ARGYLL & BUTE CHP COMMITTEE MEETING …...ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 19 February 2014 Rooms J03-J07 Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead

ARGYLL & BUTE CHP COMMITTEE MEETING

Wednesday 19 February 2014

Rooms J03-J07 Mid Argyll Community Hospital & Integrated Care Cen tre,

Lochgilphead

12.30pm – Lunch

1pm – Committee Meeting

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

3. Conflicts of Interest Robin Creelman

4. Minutes from Previous Meeting Robin Creelman 4.1 Minutes of 18 December 2013 (attached) 5. Matters Arising 6. NHS Highland Organisational Issues

6.1 NHS Highland Board Meeting 4-2-14 (verbal) Robin Creelman 6.2 Director of Operations Report (to follow) Derek Leslie

7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 8. Financial Governance 8.1 Finance Report (attached) George Morrison 8.2 Revenue Budget Report (attached) George Morrison

10.30am - 12.30pm – Committee Members Development Session

• Health Aspects of the Single Outcome Agreement – Alison McGrory, Health Improvement Principal

• Health and Safety Improvement Plan – Fiona Campbell, Clinical Governance

3.30pm : Public Session

9. Staff Governance 9.1 PDP/R and eKSF Implementation (attached) Derek Leslie 9.2 Minute of Partnership Forum Meeting of 14-11-13 (attached) Derek Leslie

10. Partnership Working 10.1 Marie Curie Delivery Choice – Brief & Programme Plan (attached) Pat Tyrrell 10.2 Public Partnership Forum – Localities Update (verbal) Duncan Martin 10.3 Joint Performance Report – December 2013 (attached) Derek Leslie 11. Performance Management

11.1 Delayed Discharge Quarterly Census (attached) Derek Leslie

12. Mental Health Modernisation Update (attached) John Dreghorn 13. Noting 13.1 Mental Health Newsletter (attached) 14. AOCB*

15. Date of Next Meeting Wednesday 23 April 2014 at 1pm, The Pavilion, Rothesay

* to be notified to Chairman in advance of meeting

The Committee meeting will be followed by:

Argyll & Bute CHP Committee 19 February 2014

Item : 4.1

DRAFT MINUTE OF MEETING OF THE

ARGYLL & BUTE CHP COMMITTEE

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

RSR Braeholm, Helensburgh

18 December 2013 – 1.00 pm

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 Mr Duncan Martin, Chairman, Public Partnership Forum Ms Elaine Wilkinson, Non-Executive Member

In Attendance Apologies

Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Ms Christina West, Locality Manager, Mid Argyll, Kintyre & Islay Councillor John McAlpine, Argyll & Bute Council Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Councillor Elaine Robertson, Argyll & Bute Council Representative Councillor George Freeman, Argyll & Bute Council Representative Ms Glenn Heritage, CVO Representative Mr Jim Robb, Head of Service, Adult Care, Argyll & Bute Council Mr Michael Roberts, Vice Chair, Public Partnership Forum Ms Dawn Gillies, Staffside Representative Ms Elizabeth McMillan, Staffside Representative Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP

1. CHAIRMAN’S WELCOME The Chairman opened the meeting by welcoming everyone to the RSR Braeholm, Helensburgh. 2. APOLOGIES Apologies for absence were noted as above. 3. CONFLICTS OF INTEREST There were no conflicts of interested noted.

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4. MINUTE FROM PREVIOUS MEETING 4.1 Minute of Meeting held on 23 October 2013 The Minute of the meeting on 23 October 2013 was accepted as an accurate record of the meeting. The Committee: • Approved the content of the Minute. 5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 23 October 2013 Opiate Substitute Prescribing – Mr Leslie advised that 1 nurse prescriber is now available to prescribe in the Kintyre community. Health Care in the Ross of Mull & Iona – Mr Leslie reported that the GP has now withdrawn his resignation. A meeting between relevant stakeholders and the public is being arranged to take place in January 2014 to address concerns originally attributed to the resignation and to ensure a continued sustainable GP service to the population. 6. NHS Highland Organisational Issues 6.1 Highland NHS Board Briefing 3 December 2013 Reference was made to the comments in the Briefing relating to the financial position within Argyll & Bute CHP. Mr Morrison reaffirmed that the current underspend position has been achieved by not applying the additional uplift to the SLA payment to NHS Greater Glasgow & Clyde of £1m and applying restrictions in the CHP to non-essential expenditure. The Committee noted there is no expectation that the CHP’s £1m contribution to address this year’s potential deficit in the NHS Highland Board position will be recurring and that there are no ongoing discussions regarding this. The Committee: • Noted the content of the NHS Board Briefing. 6.2 Director of Operations Report Mr Leslie referred to the circulated report and highlighted: Staff Flu Vaccine Uptake - the latest report has indicated an uptake of 44% of the staff flu vaccine this year. This is to the credit of the Flu Champions who have managed to encourage such a good uptake – this is 7% higher than last year and is now not too far off the 50% target. A final reminder will be sent out to staff within the next week for anybody who will reconsider if they have not yet received the vaccine.

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Integrated Equipment Store Redesign - commencing in 2011 a 12 month review of the Integrated Equipment Service was undertaken. This identified that the existing HUB and SPOKE model had significant shortfalls in providing a safe, sustainable value for money service. Throughout 2012/13 various options were considered culminating in a service redesign paper. The paper concluded that a single store based in Helensburgh, distributing to all localities was the most appropriate way forward. This paper was approved and the redesign moved to an implementation stage with the development of a plan to take this forward The Integrated Equipment Service Redesign Implementation Plan was approved to progress during the summer of 2013. Within the plan there are some 49 actions split into two distinct areas of work, namely operational and property. Work is progressing in parallel in both areas. Operational actions primarily focus on a move towards a more technically focused department operating from a single base, this has resulted in a full review and rewriting of job descriptions. Transition from existing to future service is ongoing Property actions are progressing with a view to purchase of the Lomond Street, Helensburgh store within the current financial year and adaptation to suit the new service early in financial year 2014 -2015. With implementation of the operational aspects and completion of the new facility it is intended that the new service will be operational by late summer 2014. Cowal Out of Hours - the out of hours non-emergency for Cowal is close to being implemented. One Doctor has been appointed at Dunoon Hospital, with another due to start early in 2014. There is also a Rural Fellow in place, a qualified doctor who wishes to expand his experience with work in a more rural environment. Negotiations are currently taking place with the British Medical Association to reach an agreement about employing Cowal’s rural doctors to cover evenings and weekends on a permanent basis. Cowal Community Mental Health Team – Change of Base - the Community Mental Health Team in Cowal has expanded greatly and outgrew their existing base in Dochas Lodge. The have now moved to bigger and more accessible premises within Cowal Community Hospital. Some issues have been raised by members of the public about the access to the services being through the main hospital entrance or via the ambulance station roadway at the side of the hospital. Public re-engagement will take place to address the concerns raised. Oban Dental Centre - the Dental Access Centre is now open and the new leaseholders are due to move by January 2014. Two Open Days were successfully held recently. Lorn & Islands Hospital - Surgical Services - a third Consultant Surgeon has recently been appointed. The current long term locum will remain in post until early 2014. Lorn & Islands Hospital - Physician Post - long term locum cover continues. The post was recently re-advertised but unfortunately the candidate due to be interviewed on 18 November

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2013 withdrew his application. A meeting is being arranged for January 2014 to look at options/models. Campbeltown Dental Access Centre - is now fully operational in the new facilities. The community mental health and addictions teams have now moved into the recently renovated area of Campbeltown Community Hospital which has been named Ionad nan Eilean. Mid Argyll - the refurbishment programme to provide a day treatment unit and relatives room within MACHICC have been completed and an official opening took place on 9 December, attended by Mike Russell, local MSP. Working in partnership with MacMillan Cancer this refurbishment will enhance the environment for patients by providing a dedicated treatment space for three patients. A relatives’ area has also been developed within the hospital, providing an area of privacy and relaxation for families to stay when relatives are receiving end of life care in the hospital. Patient Management System (PMS) Implementation Update - the NHS Highland PMS is due to ‘go live’ on 3 March 2014. Work is progressing well and significant progress continues to be achieved to date. Extensive data migration work is taking place to merge the patient data from the existing Patient Administration Systems (PAS) into the new and unified PMS. “Super users” have been identified who will be available on an ongoing basis to offer advice once training is complete. Work is continuing to rigorously test all data that will be transferred from the two existing PAS. This testing will continue in phases until February 2014. The creation of standardised business process maps and corresponding training procedural instructions for all the administrative processes that will be undertaken by PMS users is almost complete. Once signed off, these will be located in a specific section of the Intranet so that all relevant staff can have full access. This will also ensure that staff use the correct and current NHS Highland agreed procedures. Comprehensive training packages are being created which will be used to train all of our staff. Training will be delivered during January and February 2014 using an innovative blend of physical training courses and training via WebEx facilities. Significant work is continuing to ensure that all the technical components required by the system are in place. Staff will be provided with training prior to ‘go live’ and it is important that staff attend these sessions. To supplement the training the PMS Programme is arranging for additional resources to be available. The training calendars will be on the intranet for staff to book into during December 2013. Regular presentations on the progress being made in relation to implementation of the programme are delivered on a monthly basis at the following locations, Inverness, Wick, Fort William, Lochgilphead

The Committee: • Noted the content of Director of Operations Report.

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7. Clinical Governance 7.1 Clinical Governance & Risk Management Rep ort Ms Tyrrell spoke to the circulated paper. Risk Management Incidents A total of 523 incidents were reported at end September 2013. Cowal & Bute – 85 (16.2%) Helensburgh – 12 (2.3%) Mid Argyll & Kintyre – 253 (48.4%) Oban, Lorn & Isles – 162 (31.0%) Outwith NHS Highland – 11 (2.1%)

Locality breakdown: Cowal & Bute – transfer / discharge (20) Helensburgh – medication (2), communication / confidentiality (2) Mid Argyll & Kintyre – falls (56) Oban, Lorn & Isles – falls (47) Outwith Highland – pressure ulcers (6) The reported incidents were graded as: Low - 284 (54.3%), Medium – 199 (38.0%), High - 4 (0.8%) The figure reported for Mid Argyll, Kintyre & Islay reflects the number of hospitals within that locality. A total of 6 incidents were reviewed by a manager and identified as major or extreme. Cowal & Bute – infection control (2), treatment/procedure (1) Mid Argyll, Kintyre & Islay – clinical assessment (1), fall (1), transfer/discharge (1) Following a further review 3 of the above incidents were subsequently downgraded. 2 of the 3 remaining incidents were subject to a Serious Event Review (SER). There were no RIDDOR reportable incidents since April 2013. Falls - it was noted that falls remain the highest category of incidents this quarter. Ms Tyrrell advised that although the overall reported rate for Argyll & Bute is higher than that for NHS Highland as a whole, it is thought that this may be due to a higher number of older people being at risk of falling within a community hospital setting. Falls prevention has been indentified as one of the key priorities for Scottish Patient Safety Programme. Implementation of the Falls Care Bundle is being tested in Lorn and Islands Hospital. In addition they will trial the new process where all incidents related to falls will be flagged through Datix to the physiotherapy team who will work with the nursing teams to ensure that all appropriate preventive actions are being taken to reduce risks for individual patients. Violence, Aggressive and Disruptive Behaviour - the second highest category of reported incidents relates to violence and aggressive behaviour. Overall the incidents by hospital for Argyll and Bute reflect greater number of reports from the Argyll and Bute and Mid Argyll Hospitals, both of which provide care for people with mental distress/illness and/or dementia. For the last quarter there was also an increased number of incidents reported from Lorn and Islands Hospital and these are currently being further investigated.

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Pressure Ulcers - the third highest category of reported incidents relates to pressure ulcers. The sustained reduction in Grades 3 and 4 pressure ulcers across all hospitals is very positive in improving outcomes for patients. This has been achieved primarily from the implementation of the evidence based SSKIN bundle. As with falls prevention, pressure ulcer prevention has also been indentified as a key priority for the Scottish Patient Safety programme. Significant Event Reviews - five SERs were declared relating to incidents which occurred in Quarter 2 in Argyll and Bute. Categories of incidents :

• Lack of clinical/risk assessments (highlighted as a result of a complaint) - 1 • Transfer delay of infant awaiting air transfer - 1 • Review of assessment and treatment of baby at A&E – 1 • Transfer delay/ communication issues - 1 • Disruptive and violent incident in the community – 1

To date no incidents have been declared as SERs within Quarter 3. CHP Risk Register - Ms Tyrrell referred to the appendix which detailed the top eleven risks that Argyll and Bute CHP is currently managing. The compilation of the list was through a robust and aggregated approach by the CHP Core Management Team. The risks identified will be managed by CHP Managers and monitored through the Core Management Team. The action plans in place will be monitored for relevant grading, i.e. infection control and will be reported through the Clinical Governance and Risk Management Group. Complaints Of the 22 complaints received during August to September, the themes can be broadly categorised as follows : - care/ treatment 9 - dental services; access/waiting times/treatment 6 - communication 3 - transfer 1 - wheelchair access 1 - attitude 1 - delay in referral 1 As previously reported, a rigorous process is applied in to ensure the complainant received a comprehensive response which address all the points and concerns raised. Ms Tyrrell agreed to include in the next report to the Committee, details of the criteria applied for risk rating a complaint. Standards Older People in Hospital Care - reports from the multi disciplinary site visits which were undertaken to each of the Argyll and Bute Hospitals in May/June 2013 have been compiled for each hospital. There were a number of common themes across the hospitals in both the strengths and the areas for improvement.

The areas for improvement will be included within the overall Older People in Acute Hospitals workplan; each hospital also has its own action plan for which the Clinical Services Manager is responsible.

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The programme for further site visits is being finalised with multi disciplinary visits planned for each hospital in January/February 2014, which are designed to support the improvement work across Argyll and Bute and to enable sharing of best practice. In November 2013 NHS Highland received the published report of the HEI inspection of Standards for Older People in Hospital at Raigmore Hospital which took place in September 2013. This is the first such inspection that has taken place in NHS Highland and a number of important learning points have been reviewed by the Argyll and Bute Quality Care in Hospital Group to ensure that appropriate actions are taken to address issues which pertain locally. Obstetric Ultrasonography - following two incidents related to antenatal scanning in Argyll and Bute, the local services were reviewed by NHS Greater Glasgow and Clyde and the findings reported through NHS Highland Maternity Services Strategy Group. Following further consultation with NHS Greater Glasgow and Clyde it has been considered that there is potential clinical risk to women and babies in continuing with the current service which is non compliant with national guidelines. The decision was made that all antenatal scanning carried out locally should be stopped until the CHP can ensure that staff (midwives/radiographers) have been trained as obstetric ultrasonographers and meet the national standards. Argyll and Bute CHP is committed to developing this local service and is currently planning how this can be effected at as early a stage as possible. Short term and longer term training options are being considered, together with the supervision requirements for each option, and the outcome will be presented to the CHP Management Team to agree. In the meantime all women will be offered scans in line with national programme of antenatal screening and these will be carried out in NHS Greater Glasgow and Clyde. The changes in scanning have been explained to each woman at the time of booking in early pregnancy; midwives are measuring the impact and consequences of these changes. Quality and Safety Clinical Quality Indicators (CQIs) - the latest results for the standards CQIs for Pressure Ulcers, Falls & Food, Fluids & Nutritional Care show the overall compliance set out for each of these indicators is very good. From March 2014 the CHP will initiate external audit to quality assure the self evaluation processes that are in place. Maternity and Child Quality Improvement Collaborative - Karen McAlpine, midwife in Mid Argyll, is leading the work within Argyll and Bute to improve maternal and child outcomes – this is at very early stage. The initial focus is on reducing the incidence of smoking in pregnancy, with the first tests related to offering all women carbon monoxide monitoring in pregnancy. Primary Care SPSP - the NHS Highland SPSP Primary Care GP Steering Group has been established. Membership from Argyll and Bute includes Dr John Lyon, Clinical Lead and Joyce Robinson, Primary Care Manager. The Steering group has proposed the introduction of a Medicines Reconciliation Enhanced Service and a Warfarin Care Bundles Enhanced Services across NHS Highland GP Practices from 1 April 2014. The service specifications for both are currently being developed and will be agreed with NHS Highland GP Sub Committee. Argyll and Bute CHP held two Learning Events in November for SPSP-PC, focussing on Warfarin Care Bundles and Trigger Tool Reviews. All 33 GP Practices in Argyll and Bute CHP were represented at the events by at least one GP.

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Mental Health SPSP - an event was held in Inverness on 16th November for rolling out of Phase 2 for Mental Health - attended by cohort of 8 people from Mental Health in Argyll and Bute. Argyll and Bute will focus on the Patient Climate Tool which will allow feedback about how patients find the ward culture within Argyll and Bute Hospital. Acumen will help to implement this to ensure objectivity. In early 2014 the focus will be on physical health checks and medicines reconciliation will come on stream in the spring when the new pharmacist is in post. Health and Safety CoSHH Audits - Health and Safety Managers have completed nine CoSHH audits across A&B CHP. The audit findings are currently being analysed along with the audit findings from all NHSH Operational Units. The preliminary findings in Argyll and Bute were mainly positive. There were a number of excellent completed CoSHH folders, with a high degree of compliance with the new NHSH CoSHH policy. NHSH findings will be reported at the Health and Safety Committee meeting in February 2014. Health and Safety Improvement Plan - the NHS Highland Health and Safety Committee has endorsed the revised Health and Safety Improvement Programme 2014-2016. This sets out our priorities for Health and Safety over the next 2 years in the form of Corporate and Operational Unit Improvement Plans. The programme has a number of themes including; risk assessment, system improvement, competence building, improved access to training, and improved monitoring and reporting. The programme is split into two improvement plans, a Corporate Improvement Plan and an Operational Improvement Plan. The Improvement Plan has been discussed at a number of Argyll and Bute CHP key meetings and at each of the locality/sub-locality CGRM Groups in order to plan, implement and monitor progress against each area of the Plan. The Committee agreed that the Improvement Plan should be a discussion topic at Development Session in early 2014. Fire Safety Fire Risk Assessments - fire risk assessments have been carried out by the CHP Risk Advisor, Fire Safety, using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay, Lorn & Islands, Dunoon, Rothesay, Mid Argyll and Mull and Iona Community Hospital are now complete and have been issued. Action plans are being prioritised locally. Assessment of Victoria Integrated Care Centre, Helensburgh is under way. Some premises are now due an annual audit. Compartmentation Survey - part of the capital funding request has been released to start some of the much needed compartmentation works. Partial funding for Lorn & Islands and Cowal Community hospitals has been made available. Work will be prioritised in line with the recent Scottish Fire and Rescue Service audit letters. The Committee: • Noted the content of the Clinical Governance & Risk Management Report.

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7.2 Infection Control Report Ms Tyrrell spoke to the circulated report which updated CHP Committee members on the current status of Healthcare Associated Infections (HAI) and infection control measures in Argyll and Bute CHP and NHS Highland. Staphylococcus Aureus Bacterim (SAB) - there has been one case of SAB in Lorn and Islands Hospital since the last report and enhanced surveillance is being carried out on this case. HAI Quality Improvement Facilitator (HAI QIF) posts - the recruitment process for NHS Highland HAI Quality Improvement Facilitator (HAI QIF) posts is underway and it is hoped to have 2 Facilitators in post early in 2014. Clostridium Difficile Infection (CDI) - there have been no new cases of CDI in Argyll and Bute since the last report in October 2013.

The point prevalence study of antimicrobial prescribing practice took place across each hospital in September to identify the level of compliance with the guidance. The final reports have been compiled by the Lead Antimicrobial Pharmacists for NHS Highland; the findings will inform further work to improve the knowledge and practice of all prescribers across Argyll and Bute. A common theme is an issue in documenting decisions around antibiotic therapy choices. Variation from guidelines is expected if patient needs or the complexity of illness warrant alternative treatment but this can only be assessed during the audit if details are recorded in the medical record. The use of an antibiotic sticker has been promoted to all groups to improve documentation.

Antibiotic prescribing data continues to be reviewed in conjunction with the Antimicrobial Pharmacist, Unit/Hospital Pharmacist and NHS Highland Antimicrobial Management Group. Work is ongoing with GPs to further reduce antimicrobial prescribing and the use of proton pump inhibitors (PPIs).

The Infection Prevention & Control Teams continue to maintain accurate real time surveillance of all CDI cases in all areas in consultation with Infection Control Doctor.

The weekly and monthly surveillance reports for CDI and SAB are undergoing a complete review with the aim of improving the quality and usefulness and to consider how to report in a way that shows demonstrable improvement. A CDI and SAB Action Group has been established, chaired by the Microbiology Consultant lead for Infection Control. The focus of this group will be to drive forward the work streams which will enable the Board to deliver against very challenging SAB and CDI. Hand Hygiene Reporting - NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining 99% compliance in September and 98% in October 2013. All areas in Argyll and Bute continue to demonstrate compliance with the standards. Cleaning & the Healthcare Environment - at end October 2013 Argyll & Bute reported compliance rates of 96.7% for cleaning and 96.9% for Estates.

Outbreaks/Incidents - there have been no outbreaks or incidents in Argyll and Bute since the last report.

Standards for Healthcare Associated Infections - Healthcare Environment Inspectors recently made unannounced visits to Belford Hospital and Caithness Hospital. The requirements and recommendations from the reports for both hospitals are being used by Argyll & Bute locality and clinical services managers to inform improvement which is ongoing in each site to

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implement and maintain the standards to prevent HAI, with the focus currently being on maternity services.

The Committee:

• Noted the content of the Infection Control Report.

7.3 Health Improvement – Summary of Director of P ublic Health Annual Report Ms Garman referred to the circulated paper which focused on emergency planning arrangements within the CHP. Argyll and Bute CHP has major incident and service continuity plans for the rural general hospital and each of the community hospitals, the Argyll & Bute Hospital (service continuity plan only) and any primary care premises owned by the CHP. MACCHIC’s service continuity plan is provided by the contractors for the building. An Incident Management Plan is in place for each of the four localities and these are in the process of being ratified by the CHP Emergency Panning and Business Continuity Group (EPBCG). GP practices are encouraged to have business continuity plans there has been liaison with NHS GGC to ascertain that they too have business continuity plans for the services that the CHP can use. There continues to be good progress in emergency and business continuity planning. Plans are in place and are being exercised by table top exercises, live scenarios and real incidents. Focus is currently on the business continuity plans and response to the audit. 10 GPs have recently been recruited to provide the function of Medical Incident Officer (MIO) in the case of a major incident. As there is not an even spread of MIOs across the CHP there may still be a reliance on the Emergency Medical Retrieval Service (EMRS) to provide this function. The two recent severe weather incidents and one road traffic incident, which was declared a major incident, have shown that the CHP’s plans have been robust although there has always been learning to be incorporated into revised plans or training. The latest weather incident showed the learned importance of up to date lists of vulnerable patients in the community and the need for training and induction on this issue have been emphasised, with additional managerial support as required to ensure an adequate response. The weather incident in March also highlighted the need for critical buildings in the community to have back up generators – specifically care homes and GP practices (where we have ownership). The latter has been put on our risk register. The issue of care homes will be discussed through the commissioning process. Independent providers should have alternative sources of power within their facilities in the event of a power outage to ensure the care of vulnerable people. Councillor MacAlpine expressed concern about GP practices being without generators and the implications and effect on communities during power outages. Ms Garman reaffirmed that this is not solely the responsibility of the CHP, which does not have ownership of many of the GP practices premises. Practices are encouraged to consider the availability of generators as part of their business continuity plans. Ms Garman stated that there is a need to progress identifying a community hub to facilitate a joint community response during severe incidents and this is being taken forward during community planning discussions. The availability of generators will be taken forward as part of this work, when it will also be necessary to take into account the recurring costs for maintenance and running costs. Training has been undertaken for key staff and loggist training for administrative staff that are essential to the record keeping aspects for both effective running of incidents as well as the

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contemporaneous notes that are required should incidents ever result in enquiries. A live exercise is being planned to be held in Oban during March.

