will inform the Board Local Delivery Plan. The circulated CHP plan will also detail how the CHP will be implementing the Highland Quality Approach, including initiatives and organisational development. The CHP Service Planning Priorities for 2013/2014 will be aligned with budget proposals.. The final draft of the ODP will be considered at the NHS Highland Senior Management Team on 28 February 2013. The final OUD Plan will be considered by Highland NHS Board on 9 April 2013. The Committee: Noted the content of the of the circulated CHP Operational Unit Delivery Action Plan 2013/2014 12. Mental Health Modernisation Update The circulated report gave an update on the implementation of the modernisation of mental health services in Argyll & Bute. Mr Dreghorn commented on specific items of the report. Project Governance At the recent Capital Project Board it was reported that the review of the site and content of the support services building is due to be completed in February 2013. The outline business case is still under development, with the resubmission of the stage 1 report by Hubco expected in early April 2013. Inpatient Services A new Senior Charge Nurse has been appointed to the inpatient team. Community Mental Health Teams Vacant community posts have now been appointed to. Mr Martin enquired if the enhanced community mental health teams have had an impact on hospital admissions. Mr Dreghorn confirmed that the number of beds had reduced as had length of stay. However, the main impact would be evident in the longer term through reduced morbidity contributed to by increased Tier 1 and Tier 2 services, guided self help, Primary Mental Health Care Workers and enhanced access to talking/psychological services.

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Transfer of Detained Patients The option appraisal exercise for the transfer of detained patients was concluded and the preferred option will be presented for approval by the Programme Board on 15 March 2013. Places of Safety Review visits to each site have been undertaken by Mr Dreghorn and Mr Wright, Service Manager, Acumen. The findings show that there are differences in the quality of facilities and in effective local arrangements for looking after patients awaiting transfer to Argyll & Bute Hospital. Additional work is required on staff training and development and the quality of facilities to ensure a consistent level of care and service in each locality. Mr Creelman stated his concern around the time issue for transfers and the availability of an appropriate level of care and safe transport of mental health patients. Mr Leslie advised that the work of the Highland Quality Approach will assist in introducing a consistency of approach in management and safety of patients. The Committee: Noted the current key issues and progress against the action plan. 13. Code of Practice for Joint Inspection of Servic es for Children The above document was circulated to inform on the process of the inspection due to commence in Argyll & Bute CHP in March 2013. The Committee: Noted the content of the document 14 AOCB There was no other business. 15 DATE, TIME & VENUE FOR NEXT MEETING: Wednesday 24 April in Guide Hall, Kinloch Road, Cam pbeltown 10.30am : Development session 1pm : Meeting

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Agenda item : 6.1

Argyll & Bute CHP Committee Date of Meeting: 24 April 2013

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 information relates to incidents reported in Quarter 4, the period from January to March 2013.

2

FIGURE 1 Argyll and Bute Incidents Last 13 months

FIGURE 2 Categories by Locality from January – Marc h 2013

For Quarter 4, January to March 2013, the overall number of incidents reported through Datix in Argyll and Bute was 447 – an increase from 438 in Q3.

The top 3 categories of reported incidents for Q4 are:

- Slips, Trips and Falls

- Disruptive, Violent and Aggressive Behaviour

- Pressure Ulcers

The increase in incidents related to self harming behaviour can be attributed to one patient.

3

FIGURE 3 Grade of Incidents by Locality January – M arch 2013

FIGURE 4 Incidents with a Major or Extreme Conse quence January – March 2013

Four incidents were graded as high in Q4 C&B: 1 MAKI:2 OLI:1

There were 6 incidents with a major or extreme consequence in Q4: Maki: 4 C&B:2 Outwith NHS Highland:1

4

Figure 5: Category by Consequence January – March 2 013

FIGURE 6 RIDDOR REPORTABLE INCIDENTS

There was one RIDDOR Reportable incident in Q4.

Major and Extreme Categories: Consent:1 Pressure Ulcer:1 Security:1 Slips, trips and falls:2 Transfer/Discharge:1

5

2.1.2 Pressure Ulcer Prevention Implementation of NHS Highland Zero Tolerance approach to preventable pressure ulcers continues with a range of measures being taken to improve the identification and management of those patients at risk of developing pressure ulcers in all settings. These include:

- staff training using the NHS Education Scotland Module in Pressure Ulcer Prevention

- more rigorous application of prevention standards - raised awareness and scrutiny by managers across all sites - increased availability of pressure ulcer prevention equipment - root cause analysis of each Grade 3 and 4 pressure ulcer

In Argyll and Bute this work is leading to reduced numbers of hospital acquired pressure ulcers. In Q4 there were no Grade 3 or 4 hospital acquired ulcers in Argyll and Bute. Work continues with staff from NHS GGC to ensure that there is feedback and reporting on patients transferred back from Acute Services who have identified pressure ulcers. Further work is required across all community settings to raise the awareness of patients, carers and staff in all sectors to ensure that appropriate risk management is undertaken at all times. FIGURE 7 NHS Highland Number of Patients with Hospi tal Acquired Pressure Ulcers from

March 2012 to March 2013

The overall number of Hospital Acquired Pressure Ulcers in NHS Highland for Q4 was 129.

6

FIGURE 8: Operational Units: Numbers of Patients wi th Hospital Acquired Pressure Ulcers from March 2012 to March 2013

FIGURE 9: Hospital Location where Pressure Ulcer De veloped March 2012 to March 2013

From the overall number for NHS Highland 4 of these pressure ulcers were acquired in hospitals in Argyll and Bute

Hospital acquired pressure ulcers in Q4 in Argyll and Bute: Islay Hospital:2 Campbeltown:1 Victoria, Bute:1

7

Figure 10: Total Number of Pressure Ulcers per mont h in Argyll and Bute from March 2012- March 2013

Figure 11: Where Pressure Ulcer Developed by Sub Ca tegory

8

TABLE 1: Pressure Ulcers Rates per 1000 OBDs and CQ I Compliance Rates for each Hospital in Argyll and Bute CHP

2.1.3 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 graph below illustrates trends across NHS Highland. FIGURE 12 NHS Highland Patient Falls in Hospitals f rom March 2012 to March 2013

9

FIGURE 13: All Patient Falls by Operational Unit an d Consequence January to March 2013

FIGURE 14: NHS Highland Patient Falls in each Hospi tal January- March 2013

10

TABLE 2 Rate of Falls per 1000 Occupied Bed Days an d Falls Prevention CQI Compliance Scores for each Hospital

** please note that from December onwards the rate per 1000 occupied bed days includes all falls. Prior to December the rate incl uded only falls with harm. 2.2 Serious Untoward Incidents (SUI) Significant Event Review was carried out in early March into failure to adequately plan for transfer of very elderly patient from community hospital to home. This has resulted in some significant learning and the implementation of key actions to address potential shortfalls in planning systems and processes as well as communication. 3 COMPLAINTS TABLE 3 Argyll and Bute Complaint Performance repo rt

Target Amber Red Dec-12

Jan- 13

Feb- 13

Number of complaints received 4 5 ~ 6 7 and over 4 4 6 Achievement against 20 day 80% 70 - 79% Under 69% 25% 25% 17% Number of complaints over 40 working days old * 0 ~ 1 or more 1 0 Number of further correspondence over 20 working days old * 0 ~ 1 or more 1 2 Number of complaints categorised as high risk 1 2 3 and over 0 0 0

11

Of the complaints received in January/February 2013 the causes of complaint can be categorised as follows:

Access/Admission: 5 Communication: 1 Treatment Procedure: 1 Transfer/Discharge: 1 Attitude/Behaviour: 1 Policy: 1

As part of the Highland Quality Approach, and in response to the Patients Rights Act, NHS Highland is reviewing its overall performance in relation to complaints management. In addition, we have introduced further system of scrutiny within the CHP to ensure that appropriate clinical/professional leaders view complaints and draft responses prior to final sign off to ensure that all key aspects of the complaint have been investigated and that the response to the complainant is of high quality. 4. EXTERNAL REVIEWS 4.1 Joint Inspection of Children’s Services in Argy ll and Bute The on site inspection, led by the Care Inspectorate, with inspectors drawn from range of partner organisations, commenced in March 2013 and is due to conclude at the end of April. This is a pilot inspection which is seeking to test the inspection methodology prior to carrying our inspections across all Local Authority areas in Scotland. Verbal feedback will be provided to members of Community Planning Partnership on May 3rd. The written report will be published in June 2013. 4.2 CPA Surveillance Inspection of LIH, Oban Labora tories Follow up inspection will take place in April 2013. 4.3 National Plans for Joint Inspection of Adult Se rvices A joint approach to the inspection of adult services is being undertaken by Healthcare Improvement Scotland in conjunction with the Care inspectorate to examine the effectiveness of collaborative working, primarily between health, social work and social care services for adults. The aim is to build on the previous experience of multi-agency inspections and the proposals for the integration of health and social care systems. We have been working closely together to develop the model and methodology for scrutiny and improvement that considers how well strategic partners work together to deliver support that maintains people in the community at home or in a homely setting. The initial inspections will consider the way in which better outcomes for older people are being jointly achieved, for example through early intervention and preventative support, speedier assessments when needs are identified, more effective setting up of care packages to support people at home, promoting self care and reducing delays in discharge from hospital. For the purpose of these inspections adults are defined as being 65 years of age and over.

12

The inspection model has been produced by bringing together the most relevant elements from the Care Inspectorate and Healthcare Improvement Scotland into an improvement model for services for adults. The model will look at 6 key themes:

• jointly meeting needs through person centred approaches • key outcomes for people and carers • joined up delivery of services • management of whole systems and partnership approach • leadership and direction • capacity for improvement.

During 2013/14 the Care Inspectorate is undertaking 6 joint inspection of adult services. Local Authorities and NHS Boards will be given 12 weeks notification prior to individual inspections. Inspection teams will be multidisciplinary and multi-agency and comprise inspectors from the Care Inspectorate and Healthcare Improvement Scotland and clinical expertise from nursing, medicine and allied health professionals. Nominations for Clinical Experts to join the inspection teams have been requested by HIS and this request has gone to a number of staff in Argyll and Bute. 5. QUALITY 5.1 Older People in Acute Care All hospitals in Argyll and Bute are working towards the implementation of the standards for Older People in Acute Care. Inspection visits using the national tools from HEI will be carried out in each hospital during May and June 2013. The purpose of these visits is to share learning across all sites and to ensure that we are focussed on the key priorities for improvements. 5.2 Food Fluid and Nutritional Care Recently the focus for improvement work relating to food fluid and nutrition has been targeted at achievement of the standards within the National Catering and Nutritional Services Specification. Argyll and Bute CHP recorded 100% compliance in the December 2012 audit. The CHP Food Fluid and Nutritional Care Group is currently refreshing its work plan. In addition to actions focused on monitoring and maintaining compliance with the national catering specification, new improvement actions have been identified. In particular there will be a focus on the nutritional elements of the HIS Older People in Acute Settings Standards and learning from National Inspection Reports. .

13

5.3 Scottish Patient Safety Programme Acute Services: Appendix One contains the latest information in relation to SPSP across NHS Highland Acute Hospital sites. This information is presented in different format from the previous dashboard and allows comparison across the four hospital sites. Lorn and Islands Hospital In Patient Raw Mortality: there have been 5 consecutive months above baseline; control chart shows 1 point beyond Upper Confidence Limit (UCL. Lorn and Islands Hospital HDU Mortality: 6 consecutive months above baseline, control chart shows 1 point beyond UCL. These figures have been scrutinised through the mortality monthly audit by senior nurses, consultants and managers and there are no identified adverse events. There have been a significant number of patients requiring palliative/end of life care admitted into Ward B and HDU side rooms. This has been caused by reduced side room availability in Ward I due to increase in number of patients awaiting discharge. This is under review with the Hospital Manager and Senior Nurses. Mental Health The roll out of SPSP in mental health is underway with the team from Argyll and Bute Hospital having attended two of the national learning set events in Glasgow. Using the improvement methodology the main focus is on reducing risk by improving communication; this will also include improving risk assessment and medicines management. Daily Board Rounds at the hospital have helped with internal clinical communication. The implementation of new care plans will help to address the issues in communication between inpatient and outpatient care since the same plan will be continued. These are being rolled out at present. Primary Care The Scottish Patient Safety Programme in Primary care was officially launched on 14/15 March by the Cabinet Secretary for Health and Wellbeing and the Chief Exec of NHS Scotland. Joyce Robinson, Primary Care Manager represented Argyll and Bute CHP at the launch. Two elements of the Primary Care Safety Programme are included in Quality and Outcomes Framework (QOF) of the GMS contract this year:

• The Safety Climate Survey, and • Structured case note review using the Primary Care trigger Tool.

Training for the GP practices in A&B is being arranged for early June with Dr Kirsty Vickerstaff, who was involved in the Safety Improvement in Primary Care Pilot Programme for NHS Highland.

14

5.4 Francis Report of Public Inquiry into Mid Staff ordshire Hospitals The CHP Clinical Governance Group, Partnership Forum and Management Team have reviewed the findings of the Mid Staffordshire public inquiry which was led by Robert Francis. This will be presented to the next CHP Committee Development Session. The recommendations of the report will have implications for all organisations; we will continue to work with people who use our services and with our staff to highlight and address areas for improvement. The report can be accessed through the following link: http://www.midstaffspublicinquiry.com/report 5.5 Supplementary Staffing Supplementary staffing is the term used to describe staffing which is additional to the employed establishment for any services and includes bank and agency staff as well as overtime, additional hours and on call. Considerable work has been undertaken by all managers across Argyll and Bute to reduce the level of supplementary staffing in our nursing and midwifery services. While there will always be a need for percentage of staffing to be delivered through supplementary routes, it is preferable for this to be kept below 10% where possible as this improves continuity and quality of care provided. Figures for Argyll and Bute showed sustained improvement throughout 2012-2013. FIGURE 15: NHS Highland Unit Comparison Nursing and Midwifery Total Supplementary Workforce Costs as % of Pays

Unit ComparisonN&M Total Supplementary Workforce Costs

Expressed As A Percentage Of Pays

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4

2012-13 2013-14

North & West

South & Mid (Excl. NC)

New Craigs

Argyll & Bute

NHS Highland Total

Corporate

Raigmore

15

FIGURE 16: Argyll and Bute Nursing and Midwifery T otal Supplementary Workforce Costs as % of Pays

Argyll & ButeN&M Supplementary Workforce Costs

Expressed As Percentage of Pays

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4

2012-13 2013-14

Bank

Agency

Excess PT

Overtime

Tot Supplementary

On Call / Call Out

6. HEALTH AND SAFETY 6.1 Cowal Community Risk Matrix The Cowal Community team have been developing a risk matrix to determine the risk and appropriateness for patient discharge from casualty to the patient’s home. The CHP health and safety managers have reviewed and provided input on the risk matrix, for consideration and incorporation. 6.2 Ward COSHH Control Summary Sheets In preparation for the new policy on COSHH and the associated audit process, the CHP health and safety managers have assisted Oban General Ward in completing the internal COSHH control summary sheets for the chemicals they are currently utilising. The same control sheets have been disseminated to other wards in Oban and in Cowal, so they may evaluate and amend as appropriate for their own circumstances. 6.3 Dentistry Risk Assessments The dentistry service has been working on completing general risk assessments for different dental staff groups, dental nurses, dentists and dental receptionists for the general duties and tasks performed by these staff. These assessments have been reviewed by the health and safety managers and comments provided. These assessments have been placed on the A&B CHP, Health and Safety intranet page to assist others in carrying out risk assessments.

16

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 and Lorn & Islands are now complete and have been issued. Action plans are now being progressed and will be reviewed. Cowal Hospital risk assessment has been carried out, the process of uploading the information to the 3i data base is underway and will be issued to managers in April 2013. Managers have been issued with draft pictorial reference sheet to highlight where prompt actions are required. 7.2 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 well underway to upgrade the fire alarm systems to L1 standard in Dunoon and Oban. 7.3 Unwanted Fire Alarm Signals The number of unwanted fire alarm signals continues to fall. Emphasis is being placed on the timely investigation of incidents and implementation of actions to minimise the risk of recurrence. 7.4 Fire Service Audits The enforcing authority has now completed audits in Cowal, Rothesay and Islay hospitals. Duty holders have received letters of recommendations; no formal action has been issued. Audits of Lorn & Islands and Campbeltown Hospitals took place in April. The outcome of these visits is awaited.


Agenda item:

- 17 -

Appendix One: Scottish Patient Safety Data


Agenda item:

- 18 -


Agenda item:

- 19 -


Item No: 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”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board.

3. New Staphylococcus aureus bacteraemia & Clostrid ium difficile National HEAT Targets

From 01/04/2013, the National HEAT target for Staphylococcus aureus bacteraemia (including MRSA) cases is 24.0 or less per 100,000 acute occupied bed days by year ending March 2015. The National HEAT target for Clostridium difficile infections in patients aged 15 and over is 0.25 cases or less per 1,000 total occupied bed days by year ending March 2015

4. Summary

Table 1 NHS Highland Infection Prevention & Control targets and performance data Group Target NHS

Scotland NHS Highland

Clostridium difficile

Age 65 and over

39.0 (100,000 OBDs)

29.2 For period January 2012 – December 2012.

Green

Staphylococcus aureus bacteraemia

Age 15 and over

26.0 (100,000) AOBDs

22.5 For period January 2012 – December 2012.

Green

Hand Hygiene

95% 95%

98% Green

2

Cleaning 90% 95.7%

95.9% Green

Estates

90% 97.3% 97% Green

AMAU - 96%

Green Antimicrobial prescribing

Hospital-based Empiric prescribing

95%

Ward 4A – 95%

Green

Surgical antibiotic prophylaxis

Compliant Yes Green

Primary Care empirical prescribing

Compliant Yes Green

Source: - Health Protection Scotland/ISD/Local data.

5. Achievements

A fourth Consultant Microbiologist will be recruited; the creation of this post will enable additional Infection Prevention and Control support. This will also enable Infection Control Clinical Leadership to be delivered to Argyll and Bute CHP from NHS Highland rather than from NHS Greater Glasgow and Clyde.

6. Challenges

• To engage all clinical staff in hospitals and in the community to put in place and

sustain initiatives to reduce device/healthcare related infections. • To have access to high quality data for all areas.

3

Argyll and Bute CHP Healthcare Associated Infection Report –

April 2013

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

1. Staphylococcus aureus (including MRSA)

1.1 New Staphylococcus aureus bacteraemia target From 01/04/2013, 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 or less per 100,000 acute occupied bed days. 1.2 Trends Altogether, 379 new S. aureus bacteraemia cases were reported to Health Protection Scotland (HPS) during this period. This is a decrease of 7.1% compared with the same quarter last year (October to December 2011) when 408 cases were reported and it is the second equal lowest number of cases reported since the start of the mandatory S. aureus bacteraemia surveillance programme. In the last year, January 2012 to December 2012, 1509 episodes of S. aureus bacteraemia were reported to HPS. This represents a decrease of 6.2% on the previous year , January 2011 to December 2011, when 1609 episodes were reported. The overall rate of S. aureus bacteraemias for Scotland was 29.9 S. aureus bacteraemia cases per 100 000 acute occupied bed days (AOBDs). This represents to a small increase of 1.6% compared to the previous quarter (from 29.4 to 29.9). This is, nonetheless, the third lowest S. aureus bacteraemia rate reported since the start of the mandatory S. aureus bacteraemia surveillance programme. In comparison with the same quarter of 2011, the overall S. aureus bacteraemia rate for Scotland has decreased by 7.1%, from 32.1 to 29.9 per 100 000 AOBDs.

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

During this quarter, the S. aureus, MRSA and MSSA bacteraemia rates at all NHS boards were within or below the 95% confidence limits on the funnel plots. The annual rate for NHS Highland, January 2012 – December 2012 is 22.5 per 100,000 AOBDs (National target March 2013, 26 per 100,000 AOBDs) which means that NHS Highland is on track to meet HEAT target. Within NHS Highland there were 2 MSSA SABs in January 2013 and 8 SABs (2 MRSA and 6 MSSA) in February 2013. The causes were attributed to 2 x PICC lines, 1x skin & soft tissue, 1 x catheter related urinary tract infection and 1 which was probably not preventable, with root cause analysis to be completed for the remainder. In Argyll and Bute there have been no SAB cases reported during the last quarter of 2012- 2013. Figure 1 Staphylococcus aureus bacteraemia (MRSA an d MSSA) cases per 100,000 occupied bed days, all ages, with 95% confidence interval (v ertical lines), linear trend (Black line) and target (Red line) = 26, CI = Confidence Interval

Figure 1 shows that SAB rates have remained stable at low levels between January 2010 and December 2012

5

Figure 2 shows that in the current reported quarter ending December 2012 that the Highland SAB rate was significantly lower than that of most other Scottish Boards.

HG = Highland 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 0 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 Dunaros, Mull 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 new cases of SAB in Argyll and Bute since the last report. 1.3 MRSA Screening A National Key Performance Indicator (KPI) tool has been developed by Health Protection Scotland (HPS) to monitor compliance with the National MRSA screening policy. There is a requirement to achieve a minimum of 90% compliance. All NHS Boards are now collecting data which will be reported annually by HPS. The effectiveness of the MRSA screening policy will be reviewed by HPS after 3 years (March 2015).

6

2. Clostridium difficile

2.1 New Clostridium difficile Target

From 01/04/2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, the rate of Clostridium difficile infections in patients aged 15 and over is 25.0 cases or less per 100,000 total occupied bed days. 2.2 Trends In total, 313 new cases of CDI in patients aged ≥65 years were reported to Health Protection Scotland (HPS) during this quarter. The overall incidence rate for Scotland was 26.7 cases per 100000 total occupied bed days. This is a 16% decrease from the previous quarter and is the lowest rate reported for this age group since the beginning of mandatory surveillance. In total, 120 new cases of CDI in patients aged 15-64 years were reported to HPS during this quarter. The overall incidence rate for Scotland was 34.4 cases per 100000 acute occupied bed days. This is a 17% decrease from the previous quarter . The year on year trend analysis comparing 2011 to 2012 shows a non-statistically significant decrease in the overall incidence rate for patients aged ≥65 years of 2.0% (95% CI: -15.2% to 13.3%). In patients aged 15-64 years, there was a non-statistically significant decrease of 10.6% (95% CI: -24.7% to 6.1%). October – December 2012 NHS Highland rate is 18.9 per 100,000 OBDs (9 cases). The annual rate for NHS Highland, January 2012 – December 2012 is 29.2 cases per 100,000 OBDs (National target March 2013, 39 cases per 100,000 OBDs). In NHS Highland there were 4 cases of Clostridium difficile infection in patients aged 65 and over in January and February 2013.

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

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Figure 3 Clostridium difficile cases per 100,000 oc cupied bed days, 65 years and over, with 95% confidence interval, linear trend and target = 39.

The graph shows that NHS Highland has achieved a sustained downward trend in Clostridium difficile rates despite some variation quarterly. Figure 4 Funnel Plot of CDI incidence rates in pati ents aged 65 and over for all NHS Boards in Scotland, September – December 2012.

8

Figure 5 Funnel Plot of CDI incidence rates in pati ents aged 15 – 64 years for all NHS Boards in Scotland, September- December 2012

With effect from 01/04/2013, Clostridium difficile in patients aged 15 – 64 years rates will be included in the national HEAT target. There have been two reported cases of CDI in Argyll and Bute since the last report. Both of these were community acquired and further surveillance is underway to identify root causes. TABLE 3 shows the cumulative CD Toxin Positive Case s in each CHP Hospital for the years since 2009-2012

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

Lorn and Islands Hospital, Oban 0 1 2 1 0

Cowal Community Hospital, Dunoon 3 1 2 2 1

Victoria Hospital, Rothesay 3 0 1 0 0

Dunaros, Mull 0 1 0 0 0

Argyll & Bute Hospital, Lochgilphead 0 0 0 0 0

Mid Argyll Hospital, Lochgilphead 0 0 1 0 0

Campbeltown Hospital 0 0 1 1 0

Islay Hospital, Bowmore 0 0 0 0 0

TABLE 4 shows the cumulative CD Toxin Positive Case s in community for the years since 2009-2012

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

13/14

North and West Unit 22 0

South and Mid Reported as CHPs 21 0

Argyll & Bute CHP 2 4 2 2 1

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3. Hand Hygiene

3.1 Trends NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining an average of 98% compliance for January and February 2013. 3.2 Initiatives 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- the results for each hospital are included within the charts in section 2 of the report. 4. Cleaning and the Healthcare Environment

4.1 Current Rates Domestic and Estates Services report, produced by Health Facilities Scotland (HFS), provides data on compliance as set out in the NHS Scotland National Cleaning Services Specification. For April – December 2012 NHS Scotland cleaning compliance was 95.7%, NHS Highland 95.9%. NHS Scotland Estates compliance for April-December 2012 was 97.3%, NHS Highland 97%.

Results for all Argyll and Bute Hospitals are highlighted in the charts in Section 2 of this report. All areas achieved above the 95% target for March 2013. 4.2 Estates Work has been undertaken in the last quarter of 2012-2013 to address the estates issues in most hospitals which were identified during the preparation for inspection visits. This has

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

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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included replacement of carpets in remaining clinical areas, refurbishment of some departments and replacement of furniture and equipment. 5. Outbreaks/Incidents There have been no outbreaks or incidents since the last report. 6. Inspections 6.1 Preparation for Inspection Visits All localities will submit their action plans to the May Infection Control meeting in order to monitor progress and to ensure that all key actions are being taken to address areas for improvement Recent information received from HEI indicates that for non acute settings:

- they will use the existing methodology, tools and processes for the inspection, whilst varying the size of the inspection team and duration in response to the size of non acute hospitals.

- A risk based, and targeted approach drawing on national data sets will determine the priority for non-acute/community hospitals for inspection.

