ARGYLL & BUTE CHP COMMITTEE MEETING

Transcription

1 ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 20 February 2013 J03-J07, Mid Argyll Community Hospital & Integrated Care Centre 10.30am pm Committee Members Development Session Adult Health Profiles of HSCP Areas and Argyll and Bute CHP Elaine Garman/Sarah Griffin Fall Prevention Christine McArthur, Falls Prevention Co-ordinator Dallas/Telehealth Pat Tyrrell/Maggie Clark 12.30pm to 1pm Lunch 1pm - Meeting AGENDA 1. Chairman s Welcome Robin Creelman 2. Apologies Robin Creelman 3. Conflicts of Interests Robin Creelman 4. Minutes from Previous Meeting 4.1 Minute 19 December 2012 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues 6.1 Highland NHS Board 5 February 2013 Action Plan (to follow) Robin Creelman 6.2 Director of Operations Report (verbal) Derek Leslie 7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 7.3 Health Improvement (attached) Elaine Garman

2 8. Financial Governance George Morrison 8.1 Finance Report (attached) /14 Revenue Budget (attached) 8.3 Highlands & Islands Travel Scheme Changes to Earmarked Funding Arrangements (attached) 9. Staff Governance 9.1 PDP/R and eksf Implementation (attached) David Logue 10. Partnership Working Derek Leslie 10.1 Draft Minute of CPP Full Partnership Meeting (attached) 10.2 Draft Minute of CPP Management Committee (attached) 11. Performance Management 11.1 Balanced Scorecard Summary (attached) Derek Leslie 11.2 Joint Performance Report December 2012 (attached) Derek Leslie 11.3 Operational Delivery Plan (attached) Stephen Whiston 12. Mental Health Modernisation Update (attached) John Dreghorn 13. Code of Practice for Joint Inspection of Services for Children (attached) 14. AOCB* 15. Date, Time & Venue for Next Meeting Wednesday 24 April 2013 at 10.30am in Arran Room, Ardshiel Hotel, Campbeltown * to be notified to Chairman in advance of meeting The Committee meeting will be followed by: 3.30pm 4pm - Public Meeting

3 Argyll & Bute CHP Committee Date of Meeting : 20 February 2013 Agenda item : 4.1 MINUTE OF MEETING OF THE ARGYLL & BUTE CHP COMMITTEE Argyll & Bute Community Health Partnership Aros Lochgilphead Argyll PA31 8LB Queens Hall, Dunoon 19 December 2012 Present In Attendance Apologies 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 Tricia Morrison, CVO Representative, Argyll & Bute CHP Mr Duncan Martin, Chairman, Public Partnership Forum Mr Michael Roberts, Vice Chair, Public Partnership Forum Ms Dawn Gillies, Staffside Representative Councillor Elaine Robertson, Argyll & Bute Council Representative Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Ms Viv Smith, Locality Manager, Cowal & Bute/Helensburgh & Lomond, Argyll & Bute CHP Mr Raymond Stewart, NHS Highland Employee Director Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Councillor George Freeman, Argyll & Bute Council Representative Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Ms Elizabeth Reilly, Area Dental Committee Representative Ms Glenn Heritage, CVO Representative Jim Robb, Head of Service, Adult Care, Argyll & Bute Council 1. CHAIRMAN S WELCOME The Chairman opened the meeting by welcoming everyone to the Queens Hall, Dunoon. 2. APOLOGIES Apologies for absence were noted as above. 3. CONFLICTS OF INTEREST No conflicts of interest were declared.