An audit of business continuity processes within NHS Highland highlighted that not all core plans have been completed and there is insufficient connection between plans e.g. estates service continuity plans and locality business continuity plans. A specific concern was also raised about the need for IT disaster recovery plans and business continuity plans. The response to the audit will be monitored through the CHP EPBC Group.

The Committee: • Noted the content of the Health Improvement Report. 8. Financial Governance 8.1 Report Mr Morrison referred to the circulated paper and advised that NHS Highland is facing a significant challenge if it is to achieve a year-end financial break-even position. At the end of October, the Board was continuing to forecast achievement of this statutory target however this is contingent on management action to address a potential £9m deficit, of which £8.5m relates to north Highland and £0.5m relates to Argyll & Bute. To address this potential deficit, all parts of the organisation have been asked to respond by reducing expenditure over the remainder of the financial year. For Argyll & Bute, this means a revised year-end target of a £1.3m underspend to support the corporate position. It is expected that this will be achieved by two specific actions;

• a decision not to apply the additional £1m uplift in the SLA payment to NHS Greater Glasgow & Clyde.

• restrictions applied to non-essential expenditure within Argyll & Bute to generate a

further £300k in-year benefit. The first action has been dealt with in a letter to NHS Greater Glasgow & Clyde dated 2 December 2013. The second action is expected to be delivered by managers across Argyll & Bute CHP by their application of sensible spending controls without affecting the delivery of patient care services. To achieve this, managers have been directed to restrict spending and to avoid any discretionary spending that does not have an impact on patient care where it is possible, appropriate and safe to do so. Responding to an enquiry submitted by Councillor Robertson regarding NHS Greater Glasgow & Clyde’s reaction to the measures being taken by NHS Highland and the impact on the NHS GG&C budget, Mr Morrison advised that the decision has had no bearing on the discussions and relationship and there will be no financial implications for NHS GG&C. Argyll & Bute CHP – Month 8 Financial Position - for the eight months ended 30 November 2013, Argyll & Bute CHP recorded an underspend of £395,000, which is a substantial reduction of £816,000 on the overspend of £421,000 reported at the end of October and this relates mainly to two specific actions;

1. a decision not to apply the additional £1m uplift in the SLA payment to NHS Greater Glasgow & Clyde.

2. a negotiated reduction in charges from the Golden Jubilee National Hospital for

cardiac services.

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Details of budgetary performance across the CHP at month 8 were discussed, relating to the conflicting variances contributing to the CHP’s net underspend of £395,000 at the end of November 2013. There are a number of favourable variances, the most notable of which is the underspend of £678,000 on the NHS Greater Glasgow & Clyde services budget reflecting the decision not to apply the £1m uplift to the SLA payment. Partly offsetting this are a number of adverse variances (overspends) the details of which were noted. Analysis of Budget Overspends - Mr Morrison referred to a number of major issues detailed in the paper which are contributing to a significant budget overspend. Regular discussions take place with budget managers in areas of particular concern. Cost Improvement Programme Plan - to achieve a balanced revenue budget in 2013/14 and support a number of service developments, the CHP agreed to implement a £2.4m recurring savings plan. Achievement of the plan shows progress, with £900k still to be achieved. Particular reference was made to savings in public health, commissioned services and depreciation having been achieved. Savings in prescribing, the lead nurse’s budget and management & corporate services are likely to be achieved. However the savings targets for Localities looks challenging. The likely overall shortfall of £400k against the savings target is a contributing factor towards the need to take management action to achieve the expected year-end outturn. Forecast Outturn for 2013/14 - as a consequence of the Health Board’s overall financial position, Argyll & Bute CHP is now forecasting a year-end underspend of £1.3m, however this is dependent on management action to reduce spending in the final four months of the financial year to achieve this outturn. Mr Leslie emphasised that any containment and reviewing of expenditure by budget managers will have no effect to the delivery of patient services. Revenue Budget 2014/15 - planning for the 2014/15 revenue budget has commenced. The expected funding uplift of 2.76% is likely to be sufficient to cover pay awards and inflation however any service developments and other commitments will probably have to be met from savings. The details of the first draft of proposed commitments over and above pay awards and inflation were noted. Ms Wilkinson enquired about the financial consequences as a result of the proposed move to GP care of custodial and forensic medical services. Mr Morrison responded that the CHP is planning for the financial risk. However, to comply with HEI standards there is a need for environmental improvement in a number of locality custody suites, which will require capital investment by Police Scotland to enable the work identified to be undertaken.

Mr Leslie referred to an NHS Highland directive in relation to procurement. He has requested that budget managers ensure that all staff with requisition authority are clear about the rigour now being applied to all sources of discretionary supply requisitioning.

The Committee: • Noted the revised year-end position expected to be achieved by Argyll & Bute CHP. • Noted the requirement for management action to achieve the expected year-end outturn. • Noted the financial position at month 8. • Noted the content of the Finance Report and the need to review funding commitments for

2014/15.

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9. Staff Governance 9.1 PDP/R and eKSF Implementation The circulated report showed the current position of 1093 PDPs having been undertaken out of 1973 employees (56.4%) over the last 12 months. Since April 2013 369 staff (18.7%) have recorded a meeting on eKSF, however, there is currently a downward trend in the rolling 12 month figure and actions are being undertaken to address this. Mr Logue reported that in order to progress efforts in 2013/14 and improve the proportion of staff that have an annual review, there continues to be a focus on the following:

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

• ongoing work in each area to ensure that all bank staff have an identified manager, outline and review.

• continuing commitment by line managers to plan their staff PDPs into diaries over the next 3 months.

• ensuring and improving quality of reviews and evidence. A number of national support activities are also available on line. In order to obtain feedback around the experience of using e-KSF, and the benefits or challenges, a review is currently being undertaken by meeting with local management forums and by asking members of A&B CHP Partnership Forum to complete a short survey questionnaire. This feedback will then be used to identify any issues that need addressed, or to consider, when starting to use e:ESS in relation to e-KSF. The results of the survey will be included in the report to the Committee in February 2014. Mr Creelman raised concern around the rapid increase in trajectory towards the target date for completion and the benefits and outcome for staff within this period. He is also aware of some staff opinion that the eKSF software is ‘clunky’ and impacts on discussions with managers and staff. Mr Logue reported that the national contract for e-KSF is due to end in March 2014, with an option to extend this to March 2015 and it is anticipated that this option will be utilised. This will enable the KSF national leads to take forward a piece of work to identify how the KSF/PDP&R process will continue to be recorded electronically. This is likely to result in simplified processes and language used and adaptation to incorporate and link to e:ESS, the new electronic Employee Support System currently being implemented across all boards in Scotland. This includes a function for recording employees’ learning history. The Committee: • Noted the current position. • Noted the progress in embedding this in practice to support and direct staff development

in line with CHP and NHS Highland objectives. • Noted the need to ensure reviews and PDPs are planned for the next 4 months. • Noted the need to ensure bank staff have a review.

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10. Partnership Working 10.1 Joint Performance Report – October 2013 Mr Leslie referred the Committee to the circulated report which is delivered to the Health & Care Strategic Partnership by Pat Trehan, Project Officer Integration, Argyll & Bute Council. Mr Leslie asked the Committee to note the level of detail within the report which he said is to be commended. The Committee: • Noted the content of the circulated report. 10.2 Public Partnership Forum (PPF) Mr Creelman requested that Mr Martin provide an update on locality PPF’s to the next meeting. The Committee: • Noted an update will be given at the next meeting. 11. Performance Management 11.1 CHP Delivery Plan 2013/14 - Update Mr Leslie referred to the circulated updated delivery plan which is aligned with the Health Board’s Local Delivery plan and incorporates a summary public health and demographic profile of the CHP, finance, workforce, HQA and service and capital plans, Single Outcome Agreement (SOA). The plan is a guide to current performance and reflects the scale of work the CHP is undertaking. CHP Service Planning Priorities - the following CHP service planning priorities red flagged indicators and issues were advised : o Mental Health modernisation – most significant risk is the delay in the new hospital

building o Sustaining our Community and Rural General Hospital core services re acute care,

trauma and out of hours services • Business 2 Business contract renegotiation for 01/04/14

o Primary Care redesign– including GMS modernisation, workforce recruitment/new models of delivery in Inveraray, and Bunessan on Isle of Mull

o Progress with Health & Social Care integration in Argyll & Bute • Hiatus in commencing scoping and preparation • Principles • Clinical engagement • Organisational engagement

Establishing HQA Capability & Capacity - the CHP has 2 accredited practitioners in the Highland Quality Approach (HQA) methodology and delivery whose capacity will be formalised to utilise their capability to deliver CHP priorities as identified. Further development and capability within the CHP is planned.

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CHP Capital Developments in 2013/14 :

• Dental access in Oban - complete • Cowal Hospital Compartmentalisation Upgrade – completion due March 2014 • Cowal main water tank replacement – completion due March 2014 • CEEF Funding – Biomass in various locations – completion due March 2014 • CEEF Funding – solar panels in Jeanie Deans, Helensburgh - complete • Lorn&Islands Hospital, Oban – fire system – complete • Lorn&Islands Hospital, Oban – decontamination unit – completion due March 2014 • Port Appin GP surgery extension – completion due March 2014 • Jeanie Deans Boiler plant – project tendered as Biomass • Lorn&Islands Hospital, Oban – compartmentalisation - completion due March 2014 • Coll GP House upgrade – completion due March 2014

Workforce Risks – identified as :

• Sustaining services in remote and rural setting • Sustaining secondary care services in remote and rural setting • Medical and dental workforce has a high percentage of staff over 50 years

It was agreed that Mr Logue will provide a Workforce Planning report to the next meeting in February 2014. Balance Score Card Indicators and Standards – the report provided an update on the CHP’s performance for the latest reported period. The Committee: • Considered the update to CHP delivery Plan as at December 13. • Noted the progress and exceptions relating to red flagged indicators. • Considered the reporting position of the plan against the CHP’s Risk Register. 11.2 Delayed Discharge Report The circulated report detailed the current position at 5 December 2013. Total Delayed Discharges reported as 13 over 2 weeks, 3 over 4 weeks and 6 under 2 weeks. 3 clients were coded 9/51x (AWI cases) who are all exempt and 3 clients coded 100 who are excluded as they are awaiting reprovisioning / recommissioning. The Committee: • Noted the details of the circulated report. 12. Islay Clinical Services Review Ms West referred to the work of the Review Steering Group which was concluded at the end of November, following receipt and endorsement of Professor Peterkin’s final report and recommendations, which were endorsed by the CHP Core Management Team and the CHP Management Team, with implementation phase due to commence January 2014. Work undertaken as part of the Review thus far includes: • Undertaking an Integrated Nursing Team workshop and follow up education event

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• Adapting the Integrated Nursing Competency Framework to include dementia and community nursing competencies and holding education sessions with the staff to explain how they will each be supported to develop individual learning plans

• Introducing dedicated admin support to the ward • Developing and distributing a community questionnaire to gather feedback from the

wider community about service provision on Islay • Detailed examination of patient activity (clinical profile and quantity) on Islay and the

skills required to provide safe care • The GPs have been working with an independent consultant to develop a business

plan which will enable the three practices to consider ways of working closer in April 2014.

• Building blocks for future service provision have been agreed. • A visioning workshop for the future service model on Islay was held on 22nd August • An integrated manager job description has been developed • An individually tailored multidisciplinary clinical skills course from BASiCS has been

commissioned for delivery on Islay in January 2014. • Meetings between NHS 24 and local clinicians and local community members have

been undertaken to explore OOHs service delivery. • A Report detailing 9 key areas from community and staff feedback has been

considered by the Steering Group and will inform the recommendation and implementation plan.

Outcome and Implementation - the next step is to establish an Islay Health Services Review Implementation Group who will be responsible for directing the implementation of the model and ensuring sustainability of the service both in and out of hours. The group will be responsible for implementing the agreed action plan which prioritises the areas outlined in the list of 42 actions from the visioning workshop and will have representation from the clinical groups on Islay, CHP, Local Authority and community members. A draft Terms of Reference was agreed and signed off by the Islay Review Steering Group at their meeting on 29th November Priority Areas of Work -

• GP Practice integration - to be led by Christina West and Kate Pickering • Appointment of an Islay Integrated Care Manager- to be led by Derek Leslie.

Management of an Islay Integrated Care Manager - to be led by Christina West • Contracts and Finance- to be led by Stephen Whiston and Christina West • Service Quality and Workforce Development - to be led by Alison Guest and

Kate Pickering • Community Engagement - to be led by Anne Pilley and Pat Farrington • Infrastructure - to be led by Moira Gillies and Integrated Manager when appointed • IT - to be led by James Brass

Mr Leslie agreed to discuss with Argyll & Bute Council colleagues concerns regarding the delay in progress the appointing to the Islay Integrated Care Manager post. Next Steps and Recommendations

• Meeting with the GPs to discuss the business plan and identify the need for any transitional support.

• Agree the establishment of the Islay Health Services Review Implementation Group, responsible for directing the implementation of the model and ensuring sustainability of the service both in and out of hour- first meeting to take place in January 2014.

• Agree the priority areas of work to inform the action plan to be progressed by the Implementation Group.

During the Review there has continued to be wide engagement with the community and workforce.

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Ms Reilly enquired about the inclusion of dental services within the review and Ms West confirmed the services will be included in the longer term plan. The Committee: • Noted the progress of the Islay Clinical Services Review and the next steps to be

undertaken. • Agreed the recommendations to ensure implementation of the outputs from the Clinical

Services Review. 13. Mental Health Modernisation Update Mr Leslie referred to specific points in the report: Project/Service Management - the CHP Core Team recently discussed a number of options with regard to the management of mental health services. Options included: re-establishment of a single management structure for MH services; joint reporting arrangements through locality management and MH management; and reverting to locality management for all aspects of the service. After discussion the latter option was agreed. As a result of this the management of Argyll & Bute Hospital will revert the management of the MAKI Locality. This in turn will release the Programme Director from operational responsibilities to focus on the remaining challenges within the modernisation project

Inpatient Services - the bed compliment is currently 27 plus 3 minimal supervision places in the refurbished Firgrove building. Budget - Bridging: The bridging allocation for the project during 2013/14 remains unchanged at £500k as set by the CHP management team. However, it is unlikely that this level of funding will be required in 2013/14 due to the delays in the capital project. Supported Transfer of Detained Patients - following the appointment of a number of new staff at Argyll & Bute Hospital, it is now planned to introduce the new patient transfer service in January 2014. A policy on the transfer of detained patients was reviewed by the Programme Board on 13th December and discussions are taking place to address concerns regarding the management of patients in localities while waiting transfer to Argyll & Bute Hospital. A mid-point evaluation will be carried out to advise staff and stakeholders of the current status of the project. An indication of the work around the workforce requirements is still to be developed. The Committee: • Noted the current key issues and progress against the action plan detailed in the

report. 14. Noting 14.1 Draft Minute of eHealth Group The Draft Minute of eHealth Group Meeting of 6 November 2013 was circulated for information.

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The Committee: • Noted the content of the circulated draft Minute. 14.2 CHP Committee Meeting Dates 2014 The dates for 2014 were circulated for noting. The Committee: • Noted the dates for 2014. 15. AOCB There were no AOCB items. 16. DATE, TIME & VENUE FOR NEXT MEETING: Wednesday 19 February 2013 at 10.30 am J03-J05, Mid Argyll Hospital, Lochgilphead

Argyll & Bute CHP Committee 19 February 2014 Item : 7.1 Argyll and Bute CHP Clinical Governance and Risk Ma nagement Report Report by Pat Tyrrell, Lead Nurse and Fiona Campbel l, Clinical Governance Manager

The CHP Committee is asked to:

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

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

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

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

2. RISK MANAGEMENT 2.1 Incidents The following data relates to incidents reported between 1 October to 31 December 2013. The data is correct as of 17 January 2014. Further information relating to the report can be found on the DATIX dashboards and my reports sections. FIGURE 1: TOTAL NUMBER OF INCIDENTS PER MONTH JAN 2013-DEC 2013

FIGURE 2: CATEGORY OF INCIDENTS BY LOCALITY QUARTER 3

A total of 497 incidents were reported during quarter 3. Locality breakdown: Cowal & Bute – 90 (18.1%) Helensburgh – 12 (2.4%) Mid Argyll & Kintyre – 264 (53.1%) Oban, Lorn & Isles – 119 (23.9%) Outwith NHS Highland – 12 (2.4%)

Falls remained the highest category of incidents reported in Quarter 3. Locality breakdown: Cowal & Bute – transfer/discharge (17) Helensburgh – medication (4) Mid Argyll & Kintyre – violence & aggression (87) Oban, Lorn & Isles – falls (52) Outwith NHS Highland – pressure ulcers (5)

FIGURE 3: GRADES OF INCIDENT BY LOCALITY QUARTER 3

FIGURE 4: INCIDENTS WITH MAJOR AND EXTREME CONSEQUENCE JAN 201 3-DEC 2013

FIGURE 5: NUMBER OF INCIDENTS BY OUTCOME AND LOCALITY QUAR TER 3

During quarter 3 incidents reported in Argyll & Bute were graded as follows: Low – 284 (57.1%) Medium – 143 (28.8%) High – 7 (1.4%) The remaining incidents have not yet been graded.

A total of 1 incident was reviewed during Quarter 3 and graded with a consequence of extreme. Helensburgh – medication error by an independent pharmacy. This figure is subject to change as not all incidents have been graded.

The overall outcome for Argyll & Bute was noted as: No injury / no harm – 309 (62.2%) Near miss – 38 (7.6%) Injury / harm – 128 (25.7%) Death – 1 (0.2%) Property damage – 21 (4.2%)

Argyll & Bute CHP Committee 19 February 2014 Item : 7.1

FIGURE 6: RIDDOR REPORTABLE INCIDENTS JAN 2013-DEC 2013

There were no RIDDOR reportable incidents recorded for Quarter 3, However a member of A&B staff sustained a fracture whilst visiting another area of the Board.

5

2.1.1 Falls Falls remain the highest category of reported incidents across Argyll and Bute. The following graphs illustrate the trends from Board to CHP to hospital level. The trend reports are reliant on accurate reporting through Datix of all falls that take place in hospital. Falls prevention has been indentified as one of the key priorities for Scottish Patient Safety Programme and the approach will be tested within Lorn and Islands Hospital in Oban as well as across the other consultant led hospitals in NHS Highland. In addition each hospital in Argyll and Bute continues to work on ensuring effective risk assessment and management is taking place for each patient from admission to discharge. FIGURE 6 RATE OF REPORTED PATIENT FALLS PER 1000 OCCUPIED BED DAYS FOR NHS HIGHLAND OVERALL JAN 2011- NOV 2013

FIGURE 8 NUMBER OF REPORTED PATIENT FALLS PER 1000 OCCUPIED BED DAYS BY HOSPITAL IN NHS HIGHLAND FOR QUARTER 3

6

FIGURE 9: PATIENT FALLS HARMS AND NO HARM BY OPERAT IONAL UNIT, NHS HIGHLAND QUARTER 3

2.1.2 Violence, Aggressive and Disruptive Behaviour The second highest category of reported incidents relates to violence and aggressive behaviour. The following graphs demonstrate the trends in these incidents, both in numbers and sub categories. FIGURE 10 NUMBER OF INCIDENTS RELATED TO VIOLENCE AND AGGRESSIO N OVER THE PAST 13 MONTHS IN ARGYLL AND BUTE JAN 2013-JAN 2014

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FIGURE 11 NUMBER OF INCIDENTS BY CONSEQUENCE AND OPERATIONAL UNIT FOR QUARTER 3 IN NHS HIGHLAND

In Argyll and Bute the highest number of reported incidents related to Disruptive, Violent and Aggressive behaviour continues to emanate from Argyll and Bute Hospital – both the Intensive Care Psychiatric Unit and Succoth Admissions Ward. 2.1.3 Pressure Ulcers The third highest category of reported incidents relates to pressure ulcers. The sustained reduction in Grades 3 and 4 pressure ulcers across all hospitals is very positive in improving outcomes for patients. This has been achieved primarily from the implementation of the evidence based SSKIN bundle. As with falls prevention, pressure ulcer prevention has also been indentified as a key priority for the Scottish Patient Safety programme. The target for the SPSP in acute hospitals is zero pressure ulcers, grade 2-4, or 300 days between for each ward/department by December 2015. FIGURE 12 NHS HIGHLAND NUMBER OF HOSPITAL ACQUIRED PRESSURE UL CERS FROM JAN 2013-JAN 2014 BY OPERATIONAL UNIT

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FIGURE 13 NHS HIGHLAND NUMBER OF HOSPITAL ACQUIRED PRESSURE U LCERS BY HOSPITAL SITE FOR QUARTER 3

FIGURE 14 NHS HIGHLAND NUMBER OF PRESSURE ULCERS DEVELOPED IN COM MUNITY SETTINGS BY LOCALITY FOR QUARTER 3

2.2 Significant Event Reviews (SERs) Two SERs were declared relating to incidents occurring / complaints received in Q3 Categories of incidents as follows:

• Medication dispensing error by independent pharmacy resulting in overdose (initial SUI review resulted in SER/ suicide review being commissioned by GG&C)

• Antenatal /Postnatal care (complex complaint) To date in Q4 a further 3 incidents have been declared as SERs/SUIs

• Mental Health Crisis/ Transport Delay / Failure • Suicide (SUI) • Complaint about Palliative care

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3. FEEDBACK 3.1 Compliments In addition to providing detailed information on complaints it is hoped that within the next six months we will be in a position to report regularly on positive feedback received from those who experience services in Argyll and Bute. Positive feedback is not currently routinely collected from across the localities; its use will help develop the culture of learning and improvement, highlighting areas of good practice from which others can learn and develop. 3.2 Complaints TABLE 1 ARGYLL AND BUTE COMPLAINT PERFORMANCE REPORT

TARGET AMBER RED SEPTEMBER OCTOBER NOVEMBER

No complaints received 7 8 - 9

10 and

over 8 5 3

Achievement against

20 day target (old

measure) 80% 70 - 79%

Under

69% 13% 0%

Simple - achievement

against 20 days 80% 70 - 79 %

69 %

and

under 0%

Simple - achievement

against 40 days 100% 90 - 99 %

89 %

and

under 100%

Complex - achievement

against 40 days 100% 90 - 99 %

89 %

and

under 50%

Further

correspondence -

achievement against 20

days 80% 70 - 79 %

69 %

and

under n/a

Number of high risk

complaints received 2 3

4 and

over 1

FIGURE 15: NUMBER OF COMPLAINTS RECEIVED, BY MONTH, IN ARGYLL AND BUTE DEC 2012-NOV 2013

Argyll & Bute Complaints Received

4 4

7

2

9

6

7

10

9

8

5

3

0

2

4

6

8

10

12

10

Of the complaints that have been open for more than 20 days the following information is available: TABLE 2 ARGYLL AND BUTE OPEN COMPLAINTS

Locality/Division Site Service / Spec Sub type Complaint risk rating

First received

Description of complaint

Mid Argyll, Kintyre & Islay

GP Nursing - District Nursing

Complex High 8-Jul-2013 Relating to community nurse.

Oban, Lorn and Isles

Hospital Medical - General

Complex High 20-Aug-2013

Care and treatment that late mother received

Cowal and Bute Medical - General

Complex Medium 16-Sep-2013

Lack of medical care provided out of hours.


Hospital - Mental Health Services -

Adult Psychiatry

Complex High 17-Oct-2013

Care and treatment that late son received


Hospital - Head & Neck - Orthodontics

Simple Medium 31-Oct-2013

Orthodontic treatment and the waiting time for appointment.