- All first inspections will be announced

6.2 HSE Joanna Hynd, District Manager in Lochaber, attended the April Infection Control meeting to inform the group of the learning and actions taken to address the requirements of the HSE Improvement Notice for Community Nursing which was issued in September 2012. Number of actions were agreed to ensure that training for Community staff and adherence to Standard Infection Control precautions in community settings all meet the required standards. 7. 2012 Staff Influenza Vaccine Uptake Uptake of the Influenza Vacine was higher among staff in 2012 than in any other previous year – this was due to a high profile campaign and real dedicationa and commitment from those identified as “Flu Champions” across the CHP. The target for the Staff Vaccine programme was to reach 50% of frontline staff; although this figure was achieved for some staff groups further awareness raising is required to improve the uptake in 2013 so that the overall target is reached. Table 5 shows the Influenza Vaccine Uptake by staff groups across NHS Highland Operational Units.

A&B South & Mid

North & West Raigmore

Medical Practitioner (other than GP) 46% 20% 28% 47%

General Practitioner (GP) 50% 53% 15% 67%

Nursing 34% 24% 27% 38%

Midwifery 33% 64% 34% 57%

Medical support 50% n/a 100% 19%

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Administrative services 39% 38% 27% 47%

Allied health professionals 65% 35% 39% 81%

Support services 37% 27% 33% 42%

Healthcare sciences 35% 50% 36% 31%

Other Therapeutic Services 41% 18% 26% 189%

Community pharmacists n/a n/a n/a n/a

Dentists & dental support 34% 33% n/a 81%

Emergency services n/a n/a n/a n/a

Personal and Social Care 47% 56% 23% 100%

Senior management 100% 333% 233% 100%

Other n/a 0% 0% n/a

Blank 0% 0% 0% 0%

Total 39% 29% 30% 45%

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

The following section is a series of ‘Report Cards’ which provide information 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

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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 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

Argyll and Bute CHP Committee Date of Meeting : 24th April 2013

Agenda item : 7.3 Health Promoting Health Service Report by Elaine C Garman, Public Health Specialist The CHP Committee is asked to: • Note the content and agree the recommendations of the report

1 Background and Summary

Over the past number of years there has been a Chief Executive Letter (CEL) from Scottish Government with regard to implementation of the Health Promoting Health Service. CEL 1, 2012 ( http://www.sehd.scot.nhs.uk/mels/CEL2012_01.pdf ) was the last such letter and reiterated that, “every healthcare contact is a health improvement opportunity” and is central to the Quality Ambitions for both person-centred and effective care. The CEL extended the aspirations and range of actions from the previous one and included community hospitals in the settings targeted. It aimed to sharpen local leadership, governance and accountability in this area, and harness improvement capability for the health promoting health service. NHS Boards were asked to implement this CEL and report annually for the following three years; this report is the first of these reports. The full report can be found in Appendix 1. 2 Supporting health improvement in all hospital settings

2.1 Summary Whilst the CEL focuses on hospital settings, for our context it is usefully extended to all settings and therefore we include community staff so there is no dubiety that whether a staff group works in hospital, between hospital and community, in integrated teams or solely in community that the ethos of ‘every healthcare contact is a health improvement opportunity’ relates to their work. Development of the public health team, both in getting posts established and people trained has been a priority since the establishment of the Community Health Partnership (CHP). Whilst this does not stop, it has largely been achieved and in the last few years there has been greater focus on delivery in key areas such as smoking cessation. We know we still have a way to go in delivery of Alcohol Brief Interventions in acute settings and suicide prevention training (not a feature of this CEL). The key area to which we now have to give more attention is physical activity. This needs to be linked to activity around healthy eating. Whilst this is a CEL directed at the health service I would advocate resisting having a separate plan for this from the rest of the community planning partnership but acknowledge that we have to be clear what the health service staff are delivering within this. The CHP has been very active in promoting Healthy Working Lives with only Bute left to bring up to the level of the other areas. We can do more to tie together issues from the staff survey and sickness absence into Healthy Working Lives and we now have developed the connections to do this.

2

2.2 Recommendations It is recommended that starting in 2013/14 that the CHP has greater health improvement focus on physical activity whilst maintaining momentum on other targets. In addition the work that can be done beneficially between Healthy Working Lives and the Staff Partnership Forum on improving the health of staff and specifically picking up issues from the staff survey and sickness absence are taken forward as a priority.

3 Contribution to Board Objectives The report contains recommendations to improve preventive care and service delivery across Argyll and Bute, and contributes to Better Health, Better Care and Better Value 4 Governance Implications

• Staff Governance: the report calls for staff to embrace the ethos of every healthcare contact is a health improvement opportunity, which will have training and customer care implications for staff

• Patient and Public Involvement: the report should ideally be widely discussed with patients and the public to ensure full implementation of its recommendations

• Clinical Governance: the report calls for health improvement to be set out in care pathways

• Financial Impact: the report contains no specific resource requirements, but does support interventions aimed at reducing use of hospital-based health care which may result in cost savings

5 Risk Assessment

The report makes recommendations on improving the health and well-being of the Argyll and Bute population through actions by the NHS. Risk assessment is not required at this time. 6 Planning for Fairness

The report makes recommendations on improving the health and well-being of the population through actions by the NHS. Impact assessment on the report itself is not appropriate but will need to be considered as and when the recommendations are implemented.

Elaine Garman Public Health Specialist 17 April 2013

CEL (01) 2012 Annual Report 2013/14 Please refer to CEL (1) 2012 Implementation APPENDI X A for guidance on completing the attached table,

principally information BY TOPIC on Performance Man agement Context for details of required data.

NHS Health Scotland/ Scottish Government CEL (1) 2012 Annual Report Submission: Year 1- March 2013 1

Health Board: NHS Highland,

Argyll & Bute CHP

Submission date: - April 2013

CEL

Action Performance Measures Required Evidence of

Delivery

Submission of Evidence

Exception to evidence provision

Core Actions

1. Chief Executives are asked to delegate responsibility for implementation to the appropriate committee and governance structures and to provide a report to the Board on progress, at least annually, in each of the next 3 years.

Local Governance and implementation structures submitted and evidence of Board reports/ minutes on progress achieved.

In Argyll and Bute CHP this is delegated to the CHP Management Committee which is chaired by the Director of Operations.

2. The attainment of generic health improvement competences should be supported through provision of appropriate professional development programmes.

Submission of proportion of staff undertaking and completing generic health improvement professional development programmes.

NHS Highland, in partnership with NHS GGC, NHS Lanarkshire and NHS Ayrshire and Arran supports the pilot of the UK Public Health Register (UKPHR). In Argyll and Bute CHP one member of staff has been trained as an assessor, one has been trained as a verifier and 4 people are preparing their portfolios of evidence. NHS Highland supports staff in their professional development via a bursary scheme. It is known that a number of staff use this scheme to support undergraduate and postgraduate study in health




improvement and public health. Data is not routinely gathered on total numbers of staff undertaking this form of study nor the proportion of the total workforce. However within the public health team 100% of the staff have either completed professional and academic qualifications, are in the process of completing such or have attended relevant short professional courses that are specific to their area of expertise. The team offers motivational interviewing and brief intervention training to all hospital and community staff.

3. Local expertise on improvement methodology should be made available to jointly support all hospital and public health staff to test, adopt and spread good practice.

Named Lead and description of what planned and/or operational improvement processes are in place

The following health improvement staff are employed in Argyll and Bute CHP: Alison McGrory, Health Improvement Principal – responsible for managing the health improvement function and with specific responsibilities in relation to health improvement in older people. Alison Hardman, Senior Health Improvement Practitioner (Health Inequalities) – currently leading on Keep Well using a co-production model. Angela Coll, Health Improvement Practitioner (Healthy Working Lives) – supports workplaces including NHS sites to progress the Healthy Working Lives Awards. Carol Muir, Senior Health Improvement Specialist (Community Development) –




responsible for developing population wide programmes. Craig McNally, Senior Health Improvement Specialist (Alcohol and drugs) – leads on delivery of ABI HEAT target and supporting front line staff. Laura Stephenson, Senior Health Improvement Specialist (Sexual Health) – leads sexual health improvement and currently working on a sexual health website for Argyll and Bute. Lorna Crawford, Training Officer (Suicide and Self-harm prevention) – provides training Sam Campbell, Senior Health Improvement Specialist (Mental Health) – leads on delivery of mental health improvement Tracy Preece, Senior Health Improvement Specialist (Choose Life) – leads the delivery of suicide and self harm, specifically in relation to the NHS workforce Yennie van Oostende, Senior Health Improvement Specialist (Long Term Conditions) – leads on development of the LTC agenda. Improvement methodologies such as LEAN are available to NHS staff through CHP management team and linkage is made to the Highland Quality Approach.




4. Patient Focus and Patient Involvement (PFPI) and patient experience leads should enable patient, carer and volunteer participation in developing and implementing the action plan

Details of how and what PFPI leads have influenced in the development and implementation of the local delivery plan.

Individual work items have been taken to PPF, for example screening programme implementation.

5. Medical Directors and Directors of Public Health should jointly support and encourage all hospital Clinical Directors to take account of involvement in health improvement actions through the annual appraisal cycle for hospital consultants

Hospital consultants have demonstrated involvement in health improvement action.

This is a new action and will be discussed with the Medical Director to take forward with consultants in Lorn and Isles Hospital.

Smoking

CEL


Delivery CEL Action Performance

Measures Increased quit attempts and successful quits amongst hospital in-patients, out-patients, day surgery and pregnancy. Community-based quit attempts and quit successes following a referral, or delivery of brief interventions and referrals, from a hospital setting;

Number of acute-setting referrals to Community Smoking Cessation Services Number of acute setting referral to attend first SCS session/ group Breakdown of Quit Attempts of Smoking Cessation Users referred from Hospital Setting

HEAT data available shows that a total of 1012 which exceeded the trajectory of 805 (Feb 2013) which include referrals from hospital and primary care settings. The inequalities target as of Dec 2012 was 405 and 423 were achieved. A supplementary paper will be tabled at the meeting giving more detail on this section.

18.1

Evidence of existence and Submission of Local Integrated Referral routes are specific and known in Local Integrated Care




application of Integrated Care Pathways for smoking cessation in secondary care (and for patient flows to and from primary care);

Care Pathway(s). Including details of:

I. pathway alignment with MCNs

II. if opt-out scheme approach is in practice.

III. approach to integrate with primary care

each of the localities. Pathways to evidence this will be written.

Evidence of appropriate training and/ or support in the delivery of brief advice for smoking cessation in secondary care;

Number of hospital staff by ward/setting trained in the effective delivery or brief advice or use of the Integrated Care Pathways.

Database to be constructed and data gathered

Evidence of specialist smoking cessation support (or Health Behaviour Change equivalent) available within (or to) secondary care sites within Boards.

Submission of outline of specialist smoking cessation support available within or to secondary care sites within Boards (or health behaviour change equivalent).

Motivational interviewing and brief intervention training calendar of training available.

Implement a comprehensive organisational tobacco policy, with specific timescales to enable progress to be measured.

Submission of Local Tobacco Policy with update report on delivery. This would include;

i. Details on how the policy is communicated to staff, patients and

Intelligence on progress of Smoke Free Hospital Sites currently being gathered. Action plan will follow when baseline is known.




visitors.

ii. Details of Smoke Free Target Dates for Hospital Sites and plans for those yet to set target dates.

Alcohol

CEL Action

Performance Measures Required Evidence of Delivery

CEL Action Performance Measures

The number of A&E attendances who are screened opportunistically for alcohol misuse, as a % of total attendances; The number of A&E attendances screened (using a validated screening tool) for harmful or hazardous drinking and the % screening positive i) with % eligible for ABI ii) % eligible for referral to treatment services;

The number of screenings for all services, including the number of A&E attendances screened, as part of the total number of A&E attendances

18.2

The number of alcohol brief interventions delivered in accordance with the HEAT Standard Guidance 2012/13.

The number of alcohol brief interventions delivered in accordance with the HEAT Standard Guidance 2012/13.

This evidence will be reported as part of revised Governance & Accountability arrangements for Alcohol & Drug Partnerships (ADPs) every 12 months, and therefore boards are not required to individually supply this data.




The number of staff trained in both A&E and other acute settings (as part of wider settings) in ABI (extracted from required 6 monthly report)

Within the year 2012/13 there were a total of 10 ABI training sessions training 58 staff from a wide variety of settings. Of these 10 staff from A&E and other acute settings were trained.

Evidence of planning, delivery and/or evaluation of ABIs across the acute settings in accordance with the ABI HEAT standard guidance 2012-13.

Within the year 2012/13, from a target of 1066, a total of 57 ABIs have been delivered within acute settings. An evaluation of the current strategy is underway with a view to increasing the number of ABIs in these settings.

Breastfeeding

CEL



Measures Achievement and maintenance of UNICEF Baby Friendly Initiative in all maternity units.

Submission of evidence that confirms attainment or maintenance of UNICEF BFI Award.

UNICEF baby friendly initiative has been achieved in Argyll and Bute.

18.3

All mothers are signposted to available breastfeeding support programmes in the community. Those with additional needs who are least likely to breastfeed, or breastfeed only for a short time, are supported to access and engage

Report on the proportion of breastfeeding women signposted to community support services at point of discharge through appropriate referral processes.

Argyll and Bute CHP has recently appointed 3 infant feeding advisors. They provide one to one support to women pre and post delivery to establish breastfeeding. Breastfeeding support is also offered via peer to peer support by mothers who have




with services through an appropriate referral process.

Proportion of women who access a breastfeeding clinic or a breastfeeding support worker.

breastfed and been trained.

Develop and establish pathways to maintain support and continuity of breastfeeding in the community, including measures aimed at reducing attrition rates of those initiating lactation.

Submission of local pathways for signposting to community breastfeeding support including feedback mechanism on breastfeeding rates at 5 days (or locally available data equivalent on post-discharge attrition rates )

Local referral routes known in each locality. Local pathways to be written up and definitive mechanism for feedback to personnel on breast feeding rates.

All women returning to work from maternity leave are advised of the breastfeeding support policy 4-6 weeks prior to returning to work.

Submission of staff breastfeeding support policy and details of how policy is communicated to women returning to work.

NHS Highland has a policy for breastfeeding mothers to enable them to return to work whilst continuing to breastfeed. Managers will signpost staff to this as will HR.

Food and Health

CEL



Measures 18.4 Number of sites with hospital

caterers from all sectors with Healthy living Award (or Healthy living Award Plus for those caterers who have already achieved the Healthy Living Award) as a proportion of total sector delivery units.

Performance measures 1-4 will be reported on within results contained within the annual report from each NHS board. Performance measures 1-2 will be reported on specifically by the relevant national food &

The Healthy Living Award and the SGF Healthy Living Programme will report quarterly on progress and this evidence will be collated by NHS Health Scotland. Argyll and Bute CHP activity: healthyliving plus award status




Number of units with retailers in the Healthy living Programme as a proportion of total sector delivery units;

Number of sites with community food co-ops and other social enterprises selling predominantly healthier produce;

Number of sites with healthy options within vending machines in place as a proportion of total sector vending machines. In addition, NHS Boards should continue to implement the actions to remove sugary drinks from

health project as part of their quarterly reporting.

Campbeltown hospital achieved – 24th April 2012 Lochgilphead hospital achieved – January 2012 Oban hospital achieved – 8th September 2011 Dunoon hospital achieved All sites in Argyll and Bute with catering services for the public have achieved healthyliving plus There are no community food co-ops or food social enterprises in Argyll and Bute. The organic garden in Campbeltown sells vegetables in the hospital in summer and autumn. Other veg box schemes are available in local communities from community gardens which is more appropriate given the footfall in community hospitals.




vending machines on NHS sites outlined in CEL 14 (2008) and provide details of progress in their annual report.

Healthy Working Lives

CEL



Measures NHS Boards commit to minimum achievements of a Bronze Healthy Working Lives Award by end of March 2013 and a Silver by end of March 2015;

The following HWL awards have been achieved in five out of six sites in Argyll and Bute: Kintyre Locality – gold achieved June 2009 Cowal Community Hospital - gold achieved June 2009 Islay Hospital – gold achieved Dec 2012 Mid Argyll Locality – gold achieved Dec 2012 Victoria Integrated Care Centre – bronze achieved March 2012 Oban, Lorn and the Isles Locality – gold achieved April 2012

NHS Boards who already hold a Bronze Award should commit to attaining a Gold Healthy Working Lives Award by March 2015

Submission of evidence that confirms attainment in all hospital and community hospital services elements of HWL Bronze Award by March 2013, and HWL Silver Award by March 2015.

This applies to Bute, the remaining sixth site.

18.5

NHS Boards should give consideration to self-monitoring of performance indicators. These

Inclusion of sickness absence rates.

Staff Survey results and sickness absence rates are reported to the CHP Management Committee and CHP Committee.




should include, but are not limited to, monitoring of sickness absence.

NHS staff survey report includes questions on staff experience of workplace health support, employee satisfaction and employee engagement.

Sexual Health

CEL



Measures The number of women who have contraception methods recorded.

Percentage of all women aged 16-50 admitted to maternity and termination services who have contraceptive method recorded Percentage of women offered effective contraceptive methods prior to discharge from maternity and Termination Services.

Proportion of reproductive age women using LARC

This data is recorded in individual patient case notes. It is not routinely gathered into a report for all women.

18.6

The number of women (including teenagers and women with drug and alcohol problems) who are provided with longer lasting contraception

Percentage of women who have contraceptive method recorded and are offered effective contraceptive

As above




prior to discharge.

methods prior to discharge from maternity and Termination Services who are: i) under 20 years old ii) In SIMD groups 1 and 2

The number of terminations and repeat terminations

The rate of terminations of pregnancy

The Scottish rate per 1,000 of terminations for women aged 15 – 44 in 2011 was 12.0 and for Argyll and Bute was 8.3. Repeat terminations are reported by Board area and this data is not broken down into CHP or local authority area.

The number of unintended pregnancies, particularly amongst teenagers and others at risk of poor sexual health.

The rate of repeat terminations of pregnancy

There were 124 teenage pregnancies in Argyll and Bute over the period 2007 – 2010 which give a rate far below the Scottish average.

Physical Activity

CEL



Measures 18.7 Evidence of brief advice and/or brief

interventions for the routine provision of information and advice to patients on physical activity.

Details of staff/ staff groups delivering brief advice and/or brief interventions within defined patients pathway, and consistent with the National Physical Activity Pathway. Evidence of adoption of

This can include proportion/ numbers of staff members/ groups planning to deliver or delivering BA/ BIs and this should be specified in details provided, including description of clinical teams and/ or professional groups e.g. All physiotherapist within cardiac-rehabilitation




National Physical Activity Pathway for Brief Advice & Intervention to Patients. Staff Training Plan for employees responsible for the delivery of the Local Physical Activity Pathway for Brief Advice & Intervention to Patients.

Cardiac rehabilitation phase 3 is carried out in RGH, community hospitals, community sites or at home with specialist cardiac nurse support. All patients are given a Heart Manual for ongoing support. As yet the National Physical Activity Pathway has not been adopted. Motivational interviewing training programmes are delivered and this will be reviewed in terms of staff group uptake. AHPs have a role in relation to increasing physical activity and this is recognised in the implementation of the latest national AHP strategy.

CHP work on implementation of Local Physical Activity Pathway to be commenced in 2013/14 within the context of the Community Planning Partnership

Increase opportunities for staff to be move active

Plans and/or Reports on Workplace Physical Activity Schemes.

Healthy Working Lives programmes include physical activity opportunities for staff.

Increase uptake of opportunities to be more active by staff.

Baseline data of staff physical activity scheme uptake.

This information is recorded in local HWL portfolios and informs ongoing action plans.

Evidence of the use of promotional and motivational posters and other materials to encourage staff and visitors to make more active choices.

Evidence describing the range of physical activity promoting and motivational tools in place for staff, visitors and/or patients.

As above. In addition a new promotional resource has been developed by AHPs to signpost people to local physical activity opportunities.




Active Travel

CEL



Measures 1. Evidence that NHS sites have developed and promoted an active travel plan. 2. Evidence that NHS Boards have made available promotional material to raise awareness of active travel options e.g. make leaflets available to all staff, patients and visitors.

18.8

3. Evidence of initiatives and infrastructure in place to support active travel, such as walking maps, cycle friendly employer, bike purchase I training schemes, stair walking.

Evidence of active travel plan (or equivalent), including method of communication to staff. Submit baseline data of staff participating in employer active travel schemes.

Green travel plans are in place in Lochgilphead as they are a requirement of new build developments. They are also being reviewed as part of the Staff Health Action Plan which reports to the Staff Partnership Forum and this will include actions in relation to ongoing promotion for staff.




PM 16-18 Innovative and emerging practice- minimum of one submission for this category Examples are encouraged that:

• Demonstrate specific actions to advance equality and/ or tackle health inequalities and/or

• Demonstrate mental health benefits to patients, relatives or staff and/or

• Demonstrate effective partnership working and collaboration

Description (summary of action taken, drivers,

aims and objectives, timescale)

Alignment with CEL (1) 2012 topic

(e.g. physical Activity)

Inputs (resources

used)

Reach (who was

engaged- staff/ patients/ visitors)

Activities (what

interventions/ actions were undertaken)

Outcomes (please relate to aims

and objectives)

Impact and Future Actions (describe impact and

next steps to be taken)

Scottish Mental Health Arts and Film Festival (SMAFF) – local programme of events in Argyll and Bute during October 2012.

• This activity targeted stigma associated with mental health problems and aimed to reduce the associated health inequalities

• Activities were planned that would be enjoyable to give participants the opportunity to have improved mental wellbeing

Mental health Staff time – health improvement team and health and wellbeing networks Funding - £4,000 from public health budget, £3,000 from Choose Life budget and

Patients, staff and visitors at Argyll and Bute Psychiatric Hospital. The general public. Third sector partners. Some events were also

Woodland walks in Lochgilphead Music sessions in Lochgilphead Film show in Lochgilphead Arts workshops for homeless/traveller groups in Lochgilphead and Oban Midsummer Night’s Dream Walking Theatre

140 attendees 70 attendees 26 attendees 7 attendees 7 attendees

More than 500 people were impacted by SMAFF during October 2012. Events were evaluated on a scale consistent with their size. This involved recording numbers of participants for the national festival organisers and feedback from attendees.




• Events were organised in partnership with health improvement staff, NHS colleagues, local authority colleagues and third sector organisations

£1,000 from health and wellbeing grant fund Support from national SMAFF team A programme was printed and email widely throughout Argyll and Bute A press release was issued before the events and there was some local press coverage.

promoted via Healthy Working Lives working groups.

Campbeltown Helensburgh Choose Life comedy roadshow throughout Argyll and Bute Islay Link club art workshop Oban arts in the community workshop Dunoon film screening

60 attendees 40 attendees 143 attendees 14 attendees 6 attendees 11 attendees

2012 was the second year that SMAFF was promoted in Argyll and Bute and it is hoped it will now be an annual feature in the health improvement calendar. Mental health is a strategic priority for Argyll and Bute’s Health and Wellbeing Partnership.




“Keep Well With Local Produce Road Show” Local Producers teamed up with the NHS as part of their Rocking Red Heart Roadshow (British Heart Foundation Heart Health Month) The Local Produce project in Kintyre joined in with NHS Highland to promote the health benefits of using good wholesome local food. Getting out and meeting producers, looking at production methods are all key areas to promote a good healthy lifestyle and not least of all a good healthy local economy. Where possible events were held in local Community Gardens, with trained staff on hand to answer any questions on growing fruit and vegetables. There was at least one large scale local producer available at each event to answer questions to put a face to the person who is providing Local high quality food. An Argyll based chef was on hand to cook samples of good local food and at the same time demonstrate

Food and Health Preventing Obesity Plan National Food and Drink Policy Physical Activity Lets Get Scotland more Active (2003) Preventing Overweight and Obesity in Scotland : A route map towards Healthy Weight Healthier Choices- Understanding Nutritional Values Fairer Society

Co-production was undertaken with NHS A&B and Local Produce networks to organise the events. In each location different partners were involved reflecting the individuality of each locations available ASSETS. AVA Local Produce and community Gardens Inspiralba-(Social

The aim of the Road show was to reach out to adults and children in localities. Local Schools engaged in the events and were provided with resources of an educational nature. 3rd sector partners were also fully engaged with the process/events & also in a lead organising role for some of the activities

Education regarding growing your own foods and nutrition, local produce that’s available. Cookery demonstrations and education to ingredients and when possible locally sourced products. Such as Seaweed in Bute. Taster and samples given. 5 minute MOT’s for adults. Blood pressure, height, weight, wellbeing chat and relevant information required. Oral education and information. Food and nutritional

Wide ranging co-production with 3rd sector partners in all localities Networking opportunity between NHS/CHN’s/Oral Health & 3rd Sector Awareness raised of heart health & Keep Well & CHD checks in roadshow localities Promotion of Local Produce and Healthy cooking/eating and local growing in roadshow localities Opportunity to raise awareness of Keep Well with local Producers while giving them a different opportunity/venue to sell their wares Extensive engagement/education

Learn from good practice at Atlantis leisure social enterprise – this centre is bursting at the seams and very busy in all areas/all target groups compared to council run facilities – opportunity to look at this and emulate in other localities/facilities possibility/opportunity to develop funding application to audit Atlantis success and run pilot in other areas using their good practice re visit CHN teams to further discuss issues around the X programme nd how can be addressed – link with opportunity above for evolving the X programme to




how fresh foodstuffs are much easier and more nutritious to cook than frozen or preserved produce. It’s all about good wholesome Local food and raising awareness of where our food comes from and the benefits of using local produce and at the same time raising awareness of Heart Health and the up an coming Keep Well CHD checks - http://www.keepwellscotland.org.uk/ Keep well checks will be starting in Campbeltown April 2013, Dunoon the following year and Oban the year after that, these are the pilot areas in Argyll. The Venues were Campbeltown Community Organic Garden, Tarbert Harbour Café Barge & on Tarbert Pier –supported by Tarbert Healing garden ( at Tarbert Health Centre) , Bowmore, Primary School, Islay supported by Islay House Community Garden, Oban- Benderloch Local Farmers market, Rothesay Community Garden supported by Bute Produce, Dunoon town centre.

Delivering For Health (2005) Better Health Better Care (2007) The Health Care Quality Strategy for Scotland (2010) Better Heart Disease and Stroke Care Action Plan (2009) Shifting the Balance of Care Equally Well (2008 Curriculum For Excellence

Enterprise) Local NHS professionals pending availability; Health Visitors, district Nurses, Oral hygiene practitioners, Café Barge, THG, COCG, CPP, Health & Wellbeing Networks, Cardiac Rehab Nurse, Peer Ed. Group, High School Children, local volunteers, Islay Link Club, IHGG, Recycling Projects, CHWN. Senior

education packs for the schools and children attending. In some areas the Barrowland Band visited the schools in other’s the children came to the road show. In relevant venues Keep Well public consultation and awareness raising was undertaken. Smoothie bike to provide nutritional drinks but also encourage activity. The BarrowBand was both educational and entertaining. Engaging the children and proved a great success.

with primary school pupils using interactive activities with The Barrowband Provision of educational resources to all primary schools to follow up lessons learned from barrow band – Comic Company resource packs for each school on heart health and Eat 5, Gimme 5, Fun ways with fruit and veg, healthy mummies for young tummies Promotion of NSD 2013 campaign and smoke free homes – Swap Fags for swag Promotion of X programme Ideas Tree – interactive community engagement tool asking ‘ How can we

work in A & B and how to resources staff to deliver it Look at impact of Barrowband on school population – opportunity for developing programme with Barrowband akin to smoke free me. Visiting schools throughout A & B in a more formal manner with workshops Barrowband already have an interactive DVD with 140+ downloadable resources and lesson plans. Follow up and develop Leaves from IDEAS tree – i.e. Ideas/thoughts gathered on the roadshow from each locality on how we




Health Improvement Practitioners x 2 Family swim vouchers were provided in each area to encourage active lifestyles for children who will be enrolling on the X-programme Chooselife Smoothie Bike Apple Press/juice The Barrowband NHS A&B Adult Healthy

Various displays on boards and hanging in tents, on fences, lampposts, trees (depending on venue) on • Heart health • Causes of

CHD • No smoking

Day • Statistics on

heart disease • Healthy

eating/calories • Physical

activities/calories burned

• Oral health • Model

allotment • Growing your

own • Food

Standard agency heart health food

achieve a healthy weight in communities?’

should be addressing healthy weight in communities Link ideas/thoughts on outdoor activities/green gym/local growing with future development work with AICCT Further develop collaborative work with Local Produce and community Gardens Collaborate with Dunoon community on finding suitable land for local growing /community alllotments Develop a similar map to the Local produce map but for physical activity - walking/fitness/core paths/cycle lanes




weight monies were made available and resourced the events.

local exercise classes/local leisure centres - info should be in signpost develop links of all of the above to new social prescribing website

Conduct survey monkey evaluation with all partners/workers involved o-produce evaluation report with Local Produce




To support this submission please answer the follow ing questions:

1. Please describe what went well in delivery CEL ( 1) 2012 and provide examples.

2. Please describe any key Issues/barriers to achie ve progress on delivery of CEL (1) 2012, and descri be how you have, or plan

to overcome them for year 2?

Argyll & Bute CHP Committee Date of meeting: 24 April 2013

Item No 8.1

1

FINANCE REPORT REPORT BY GEORGE MORRISON The CHP Committee is asked to: • Note the 2012/13 year-end financial position • Note the financial challenge facing Argyll & Bute CHP in 2013/14 1. Argyll & Bute CHP – 2012/13 Year-end Financial Position For the year ended 31st March 2013, Argyll & Bute CHP recorded an underspend of £162,000. This is broadly in line with the forecast outturn position which had been estimated as a £200,000 underspend for several months. It also represents the seventh consecutive year in which Argyll & Bute CHP has achieved a year-end break-even or better position. Table 1 below provides a summary of budgetary performance across Argyll & Bute CHP for the year ended 31st March 2013.

Table 1: Budget analysis for the year ended 31st Ma rch 2013

Budget Budget Actual Variance £’ 000 £’ 000 £’ 000 Oban, Lorn & Isles Locality 18,577 18,853 (276) Mid Argyll, Kintyre & Islay Locality 16,718 16,800 (82) Mental Health In-Patient Services 7,688 7,669 19 Cowal & Bute Locality 12,848 12,984 (136) Helensburgh & Lomond Locality 4,980 4,857 123 Other Clinical Services 4,899 4,880 19 General Medical Services 15,437 15,540 (103) Prescribing 16,922 16,235 687 Dental, Ophthalmic & Pharmacy 11,581 11,581 0 Services from NHS GG & C 46,922 46,939 (17) Commissioned Services 3,880 4,086 (206) Resource Transfer 4,559 4,533 26 Depreciation 3,307 3,285 22 Management & Corporate 9,502 9,420 82 Budget Reserves 0 0 0 Total Expenditure 177,820 177,662 158

Income (1,324) (1,328) 4 Net Budget Position 176,496 176,334 162

Explanations for the more significant variances are as follows; Oban, Lorn & Isles Locality - £276k Overspent There were three main factors contributing to this overspend;


Item No 8.1

2

• A drugs budget overspend of £225k – this relates almost entirely to local service

developments in chemotherapy and haematology. It includes charges made in March 2013 of over £100k for a years supply of cancer drugs (rituximab and trastuzumab) issued by NHS Greater Glasgow & Clyde to Lorn and Islands Hospital.

• An overspend of £81k on the medical services budget relating to locum cover for a vacant

consultant physician post.

• Unachieved savings of £106k. There were compensating underspends in the Locality restricting the overall net overspend to £276k. Mid Argyll, Kintyre & Islay Locality - £82k Overspe nt Several factors contributed to this overspend; • Islay nursing pay costs overspend of £80k (now largely under control). • Islay – service continuity payments to the GP practices with an in-year effect of £65k. This

will be an ongoing issue into 2013/14 but provision has been made for it in the budget. • Unachieved savings of £58k relating to Mid Argyll. Both Kintyre and Islay achieved their

targets in full.

Cowal & Bute Locality - £136k Overspent This was due almost entirely to locum cover for medical vacancies in Dunoon (casualty and out of hours services). There was an overspend of £300k on this budget and it will continue to be an issue moving into 2013/14. Budget underspends elsewhere restricted the Locality net overspend to £136k. Helensburgh & Lomond Locality - £123k Underspent This was due almost entirely to a higher than expected level of staff vacancies. General Medical Services - £103k Overspent Due to locum cover in vacant small practices over the year (Bowmore, Jura and Inveraray). This will continue to some extent into 2013/14 with vacancies currently in Inveraray and Kilmun. Prescribing - £687k Underspent This was due mainly to the benefit from a range of drugs coming off-patent and the financial impact being far greater than expected. This underspend will be declared in 2013/14 as a recurring saving. Commissioned Services - £206k Overspent Due mainly to three new care packages which commenced in 2012/13. Provision for these costs has been included in the 2013/14 budget.


Item No 8.1

3

Management & Corporate Services - £82k Underspent Several factors have combined to create a net underspend of £82k on this budget heading. The only issue worth highlighting is an underspend of £53k on the Lead Nurse’s budget which relates to two specific in-year allocations (child healthy weight & maternal and infant nutritional feeding). A request has been made to the Health Board to carry-forward these funds into 2013/14. 2. Cost Improvement Programme 2012/13

The CHP approved budget for 2012/13 contained a requirement to achieve savings of £5m. Several of these savings arose naturally e.g. prescribing drugs coming off-patent, restricted uplift to SLA values etc, however a balance of £1.56m was required to be delivered through management action.

Table 2 below identifies recurring savings targets by budget manager and achievements against the targets.

Table 2: Argyll & Bute CHP Cost Improvement Program me 2012/13

Recurring Savings Targets Responsible Manager

Target £ ' 000

Achieved £' 000

Shortfall £’ 000

Oban, Lorn & Isles V Kennedy 461 355 106 Mid Argyll, Kintyre & Islay C West 348 290 58 Cowal & Bute V Smith 290 290 0 Helensburgh & Lomond V Smith 102 102 0 Unfunded Displaced Staff D Leslie 138 48 90 Pharmacy F Thomson 38 38 0 E-Health J Brass 35 35 0 Lead Nurse P Tyrell 32 32 0 Public Health E Garman 30 30 0 Human Resources D Logue 28 0 28 Practitioner Services J Robinson 19 0 19 Finance G Morrison 18 18 0 Procurement G Morrison 11 0 11 Planning S Whiston 10 10 0 Totals 1,560 1,248 312

Table 2 indicates that there was a shortfall of £312k against savings targets. However, budget underspends elsewhere (principally prescribing) enabled the CHP to offset this shortfall in-year. It should be noted that the revenue budget for 2013/14 contained provision to write-off these shortfalls and absorb the impact within a new savings plan for 2013/14. 3. Outlook for 2013/14 Argyll & Bute CHP faces another challenging financial year in 2013/14. The funding uplift of 2.8% is insufficient to cover inflation, pay awards, cost pressures and agreed service developments. As a result, the CHP is required to deliver savings of £2.4m to achieve financial balance. It is expected that this will be delivered by prescribing savings and a 2% target applied to other budgets. In addition to the £2.4m savings target, there will be a number of other financial challenges;


Item No 8.1

4

• Containing the cost of the NHS Greater Glasgow & Clyde SLA in the face of a claimed £5m underpayment

• Managing locum costs which will be an issue in Oban, Dunoon and vacant GP practices • Controlling the cost of local service developments, particularly drugs costs. Financial performance will be closely monitored throughout the course of the year and regular reports will be provided to the management team and committee highlighting risks and areas of concern. George Morrison Head of Finance Argyll & Bute CHP 16th April 2013


Item No : 9.1

PDP/R AND e-KSF IMPLEMENTATION 2012/13 1. BACKGROUND AND SUMMARY The CHP has made considerable progress 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. Levels of activity show steady progress on a month by month basis in 2011/12, rather than a peak of activity at the end of the year which was apparent in previous years. This indicates that the review and development process is becoming more mainstreamed and embedded in the culture of the CHP. Prior to implementation of e-KSF, there was no systematic way of knowing which staff had a regular review. NHS Highland is now in the position to be able state exactly the number of staff who have had reviews, that these follow the same process, and that staff are actively involved. The evidence is also being used as support for 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 raises the profile and acts as a reminder and record enabling reporting of the levels of completion of required training across the organisation. 2. TARGETS 2012/13 The actual performance against the CHP trajectory for 2012/13 is shown in Appendix 1. While the figures remained consistently below the planned trajectory, they have shown a more even spread throughout the year. 3. MONITORING PROGRESS The position across NHS Highland at 31 March 2013 is as follows (figures in brackets are those last reported to CHP Committee – February 2013) : Area All AfC

staff Review signed

off % of AfC staff

(all) % of AfC staff

(excl bank) Argyll and Bute CHP 2028 1295(814) 63.86(39.84) 86.22(54.74) Corporate Services 709 438(147) 61.78(20.68) 63.20(21.06) Mid Highland 454 254(138) 55.95(29.68) 79.13(44.95) North Highland 988 438(209) 44.33(21.09) 64.13(31.29) Raigmore Hospital 3274 1018(558) 54.28(31.50) 70.91(41.38) South Highland 766 402(207) 52.48(26.71) 67.11(34.44) Note : Extract from e-KSF 08-04-13 The CHP has currently 63.86% of all staff (86.22% excl bank) have had reviews and personal development plans signed off in e-KSF (see Appendix 2). The total percentage for NHS Highland is 56.35% (73.03% excl bank posts). (see Appendix 3)

The CHP Committee is asked to:

• Note the end of year position • Note progress made in ensuring staff have a review and mainstreaming this within

the CHP

2 Sally Munro Workforce Development Facilitator 08-04-13

It is a significant achievement to be able to report that 86% of our permanent staff have had the opportunity to undertake a review. Considerable efforts are continuing to ensure that our bank staff reach the same level. 4. ACTIONS FOR 2012/13 There are still some 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. The KSF Review and Development Process and use of e-KSF now appears to be 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.

5. QUALITATIVE BENEFITS OF KSF Although planned e-KSF Focus Groups have not taken place due to low take up of places, staff were invited to offer comments on the process. Some points highlighted were:

• “A very useful tool, however, engaging staff to see the benefits is difficult - with some not engaging from year to year”

• “I use it as a personal tool - almost reflective and it is great for then printing off to show what you have achieved”.

• “I find it a quick easy system you can dip in and out of”. • “My manager has many pressures and so a booked time has worked well” • “having to chase constantly for their evidence” • “Better preparation for review means more time can be spent discussing progress”. • “don’t feel any particular barriers” • “I think it makes staff reflect and evaluate their practice more-“ • “I feel the process works for me”

It was also reported that 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.

6 CONTRIBUTION TO BOARD OBJECTIVES The achievement of the target is in line with the NHS Highland Board objectives.

3 Sally Munro Workforce Development Facilitator 08-04-13

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. David Logue Head of HR Argyll and Bute CHP April 2013

Argyll and Bute CHP 9.1a Appendix 1Trajectory for e-KSF 2012-13 31/03/2013

2012/13 Profiled trajectory - all staff

Month End

No of reviews required

this month 2012/13

No of reviews required -

cumulative 2012/13

% Trajectory 2012/13

Actual % 2012/13 No of staff 2012-13(all) 2028

April 55 55 3 2.5 Target 80% all 1622May 110 165 8 3.84 Actual 1295June 120 285 14 4.71July 125 410 20 5.87August 130 540 27 7.56September 140 680 34 10.86October 145 825 41 16.23November 150 975 48 24.14December 155 1130 56 30.12January 160 1290 63 39.84Feb-15 1401 69 45.7Mar-13 75 50.57March 80 63.86

A&B CHP e-KSF trajectory 2012/13 compared to Actual

0102030405060708090

100

April May Jun July Aug Sep Oct Nov Dec Jan F M Mar

Month

% R

evie

ws

% Trajectory 2012/13

Actual % 2012/13

Prepared by sally.munro 17/04/2013

e-KSF Reviews Report by Operational Unit For Period 01/04/2012 - 31/03/2013

e-KSF Reviews 8th April 2013Total

Posts1

NHS Highland 10002 293 2.93% 2876 28.75% 835 8.35% 362 3.62% 5636 56.35% 73.03% 6833 68.32%A&B Mental Health Services 193 12 6.22% 40 20.73% 10 5.18% 7 3.63% 124 64.25% 93.23% 141 73.06%

Argyll & Bute Central Services 142 10 7.04% 25 17.61% 16 11.27% 4 2.82% 87 61.27% 63.04% 107 75.35%Cowal and Bute Area 380 11 2.89% 38 10.00% 28 7.37% 17 4.47% 286 75.26% 95.97% 331 87.11%

Dental Service (Argyll & Bute) 95 21 22.11% 6 6.32% 4 4.21% 1 1.05% 63 66.32% 87.50% 68 71.58%Helensburgh and Lomond Area 83 2 2.41% 13 15.66% 8 9.64% 4 4.82% 56 67.47% 73.68% 68 81.93%

Mid Argyll Kintyre & Islay 553 26 4.70% 125 22.60% 80 14.47% 19 3.44% 303 54.79% 78.91% 402 72.69%Oban Lorn & Isles Area 582 32 5.50% 115 19.76% 42 7.22% 17 2.92% 376 64.60% 93.77% 435 74.74%

Argyll and Bute CHP 2028 114 5.62% 362 17.85% 188 9.27% 69 3.40% 1295 63.86% 86.22% 1552 76.53%

Notes1. From e-KSF

Current position if Bank Posts are removed from 'Total Posts' - data from Workforce Information Staff List

Reviews at all stages1Reviews 'Started'1Reviews 'Completed & Not Signed Off'1

Reviews 'Completed & Signed Off'1

No Post Outline No Review

Page 1 of 1 08/04/2013

9.1b Appendix 2



Posts1

NHS Highland 10002 293 2.93% 2876 28.75% 835 8.35% 362 3.62% 5636 56.35% 73.03% 6833 68.32%A&B Mental Health Services 193 12 6.22% 40 20.73% 10 5.18% 7 3.63% 124 64.25% 93.23% 141 73.06%

Argyll & Bute Central Services 142 10 7.04% 25 17.61% 16 11.27% 4 2.82% 87 61.27% 63.04% 107 75.35%Cowal and Bute Area 380 11 2.89% 38 10.00% 28 7.37% 17 4.47% 286 75.26% 95.97% 331 87.11%

Dental Service (Argyll & Bute) 95 21 22.11% 6 6.32% 4 4.21% 1 1.05% 63 66.32% 87.50% 68 71.58%Helensburgh and Lomond Area 83 2 2.41% 13 15.66% 8 9.64% 4 4.82% 56 67.47% 73.68% 68 81.93%

Mid Argyll Kintyre & Islay 553 26 4.70% 125 22.60% 80 14.47% 19 3.44% 303 54.79% 78.91% 402 72.69%Oban Lorn & Isles Area 582 32 5.50% 115 19.76% 42 7.22% 17 2.92% 376 64.60% 93.77% 435 74.74%

Argyll and Bute CHP 2028 114 5.62% 362 17.85% 188 9.27% 69 3.40% 1295 63.86% 86.22% 1552 76.53%Chief Executive 17 0 0.00% 10 58.82% 3 17.65% 0 0.00% 4 23.53% 23.53% 7 41.18%

Clinical Governance Team 15 1 6.67% 2 13.33% 2 13.33% 0 0.00% 10 66.67% 66.67% 12 80.00%Community Care 2 0 0.00% 1 50.00% 0 0.00% 0 0.00% 1 50.00% 50.00% 1 50.00%eHealth Services 81 0 0.00% 9 11.11% 5 6.17% 6 7.41% 61 75.31% 75.31% 72 88.89%

Facilities 185 3 1.62% 79 42.70% 5 2.70% 4 2.16% 94 50.81% 52.22% 103 55.68%Finance 70 2 2.86% 13 18.57% 5 7.14% 2 2.86% 48 68.57% 68.57% 55 78.57%

HR Services 124 5 4.03% 25 20.16% 15 12.10% 6 4.84% 73 58.87% 62.93% 94 75.81%Integrated Pharmacy 101 2 1.98% 9 8.91% 5 4.95% 2 1.98% 83 82.18% 83.00% 90 89.11%

Medical Director 4 1 25.00% 1 25.00% 0 0.00% 0 0.00% 2 50.00% 50.00% 2 50.00%Nursing Midwifery & AHP Mgt 40 2 5.00% 8 20.00% 2 5.00% 1 2.50% 27 67.50% 69.23% 30 75.00%

Operational Support - Other 21 2 9.52% 4 19.05% 11 52.38% 0 0.00% 4 19.05% 19.05% 15 71.43%Public Health 49 1 2.04% 13 26.53% 4 8.16% 0 0.00% 31 63.27% 64.58% 35 71.43%

Corporate Services 709 19 2.68% 174 24.54% 57 8.04% 21 2.96% 438 61.78% 63.20% 516 72.78%Medical & Diagnostics Division 1091 19 1.74% 151 13.84% 62 5.68% 26 2.38% 833 76.35% 77.63% 921 84.42%

Patient Support Division 180 12 6.67% 22 12.22% 18 10.00% 5 2.78% 123 68.33% 86.01% 146 81.11%Raigmore Central 692 23 3.32% 625 90.32% 22 3.18% 4 0.58% 18 2.60% 60.00% 44 6.36%

Raigmore Hotel Services 348 1 0.29% 40 11.49% 11 3.16% 2 0.57% 294 84.48% 94.53% 307 88.22%Surgical Specialties Division 963 5 0.52% 257 26.69% 142 14.75% 50 5.19% 509 52.86% 53.64% 701 72.79%

Raigmore Hospital 3274 60 1.83% 1095 33.45% 255 7.79% 87 2.66% 1777 54.28% 70.91% 2119 64.72%Highland Sexual Health 26 0 0.00% 0 0.00% 0 0.00% 1 3.85% 25 96.15% 100.00% 26 100.00%

Hotel Services (West) 90 3 3.33% 32 35.56% 5 5.56% 0 0.00% 50 55.56% 62.50% 55 61.11%Lochaber District 417 10 2.40% 147 35.25% 41 9.83% 29 6.95% 190 45.56% 65.97% 260 62.35%

Out Of Hours Service 72 16 22.22% 23 31.94% 3 4.17% 8 11.11% 22 30.56% 57.89% 33 45.83%Skye Lochalsh & Wester Ross 294 7 2.38% 88 29.93% 21 7.14% 14 4.76% 164 55.78% 75.58% 199 67.69%

West Area Central Services 28 2 7.14% 6 21.43% 1 3.57% 0 0.00% 19 67.86% 76.00% 20 71.43%West 927 38 4.10% 296 31.93% 71 7.66% 52 5.61% 470 50.70% 70.57% 593 63.97%

Reviews at all stages1Reviews 'Started'1Reviews 'Completed & Not Signed Off'1



Page 1 of 2 08/04/2013

9.1c Appendix 3



Posts1 Reviews at all stages1Reviews 'Started'1Reviews 'Completed & Not Signed Off'1



Hotel Services (Mid) 55 1 1.82% 3 5.45% 1 1.82% 0 0.00% 50 90.91% 100.00% 51 92.73%Mid Ross District 399 5 1.25% 144 36.09% 30 7.52% 16 4.01% 204 51.13% 74.18% 250 62.66%

Mid 454 6 1.32% 147 32.38% 31 6.83% 16 3.52% 254 55.95% 79.13% 301 66.30%Caithness Acute 428 1 0.23% 148 34.58% 28 6.54% 33 7.71% 218 50.93% 78.14% 279 65.19%

Caithness District 138 6 4.35% 57 41.30% 9 6.52% 7 5.07% 59 42.75% 63.44% 75 54.35%Hotel Services (North) 150 2 1.33% 69 46.00% 9 6.00% 15 10.00% 55 36.67% 48.67% 79 52.67%

North Area Central Services 56 1 1.79% 13 23.21% 5 8.93% 3 5.36% 34 60.71% 65.38% 42 75.00%Sutherland District 216 0 0.00% 123 56.94% 18 8.33% 3 1.39% 72 33.33% 49.32% 93 43.06%

North 988 10 1.01% 410 41.50% 69 6.98% 61 6.17% 438 44.33% 64.13% 568 57.49%Dental Service 299 6 2.01% 33 11.04% 20 6.69% 4 1.34% 236 78.93% 81.66% 260 86.96%

MH and LD Services 520 8 1.54% 152 29.23% 37 7.12% 22 4.23% 301 57.88% 70.66% 360 69.23%South & Mid Central Services 37 4 10.81% 4 10.81% 3 8.11% 1 2.70% 25 67.57% 78.13% 29 78.38%

Grouped Services (S & M) 856 18 2.10% 189 22.08% 60 7.01% 27 3.15% 562 65.65% 75.23% 649 75.82%Hotel Services (South) 89 4 4.49% 10 11.24% 2 2.25% 0 0.00% 73 82.02% 94.81% 75 84.27%

Inverness District (East) 156 6 3.85% 55 35.26% 37 23.72% 9 5.77% 49 31.41% 42.98% 95 60.90%Inverness District (West) 188 0 0.00% 42 22.34% 38 20.21% 8 4.26% 100 53.19% 62.50% 146 77.66%

NABS District 274 8 2.92% 81 29.56% 24 8.76% 11 4.01% 150 54.74% 78.53% 185 67.52%South Area Central Services 59 10 16.95% 15 25.42% 3 5.08% 1 1.69% 30 50.85% 52.63% 34 57.63%

South 766 28 3.66% 203 26.50% 104 13.58% 29 3.79% 402 52.48% 67.11% 535 69.84%

Notes1. From e-KSF

Current position if Bank Posts are removed from 'Total Posts' - data from Workforce Information Staff List

Page 2 of 2 08/04/2013

9.1c Appendix 3

ARGYLL AND BUTE COMMUNITY PLANNING PARTNERSHIP

MINUTES of CPP MANAGEMENT COMMITTEE MEETING held within COMMITTEE ROOM 1, KILMORY, LOCHGILPHEAD

on WEDNESDAY 6th February 2013

Present

Sally Loudon Argyll and Bute Council Eileen Wilson Argyll and Bute Council Joyce Cameron (Minutes) Argyll and Bute Council Derek Leslie (Chair) NHS Highland Andrew Campbell Scottish Natural Heritage Glenn Heritage Third Sector Partnership/Argyll Voluntary Action Jane Fowler Argyll and Bute Council Louise Long Argyll and Bute Council Douglas Cowan Highlands and Islands Enterprise Donald Henderson (VC) Scottish Government Bruce West Argyll and Bute Council Fergus Byrne (VC) Strathclyde Police Jim Scott Strathclyde Fire & Rescue Cleland Sneddon Argyll and Bute Council Fraser Durie Argyll College Apologies: Shirley MacLeod Argyll and Bute Council

ITEM DETAILS ACTIONS

1.

WELCOME AND APOLOGIES Derek Leslie welcomed everyone to the meeting and intimated apologies.

2.

MINUTES OF THE MANAGEMENT COMMITTEE MEETING HELD ON 12th December 2012 The minutes of 12th December 2012 were approved as an accurate record. Matters Arising:- Agenda Item 4 – Scottish Government Review of Community Planning and Single Outcome Agreements. It was agreed that the note of the meeting held on 5th December and

Agenda Item 2Page 1

the letter from Derek MacKay can now be circulated. Agenda Item 12 – Strathclyde Police and Fire and Rescue Reform Report. The report submitted to Council has been circulated . Agenda Item 13 – Plugged In Places. It was agreed that the Community Planning Partnership would support the Council with the Plugged in Places funding application. Agenda Item 14 – Emergency Responders Update. Jane Fowler advised that the CPP would approach the Ambulance Service along with all other partners when the terms of reference have been agreed and the new partnership agreement is prepared.

CPP Admin CPP Admin

3. a) b)

SOA SCORECARDS (1ST AND 2ND FQ) – THEME LEADS Sally Loudon pointed out that some measures contained in the CPP Scorecard are no longer being measured or are no longer appropriate. She recommended that the partnership should decide if some of these measures should remain in the system. Derek Leslie questioned why some health measures were not shown on the scorecard and suggested a full review of the scorecards and all associated measures. Action Point Sally Loudon advised that the presentation of data needs to be looked at. Admin issues need to be ironed out to ensure data is gathered and reported. Clear instruction were given for Jane Fowler to liaise with theme leads to ensure that there are no gaps in data. Economy Douglas Cowan advised that his scorecard did not reflect on 3rd quarter. He pointed out that the vast majority of measures are on or above target.