Cowal and Bute Hospital - Medical - Emergency

Care

Medium 4-Nov-2013 Care and treatment received at A&E

Helensburgh Patient's Home Nursing - Health Visiting

Complex Medium 2-Dec-2013 Care received from Health Visitor


Patient's Home Other - Adult Social Care -

Other

Simple Medium 23-Dec-2013

Attitude and behaviour of 2 staff members

Cowal and Bute GP General Practice

Services - General

(salaried)

Simple Medium 16-Dec-2013

Security at Medical Practice and lack of action by the estates department

Cowal and Bute Hospital - Other Simple Medium 30-Dec-2013

Mortuary access

TABLE 3: LIST OF OUTSTANDING ACTIONS FROM PREVIOUS COMPLAINT INVESTIGATIONS

District/Division Priority Description Recommended Action Due

Helensburgh Medium - desirable improvement / action

Discharge planning procedures to be reviewed at V of L Hospital

Discharge planning procedures to be reviewed.

20/05/2013


Low - improvement / action for discussion

Review of management of appointments

Review of management of appointments at Mid Argyll Clinic

27/09/2013

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District/Division Priority Description Recommended Action Due

Cowal and Bute Medium - desirable improvement / action

emergency care plan Ensure patient has emergency care plan in place with NHS 24 and also held in A&E department

12/12/2013


Review of clinical assessment skills

Review of clinical assessment skills undertaken to enhance clinical assessment skills for hospital nursing staff. This will also look at thresholds for requesting a clinical review by a doctor.

28/01/2014


Review of assessment Review of assessment, documentation and care planning process to ensure assessment documentation is completed.

28/01/2014


discharge procedures Review of discharge process 28/01/2014


OPD letters to be amended to include access info

OPD letters to be amended to include access info as per action 1 in complaint ID 1237

31/01/2014


Call bell for assistance to be sited at bottom of ramp

Call bell for assistance to be sited at bottom of ramp as per action 2 in complaint ID 1237

31/01/2014


Drop off bay to be installed Drop off bay to be installed as per action 3 in complaint ID 1237

31/01/2014


Staff advised of how to support patients who require assistance

Staff advised of how to support patients who require assistance as per action 4 complaint ID 1237

31/01/2014


training for casually staff Casualty staff to be updated on mental health care and treatment act 2003

12/02/2014

Cowal and Bute High - essential improvement / action

Audit of documentation Documentation will be audited using best practice guidelines to determine any additional training or improvement in assessment processes and recording of care that may be required.

06/03/2014


Pain assessment The use of pain assessment indicators and documentation will be examined to ensure that pain levels can be more robustly assessed, acted upon and compared over time.

13/03/2014

Each of the outstanding actions identified in Table 3 is currently being followed up with the accountable manager. Datix system will be updated with the completed actions.

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3.3 Patient Opinion Patient Opinion is the leading independent feedback website enabling patients to share their experiences of healthcare services. As a not-for-profit social enterprise, it exists to help facilitate dialogue between patient and health service providers and to improve services and staff morale. Founded in 2005, over 65,000 patient stories have now been published and these have been viewed 51 million times by the public. More than half of these stories are positive, a third are mixed and a sixth negative. All postings are moderated according to our moderation policy prior to publication to ensure patient anonymity and to avoid potential defamation of any individual staff members. Gina Alexander, Scottish Manager of Patient Opinion led a workshop in Inveraray in January 2014 for number of service managers. As a result work is underway to agree promotion of Patient Opinion across Argyll and Bute. Sample report for Argyll and Bute, based on the postings to date, is included in Appendix Four. Further information is available through Patient Opinion website: https://www.patientopinion.org.uk/

4. QUALITY AND SAFETY 4.1 Clinical Quality Indicators (CQIs) Appendix 1 contains three tables showing the latest available results for the standards CQIs for Pressure Ulcers, Falls and Food, Fluids and Nutritional Care. The overall compliance set out for each of these indicators is very good. From March 2014 we will initiate external audit to quality assure the self evaluation processes that are in place. 4.2 Lorn and Islands Hospital Scottish Patient Safe ty Programme (SPSP) Appendix 2 shows the outcome measures for the range of indicators for Lorn and Islands Hospital, Oban.

The trend for Hospital Standardised Mortality Rate is down and investigation reviews reveal no clinical concerns with unexpected deaths. Palliative care expected deaths are being reviewed with the Macmillan audit tool developed locally.

Over the past two months there has been a reduction in the audit results for compliance with the actions taken following SEWS (Scottish Early Warning System) assessment. This is being addressed by the hospital Clinical Services Manager in tandem with the Senior Charge Nurses.

The Victoria Hospital in Bute has been identified as the first Community Hospital test site for roll out of SPSP. Arrangements are underway for staff from Bute to shadow staff in Lorn and Islands to become more familiar with the programme and identify plans to progress.

4.3 Maternity and Child Quality Improvement Collabo rative (MCQIC)

All 5 Community Maternity Units now have an identified MCQIC link midwife. From the 27 measures of the measurement plan. Argyll and Bute are measuring the following;

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• Women being offered Carbon Monoxide monitoring at booking apt. • Women with Carbon Monoxide levels >4ppm • Women referred to smoking cessation services • Percentage of birth plans signed by midwives.

Data is sent to the collaborative on a monthly basis on a measurement toolkit, which generates a run chart. Appendix 3 shows the run charts available to date. These are still at a very early stage of development. 4.4 Primary Care SPSP The SPSP programme in Primary Care has not yet commenced. It is hoped that the Warfarin Care Bundles and Medicines Reconciliation Care Bundles will commence in April dependent on final agreement of funding. 4.5 Mental Health SPSP Wards include Succoth and IPCU in Argyll and Bute Hospital. No run charts are available as yet, progress is reported under the following headings: Staff Safety Climate Survey This has been completed twice and plans to repeat the survey later this year are ongoing. Patient Safety Climate Survey Argyll and Bute Hospital plans to test the adapted NHS Highland Safety Climate Survey. Meetings are planned with Acumen to assist in the support of patients to carry out the survey. Leadership Walk rounds have yet to commence. Risk Assessments and Safety Plans Testing of risk assessments and safety plans has to be confirmed for later in the year. Currently Safety briefs are being tested in both wards. These occur three times daily and are updated at the briefings or if any untoward event occurs. The plans are to continue testing this and developing a patient feedback system with regards to safety plans. Communication at Transition The hospital (morning) communication meeting reviews all admissions, transfers and discharges of patients. Discharge planning and crisis planning are also discussed here. A safety brief is carried out at this meeting with all members of the multidisciplinary team encouraged to attend. There are plans are to expand the communication meetings to cover the weekend with the on call medical staff. Physical Health Screening This is currently being tested in Succoth Ward. Most patients have the initial physical examination completed within 2 hours of admission and the updated physical health screening completed within 72 hours. The plans to improve on health screening include developing a more robust screening system which clearly identifies all tests to be completed on admission, depending on the individual patients needs This would include for example lithium and clozapine protocols, as well as the current high dose antipsychotic protocol.

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Incident Debriefing There are plans to develop incident debriefing at ward level. This should be ready for testing in March 2014 4.6 Person Centred Care The Reshaping Care for Older People Programme Board is very keen to make sure that our health and social care services are focussed on meeting, in a dignified, respectful and person centred way, the needs of each person who experiences the care services. In 2013 we were very impressed by work which was presented to us by colleagues from Sweden who have set up a network to improve services for people based on their experiences and improvement suggestions. On March 5th we will be holding an event, Caring Connections, in Arrochar’s Three Villages Hall where we will begin to develop a similar person centred network to meet the needs of people in Argyll and Bute. This network will be developed in collaboration between those who experience the care services and those who deliver the services. Flyer for this event is included in Appendix Five. 5. HEALTH AND SAFETY 5.1 Moving and Handling Training A paper was submitted to the Core Management Team on the 31st January, detailing the proposed changes to the delivery of Moving and Handling Training. The proposal is to move from classroom based training and refresher training for patient handlers to a competency assessment model, supported by key workers. The Core Team approved the implementation of the new model and agreed in principle to increasing the moving and handling staff resource to support the new model. 5.2 Health and Safety Improvement Plan In addition to NHSH Corporate Health and Safety Improvement Plan, each operational unit will develop a local Health and Safety Plan in line with local priorities and risk profile. A&B CHP Health and Safety Managers are developing the local plan to address issues specific to the CHP. The plan will be completed following discussions at the February meeting of the CHP Operational Health and Safety Group.

6. FIRE SAFETY 6.1 Fire Risk Assessments

Fire risk assessments carried out by the CHP Risk Advisor, Fire Safety, using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay, Lorn & Islands, Dunoon, Rothesay, Mid Argyll, Mull and Iona Community Hospital & Helensburgh VICC are now complete and have been issued. Action plans are being prioritised locally. Assessments of Rothesay Annexe, Rothesay GP Practice, Dalmally, Taynuilt, Inveraray, Tarbert and Muasdale are under way.

Annual audits completed for Garelochhead and Kilcreggan Health Centres. Campbeltown Hospital is in progress and Lorn & Islands Hospital has been scheduled. The 3i system will

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be updated on receipt of completed action plans from duty holders. Due to material changes, new risk assessments have been carried out for Lorn & Islands EDU and Dental unit. 6.2 Compartmentation Survey Compartmentation work is underway at Cowal Community Hospital. Planned work at Lorn & Islands Hospital has been postponed. Funding for work in Campbeltown, Islay and Rothesay is awaited.

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

JANUARY 2013 FEBRUARY MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

JANUARY 2014

CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI %

COWAL AND BUTE Victoria Hospital

93 93 98 95 98 93 96 98 97

99 99 97

99 CCH Ward 1 96 96 98 96 100 100

98 100

100 100 100 100 98 CCH Ward 2

MID ARGYLL, KINTYRE AND ISLAY Glenaray 95 95 100 100 83 100 100 100 100 100 100 NR 100 Glassary 100 100 100 100 100 100 100 100 100 100 100 100 Cara Knapdale Campbeltown 100 100 100 98 98

100 100 100 98 98 85 100 100 Islay 92 95 100 100 100 100 100 100 100 100 100 100 100 OBAN, LORN AND ISLES Ward A 100 100 83 100 100 100 100 100 100 100 100 100 100 Ward B 93 95 100 100 95 98 95 100 85 100 100 NR 98 Ward I 100 100 100 100 100 100 100 100 100 100 100 100 100 MICH 100 NR 91 92 100 100 100 100 100 100 100 100 100

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


JANUARY 2014

CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % COWAL AND BUTE Victoria Hospital

96 100 100 100 100 91 100 99 99

99 99 98 98 CCH Ward 1 97 97 97 97 100 96 95 97 100

96 100 100 98 CCH Ward 2

MID ARGYLL, KINTYRE AND ISLAY Glenaray 100 100 100 100 100 100 100 100 100 100 100 NR 100 Glassary 100 100 100 100 100 100 100 100 100 100 100 100 100 Cara Knapdale Campbeltown 96 76 89 100 96.3 100 98 100

100

100 87 Islay 93 67 96 84 82 100 96 100 86 100 100 100 OBAN, LORN AND ISLES Ward A 97 96 100 100 100 100 100 83 95 95 96 100 100 Ward B 87 100 100 100 97 98 100 100 98 100 100 NR 100 Ward I 100 100 100 100 100 100 100 100 100 100 100 100 100 MICH 94 NR 100 100 100 100 100 100 100 100 100 94 100

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


JANUARY 2014

CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % CQI % COWAL AND BUTE Victoria Hospital

NR 98 96 97 NR 97 98 99 98

98 98 97 98 CCH Ward 1 96 95 95 97 100 98 100 100 100

100 100 100 100 CCH Ward 2

MID ARGYLL, KINTYRE AND ISLAY Glenaray 99 100 94 100 91 100 97 100 100 95 95 NR 93 Glassary 100 100 100 100 100 100 100 100 100 100 100 100 100 Cara Knapdale Campbeltown 96 94

NR 90 Islay 100 100 100 100 100 100 OBAN, LORN AND ISLES Ward A 100 100 100 100 100 100 100 100 100 100 100 100 100 Ward B 95 100 100 100 97 97 97 99 85 100 100 NR 100 Ward I 100 100 100 100 100 100 100 100 100 87 100 100 100 MICH 100 95 100 100 100 100 100 100 92

- 19 -

APPENDIX TWO SCOTTISH PATIENT SAFETY PROGRAMME OUTCOME MEASURES FOR LORN AND ISLANDS HOSPITAL

- 20 -

APPENDIX THREE; MCQIC RUN CHARTS TO DATE

Shows variance from 95% target. Blue >= 95% compliance Red < 95% Compliance The higher the peak/ darker the shade of red, the worse the performance. (Dark Red <=65% compliance)

Hand Hygiene data - from early 2011 onwards and only from wards who have input data into ward based tools.

- 21 -

APPENDIX 3: MATERNITY CARE QUALITY IMPROVEMENT: RUN CHARTS TO DATE

No Monitor avai lable

0

20

40

60

80

100

No

v 1

3

Dec 1

3

Jan

14

% o

ffere

d C

O m

on

ito

rin

g

% of pregnant women offered CO

monitoring at booking

Mid Argyll

Mid Argyll

offered

0

20

40

60

80

100

Nov 1

3

Dec 1

3

Jan 1

4

% r

efe

rred

% of pregnant women with CO level > 4 ppm (or

current/recent smokers) referred to smoking cessation

services

Raised staff

awareness

0

20

40

60

80

100

Jan 13

% of signed birth

plans

% of birth plans that are signed and dated by the

woman and midwife

- 22 -

APPENDIX FOUR: PATIENT OPINION

- 23 -

- 24 -

- 25 -

- 26 -

- 27 -

- 28 -

APPENDIX FIVE; CARING CONNECTIONS EVENT FLYER


Agenda item: 7.2

INFECTION CONTROL REPORT Report by Pat Tyrrell, Lead Nurse, Argyll and Bute CHP 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. Summary TABLE 1 SHOWS NHS HIGHLAND INFECTION PREVENTION & CONTROL T ARGETS AND PERFORMANCE DATA

Group Target NHS

Scotland NHS Highland

41.6 July-Sept 13

38.8 July-Sept 13

Red Clostridium difficile

Age 15 and over New Target 32.0 (100,000 OBDs) to be achieved by 03/15 35.6 Oct-

Dec (not yet HPS validated data)

Red (not yet validated)

27.2 July-Sept 13

Red

Staphylococcus aureus bacteraemia

Age 15 and over 24.0 (100,000) AOBDs

31.4 July-Sept 13

24.0 Oct-Dec (not yet HPS validated data)

Amber (not yet validated)

2

Group Target NHS Scotland

NHS Highland

Hand Hygiene 95% 95% 98% Green

Cleaning 90% 95%

96% Green

Estates

90% 97% 96%

Green

AMAU 95%

Green Antimicrobial prescribing (includes data to the end of November 2013).

Hospital- based Empiric prescribing

95%

Ward 4A 95%

Green

Surgical antibiotic prophylaxis

Compliant Compliant Green

(includes data to the end of September 2013)

Primary Care empirical prescribing

Less than 5%

4.8% Green

Source: - Health Protection Scotland/ISD/Local data. 4. Achievements

• Formation of a Working Group for NHS Highland to investigate reasons for the recent increase in numbers of C difficile cases, and to take actions to reduce the number of cases

• The roll-out of the new Infection Prevention & Control Risk Assessment tool has begun

• The new Infection Control Manager for NHS Highland, Catherine Stokoe, started in post on 20th January

5. Challenges

• To support all clinical staff in the prevention and reduction of Clostridium difficile infections.

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

• To engage all clinical staff to use the new infection prevention & control risk assessment process and screening for Multi-Drug Resistant bacteria (Carbapenemase

3

producers) as per recent Interim Guidance from Health Protection Scotland, and CMO/SGHD (2013)14 letter.

6. Risks Achieving the Clostridium difficile and SAB HEAT targets. Argyll and Bute CHP Healthcare Associated Infection Report – February 2014

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

1. Staphylococcus aureus (including MRSA)

1.1 Staphylococcus aureus bacteraemia target From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, Staphylococcus aureus bacteraemia (including MRSA) cases are 24.0 cases or less per 100,000 acute bed days. For NHS Highland this means no more than approximately 60 cases in year ending 2015. 1.2 Trends National data published by Health Protection Scotland identifies that NHS Scotland Staphylococcus aureus bacteraemia rate July – September 2013 was 31.4 pe r 100,000 acute occupied bed days (AOBDs). NHS Highland’s ra te for the same period was 27.2 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

FIGURE 1 NHS HIGHLAND STAPHYLOCOCCUS AUREUS BACTERAEMIA (MRSA AND MSSA) CUMULATIVE CASE NUMBERS YEAR ON YEAR SINCE 2009. FIGURE 2 FUNNEL PLOT OF STAPHYLOCOCCUS BACTERAEMIA RATES FOR A LL NHS BOARDS IN SCOTLAND AGAINST ACUTE OCCUPIED BED DAYS(X 100,000), JULY-SEPT EMBER 2013.

In NHS Highland from October – December 2013, there were 15 Staphylococcus aureus bacteraemia cases, (15 MSSA & 0 MRSA) with a rate of 24.0 per 100,000 acute bed days (not yet validated by HPS) Since April 2013, the main sources of the potentially preventable Staphylococcus aureus bacteraemia cases are contamination at the time of venepuncture (11%) and vascular devices (lines) (12%). Actions to address these issues are ongoing.

0

10

20

30

40

50

60

70

80

April May June July Aug Sept Oct Nov Dec Jan Feb March

Cum

ulat

ive

Cas

e N

umbe

rs

2009-10 2010-11 2011-12 2012-13 2013-14 Heat Target to 31-3-15

5

TABLE 2 SHOWS THE CUMULATIVE TOTALS FOR SAB WITHIN ARGYLL AND BUTE CHP FOR THE YEARS SINCE 2009-2010: Hospitals 09/10 10/11 11/12 12/13 13/14 Lorn and Islands, Oban 8 3 0 5 5 Victoria Hospital, Rothesay 1 1 0 0 0 Mid Argyll Hospital, Lochgilphead 0 1 0 0 0 Argyll & Bute Hospital, Lochgilphead 0 0 0 0 0 Campbeltown Hospital 0 0 0 0 0 Mull and Iona Community Hospital 0 0 0 0 0 Islay Hospital, Bowmore 0 0 0 0 0 Cowal Community Hospital, Dunoon 0 0 0 0 0 There has been one case of SAB in Lorn and Islands Hospital since the last report. Enhanced surveillance is being carried out on this case. 1.3 Current Initiatives Current initiatives are concentrating on infections associated with vascular devices (lines), as well as working to reduce blood culture contamination rate. A Highland wide working group is to be set up to provide guidance, support and oversight all the work streams. The Vascular Devices short life working group is reviewing current documentation, compliance and levels of spread of the CVC Insertion and Maintenance Bundle and the PVC Maintenance Bundle and will monitor progress of above to achieve 95% or > compliance with these bundles in all relevant applicable patient population areas with the aim of achieving 0 or 60 days between invasive device related SABs (50% Reduction in SABS) by end September 2014. The Group will initially focus on Raigmore Hospital before extending across Highland (most line-related SABs occur within Raigmore). A new PVC Insertion Bundle has been developed and is being trialled. 1.4 HAI Quality Improvement Facilitator (HAI QI F) posts The recruitment process for NHS Highland HAI Quality Improvement Facilitator (HAI QIF) posts is underway and it is hoped to have 2 Facilitators in post by spring 2014. 2. Clostridium difficile

Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at:

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of Section 1 and for each hospital within the CHP in Section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at:

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

6

2.1 Clostridium difficile HEAT Target From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, the rate of Clostridium difficile infections (CDI) in patients aged 15 and over is 32.0 cases or less per 100,000 total occupied bed days. For NHS Highland that means no more than approximately 78 cases in the year ending March 2015. 2.2 Trends National data published by Health Protection Scotland identifies that NHS Scotland Clostridium difficile infection (CDI) in patients aged 15 and over July – September 2013 was 41.6 per 100,000 bed days. NHS Highland’s rate for the same period was 38.8 per 100,000 bed days (24 cases of which there were 20 cases in over 65 and 4 cases 15 - 64 years). 9 of the 11 mainland boards show an increase to C. diff rates between July and September 2013. The increase in NHS Highland was statistically significant. However the increase was most marked in the over 65 age group with NHS Highland seeing the lower rates of infection for the 15-64 year olds. Investigations with NHS Highland have not revealed any links between CDI case reported in this quarter (case are spread out geographically and involved a mixture of ribotypes). No outbreaks were reported. FIGURE 3: FUNNEL PLOT OF CDI INCIDENCE RATES IN PATIENTS AGED OVER 65 YEARS FOR ALL NHS BOARDS IN SCOTLAND, JULY-SEPTEMBER 2013.

FIGURE 4: NHS HIGHLAND CLOSTRIDIUM DIFFICILE INFECTION CUMULATIVE CASE NUMBERS AGE 15 YEARS AND OVER YEAR ON YEAR SINCE 2009.

0

20

40

60

80

100

120

140

160

Cum

ulat

ive

Cas

e N

umbe

rs

2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 Heat Target to 31-3-15

7

In NHS Highland between October- December 2013 there were 22 cases of Clostridium difficile infection in patients aged 15 and over with a rate of 35.6 per 100,000 bed days (not yet validated by HPS). TABLE 3 SHOWS THE CUMULATIVE CD TOXIN POSITIVE CASES IN EACH ARGYLL AND BUTE CHP HOSPITAL FOR THE YEARS SINCE 2009 UNTIL JANUARY 31 ST 2014

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

Lorn and Islands Hospital, Oban 0 1 2 1 3

Cowal Community Hospital, Dunoon 3 1 2 2 4

Victoria Hospital, Rothesay 3 0 1 0 1

Mull and Iona Community Hospital 0 1 0 0 0

Argyll & Bute Hospital, Lochgilphead 0 0 0 0 1

Mid Argyll Hospital, Lochgilphead 0 0 1 0 0

Campbeltown Hospital 0 0 1 1 2

Islay Hospital, Bowmore 0 0 0 0 0

TABLE 4 SHOWS THE CUMULATIVE CD TOXIN POSITIVE CASES IN ARGYLL AN D BUTE COMMUNITY FOR THE YEARS SINCE 2009 UNTIL JANUARY 31 ST 2014

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

13/14

North and West Unit 22 8

South and Mid Reported as CHPs 21 6

Argyll & Bute CHP 2 4 2 2 6

There have been 2 cases of CDI in Argyll and Bute since the last report. One of these was hospital acquired in Lorn and Islands and the other in Helensburgh. Enhanced surveillance is being completed. 2.3 Improving Patient Safety in Relation to CDI The higher numbers of cases of CDI across NHS Highland have led to the establishment of a Boardwide action group. In addition each operational unit has established a task group to identify further improvements that can be made to reduce the risks of CDI. First meeting of Argyll and Bute Action Group took place on January 31st- this group will be accountable to the Highland-wide working group which is chaired by Lead Infection Control Doctor. Review of the recent antimicrobial audit results (included in Appendix One) was undertaken and number of actions agreed. Sarah Whitehead, Lead Microbiologist within NHS Greater Glasgow and Clyde will organise education sessions for all clinical prescribers at locality level over the coming months. In addition, primary care prescribing data, in relation to both anti microbials and proton pump inhibitors(PPI) will be analysed to identify areas for follow up.

Health Protection Scotland have been involved in providing support and advice, in particular the Scottish C Difficile Reference Laboratory in Glasgow will undertake enhanced epidemiological typing of 40-50 of the stored NHS Highland isolates from the period of increase to allow a greater epidemiological understanding to be reached.