Social Affairs Cleland Sneddon highlighted that Welfare Reform should be monitored closely. Changes in Adult Care management have taken place. It was advised that an Employee Equalities Forum has to be formed.

Jane Fowler/David Clements CPP Admin/Jane Fowler/Theme Leads

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c) d)

Environment Andrew Campbell advised that most of the measures are going in the right direction. Third Sector and Communities Glenn heritage advised that all targets are on track. There is likely to be a red with regards to organisational equal opportunities measure not reaching target by year end. It was agreed that we need to look closely at measures for the new Community Plan/SOA and identify those that are going to be of high impact.

4.

SOA ANNUAL REPORT This 2011/12 report brings to a close the Argyll and Bute Single Outcome Agreement 2009 – 2012, and highlights the progress made towards the national outcomes made by Argyll and Bute CPP. The report contains performance information on 13 of the 15 national outcomes that were included in the SOA. During the period of the SOA, some actions measured have been completed, some removed from partner operating plans and some are measured on a 2 yearly basis. Those that would present repeat information to last year’s SOA are not included. Discussion took place around the report and it was agreed that Jane Fowler would need to input more data around ABC04c before the report is submitted to the Scottish Government Action Point Jane Fowler to input more data around ABC04c before the report is submitted to the Scottish Government

Jane Fowler

5.

THIS PLACE MATTERS – RETHINKING LOCAL LEADERSHIP The University of Glasgow School of Social and Political Sciences has been carrying out research to explore the importance of local leadership in achieving the sustainable development of localities within Scotland. There is an opportunity for the Argyll and Bute Community Planning Partnership to take part in a half day facilitated workshop in March or

Page 3

April, offered by the University, to explore the role of local leadership in shaping places. Jane Fowler advised that around 20 places are for Argyll and Bute. To date a number of elected members have been nominated to attend. All partners agreed to consider nominations. Action Point It was agreed that partners are to nominate participants (10) with feedback to Jane Fowler by 13th February 2013.

All Partners

6.

HEALTH INEQUALITIES IN SCOTLAND – AUDIT SCOTLAND REPORT The report outlines the scale and effects of health inequalities, how much is spent by the public sector on reducing health inequalities and the quality of the evaluations used. The report also looks at whether access to health services is equitable across all groups within the population. The report contains a number of recommendations for Scottish Government, NHS Boards, Councils, CHPs and CPPs. CPP were asked to ensure that all partners are clear about their respective roles, responsibilities and resources in tackling health inequalities, and to take shared ownership and responsibility for actions aimed at reducing health inequalities. The full report was emailed out to all partners prior to the meeting. Partners were asked to comment on the key recommendations for CPPs and feed back to Eileen Wilson for collation prior to this meeting. The attached response document contains all the information received to date. Action Point It was agreed that each of the partners’ responses should be collated and a draft version passed to Derek Leslie, Sally Loudon and Donald Henderson before submitting to the Audit Committee and the Scottish Government.

All Partners

7.

PARTNER PLANS a) NHS HIGHLAND – ARGYLL AND BUTE CHP LOCAL

OPERATIONAL PLAN Derek Leslie presented the NHS Highland, Argylland Bute CHP Local Delivery Plan for 2013/14.

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b) POLICE – DEVELOPMENT OF LOCAL POLICE PLAN

Fergus Byrne presented the Argyll and Bute Local Policing Plan 2013/2014. Fergus also advised that there was a new community investigation point starting mid-February.

c) FIRE REFORM – DEVELOPMENT OF FIRE AND RESCUE PLAN Jim Scott presented Strathclyde Fire and Rescue’s local Fire and Rescue Plan for Argyll and Bute.

Action Point Both Fergus and Jim Scott would like to hear back from partners if they’re happy with the Police and Strathclyde Fire & Rescue plans and priorities. Draft Fire and rescue document to be passed to Derek Leslie(Chair) with feedback to Jim Scott.

CPP Admin

8.

NEW COMMUNITY PLAN – UPDATE It was advised that 3 groups have had discussions and the content that is tabled in the papers is a first draft. Cleland Sneddon further advised the Management Committee that group 2 will get together again to refine the draft outcomes into something that better reflects their requirements. Discussions took place and it was noted that there was still feedback to be passed to Eileen Wilson. All were in agreement that this item should be on the next Management Committee agenda for discussion. Eileen Wilson also advised the Management Committee that all three groups are scheduled to meet again. Groups 1 and 2 on the 22nd of February and group 3 on the 18th of February. This next round of meeting is to further refine the outcomes and to consider action areas. Action Point Fraser Durie (Argyll College) to be invited to join Group 1. Item to be included on the Management Committee agenda for 6th March 2013. Final draft of the new Community Plan/SOA to go to the Full Partnership on 27th March 2013.

Eileen Wilson CPP Admin/Eileen Wilson

Page 5

Draft plan to be tabled at the Council meeting scheduled for 21st March 2013.

9.

DRAFT TERMS OF REFERENCE FOR NEW GOVERNANCE ARRANGEMENTS It was agreed at the CPP Management Committee on 12 December 2012 that draft terms of reference and a draft meeting schedule be prepared for consideration by the Management Committee The draft partnership agreement, incorporating the terms of reference and full operational and support arrangements will be reviewed by the Management Committee on the 6th of March and a final version submitted for approval to the Full Partnership meeting on 27 March. The succession of chair was discussed as Derek Leslie is approaching the end of his two year appointment as chair of the Management Committee. Further consideration will be given to this matter and a proposal put to the Management Committee on the 6th of March with a recommendation made for approval by Full Partnership on the 27th of March. Action Point A revised Partnership Agreement is draft for the Management Committee on the 6th of March and a final version prepared for the Full Partnership meeting on 27th March 2013.

CPP Admin/Eileen Wilson

10.

INSPECTION OF CHILDRENS SERVICE UPDATE The Report submitted informed the Management Committee that the Inspection will be conducted over 13 days between Monday 4th March 2013 and Friday 19th April 2013. The Inspection Lead who will have overall responsibility for the pilot inspection and the reporting of findings is Judith Tait, Senior Inspector, Care Inspectorate. The Lead Officer for the partnership during the inspection is Liz Strang Argyll and Bute Council. Louise Long advised that Elaine Mead, Chief Executive of NHS Highland had agreed to attend an Early Years collaborative workshop. The partners were further advised that at the conclusion of Phase 1 of the inspection, 30 activities had taken place and all grades have gone up. A pre-inspection return had been submitted and at least 100 files

Page 6

are active. The partners agreed that they were happy to endorse the two statements and supporting evidence circulated. The question was raised as to how the signing off of the other 7 statements would be done. The signing off of the final statements will be by Barry McEwan, Sally Loudon and Derek Leslie. It was advised that any concerns regarding the signing off should be direct to Louise Long.

11.

EARLY YEARS COLLABORATIVE UPDATE Paper circulated. This item will be given further consideration at the management Committee meeting on the 6th of March. Action Point Item to be included on the Management Committee agenda for 6th March 2013.

CPP Admin

12.

OPPORTUNITIES FOR ALL – ARGYLL AND BUTE COUNCIL PAPER ON SKILLS PIPELINE AND YOUTH PIPELINE AND YOUTH EMPLOYMENT ACTION PLAN Cleland gave a verbal update to the partners on recent progress, and it was noted that detail around opportunities is required to match young people’s needs. This information is required as soon as possible.

13.

ARGYLL AND BUTE LOCAL SERVICES INITIATIVE The report submitted provides details of the Argyll and Bute Local Services (ABLSI) launch event which will follow the full Community Planning Partnership meeting on 27th March 2013, as agreed at the CPP Management Committee on 12th December 2012. ABLSI is a partnership of statutory and third sector organisations, and the Carnegie UK Trust project. It has provided reports to the CPP Management Committee on activities, the most recent in February 2012. The aim of the event is to launch the final report which contains findings and recommendations from the work of ABLSI. This work took place over a two year period and included working with managers and third sector organisations through the Council’s Service Review Process and researching case studies of social enterprise in Argyll and Bute.

Page 7

Jane Fowler asked that the Management Committee encourage a target audience to attend the launch event which will follow the full Community Planning Partnership meeting on 27th March 2013, and provide contact details of those within their organisations to invite. Action Point All partners to provide contact details of those to be invited.

All Partners

14.

REVISED MEETING DATES Following discussions at agenda item 9 (Terms of Reference)it was agreed that the Full Partnership would meet once each year in September or October, further meetings could be called with the agreement of the Chair and subject to the required notice being given. The Management Committee will meet once each quarter (4 times a year) with the meetings normally taking place in February, June, August and November. If required, further meetings could be called with the agreement of the Chair and subject to the required notice being given. The CPP Chief Officers Group (COG) will normally meet once every 2 months (6 times per year). These meetings will normally be in February, April, June, August, October and December. Action Point Meeting dates to come back to Management Committee meeting on 6th March 2013.

CPP Admin

15.

AOCB ACPG report The management Committee noted the role which the Area Community Planning Groups can play in facilitating effective local community engagement. Citizen’s Panel Partners were reminded that the spring survey will be due soon and were asked to consider any possible subjects and/or questions for inclusion. It was agreed that this items be included on the March meeting agenda. Action Point Item to be included on the Management Committee agenda for 6th March 2013. Strathclyde Fire and Rescue Jim Scott, Strathclyde Fire and Rescue advised that Paul Connelly

CPP Admin

Page 8

would be returning to Argyll and Bute.

16.

Date of next meeting – 6th March 2013

Page 9

NHS HIGHLAND BALANCED SCORECARD 2011/12

A&B CHP HEAT TARGETS

APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR

Health Improvement

Healthy Weight of Children Achieve 246 interventions for child healthy weight intervention programme for 2-15 year olds over 3 years ending March 2014 28 Mar-12 54 54 54

Cumulative Monthly Qtr 3 trajectory = 55

Smoking Cessation Number of successful quits at one month after quit in 40% most deprived areas (i.e. the bottom 2 local SIMD quintiles) from April 2011 to March 2014. This equates to 688 quits over the period 277 Mar-12 30

1

370

423

Quarterly Qtr 3 trajectory = 405

Smoking Cessation 7.5% of the general smoking population target in the NHS Board successfully quitting (at one month post quit) from April 2011 to March 2014. This equates to 1260 quits over the period 611 Mar-12 63

9

659

669

741

792

838

910

926

968

1004

1012 Cumulative

Monthly Trajectory for February 2013 = 805

Child Fluoride Varnish Applications Achieve at least 60% of 3 and 4 year old children in each SIMD quintile to receive at least 2 applications of fluoride varnish per year by March 2014 0% Jun-11 Quarterly

Reporting on a quarterly basis and shows the worst performing quintile. Reports received 4 months in arrears - Trajectory for March = 0.5%

Financial Performance Operate within agreed revenue resource and capital resource limits, and meet cash requirement. £0 Mar-12 £0 £0 £0 £0 £0 £0 £2

00

£200

£200

£200

Preceding Year A&B CHP continues to show a forecasted position for year end of £200k underspend

Cash Efficiencies Deliver a 3% efficiency saving to reinvest in frontline services 100% Mar-12 10

0%

100%

100%

100%

100%

100%

100%

100%

94%

Monthly YTD Savings are showing a 94% achievement against the LDP trajectory

Drug & Alcohol Treatment: Referral to Treatment By March 2013, 90% of clients referred for treatment will wait no longer than 3 weeks from referral 81

.5%

Mar-12 80.9

%

83.2

%

87.5

%

Quarterly Qtr 4 data will not be published by ISD until the end of Jun 2013.

Faster access to Specialist Child & Adolescent Mental Health Services (CAMHS) By March 2013 no one will wait longer than 26 weeks from referral 1 Mar-12 0 0 1 1 0 1 1 1 0 1 2 Monthly No Trajectory has been agreed under LDP. Proposed Trajectory is being developed

Faster access to Psychological Therapies By Dec 2014 no one will wait longer than 18 weeks from referral to treatment 17 Dec-11 13 16 13 16 21 13 26 17 12 22 15 Monthly No Trajectory has been agreed under LDP. Proposed Trajectory is being developed

Reduction in Emergency Bed Days for Patients Aged 75+Reduce emergency inpatient bed days to 5149 per 1,000 population for aged 75+ by Mar 2012 4,347* Jan-12 4,

257*

4,24

6*

4,29

9*

4,34

5*

4,37

5*

4,39

4*

Annual*These figures include an estimated correction factor (1 to 5%) to take account of

the under-reporting associated with current inpatients.

28 Days Delayed Discharges To have no clients waiting more than 28 days to be discharged from hospital from April 2013, followed by a 14 days maximum waiting time from April 2015 0 1 3 0 1 0 1 0 0 0 0 0 MonthlyStroke Unit 80% of stroke patients admitted to a stroke unit on day of admission or day following presentation at hospital by March 2013 (90% Annual

Hospitals included in target are - Raigmore, Belford, Caithness General and Lorn and Isles. Data not available at Hospital level currently

Rate of Attendance at A&EAgreed reduction in number of new and unplanned attendances to A&E by March 2015 to 108 per 100,000 population per month

144

Mar-12 152

175

180

183

180

178

173

155

140

132

Monthly

A&E attendances to Lorn & Isles Only.Rolling quarter rates expressed in terms of the total Highland population (323,000

approx.) September Tarjectory = 169

Efficiency

Access to Services

Treatment Appropriate for Patient

Latest Reported PeriodCommentsHEAT Measure & DetailIndicator

Date of outturn

OutturnReporting

Period


Agenda item : 11.1

Argyll Bute CHP CommitteeDate of Meeting : 24 April 2013

Agenda item : 11.2

NHS HIGHLAND BALANCED SCORECARD 2011/12

A&B CHP HEAT TARGETS


Health Improvement


Cumulative Monthly Qtr 3 trajectory = 55


1

370

423

Quarterly Qtr 3 trajectory = 405Smoking Cessation 7.5% of the general smoking population target in the NHS Board successfully quitting (at one month post quit) from April 2011 to March 2014. This equates to 1260 quits over the period 611 Mar-12 63

9

659

669

741

792

838

910

926

968

1004

1012 Cumulative

Monthly Trajectory for February 2013 = 805 Child Fluoride Varnish Applications Achieve at least 60% of 3 and 4 year old children in each SIMD quintile to receive at least 2 applications of fluoride varnish per year by March 2014 0% Jun-11 Quarterly

Reporting on a quarterly basis and shows the worst performing quintile. Reports received 4 months in arrears - Trajectory for March = 0.5%


00

£200

£200

£200

Preceding Year A&B CHP continues to show a forecasted position for year end of £200k underspend


0%

100%

100%

100%

100%

100%

100%

100%

94%

Monthly YTD Savings are showing a 94% achievement against the LDP trajectory


.5%

Mar-12 80.9

%

83.2

%

87.5

%

Quarterly Qtr 4 data will not be published by ISD until the end of Jun 2013. Faster access to Specialist Child & Adolescent Mental Health Services (CAMHS) By March 2013 no one will wait longer than 26 weeks from referral 1 Mar-12 0 0 1 1 0 1 1 1 0 1 2 Monthly No Trajectory has been agreed under LDP. Proposed Trajectory is being developed

Faster access to Psychological Therapies By Dec 2014 no one will wait longer than 18 weeks from referral to treatment 17 Dec-11 13 16 13 16 21 13 26 17 12 22 15 Monthly No Trajectory has been agreed under LDP. Proposed Trajectory is being developed

Reduction in Emergency Bed Days for Patients Aged 75+Reduce emergency inpatient bed days to 5149 per 1,000 population for aged 75+ by Mar 2012 4,347* Jan-12 4,

257*

4,24

6*

4,29

9*

4,34

5*

4,37

5*

4,39

4*

Annual*These figures include an estimated correction factor (1 to 5%) to take account of

the under-reporting associated with current inpatients.28 Days Delayed Discharges To have no clients waiting more than 28 days to be discharged from hospital from April 2013, followed by a 14 days maximum waiting time from April 2015 0 1 3 0 1 0 1 0 0 0 0 0 MonthlyStroke Unit 80% of stroke patients admitted to a stroke unit on day of admission or day following presentation at hospital by March 2013 (90% Annual

Hospitals included in target are - Raigmore, Belford, Caithness General and Lorn and Isles. Data not available at Hospital level currently


144

Mar-12 152

175

180

183

180

178

173

155

140

132

Monthly

A&E attendances to Lorn & Isles Only.Rolling quarter rates expressed in terms of the total Highland population (323,000

approx.) September Tarjectory = 169

Efficiency

Access to Services


Latest Reported PeriodCommentsHEAT Measure & DetailIndicator

Date of outturn

OutturnReporting

Period


Item : 11.3

LOCAL DELIVERY PLAN and CHP OPERATIONAL UNIT DELIVERY ACTION PLAN 2013/14 Report by Stephen Whiston Head of Planning, Contracting & Performance The CHP Committee is asked to: • To note the current iteration of the CHP Operational Unit Delivery Plan and its alignment

with the targets set by the SGHD, NHS Highland LDP, NHS Highlands Performance standards and Highland Quality Approach

• To endorse the targets, objectives and service planning/priorities for the CHP in 2013/14 • To note that progress against the plan will be recorded by regular updates using the

traffic light system and linked to NHS Highland Improvement committee, partnership and HQA monitoring reports with formal report to the committee in November 2013

1 INTRODUCTION

The 2013/14 Local Delivery Plan is informed by Scottish Government’s guidance which specifies: � A revised core set of key objectives, targets and performance measures � The format and content of the Local Delivery Plan, the process for its completion and

submission The four overarching key objectives remain as before:

� Health improvement for people of Scotland – improving life expectancy and healthy life expectancy

� Efficiency and Governance improvements – continually improve the efficiency and effectiveness of the NHS

� Access to services – recognising patients need for quick and easy use of NHS services

� Treatment appropriate to individuals – ensure patients receive high quality service that meets their needs

2 ARGYLL AND BUTE CHP OPERATIONAL PLAN The Operational Plan is Argyll and Bute Community Health Partnership’s response to NHS Highland’s Local Delivery Plan objectives and priorities and performance framework. It also includes how the CHP will be taking forward the Highland Quality Approach (HQA) through various initiatives and taking forward the roll out of the methodology and process in the CHP. The Operational Plan has been modified to ensure that there is closer alignment between Service, Finance and Workforce plans and is structured accordingly. 3 CHP SERVICE PLANNING PRIORITIES 2013/14 The following planning priorities have been identified and approved by the CHP management team and sit within a number of other key CHP Objectives :

2

o Mental Health modernisation o Reshaping Care for Older People- programme of initiatives o Sustaining our Community and Rural General Hospital core services re acute

care, trauma and Out of hours services o Community Hospital strategy refresh & NHS Highland pilot

� Workforce and finance modelling o Business 2 Business contract renegotiation for 01/04/14 o Implementing the outcome of the Islay CH & OOHs review

o Primary Care redesign– Including GMS modernisation, workforce recruitment (Inveraray, Kilmun, looking forward Kintyre Medical Group) and enhancement of roles of GMS to provide locality wide services.

o Preparing for Integration – Health and Social Care Partnership o Financial balance

4 SUMMARY & NEXT STEPS The Operational Unit Delivery plan (Addendum1) is an extensive document detailing the significant amount of work the CHP is conducting and its purpose is to monitor and record the CHPs performance against its targets, objectives and plans. CHP Leads for all the LDP objectives, HQA initiatives have been identified and performance monitoring re delivery of the plan will utilise the familiar traffic light system.

The Operational Unit Delivery plan will provide the CHP committee and management team with a performance baseline as to progress against priorities and objectives it will be updated on a quarterly basis, with a report brought back to the committee in November. 5 GOVERNANCE IMPLICATIONS Financial: Relevant indicators within HEAT targets Staff Governance Identifies areas and actions require staff involvement and

monitors performance Patient Focus & Public Involvement

Identifies areas and actions require public involvement and monitors performance

Clinical & Risk QIS standards Equality & Diversity Impact: Plans and initiatives identified requiring impact assessment

should be identified and actioned Stephen Whiston Head of Planning Contracting and Performance 15th April 2013

Argyll & Bute CHP Committee Date of Meeting: April 24th

Item

CHP OU Version 14 Apr 13

1

Argyll and Bute CHP

Operational Unit Delivery Action Plan 2013/14

2

1 INTRODUCTION The Board’s mission is to provide patient-centered services tailored to people’s needs in a systematic and consistent way – to provide quality care to every person every day Our approach embraces the Healthcare Quality Strategy for Scotland and also takes account of the priorities within the NHSScotland Efficiency and Productivity Framework. Our vision is to:

o Provide quality care at all times; o Support people and communities to maximise their own health; o Develop precisions driven services so that when people need our care they experience timely, focused, effective services that

minimize the duration and frequency of contact; o Ensure that every health pound spent delivers maximum health gain. Quality is therefore at the heart of our vision. We believe that a focus on efficiency without attention to quality is unthinkable but equally that promoting quality with no regard for efficiency is unsustainable. Implementation of this vision means that the characteristics of service delivery in NHS Highland over the next five years are evolving to be ones of: • promoting good health, self care and independence • High quality, integrated, equitable, needs and evidence-based, and cost-effective • Increasingly community-based with hospital beds preserved for the most acutely ill and those with specialist needs • Integrated with, and complementary to, local authority, voluntary and independent sector care • run by healthy, flexible, well-motivated and well-trained staff working to their maximum potential and capability • using modern, flexible, efficient, green assets to maximum effect • With zero wastage and inefficiency across all services and no unnecessary overheads The Operational Unit Delivery plan for 2013/14 has been developed to ensure that it mirrors NHS Highland LDP requirements re: Service, Finance and Workforce plans and is structured accordingly. Another key aspect of the plan is the direct link to Argyll and Bute councils Single Outcome Agreement with a number of joint objectives, targets and initiatives emphasizing the Scottish Governments focus on outcomes.


Item


3

The operational delivery plan is an extensive document detailing the significant amount of work the CHP is conducting. It purpose is to record and monitor the CHPs performance in meeting its targets, objectives and plans over the year. CHP Leads for all the objectives have been identified and performance monitoring of the plan will utilise the familiar traffic light system as well as the HQA reporting process. Argyll and Bute CHP Profile 1.1 Population size

Argyll and Bute covers an area of 694,277 hectares at the southern end

of NHS Highland Health Board (Figure 1) and is relatively sparsely

populated with 0.13 persons per hectare compared to the Scottish

average of 0.65 per hectare (NRS, ONS; Census 2001).

There are an estimated 89,950 people living in Argyll and Bute (NRS;

2011 Mid-year population estimate). 52% of Argyll and Bute’s

population live in ‘rural’ areas (SNS; Scottish Government Urban-Rural Classification 2009-10, NRS Mid-2010 small area population

estimates) and approximately 17% of Argyll and Bute’s population live on one of 25 inhabited islands (NRS; Census 2001). There are

5 settlements with over 4000 people in Argyll and Bute (Rothesay, Campbeltown, Oban, Dunoon settlement area and Helensburgh

settlement area). The largest of these is Helensburgh settlement area (including Rhu) with 15,430 people (NRS; mid-2010 population

estimate for settlements).

1.2 Age Profile

Argyll and Bute has a higher proportion of people of pensionable age (26%) than Scotland as a whole (20%; NRS; Mid-2011

population estimate; Table 1). National Records of Scotland produce population projections for Argyll and Bute based on Mid-2010

population estimates, current birth and death rates and estimated migration rates (Figure 2). Between 2010 and 2035 the population

of Argyll and Bute is projected to decrease overall by 7%, the number of working age adults is projected to decrease by 14% but the

number of people 75+ is projected to increase by 74% (NRS). This projected aging demographic is a major challenge for health

services.

Figure 2. A population pyramid for Argyll and Bute: NRS 2010-based population projections showing 2010 base-year and 2035 projections

15-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89

90 and over

Age

Ban

d

4

Table 1. The age profile of Argyll and Bute compare d to Scotland

(NRS Mid-Year Population Estimate 2011).

Argyll and Bute Scotland % Children (0-15) 15.8% 17.4% % Working age 58.6% 62.8% % Pensionable age 25.7% 19.8%

Total population 89950 5254800

Crown Copyright. Source: Scottish Neighbourhood Statistics.

1.4 NHS Services in Argyll and Bute Argyll and Bute is divided into 4 operational localities. The GP practice registered population of Argyll and Bute is 88,777 (Nov 2012). The locality profile, population and configuration of Argyll and Bute CHP is: Locality Population Locality Description Oban, Lorn & the Isles 21,838 Easdale to Oban, to Port Appin to Dalmally &

Isles of Mull, Tiree, Coll & Colonsay Mid Argyll, Kintyre & Islay 21,169 Southend, Campbeltown, Muasdale,

Carradale, Tarbert, Lochgilphead, Ardfern, Inveraray, Isles of Islay & Jura

Cowal & Bute 22,037 Lochgoilhead, Strachur, Tighnabruaich, Dunoon, Bute

Helensburgh & Lomond 23,733 Helensburgh, Kilcreggan, Garelochhead, Arrochar

The map below shows the hospitals, GP practices (33) within Argyll and Bute (some of which are dispensing practices) and includes

in the legend the size of the register of each practice (List size). There are 26 Pharmacies and 24 Dental Practices (comprising 11

independent practices and 13 salaried practices). The table inset illustrates the service profiles in the CHP hospitals as at March

2013


Item


5

Campbeltown Hospital Accident & Emergency Bed complement: GP Acute 19 Community Midwifery 2 Care of the Elderly 14 Total 35

Cowal Community Hospital Accident & Emergency Bed complement: GP Acute 20 Community Midwifery 2 Total 22 Day bed unit 2

Mull Community hospital Isle of Mull Community Casualty Bed complement: GP Acute 3 Total 3

Islay Hospital Accident & Emergency Bed complement: GP Acute 10 Community Midwifery 1 Total 11

Argyll and Bute Hospital, Lochgilphead Mental Health Bed complement: General Psychiatry 36 Intensive psychiatric care 6 Total 42

Mid Argyll Hospital and Integrated Care Centre, Lochgilphead Accident & Emergency Bed complement: GP Acute 15 Community Midwifery 2 Elderly Dementia 20 Elderly Dementia Assess 9 Total 46

Victoria Hospital Isle of Bute Accident & Emergency Bed complement: GP Acute 13 Community Midwifery 1 Total 14

Lorn & Islands Rural General Hospital, Oban Accident & Emergency Bed complement: General Medicine 24 General Surgery 18 HDU 6 Community Midwifery 2 Elderly assessment 12 Total 62 Day bed unit 12

6

1.5 Health of Population information

The health and wellbeing of Argyll and Bute was profiled in 2010 by ScotPho. For 47 out of

59 indicators, Argyll and Bute is either significantly ‘better’ or not significantly different from

the Scottish average (ScotPho). For example, life expectancy at birth in Argyll and Bute is

77.0 for males and 80.9 for females, higher than that for Scotland as a whole (2008-2010;

NRS). For 7 indicators Argyll and Bute is ‘worse’ than Scotland as a whole.