8

The Infection Prevention & Control Teams continue to maintain accurate real time surveillance of all Clostridium difficile infection (CDI) cases in all areas. Significant work has gone on since the last Board Report to update and improve the amount and quality of data that has been collected. In the longer term a more robust database 3. Hand Hygiene

3.1 Hand Hygiene Reporting Each Board is now responsible for monitoring and reporting hand hygiene compliance data. With effect from April 2014, percentage compliance of each staff group will be reported in the bimonthly report to the Board. The HAI Policy Unit is reviewing electronic systems such as Lanqip to make it easier for all Boards to report this data. 3.2 Trends NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining 98% compliance in November and 99% in December 2013. Figures for Argyll and Bute are contained within the report cards in Section 2 –all areas are well within the compliance target of 95%. 4. Cleaning and the Healthcare Environment

4.1 Current Rates The monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated 96% compliance in November and 96% in December 2013 for domestic monitoring and 96% for estates monitoring in November and 97% in December 2013. The results for each hospital in Argyll and Bute are included within the charts in section 2 of the report.

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

9

5. Outbreaks/Incidents One possible outbreak (gastroenteritis) in an Oban Care Home led to temporary closure in late January. The situation was de-escalated as no causative organism was identified. 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 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.

10

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.

11

12

13

14

15

16

17

18

19

20

21

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

22

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

23

APPENDIX ONE:

A Point Prevalence Antibiotic Survey Argyll and Bute CHP Hospitals Co-ordinated by Alison MacDonald Area Antimicrobial Pharmacist September 2013

24

1. Introduction. This survey was undertaken as part of the recommendations of The Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) 2008 published by Healthcare Associated Infection Task Force and Scottish Medicines Consortium on behalf of the Scottish Government. A previous publication, Antimicrobial Prescribing Policy and Practice in Scotland (2005) suggested point prevalence audits or surveys should be performed at least annually (preferably twice yearly) to monitor trends in prescribing. These surveys can be used to inform a more detailed study of prescribing practice in specific areas. The survey satisfies a requirement to monitor compliance with antimicrobial policies regularly and provide feedback on prescribing. The results will be fed back to prescribers in Argyll and Bute CHP and discussed within the Antimicrobial Management Team.

2. Method The audit was carried out in each hospital on a single day between 9th and 13th September 2013 in each in-patient ward by pharmacy, ward and infection control nursing staff. For each in-patient, the drug kardex was screened to identify those patients currently prescribed antibiotics regularly. For each patient on antibiotics, a data collection form (appendix 1) was completed using detail from the drug kardex and the patient’s medical notes. The total number of patients on the ward that day was recorded to calculate the incidence of patients prescribed antibiotics. Appropriateness of antimicrobial prescribing was assessed by Alison MacDonald, Area Antimicrobial Pharmacist in conjunction with Professor Alistair Leanord, Consultant Microbiologist, NHS Greater Glasgow and Clyde.

3. Results In each clinical area, the data collection was undertaken on a single day covering all in-patient areas. Total number of beds audited 135 Number of patients receiving treatment with antimic robials 32 (23.7%) Demographics of Patients Prescribed Antimicrobials The average age of patients was 70.8 years (range 19 to 100 years). Table 3.1

Hospital

Total Number

of Patients

Number of Patients Prescribed antimicrobials (%)

Argyll and Bute Hospital, Lochgilphead 20 2 (10%) Campbeltown Hospital 19 6 (31.6%) Cowal Community Hospital 8 2 (25%) Mid Argyll Community Hospital and Integrated Care Centre 32 7 (21.9%) Victoria Hospital and Annexe, Rothesay 8 3 (37.5%) Lorn and Islands Hospital, Oban 43 12 (27.9%) Dunaros Hospital, Mull 1 0 Islay 4 0

Total 135 32 (23.7%) Indication for treatment and antibiotics prescribed Of the 32 patients prescribed antibiotics, 18 were on one agent, 11 were in dual therapy with 2 drugs, 2 were being treated for two separate infections with two drugs and one patient was prescribed a combination of 3 drugs for one infection. One patient was receiving prophylaxis for a urinary tract infection. The indication was documented in the medical notes for all except two patients, both in Ward B, Lorn and Islands Hospital. The details of the broad indications being treated are detailed in table 3.2 below.

25

Broad Infection Category Frequency GU (UTI) 11 Resp 9 GI 6 Resp/GU 2 SSTI 2 Neutropenic Sepsis 1 Not documented 1

Table 3.2 Antibiotics prescribed In total, 47 antibiotic prescriptions were reviewed. The intravenous route was used to deliver antibiotic treatment in 36% of cases (17/47 drugs) including 5 prescriptions for antibiotics available only as IV formulations. All antibiotics prescribed were in the formulary and 21% are classed as having a higher associated risk of infection with Clostridium difficile. Ten patients were concurrently prescribed a proton pump inhibitor and five of those patients were also prescribed a higher C. difficile risk antibiotic. The antibiotics prescribed are detailed in the chart below.

Frequency of Antibiotics PrescribedArgyll and Bute Hospitals Sept 2013

0

1

2

3

4

5

6

7

8

9

10

Amoxic

i llin

Clarit

hrom

ycin

Metro

nidazo

le

Co-am

oxicl

av *

Trimet

hoprim

Nitrofu

ran to

in

Piper a

cillin

/ tazo

bact

am *

Doxyc

ycli n

e

Fluclox

acili

n

Gentam

icin

Ciprofl

oxa

cin *

Antibiotic

Num

ber

of A

ntib

iotic

s P

resc

iptio

ns

* indicates and antibiotic with a higher risk of CDI infection

Chart 3.1

26

Appropriate Prescribing of Antimicrobials For each infection, the currently prescribed antimicrobials were assessed for appropriateness with reference to the NHS Greater Glasgow and Clyde antimicrobial prescribing guidelines. Of the 32 infections where the indication was documented in the medical notes, prescribing was in line with guidelines or specialist advice in 21 cases. For the two case where the indication was not documented, information provided by the clinical team suggests the correct antibiotic therapy had been prescribed for one but no details were noted for the second case. The details of unexplained variation from guidelines are given below. Lorn and Islands Ward A

o Use of amoxicillin for a UTI with no documentation of urine culture results. Amoxicillin provides limited cover for a urinary tract infection due to significant resistance rates in the main pathogen, E. coli.

o Combination of co-amoxiclav and metronidazole for a skin infection following a dog bite, single therapy with co-amoxiclav will provide sufficient anaerobic cover hence metronidazole is not necessary.

o Combination of co-amoxiclav and metronidazole for treatment of possible appendicitis; triple therapy with amoxicillin, gentamicin and metronidazole is recommended in guidelines. Significant renal impairment was not mentioned and in that instance, piperacillin/tazobactam would be drug of choice.

Lorn and Islands Ward B

o Combination of clarithromycin and IV metronidazole for aspiration pneumonia (not documented) in a patient with no drug allergies; amoxicillin combined with metronidazole is the drug of choice.

o Piperacillin/tazobactam prescribed for an undocumented indication. Campbeltown Hospital

o Use of clarithromycin and amoxicillin for a chest infection and urinary tract infection. Combination therapy of amoxicillin and clarithromycin is indicated for treatment of community-acquired pneumonia with a CURB65 score of 2 and treatment of a urinary tract infection with amoxicillin is indicated only is culture and sensitivity information is already known as resistance rates in E. coli are around 50%. Appropriateness of antibiotic therapy in this case is unassessable due to insufficient information in the medical notes

Mid Argyll Community Hospital and Integrated Care Centre

o Combination therapy with amoxicillin and clarithromycin for pleurisy/chest infection. This combination is indicated for community-acquired pneumonia only in accordance with the CURB65 score. No reason for the combination therapy was recorded in the medical notes.

o The use of co-amoxiclav for two patients with a urinary tract infection is not in line with guidelines unless an upper urinary tract infection (pyelonephritis) is suspected. No reason for variation from the guidelines was recorded in the medical notes.

o The addition of metronidazole to co-amoxiclav for the treatment of an exacerbation of ulcerative colitis is not in line with guideline recommendation as duplicate anaerobic cover is not required.

o Antibiotic therapy was prescribed for an infective exacerbation of asthma. SIGN 101 states that the most likely cause of an infective exacerbation of asthma is viral and antibiotics are only indicated when there are features of a bacterial infection such as pneumonia.

Summary From 9th to 11th September 2013, the drug kardexes of 135 patients in Argyll and Bute Hospitals were screened and 32 of those patients were identified as currently receiving antimicrobial treatment for 34 infections. The indication for treatment was documented in the notes for all except one patient and a duration or review date noted in 19. Antimicrobials were assessed as in line with guidelines or specialist advice in 21 of 32 cases (67.6%). The reasons for variation from prescribing guidelines should be recorded in the medical notes at the time of prescribing along with the indication and a review date or duration of therapy.

27

4. Action Plan Table 4.1 Area Action required Method Documentation of indication for antibiotic treatment

Ensure 100% recording of indication in patient medical notes

Consider use of antibiotic sticker (Appendix 2) or incorporation into ward round stickers/common admissions document.

Documentation of treatment duration or review date.

Strive for 100% documentation in patient medical notes.

Medical staff to ensure full documentation of duration or review. Follow up in future audits.

Treatment variation from guideline recommendations

Decisions to vary antibiotic treatment from guideline recommendations must be recorded in the medical notes

Consider the use of the antibiotic sticker as this contains a prompt about variation from guidelines.

Use of combination therapy with metronidazole

Dual anaerobic cover with metronidazole not routinely indicated. Use empiric prescribing guidelines for optimal place in therapy

Dual anaerobic cover only indicated following specialist advice from Microbiology or Infectious Diseases Physician

Use of CURB65 score for severity assessment in community acquired pneumonia (CAP)

CURB65 score and sepsis severity markers should be used in combination to guide appropriate antibiotic cover.

Record CURB65 score along with other severity markers in medical notes when treating CAP.

The audit will be repeated at regular intervals, preferably once a year with timely feed back to prescribers and other staff. The results have been discussed with the clinical lead for the hospital and will be discussed at the next meeting of the NHS Highland Antimicrobial Management Team.

28

Appendix 1 Data collection Form NHS Highland Antimicrobial Prescribing Audit for Argyll & Bute Hospitals

PLEASE COMPLETE ONE FORM PER PATIENT FOR ALL PATIENTS RECEIVING ANTI-INFECTIVES TODAY RECORD CURRENT ANTIBIOTICS ONLY (Use an additional form if patient on > 3 antibiotics and staple together)

Date of Audit

Hospital :

Ward :

Speciality

Total no. of patients on ward on day of audit:

Patient: Age/DoB

Admission date:

Gender: M / F

Allergies Recorded on Kardex Y / N / NKDA:

List drug allergy & symptoms

Proton pump inhibitor prescribed? Y / N

( * see NHS Highland Management of Infection

Guidance in Highland Formulary)

Anti-infective 1 Anti-infective 2 Anti-infective 3

1. Antibiotic Name Route

IV / Oral / Other ……………….



2. If IV therapy is this route appropriate?

3. For current, antibiotic is duration or review date stated in patient notes?

Y / N

Y / N

Y / N

4. Is the indication clearly documented in notes? 5. State Indication 6. If Prophylaxis is it:

Y / N

Medical / Surgical / NA

Y / N


Y / N


7. Are either of the following documented on day 1 of antibiotic SIRS (see reverse of form + document) CURB 65* (CAP only - document score)

Score SIRS Y / N ……. CURB-65 Y / N / NA …….



8. On the day of audit is the choice of antibiotic in line with NHS GGC Antibiotic Prescribing Guidance?

Y / N / Don’t know Y / N / Don’t know Y / N / Don’t know

9. If not in line with NHSH Management of Infection Guidance, reason why (tick all applicable reasons)

No guideline � Not documented in notes �

Drug allergy � GI intolerance �

Recent antimicrobials � Recent hospitalisation �

Renal impairment � Hepatic impairment �

Immunocompromised � Interacting drug �

Treatment failure/ Second line � Culture & Sensitivities �

Microbiology advice � Unknown �

Correct agent wrong route � Other________________

















10. Alert / Restricted antibiotic? (see attached list) Y / N Y / N Y / N

11. If yes, why was this prescribed?* (tick all applicable reasons)

Permitted indication � Permitted prescriber � Microbiology advice �

Culture & Sensitivities � Unauthorised �

Unknown/other �



Unknown/other �



Unknown/other �

29

________________________ _________________________ _________________________

Alert/Restricted antibiotics

• Aztreonam • Cefotaxime • Ceftriaxone • Ceftazidime • Clindamycin • Colistimethate sodium • Meropenem • Teicoplanin • Quinupristin and dalfopristin • Daptomycin (NF) • Tigecycline (NF) • Levofloxacin (NF)

Antifungals

• Ambisome • Caspofungin • Voriconazole

Sepsis criteria (2 or more should be documented in case notes): Temp < 36 / > 38oC Pulse > 90 Resp. rate > 20 WCC < 4 / > 12 Acutely altered mental state ↑ glucose without presence of diabetes Appendix 2 Antibiotic Sticker

Date: _________________ Time: ______________

Indication _______________________________________ Samples sent (specify) ____________________________ Pathogen known? Yes / No - Organism __________________ Antimicrobial Details_________________________________ New � Change � Reason for change ___________________ Duration of therapy _____________Review Date __________ REVIEW FOR IV TO ORAL SWITCH AT 48 to 72 HOURS

Decision for therapy made by (name, grade, bleep):

___________________________________________________

Out with Management of Infection Guidance? (specify why):

___________________________________________________

Argyll & Bute CHP Committee Date of meeting: 19 February 2014

Item No 8.1

FINANCE REPORT REPORT BY GEORGE MORRISON The CHP Committee is asked to; • Note the forecast year-end position expected to be achieved by Argyll & Bute CHP • Note the requirement for management action to achieve the expected year-end outturn 1. Argyll & Bute CHP - Month 9 Financial Position For the nine months ended 31st December 2013, Argyll & Bute CHP recorded an underspend of £645,000. This is an improvement of £250,000 on the underspend of £395,000 reported at the end of November and is in line with expected performance. Table 1 below provides details of budgetary performance across the CHP at month 9.

Table 1: Financial performance by budget at 31 st December 2013 Year to Date

Budget Annual Budget Budget Actual Variance

Forecast Outturn

£’000 £’000 £’000 £’000 £’000 Oban, Lorn & Isles Locality 19,280 14,411 14,822 (411) (500) Mid Argyll, Kintyre & Islay Locality 17,212 12,817 12,743 74 140 Mental Health In-Patient Services 7,547 5,449 5,331 118 300 Cowal & Bute Locality 12,775 9,566 9,706 (140) (150) Helensburgh & Lomond Locality 4,930 3,699 3,610 89 140 Salaried Dental Service 3,750 2,610 2,610 0 0 Other Clinical Services 4,974 3,499 3,505 (6) 7 General Medical Services 15,616 11,666 11,813 (147) (213) Prescribing 17,010 12,741 12,663 78 80 Dental, Ophthalmic & Pharmacy 7,782 5,972 5,972 0 0 Services from NHS GG & C 49,517 37,138 36,384 754 1,004 Commissioned Services 3,995 2,980 3,210 (230) (313) Resource Release 4,658 3,494 3,494 0 0 Depreciation 3,360 2,506 2,506 0 0 Management & Corporate 9,243 6,783 6,731 52 70 Budget Reserves 719 375 0 375 500 Total Expenditure 182,368 135,706 135,100 606 1,065 Income (1,403) (1,124) (1,163) 39 35 Net Budget Position 180,965 134,582 133,937 645 1,100 Planned Management Action 200 Forecast year-end outturn 1,300

There are a number of favourable variances contributing to this position, the most notable of which is the underspend of £754,000 on the GG&C services budget reflecting the decision to restrict the annual SLA payment. Partly offsetting this are a number of adverse variances, details of which are noted in section 2 below.

2

2. Analysis of Budget Overspends Significant budget overspends are detailed below. (Note that entries listed against budgets will not add up to the total overspend as only major issues have been highlighted). Oban, Lorn & Isles Locality - overspent £411k Unachieved savings - £208k shortfall at month 9 reflecting the low level of declared savings to date. Medical locums - £130k overspent due to a consultant physician vacancy. Ward B nursing pay costs - £46k overspent due to sickness absence, maternity leave and special care nursing requirements. Ward I drug costs - £38k overspent due to the development of local cancer treatment services. Surgical services - £34k overspent due to locums covering junior vacancies (£17k), urology sessions provided from Raigmore (£13k) and locums for consultant annual leave cover (£4k). A&E nursing pay costs - £30k overspent due to sickness absence and excess staffing. Radiography - £26k overspent due to employment of agency staff to cover vacancies. Development of a Pain Relief service - £24k of unfunded costs. Portering/Transport - £20k overspent due to additional staffing to support duties outwith normal shift rotas. Medical Physics - £20k overspent due to increased equipment repair costs. Tiree/Coll nursing pay costs - £20k overspent due to additional hours being worked on an ongoing basis. The reasons for this are unclear and are under investigation. ECG - £18k overspent due to the employment of agency staff to cover sickness absence. Discussions are ongoing with the Locality Manager regarding the actions required to address the various causes of these overspends. Commissioned Services – overspent £230k A number of commissioned services budgets are overspent, including; Huntercombe - £164k overspent due to increased CAMHS referrals. NHS Highland (north) - £69k overspent due to increased patient activity. NHS Lothian - £38k overspent due to an expensive patient referral. Rohallian Unit - £31k overspent due to an expensive patient placement. This is ongoing at the rate of £9k per month. All of these overspends relate to increased patient activity that is high cost and low volume.

3

General Medical Services - overspent £147k Locums covering vacant small practices and maternity leave - £125k overspent. Global Sum payments – overspent £25k due to an underfunding of payment uplifts. Minor Surgery - £18k overspent due to an increase in claims. Seniority payments - £12k overspent due to increased seniority payment entitlement. Cowal & Bute Locality - overspent £140k Medical locums in Dunoon covering gaps in the casualty and out of hours rota - £266k overspent. Medical locums in Dunoon covering the hospital in-patient service - £73k overspent. The appointment of new medical staff in Dunoon over the next few months is likely to resolve these overspends in 2014/15. It should be noted that without these specific cost pressures, Cowal & Bute Locality would be almost £200k underspent. 3. Cost Improvement Programme To achieve a balanced revenue budget in 2013/14 and support a number of service developments, the CHP agreed to implement a £2.4m recurring savings plan. Progress towards achievement of these savings is noted in table 2 below.

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

Recurring Savings Targets Responsible Manager

Target £' 000

DeclaredAchieved

£' 000 Outstanding

£’ 000

Forecast Achievement

£' 000

Likely Shortfall

£' 000 Oban, Lorn & Isles V Kennedy 365 87 278 165 200 Mid Argyll, Kintyre & Islay C West 331 246 85 276 55 Cowal & Bute V Hamilton 252 155 97 202 50 Helensburgh & Lomond V Hamilton 102 90 12 102 0 Unfunded Displaced Staff D Leslie 90 15 75 15 75 Prescribing F Thomson 1,000 787 213 1,000 0 Lead Nurse P Tyrell 20 0 20 0 20 Public Health E Garman 21 21 0 21 0 Management and Corporate D Leslie 76 36 40 76 0 Commissioned Services D Leslie 77 77 0 77 0 Depreciation G Morrison 66 66 0 66 0 Totals 2,400 1,580 820 2,000 400

Savings in public health, commissioned services and depreciation have been achieved. Savings in prescribing, management & corporate services and Helensburgh & Lomond locality are likely to be achieved. However the savings targets for the other three localities, displaced staff and the lead nurse’s budget will not be achieved in full, resulting in a shortfall against the £2.4m recurring target. The shortfall against the savings target is a contributing factor towards the need to take management action to achieve the expected year-end outturn. In addition, the shortfall will carry forward into next financial year and put pressure on the 14/15 budget.

4

4. Forecast Outturn As a consequence of the Health Board’s overall financial position, Argyll & Bute CHP is now forecasting a year-end underspend of £1.3m, however this is dependent on management action to reduce spending in the remainder of the financial year to achieve this outturn. George Morrison Head of Finance Argyll & Bute CHP 10th February 2014


Item No 8.2

REVENUE BUDGET 2014/15 REPORT BY GEORGE MORRISON The CHP Committee is asked to; • Agree the approvals process for the 2014/15 revenue budget • Note the expected content of the 2014/15 revenue budget • Note the requirement for a £2.5m savings plan to achieve a balanced budget 1. Revenue Budget approvals process The 2014/15 revenue budget proposal will be presented to the CHP Core Management Team meeting on 28th February 2014 for approval and will thereafter be taken to the CHP Management Team meeting on 9th April and the CHP Committee meeting on 23rd April for endorsement. 2. Summary financial information for the budget The funded recurring cost base of Argyll & Bute CHP, as at 20th January 2014, was £178.543m, as detailed in table 1 below;

Table 1 : Argyll & Bute CHP Recurring Funding

Funding Description £' 000 Base formula funding 149,162 Internal Health Board adjustments (1,199) SGHD Annual Allocations 3,646 General Medical Services 15,403 NCL Dental, Pharmaceutical & Ophthalmic Services 7,781 Salaried Dental Service 3,750 178,543

The uplift on the base formula funding from SGHD (through NHS Highland) is expected to be 2.69% which equates to £4.014m. There is also likely to be an NRAC “move to parity” funding uplift of £2.5m for NHS Highland, of which £747k is expected to pass through to Argyll & Bute CHP. The total expected funding uplift for Argyll & Bute CHP is therefore expected to be £4.761m. Of this, approximately £3.416m will require to be committed to cover the impact of natural cost growth through pay awards and inflation. Full details of this calculation will be visible when the final budget proposal is presented for approval. The balance of funding remaining is therefore £1.345m and any approved budget increases beyond this will require to be funded from a savings programme.

2

3. Proposed budget increases The CHP Core Management Team has considered a number of proposals for inclusion in the budget. These relate to; existing cost pressures, previously agreed commitments and further proposed commitments. The following tables set out the various proposals which will be included in the budget.

Table 2 : Existing cost pressures to be funded

Savings Target shortfalls in 2013/14 £ ' 000 Commen t Unfunded displaced staff 75 Shortfall against a £90k target Oban, Lorn & Isles Locality 200 Shortfall against a £365k target MAKI Locality 55 Shortfall against a £331k target Cowal & Bute Locality 50 Shortfall against a £252k target Lead Nurse 20 No savings achieved against a £20k target sub-total unachieved savings 2013/14 400 Service Cost Pressures in 2013/14 LIH A&E nurse staffing 46 Additional staffing LIH Ward B nurse staffing 30 Additional trained hours on day shifts Commissioned services – N Highland 100 Increased referrals for acute care Commissioned services - Rohallion 111 Individual patient placement Ad hoc pay settlements 50 Various regradings & pay increases Child protection services/Viewpoint 7 Payments to A&B Council 744

Table 3 : Previously agreed commitments

Service/Cost Description £ ' 000 Comment Pain Relief Service 47 CMT 22 Feb 2013 Point of Care Testing 70 CMT 22 March 2013 Lead OT 13 Upgrade band 7 to 8a plus 0.2 band 6 Early Years Collaborative 42 CMT 31 May 2013 Violence Against Women Co-ordinator post 5 DL commitment 5 June 2013 Psychiatric Emergency Patient Transfer Service 100 Core Team 28 June 2013 - paper 8 Sustainable High Qual H/care in Remote Areas 287 Core Team 28 June 2013 - paper 9 Canakinumab high cost drug for 1 patient 90 Approved by IPTR panel Pharmacy Data Analyst / Technician band 5 19 Core Team 26 July 13 – already part funded Infection Control Advice 19 Balance arising from an increase from 2 to 3.5 sessions Superannuation auto enrolment 20 Implemented 13/14 - full year effect WoS Radiotherapy Satellite Unit 37 Approved by Regional Planning Group Lorn & Isles decontamination unit 19 Full-time AfC band 2 PMS running costs 250 Based on the approved business case Depreciation costs arising from 13/14 cap prog 194 Based on 13/14 capital investment New immunisation programmes 37 Additional Staffing costs 1,249

Table 4 : Further Commitments

3

Service/Cost Description £ ' 000 Comment Radiography review 289 Additional 5.9 wte staffing Custodial and forensic medical services 80 Transfer of service from Police Scotland New drugs 200 Oban and Lochgilphead Commissioned Services 200 New care packages and increased referrals NSD risk shares 130 Annual funding top-slice Insulin Pump Therapy for Type 1 Diabetes 95 Based on 12 paediatric and 16 adult new cases GG&C gap 500 per discussions at meeting held 23/1/14

GG&C s GG&C service developments 100 Cancer care, homecare, ante-natal scanning etc. LIH lucentis development 100 S. Whiston email 2/12/13 LIH OP clinics 27 Additional auxiliary nursing hours LIH ward B 67 Additional auxiliary nurse on night shift Moving and Handling Advisor 23 Band 6, 0.5 wte – CMT 31/1/14 1,811

Taken together, the three tables add to £3.804m which is greater than the available funding of £1.345m by £2.459m. As a result, a savings programme of £2.459m will also require to be agreed to enable a balanced budget to be approved. 4. Savings programme Table 4 below gives an indication of the level of savings that could be achieved from a blanket “2.5% across budgets” approach.

Table 5: Potential savings plan

Recurring Savings Targets £ ' 000 Comment Oban, Lorn & Isles Locality 482 Mid Argyll, Kintyre & Islay Locality 432 Argyll & Bute Hospital - Mental Health Service 187 Cowal & Bute Locality 322 Helensburgh & Lomond Locality 126 Other CHP-wide Clinical Services 79 Prescribing 426 Corporate services 101 Public Health/Health Promotion 28 Lead Nurse 26 Commissioned Services 100 Depreciation 75 Displaced Staff 75 Relates to specific posts 2,459

A savings programme of this scale will be a significant challenge and it is clear that more work is required to define how savings of £2.5m can be achieved to support the various commitments contained in the budget. In addition, it should be noted that there is also separate requirement to generate savings to support recurring investments made through the RCOP Change Fund. There is currently a

4

£200k shortfall in the RCOP disinvestment plan that requires to be addressed and this is in addition to the general savings programme. George Morrison Head of Finance Argyll & Bute CHP 11th February 2014


Item No 9.1

PDP/R AND e-KSF IMPLEMENTATION 2013/14 Report by : David Logue, Head of HR 1 BACKGROUND AND SUMMARY The implementation of the KSF Personal Development Planning and Review process using e-KSF for staff is now well established in the CHP. This provides clear data that the majority of managers and their staff are meeting regularly to discuss employee development and performance. The target is that 80% of all staff will undertake a PDP/Review discussion each year and have this recorded on e-KSF. At the end of January 2014 progress was as follows: Area All

AfC staff

Reviews signed

off

% of AfC staff (all)

% of AfC staff (excl bank)

No of Reviews

completed within last 12 months

% Reviews

completed within last 12 months

(excl bank)

% Reviews

completed within last 12 months ( % of all

Staff)

% Reviews

completed within last 12 months ( % of all

Staff) %

previous month

Argyll and Bute CHP

2157 640 29.67 39.79 1008 62.5

46.73 56,40

Corporate Services

758 154 20.32 20.92 431 58.56 56.86

N/A

West 992 227 22.88 32.80 435 62.86 43.85 N/A Mid Highland

589 124 21.05 28.51 250 57.57 42.44 N/A

North Highland

1024 251 24.51 34.81 413 62.14 43.75 N/A

Raigmore Hospital

3578 631 17.64 24.57 1244 48.44 34.77 N/A

South Highland

673 108 16.05 21.09 244 47.66 36.26

N/A

Source: e-KSF 31-01-13 2 MONITORING PROGRESS 2013/14 The table above shows the current position with 1008 Reviews having been undertaken out of 2157 employees (62.5%) over the last 12 months. Since April 2013 640 staff, (29.67%), have recorded a meeting on e-KSF. These figures are higher than other areas within NHS Highland, however, there is currently a downward trend in the rolling 12 month figure and actions are being undertaken by operational managers to address this. Usually there is an increase and concentration on carrying out reviews between January and March. However it is recognised that considerable efforts will be required to reach the same level as at 31st March 2013, (63.86%).

The CHP Committee is asked to:

• Note the current position • Note the progress in embedding this in practice to support and direct staff

development in line with CHP and NHS Highland objectives • Note the need to ensure reviews and PDPs are actively progressed over next 2

months • Note the need to ensure bank staff have a review

2 Sally Munro Workforce Development Facilitator 05-02-14

3 ACTIONS FOR 2013/14 In order to progress efforts in 2013/14 and improve the proportion of staff that have an annual review, there continues to be a focus on the following :

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

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

outline and review

• Continuing commitment by line managers to schedule and complete their staff PDPs over the next 2 months

• Ensuring and improving quality of reviews and evidence

The KSF Review and Development Process and use of e-KSF now appear 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 Worker(HCSW) Standards to ensure public protection and maintenance of professional standards within our workforce. Also, national support resources which have been detailed in previous reports have been circulated and are being used by managers to improve the quality of the PDP discussions. 4 FUTURE DEVELOPMENTS The contract for e-KSF is likely to end in March 2015. Work is progressing nationally to identify how the KSF/PDP&R process will continue to be recorded electronically and this is most likely to be incorporated into the recently implemented national Workforce software - Electronic Employee Support System (e-ESS). This is likely to result in simplified processes and language used and should be an opportunity to address some of the drawbacks and criticisms which have been highlighted by staff using e-KSF. 5 CONTRIBUTION TO BOARD OBJECTIVES The achievement of the target is in line with the NHS Highland Board objectives. 6 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.

3 Sally Munro Workforce Development Facilitator 05-02-14

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. 7 IMPACT ASSESSMENT The KSF and e-KSF processes are impact assessed at National level and will be monitored as part of overall staff engagement measures. David Logue February 2014

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

All Staff Non Bank All Staff Non BankNHS Highland 10665 1489 13.96% 355 3.33% 2282 21.40% 28.41% 4126 38.69% 4441 41.64% 55.28%

A&B Mental Health Services 214 11 5.14% 4 1.87% 53 24.77% 38.41% 68 31.78% 79 36.92% 57.25%Argyll & Bute Central Services 143 22 15.38% 9 6.29% 47 32.87% 34.31% 78 54.55% 79 55.24% 57.66%

Cowal and Bute Area 391 48 12.28% 13 3.32% 154 39.39% 48.28% 215 54.99% 227 58.06% 71.16%Dental Service (Argyll & Bute) 95 14 14.74% 4 4.21% 41 43.16% 44.09% 59 62.11% 52 54.74% 55.91%

Helensburgh and Lomond Area 90 19 21.11% 3 3.33% 23 25.56% 29.87% 45 50.00% 39 43.33% 50.65%Mid Argyll Kintyre & Islay 591 82 13.87% 14 2.37% 175 29.61% 43.97% 271 45.85% 231 39.09% 58.04%

Oban Lorn & Isles Area 633 99 15.64% 15 2.37% 147 23.22% 32.67% 261 41.23% 301 47.55% 66.89%Argyll and Bute CHP 2157 295 13.68% 62 2.87% 640 29.67% 39.70% 997 46.22% 1008 46.73% 62.53%Notes1 From e-KSF - does not include Adult Social Services data (unless Agenda for Change)Current position if Bank Posts are removed from 'Total Posts' - data from Workforce Information Staff List

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

Off'1 (01/04/2013-31/01/2014)e-KSF Reviews 31st January 2014

Total Posts1 Reviews 'Started'1

Reviews 'Completed & Not Signed Off'1

Page 1 of 1 03/02/2014

Argyll & Bute CHP Committee19 February 2014

Item : 9.1a

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

All Staff Non Bank All Staff Non BankNHS Highland 10665 1489 13.96% 355 3.33% 2282 21.40% 28.41% 4126 38.69% 4441 41.64% 55.28%Argyll and Bute CHP 2157 295 13.68% 62 2.87% 640 29.67% 39.70% 997 46.22% 1008 46.73% 62.53%Corporate Services 758 130 17.15% 22 2.90% 154 20.32% 20.92% 306 40.37% 431 56.86% 58.56%Raigmore Hospital 3578 447 12.49% 126 3.52% 631 17.64% 24.57% 1204 33.65% 1244 34.77% 48.44%West Area 992 120 12.10% 32 3.23% 227 22.88% 32.80% 379 38.21% 435 43.85% 62.86%Mid Area 589 62 10.53% 13 2.21% 124 21.05% 28.51% 199 33.79% 250 42.44% 57.47%North Area 1024 124 12.11% 38 3.71% 251 24.51% 34.81% 413 40.33% 448 43.75% 62.14%S+M Grouped Services 888 183 20.61% 46 5.18% 146 16.44% 19.44% 375 42.23% 381 42.91% 50.73%South Area 673 128 19.02% 16 2.38% 108 16.05% 21.09% 252 37.44% 244 36.26% 47.66%Children's Services 229 33 14.41% 7 3.06% 59 25.76% 25.76% 99 43.23% 108 47.16% 47.16%Adult Social Care Services 1961 21 1.07% 0 0.00% 0 0.00% 0.00% 21 1.07% 0 0.00% 0.00%

Notes1 From e-KSF - does not include Adult Social Services dataCurrent position if Bank Posts are removed from 'Total Posts' - data from Workforce Information Staff List

Reviews 'Completed & Signed Off'1 (12 month rolling)e-KSF Reviews 31st January

2014Total

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

Reviews 'Completed & Signed Off'1 (01/04/2013-31/01/2014) Reviews at all stages1

Page 1 of 1 03/02/2014


Item : 9.1b


Item No : 9.2

ARGYLL & BUTE CHP

ARGYLL & BUTE CHP PARTNERSHIP FORUM

MINUTE OF MEETING HELD on

14th November 2013 in Aros Boardroom Present: Derek Leslie (DLe) Director of Operations Co-Chair David Logue (DLo) Head of HR Alastair Craig (AC) Senior Management Accountant Gaye Boyd (GB) Personnel Manager Louise Stanesby (LS) Royal College of Nurses Elizabeth Reilly Assistant Clinical Director for Dentistry Fiona Broderick (FB) Unite

By VC Dawn Gillies (DG) Unison (Co-Chair) Pauline Murtie (PM) Assistant Locality Manager H & L Lorna Low (LL) Royal College of Midwives Sally Munro (SM) Workforce Development Facilitator Apologies: John Dreghorn (JD) Mental Health Project Director - Mental Health Modernisation Christina West (CW) Locality Manager MAKI Veronica Kennedy (VK) Acting Locality Manager OLI Angela Dewsnap (AD) Personnel Officer Pat Tyrrell (PT) CHP Lead Nurse Helen Duthie (HD) Unison Colin Crawford (CC) British Dental Association Kate McAulay (KM) Clinical Service Manager MAKI Bill Staley (BS) Information & Projects Manager George Morrison (GM) Head of Finance Stephen Whiston (SW) Head of Planning, Contracting and Performance Elizabeth McMillan (EM) Unison (Co Chair) Julian Gascoigne (JG) Risk/Health & Safety Manager, Clinical Governance & Health & Safety Team Mark Middleton Risk/Health & Safety Manager, Clinical Governance & Health & Safety Team Barbara MacGilp Senior Radiographer Peter Cartwright Lead Nurse Mental Health Donald Watt Clinical Service Manager OLI

Minutes: Rose MacVicar (RM) HR & Planning Contracting & Performance

Subject Action 1 Welcome and introductions

DLe agreed to chair and welcomed all to the meeting. It was agreed that despite the number of apologies that the meeting was quorate.

2 Minutes of the meeting held on 3rd October E Cowan had advised that she did not attend the meeting but had submitted her apologies. With this change the minutes were accepted as a full account of the meeting.

RM

3a Matters arising (not included in the agenda items) a) DLe advised that as before the recording equipment was to be used for the

enhancement of the minutes of the meeting.

2

Subject Action 3a) Matters arising (not included in the agenda items) continued

b) Whistle blowing

DLo advised that Confidential Alert Line information cards and posters have been distributed. The card is designed to aid and direct individuals who wish to raise issues of concern. DLo had contacted Adam Palmer (AP), Employee Director, who in turn contacted Maimie Thomson, regarding NHS Highland (NHSH) contact details to be included on the posters should staff wish to go through NHSH rather that through Scottish Government contact – DL advised that he is awaiting update.

DG advised that cards have not been issued in the Cowal area. DLo advised if the Alert cards have not been dispersed staff should check with their Locality Managers.

c) Staff survey DLo had contacted Adam Palmer who advised hard copies of the survey had been circulated across Highland though the number returned was fairly low in ratio to staff. Due to the nature of the survey it may be difficult to get actual numbers on returned forms for Argyll & Bute. It was noted that the official outcome will be published later this month.

d) Mileage rates As noted in previous minutes concerns remain regarding the financial impact of deduction of home to work mileage for staff who are working away from home for more that one day (e.g. Public Health staff based in Islay for 2 – 3 days). For information DLo presented an overview of the process and completion of travel claims for these scenarios. It was noted that STAC guidance has clarified that in cases where staff were away from home overnight for more than one day only one day’s home to work will be deducted.

e) Public holidays accrued during Maternity leave.

FB advised due to the introduction of new systems and mandatory training it may be challenging for staff who have accrued public holidays during maternity leave to ensure they use their full entitlement prior to 31st March. DLe advised that where possible staff should ensure that all leave is taken before 31st March. Any leave carried forward – up to maximum of 5 days – will be at the discretion of Line Managers and assessed on a case by case basis.

f) Highland Partnership Credit Union DLo advised that NHS Highland are promoting HI-Scot amongst staff members. Full details are available on the HI-Scot website via the NHS Highland Intranet site at htpp://intranet.nhsh.scot.nhs.uk/Staff//Pages/HI-ScotCreditunion.aspx

There are no plans for information posters etc to be made available at this time. FB advised this may be detrimental to staff who do not have access to a computer. DLo will raise at the Highland Partnership meeting to be held on 15th November.

g) DLe advised an invitation to attend the Partnership meetings was forwarded to

Adam Palmer (AP) and was pleased to advise that AP will be VC to the

DLo

3

Subject Action 3b Matters arising (not included in the agenda items) continued

g) Partnership meeting in January.

On behalf of the Partnership DLe extended a welcome to AP and it is hoped that AP will also be able to attend a meeting in person in the future.

DLe further advised that he had received an email of thanks from Ray Stewart former Employee Director, thanking the Partnership for the kind thoughts on his retirement.

DLe will forward a copy of the email for onward circulation.

Matters arising (contained in agenda) a) Contact Officers

DLo advised that he was unable to source a Role Descriptor for Contact Officers. FB enquired if information had been circulated regarding the decision to appoint Contact Officers. FB stated further that she was aware of some interest in the former role and asked for an overview of how the recruitment process was conducted. DLo advised that prior to their retiral there were three individuals in Argyll & Bute who would visit and discuss issues with staff. Unfortunately there was a very poor response to the advert for these posts thus proving difficult for the CHP to recruit to the posts. It was agreed through Highland Partnership Forum that, rather than lose this type of contact for staff, Contact Officers be appointed. DLo further advised that the former role is no longer applicable and the recently named contact officers would provide information and act as signposts for staff. They would not assume the role of advocate or advisor as contact officers had done previously.

DLe/RM

At this point AC joined the meeting Matters arising (contained in agenda)

b) eESS Letters with login details have been circulated to Managers, Team Leaders etc for onward dispersal to staff members. In due course all staff will be accessing the system to review personal details and apply for annual leave. FB enquired if training or a demonstration on how to access the system will be made available to staff. DL advised that details on how to access/use can be found on the Intranet page. FB wished to emphasise that there will be issues using this system and other electronic methods as not all staff have access to computers. It was acknowledged that as the CHP and NHSH are moving more to communicating with staff via electronic means, consideration/discussions will have to be held on how access can be achieved. Managers must be proactive in engaging and encouraging staff to use the systems and where possible ensure access is made available.

c) Highland Quality Approach As JG was unable to attend the meeting this item will be carried forwarded to the next Partnership Forum meeting

JG

4 Integrated Store As neither David Ross nor Veronica Kennedy were able to attend the meeting it was agreed that the item be carried forward to the next meeting.

4

Subject Action 4 Integrated Store continued

GB advised that she attended the OLI Organisation Change. The issue of the Integrated Store was raised by Helen Duthie. It was advised at the meeting that DR with support from HR has had meetings with staff to discuss proposed changes.To aid discussion it was felt that it was vital for David Ross to attend the next meeting of the group. DLe agreed to contact DR.

DLe

5 Staff Flu immunisation Programme As PT was unable to attend the meeting DLo presented an overview of the paper compiled by PT (copies of which will be circulated following the meeting). It was noted that there has been a low uptake with Health Care workers throughout Scotland. Health Boards are being encouraged to offer immunisation and ensure that all staff consider the benefits of having the vaccine. Flu champions are in situ within Argyll& Bute their role being to enthuse and encourage staff to be vaccinated particularly staff who are in direct contact with patients. It was noted that there has been some negative reaction from staff. It was agreed that the Partnership support the commitment to the vaccination programme and the work of the flu champions. DG raised the issue of availability of flu vaccination for those who have a caring role in the community e.g. Local Authority, Third Sector and private care services employees. LL advised Local Authority staff have been accessing vaccinations through the flu clinics. LS advised GPs run flu clinics locally and carers etc can approach their local GPs for vaccination.

RM

6 Finance Update AC presented an overview of the report which was circulated prior to the meeting. It was noted there is a slight increase in the overspend reported at the end of August. Budget pressures have occurred due to unachieved savings as detailed in the report. In order to achieve a break even position at the end of the financial year it is imperative that all staff minimise the out flow of funds and make every effort to curb expenditure over next few months ensuring that any such action does not impact on the service to patients.

7 Highland Partnership No update available as no members were available to attend the last meeting.

8 Argyll & Bute CHP Committee DLe presented an overview of the meeting held on 23rd October. a) Islay clinical Review Group

Update paper tabled at CHP Core Management Team on 30 August 2013 - recommendations of Review Steering Group were endorsed.

b) Kintyre Continuing Care Beds – Campbeltown Hospital

The CHP are committed to reviewing the outcome of the bed modelling process and are taking advice from the Scottish Health Council about how the CHP review the involvement and engagement process. Until this is completed, matters remain pending. At present the hospital are managing to operate with the 21 available beds, with a contingency plan for additional beds to cope with increases in demand.

5

c) GP service Ross of Mull & Iona DLe advised that the GPs have tendered their resignations. Given the difficulties experienced in recruiting to similar posts in Argyll & Bute it is the intention of the

Subject Action 8 Argyll & Bute CHP Committee continued

c) CHP to work with relevant stakeholders on the Isle of Mull and the community to

explore the issues and examine service options which will enable a sustainable GP service to be provided to the population.

Throughout the process the CHP will continue to provide a GP service by the use of long term Locum GPs.

d) Patient Management System

The system is due to “go live” on 3 March 2014. Process for the outpatient clinics has begun with letter templates due to be completed January 2014.

e) Public Health Annual Report

Was circulated and discussed. It was noted that this was very readable and useful reference document

f) Mental Health Modernisation

It was advised that the replacement building for the Argyll & Bute Hospital has been further delayed due to the complex tendering process required by Scottish Government. It is now anticipated that the date of completion in will be 2016.

DLe advised that the next meeting of the Committee will be held in December. An overview of the discussions at this meeting will be tabled at Partnership Forum in January 2014.

DLe

9 Mental Health Redesign Unfortunately JD was unable to attend the meeting today. FB agreed to forward the most recent report to RM for onward circulation.

FB/RM

6

10 Workforce Planning and Development a) HCSW

SM presented an update on Code of Conduct for HCSW. • New staff

It was noted that Managers are continuing to report difficulties in achieving the standards in the required timescale - the main reason being these are members of staff who work very limited shifts.

It was noted that 16% of staff have completed within the timescale, 71% are beyond the three months target with 39 members of staff still to complete.

• Existing staff

840 signed forms have been received confirming the Code of Conduct has been signed and agreed giving a figure of 88%. Whilst this is a huge improvement there is still some way to go to achieve the 100% target. Once more Managers advise that it is mainly bank staff, though it was noted that 50% of the outstanding are permanent staff. The delay in completion for permanent staff may be the result of career breaks, long term sick etc. SM has requested Managers forward details of reasons for delay to her to allow this to be included with future reports.

SM will forward copies of the report to RM for onward circulation b) EKSF

SM presented an overview of the position across NHS Highland as at 31 October 2013. The CHP currently has 12.62% of all staff (17.76 % excl bank) with reviews and

SM/RM

Subject Action 10 Workforce Planning and Development

b) EKSF continued personal development plans signed off in e-KSF for this year so far. The total percentage for NHS Highland is 9.04% (12.22% excl bank posts) As advised in last meeting we now operate a rolling 12 month figure. Based on the reported figures it is noted that there has been a marked drop since last report and from the set target of 80%. SM advised further that monitoring of the trends have indicated a continuing downward trend and that steps should be taken to ensure that reviews are carried out during the year rather than done as a bulk process towards the end of the March. Specific actions will need to be undertaken to address issues for staff who require a named manager, an e-mail address or do not have an KSF outline. These issues will continue to impact on the statistics unless addressed.

Discussions were held on the difficulty of completion of EKSF for bank staff or staff who work limited hours within the year. Although acknowledged that all staff must undergo the EKSF process the viability of using staff who only work for a limited period e.g. one shift over a period of several months came under consideration with particular emphasis being placed on the mandatory training required, how up-to-date their skills were and how other mandatory process i.e. EKSF can be accommodated. SM advised that a number of bank staff used are already in post in the CHP and may also have more than one bank staff contract.

7

It was noted that the Integrated Bank Hub can provide details of nursing bank staff. GB advised that a letter had been circulated asking bank staff if they wished to remain on the availability register. This resulted in a number of people advising that they no longer wish to be included.

SM will forward copies of the report to RM for onward circulation c) Redeployment

GB presented an overview of the up-to-date position advising that there had been little change from last month’s report. GB will forward copies of the report to RM for onward circulation

Some discussion was held on ‘protection’ for staff who come under the agenda for change guidelines.

For information DLo will circulate paper form Donald Shiach for information.

SM/EM GB/RM DLo

11 Organisational change a) CHP & Locality Group

DLo advised that the next meeting is due to be held on 18thNovember. A full update will be given at the next Partnership meeting.

b) Mid Argyll

No update available at this time.

DLo

Subject Action 11 Organisational change continued

c) B & C H&L Meeting was cancelled to be rearranged and an update will be forwarded in due course.

d) OLI A copy of the minutes of the meeting held on 24th October arrived too late for circulation. As VK was unable to attend the meeting DLe agreed to present an overview of the minutes.

• No changes noted on the displaced register • Medical Records Redesign Update - Admissions Office is now open. • Mull redesign – to be discussed at the next meeting • Mull LA Progressive care discussed • Integrated store briefing given by David Ross • Speech and Language Therapy are in the process of redesign • Review of children’s services - additional impact on staff – Patricia Renfrew

to attend the next meeting of the group. • Radiology review WFP workforce issues being discussed • Dental services – staffing issues discussed.

Copy of the minutes will be circulated in due course.

RM

12 AOCB a) DLe presented an overview of the email received from Elaine Mead regarding

annual leave copy of which was circulated prior to the meeting.

b) As advised earlier in the meeting Adam Palmer attending the Partnership meeting in January by VC.

8

c) DLo presented an overview of the email from Heidi May regarding the uniform

policy copy of which was circulated prior to the meeting.

Within the content of the email it was noted that all staff must adhere to national policy. DLo agreed to circulate a copy of the uniform policy for information.

d) Pin Policy Consultation

Overview of the Pin Policy consultation document was presented by DLo. It was noted that comments are to be submitted by 31st January. As the paper is lengthy and time is required to consider and draft comments it was agreed that discussions be held at the next Partnership meeting. Comments on the document will be collated and included as a composite reply for the Partnership.