These are:

• Road traffic accident casualties • 1Patients hospitalised after a fall in the home (65+) • People (65+) receiving free personal care at home • Households in extreme fuel poverty • People living in 15% most 'access deprived' areas • 2Immunisation uptake at 24 months – MMR • 3Child obesity in primary 1

1. This data is known to be inaccurate as coding of falls in the home varies across hospitals with som e areas coding many falls as occurring in an unknown location. 2. Not included in the data is how many children re ceive separate vaccines instead of the MMR vaccine. 3. Data were incomplete for all Scotland. Most of G lasgow was not included in the comparison.

Although Argyll and Bute compares relatively favourable with Scotland as a whole, this does

not indicate a lack of health needs. ScotPho health profiles for intermediate geographies

within Argyll and Bute show that there are areas within Argyll and Bute with relatively poorer

health than Scotland as a whole. Inequalities in health remain and health and wellbeing are

strongly linked to wealth. There are ten data zones (small areas) in Argyll and Bute

classified as within the 15% most deprived data zones in Scotland. These are located within

the five towns of Campbeltown, Dunoon, Helensburgh, Oban and Rothesay (SNS). 6.9% of

the population of Argyll and Bute live in these 10 most deprived data zones (2011, NRS

mid-year population estimates). However approximately 13% of the population of Argyll and

Bute are classified as income deprived and many of these people live outside the most

deprived areas (2009/2010, Source: SNS).

In 2010, over half the deaths in Argyll and Bute were due to Cancer (29%), Heart diseases

(18%) and Cerebrovascular diseases (9%). Chronic Lower Respiratory diseases and Mental

and Behavioural disorders (including dementia) each accounted for a further 6% of deaths

(NRS). These diseases are typical of a developed and aging population. They are also

predominantly conditions where lifestyle choices (including alcohol and drug consumption,

smoking, activity levels and pre- and ante-natal exposures) have a major impact on health

outcomes.

Argyll & Bute CHP Committee

Date of Meeting: April 24th Item


7

Strategic

Framework 2012

•promoting good health, self care and independence•high quality, integrated, equitable, needs and evidence-based, and cost-effective•increasingly community-based with hospital beds preserved for the most acutely ill and those with specialist needs•integrated with, and complementary to, local authority, voluntary and independent sector care•run by healthy, flexible, well-motivated and well-trained staff working to their maximum potential and capability•using modern, flexible, efficient, green assets to maximum effectwith zero wastage and inefficiency across all services and no unnecessary overheads

Strategic Framework

Service

Characteristics

Corporate Objectives

The Q&E Plan 2012/14

(aka The Big Plan)

Harm Variation Waste

……………….. Person-centered ………………..

SPSP(Acute and Mental Health

Falls

Pressure Ulcers

Sepsis

VTE

Medication errors

Care Pathways

COPD

Stroke

Dementia

Falls

Endoscopy

Admin & Clerical

Corporate Services

Care CapacityBeds

BodiesBuildings

�LOS

�Admissions

�Readmissions

Medicines

Qu

ality

Co

sts

Space Utilisation

The Big Plan

Long Term Vision

5 Year Goals

Annual Objectives

Annual Plan

2 CHP SERVICE PLANNING AND HQA PRIORITIES 2013/14 In response to the NHS Highland Strategic Framework and Highland Quality Approach, the CHP will align its performance monitoring processes with NHS Highland. It has identified CHP clinical and managerial leads for delivery against each target or objective. 2.1 CHP Service Planning Priorities The CHP Core management team and Committee have confirmed its priorities for 2013/14 as:

o Mental Health modernisation o Reshaping Care for Older People- programme

of initiatives o Sustaining our Community and Rural General

Hospital core services re acute care, trauma and Out of hours services

• Community Hospital strategy refresh & NHS Highland /SGHD pilot

• Workforce and finance modeling • Business 2 Business contract

renegotiation for 01/04/14 • Implementing the outcome of the Islay

Community Hospital and OOHs review o Primary Care redesign– Including GMS

modernisation, workforce recruitment (Inveraray, Kilmun, looking forward Kintyre Medical Group) and enhancement of roles of GMS to provide locality wide services.

o Financial balance. o Preparing for Integration with Argyll and Bute Council– HSCP

• Principles • Clinical engagement • Organisational engagement

o Financial balance

2.2 Quality Plans for 2013/14

The quality initiatives (as at March 2013) the CHP is planning/progressing in 2013/14 are detailed below:

8

Number Title of Charter Lead Status - Agreed at Core Team

Outcome – Individual leads to complete summary outcomes

Performance monitoring

Project Team Established

1.1 Structure & Role of SLT Mary Wilson Approved (last updated Oct ’12) ?

1.2 Orthotic Service Development Christina West Approved

Yes

1.3 Radiography OOHs Review Mary Wilson Approved (last updated Oct ‘12 ? 1.4 AHP Establishment Review Mary Wilson Approved (last updated Oct ’12) ?

2.1 Ophthalmology Redesign Oban Stephen Whiston Awaiting

Maintenance of 18 week RTT and utilisation of Primary Care Optometrists for review and follow up

Redesign event completed –action plan being formulated- Charter outstanding No

3.1 Energy Costs Veronica Kennedy Approved

Draft Charter produced, input from Head of Estates awaited No

4 Dental OOHs Review Elizabeth Reilly Approved

(The system will be written into the contract – payment will be by banker’s draft rather than cheque. The dentists will be paid through their schedule rather than by cheque.

? 8.1 Falls Prevention Mary Wilson Approved (last updated Oct ’12) Yes

13 CAMHS Christina West Approved

Compliance with 18 Week RTT

SLA reviews underway & Value stream mapping Yes

Green – Approved at Core Team and in receipt of Charter Amber – approved at Core Team, awaiting receipt of Charter Red – yet to be presented/approved at Core Team, no Charter available


Item


9

Number Title of Charter Lead Status - Agreed at Core Team

Outcome – Individual leads to complete summary outcomes

Performance monitoring

Project Team Established

event completed

15 Children’s Services Redesign Pat Tyrrell Awaiting Yes 16.2 Air Transport George Morrison Awaiting No 17.2 Procurement Savings George Morrison Awaiting No

19 Employee Relations Case Process Gaye Boyd Approved

Yes

20 Scottish Patient Safety Roll Out to Community Hospital Veronica Kennedy Awaiting

Yes?

The CHP has designated the Planning Department as the lead function to implement the HQA across the organisation and it is progressing recruitment, training and enhancing capacity and capability within the department to progress this in 2013/14. The approach to role out the HQA will include establishment of OD initiatives in both the clinical and non clinical areas by utilising the resource and capability of the Learning Development Team and Practice Development Nurses with the intention to focus on clinical care pathways. The intention is to develop CHP wide capacity and capability with regard to the cascading HQA in localities and corporate departments so that it becomes normal business:

o Adding value o Waste elimination o Standard Operations

10

3 Capital developments The major capital investment in the CHP in 2014/15 is:

o Oban Dental Centre- LIH £2.2m o Biomass boilers - £940,000 o Solar panels Helensburgh - £65,000 o Endoscopice decontamination unit upgrade- LIH o McMillian palliative care facilities MAHICC, LIH o HAI upgrades- £100,000 o Fire protection- £TBI o Legionella works - £TBI

4 Current budget and financial performance - 2012/1 3 In 2012/13, Argyll & Bute CHP is operating a budget of £177m. At this stage (February 2013) it looks likely that the CHP will end the financial year with a modest under spend in the region of £200,000 (0.1%). A number of cost pressures have arisen during the year with the main ones relating to medical locum cover in Oban, Cowal and vacant single-handed GP practices. However, an unexpectedly large underspend on the prescribing budget, due to drugs coming off patent, has more than compensated for the in-year cost pressures. This has resulted in a forecast year-end under spend. It should be noted that this will be the seventh consecutive year in which Argyll & Bute CHP has achieved a year-end break-even or better outcome. Actual financial performance of the CHP as at 31st December 2012 is shown in the table below;

Table 1: Budget analysis for the 9 months ended 31 December 2012 Year to Date

Budget Annual Budget Budget Actual Variance

Forecast Outturn

£000 £000 £000 £000 £000 Oban, Lorn & Isles Locality 18,419 13,722 13,826 (104) (201) Mid Argyll, Kintyre & Islay Locality 16,560 12,382 12,398 (16) (109) Mental Health In-Patient Services 7,610 5,585 5,585 0 75 Cowal & Bute Locality 12,686 9,471 9,538 (67) (100) Helensburgh & Lomond Locality 4,915 3,637 3,575 62 100 Other Clinical Services 4,847 3,178 3,201 (23) (29)


Item


11

General Medical Services 15,314 11,509 11,611 (102) (100) Prescribing 17,053 12,773 12,337 436 660 Dental, Ophthalmic & Pharmacy 12,471 8,496 8,496 0 0 Services from NHS GG & C 46,930 35,208 35,208 0 0 Commissioned Services 3,880 2,911 2,959 (48) (169) Resource Transfer 4,538 3,404 3,404 0 0 Depreciation 3,303 2,477 2,459 18 20 Management & Corporate 8,980 5,631 5,590 41 57 Budget Reserves 201 0 0 0 0 Total Expenditure 177,707 130,384 130,187 197 204 Income (1,324) (1,054) (1,051) (3) (4) Net Budget Position 176,382 129,330 129,136 194 200

In terms of cost improvements, in 2012/13 the CHP required to achieve recurring savings of 3% to achieve a balanced budget. It looks likely that this will be mainly achieved, with a shortfall in the region of £300,000. It should be noted however that the recurring shortfall has been offset by non-recurring savings. 4.1 Financial Plans 2013/14 NHS Highland will receive a funding uplift of 2.8% in 2013/14 and a share of this will be passed to Argyll & Bute CHP amounting to £4.072m. Initial analysis indicates that natural cost growth will be in line with the 2.8% uplift. Specific examples of estimated cost growth are given below; Pay awards - 1% Incremental drift - 0.5% Prescribing - 3% Energy - 10% Tertiary referrals - 2.8% (in line with funding uplift)

12

Overall, cost growth is expected to be in the region of 2.8%, in line with funding. However, additional costs are likely to be incurred due to growth in service demand and other pressures. It is likely that a further contribution to the GG&C SLA will be required and, in addition to this, it is known that a range of new cancer drugs are being introduced. Within the Argyll & Bute area, cost pressures relating to medical services and local drug treatments are likely to have a significant financial impact. Broadly, it is estimated that additional costs, over and above natural cost growth, in the region of £2.4m will be incurred. This is summarised as follows; GG&C existing service pressures - £0.5m GG&C new cancer drug treatments - £0.5m Local service pressures within Argyll & Bute - £0.7m Service developments within Argyll & Bute - £0.7m To meet these additional costs, savings targets of £2.4m will be applied within Argyll & Bute CHP, this is equivalent to 1.6%. Approximately £1.0m of this will be applied to the prescribing budget, with the remainder applied to operational service budgets. Details of how these savings will be achieved have yet to be agreed but it is recognised that there is scope to do so. An important point which should be noted is that while there will be a provision within the CHPs financial plan to pay an extra £0.5m to GG&C in respect of existing service pressures, this falls far short of GG&Cs claimed underpayment of £5.8m. If the balance of £5.3m was accepted, this would increase the CHPs savings target in 2013/14 from 1.6% to 5.1%. It is important therefore that robust negotiations continue with GG&C regarding the correct value for services provided as this represents a very significant financial risk to Argyll & Bute CHP.

5 Workforce Plans 2013/14

The profile of the Workforce in Argyll and Bute is summarized in he tables below as at December 2012 5.1 Workforce profile (Whole Time Equivalent): Staff Group Wte Nursing and Midwifery (Registered) 431 Nursing and Midwifery (non registered) 167.5 Administration 209.5 Support services 197 Allied health professionals 109 Medical 39.5


Item


13

Dental 14.3 Medical and dental Support 44.2 Healthcare Science 21.3 Other therapeutic 19.7 Personal and Social Care 13.5 Senior Managers 8.5 Total wte 1275 5.2 Age Profile (Whole Time equivalent):

Age Group Wte %

Under 20 1.5 0.1%

20 - 24 23 1.8%

25 - 29 56.1 4.4%

30 - 34 78 6.1%

35 - 39 102.8 8.1%

40 - 44 195.2 15.3%

45 - 49 249.1 19.5%

50 – 54 246.7 19.3%

55 - 59 201.6 15.8%

60 - 64 94.9 7.4%

Over 65 26.1 2.0% Total 1275 100.0%

5.3 Age profile: staff - percentage age 50 or over by job Family: Staff Group % Nursing and Midwifery (Registered) 42% Nursing and Midwifery (non registered) 42% Administration 48%

14

Staff Group % Support services 52% Allied health professionals 31% Medical 72% Dental 67% Medical and dental Support 19.5% Healthcare Science 59% Other therapeutic 28% Personal and Social Care 47% Senior Managers 70% 5.4 Posts which are difficult to recruit to: Salaried GPs Salaried Dentists Medical Consultants – all disciplines Estates Officers Estates Craftsmen and maintenance Dental Hygienist Radiographers Psychologists. Healthcare Science 5.5 Workforce Requirements a result of Quality impr ovement initiatives: A Senior Management role for 20 hours per week has been in place to lead the initiation and development of Improvement initiatives within the HQA. However, on this post becoming vacant the Senior Management team agreed that this approach should be redesigned and incorporated within the Planning department with the intention to facilitate and support the mainstreaming of this into current roles over time. Initially this will be taken through the L&D, RCOP Project manager and Practice Development Nurses to develop quality facilitators but will then be rolled out to Operational and Departmental Senior Management, AHP and Nursing leads.


Item


15

The Quality Improvement charter approval process has Charter leads to be identified for all HQA initiatives with the Head of Planning, Performance and Contracting providing the monitoring and performance overview. It is however recognised that there is a need for a focus of expertise and knowledge on HQA in the CHP and the roles of the existing posts of Service Manager in Planning, and Workforce Development Advisor in HR have been amended to support the adoption of the HQA approach. The L&D and the Personnel teams will continue to provide support and advice to managers in relation to Service redesign. 5.6 Workforce development required: Senior management team to lead on the HQA in the CHP:

o Have attended the Leadership Event for NHS highland o Are attending a dedicated session on HQA on the 21st January.

Operational Managers and Team leads to implement and manage HQA initiatives:

• A number of this cohort will be included in the OD programme for the Argyll and Bute RCOP partnership. This strategy covers all partners in RCOP and will complement the HQA.

• The RCOP partnership will introduce and drive forward changes to the balance of care and to clinical pathways and referral patterns. Workforce development to support this is embedded in each work stream within the project. Workforce development will be taken forward by nursing, midwifery and AHP leads, Practice Development Nurses, lean practitioners and L&D practitioners from across the partner organisations.(e.g. Local Authority, NHS, Voluntary sector and independent sector)

• The implementation of the modernisation of the Mental Health Service in Argyll and Bute is now well established. A workforce development plan is being facilitated by L&D and clinical practitioners to ensure that the vision and values of the service, particularly in relation to bringing together Community and the Inpatient services to provide a clear integrated service and referral pathways to service users.

5.7 Summary of key Workforce risks:

• Sustaining Primary care services in Remote and Rural setting:

o Difficulty in recruiting to GP and salaried GP posts.

16

o OOH service fragility due to opt out and costs of locum/agency contracts o Sustainability of Independent GPs to continue to provide appropriate levels of service in Community Hospitals due to

attractiveness of roles (24/7 commitment), levels of remuneration when benchmarked to urban areas and recruitment difficulties.

o Maintenance of skill levels of GPs, Specialist nurses and AHPs, midwives, with low levels of activity. o Maintenance of OOH radiology service as radiographers support is possibly compromised by AfC on call agreement

levels of payment and attractiveness to recruit/sustain existing service. – Impact on core hospital services over short to medium term.

• Sustaining Secondary care services in Remote and Rural setting:

o Difficulty in recruiting to consultant posts in surgery and medicine at RGH. o Difficulty in staffing junior doctor rota’s in RGH o Difficulty in recruiting consultant psychiatry posts

• Quality Improvement charters lose momentum due to other operational priorities engaging the energy and attention of Charter

leads.

o Leads have high level of Operational and Strategic responsibilities to balance o Leads have up to 5 projects to take forward o Supporting managers lack development yet in HQA ethos and processes.

• Specialist posts: for example Specialist Nurses, AHPs, may experience difficulties in maintaining skills due to lone working,

limited hours in specialist role, and being required to cover wide geographic area to engage with other staff. Also, lone working status makes succession planning, transfer of skills problematic and leads to skills vacuum when specialist post holder moves on.

• Medical and Dental workforce has high percentage of staff over 50. Recruitment into these areas is difficult. Models of

service need to be developed to ensure that the professional benefits of working in NHS Highland are attractive to bring in new staff. Also, ensuring that skill mix is appropriate and supportive of a quality remote and rural healthcare service.


Item


17

6. Single outcome agreement

Argyll and Bute Community Planning Partnership’s Single Outcome Agreement (SOA)/Community Plan is currently being written. It has long term (10 year) and short term (three years) outcomes, priority action areas (for years 1-3), measures and indicators and indicates where it links to national outcomes (1-16). The short term and priority action areas are in draft and will be agreed by the end of March and the measures and indicators by the end of June. The draft short term outcomes are subject to change. The main ones with a health focus are listed below but there are many others which require our input on a partnership basis.

• Improve the life chances for our young people and those of future generations • All children are developmentally ready to start P1 • Children, young people and families at risk are safeguarded • All babies experience the best possible pre and peri natal environment • Older people live active, independent, healthy lives • People are active members of the community and contribute to the local economy • People choose to maintain independence and are an integral part of their local communities • People are empowered to make their own choices and live safely with dignity in their own communities • The impact of alcohol and drugs on our communities and on the mental health of individuals is reduced • The incidence and impact of domestic violence is reduced • Mental health and wellbeing is improved • Break the inter generation cycle of inequality through targeted prevention • Promote positive lifestyle choices through education and encouragement • Narrow the gap in health inequalities through targeting disadvantage • Reduce health conditions most closely associated with deprivation • Reduce adverse childhood events • Support generic initiatives and services which improve quality of life and wellbeing for all

18

7 HEAT TARGETS 2013/14 and key standards The new HEAT Targets for 2013/14 are listed below and the following tables provide the narrative for each target re Management of Risks against Delivery (including trajectory), Improvement, Workforce, Finance and Equalities. The targets are captured in a matrix which identifies the lead in the CHP as well as aid review and provide a template for assessing progress through the year utilizing the familiar traffic light index. o To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25%, by

2014/15

o At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviors

o Reduce suicide rate between 2002 and 2013 by 20%

o To achieve 14,910 completed child health weight interventions over the three years ending March 2014

o NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post

quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014

o At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014

o NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to

the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009

o Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) from March 2013; reducing to 18 weeks from December 2014; and 18 weeks referral to treatment for Psychological Therapies from December 2014

o Eligible patients will commence IVF treatment within 12 months by 31 March 2015


Item


19

o To deliver expected rates of dementia diagnosis and by 2015/16, all people newly diagnosed with dementia will have a minimum of a year’s worth of post-diagnostic support coordinated by a link worker, including the building of a person-centered support plan

o Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by at least 12% between

2009/10 and 2014/15

o No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013, followed by a 14 day maximum wait from April 2015

o Further reduce healthcare associated infections so that by 2014/15 NHS Boards’ staphylococcus aureus bacteriamia

(including MRSA) cases are 0.24 or less per 1000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 15 and over is 0.25 cases or less per 1,000 total occupied bed days

o To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E

between 2009/10 and 2013/14

. Argyll and Bute CHP will also monitor its performance against these HEAT and key NHS Highland standards using the Boards Improvement Committee Governance process. The latest balance score card reports for the 2012/13 HEAT and Standards are shown overleaf;

20


Health Improvement


Cumulative Monthly


1

370

423

QuarterlySmoking Cessation 7.5% of the general smoking population target in the NHS Board successfully quitting (at one month post quit) from April 2011 to March 2014. This equates to 1260 quits over the period 611 Mar-12 63

9

659

669

741

792

838

910

926

968

1004

1012 Cumulative

MonthlyChild Fluoride Varnish Applications Achieve at least 60% of 3 and 4 year old children in each SIMD quintile to receive at least 2 applications of fluoride varnish per year by March 2014 0% Jun-11 Quarterly


00

£200

£200

£200

Preceding Year


0%

100%

100%

100%

100%

100%

100%

100%

94%

Monthly


.5%

Mar-12 80.9

%

83.2

%

87.5

%

QuarterlyFaster access to Specialist Child & Adolescent Ment al Health Services (CAMHS) By March 2013 no one will wait longer than 26 weeks from referral 1 Mar-12 0 0 1 1 0 1 1 1 0 1 2 MonthlyFaster access to Psychological Therapies By Dec 2014 no one will wait longer than 18 weeks from referral to treatment 17 Dec-11 13 16 13 16 21 13 26 17 12 22 15 Monthly

AppropriatReduction in Emergency Bed Days for Patients Aged 7 5+Reduce emergency inpatient bed days to 5149 per 1,000 population for aged 75+ by Mar 2012 4,347* Jan-12 4,

257*

4,24

6*

4,29

9*

4,34

5*

4,37

5*

4,39

4*

Annual28 Days Delayed Discharges To have no clients waiting more than 28 days to be discharged from hospital from April 2013, followed by a 14 days maximum waiting time from April 2015 0 1 3 0 1 0 1 0 0 0 0 0 MonthlyStroke Unit 80% of stroke patients admitted to a stroke unit on day of admission or day following presentation at hospital by March 2013 (90% Annual


144

Mar-12 152

175

180

183

180

178

173

155

140

132

Monthly

Efficiency

Access to Services

Latest Reported PeriodHEAT Measure & DetailIndicator

Date of outturnOutturn

Reporting Period

Argyll and Bute CHP- Balance Scorecard HEAT 2012/13


Item


21


Health ImprovementAlcohol Brief Interventions Achieve 1066 brief interventions in line with SIGN 74 guidelines by March 2013 1018 Mar-12 51 12

9

217

422

564

621

723

794

887

978

1057 Cumulative

Monthly

Breast Feeding at 6-8 Weeks New-born babies exclusively breastfed at 6-8 weeks review to increase from 28.8% in 2006/07 to 36% in 2010/11 28.6% Mar-12 29.1% 30.0%

Preceding 4 Quarters

Immunisations - MMR1 Monitor MMR1 uptake rates (% at 5 years old). Target 95% uptake nationally 98.1% Mar-12 93.9% 92.0% 96.0% Quarterly

NATIONAL STANDARDS

Sickness Absence Achieve a sickness absence rate of 4% from 31 March 2009

4.87% 4.43% Nov-11

4.27% 4.42%

4.78% 4.48%

4.95% 4.53%

4.76% 4.58%

4.37% 4.61%

4.73% 4.65%

5.13% 4.71%

5.45% 4.78%

5.35% 4.86%

5.83% 4.96%

Monthly Actual Annual Rolling

SMR Return Rate Monitor % of SMR01 returns received (2 month lag averaging over 3 month period). National target is 9 95.4% Nov-11 94

.1%

97.5

%

98.7

%

96.1

%

91.8

%

92.4

%

92.0

%

93.2

%

97.8

%

97.8

%

MonthlyCompleted Complaints Monitor % of completed complaints resolved within 4 weeks. Tar 50

%Mar-12 20

%

25%

29%

20%

0% 0% 0% 25%

MonthlyNumber of complaints over 40 working days old (at time of monthly report) - target 0 0 Mar-12 0 2 2 0 0 0 2 1 MonthlyNumber of complaints received - Target 3 per month or less 4 Mar-12 5 4 7 5 7 3 4 4 MonthlyNo of complaints categorised as high risk* - Target - 1 or less 0 Mar-12 1 0 1 0 2 0 2 0 MonthlyEfficiency Savings: Same Day Surgery Improved efficiencies by March 2011 to increase day case rate to 60.9%. The number of BADS surgical procedures performed in a day case or outpatient setting 81.2% Dec-11 74

.2%

74.0

%

76.9

%

68.3

%

82.4

%

71.7

%

80.7

%

75.0

%

78.7

%

80.3

%

68.1

%

Monthly

Efficiency Savings: New Outpatient Appointment DNA rates Improved efficiencies by March 2011 to reduce 1st outpatient attendance DNA rate to 7.4% 8.4% Mar-12 8.

1%

10.2

%

9.1%

12.8

%

10.2

%

11.0

%

10.2

%

11.0

%

9.1%

8.5%

Monthly

Reduce Pre-operative Stay Improved efficiencies by March 2013 to reduce pre-operative stay by 20% to 0.61 days for elective surgery 0.55 Mar-12 0.

52

0.53

0.53

0.52

0.51

0.49

0.49

0.47

0.49

0.48

0.49

Rolling year

Efficiency Savings: Review to New Outpatient Attend ance Ratio Improved efficiencies by March 2011 to reduce the ratio of return to new outpatient 1.95 Mar-12 1.

91

2.22

2.04

1.98

1.97

2.09

2.15

2.45

1.81

1.90

Monthly

KSF and Personal Development Plan 80% of staff to have had a KSF/PDP review, completed and recorded on E-KSF by March 2012 28.21% Jan-12 2.