All comments on the documents should be forward to RM no later than the 7th January 2014. e) DG advised that she had attended training recently on Sect 47 Mental Health

Act. She felt that the training would be of value to all nursing staff.

FB advised that the training is organised by Argyll & Bute Council and anyone interested in attending should contact ABC directly. It was noted that the course is held over a morning or afternoon.

DG advised that Elizabeth MacMillan the Co-chair of this group is retiring from

DLo/RM All/RM

Subject Action 13 AOCB continued

e) her clinical role on 30th November, though is planning to return some time in

December to continue in her staff side representation role.

On behalf of the Partnership DLe expressed good wishes to Elizabeth on her retirement.

11 Meeting closed Next meeting to be held on 9th January 2014 in Aros Boardroom at 12.30 p.m. Dates for further meetings in 2014 as follows 20th February 3rd April 15th May 26th June 14th August 25th September 6th November 18th December

All meetings to be held in Aros Boardroom commencing at 12.30 p.m. All papers for discussion must be submitted 7 days prior to the meeting

9

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

mariecurie.org.uk/argyllandbute

Argyll and Bute: Post launch brief January 2014 Launch details On 25th November 2013, the Argyll and Bute Delivering Choice Programme was launched in Inveraray, Argyll and Bute by several leading Scottish figures.

The aim of the launch was to raise awareness of planned services and initiatives; and celebrate partnership working and collaboration that has been a theme throughout the programme.

The day was co-chaired by Derek Leslie, CHP Director of Operations and Nichola Summers, Marie Curie Divisional General Manager and who celebrated the collaboration and use of evidence and research with local audit and stakeholder events to deliver a robust and quality set of initiatives.

Over 80 people attended the event and represented the public, independent, third sector, MSPs and local councillors.

Speakers included: Argyll & Bute Programme Sponsors, Pat Tyrrell, Lead Nurse and Derek Leslie, Director of Operations; Ranald Mair (CEO, Scottish Care), Mike Russell (MSP for A&B); Dr Elizabeth Ireland (Local GP, author of Living and Dying Well and former National Palliative Care Lead). Marie Curie speakers were Diana Hekerem (DBSDM), Lynne Millar (CLN) and Nichola Summers (DGM).

Information was displayed from: Marie Curie, Good Life Good Death Good Grief, Scottish Care, Solicitors for Older People, Living it Up, and Oban Hospice at Home service.

The evaluation scored very good or excellent and informal feedback has been very positive from all our stakeholders, and referenced at several key Argyll and Bute meetings since

Feedback

Verbal feedback on the day was positive and we received 13 completed evaulation forms. Feedback included - “I would like to acknowledge all who have worked hard to deliver a huge piece of work. The launch event was excellent” and “Very exciting time for Argyll and Bute. Lots of initiatives and dedication.” Other feedback related to the venue space, however, this was the result from the event being over-subscribed, with people unexpectly attending on the day. This highlights the wide interest in palliative and end of life care.

The launch was positively referenced at a number of key A&B meetings since (Care Home Network Meeting and Palliative Care Development Steering Group).

Budget

The budget was set for £2, 000 and the final total was £2, 157.80. The additional £157.80 will be taken from the contingency fund, leaving a total of £7, 842.2.

Support in launch planning

There was excellent support from external and internal people and teams. Particular thanks to the Ardenlee Care Home in Helensburgh, who allowed the BBC to film, Scottish Care reps Anna Houston and Julie Thompson, Fiona Sharples, Rebecca Paterson (SPPC) and the organisations providing information for the stand.

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Item : 10.1a

Within Marie Curie, the following individuals are thanked for their input and support: Stefanie McNamee (Team Adminstrator), Richard Meade (Policy and Public Affairs), May Fern Lee (Marketing), Ben Wicks (PR), and the Webber Shandwick PR team.

Press and social media coverage

A press release included quotes from Pat Tyrrell, Mike Russell (A&B MSP) and Michael Matheson (MSP & Public Health Minister).

The Argyll Advertiser and Campbeltown Courier attended the launch. Local newspapers Argyllshire Advertiser and Dunoon Observer featured articles (see appendix). The Herald and Third Sector News had a “news in brief” piece.

Pat Tyrrell was interviewed about palliative care in A&B and a Helensburgh Care Home was featured in a piece by BBC Scotland news. Diana Hekerem was interviewed live on Good Morning Scotland on the morning of the event about the project.

Jen Layden blogged about the programme was released on the website, twitter and facebook on the event day (see appendix).

Mike Russell (A&B MSP) wrote about the event on his personal blog, giving his support to the “important project” and of the “interesting and informative contributions.”

The A&B webpage hosted on the Marie Curie website has been updated with material from the launch http://www.mariecurie.org.uk/en-GB/Commissioners-and-referrers/Commissioning-our-services/pilot-projects/Argyll-and-Bute/?Tab=4

Political

Following the launch, Mike Russell and Jamie McGrigor were sent thank you emails and pictures to use on their constituency websites.

Emails sent to MSPs and councillors not in attendance updating on the launch. As a result, a meeting with Mike MacKenzie MSP has been arranged for 23rd January to provide more information. Jean Urquhart has expressed interest in attending any furture events or roadshows.

Marie Curie is holding an event at Scottish Parliament for 4 days in March 2014. Information about the Argyll and Bute DCP will be displayed at this event.

Learning points:

Better utilisation of social media i.e. Youtube clips and Twitter feeds.

Earlier identification and arrangement of patient case studies. STV did not attend as they wished to film in a patient home with a nurse delivering care. Arranging filming for the BBC occurred very late in the planning.

Next steps: 1. Ensure continued engagement and increase work with local communities in engaging with programme

initiatives and servcies. This will occur through membership to project steering groups, working closely with all partners, attending key events in Argyll and Bute (such as Person Centred workshop in Mar 14) and regular programme newsletters.

2. Attend meeting with Mike MacKenzie MSP (23rd January 2014) and continue to inform council and political contacts of programme progress.

3. Identify future PR opportunities to support the launch of other DCP services and initiatives within Argyll and Bute. Current plans to agree a piece in local press about new MCNS, including interview with Pat Tyrrell and local Marie Curie Nurse.

4. Attend a meeting with Rebecca Paterson and Mark Hazelwood (27th January 2014) to gain support from GLGDGG and SPPC for the Health Promoting Palliative Care project and wider DCP programme.

5. Identify opportunities to inform best practice in service development, partnership working and community engagement. A poster presentation on community engagement including work in Argyll and Bute, will be presented at the Marie Curie/RSM conference in London on 28th March 2014.

6. Work with Living it Up to support palliative care material and DCP programme material.

http://www.mariecurie.org.uk/en-GB/Commissioners-and-referrers/Commissioning-our-services/pilot-projects/Argyll-and-Bute/?Tab=4

http://www.mariecurie.org.uk/en-GB/Commissioners-and-referrers/Commissioning-our-services/pilot-projects/Argyll-and-Bute/?Tab=4

For more information: Jennifer Layden

Project Manager

Argyll and Bute Delivering Choice Programme

Marie Curie

Glasgow Hospice

Glasgow, G21 3US

Phone: 0141 557 7538

Email: [email protected]

Appendix A: Press and social media coverage The Herald:

Marie Curie blog:

mariecurie.org.uk/argyllandbute

Dunoon Observer:

Argyllshire Advertiser:

Page 1 of 15

ARGYLL AND BUTE DELIVERING CHOICE PROGRAMME

Programme Plan

Author: Jen Layden

Approved: DCP Programme Board

Date: January 2014

Version: 1.0


Item : 10.1b

Page 2 of 15

Purpose 1. The purpose of this document is to describe the programme plan for the

implementation of new services and initiatives under the Argyll and Bute Delivering Choice Programme (DCP).

2. This document relates to the overarching DCP strategic objectives and aims.

Separate project documentation will be produced for services and initiatives implemented under the DCP programme.

3. The programme utilises the Marie Curie Delivering Choice Programme (DCP) methodology, which incorporates robust programme and project management principles, and service design and implementation.

Section A: Background Key issues in palliative and end of life care within Argyll and Bute: 4. Palliative care is an approach aimed at improving quality of life for patients,

families and their carers, focusing on addressing psychological, social, spiritual as well as physical needs. Palliative and end of life care has, in recent years, become institutionalised. This is reflected in the shift from dying at home to dying within hospital and other institutions. National surveys have indicate that around 65% people would prefer to die at home. However, 2012 figures from the General Registers Office for Scotland show that 23% of people from Argyll and Bute died at home, and 49% (approx. 500 people) have a hospital admission preceding death.

5. The Argyll and Bute DCP programme has to date identified a number of key issues to be addressed within the area:

a. Addressing the culture around death, dying and bereavement is a core element to the Argyll and Bute Delivering Choice Programme. A recent survey identified that 70% of Scottish respondents questioned felt that death and dying was not discussed enough and 53% felt comfortable talking about death and dying.1 It has been argued that death has become medicalised, and as such there is often anxiety, a sense of failure and taboo around death and dying.2 The unwillingness to discuss death, dying and bereavement may lead to a lack of appropriate care.3

b. Inequities in care still occur throughout health and social care systems. In relation to Argyll and Bute, there are a number of inequalities that project teams should remain mindful of when designing new services and initiatives:

1 Marie Curie Cancer Care and ComRes (2013) Public Perceptions of Death.

http://www.mariecurie.org.uk/Documents/press-and-media/Marie%20Curie_Perceptions%20of%20Death%20Toplines_11%20February%202013_FINAL.pdf 2 McCann, C.J, and Adames, H.Y. (2013) Dying other, dying self: Creating culture and meaning in

palliative healthcare. Palliative and Supportive Care, 11, 289-293. 3 Seymour, JE., French, J., and Richardson, E. (2010) Dying matters: let’s talk about it. BMJ, 341, 644-

648.

http://www.mariecurie.org.uk/Documents/press-and-media/Marie%20Curie_Perceptions%20of%20Death%20Toplines_11%20February%202013_FINAL.pdf

http://www.mariecurie.org.uk/Documents/press-and-media/Marie%20Curie_Perceptions%20of%20Death%20Toplines_11%20February%202013_FINAL.pdf

Page 3 of 15

i. Remote rural context including access to transportation ii. Palliative care for non-malignant disease

iii. Social deprivation iv. Inequality due to race, gender, age or other social factors.

Strategic context in Argyll and Bute: 6. It is widely recognised that our population is aging and more people are dying of

chronic disease. A number of Scottish Government strategies support the changes required to health and social care including closer working relationships with the independent and voluntary sector.

7. The ‘Better Health Better Care’ (2007) action plan stated a commitment to the delivery of high quality palliative care based on need rather than diagnosis, and stated the intention to publish a national action plan for palliative care in 2008.4 In Audit Scotland’s Review of Palliative Care Services in Scotland presented the first detailed look at activity, quality and costs of palliative care services across Scotland.5

8. ‘Living and Dying Well’ (2008) uses the concepts of planning and delivery of care,

communication and information sharing as a framework to support a person centred approach to delivering consistent palliative and end of life care in Scotland.6 Within Argyll and Bute, the Palliative Care Service Development Group was established to progress the Living and Dying Well action plan for the CHP.

9. Shifting the Balance of Care has identified the improvement of palliative and end

of life care, as one of eight high impact areas required to deliver national and local outcomes and targets. 7 This policy aims to improve the health and wellbeing of Scottish people by increasing an emphasis on health improvement and anticipatory care, providing more continuous care and more support closer to home. This will be achieved through a partnership approach between the NHS, Local Authorities, Independent sector and the Third sector.

10. Service redesign and partnership working is also underway as part of Reshaping

Care for Older People.8 This work is funded directly from the Scottish Government through the Change Fund. It is through this strategy work that Marie Curie was commissioned to review and redesign palliative and end of life care in Argyll and Bute.

4 The Scottish Government (2007) Better Health, Better Care: action plan

5 Audit Scotland (2008) Review of palliative care services in Scotland.

6 The Scottish Government. Living and Dying Well: A national action plan for palliative and end of life

care in Scotland. 7 Shifting the Balance of Care Delivery Group (2009). Improving Outcomes by Shifting the Balance of

Care – Improvement Framework. 8 The Scottish Government. (2009) Reshaping Care for Older People.

Page 4 of 15

The role of the Delivering Choice Programme 11. Marie Curie has been leading in service design and research in palliative and end

of life care for decades. The primary aim of Marie Curie is to provide high quality palliative and end of life care support to patients, carers and families.

12. The Marie Curie Delivering Choice Programme (DCP) utilises programme management, change management and service redesign for palliative and end of life care.9 The DCP programmes have the following key principles:

Person centred care

Ensuring that palliative and end of life care needs are met regardless of diagnosis

Building resilience in individuals and communities to support palliative and end of life care.

Engaging with communities to design and deliver services that meet local needs.

Involving all providers and stakeholders including voluntary and independent sectors.

A whole systems, evidence based approach to palliative and end of life care

13. The programme was funded through the Argyll and Bute Reshaping Care for Older People programme board to deliver new models for palliative and end of life care.

14. The programme will not replace current or planned workstreams underway as part of Reshaping Care for Older People, Living and Dying Well, or other relevant workstreams. However, it will work closely in collaboration with them to avoid duplication or replication.

Description of the Argyll and Bute DCP Programme 15. The programme is the overarching structure to support the delivery of

workstreams, projects and service implementation. The Programme Board exists to monitor the delivery of the programme.

16. It is recognised that strong partnership working among service providers, and health and social care is central to successful programme implementation and delivery of care. The programme will contribute to the overall development of community and specialist palliative and end of life care services. Focus will also be maintained on the key issues, such as inequalities in the delivery of care, and ensure that local needs are addressed.

9 Marie Curie Delivering Choice Programme. http://www.mariecurie.org.uk/en-GB/Commissioners-

and-referrers/Service-design/DCP-Local/

http://www.mariecurie.org.uk/en-GB/Commissioners-and-referrers/Service-design/DCP-Local/

http://www.mariecurie.org.uk/en-GB/Commissioners-and-referrers/Service-design/DCP-Local/

Page 5 of 15

Argyll and Bute Delivering Choice Programme Objectives 17. The vision for the programme is to enhance palliative and end of life care for

patients, families and carers within Argyll and Bute through the provision of services as close to home as possible.

18. The programme objectives are as follows:

a. To increase capabilities to identify patients and to plan care in anticipation and in advance of needs.

b. To improve co-ordination of care, within and across settings, to support patients and families with complex and unstable palliative and end of life care needs.

c. To increase community based care service provision, and accelerate progress in shifting the balance of end of life care towards greater community based care.

d. To raise public awareness of, and promote community involvement in death, dying and bereavement.

19. This section describes the benefits that will result from the implementation of

the programme. The benefits will focus on: a. Effectiveness: improving the coverage and quality of palliative and end of

life care. b. Efficiency: Delivering more for the same or with less resourcing. c. Economic: releasing or shifting monies from one area to another, such as

acute to community. 20. The Programme Plan will include the programme objectives and evaluation plan.

The development of outcome measures and benefits will be informed by current research on outcomes for palliative and end of life care services.

Programme Scope 21. The scope of the programme will include:

a. All people resident within Argyll and Bute with palliative and end of life care needs.

b. People with non-malignant and malignant conditions who require palliative and end of life care.

c. Informal carers and families and their needs in respect to palliative and end of life care.

d. Address all aspects relating to palliative care (physical, social, psychological and spiritual).

e. Ensure alignment with relevant strategic and policy drivers including, Reshaping Care for Older People, Living and Dying Well.

22. The following are excluded from the programme scope: f. People who die with no identifiable palliative or end of life phase e.g.

sudden death, are not included.

Page 6 of 15

g. The programme will not include palliative and end of life needs of patients under the age of 18 years. This will also include patients in transition between paediatrics and adults, unless it is identified as a priority.

h. Operational or organisational issues will not be addressed. Section B: Programme Governance and Organisational Structures Background 1. Clear and effective organisation is critical to programme success, and requires

clear accountabilities and responsibilities of each role; management structures; and reporting arrangements. This section describes the organisational structure, and roles & responsibilities (see Figure 1).

2. The programme has been funded by Argyll and Bute Reshaping Care for Older People to support the facilitation of service redesign for palliative and end of life care. The role of Marie Curie is to provide expertise in change management, programme management and service redesign for palliative and end of life care. Service providers across all sectors will be involved in both the design and implementation stages of the programme.

3. The role of the DCP Programme Board is to facilitate stakeholder participation

and to be the decision making body for the programme. Figure 1: Programme and Project Structure

A&B DCP Programme Board

A&B DCPProject Board

A&B DCPProject Manager

Project Steering Group


Project steering group

Pro

ject

Man

age

me

nt

TeamAdvisory Board (Palliative

Care Development Steering

Group

Programme Sponsors 4. The Programme Sponsors are responsible for defining the strategic direction and

ensuring the programme remains aligned with this; and making the decision on the investment in the programme.

Page 7 of 15

5. In addition, the Sponsors are responsible for ensuring that the expected benefits and desired outcomes are achieved across the programme and associated projects without an undue focus on one project over another.

The Programme Sponsors are:

Derek Leslie, Director of Operations, Argyll and Bute, NHS Highland

Nichola Summers, Divisional General Manager (Scotland), Marie Curie

Senior Responsible Owner (SRO) 6. The SRO has overall responsibility, and provides direction and leadership for the

programme through:

Accountability for the programme vision and focus on achieving its objectives and realising the forecast benefits.

Maintain alignment to the agreed parameters of the programme and the overall strategic objectives of Reshaping Care for Older People, Living and Dying Well, and other relevant or emerging priorities.

Being accountable for the programme governance arrangements.

Maintaining links with key stakeholders, ensuring they are kept up to date with progress and issues that arise.

Managing the key strategic risks facing the programme.

Ensuring that there is a direct, clear and open channel of communication between the SRO and the Project Manager, to ensure that decisions made by the Project Manager have been endorsed by the SRO and that this protocol is understood by all stakeholders.

7. The SRO is:

The visible owner of the overall business change.

Recognised throughout the organisation.

The key leadership figure in driving the programme forward. 8. The purpose of having a single SRO for the life of the programme is to ensure

that a single person is responsible for the programme. If this responsibility is shared, or not acknowledged, it can be unclear who will drive the programme to completion. This can ultimately mean the programme could lose direction, momentum and potentially even fail due to no one taking responsibility for required actions.

The Programme SRO are: Pat Tyrrell, Lead Nurse, Argyll and Bute, NHS Highland Diana Hekerem, Divisional Business & Service Development Manager, Marie Curie

Page 8 of 15

Argyll and Bute DCP Programme Board 9. The Argyll and Bute DCP Programme Board, established by the SRO, helps drive

the programme forward and deliver the outcomes and benefits. The membership reflects a partnership working ethos and includes representation from statutory, independent, voluntary and patient/carer organisations. Each member of the programme board is individually accountable to the SRO for their area of responsibility and delivery in the programme.

10. The Programme Board is also responsible for:

Monitoring progress, risks and issues at a strategic level with an emphasis on the realisation of the programme benefits.

Assisting the SRO in their decision making.

Ensuring the programme maintains focus and successfully delivers agreed outcomes within its agreed boundaries (e.g. cost, organisational impact, benefits realisation, and timescales).

Resolving strategic and directional issues between projects which need the input and agreement of senior stakeholders to ensure the success of the programme.

Assuring the integrity of the programme objectives and evaluation.

Providing assurance for operational stability and effectiveness of the programme.

11. The Programme Board will meet at key decision points and may call an

extraordinary meeting of the Programme Board should any critical issues arise. Advisory Board – Palliative Care Development Steering Group 12. The Advisory Board provides expert advice and guidance on the model(s) of the

future services and initiatives. The Palliative Care Development Steering Group acts as the Advisory Board.

13. The responsibilities of the Advisory Board includes:

Assuring quality of the service design process and outputs

Reviewing plans to ensure there is adequate quality assurance in respect of clinical standards and policies.

Advising on any changes to clinical standards and policies required by or impacting on the programme.

Ensuring that an appropriate knowledge base is established, preserved and expanded through the experience of service redesign.

Programme Management Team 14. The Programme Management team consists of the Project Manager, the SROs,

and a Project Coordinator. The team are responsible for supporting the day to day management of the programme, and related project(s) emerging from the programme.

15. The Project Manager has the following responsibilities:

Page 9 of 15

The authority to run the programme on a day-to-day basis on behalf of the SRO.

To successful delivery of the new capabilities and establishing the governance arrangements. The Project Manager is also responsible for the co-ordination of the projects and engaging with the programme’s stakeholders.

Plans and designs the programme and monitors its overall progress. To do this they are responsible for creating and updating several documents that describe the strategies the programme will use.

Monitors the projects to ensure they will deliver the capabilities required for the programme and that the costs, benefits and outcomes as stipulated in the business case are realised.

Directs the specific project work to be undertaken by the Project Steering Groups and the Project Coordinator. Further details on the responsibilities of the Project Manager can be found in Appendix C.

The Project Manager reports regularly to the DCP Programme Board, keeping them informed of progress and highlighting any problems they can foresee. The Programme Board is responsible for providing the Project Manager with the necessary decisions for the project to proceed and to overcome any problems.

Project Steering Groups 16. Each Argyll and Bute DCP project will include a project steering group set up by

the DCP project manager and following the parameters set in this document. 17. The Project Steering Group membership will consist of key stakeholders including

patient and carer representatives. Where possible, the Project Steering Groups will be chaired by a DCP Programme Board member, as they have the authority to make decisions and are responsible for the commitment of resources to the project, within the constraints handed down by the Programme Board.

18. The membership of the Project Board can vary from project to project, but each member should have a specific role in the management of the project; the board should not simply mirror the stakeholder list.

19. The Project Steering Groups are responsible for contributing to the

operationalisation and implementation of the project and will meet on a regular basis.

Page 10 of 15

Section C: Workstreams and project dossier 1. The Argyll and Bute DCP programme has the following workstreams and projects within these workstreams (Figure 2). Figure 2: DCP workstreams and projects

Argyll and Bute Delivering Choice Programme Workstreams Delivery of high quality, person centred palliative and end of life care that supports patients, families, carers and professionals.

Direct Patient & Carer Support

Marie Curie Nursing Service

Supporting Staff & Organisations

Care home & formal carer project

Improved generalist/specialist PC network

Carers training

Volunteer bank service*

Best practice guidance for

transportation

Awareness raising

Health Promoting Palliative Care

Service/initiative promotion

Publication of findings in

professional and policy networks

*awaiting approval from Marie Curie Executive Board

Page 11 of 15

2. Table 1 provides an overview of the projects under the DCP programme. Each project will have a minimum of a project brief, project initiation document and project plan.

Table 1: DCP high level project dossier

Project Description Resourcing Budget (DCP funding)

Marie Curie Nursing Service Flexible 24/7 model with local coordination & assessment

0.5 Senior Nurse

Clinical Nurse Manager support

MC Service Implementation Lead

Steering group

£100, 000 (2 years)

Care home project Pilot a model of governance and training to support care homes & independent care at home providers in palliative care delivery

0.2 WTE Specialist Nurse (2 years)

AB DCP Project Manager

Steering group

£30, 000 (2 years)

Carer’s training module A module for delivery with existing carer’s training focussed on palliative and end of life care issues

0.1 WTE Specialist Nurse (1 years)


Steering group

£7, 300

Health promoting palliative care

Raising community awareness of death, dying and bereavement


Palliative Care Development Steering Group


Manage within current resources or assign some DCP contingency fund money.

Carer information To develop palliative and end of life care resource pack for carers in conjunction with Macmillan Carers Information Support Service project


MCISS steering group

Manage within current resources

Best practice guidance for remote rural transport

To assist professionals within and outwith Argyll and Bute on best practice, and considerations for transport




Awareness of services, projects and initiatives from

Through multiple channels ensure the work of the programme is promoted


DCP Programme Board and


Page 12 of 15

the programme Palliative Care Development Steering Group

Development of improved networks for specialist/generalist palliative care

Development of pathways, guidance, networks e.g. NHS GGC, NHS 24.