51%

2.33

%

4.74

%

5.87

%

7.25

%

10.8

6%

16.2

3%

Monthly

LOCAL STANDARDS

Efficiency

Reporting Period

Indicator HEAT Measure & Detail OutturnDate of outturn

Latest Reported Period

Argyll and Bute CHP- Balance Scorecard 2012/13- Sta ndards

22


NATIONAL STANDARDS

New Outpatient Waiting Times: Maximum Wait 12 Weeks No patient to wait longer than 12 weeks from referral from all sources to 1st outpati 0 0 0 0 0 0 0 0 2 2 3 1 Monthly

Inpatient/Day Cases Waiting Times: Maximum Wait 9 W eeks No patient to wait longer than 9 weeks from being placed on waiting list to admission for an inpatient or day case procedure from 31 March 2011 0 Dec-11 0 0 0 0 0 0 0 0 Monthly

12 week Treatment Time GuaranteeNo patient will wait longer than 84 days from date decision to treat to treatment for an inpatient or day case procedure from 1st October 2012 MonthlyCataract Waiting Times (Outpatient) Reduce nos of patients waiting over 9 weeks for outpatient treatment to 0 by Dec 2007 0 Dec-11 0 0 0 0 0 0 0 0 0 0 0 Monthly8 Key Diagnostic Tests No patients waiting over 4 weeks by March 2010. 0 Dec-11 0 0 0 1 0 0 0 0 0 0 0 Monthly

NATIONAL STANDARDS

A&E Waits To Be A Maximum of 4 Hours Increase nos of patients waiting under 4 hours from arrival to treatment to 98% by March 2009. 99% Mar-12 98

%

98%

98%

98%

98%

98%

98%

97%

98%

97%

97%

Monthly


Cervical Screening rate Monitor % of 20-60 yr old women screened. Target is 80% Uptake as per smear history within last 5 yrs for women aged 21-60 yrs on the LDP target of 5.5 yrs for women aged 20-60 yrs. 79.7% Mar-12 79

.6%

79.4

%

79.7

%

Quarterly

Reduction in Bed Days For Long term Conditions Reduce admission rates (for COPD, Asthma, Diabetes, CHD) to 9,130/100,000 population by Mar 2011. 7,431* Jan-12 7,

219*

7,23

5*

7,23

6*

7,24

9*

7,18

1*

7,04

2*

Annual

NATIONAL STANDARDS

Dementia Increase nos of patients' with an early diagnosis & management of dementia to 831 by Mar 2011 759 Mar-12 74

9

741

741

750

754

746

760

773

768

772

771 Preceding

Year

Access to Services

Reporting PeriodIndicator HEAT Measure & Detail Outturn

Date of outturn

Latest Reported Period

Argyll and Bute CHP- Balance Scorecard 2012/13- Sta ndards continued


Item


23

HEAT TARGETS 2013/14 HEAT/Key indicator &

Description Action Lead Progress/Completed TL

To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal an d lung cancer by 25%, by 2014/15

Delivery Awaiting Trajectory Finance Financial implications not known- expectation no impact within existing services and SLA arrangements with GG&C (TBC) Workforce No implications within CHP Improvement Majority of service is provided by NHS GG&C. LIH participates in national bowel screening diagnostic pathway and currently all patients have exploratory diagnostic scopes within RTT standards Equalities The key risks can be summarized as: 1 Identification of relevant baseline for CHP 2 Identifying monitoring info to support Planning for Fairness Impact

Review of SLA specification in 2013/14 to include standards and Governance reporting information

24

HEAT/Key indicator &


H5: Reduce suicide rate between 2002 and 2013 by 20 %.

Delivery The CHP has trained staff to be able to deliver Applied Suicide Intervention Skills Training (ASIST) and Skills based Training On Risk Management (STORM), and has at least 2 trainers in each Community Health Partnership (CHP) area. Training has been provided to a wide range of multi-agency staff Finance The ring-fenced Choose Life resource will be included in Highland Council and Argyll & Bute Council’s general allocation. NHS Highland will seek to support the Councils in their work on this, and will continue to collaborate and share resource wherever possible. Workforce CHP to develop method of recording this in the A&B Council area CHPs and have agreed collated information sharing across all four CHPs. This needs further work but we are confident that it will be achieved. Improvement Multi-agency working. The changes to funding must not interrupt the joint work on suicide prevention and we will continue to work with Argyll & Bute Councils on suicide prevention. Target- 20% reduction in suicide rate between 2002-2013- reduction rate between 2002- 2007 7.4% (10% required to be online to achieve target) CAUTION- low numbers distort the data Equality Service meets planning for fairness requirements re access and availability.

CDMH Extensive community training will continue and the NHS will ensure Commitment 7 of the Delivering for Mental Health plan is implemented in partnership to ensure key front line staff are adequately trained Training ongoing on target to achieve 50% target. Current position -figures are awaiting confirmation but indicative figure is 23% at present. Figure is indicative because our database does not record if staff trained

are still employed. Work is ongoing to improve data collection system".

More targeted training taking place during 2013/14 to ensure improved

training uptake for key staff group (mental health and casualty/A&E staff) CHP will continue to contribute staff time for training and to release staff for training activities as part of their Personal Development Plans (PDPs). Wherever possible, we will deliver training as close to staff as possible. 2013/14 training programme includes dates in all localities Continue the multiagency approach to deliver action for target including identifying performance ownership within SOA & CPP.


Item


25



To achieve 14,910 completed child health weight int erventions over the three years ending March 2014

Delivery • A&B CHP in delivery targets as per trajectory • Pathways for managing overweight and obese children and young

people in Highland • Parents may feel defensive if their child is identified as overweight

or obese • CHP staff awareness of the work required to address the target Finance Allocation of funding based on needs led approach Workforce • Capacity issue for public health nurses to commence delivery of • Skills/competency issue for the range of staff involved in

identifying and delivering interventions • Capacity issue for medical paediatric services, specialist dietetic

and CAMHS services to work with those identified as morbidly obese.

• Improvement Ongoing Equality Planning for fairness requirements re access and availability TBI

CPH

• Argyll and Bute multiagency working group set up to look at the best way of addressing delivery of the interventions

• An eight week healthy weight intervention programme has been developed. Where a child is identified as at or above the 91st centile they will be invited to take part in the healthy weight

interventions programme • As at end of December 2012 54 interventions had been undertaken

compared to the target of 55.

26



NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014

Delivery The target of 8% successfully quitting would equate to 1437smokers to have successfully quit at one month by NHS Highland –pro rata approx 420 in A&B CHP. Single Outcome Agreement (SOA) also contains an indicator addressing this issue, partnership input required Finance Scottish Government gave a verbal guarantee of funding for the next 2 years This funding is ring fenced and is part of the Public Health Budget “bundle” 2012/3 – 2013/4 . Workforce All Localities have a Smoking Cessation Advisor, Community nurses, or General Practice nurses delivering Smoking Cessation support. There are also trained Pharmacists throughout Argyll and Bute. Smoking cessation co-ordination post (0.5 wte) since summer 2012 has been delivered by 2 members of staff. Improvement Multiagency working to be improved to increase the awareness of the importance of support for Smoking Cessation for the Argyll and Bute Smoking population. Raising The Issue of Smoking, Training is being delivered in each locality throughout the year. This is brief intervention training for all health workers who have contact with smokers. The HEAT target is to target the most deprived within the board. 40%

CPH PHP

The service has been at target for I month quit rate for the past year and remains on trajectory to continue this achievement The budget is managed to deliver an effective service in Argyll and Bute. All the staff are trained, and skilled to deliver the service. Commissioning smoking cessation services from GP practice staff has shown an improvement in local areas. Smoking prevention remains one of the 8 strategic priorities for the Health and Wellbeing Partnership. This is supported by action in 7 local action plans delivered via local networks. There is grant funding to support activity. NHS Highland Smoking prevention input planned for joint health improvement planning day on 26.2.13. For June - Sept 2012 the cumulative trajectory is 348 quits to be from deprived communities. The actual total is 370. This target began in April 2011.


Item


27

HEAT/Key indicator & Description

Action Lead Progress/Completed TL

of 1 month quits to be in SIMD areas. The Smoke Free Homes and Keep Well project will support this target. Equalities Continuing to work to target to include 40% of successful quitters from most deprived datazones.

Roll out of Keep Well in Campbeltown

28



At least 60% of 3 and 4 year old children in each S IMD quintile to receive at least two applications o f fluoride varnish (FV) per year by March 2014

Delivery Delivery is below target in all SIMDs. The poorest performance in relation to the target is among 3 year olds in SIMD 5 at 17.65%, followed by 4yr olds in SIMD 5 at 18.38%. The highest level of delivery is to 4 year olds in SIMD 1 at 46.51% Finance FVA in general dental practice is funded centrally through item of service payments to practitioners. Childsmile activity by Oral Health Improvement Practitioners and Oral Health Support Workers is funded by an allocation of money (the ‘Dental Bundle’) which covers Childsmile and other specified activities. Workforce 7xOral Health Improvement Practitioners, 6xOral Health Support Workers, 6x Extended Duty Dental Nurses, Dentists. EDDNs and dentists in the Salaried Dental Service are delivering Childsmile Practice. All Childsmile activities are directed by the Oral Health Improvement Manager for the CHP. Improvement The risks can be summarized as: Failure to meet the target in the least deprived ar eas, which currently show the lowest level of FVA . The Childsmile Integrated Monitoring Report January to June 2012 NHS Highland, shows where actions can be targeted to increase FVA levels in all SIMDs.

CDD/HPCP

See Table on Page 20 for most recent results. NHS Highland trajectory for HEAT 9 is March 12 5.9% June 13 45% September 13 50% December 13 55% March 14 60%

Spending of the Childsmile budget is monitored nationally. Health Boards report every six months. Argyll and Bute CHP participates in the NHS Highland review process and is within budget. The Oral Health Improvement team is fully staffed. We continue to support the training of dental nurses as EDDNs in the Salaried Dental Service and in the independent General Dental Service. The EDDN training programme designed by NES is delivered in Argyll and Bute CHP by staff qualified to deliver it.


Item


29



1. In Argyll and Bute CHP, 94% of referrals to Childsmile Practice are made by Health Visitors. 2. Numbers of referrals from SIMD 4 and 5 are low but first and subsequent appointments are kept to a higher extent than SIMD 1-3. 3. Failure to make first contact between DHSW and family is 27% of all referrals. 4. Failure of subsequent contact appointments is 27% of kept first appointments. 5. The proportion of subsequent appointments declined on the day of appointment is 20% - the most common reason given is ‘inconvenient time’(67%). 6. The number of children receiving one FVA far exceeds the number receiving 2 or more FVA. 7.The Salaried Dental Service in Argyll and Bute CHP appears to be underperforming in HEAT 9 compared with the non-salaried GDS. Equalities The National Dental Inspection Programme (NDIP)data for 2011-2012 shows that 74.1% of 5 year old children in Argyll and Bute have no caries experience, compared with national and Health Board levels of 67% and 70.2% respectively. Nationally, the number of children with no caries experience has risen in all quintiles and the gap between SIMD1 and SIMD5 remains virtually unchanged since 2008. Most decay experience is concentrated in a small proportion of the population - SIMD1 has not yet reached the 2010 target of 60% of 5 year olds having no caries experience.

Action plans to be drawn up to Increase referrals from sources other than HVs. Establish cause of low referral rate from SIMD 4 and 5 and work to increase number of referrals. Establish what time would be most convenient for attendance. Work with dental practice staff on flexibility of appointment times , Work with dental practitioners to ensure follow-up of patients who have had one FVA. Action plans in place Failed appointments are followed up by OHSWs and enter the Care Pathway which is part of the Childsmile Practice programme. NHS Highland has an action plan to promote FVA within the Salaried Dental Service. ISD do not analyze NDIP data at SIMD level for each CHP. NHS Highland is investigating whether the analysis can be done locally from raw data. There is no reason to expect the distribution of caries experience in children in Argyll and Bute to differ from the national picture of higher levels of caries in the lower SIMDs. Fluoride varnish applications are higher in those areas in keeping with their greater need for caries prevention. Efforts to achieve the HEAT 9 target will continue in all SIMDs to ensure that all children have the opportunity to benefit from the Childsmile Practice programme.

30

HEAT H9 Data: Number & Proportion of Children Aged 3 & 4 who had 2 of more FVAs

between 01 July 2011 & 30 June 2012

CHP SIMD (2009) QUINTILE OF CHILD

Most

Deprived

Least

Deprived

1 2 3 4 5 N/K

ARGYLL & BUTE CHP

No aged 3 who had 2 or

more FVAs 67 46 33 19 21 2

Estimated population aged

3 174 136 167 140 119

Proportion aged 3 who had

2 or more FVAs 38.51% 33.82% 19.76% 13.57% 17.65% -


more FVA's 80 79 40 30 25 4


4 172 183 158 143 136


2 or more FVAs 46.51% 43.17% 25.32% 20.98% 18.38% -

Minimum rate by CHP

SIMD quintile 18.38%

HB SIMD (2009) QUINTILE OF CHILD

Most

Deprived

Least

Deprived

1 2 3 4 5 N/K

HIGHLAND


more FVAs 262 128 109 73 50 10


3 750 595 567 590 579


2 or more FVAs 34.93% 21.51% 19.22% 12.37% 8.64% -


more FVA's 304 198 112 105 66 16


4 780 614 526 568 603


2 or more FVAs 38.97% 32.25% 21.29% 18.49% 10.95% -

Minimum rate by HB SIMD

quintile 8.64%


Item


31

At least 80% of pregnant women in each SIMD quintil e will have booked for antenatal care by the 12 th week of gestation by March 2015 so as to ensure improvem ents in breast feeding rates and other important health behaviors



At least 80% of pregnant women in each SIMD quintil e will have booked for antenatal care by the 12 th week of gestation by March 2015 so as to ensure imp rovements in breast feeding rates and other important health behaviors

Delivery On target to achieve 80% of women booked by 12 week s. Measurement system to evidence performance to be finalized. Finance Support for breastfeeding provided through national allocation of funding. Workforce Local midwifery teams provide antenatal care according to national standards with strong focus on woman centered care and working in an assets based approach using the GIRFEC framework to ensure that practice is focused on the needs of the mother and baby. Review of maternity services in Argyll and Bute will commence in 2013 to ensure that each of the teams is effectively configured, aligned and led to meet the requirements of the Early Years Framework and collaborative. Further training for midwives in GIRFEC and aspects of health improvement will continue. Support is also provided through the Smoking Cessation and Alcohol Health Promotion Advisers as well as through the Infant Feeding Co-ordinators. Improvement Ongoing dialogue with CHPs regarding support for change and innovation

LN/PCP

Argyll and Bute currently meet the target for 80% pregnant women booking in first trimester of pregnancy. Midwives have all been trained in use of Alcohol Brief Interventions and Smoking Cessation advice. All women are asked at booking about their alcohol and tobacco consumption, as well as a range of other health affecting behaviours and influences in their lives. Use of the Health Plan Indicators enables midwives to identify those who may require additional support during pregnancy and the ante natal plans and pre birth pathway have been introduced to identify vulnerable women and babies and ensure the right level of support throughout pregnancy, on an interagency basis where required, which aims to improve the outcomes for mothers and babies. Argyll and Bute is a UNICEF accredited organisation to provide Babyfriendly services which support breastfeeding. Midwives and Public Health Nurses are trained to deliver training to women and professionals in breastfeeding. Breastfeeding Peer Support groups have been established in each locality where local women and professionals meet together to provide one to one and group support as well as to plan other interventions which further promote breastfeeding locally. Recent figures for breastfeeding rates in Argyll and Bute have

32

regarding breast advice, support and training. Achievement of UNICEF Baby Friendly Initiative (BFI) for all NHS sites Equalities

improved as follows: At Birth 62.1% Discharge 47.8% HV 1st visit 39% 6-8 weeks 30.1%.

PRIORITY: - Efficiency & Governance Objective: Efficiency HEAT/Key indicator &


NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emi ssions reduction targets set in the Climate Change (Scotland) Act 2009

Delivery CHP received funding to install Biomass boilers complete 2013/14 in Campbeltown Dunoon Helensburgh Oban Aros Islay Finance Funded CEEF- SGHD initiative Revenue cost neutral Workforce 1. Existing workforce capability/capacity risk – until service specification and operational arrangements confirmed Improvement Data on carbon emission reduction will be identified once implemented Risks can be summarized as:

LM- VK/D R

Mull PCC opened in December 2012 included Biomass Boiler as heating system.


Item


33



1 Limited availability of local supply- for wood pellets/chips – capacity building in discussion with Community planning partners – Portavadie and Campbeltown current suppliers 2 Continuity of supply – mitigation this is supplementary to existing heating systems to protect essential services

34

PRIORITY:- Efficiency & Governance Objective: Tre atment LDP HEAT/Key indicator &


Deliver faster access to mental health services by delivering 26 weeks referral to treatment for speci alist Child and Adolescent Mental Health Services (CAMHS ) from March 2013; reducing to 18 weeks by December 2014; and 18 weeks referral to treatment f or Psychological Therapies from December 2014 Delivery Development of the skill mix and capacity within the team has been achieved in 2012 through the recruitment of 2 clinical psychology posts and two trauma therapist posts. The latter were developed through partnership working between Argyll & Bute Council and the charity Children First. Finance Funding within financial plan Workforce Integrated team working across health, local authority and Children First to be further developed. Improvement Work utilizing Highland Quality Approach to be undertaken, commencing March 2013 to focus on capacity building to ensure target achieved, even with anticipated increase in referrals to service as age of referrals to service increases to 18 years by 2015. Goals: - to identify areas of waste which can be eliminated to increase capacity and reduce waiting times. - clarity of pathway to CAMHS in and out of hours - to be HEAT compliant without compromising quality of service Equalities CAMHS service to Cowal and Bute currently provided by NHS GG&G through SLA.

The implementation of Helix, patient information and management system, and an increase in administrative support for the team has enabled the monitoring of waiting times to commence in October 2012. The longest wait for first assessment is currently 26 weeks; however the majority are seen before 16 weeks. Only 3 patients have been reported waiting longer than 16 weeks. Value Stream Mapping to take place 6th March to focus on referral pathway for CAMHS.


Item


35

HEAT/Key indicator & Description Action

Lead Progress/Completed TL

Eligible patients will commence IVF treatment withi n 12 months by 31 March 2015 Delivery NHS GG&C provide this service for A&B CHP residents – awaiting plans from them which may include a regional west of Scotland approach Current wait 20 months (Feb 2013) Finance TBI. Workforce NA. Improvement NA Equality NHSGG&C responsibility re planning for fairness

HPP

.

36



Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by a t least 12% between 2009/10 and 2014/15 Delivery Trajectory data – on target. Argyll and Bute set 10% reduction target in year 2012-2013 and on line to meet this target. Rates of emergency admission in this age group are lower in Argyll and Bute than many other areas of Scotland. RCOP initiatives Finance Existing resources and Change Fund . Workforce To sustain the decreasing rate of hospital admissions and bed days there will be a requirement for an increase in the workforce in the community. There may be a skills gap. Improvement The very rapidly ageing Highland population means any reduction in admissions is against a backdrop of an epidemiological “rising tide”. More overt incentives to shift resources from secondary to primary care where appropriate and, if possible, substantial improvement in the way in which nGMS, especially enhanced services, contracts, are developed, to better utilise their potential contribution. Equality Approach adopted across whole CHP, RCOP monitoring process to pick up any planning for fairness implications

LM/LN HPP

Emergency Admissions Scrutiny Groups in place in each hospital. All emergency admissions and readmission examined in detail on weekly basis and information captured to ensure that common themes at local and CHP level are identified and acted upon. Extended Community Cares being established in each area with extended working hours to provide more intensive community based support as alternative to hospital admission. Trial of OTs based in Casualty at LIH, Oban to identify if this has an impact on reducing number of admissions from casualty. Unscheduled Care Pathway for Falls being tested in Bute and in Oban to identify improved support to keep people at home if they do not require hospital care after a fall. Alternative transport provision through Red Cross being commissioned in Cowal to get people home from casualty if not requiring admission. Direct Commissioning of home care by GPs/District Nurses has improved support as has overnight support from Carr Gomm in all areas.


Item


37



No people will wait more than 28 days to be dischar ged from hospital into a more appropriate care setting, once treatment is complete from April 2013 , followed by a 14 day maximum wait from April 2015 Delivery Partnership working on course to achieve target- Trajectory Monitoring through council pyramid system. Finance Argyll & Bute The funding of complex care packages is currently through the joint Delayed Discharge budget and Argyll & Bute Council resource. Presently the issue is seen as one of dealing with delayed discharges and resource availability is contingent on client turnover. Workforce Argyll and Bute Council directly employ Home Carers in more rural parts of Argyll and Bute. In all other areas Independent Providers are commissioned to deliver Home Care services with a small number of preferred provider organizations contracted to do this. Through Reshaping Care for Older People, Extended Community Care Teams are under development in each locality and these include Health and Social Care professionals who work in close liaison with the Independent and Third Sector. Workforce development plan for staff in each sector is underway with training priorities identified to support the shift in practice towards one of enablement and reablement. Improvement The Partnership has a ‘whole-systems’ approach with a ‘critical path’ for service users at its care. It is recognised that the Single Outcome Agreement also contains an indicator addressing this issue and efforts to achieve the target will

PT/DOO

A&B Council is leading a service redesign of OP Services (Homecare, Single Care Homes and Day Care). Argyll and Bute have already been working to the 28 day target with only two breaches during 2012-2013. The application of the Admission, Transfer and Discharge policy is receiving renewed focus by Senior Leaders to ensure that all staff are focused on discharge from the time of admission to hospital. Completion of the discharge planning checklist, application of estimated date of discharge and multi disciplinary daily planning rounds are speeding up the process. The partnership, while still focusing on getting people home from hospital as quickly as possible, is also working on the provision of alternatives to hospital admission where appropriate. This includes a range of actions including anticipatory care planning, transport provision and use of telehealth and telecare.

38



require continued joint working with local partners. Equality Challenges re delivery on Islands and very remote rural areas


Item


39

HEAT/Key indicator & Description Action Lead Progress/Completed TL

To deliver expected rates of dementia diagnosis and by 2015/16, all people newly diagnosed with dementia will have a minimum of a year’s worth of p ost-diagnostic support coordinated by a link worker, including the building of a person-centered support plan Delivery Argyll and Bute identified as pilot site for Post Diagnostic Support Project. 3 multi disciplinary Community Dementia Teams in place – consisting of CPNs, OT, social work and Alzheimer Scotland Link Workers.

1 service level agreement with NHS GG&C for provision of dementia services in H&L locality Dementia Pathway being rolled out across CHP during 2013 Data capture of post diagnostic support being developed nationally. Trajectory data to be confirmed Finance Current resource profile: Staffing costs for Dementia Teams: £481,286 – uncertain of cost of SLA with GG&C Workforce SLA in place for link workers employed by Alzheimer Scotland. Dementia teams meeting with local GP teams to introduce selves and raise awareness of dementia resource pack. Improvement The dementia pathway was introduced to primary care teams and discussion focused on the importance for both patients and carers of early diagnosis and access to post-diagnostic support during external review meetings at end of 2012. Protocol for diagnosis of dementia by GPs to be developed

The CHP currently has no performance data to use, however plans are in place to start collecting performance information in 2013.

40

Series of stakeholder events planned for March/April to cascade information about referral pathway and what service is available as post diagnostic support. Dementia Development Day planned for April 2013. Equality Link workers will cover large geographical areas. Audit of uptake of referrals will identify any accessibility issues.


Item


41

HEAT/Key indicator & Description Action Lead Progress/Completed TL

Further reduce healthcare associated infections so that by 2014/15 NHS Boards’ staphylococcus aureus bacteriamia (including MRSA) cases are 0.24 or less per 1000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 15 and over is 0.25 ca ses or less per 1,000 total occupied bed days. Delivery Rates for SAB and C Diff in Argyll and Bute are well below the overall Highland rates and also below the national targets Finance Funding for the above initiatives will come from current budget allocations. Workforce Achievement of the target will require co-operation from all staff involved in direct patient care. Improvement 1 Continued implementation of the MRSA Care Pathway should help ensure that patients colonized or infected with MRSA are handled in the appropriate manner. 2 The NHS Highland programme for improving hand hygiene compliance should greatly reduce transmission of Staph aureus (including MRSA) between patients, thus reducing the likelihood of spread of an invasive strain. 3 There are several elements within the Scottish Patient Safety Programme that, when implemented, should reduce the risk of patients becoming infected and bacteraemic with Staphaureus. 4 Continued implementation of the Clostridium Difficile action plan will help contain other infectious organisms spread by the contact route, chiefly MRSA.

LN Application of the HAI standards has taken place across all hospitals in Argyll and Bute. These standards include full range of measures to reduce the risk of both SAB and CDI. Action plans are monitored at local level by Clinical Services Managers and regular walk rounds by Senior Managers take place to provide support to patients and staff and scrutiny of practice and the environment. Surveillance data is closely monitored on a weekly basis. Each new case of SAB/CDI is subjected to root cause analysis. Increase in numbers of frail older people in community settings along with the increased number of interventions in primary care, heighten the risk of community acquired infections. Further work is being initiated to support GP practices to reduce the risks of infection in these settings. Roll out of the SPSP is taking place in each community hospital with initial focus on the use of the PVC/CVC Care Bundle. Further audit of antimicrobial prescribing is planned for springtime and this will be carried out over 2 week period across all hospitals.

42



To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14 .