Palliative Care Development Steering Group


Volunteer bank service for carers and patients

Proposal to utilise Marie Curie Helper service to support carers and patients

To be confirmed Awaiting approval from Marie Curie Executive Board

Page 13 of 15

3. The following Gantt chart provides an overview of the project timelines. The end date for the programme is July 2015 and all projects with the exception of the Marie Curie Nursing Service, will close by this date.

Figure 3: Overview of project timelines

ID Project2013 2014 2015 2016

Dec Jan Feb Mar Apr May Jun Jul Aug

1 Marie Curie Nursing Service

2 Operationalise service

3 Delivering service

5 Care home project

6 Define and scope project

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul

7

8

9

10

11

Aug Sep Oct Nov Dec Jan Feb Mar Apr

Project delivery

Service evaluation write up

Palliative care training and education module for carers

Define, scope and set up project

Project delivery

15

14

13

12 Project evaluation write up

Health Promoting Palliative Care

Define and scope awareness strategy

Delivery of strategy and events

22

16

23

Project evaluation

21

19

18

17 Best practice transport guidance

Define and scope project

Develop and dissemination of guidance

Carer information resources project

Define and scope carer information needs

Development and/or collation of resources

28

26

25 Improve generalist/specialist PC network

Define and scope project

Write up workstream

Start

02/12/2013

02/12/2013

01/04/2014

18/12/2013

18/12/2013

01/04/2014

01/04/2015

01/01/2014

01/01/2014

01/07/2014

01/07/2015

01/01/2014

01/01/2014

01/07/2014

01/07/2015

01/10/2014

01/10/2014

01/04/2015

25/11/2013

25/11/2013

01/04/2014

01/01/2014

01/01/2014

01/07/2015

Finish

31/03/2016

31/03/2014

31/03/2016

29/05/2015

31/03/2014

31/03/2015

29/05/2015

31/07/2015

30/06/2014

30/06/2015

31/07/2015

31/07/2015

30/06/2014

30/06/2015

31/07/2015

01/07/2015

31/03/2015

30/06/2015

31/07/2015

01/04/2014

30/06/2015

30/10/2015

31/03/2014

30/10/2015

4 29/05/201501/05/2015Evaluation for DCP evaluation report

20 01/07/201501/07/2015Write up of workstream

27 31/07/201501/04/2014Agree and implement workplan

24 31/07/201501/07/2015Write up workstream

Page 14 of 15

4. The figures below provide an overview of the stakeholder management and programme risks for the DCP programme. Each individual project will include a stakeholder analysis, communication plan and risk management register.

STAKEHOLDERS

Strategic: Impact of the Public Bodies

bill on health & social care provision

Impact of Scottish Referendum

End of RCOP programme DCP projects with cross-

organisational partnership

HIGH LEVEL PROGRAMME RISKS

Programme Aggregated risks from

projects Lack of commitment or buy

in from stakeholders/partners

Management of interdependencies between programme & the projects

Project Availability of resources Management of project

partner expectations Scope creep and scheduling Managing timelines and

deliverables

Operational Transition from programme

management to business as usual

Business continuity and sustainability

Availability of resources to support changes

Stakeholders

Keep informed

Key players

Collaborate

Other programmes e.g. RCOP

Political & council reps

Third sector partners

Statutory sector partners

Independent sector partners

DCP Programme Board

Marie Curie SMT/Executive Board

Palliative Care Development

Steering Group

Patients & carers

Page 15 of 15

Appendix: Membership of Programme Board Derek Leslie Chair, Director of Operations, Argyll and Bute CHP Chris Doogan Carers Development Diana Hekerem Divisional Business & Service Development Manager Anna Houston Director, Carewatch Glenn Heritage CEO, Argyll Voluntary Action Jen Layden Project Manager, Argyll and Bute DCP Valerie Maxwell Regional Manager - Scotland, Marie Curie Cancer Care Peter MacLaren Service Manager, Argyll and Bute Council Lynne Millar CNM, Argyll and Bute, Marie Curie Pat Tyrell Lead Nurse, Argyll and Bute CHP Nichola Summers Divisional General Manager, Scotland Vacant Clinician Vacant Locality manager Vacant Council area manager


Joint Performance Report: December 2013.

Executive Summary.

The overall balance of care describes people aged 65+ who receive funded care

provision from the Partnership. In December 2013 73% were cared for in the

community and 27% in an institutional setting. The overall Balance of Care target

increased in April 2013 to 80%/20%

The in-year Balance of Care shows 74% of people being cared for in the community as

at December 2013. The target is 80%.

At the December census date there were a total of 22 delayed discharges. One

patient breached the national target of zero delays at 4 weeks.

We had a total of 68 permanent and 2 respite care home vacancies across the area at

the end of December 2013.

The Overnight Care teams work in 8 main towns and as far as possible the areas

outlying their base, details of this work are given within the report.

The Learning Disability service review is on-going. The Balance of Care for LD service

users is 91% cared for in the community.

The Balance of Care for MH Service users is 99% cared for in the community as

opposed to residential care. Data for Mental Health unplanned admissions in shown

in this report.

Data for Children & Families services are to be included in the report at a future date,

to be agreed by the Head of Service and Area Manager, Service Development.

Key points for discussion by Joint Managers are highlighted within the report.


2

JOINT PERFORMANCE ACTION PLAN:

Action Responsible

person

Timescale Status

1 Re-design ADP Pyramid scorecard using

data from national database and change

data interval to monthly.

Area Manager,

Service

Development/ADP

Co-ordinator &

Information Officer

To be agreed Amber

2 Achieve a 10% reduction in unplanned

hospital admissions during the financial

year 2013/14 (will be monitored monthly

on Pyramid for reduction on the 2012/13

data)

CHP Director of

Operations and Lead

Nurse

31st

March

2014.

Amber

3 Children and Families dataset to be

included in this report

Head of Service

Children and

Families, Area

Manager Service

Development.

To be agreed

Amber

4 A range of measures (as described on

page 10) will be implemented to

investigate emergency hospital

admissions and seek to reduce them

CHP Lead Nurse February 2014 Amber

5 Develop an action plan for 2014 to

identify key priorities for managing and

reducing the number of delayed

discharges in order to meet the zero-at-

2-weeks target from April 2014

Service Manager

Operations/CHP

Lead Nurse

February 2014 Amber

6 Review Carr Gomm overnight Teams and

reporting mechanism for this.

Task to be delegated

by Head of Service,

Adult Care & CHP

Lead Nurse

March 2014 Amber


3

ADULT CARE

1. Joint Performance and Balance of Care, Older People.

Table 1.1 Emergency hospital admissions to local and Glasgow hospitals – December 2013

Area Emergency admissions

to local hospitals

Emergency admissions

to Glasgow hospitals

Totals

Bute & Cowal 57 74 131

Helensburgh and

Lomond (VoL)

37 60 97

MAKI 53 12 65

OLI 70 9 79

Totals 217 155 372

Table 1.1a Emergency Hospital Admissions and Re-admissions to local hospitals December

2013

Area Total

emergency

admissions

Number of

these with 2

or more

emergency

admissions

in 12

months

Re-

admissions

as a % of

the total

Age

65+

Age

75+

Cumulati

ve

Variance

YTD

(compar

ed to

2012/13)

Target

and RAG

status

Lorn 69 29 42% 27 42 +25 -48

Mull & Iona 1 0 0% 1 0 +18 0

Tiree & Coll 0 0 0 0 0 0 0

Cowal 38 17 45% 11 27 +60 -27

Bute 19 9 47% 5 14 +13 -13

Mid Argyll 26 8 31% 5 21 -9 -19

Kintyre 22 7 32% 9 13 +7 -27

Islay & Jura 5 1 20% 1 4 +7 -10

Helensburgh

(Vale of

Leven)

37 12 25 +32 -27

Totals 217 71 39% 71 146 +153 -171


4

A 10% reduction target for unplanned admissions continues to be applied to Argyll & Bute

hospitals and Vale of Leven. There is an aspiration to reduce unplanned admissions to the

Glasgow hospitals, but no target is applied at this stage, therefore these admissions are

show separately in Table 1.1a

None of the reduction targets have been achieved and all areas except Mid Argyll have

increased numbers of unplanned admissions compared to 2012/13.

In the forthcoming financial year the target needs to be reviewed, with a focus on reducing

avoidable unplanned admissions, accepting that some unplanned admissions are fully

necessary. A clear plan of action needs to be implemented to achieve the target reduction.

Scrutiny groups are already in place in all localities and analysis of unplanned admissions,

using a variety of criteria is regularly being carried out.

Emergency admissions by month/financial year 2013/14

Table 1.2 Total unplanned admissions 65+ – Argyll & Bute and Vale of Leven, 2013/14

showing linear trend.

185

209 206191

204 196

253

216 217

0

50

100

150

200

250

300

Ap

r-1

3

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Se

p-1

3

Oct

-13

No

v-1

3

De

c-1

3

Jan

-14

Fe

b-1

4

Ma

r-1

4

Unplanned admissions A&B and VoL

Unplanned admissions

A&B and VoL

Linear (Unplanned

admissions A&B and VoL)

There were 217 unplanned admissions to Argyll & Bute and Vale of Leven hospitals during

December 2013.


5

Table 1.2a Total unplanned admissions 65+ – Argyll & Bute and Vale of Leven, showing

2012/13 comparators

218211

189

232

197

175

137

156

207 209

183171

185

207 206

191204

196

253

216 217

0

50

100

150

200

250

300

apr may jun jul aug sep oct nov dec jan feb mar

Total unplanned adm.

2012/13

Total unplanned adm.

2013/14

Linear (Total unplanned adm.

2012/13)

Linear (Total unplanned adm.

2013/14)

Total unplanned admissions in December 2013 have fallen from the October peak, but

remain at higher level than last year, with an upward trend. There were 217 admissions to

Argyll & Bute and Vale of Level hospitals, with a further 155 admissions to the other

Glasgow hospitals, giving a total of 372 unplanned admissions during the month.

Table 1.2b Glasgow hospitals – 65+ unplanned admissions by month/financial year2013/14

63

73 75 75

62 63

75

58

6466

82

65

77

49

7570

65

71

16 1613 14 14

83 5

17

0 0 0

10

3 2

15

3 40

10

20

30

40

50

60

70

80

90

IRH

RAH

SGH

GRI

WGH

ViC


6

During December 2013 there were 155 unplanned admissions of Argyll & Bute residents aged 65+ to

the Glasgow hospitals. The highest numbers were admitted to RAH and IRH, from the Bute & Cowal

and Helensburgh areas.

Table 1.3 Bute & Cowal 65+ unplanned admissions

12

16

11

19 20

118

13

17

22

17

8

29

44

2730 29

44

19

23

3235

20

33

42 43

35 35

39

30

3639 38

0

5

10

15

20

25

30

35

40

45

50


Bute 2012/13

Bute 2013/14

Cowal 2012/13

Cowal 2013/14

Linear (Bute 2012/13)

Linear (Bute 2013/14)

Linear (Cowal 2012/13)

Linear (Cowal 2013/14)

There were 19 unplanned admissions in Bute during December 2013 and 38 unplanned admissions

in Cowal. There were also 74 unplanned admissions from Bute and Cowal to Glasgow hospitals

during the month, creating a total of 131 unplanned hospital admissions from Bute & Cowal during

December.


7

Table 1.4 Helensburgh (Vale of Leven) 65+ unplanned admissions

3433

23

27

3332

31

34

38

42

29

18

40

37

33

38

33

3634

29

37

0

5

10

15

20

25

30

35

40

45


VoL 2012/13

VoL 2013/14

Linear (VoL 2012/13)

Linear (VoL 2013/14)

There were 37 unplanned admissions to Vale of Leven hospital during December 2013, plus 60

Helensburgh patients were admitted to other Glasgow hospitals, creating a total of 97 unplanned

hospital admissions from the Helensburgh area during December.


8

Table 1.5 MAKI

1.5a Mid Argyll 65+ unplanned admissions

35

19 19

30

14

11

16

23

28

24

19

24

1719

1415

1920

32

2426

0

5

10

15

20

25

30

35

40

Apr may jun jul aug sep oct nov dec jan feb mar

2012/13

2013/14

Linear (2012/13)

Linear (2013/14)

There were 22 unplanned admissions in Mid Argyll during December 2013.

1.5b Kintyre & Islay 65+ unplanned admissions

35

21

35

23

2827

22

27

3634

37

32

2726

28

3231

36

31

28

22

2

6

12

9

14

8

4

7

3

11

16

45

13

16

86 6

9

4 5

0

5

10

15

20

25

30

35

40


Kintyre 2012/13

Kintyre 2013/14

Islay 2012/13

Islay 2013/14

Linear (Kintyre 2012/13)

Linear (Kintyre 2013/14)

Linear (Islay 2012/13)

Linear (Islay 2013/14)

There were 22 unplanned admissions in Kintyre and 5 in Islay during December 2013. There

were also 26 unplanned admissions from MAKI to the Glasgow hospitals creating a total of

53 unplanned hospital admissions from MAKI during the month.


9

Table 1.6 OLI 65+ unplanned admissions

6872

65

94

59

38 39

29

53

4045

52

39

59 57

44

5551

95

7369

0

10

20

30

40

50

60

70

80

90

100


LIGH 2012/13

LIGH 2013/14

Mull 2013/14

Linear (LIGH 2012/13)

Linear (LIGH 2013/14)

There were 69 unplanned admissions to L&IH during December 2013, with a total of 19

patients admitted for surgery. There was 1 unplanned admission on Mull. There were 9

unplanned admissions from OLI to Glasgow hospitals, giving a total of 79 unplanned hospital

admissions from the OLI area (including Mull) during December.

Table 1.7 Lorn Admissions by specialty:

30

37 3734

70

49 50

9

21 2017

25 24

19

0 0 0 0 0 0 00

10

20

30

40

50

60

70

80

Ap

r-1

3

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Se

p-1

3

Oct

-13

No

v-1

3

De

c-1

3

Jan

-14

Fe

b-1

4

Ma

r-1

4

Gen medical

Gen surgical

Geriatric assessment


10

POINTS FOR DISCUSSION:

• Argyll and Bute is one of the better performing partnerships in Scotland

overall in relation to numbers of emergency admissions to hospital

• We have set a challenging 10% reduction target for unplanned admissions in

Argyll & Bute and an aspiration to reduce unplanned admissions to the

Glasgow hospitals. The reduction target is not being met during 2013/14;

overall there is an increase in unplanned admissions compared to last year.

Re-admissions make up a high percentage of the unplanned admissions.

• The CHP Lead Nurse is heading up a scrutiny group to look at the numbers of

emergencies in the community and identify those people admitted to

hospital who could be looked after elsewhere.

• CSMs will provide emergency admission data from each area, to be analysed

by Joint Planning & Performance Officer.

• Review of the impact of the local scrutiny groups will be carried out jointly in

January/February 2014

• Action plan under development to improve the levels of anticipatory care

planning and intensive case management for those at highest risk of

admission/readmission – focussing on readmissions in the first instance

• Workshop session for service managers to be held in early 2014 with specific

focus on emergency admission/readmission


11

Table 1.8 Total Emergency Re-admissions – Rolling 12 month period to December 2013.

Area Total

patients

re-

admitted

as

emergenc

y in the

last 12

months

Age

d

65-

74

Age

d

75+

Admitted

from care

home

Admitted

from

Sheltered

Accommo

dation

Admitted

from own

home

Total

compare

d to last

month

Bute 47 9 38 1 2 44 +2

Cowal 98 21 77 9 0 89 -14

Helensburg

h &

Lomond

1 0 1 0 0 1 O

Mid Argyll 74 21 53 0 2 72 -1

Kintyre

103 30 73 6 7 90 +6

Islay & Jura 34 7 27 0 0 34 +2

Lorn 163 41 122 14 22 127 +2

Mull & Iona 24 5 19 0 1 23 -1

Colonsay 1 1 0 0 1 0 0

Tiree & Coll 1 0 1 0 0 1 0

OOA/not

know to

SW

120 64 56 0 0 120 +1

Totals 666 199 467 30 35 601 -3

Within this reporting system Helensburgh & Lomond rolling re-admission data shown relates only to

admissions to Argyll & Bute hospitals, not to Vale of Leven hospital.


12

Table 1.9 NHS Continuing Care Bed Occupancy:

NHS Continuing Care beds are available in Oban, Campbeltown and Lochgilphead, with Mid Argyll

Hospital accepting dementia patients from other areas.

Hospit

al code

Hospital name Designated

CC beds at

Aug 2011

Occupied

Sept. 2013

Occupied

October

2013

Occupied

November

2013

Occupied

December

2013

C101H Argyll & Bute

Hospital

0 0 0 0 0

C106H Cowal

Community

Hospital

0 2* 2* 2* 2*

C108H Islay Hospital 0 0 0 0 0

C113H Rothesay

Victoria

Hospital

0 0 0 0 0

C114H Rothesay

Victoria

Annexe

0 0 0 0 0

C121H LIGH 2 2* 2* 2* 2*

C122H Campbeltown

Hospital

14 2 2 2 2

H224H Mid Argyll

Hospital

20 9 9 9 10

Total 36 15 15 15 16

*Patients placed in Mid Argyll hospital, but shown in their home area.


• There are political pressures related to closing any Continuing Care beds and the

negotiation process requires time and sensitivity.

• The 20 beds in Mid Argyll are specifically dementia beds, which are available to

patients from any area of Argyll & Bute. Whilst we do have some specialist dementia

care homes, there are patients whose needs challenge their capacity and who need to

be accommodated in a hospital setting.


13

Table 1.10 Social Care bed vacancies, by area as at 31.12.2013.

There were 68 social care vacancies across the area, plus 2 respite vacancies.

Vacancies Bed capacity

Area Residential

vacancies

Nursing

vacancies

Single

Care

vacancies

Area

vacancy

total

No. of

residential

beds

No. of

Nursing

beds

No. of

Single

Care

beds

Total

capacity

Local authority

Bute &

Cowal

0 0 4 4 0 0 21 21

MAKI 0 0 5 5 0 0 32 32

OLI 0 0 5 5 25 0 12 37

LA Total 0 0 14 14 25 0 65 90

Private sector

Cowal 15 0 17 32 64 0 97 161

Bute 1 0 5 6 8 0 16 24

Helensburgh 0 0 0 0 16 35 98 149

MAKI 0 0 5 5 0 0 64 64

OLI 1 0 10 11 26 0 62 88

Private

Sector Total

17 0 37 54 114 35 325 474

Total

vacancies

17 0 51 68 139 35 390 564

Total A&B vacancies 68

Respite vacancies (not included in

table above) 2

% of permanent beds available in

A&B 12.06 %


14

In total there were 68 care home vacancies in Argyll & Bute – 17 in Residential Care and 51

in Single Care. There were no Nursing Care vacancies.

Table 1.10 Planned admission to a care home by care category: December 2013

0

5

1 1

0 0

2

0 00

0

0 0

1

0

1

0 00

1

0 0

1

0

2

0 00

1

0 0

1

0

0

0 00

1

2

3

4

5

6

7

8

Spec Dementia

NC

ERC

RC

There were 18 admissions to care homes during December 2013. 5 of the admissions were

to nursing care, 9 to residential care, 5 of which were in Cowal, 2 to enhanced residential

care and 2 to specialist dementia care.


• Many people requiring care home placement wish for that to be in their local area.

• People being admitted to residential care homes are likely to have higher levels of

need than people at the point of admission a few years ago.

• We have numerous care home vacancies, but in some areas we may not have

availability of the type of care we need. For example we need to be in a position to

offer Progressive Care, Nursing Care and specialist dementia care in more areas

across Argyll & Bute, to respond to demographic changes.

• In Lorn one of the large care homes, Lynn of Lorn has restricted admissions due to

recruitment difficulties.


15

Delayed Discharges at the December 2013 census date. (15th

December 2013)

Delayed discharges are patients who are deemed to be medically fit for discharge from

hospital, but who remain in a hospital bed for non-medical reasons.

A local target of zero delays at 2 weeks has been applied from April 1st

2013, with the

national target of zero delays at 4 weeks being implemented simultaneously. Discharge at 2

weeks is a challenging target, which will be implemented nationally in 2014.

At the December census date we had a total of 22 delayed discharges. Of these 14 were

non-exempt patients. There was 1 delay at 4 weeks, therefore we breached the national

target. The delayed patient was awaiting completion of a financial assessment.

7 non-exempt patients breached the local 2 week target (which becomes the national target

in April 2014). 3 of these were awaiting completion of assessment, 2 were waiting for

commencement of a homecare package and 2 awaited care home placements.

We had 8 patients with exemption codes: 3 are long-stay patients at Argyll & Bute Hospital,

and 1 in Gartnavel hospital who require reprovisioning to enable them to be settled in the

community. 3 patients are Adults with Incapacity (code9/51x). We are monitoring length of

stay and circumstances for each AWI patient, in the monthly Delayed Discharge report with

the aim of discharging these patients to the most appropriate setting at the earliest possible

date. (see table 1.11b)

Exemption Code 9 are complex cases: the 51x suffix indicates an adult with incapacity (AWI), the

25x suffix indicates a patient awaiting a complex care package in order to return home, the 71x suffix

indicates that the desired placement is not available and that an interim placement would be

unreasonable.

Exemption code100 – detained MH patients who require reprovisioning/recommissioning of services.


16

Table 1.11a

Description Delayed under 2

weeks

Delayed 2 -

4weeks (local

target 0)

Delayed over 4

weeks (national

target 0)

Total

A&B no

exemption code

5 5 1 11

A&B Exemption

100

0 0 3 3

A&B Exemption

9/51x

0 0 3 3

A&B Exemption

9/71x

0 0 0 0

A&B Exemption

9/25x

0 0 0 0

Out of area no

exemption code

1 2 0 3

Out of area

Exemption 9

0 0 0 0

Out of area

Exemption

9/51x

0 0 1 1

Out of area

Exemption

9/71x

0 0 0 0

Out of area

exemption Code

100

0 0 1 1

Total delayed

discharges

22


17

Table 1.11b Adult with Incapacity Patients- Length of Delay December 2013

Area Hospital Patient Length of Delay

in days

Discharge Destination

Bute & Cowal Victoria Hospital H 82 Nursing Care

Campbeltown Campbeltown Hospital

B 18 Nursing Care

H & L Vale of Leven E 147 Nursing Care


• We have met the national target (zero at 4 weeks) for delayed discharges in 5 of the 8

months since it was implemented. The target changes to zero at 2 weeks on April 1st

2014.

• We applied the 2 week target locally in April 2013, but using our current systems we have

had difficulties meeting the target, for a variety of reasons.

• There is a need for greater collective urgency in planning and initiating timely discharge

from hospital – there is still a sense that people are safe in hospital even when they have

been assessed as medically fit for discharge.

• Shared local ownership of the Delayed Discharge agenda is needed, with local managers

having knowledge of each person delayed in hospital and the actions needed to facilitate

discharge

• We need to review the assessment process and understand the reasons for delays in

completion of assessment in a timely manner

• We need to understand the reasons for delays in getting people moved to care homes

• There has been difficulty in some areas getting home care packages started in time, due

to lack of availability of staff. Creative local solutions are required.

• Process mapping of the assessment process will be carried out in OLI to identify where

the delays are in the system – learning from this will need to be applied throughout Argyll

and Bute

• Action plan is under development to identify key priorities for 2014 in managing and

reducing the number of Delayed Discharges across Argyll and Bute


18

Balance of Care for Older People:

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 work 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 Balance of Care targets from April 2013 are 80% cared for in the community and 20% of

people cared for in an institutional setting. The measure represents people aged 65+ who

receive a funded service from the Partnership. This target recognises that a small

percentage of people will have care needs that require specialist equipment, or levels of

care that cannot be provided safely in the community, but also takes account of the

investment we continue to make in community based care and the increasing range of

services available for service users and carers, through the Reshaping Care for Older People

agenda.