Delivery Completion of the roll out of the EDIS system remains outstanding – only LIH on system Target only applies to DGH/RGH – LIH trend is flat – significant seasonal variation summer is the busiest period The reductions in A&E attendance s currently being examined in the form of collecting baseline performance data – linking into the RCOP initiative Finance & Manpower Within existing cohort and developments detailed in RCOP and T10 target. Improvement Equality

HoEH LTC/LM HPCP/TL

Lorn & Islands Hospital Monthly Accident & Emergency Activity:

New & Return Attendances Time Period: 1st April 2008 to 28th February 2013

0

100

200

300

400

500

600

700

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09F

eb-0

9M

ar-0

9A

pr-0

9M

ay-0

9Ju

n-09

Jul-0

9A

ug-0

9S

ep-0

9O

ct-0

9N

ov-0

9D

ec-0

9Ja

n-10

Feb

-10

Mar

-10

Apr

-10

May

-10

Jun-

10Ju

l-10

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11F

eb-1

1M

ar-1

1A

pr-1

1M

ay-1

1Ju

n-11

Jul-1

1A

ug-1

1S

ep-1

1O

ct-1

1N

ov-1

1D

ec-1

1Ja

n-12

Feb

-12

Mar

-12

Apr

-12

May

-12

Jun-

12Ju

l-12

Aug

-12

Sep

-12

Oct

-12

Nov

-12

Dec

-12

Jan-

13F

eb-1

3

No

of A

tten

danc

es

New

Return

Trend (New)

Trend (Return)


Item


43

Key CHP Director of Operations………………………DOO……….Derek Leslie (DL) CHP Head of Finance…………………………….HoF……….George Morrison (GM) CHP Clinical Director……………………………CD.………..Mike Hall (MH) CHP Lead Nurse…………………………………LN…………Pat Tyrrell (PT) CHP Head of HR ………………………….…….HR………...David Logue (DL) CHP Head of Planning Contracting & Performance HPP……….Stephen Whiston (SW) CHP Locality Manager…………………….……..LM...……..Christina West (CW), Viv Smith (VS), Veronica Kennedy (VK) Primary Care Advisor…………………………….PCM..…….Joyce Robinson (JR) CHP Public Health Consultant……………………CPH..…….Elaine Garman (EG) Clinical Director Children’s Service……………..CDC…..…..Jamie Houston JH) Practice Development Nurse…………………….PDN’s…..…Caroline Henderson (CH), Liz Higgins (Cowal & Bute) Alison Guest (AG) Public Health Practitioner………………………..PHP…….…Alison Mcgrory (AM) Deputy Clinical Director Dentistry………………CDD………Elizabeth Reilly (ER) Clinical Director Mental Health…………………CDMH….…Grace Fergusson (GF) Project Director Mental Health……………………PDMH……John Dreghorn CHP Locality Clinical Director……………………LCD

44

6 Public Focus Patient Involvement - Engagement Pla ns 2013/14

7.1 How the unit plans to regularly engage key public/p atient groups – Practice Participation Groups, Local Partnership Fora, Distr ict Partnerships etc. The CHP develops and implements a number of robust Communications & Engagement Plans, these are regularly reviewed & updated to ensure remains effective in line with Statutory Guidance (CEL 4 (2010)) & National Standards for Community Engagement. This is led by Planning & Public Involvement Manager in partnership with Locality PPF leads / members, Scottish Health Council Local Officer & Locality Management utilising the well established and developing Public Partnership forum arrangements across Argyll and Bute and developing other networks.

7.2 How the unit plans to engage with public/patients o n specific issues/quality plans. The Communication and Engagement Plan for specific quality initiatives will include, but is not restricted to, the following:

o Identification of primary, secondary & tertiary stakeholders – to support the level of appropriate engagement / involvement

o Use local press & local community newsletters o CHP webpage o NHS Highlands Face book, Twitter and Blog o CHP newsletter o Locality newsletters o Local radio o A&B PPF / Locality PPFs o Engagement with local community / voluntary groups, community councils,

third sector organisations & PPGs o Community Planning – locality groups – these are not effective in terms of 2-

way communication, only good for disseminating information o Road show events – link with A&B PPF Action Plan to raise profile of PPF &

CHP o Public meetings – on request (for example community councils) o Direct public/patients surveys and feedback from Patient Experience

programme and patient opinion web site o Staff meetings / briefing sessions o Local Authority briefings o A&B CPP briefings o Engagement with groups / individuals with Protected Characteristics (Equality

Act 2010) – this will support PFF (EQIA) processes o Guidance and support from Scottish Health Council on tools, methods and

techniques to enhance public engagement including after action reviews to learn and

The CHPs Communications & Engagement Plan will be used to monitor progress & stakeholder audits e.g. SHC "After Action review” will identify variance against the Plan thus enabling specific targeted action.


Item: 12

Review and Redesign of Hospital, Community and Care Services in Kintyre Report by : Stephen Whiston Head of Planning Contracting and Performance, Christina West, Locality Manager, Mid Argyll, Kintyre & Islay

The CHP Committee is asked to: • Note the background and process conducted within the review and redesign of services

in Campbeltown Hospital. • Note the report findings and outcome of the hospital bed modeling review process

and way forward. • Consider the feedback received from the community at the drop in event. • Endorse the conclusion reached to close the continuing care beds transfer resources

into the community. • Endorse the implementation process.

1 Introduction and Context The purpose of this paper is to update the CHP Committee on the final outcome of the 2 year process to review and redesign the Hospital, Community and Care services within Kintyre The work undertaken has been within the national policy context of transferring continuing care provision from Hospital (institutional settings) to the community under the Scottish Government “Reshaping Care for Older People: A Programme for Change 2011-2021” This will see the NHS, Council, Independent and voluntary sector moving towards a service that will focus on:

• Care Pathways – ensuring those with complex needs are well supported by all parts of the care system;

• Care Settings, which will help older people to remain at home or in homely settings; • Community Capacity, to enable older people and their communities to provide

"supported self care"

That means planning and providing services in much more integrated ways between GPs, hospitals and community-based health, social care, housing and independent sectors. It means improving the whole range of services and designing better ways of communicating across different agencies in support of this. This service requirement has been a key driver in the development of the new Health and Social Care Partnership in Argyll and Bute. Establishing a single health and social care organisation through legislation in 2013.

2 Process and Timeline

Since 2010 Argyll and Bute CHP has been working with local health professionals and communities to review its balance of care provision in its hospitals and services as per national policy now articulated in NHS Scotland 2020 Vision and Reshaping Care for Older People: A Programme for Change 2011-2021. This has resulted in a systematic review of its hospital bed complement for GP Acute and Continuing Care Beds in partnership with all stakeholders, including the local Councilors,

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Social Work, Scottish Ambulance Service, local GPs and the local community including public representatives from the Locality Public Partnership Forum and Community Council representatives. The redesign, reorganization and review of NHS services in Kintyre including an assessment of the future number of hospital beds in Campbeltown hospital and the first bed modelling exercise was conducted in November 2010. As at this date there were 2 wards in the hospital, a GP Acute ward with 19 beds and a continuing care elderly ward of 14 beds. The process involved considering the results of a statistical model which analysed a number of factors including the trends in continuing care and GP acute bed occupancy over the past four years, changes in the length of stay of patients, the age of patients and also projected population increases (Appendix 1 provides some of the key activity and modeling information). It also examined changes in how services are being delivered locally through the development of anticipatory care which helps prevent admission to the hospital, the impact of increasing the range of services in the community and more effective working with social services to speed up patient discharge. The project group also considered the challenges of providing services in a very remote and rural area, re potential delays in patient transfer and the impact on the Scottish Ambulance Service e.g. both air retrieval and land transfers to NHS GG&C which could see ambulances out of area for 5 hours. The configuration and physical layout of the hospital wards were also considered identifying and acknowledging constraints in the flexibility in the accommodation e.g. limited number of single rooms (3 in the GP Acute ward) with the remainder of the beds provided in bays. This could restrict individual patient care needs e.g. separation of male and female patients and the impact of new standards re Healthcare Associated Infection on bed space etc. Whilst undertaking this work the project group in January and February 2011 undertook a review and option appraisal exercise on the operation of the existing 2 wards. This process identified a preferred option reduce Acute ward to 18 beds and Bengullion to 14 beds running as a single ward team. This outcome resulted in the merger of the wards so they operated as a single unit, better reflecting the current and future NHS care needs of patients (hospital beds should be preserved for acutely ill patients). This reorganization ensured that all hospital nursing staff maintained their skills and strengthened the link to community nursing and Allied Health Professionals, continuing to support the shift of health and social care into the community.

The outcome of the initial bed modeling work and the reorganization of the wards saw the project team agree that there should be a pause to allow time for the new hospital, community and anticipatory care arrangements and services to take affect and then assess the impact on hospital bed usage. It was therefore agreed to repeat the bed modeling exercise in about 6 months. A number of further meetings were held through 2012 in March, August, October and December outlining the changes in community services, the impact of “Reshaping Care for Older People” and examining the trends in hospital bed use and then repeating the bed modeling exercise.

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This 2 year programme has been conducted under NHS Highlands Better Health Better Care, Better Value” initiative, the culmination of which was agreement on the future bed complement required to provide local GP acute hospital services in October 2012 with all partners. The revised bed complement was ratified at the project group meeting on 10th January 2013. This saw the closure of the empty continuing care beds on Benguillion ward with the exception of the 2 beds for existing patients (these would close in time). The GP Acute ward bed complement would remain unchanged at 19- total ward complement of 21 beds. Also at the meeting a number of additional operational arrangements were clarified and confirmed notably:

o Contingency arrangements to provide an additional 3 physical beds if there was an unexpected peak in demand due to e.g. a viral outbreak.

o How resources from the closure of continuing care beds would be reused in the community to further develop anticipatory care services including community nursing and social work care services. .

o An implementation project group would be established with appropriate representation to take forward the bed closure and redesign of services.

The culmination of this work is a further important step in NHS Highland ensuring that it has the right balance of service provision in Kintyre to make sure that hospital beds are available for those patients with acute illnesses. There has been an increase in the community services in both health and social care which is clearly helping prevent people getting ill and letting them remain in their own home. This decision to close the empty Benguillion ward will allow further development of community and social care services by transferring resources into the community. Subject to validation this is in the range of £160,000-£190,000 to be transferred into community services Argyll and Bute CHP through out the process has recognised community concerns regarding the future sustainability of hospital and care services in Kintyre and hence has taken a systematic and measured process over 2 years to get to this point. At all times it has reassured the community that it intends to maintain the 999 status of the hospital, A&E, GP Acute, GP Out of Hours and Community Midwifery Maternity Services in the hospital. 3 How is the balance of care changing in Kintyre The Outcomes Framework for Community Care 2009/10 required us to move services closer to users and carers by achieving a shift in the balance of care from ‘institutional’ to home-based care. The Reshaping Care for Older People programme builds on this requirement, by providing additional funding, until 2015, to enable and support the shift towards care in the community, through a partnership approach.

The overall Balance of Care targets in Argyll and Bute are 70% cared for in the community and 30% of people cared for in an institutional setting. The measure represents people aged 65+ who receive a funded service from the Partnership.

February 2013 joint performance report below shows how the partnership approach between the NHS, Council and voluntary sector is successfully shifting the balance of care in Kintyre thereby supporting the closure of continuing care beds so that people receive care in the community.

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Social Work and NHS Joint Performance and Balance of Care, Older People.

Table 1 Overall Balance of Care by area, February 2013: Area Clients cared for

in the community Clients cared for in an institutional setting

Trend for CiC

Number % Number %

Helensburgh & Lomond 367 74% 131 26% ↑ Bute & Cowal 383 67% 188 33% ↑ Bute 174 77% 53 23% ↑ Cowal 209 61% 135 39% ↑ Mid Argyll, Kintyre & The Islands

323 70% 136 30% →

Mid Argyll 131 72% 52 28% ↓ Kintyre 133 67% 67 33% → Islay & Jura 59 78% 17 22% ↑ Oban, Lorn & The Isles 256 71% 106 29% ↑ Oban 197 66% 95 34% → Colonsay 4 100% 0 0% → Mull & Iona 50 91% 5 9% ↑ Coll & Tiree 5 45% 6 55% → Overall delivery 1329 70% 561 30% ↑ Target 70% 30% Source: Pyramid, Joint Planning & Performance Care in the community includes Homecare, ICTs, Overnight Teams. Extra Care Housing, data for all areas is now included. To avoid double-counting Meals on Wheels, respite care, daycare and Telecare are not currently included. It is recognised that some people are supported on an on-going basis by Community Nurses, but to date, been able to gather reliable data to include this provision.

Care in an institution includes permanent and temporary/emergency stays in a care home and NHS Continuing Care.

Delayed Discharges awaiting care provision are also included in the Balance of Care calculation.

There is currently (March 2013) 4 continuing care vacancies in Kintyre Care Centre so appropriate care home placements are available for those with high levels of need.

With regard to the priority list for people needing additional social care input in the community in Kintyre. There is one person waiting for one additional hour of input. There is more work to do re forecasting demand and the transition from ECCT to homecare service delivery but this is being undertaken and will be considered within the implementation process.

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4 Kintyre Community Concerns on closure of hospital beds Due to an unfortunate administrative mistake the Campbeltown Community Council representatives on the project group were not invited to the ratification meeting in January 2013. This omission resulted in a breakdown in communication with the Community Council which led to a number of press articles and written /emails from the Community council as well as local councilors and MSPs on the closure of beds and their perceived downgrading of hospital services in the area. To rectify this Kintyre locality quickly put in place arrangements to have a public drop in event in the town on the 14th March 2013 to allow members of the public to meet members of the extended Community Care Team including Occupational Therapists, Physiotherapist, Nurses and Health Care Support Workers, the Local Authority Home Care Team and Telecare Worker, the Red Cross, Carr Gomm (private home care providers and overnight response team), Argyll Voluntary Action alongside Shoppers Aid and the local Public Partnership Forum. The Campbeltown Community Council members attended the event taking the opportunity to review the information presented, clarify the process undertaken and present their concerns. A total of 58 members of the public attended the event. In addition the CHP established a formal feedback process around the event which saw 17 feedback forms received as at the closing date of the 29th March 2013. A full analysis of the feedback is included in the attached report. The main questions asked were: Q3. Please tell us how you feel about the proposed changes in the way services are provided in Kintyre? Q4. What do you like about these proposed changes and why? Q5. Do you have any concerns or comments that you would like to make regarding the future of services provided in Kintyre (For example, for people who need support with social care, in your opinion where is this best provided)? Feedback Summary The majority of feedback received suggests that the direction service provision is moving in is not supported by the wider community. With the perceived level of disapproval through media, local Community Council and political interest, it is disappointing that more people didn’t attend the event on 14th March (59) and that so few feedback forms were returned (19). There is fear that the proposed loss of beds in Campbeltown Hospital will result on patients having to go to either Oban or Glasgow to receive care, more so than before, separating them from family, carers and friends which is important to people. Some respondees suggest that community care is a good model but that this will not be adequately resourced to meet local demand and with fewer beds in the hospital patients will not receive the care they require. Some respondees are suspicious that the proposed reduction in beds is to save

6

money rather than following national guidance on how care should focus less on hospitalisation but more on keeping people at home. There are concerns that the proposed model will fail to be adequately resourced and recruitment to the area will be a problem compromising patient care. To balance this view, some respondees were positive about the proposed changes, suggesting that they will result in less institutionalisation and promote independence. Integration is a good idea resulting in a more cohesive, efficient service for patients The key points from the feedback can be summarized as:

Key Issues/Concerns/Comments 1 Reduction of beds at Campbeltown Hospital is not widely supported

2 Community care is a good model if correctly resourced –

additional resources required, expensive model 3 Adequate beds available for those who need it, including

patients waiting transfer back from Oban or Glasgow hospitals 4 Patients being separated from family, carers and friends

5 Insufficient carers available to support the proposed model

6 Recruitment and retention of appropriately trained / skilled care staff

5 Winter Weather Major Incident Kintyre The unprecedented winter weather experienced over the weekend of the 22nd- 24th March which saw a peninsula wide failure in the power and transport infrastructure effectively cutting the area off from the rest of the country. This saw the Campbeltown Community Hospital as part of the multiagency response becoming a key facility and service for its local community. It led and coordinated the local community response with local authority partners and acted as a safe haven for the most vulnerable as well as providing essential food and protection from the elements of the wider populous until temporary generation and/or mains power was established in other buildings. Rest centre type accommodation is a key contingency in emergency planning and it is rare for hospitals to be used for this purpose but quick adaptation of NHS premises in this instance proved extremely useful. It is clear that this is a function that will always be there in extremis, not only providing 24/7 clinical service but supporting the public health safety and protection role and the multi-agency review of the incident will examine how it and other facilities e.g. School, Air base, community halls, care homes etc can be used and roles strengthened for community resilience purposes. 6 Conclusion The CHP has undertaken a lengthy and systematic and considered process in reviewing, reorganising and rationalising health and care services within Campbeltown hospital with the involvement of all stakeholders and partners in the area.

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The recent concerns expressed by the community relate to an unfortunate breakdown in communication but also the material step of closing empty continuing care beds as they are no longer used. In addition there seems to be concerns regarding the robustness of care and community services although performance and monitoring information show local need is being met. Notwithstanding this and the context of the Winter Weather Major Emergency the outcome of the review process remains valid and appropriate and its is the view of the CHP Management Team that the continuing care beds should close and the resources transferred into the community to further develop services there. The implementation team tasked with taking these changes forward must undertake a proactive and responsive PFPI and communication process with the public and politicians on the developments made and the outcomes achieved to ensure hospital and community services are meeting patient needs.

7 Contribution to Board Objectives This paper responds to the Boards objectives of achieving Better Health Better Care & Better Value. Governance Implications This paper aligns with the CHP Corporate and Governance responsibility for effective resource utilisation and maximising care. Staff Governance There are development implications for staff re change, retraining and redeployment and involvement and communication. Patient Focus and Public Involvement There is large public interest in this issue at present in the Kintyre area. Feedback from the public has revealed a number of concerns and the implementation process must address these. A proactive media and public communication approach will be required supporting the outcome as defined. Clinical Governance Clinical risk and action to reduce the risk will require identification mitigation and agreement through governance structures as part of the implementation process. Financial Impact The changes identified will have a neutral impact on the recurring cost base of the CHP, as existing resources will be redeployed into new service models. Equality and Diversity Planning for Fairness impact assessment is not required as this is a continuation of existing developments

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Campbeltown hospital Total Inpatient Bed use (GP Acute and Elderly Continuing Care) 1st March 2010 - 28th February 2013

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Appendix 1- Supporting Activity and Bed Modeling Information

Graph 1 - Campbeltown Hospital Daily Inpatient activity variation & Trend 1st March 2010- 28th February 2012

Commentary

• Graph 1 shows the daily use in total inpatient beds in the hospital over the last 3 years • Graph 1 also shows a trend line which shows the trend in total bed use over the period • Inpatient Beds in the hospital are designated for GP Acute care and Elderly continuing care

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Graph 2- Daily Inpatient Occupied Beds 1st March 2010 - 28th February 2013 Specialty: GP Acute

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Graph 3 - Daily Inpatient Occupied Beds 1st March 2010 - 28th February 2013 Specialty: Elderly ContinuingCare

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Graph 2 & 3 - Campbeltown Hospital GP Acute and Elderly Continuing Care daily Inpatient activity & Trend

1st March 2010- 28th February 2012

Commentary

• Graph 2 shows the daily use in inpatient beds in GP Acute o The Graph also shows a trend line which shows a small increase in the use of beds over the

period

• Graph 3 shows the daily use in inpatient beds in the hospital in Elderly continuing Care o The Graph also shows a trend line which shows a dramatic fall in the use of beds over the

period. Since March 2012 only 2 beds have been used

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Campbeltown Hospital Frequency of Bed Occupancy pattern 2010, 2011 & 2012/13

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Graph 4 Frequency of Inpatient Bed Use March 2010- Feb 2013

Commentary Campbeltown Community Hospital

• Graph 4 shows the number of times (frequency) beds have been used over the last 3 years • The pattern of use shows a reduction in the total beds used but an increase in the intensity

of use.

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Campbeltown Hospital Additional Activity Information Campbeltown Hospital opened in 1993

o Its bed complement has changed over time. The last 5 years are illustrated below : Table 1- Hospital Bed Complement

Specialty Nov 2008 Available Staffed Bed complement

Nov 2010 Available Staffed Bed complement

Dec 2012 Available Staffed Bed complement

Redesigned Bed Complement 2013

Maternity 1 1 1 1 Elderly Long stay

23 20 14 2*

GP Acute 19 19 18 19** Total 43 40 33 22 Note *- long stay continuing care beds for current patients **-Bed complement contingency plan to increase by a further 3 beds during peaks in activity Monthly Average Inpatient Bed Occupancy in the Campbeltown hospital wards over a 6 month period in 2012/13 is shown in the table below

Specialty Aug 2012-

% Bed Occupancy

Sept 2012- % Bed Occupancy

Oct 2012- % Bed Occupancy

Nov 2012- % Bed Occupancy

Dec 2012- % Bed Occupancy

Jan 2013- % Bed Occupancy

Maternity

0 0 0 0 0 0

Elderly Long stay

14.3 14.3 14.3 14.3 14.3 14.3

GP Acute 64.9 72 71.7 65.2 68.8 67.6 Total excluding Maternity

42.7 46.8 46.6 42.9 45 44.3

Planning for Future Hospital Inpatient Beds - modeling The Modeling process is informed by: o Historical activity and trends and profile of inpatient activity for last 12 months e.g. Length

of stay, occupancy levels & frequency of use of beds, age profile of inpatients etc. o Local Authority social care needs assessment and resource profile- continuing care

should be provided in the community o National and NHS Highland policy and targets

o Ensure the highest quality of service in the most efficient and cost effective manner

o Heath care and treatments provided to consistent standards which are evidence base with patient safety assured

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o Increasingly community-based with hospital beds preserved for the most acutely ill and those with specialist needs

o Population projections o Developing anticipatory care services - keeping people well and caring for them at

home Part 1 - Bed Modeling Tool A mathematical model developed by Information Services Division Scotland (part of NHS National Services Scotland) was used and the following parameters were agreed by the project group: • Forecast period 3 years to March 2016 • Target Length of Stay GP Acute Episode- 5.5 days • Anticipatory care level- 30% • There were 2 continuing care patients still in the hospital at this time. Therefore 2 beds

should be added to the outcome of the modeling exercise although in the future they will not be required.

• The model predicted a population increase of 725. The model identified a bed complement shown below.

Bed Model Continuing Care Beds

Total Current Beds Difference

15 2 17 32 15 Part 2- Local Planning assessment The project group then considered the findings of the model against the following context: o The remote rural context of NHS service delivery in Kintyre re transport resources of the

SAS etc o Maximising the provision of local services where safe and appropriate o Taking account of the increase in very elderly with complex morbidity and the desire as far

as is practicable to provide Acute care in the hospital and rehabilitation in the community o Assessment of the impact of the control of Hospital Acquired infection standards on bed

space – ensuring patient safety is paramount o The physical layout of the ward/s and how this supports flexibility in managing demand for

male/female beds o The formal closure of the continuing care beds and transfer of resource and funding into

community care services o Identifying the level of risk regarding peaks of activity above the 17 bed complement and

preparing contingency plans to manage this risk and support service demand. (2011/12- there were 106 occasions when 15 beds were exceeded

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Part 3 - Final Outcome Taking all these factors into account the group recommended and approved a revised bed complement for Campbeltown

Table 3- Hospital Bed Complement

Specialty Redesigned Bed Complement Maternity 1 Elderly

Continuing Care

2* GP Acute 19**

Total 22 Note *- long stay continuing care beds for current patients **-Bed complement contingency plan to increase by a further 3 beds during peaks in activity (in 2012/13- there were 25 occasions when 19 beds were exceeded)


Item : 12a

Argyll & Bute Community Health Partnership (CHP)

CHANGES TO CAMPBELTOWNHOSPITAL

PUBLIC EVENT 14 th MARCH 2103

COMMUNITY FEEDBACK

REPORT

Final Version 17th April 2013

Background Argyll and Bute Community Health Partnership (A&B CHP) has been developing services in Kintyre for a number of years now, in line with national policy. The NHS must provide services that will meet the needs of local people but also in a way that services can adapt to changes in how best to provide the most appropriate care. More people than ever before are receiving the care they require at home or in the community and as such there have been changes within Campbeltown Hospital. The review and redesign of services provided at Campbeltown Hospital are based on principle objectives to ensure that services are sustainable, meet local health needs and also meet NHS Highland’s characteristics of service delivery for the next five years. The main objectives are :

• Promoting good health, self care and independence • High quality, integrated, equitable, needs and evidence based and cost

effective service • Increasingly community based with hospital beds preserved for the

most acutely ill and those with special needs • Integrated with, and complementary to, the local authority, voluntary

and independent care sector • Run by healthy, flexible, well motivated and well trained staff working to

their maximum potential and capacity • Using modern, flexible, efficient and green assets to maximum effect • Zero wastage and inefficiency across all services with no unnecessary

overheads Community Engagement In response to a request from the local community and in an attempt to appease anxieties about the proposed changes, an information event was held on 14th March 2013 in the Town Hall, Campbeltown, 2pm – 8pm. The event provided an opportunity for local people and staff to find out about the proposed changes in Campbeltown Hospital and better understand why these changes are necessary. A total of 59 people attended the event. Community Feedback – “Your Views” Members of the public and staff who attended the event were handed a copy of the Feedback Form (Appendix 1) and encouraged to either complete it on the day or return to the Freepost address supplied. In addition, people were invited to complete the feedback form online. A dedicated email address was used for anyone wishing to share their views, concerns or provide general comments. Community Feedback Results

The evaluation of the feedback and general comments received has provided both a quantitative and qualitative feedback. A total of 19 forms were returned by the deadline, Friday 29th March 2013. The following provides a brief summary of the quantitative feedback, referring to Questions 1 and 2.

1. Before this event, were you aware of changes pro posed within Campbeltown Hospital?

No of

Responses % Yes, a little 3 17% Yes, considerably 13 72% No, not at all 2 11% n= 18 100%

1 respondee declined to answer this question therefore control total will not match the actual number of feedback forms received (19).

If so, where did you learn about this?

No of

Responses % Through the media 12 60% Through the Public Partnership Forum 4 20% Other 4 20% n= 20 100%

Some respondees ticked more than one box while two declined to answer this question therefore the control total will not match the actual number of feedback forms received (19). Of the 4 respondees who ticked “other”, one had heard through work, one was a hospital employee, one had heard “people speaking about it” and one knew “as the wife of a patient who had regular need of the hospital”.

2. Do you feel informed about the range of health a nd social care services available in Kintyre?

No of

Responses % Yes, a little 10 56% Yes, considerably 7 39% No, not at all 1 5% n= 18 100%

1 respondee declined to answer this question therefore control total will not match the actual number of feedback forms received (19). In terms of qualitative analysis, respondees were asked some general questions as follows :

3. Please tell us how you feel about the proposed c hanges in the way services are provided in Kintyre.

• There has been no talks about another ward closure of Campbeltown

Hospital. The hospital is at the heart of peoples welfare. While its ok to have back-up you must have fully trained assessment staff i.e. – doctors, nurses, an x ray dept 24 / 7. I understand if I have a broken limb on a Sat I would need to go to Oban a trip of 100 miles. This is a case for a National Newspaper to take up the concerning problem facing what I would hope is a growing town. If this is SNP policy god help us.

• Community Care is a good model if the correct resources are placed in the community to carry it out effectively and responsibly and without neglect to elderly and vulnerable people. What the NHS does not seem to appreciate is that if done properly, community care can be more expensive than hospital care (where most of the resources are in one place). In a rural area there needs to be extra resources freed up to community care due to recruitment, travelling and distance covered. There have been problems with recruitment of adequate staffing levels in an isolated community. There are concerns that in these times surreptitious savings will be made in the transfer of care from hospital to community. That bed usage may have been artificially manipulated to demonstrate a lesser need. That community care statistics will not demonstrate adequately the shortfalls that need addressing. That much credence has been given to historic bed usage but no credence has been given to future bed usage with the predicted increase in the elderly population and increases in attendance at A&E departments by the elderly.

• Feel quite worried about old people who may be separated from family if they are not able to be at home and will be sent away from Campbeltown due to closures in hospital etc.

• I do not agree with cutting back 11 beds, not asking patients you can make up as many graphs and figures as you want. But if beds are not there when needed or staff, then its to late by then? I cannot protest any more strongly. I am totally against these cuts in beds and being under NHS Highland Inverness is to far away! Our consultants come mainly from Glasgow whom we should be under.

• Do not like bed modelling. • I feel very unhappy about it all. • I am concerned that a reduction of beds means a reduction in patient

numbers which may risk the reduction of kitchen staff and introduction of frozen meals.

• I am concerned about the cut in hospital beds considering how far away we are from Glasgow. Also how this is going to impact on people

with Dementia and their carers / family in the future as well as the here and now.

• I think a lot of people will benefit from 11 regardless of age. • Feel very strongly about all this especially where we are so far away

from other hospitals and are isolated. We need to keep our local hospital open for the communities.

• Worried about lack of provision for emergency care. Concerned that patients will have to travel to Oban or Glasgow more often.

• A little worried about the number of beds available in the hospital. • Ok. • Not sure care in the community is actually working well at this point, a

bit hasty to be cutting beds in local hospital.

4. What do you like about these proposed changes an d why?

• Community care, if resourced properly, can prevent institutionalisation,

can increase independence by keeping people in their own familiar environment and can reduce chances of hospital infections.

• The changes benefit people who always wished to stay at home and not be hospitalised.

• Efficiency. • Integrated care with all professionals seems very efficient. • Increased care in the community possible. • Can’t make my mind up about it all. • That if people want to stay at home to be looked after for the rest of

their life. • I’ll see how it goes at the minute I’m not sure that I do like the proposed • changes but am prepared to give it a fair chance. • I don’t like them. • None. • Not a lot. • Nothing. Care at home is not professional care all the time with access

to doctors. Local doctors don’t do any call outs, therefore delay in seeing a doctor when in a crisis time is essential. A carer or nurse isn’t a doctor.

5. Do you have any concern or comments that you wou ld like to make regarding the future of services in Kintyre?

• Yes beside bed modelling I do not know if enough carers for

community. • I was disgusted with some of the answers I got at the meeting, such as

head of the carers told me there was 5 nursing homes in C/town and there is two and she didn’t know that.

• There seems to be an opinion that the care packages are not easy to set up and that the time allocated is not sufficient.

• At home.

• Very concerned that out of hours x-ray provision could be cut. Support with social care being provided at home is the best option and what most of us would aspire to but only if it is suitable and in quite a few cases it is not. This area has a woeful shortage of carers.

• If they want to live with them they can take the methadone programme to their own area. We are fed up with this being pushed down our gullets. A vote in Campbeltown would not be passed.

• Give what is best for the patient and if they need special care hospital is best place for them.

• None • Depending on what the needs are : high needs = hospital / low needs

at home. • I believe there are a number of people in the community that the

system has failed. • In Bengullion Ward : provided by nurses and doctors not well meaning

carers trained on courses. Concerns listed in Q4 : all this about services is to save money and to hang with the patients and will lead to poorer services in our area : what happens when carers and nurses are gone for the day and something happens? In a ward regular checks and help is there all night. It’s called the National Health Services for patients. I think these cuts are a disgrace.

• It will not be funded adequately. In a remote community it will be difficult to recruit adequate staff of the right calibre. That real problems are not identified publicly and are swept under the carpet so that they are not addressed. That in these austere times inappropriate savings will be made resulting in community neglect. That people will have to travel large distances to see their relatives if transferred to other hospitals. That there are delays back from other hospitals because there is a lack of beds at Campbeltown Hospital. That there is a lack of coordination with ambulance services and transfers are delayed or postponed. That there are not enough specialists to provide adequate cover in a remote area e.g. physiotherapists, stoma care etc. That terms and conditions of employment do not allow for consistencies in staffing and that people may be visited by different carers (not conducive to continuity of care). That the care is rushed because of pressure on time. There is not a delivery service for prescriptions, incapacitated people have to rely on family, neighbours or friends. That bureaucratic hurdles are put in the way of quickly designing appropriate and responsible care plans.

Please indicate if your interest is as :

No of

Responses % A service user 4 17% A member of public 10 42% NHS Highland staff 3 12% A member of Community Council 5 21% A&B Council staff 1 4% Other 1 4%

n = 24 100% Some respondees ticked more than one box therefore the total will not match the number of responses received (19). Having ticked “other”, 1 respondee stated they were a member of ACUMEN. Summary A total of 19 responses were completed and returned. The majority of feedback received suggests that the direction service provision is moving in is not supported by the wider community. With the perceived level of disapproval through media, local Community Council and political interest, it is disappointing that more people didn’t attend the event on 14th March (59) and that so few feedback forms were returned (19). There is fear that the proposed loss of beds in Campbeltown Hospital will result on patients having to go to either Oban or Glasgow to receive care, more so than before, separating them from family, carers and friends which is important to people. Some respondees suggest that community care is a good model but that this will not be adequately resourced to meet local demand and with fewer beds in the hospital patients will not receive the care they require. Some people are suspicious that the proposed reduction in beds is to save money rather than following national guidance on how care should focus less on hospitalisation but more on keeping people at home. There are concerns that the proposed model will fail to be adequately resourced, recruitment to the area will be a problem compromising patient care. To balance this view, some respondees were positive about the proposed changes, suggesting that they will result in less institutionalisation and promote independence. Integration is a good idea resulting in a more cohesive, efficient service for patients. In an attempt to summarise the key points, these are listed below.

Key Issues / Concerns / Comments 1 Reduction of beds at Campbeltown Hospital is not widely

supported 2 Community care is a good model if correctly resourced –

additional resources required, expensive model 3 Adequate beds available for those who need it, including

patients awaiting transfer back from Oban or Glasgow hospitals 4 Patients being separated from family, carers and friends 5 Insufficient carers available to support the proposed model 6 Recruitment and retention of appropriately trained / skilled care

staff

The results of the feedback received will be reported to the Kintyre Redesign Group and Mid Argyll, Kintyre and Islay Local Management Group with the recommendation that there is a need to carry out further work with the communities and staff. The feedback received is very important and of great value. Many thanks to all those who returned their completed forms. Caroline Cecil Planning and Public Involvement Manager Argyll & Bute CHP 17th April 2013

APPENDIX 1

Argyll and Bute Community Health Partnership (CHP) has been developing services in Kintyre for a number of years now, in line with national policy. The NHS must provide services that will meet the needs of local people but also in a way that services can adapt to changes in how best to provide the most appropriate care. More people than ever before are receiving the care they require at home or in the community and as such there have been changes within Campbeltown Hospital.

GIVE US YOUR VIEWS! The CHP wants your views on the best way to provide services in Kintyre in the future. To do this you can :

Complete the feedback form and post it to us FREEPOST to the address at the end of this form

Complete the feedback form online at http://bit.ly/ZFw9L2

Email your completed form or share your views or comments to [email protected]

Forms must be returned by Friday 29 th March 2013 Q1. Before this event, were you aware of changes pr oposed within

Campbeltown Hospital?

Yes – a little Yes – considerably No, not at all If so, where did you learn this from? Through the media Other ____________ Through the Public Partnership Forum

Q2. Do you feel informed about the range of health and social care

services available in Kintyre?

Yes – a little Yes – considerably

Highland Quality Approach

Update to Changes at Campbeltown Hospital Public Event 14 th March 2013

FEEDBACK FORM

No, not at all Q3. Please tell us how you feel about the proposed changes in the way services are provided in Kintyre.

Q4. What do you like about these proposed changes and why?

Q5. Do you have any concerns or comments that you would like to make regarding the future of services provi ded in Kintyre? For example, for people who need support with social care, in your opinion where is this best provided?

Please indicate if your interest is as (tick one bo x):

A service user A member of a Community Council A member of the public Argyll & Bute Council staff NHS Highland staff Other (please state) .…………………………

Please post to :

Caroline Cecil Planning & Public Involvement Manager

FREEPOST RRYT-TKEE-RHBZ NHS Highland (Argyll and Bute CHP)

Blarbuie Road, LOCHGILPHEAD, Argyll, PA31 8LD

Feedback forms returned by post must arrive no later than Friday 29 th March 2013

MANY THANKS INDEED FOR TAKING THE TIME TO COMPLETE THIS FORM


Item : 13 Modernisation of Mental Health Services Update Repo rt (April 2013) 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 Programme Board met on 15th March 2013. Capital Project Board also scheduled for 15th March was cancelled. Both groups are scheduled to meet again on 10th May.

� Appointment of New Project Secretary: Following Kristin Parker’s move to the Planning and Performance Department in January, the post of Secretary to the Programme Director has been vacant. Im pleased to report that Christina Ferguson has been appointed and will take up post on 22nd April.

� Capital Project Stage 1 Approvals

New target approvals dates have yet to be confirmed.

� Inpatient Services The bed compliment remains at 28 plus 3 minimal supervision places in the refurbished Firgrove building. Upgrade works in Succoth are almost complete and the upgrade works in IPCU continue with completion expected towards the end of May. While these works are taking place there will be a further temporary reduction in IPCU beds to 5, which will increase to 6 on completion of the works. Other departments benefiting from upgrade works are Occupational Therapy and Physiotherapy. Work on the new physio department should be completed by the end of April, and the service will transfer to its new location on the ground floor in May.

� Staff Redeployment Nil new to report since the last update.

� New Posts - The Neuro/Older Adult Clinical Psychologist post will be advertised within the next few weeks. - Discussions with Clinical Psychology took place in early March and will result in 2 part time posts

being recruited to. These are: one post which will work across the MAKI and OLI localities; and one post covering Cowal & Bute.

� Budget

- Bridging: The bridging allocation for the project during 2013/14 has been set at £500k by the CHP management team. This will largely be used to cover the capital project, project management and advisor costs, which are expected to exceed £400k this year and drop off during 2014/15. The other significant cost against bridging is likely to be the establishment of the revised patient transfer arrangements.

� Resettlement Group

Resettlement plans for 4 patients IPCU patients with very complex needs continue to be developed in collaboration with Argyll & Bute Council Social Work Department. This is likely to include a requirement for commissioned services.

The meeting is asked to: � Note current key issues and progress against the action plan

13 MH Services Modernisation Update Report April 2013 (1) 05/04/2013 J. Dreghorn Page 2 of 4

� New Hospital Development On 14th March the architects met with the clinical user group to consider the revised design options. As a result of this meeting a preferred floor plan has now been selected, and the architect team will now progress more detailed design work leading to RIBA stage c drawings being produced within the next few weeks. Work continues on the layout of the support services building. See approved hospital floor plans below.

Ground Floor

Upper Floor


� CMHS Team Base As reported previously, NHS Highland has allocated capital funding for the Kintyre and Dunoon CMHS bases. Works commenced on both projects during February, with completion now expected by the end of April.

� Supported Transfer of Detained Patients The preferred option has been discussed and approved by the CHP Core management team and by the Programme Board on 15th March. Details of the preferred option have now been circulated to GPs and other stakeholders for information and comment prior to introduction. Nurse staffing at Argyll & Bute Hospital will be increased to take account of the increased requirement for staff up to 10pm to provide this service. Discussion with union representatives will also be taking place as the required availability of staff to cover this service is slightly different from current shift patterns.

� Place of Safety Review The full report with recommendations was presented to the Programme Board on 15th March, and all of the recommendations accepted.

� “A Vision for Mental Health Service in Argyll & But e” – Workshop on 29 th April As previously reported there will be an all day workshop on 29th April in the Argyll Hotel in Inveraray where the revised MH Vision statement and a variety of related topics will be discussed. The event is open to NHS, Social Work and 3rd sector staff as well as service users and carers. The draft programme is appended to this report. Anyone interested in attending should email Fiona Broderick to book a place ([email protected]).

3. Summary The new hospital floor plan has now been agreed and work on the detail of the design is underway. It has taken us longer than expected to reach this stage, due to a variety of complications associated with the selected site. However, the project team are now hopeful that those issues have been addressed as part of the design selection process and that rapid progress will now be made towards approval of the OBC at NHS Highland and Scottish Government level. Upgrade works at A&B Hospital are progressing well; and work on the new community team bases in Campbeltown and Dunoon are well under way. It is expected that the NHS teams in Kintyre and Dunoon will be in their new bases along with Social Work colleagues during May 2013. Work has started to implement the new Patient Transfer Service, but it will be at least 3 months before it will be operational due to the need to recruit additional staff to cover the new 1000 – 2200 shifts. John Dreghorn Programme Director – Mental Health Modernisation


Draft programme

Mental Health Services in Argyll & Bute “The Vision”

A workshop to review the service vision statement

and refocus our service modernisation plans

Monday 29 th April 2013, Argyll Hotel, Inveraray

Programme • Registration & Coffee 0930 – 1000 • Welcome and Opening Remarks 1000 - 1015

Derek Leslie - Director of Operations, Argyll & Bute CHP • Revised Vision Statement 1015 – 1030

Dr Grace Fergusson – Clinical Director (Mental Health)

• Workshop 1 “The Vision” 1030 – 1100

Comfort break 1100 – 1110 • Recovery in mental health – 1110 – 1200

Louise Christie – Policy & Development Officer, Scottish Recovery Network • Tigh Dhilas – Recovery in action in Oban 1200 – 1215

Mark Henderson, Mental health Occupational Therapist

• The Recovery Experience 1215 – 1230 Audrey Forrest - WRAP Facilitator

Lunch 1230 – 1300 • Mindfulness 1300 – 1345

Dr Alastair Wilson, Glasgow

• CORE net 1345 - 1400 Sara Heath, Mental Health Physiotherapist

• Project Update: How close are we to the vision? 1400 - 1415 John Dreghorn, Programme Director (Mental Health Modernisation)

• What next for mental health in Argyll & Bute? 14 15 - 1445

Gillian Davies, Community Mental Health Nurse (Workshop/Discussion) Comfort Break 1445 – 1500 • Scottish Patient Safety Programme 1500 – 1515

Theresa Sinclair, Senior Staff Nurse, Argyll & Bute Hospital • Closing Remarks 1515 - 1530

David Wright, Acumen Manager


Item 14.1

eHealth Department Aros Lochgilphead Argyll PA31 8LB

Minute of Meeting of the Argyll & Bute CHP eHealth Group

6 February 2013 JO5/JO7

J05/J07, MACHICC, Lochgilphead & Talisman Room, Helensburgh

Present: Pat Tyrrell, Chair John Dreghorn, Implementation Director, Mental Health Redesign Dr Michael Hall, Clinical Director George Morrison, Head of Finance, (via VC) Kathleen Young, Medical Records Officer Kristin Gillies, Planning Manager Ken Barr, Patient Representative, Dunoon Robin Wright, GG&C Representative (via VC) Mary Wilson, AHP Lead (via VC) Bill Reid, Head of eHealth, NHS Highland James Brass, interim eHealth Manager Stephen Morrow, IT Development Manager Bill Staley, Information and Projects Manager In Attendance: Lhara Stevenson, PA (via VC) Item 1 Apologies Apologies were noted from the following: Derek Leslie, Director of Operations

Dr John Lyon, Locality Clinical Director Dr Richard Sloan, MAKI Locality Representative

Dr Grace Ferguson, Clinical Director/Consultant Psychiatrist Elizabeth Reilly, Community Dental Services Dr Brian McLachlan, Locality Clinical Director Katrina Duncan ICT Project & Liaison Manager Item 2 Minute of Previous Meeting The minute of 7 November 2012 was accepted as a true record of the meeting, with the following changes to be made: - spelling correction page 4, Item 7, change highland to Highland, PMS working group to be PMS focus group and again on page 5, page 6 Item 10 change Intranet to Internet. Item 3 Matters Arising

• Review of eHealth Group Remit & Membership: James to present document to the Core Management Team.

• Elmmediate Discharge Letter: James in discussions Iain Ross on how to progress iSoft in Argyll & Bute.

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• Use of Internet: James to present paper to the Core Management Team. Item 4 Activity Highlights/Management Report 4.1. eHealth Activity and Strategy Implementation Update James Brass/Stephen Morrow/Bill Staley spoke to the paper.

• OneSign/Single Sign On: configuring devices at Lochgilphead & Oban. • Migration to NHS Highland NHS Mail: continuing to progress may require the help of

another contractor. • Telehealth: equipment ordered, broadband going into junior doctors’ residence. ITTS –

no recurrent funding available. • Mobile Device Encryption: 1 practice to be completed. • elmmediate Discharge Letter: working with GG&C and North Highland colleagues to

establish a link for route of delivery of Glasgow GPs. • Infection Control: ICNet to provide us with the cost details of an interface for GG&C and

Highland. James to arrange a teleconference with Tom Walsh and Janet Boyd for ICNET discussions.

• 18 Week RTT/TTG: ATOS to update extract procedures. Highland is the Helix host health board, progressing, solution by end of June. Marion Willet progressing work on informing patients of legislation re wait times via letter.

• Telecoms SLA Review: Moving from C&W to BT. GG&C driving this work forward. Issues with space for kit at Oban, Islay & Lochgilphead. Migration expected end May. Waiting costs for migration. Some members of the group expressed concerns should numbers change as this may affect the PAS system. James will keep the group abreast of the situation.

• Lab Links: 12 additional practices receiving blood results. Bowmore & Easdale next. • Community Nursing: Implementation Champion Post identified. Engaged the services of

Allan Jenkins. Mary requested MSK work fast tracked on the system, specifically Podiatry & Physio. Allan Jenkins will have to advise if this is possible.

• Mobile Phones/Telecomms: Moving from Vodaphone to EE. Designated sites will hold sessions to distribute replacement SIM cards. Migration planned for March 2013.

Item 5 Finance Report eHealth funding update James Brass spoke to the paper. He spoke through his paper and in particular highlighted that in January a further £608k of funding was released to eHealth. The majority of these funds will be spent on IT A&B wireless networking. As this work requires to be carried out this financial year we need to engage the help of a contractor. Other areas of spend from this funding is; IT network switches, IT UPS power supply, IT firewall upgrade, IT A&B virus detection. 2013/2014 Capital funding will be minimal. 2013/2014 eHealth National Strategy Funding Plan focuses on PMS, MiDIS rollout and Microsoft EA.

The group approved the spending planning.

James Brass to present the eHealth Group Remit & Membership and the Use of Internet papers to the

Core Management Team.

James Brass to arrange a teleconference with Janet Boyd and Tom Walsh for ICNET discussions.

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Item 6 TrakCare implantation Update Current position: Bill Reid informed the group the Business Case and funding has been approved. Implementation is planned for 2013. Currently recruiting for a project team on a fixed term basis. A Clinical focus group has been set up. LEAN process will be applied to TrakCare. NHSH are in discussions with GG&C re interface for clinicians. Presentations are planned for various sites. Bill Staley has the schedule for the presentation dates. (See end of Minutes) James then spoke to the paper. He highlighted that A&B would not be included on the GG&C TrakCare. Intersystems said this would require significant re-engineering of the Scottish Foundation TrakCare product. James attended a meeting with Intersystems to further discuss HealthShare as an option and this has now been discounted as it does not meet the particular requirements for the A&B CHP. The only remaining option is to focus on establishing the most straightforward means for provision of NHSH TrakCare instance to appropriate clinicians in NHS GG&C. Robin Wright stated GG&C are committed to working with A&B to ensure the flow of information on clinical portals is as straightforward as possible. However GG&C have concerns around reconfiguration of their systems out with their boundaries. Robin noted that there will be significant resources required to get the interface between GG&C & NHSH working. Kristin raised the question of timescale but no detailed Project Plan has been drawn up yet, however Planning will be kept updated on timescales once known. Bill Reid said there is a PAN Highland Strategy Group and they would feed back to the eHealth Group the implementation stages. Dr Mike Hall noted that he felt that the best solution for the CHP was that it should take a solution from GG&C this view was supported by a number of the attendees. Provision of Information Services: Bill Staley spoke to the paper. The purpose of the paper is to paint a picture of how I.S. services will be affected by the implementation of TrakCare. Current I.S. procedures will have to be amended once TrakCare is implemented. During implementation he foresees disruption to some of the services I.S. currently offers mainly to Ad-Hoc information requests. Robin reported that he had knowledge of this to be true from some of the boards that have already implemented TrakCare. He suggested Bill contacts Stuart Hatrick and Jonathan Todd (NHS Lanarkshire) to discuss how they dealt with issues during their implementation. Item 7 Accident & Emergency System update Bill spoke to the paper. He noted the historical and strategic context underpinning the present position regarding an electronic information system to capture A&E activity across the CHP’s Minor Injury Units (MIU). The meeting accepted the recommendations and asked Bill to expedite the evaluation process and to report back to the May eHelath Group. Item 8 Argyll and Bute Council Update Noted that in Katrina’s absence there was no update from A&B Council. However James reported on the close working with Council colleagues to arrive at a more permanent and robust network interconnection between NHS and the Council. He noted that North Highland have been working with Highland Council on similar network interconnects and is in discussion on this topic. Pat T asked whether this work would overcome the current issue regarding access to the Intranet for Health staff working in Council premises, e.g. Union Street, Rothesay and Islay. James

Bill Staley to report back to the May eHealth Group Meeting

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replied that it should improve both reliability and performance. Bill R noted the extensive and ‘interesting’ project of integrating a large number of former Highland Council employees into NHS Highland. He noted the issues and challenges that had been addressed particularly around data sharing. He volunteered to present a short presentation at the May meeting. Ken B noted that it is his understanding the Argyll & Bute Council is not anticipating to replicate Highland Council in terms of staff transfers. Pat T noted that there seems to be some success achieved by the use of the Pyramid reporting system throughout the Council area. Bill R noted that this success has not been replicated in Highland Council area. Item 9 GG&C SLA Update The meeting re-iterated its thanks to Robin Wright for attending the meeting and hoped this would become a regular occurrence. Robin noted that his attendance at future meetings would be expedited through the use of VC. Robin repeated his support of the NHS Highland TrakCare implementation by committing to work with the project to deliver those information interfaces as are indentified. He further noted that whilst Janet Boyd is the Customer Services Manage for the eHelath SLA he is the point of contact should Janet not be available. Item 10 Papers for noting The group noted the provision of this updated document. Pat T confirmed that she has a dual role both as Chair but also the Nursing Representative. However if a suitable candidate is found she would relinquish the latter role whilst occupying the Chair’s role. Robin noted that his role is as an attendee and to have no voting rights. It was agreed that John D fulfils both the Mental Health Rep role, deputising for Grace, and a temporary role representing the Mental Health Redesign Project. It was suggested that he also act as the Locality Manager’s representative. Item 11 Any Other Competent Business Access to GP Systems by Community Nursing Staff: Pat T asked if anything could be done to allow comprehensive access to GP Practice systems by community nursing staff. James B noted that there is no technical impediment but noted that in the main Practices are Data Controllers in their own right and as such is the arbiter of allowing access to their systems. Bill R noted that NHS Highland had constituted a short-life working group to look at the issues. Its conclusion was that the decision rested with individual Practices. However it need to be defined at what level data needs to be made available to nursing staff and for what purposes. Bill S noted that the MiDIS Project was designed to facilitate community nursing staff ability to record clinical data and as such was expecting that these staff were NOT entering data into GP Practice systems. He further noted that the standard SCIGW referral protocol contains Alert, Conditions and medication information. Mike H noted that the maxim for system access should be on a ‘need to know’ basis. The sensitivity of Practices around data held in their system is known and

Bill R to provide presentation on NHS Highland/Highland Council integration experience

Lhara to arrange VC facilities to facilitate Robin’s future attendance at the eHealth Group.

John D to discuss with Veronica assuming the Locality Manager’s Representative role on the eHealth

Group.

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understood. Pat T made a plea to allow the best possible patient care. Mike H commented that must be a common sense approach. John D agreed with Pat that the wider MDT members should have access to a community single patient record. Bill R noted that this debate is rumbling along in North Highland and probably will never be wholly agreed on. Although he noted that Practice systems do have a Caseload Manager but to implement and manage these could become an ‘industry’ in its own right. Kathleen Y noted that audit trails should be able to indicate which system users access which systems if inappropriate system use was suspected. 13. Date and Venue of Next Meeting: 1st May 2013: 10:30-13:00 hrs, JO5/JO7 MACHICC & Talisman Room, Helensburgh Please find below dates supplied by Bill Staley for TrakCare Communication Sessions with Hazel MacPhail. 11th February 13:00-17:00 hrs 11th March 10:00-15:00 hrs 10th April 10:00-15:00 hrs 13th May 09:00-14:00 hrs 10th June 10:00-15:00 hrs 16th July 10:00-15:00 hrs 12th August 10:00-15:00 hrs 16th September 10:00-15:00 hrs 14th October 10:00-15:00 hrs Room J05/J07 has been booked for the above sessions.

ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 24 April ... · 4/24/2013 · ARGYLL & BUTE CHP...

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