19

Table 1.12 Overall Balance of Care by area, December 2013:

Area Clients cared for in

the community

Clients cared for in an

institutional setting

Trend for

CiC

Number % Number %

Helensburgh & Lomond 411 77% 123 23% ↑

Bute & Cowal 412 68% 193 32% ↓

Bute 183 82% 41 18% ↑

Cowal 229 60% 152 40% ↓

Mid Argyll, Kintyre & The

Islands

337 74% 118 26% ↓

Mid Argyll 132 73% 50 27% ↓

Kintyre 150 74% 53 26% ↓

Islay & Jura 55 79% 15 21% →

Oban, Lorn & The Isles 290 72% 112 28% ↓

Oban 213 68% 101 32% ↓

Colonsay 4 100% 0 0% →

Mull & Iona 63 93% 5 7% →

Coll & Tiree 10 63% 6 37% ↑

Overall delivery 1450 73% 546 23% →

Target 80% 20%

Source: Pyramid, Joint Planning & Performance

The overall Balance of Care shows people aged 65+ who receive formal (funded) care from the

Partnership. The target increased to 80% of people cared for in the community on April 1st

2013.

Care in the community should include Homecare, ICTs/ECCTs, Overnight Teams. Extra Care Housing,

and Delayed Discharges awaiting a homecare package. Data for all areas is now included. To avoid

double-counting Meals on Wheels, respite care, daycare and Telecare are not currently included.

With the development of ECCTs some areas have continued to report referrals whilst some areas

have not. Work is underway, with assistance from the Lead Nurse, to re-establish reporting early in

the new year, using an agreed data set. Reporting will ultimately be via MiDis.


20

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

Continuing Care. Delayed Discharges awaiting care home provision are also included in the Balance

of Care calculation.

Table 1.13 In-year Balance of Care by area, December 2013:

Area Clients cared for

in the community

Clients cared for

in an

institutional

setting

Trend for

CiC against

previous

month

March 2012/13

Totals (for

comparison)

Number % Number % CiC Inst

Helensburgh &

Lomond

190 81% 46 19% ↑ 80% 20%

Bute & Cowal 130 66% 66 34% ↓ 74% 26%

Bute 64 83% 13 17% ↑ 73% 27%

Cowal 66 56% 53 44% ↓ 75% 25%

Mid Argyll, Kintyre &

The Islands

154 74% 54 26% ↓ 79% 21%

Mid Argyll 67 75% 22 25% ↓ 75% 25%

Kintyre 75 71% 30 29% ↓ 82% 18%

Islay & Jura 12 86% 2 14% → 82% 18%

Oban, Lorn & The

Isles

81 71% 33 29% ↓ 72% 28%

Oban 64 68% 30 32% ↓ 69% 31%

Colonsay 1 100% 0 0% → 100% 0%

Mull & Iona 14 87% 2 13% → 90% 10%

Coll & Tiree 2 67% 1 33% → 66% 34%

Overall delivery 555 74% 199 26% ↓ 77% 23%

Target 80% 20% 80% 20%

Source: Pyramid, Joint Planning & Performance

The In-Year Balance of Care data shows the people aged 65+ who have started an episode of

care funded by the Partnership, within the financial year. The right hand columns provide

March 2012/13 percentages for comparison.


21

Care in the community includes Homecare, ICTs/ECCTs, Overnight Teams, Extra Care

Housing and Delayed Discharge patients awaiting a care package. Data for Extra Care

Housing in all areas has now been 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,

who now work until 10pm every day in most areas. We have not, to date, been able to

gather reliable data to include this provision, however work is underway, with assistance from

the Lead Nurse, to establish reporting from ECCTs, early in the new year, using an agreed data set.

Reporting will ultimately be via MiDis.

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.

Individual data for each area and type of service can be found on Pyramid, on the In-year

Balance of Care scorecard.

The overall Balance of Care stands at 73% of people cared for in the community, but falls short

of the 80% target applied since 1st April 2013.

The in-year Balance of Care shows only people new to services since April 2013, in line with the

new financial year, it is currently below target at 74% of people cared for in the community.


• The overall Balance of Care is a measure that changes slowly over time, it is

unlikely to meet the 80% target for some time yet, as there are no short term

actions that impact this measure.

• The in-year Balance of Care is below the 80% target in all areas except

Helensburgh. This has been impacted to some extent by the evolution of ICTs into

ECCTs. The ICT referral data used to feed into the Balance of Care (and still does

where ICTs are operational). The data has been temporarily discontinued in areas

where ICTs no longer operate but are moving towards working as an ECCT model.

• We need to get the ECCTs operational as quickly as possible. Work with the CHP

Lead Nurse should begin to yield ECCT reporting from February 2014 and Pyramid

data collection will be amended to include this.

• Local, operational comments from each area are provided by Area Managers (page

22)


22

AREA MANAGER COMMENTS:

Bute & Cowal

Helensburgh

MAKI

OLI


23

2. Integrated Community Based Services.

Integrated Occupational Therapy Services:

Table 2.1 OT Active Caseload

Area Active caseload

September

2013

Active caseload

October 2013

Active caseload

November

2013

Active caseload

December 2013

Bute & Cowal 145 140 139 129

Helensburgh &

Lomond

Not available Not available

MAKI 205 176 114

OLI 245 245 247 247

Source: Local Teams

Table 2.2 OT Waiting list for assessment

Area Waiting list

September

2013

Waiting list

October 2013

Waiting list

November

2013

Waiting list

December

2013

Bute & Cowal 29 19 16 28

Helensburgh &

Lomond

40 Not available

MAKI 19 24 25

OLI 27 21 36 21

Source: Local Teams


24

Table 2.3a OT Service Users awaiting major adaptations

Area Awaiting major

adaptations

September

2013

Awaiting major

adaptations

October 2013

Awaiting major

adaptations

November

2013

Awaiting major

adaptations

December

2013

Bute & Cowal 79 68 81 58

Helensburgh &

Lomond

60 Not available

MAKI 71 80 80

OLI 56 48 29 59

Source: Local Teams

Overnight Care Teams. The overnight care teams are provided by Carr-Gomm in 8 areas –

Bute, Dunoon, Lochgilphead, Campbeltown, Islay, Helensburgh, Oban and Mull. They also

offer a service to people in outlying areas, whenever this is possible to fit within their

existing planned work.

The service aims to prevent hospital admission and support discharge, the range of tasks

includes response to community alarms and enhanced Telecare systems; responding to GP

calls for support during the night to prevent hospital admission; diverting people back home

from A&E; supporting with planned visits post discharge and providing temporary support at

home to prevent hospital or care home admission. The teams work from 11pm, to 7am

every day. In most cases they can provide a rapid response within 20 minutes of receiving a

call, although travel time can be longer to more remote areas.


25

Table 2.4 Service Users/Number of visits December 2013:

Area Number of

service

users/visits –

under 65s

Number of

service users 65-

74

Number of

service users

75+

Number of

visits to

service

users aged

65+

Bute 0 3 21 382

Cowal 3 clients/95 visits 3 15 292

Helensburgh 1 client/1 visit 4 20 386

Mid Argyll 3 clients/5 visits 3 26 634

Kintyre 2 clients/113

visits

3 15 352

Islay 0 0 9 224

Oban 0 3 12 361

Mull 0 1 5 214

All areas use the service to provide temporary care at home, to maintain the person at

home and prevent admission to hospital or a care home.

All areas also use the overnight teams to respond to Telecare alarm calls, this supports

informal carers by ensuring they can have undisturbed sleep and feel confident that the

person they care for is receiving a skilled response during the night.


26

Table 2.5 Service users aged 65+, Purpose of visit December 2013:

Area Prevent

hosp.

adm.

Return

from

A&E

Support

dis-

charge

Temp.

care at

home

Resolved

alarm

activity

Unable to

resolve

alarm

activity &

referred

on

Respond

to

enhanced

T’care

system

Support

assessmen

t

Bute 0 1 0 18 5 0 0 0

Cowal 0 0 0 8 10 0 0 0

H’burgh 0 0 0 12 12 0 0 0

M. Argyll 0 0 1 4 4 0 0 0

Kintyre 0 0 0 11 11 0 0 0

Islay 0 0 0 0 0 0 0 0

Oban 0 0 0 3 3 1 0 0

Mull 0 0 0 0 0 0 0 0

Table 2.6 Service users aged 65+, Referral source December 2013:

Area Ambulanc

e or Police

GP Hospital District

Nurse/

CPN

ICT SW/HCO Alarm

Calls/Other

Bute 0 0 2 4 0 13 5

Cowal 0 0 0 0 0 10 8

H’burgh 0 0 0 2 0 12 10

M. Argyll 0 0 1 0 0 24 4

Kintyre 0 0 0 0 0 6 12

Islay 0 0 0 0 0 9 0

Oban 0 0 0 1 0 10 4

Mull 0 0 0 0 0 6 0

Source: Carr-Gomm monthly report


27

Table 2.7 Percentage use/capacity of Overnight Teams, December 2013.

2427

32

57

46

14

37

30

2527 27

32 33

2117

38

51

46

41

11

21

65

46

32

0

10

20

30

40

50

60

70

% client contact time

% travel time

% available time

All of the teams were active 31 days during the month. The service is well used in Mid Argyll

and Kintyre, with only 11% and 21% of spare capacity, respectively. There is identified need

for extension of the overnight service into the Inveraray area.

In all other areas the overnight teams have high levels of unused capacity, although local

managers report that the teams decline to extend working practices outside of the 10 mile

radius.

POINTS FOR DISCUSSION.

• Use of the overnight service needs to be reviewed in terms of the type of work

carried out and the geographical areas covered, to maximise value from the service.

• The teams have capacity to prevent unplanned hospital admissions and return

people from A&E but there is little evidence that they are used for this purpose.

• GPs need to be reminded of the availability of the service on a regular basis.

• Reporting on this service needs to be discussed with Carr Gomm and updated to

provide an indication of how their work impacts the strategic outcomes.


28

3. Integrated Learning Disability Services.

The aim of the Learning Disability Service is to move towards personalisation, through the

use of a Personal Outcomes Plan, regularly reviewed, which will ensure that every service

user is being supported towards his or her own desired outcome.

Table 3.1 Balance of Care for LD service users. December 2013

Total active LD

Service Users

Number in residential

care

% Number case managed

in community

%

350 30 9% 320 91%

Source Pyramid: Adult Services, Learning Disability

The Learning Disability Service is actively working to modernise day services, with a move

away from the traditional Resource Centre model for some people, in favour of a more

person-centred, community based approach. 91% of LD service users are receiving services

based on a Person-Centred Plan.

4. Mental Health Services.

Table 4.1 Balance of Care for MH service users, December 2013.

Total MH

Service Users

Number in residential

care

% Number case managed

in community

%

231

2 1% 229 99%

Source Pyramid: Adult Services, Mental Health

The majority of Mental Health service users are cared for in the community, as opposed to

residential care.


29

Table 4.2 Mental Health unplanned admissions (totals), by area– Financial year 2013/14

5

1

8 7

14

7 6 5 6

9

3

3 4

1

9

6

2

5

3

7

86

55

7

5

6

2

1

02

0

2

1

0

1

0

5

10

15

20

25

other

OLI

MAKI

Bute & Cowal

Table 4.2 shows unplanned admissions of all ages (adults) by area of origin. All admissions are to

Argyll & Bute Hospital in Mid Argyll, where patients are received from Bute & Cowal, MAKI, OLI and

other, non-specified areas, a category often relating to homeless or itinerant people and

Gypsy/Travellers. Patients from Helensburgh and Lomond are not usually admitted to Argyll & Bute

Hospital.

A breakdown by age is shown in table 4.3

Table 4.3 Mental Health unplanned admissions by age group – Financial year 2013/14

17

12

16 16

18

20

13

10

16

10

3 32 2

3

1 110 0 0 0

1

4

1 1

0

5

10

15

20

25

under65

65-74

75+


30

Table 4.4 MH unplanned admissions – supporting data, Financial year 2013/14

Month Total admissions Re-admissions Percentage re-

admissions

April 13 19 6 32%

May 13 12 3 25%

June 13 19 6 32%

July 13 19 4 21%

August 13 20 11 55%

September 13 23 9 39%

October 13 20 4 20%

November 13 12 8 66%

December 13 18 2 11%

January 14

February 14

March 14

5. Integrated Substance Misuse Services.

The ADP Co-ordinator and Area Manager, Service Development will work to establish

regular provision of data that will provide insight into the entirety of the work the

Partnership is undertaking in response to addictions. The ADP Co-ordinator has advised that

this piece of work should be commenced when the strategy document is complete, as the

success measures should fall out of the strategy. Until that time reporting on this section is

suspended.

Action: Redesign ADP Pyramid scorecard and collect/input data regularly: Area Manager

Service Development/ADP Co-ordinator: Timescale to be agreed.

NHS HIGHLANDARGYLL & BUTE CHPLocal Verification of Argyll & Bute CHP DataDelayed Discharge Quarterly Census as at 15th January 2014

Local verification involves all detailed validation, verification and inter-agency agreement of the data taking place locally,upon which A&B CHP and its partner authorities sign off the data as 'agreed' before onward transmission from the CHP to NHS Highland to ISD. The data will therefore be forwarded on to ISD, fully validated and verified by both NHS andsocial service colleagues.

Complex Needs (code 9) Other Codes All

Hospital Specialtyunder 4

wksover 4 wks Total

under 4 wks

over 4 wks Total under 4

wksover 4 wks Total

Campbeltown GP Acute 1 1 1 1 1 1 2Cowal Community GP Acute 1 1 1 1Lorn & Islands General Medicine 1 1 1 1Lorn & Islands General Surgery 1 1 1 1

Lorn & Islands Geriatric Medicine 0 1 1 1 1

Total LIH 0 0 0 2 1 3 2 1 3

Mid Argyll Geriatric Psychiatry 0 1 0 1 1 1

GP Acute 0 3 0 3 3 3

Total Mid Argyll 0 0 0 4 0 4 4 0 4

Islay GP Acute 1 1 0 0 0 1 1

Victoria Rothesay GP Acute 0 1 0 1 1 1

Argyll & Bute Council 0 2 2 9 1 10 9 3 12

Argyll & Bute CHP Total 0 2 2 9 1 10 9 3 12

Principal Reason Groupunder 4

wksover 4 wks Total

1 Community Care Assessment 8 0 82 Community Care Arrangements 1 1 23 Healthcare Assessment 0 0 04 Healthcare Arrangements 0 0 05 Legal/Financial 0 0 06 Disagreements 0 0 07 Other 0 0 09 Complex Needs 0 2 2

Argyll & Bute Council 9 3 12

Argyll & Bute CHP Total 9 3 12

To be Signed off by Argyll & Bute CHP and Council Representatives

Name Signature Date

Jim Robb

Derek Leslie

To be returned to Information Services, Argyll & Bute CHP. 1 of 5 Issued on 23/01/2014

Argyll & Bute CHP Committee19 Febuary 2014

Item 11.1


Item No : 12 Modernisation of Mental Health Services Update Repo rt (February 2014) (1) Report by John Dreghorn 1. Background

The following report provides an update on the implementation of the modernisation of mental health services in Argyll & Bute.

2. Progress Report

� Project Governance The MH Programme Board and Capital Project Board are due to meet on 14th and 21st February respectively.

� Project/Service Management The CHP Core Team met on 21st January and discussed a proposal to establish a nurse consultant post for mental health services. The paper was supported in principle pending confirmation of financial implications. This development follows on from the agreement last year to modify the mental health management arrangements. This new development will help to ensure that a CHP wide approach is taken to the development of mental health nursing practice, with a focus on governance and quality. The new post once approved will report the Programme Director. It is hoped that recruitment can commence before the end of March 2014. Gail McGeachy has been appointed to secretary to the Programme Director and took up post at the start of the year.

� Inpatient Services The bed compliment is currently 29 plus 3 minimal supervision places in the refurbished Firgrove building. Upgrade works on the IPCU single rooms is complete. Work to relocate the MAPS/Clinical Psychology/OPD from the portakabin to Cowal Ward was completed in December and the service commenced from its new base on 6th January. Further upgrade works are progressing in the main hospital building to address HEI & Risk related issues, and to improve the general environment.

� Staff Redeployment Nil new to report

� New Posts The new Clinical Psychology post, which will be based in Oban, but will also work across Mid Argyll initially is currently out to advert.

� Budget Bridging: The bridging allocation for the project during 2013/14 remains unchanged at £500k as set by the CHP management team. This level of bridging will also be required during 2014/15.

The meeting is asked to: � Note current key issues and progress against the action plan

:

12 MH Services Modernisation Update Report February 2014 (1) Revised 10/02/2014 J. Dreghorn Page 2 of 2

� Resettlement Group 1 patient has recently moved from the hospital to a group home in Lochgilphead. A second patient will be moving from the IPCU to Firgrove for a trial period, to establish how well he copes in a less restrictive setting. This leaves 2 other patients for whom a long term plan remains to be agreed.

� New Hospital Project � “The Bundle”: The Lochgilphead Mental Health Unit / Inverurie Health Centre project has now officially commenced, and both elements of the bundle are progressing work to complete stage 1 by May/June 2014. A new joint project board will meet for the 1st time in March.

� Enabling Funds: As previously reported £191k has been allocated by the Scottish Government to support works which require to be undertaken before the new hospital construction work commences. Plans for the demolition of Tigh na Linne and the Estates Department out buildings are progressing and it is expected that demolition will commence in early March. A umber of departments are being relocated to other part of the main building to allow these works to proceed.

� Environmental Design Workshop: A workshop hosted by Health Facilities Scotland (HFS) and Architecture and Design Scotland (A&DS) took place at Argyll & Bute Hospital on 28th January. The purpose of the workshop was to start to develop our thinking with regard to the hospital grounds and the surrounding areas to ensure a “green” approach to the development which takes account to possible art installations and makes best use of the natural surrounding and the space between existing building and the new hospital. The event was well attended by a mixture of clinical, and non clinical staff and managers, with the main architect and the landscape architect in attendance. The workshop was also attended by a representative from “Green Spaces” which is an organisation that supports environmental developments.

� Supported Transfer of Detained Patients The new service went live on 6th January. Some early problems have been identified in terms of the response from the Scottish Ambulance Service. A meeting has been arranged with senior managers from the SAS to review working joint arrangements. However, the initial impression is that there have been a reduction in incidents associated with patient transfers. This service will be reviewed after 6 months.

� Recovery Wellness Recovery Action Plans (WRAP) Roll out of WRAP workshops across Argyll & Bute is now underway. To increase capacity and to increase coverage, it is proposed that we train staff in MAKI and C&B localities as WRAP facilitators during 2014, to supplement the 2 staff training in the OLI area and the 3 volunteers who are already trained.

3. Summary

The capital project has entered a new phase which should conclude with the approval of the business case to proceed with the new build early in 2015. Enabling works will be evident on site within the next few weeks which will be the first positive sign of progress toward the building of the new unit. The appointment of Nurse Consultant for Mental Health is a clear sign of the CHPs commitment to developing and improving mental health services in general and mental health nursing in particular. The post holder will have key role during the transition into the new service and beyond. John Dreghorn Programme Director – Mental Health Modernisation

Modernisation of Mental Health Services in Argyll and Bute

Newsletter

Issue 18

January 2014

Website Updates

www.nhshighland.

scot.nhs.uk

Inside This Issue

New Unit in Lochgilphead

Mental Health Recovery

CORE Net

National ECT Award

Patient Transfer Service

Conversations with Patients

Recovery in Mental Health Care

In November two highly interactive and informative workshops were held focussing on the values and principles of recovery within mental health care. Over 30 people from the NHS, the Council, Acumen and service user groups attended and all agreed that the workshops had increased their knowledge of recovery and they would recommend the workshops to fellow peers/colleagues.

The contribution of lived experience shared during the workshops was highlighted by participants as extremely valuable and welcome. It was also recognised that the participants enjoyed sharing knowledge across groups and roles and felt this added particular value to the event as a whole.

The CHP is eager to continue to embed recovery values and principles within mental health care and indeed participants from the workshops also appear eager to engage in such discussions/actions also.

It is also hoped that there will be further workshops in the near future, for further information please contact via email: [email protected]

Update on New Hospital

The design for the new mental health hospital in Lochgilphead is almost complete and work is now underway, using the services of the NHS Green Spaces, to link the landscape and art in the building and gardens with the environment. The views of those who will use the building, the Blarbuie Woodland Trust, the architect/landscape architect and the group leading the art coordination of the building are among the groups developing this landscape strategy. This work will not only improve the outdoor areas for patients and the community in general, but also ensure the new buildings sit well within the local environment.

Work on the demolition of buildings and road access works in preparation for the new development will begin this Spring, and completion of the new hospital and the support services building within its grounds, which will provide catering and estate services for this and other NHS facilities in Argyll and Bute, are due for completion in December 2016.

CORE is a new development implemented as part of the CHP’s Mental Health Modernisation

process. Mental Health Services are routinely using the CORE patient reported outcome measure (CORE is the Scottish Government outcome measure of choice when assessing somebody’s psychological wellbeing). Mental Health staff have adopted CORE into their everyday practice to enhance patient experiences and the therapeutic outcome. CORE Net is the online software package that supports the CORE outcome measure.

The CORE system went live in November and those who are using it are reporting the benefits to both patients and staff and there is a phased training programme underway for all Mental Health staff. Currently the CHP is the only service in Scotland and second in the UK to use CORE Net for both in and out patients.


Item : 13.1

If you would like to receive this newsletter directly by

post, email or in an alternative format/language,

please contact:

Caroline Cecil Planning & Public

Involvement Manager ℡

01546 605681 or

email the Project Team at [email protected]

The Project Director is

John Dreghorn

Argyll & Bute Hospital wins National ECT Award

Congratulations to the Succoth Ward Electroconvulsive Therapy team at the Argyll & Bute Hospital for winning a Scottish ECT Accreditation Network (SEAN) Quality Improvement Award for their work on the development of nurse link workers in ECT.

Staff Nurse Lorna Livingstone accepted the award at the SEAN annual conference in November 2013 on behalf of the team.

Supported Patient Transfer Service

In January 2014 Argyll & Bute Hospital commenced a new service to provide the supported transfer of patients detained under the mental health act from local hospitals to Argyll & Bute Hospital. The service will operate between 10am and 10pm, 7 days per week, and involves sending 2 or more nursing staff from A&B Hospital out to the local hospitals to look after the patient while transport is arranged and then accompanying the patient during the transfer.

It is hoped that this new service will improve the patient experience and will help local hospitals to provide the best possible care for patients awaiting transfer. A more limited service will operate to the islands as this is obviously dependent on the ferry timetable.

‘Conversations With Patients’ The mental health service user and carer’s network ACUMEN has been meeting with inpatients at Argyll & Bute Hospital to gather experiences and opinions about what it is like to be in hospital and what could be done to improve the service. These ‘conversations with patients’ are part of a range of ways that people’s voices can influence the delivery of local health services.

David Wright from ACUMEN said that the purpose of patient conversations is not simply to find out what is wrong and can be put right but to also produce a continuing dialogue between staff and patients that will inform and raise awareness of what is possible and what is needed to achieve the best experience for patients.

The method and format is simple, quotes from patients are listed down one side of a sheet of paper. This is circulated to the relevant managers who reply with their response opposite each point. Not everything wished for is possible, but in each case an explanation is given by the appropriate person. The results of each conversation are published as laminated posters and displayed on the walls of the ward near the entrance. Topics raised have included catering, care plans, balancing the use of mobile phones with the need for privacy, aftercare, ward environment and activities.

John Dreghorn, Programme Director for Mental Health Modernisation, added that the third sector plays an important role in the community and he has been working closely with ACUMEN for a number of years. He concluded by saying that the views of patients and carers are extremely important to the CHP and he was delighted to be working with ACUMEN on this specific project.

left to right: Roslyn McGuiness, Stephen Logan, Lorna Livingstone