4 4. MINUTE FROM PREVIOUS MEETING 4.1 Minute of Meeting held on 31 October 2012 The Minute of the meeting on 31 October 2012 was accepted as a complete and accurate record of the meeting. The Committee: Approved the content of the Minute of the meeting on 31 October MATTERS ARISING FROM PREVIOUS MEETING HELD ON 31 OCTOBER 2012 There were no matters arising. 6. NHS Highland Organisational Issues 6.1 Meeting of Highland NHS Board Meeting 4 December 2012 Mr Creelman provided a verbal update on a number of points from the Draft Minute which will be circulated at the next meeting. Highland Quality Approach senior managers from NHS Highland who had been accepted on the Lean Leader Training Programme by Virginia Mason Institute had recently undertaken training in Seattle. The Board was updated on some of their learning and the next steps for the Highland Quality Improvement System and Building Capacity and Capability. Visit to Torbay & Southern Devon Health & Care NHS Trust representatives from adult social care and Highland Home Carers visited the Trust during November 2012 where they were advised on the community service model with co-located multi-disciplinary teams who had a Health and Social Care Co-ordinator. Mr Creelman advised that this is a locality based system and ensures close working with GPs and there are a number of lessons to be learned from the visit and report. Proposed Implementation of the National Patient Management System (PMS) Mr Leslie advised the Committee that the Business Case also submitted to the Board described the proposals in greater detail. Mr Leslie reassured the Committee that the CHP has contributed to the preferred proposal for implementation, observing that the Argyll & Bute patient flow is predominantly to NHS Greater Glasgow & Clyde which may create specific issues and challenges that need to be addressed as the implementation of the preferred solution progresses. Assurance has been sought that Argyll & Bute based patients will not be disadvantaged and will enjoy the same equity of priority and access, particularly to outreach services provided by NHS Greater Glasgow & Clyde and discussions are continuing to ensure a positive outcome to addressing these challenges. Mr Martin expressed anxiety regarding the future clinical management of CHP patients and expressed the opinion that patients should remain on the NHS Greater Glasgow & Clyde pathway, with NHS Greater Glasgow & Clyde linking in with NHS Highland to address any issues which may arise. Mr Leslie clarified that extant patient pathways between Argyll & Bute and Glasgow would not change. The challenge was to ensure there were no 2

5 unnecessary hurdles encountered from an ehealth perspective within the clinical management of that pathway. Mr Creelman provided assurance to the Committee that the CHP will continue in its proactive engagement with the wider ehealth team and Greater Glasgow to find a solution. Social Media the report to the Board recommended exploring the principle of opening up social media in the work place, initially through controlled access. It was noted that to date this suggestion has not been considered by the CHP but would be explored in due course. A copy of the agreed Minute of the meeting of 4 December 2012 will be circulated at the Committee meeting in February The Committee: Noted the verbal update of the meeting on 4 December NHS Highland Annual Review 2012 Scottish Government Summary Mr Leslie referred to the circulated letter which summarised the topics discussed and actions arising from the Annual Review in Inverness on 5 September Mr Leslie highlighted the action points and in particular the first bullet point, Keeping the Health Directorates informed of progress on the Partnership Agreement in respect of integration of health and social care. Mr Leslie advised that this referred to the NHS Highland North approach regarding adult care, managed by NHS Highland and Children s Services, managed by Highland Council. Mr Leslie reported NHS Highland (with involvement from the Argyll & Bute CHP) and Argyll & Bute Council continue to discuss and work through integration proposals under the auspices of the Scottish Government Consultation. In addition, the CHP Health & Care Strategic Partnership Constitution is currently being reviewed to make it more outcomes focussed and to increase the focus on Children s Services. 7. Clinical Governance 7.1 Clinical Governance & Risk Management Report Ms Tyrrell spoke to the circulated report and highlighted and summarised a number of items. Risk Management Incidents Ms Tyrrell advised that a total of 442 incidents were reported during quarter 2 of Slips, trips and falls remained the highest reported category of incidents in Cowal/Bute, Mid Argyll Kintyre & Islay and Oban, Lorn & Isles, with medication and sharps incidents being the highest category in Helensburgh. Ms Tyrrell advised that there had been no change in trend since the last reporting period. 3

6 There were no incidents of major or extreme consequence (including potential consequence) reported in July-September Pat will confirm and advise the definition of these incidents at the next meeting. Pressure Ulcer Prevention Ms Tyrrell clarified that the information presented in the circulated report was collated from the incidences recorded on the Datix system. A significant amount of work continues to be undertaken to ensure early identification and management of patients at risk of developing pressure ulcers in all settings. Improved compliance with Clinical Quality Indicators is being evidenced and reporting is showing a downward trend and consistency in preventing incidents. Investment from the Scottish Government will enable the use of improved equipment and enhancement of staff knowledge. Mr Leslie acknowledged the improvement in outcome for patients at Lorn & Isles Hospital and recognised the significant achievement for staff in achieving this positive result. Falls Prevention Ms Tyrrell advised that due to the recent transfer of Dunaros to Mull & Iona PCC, information for this area will be included in the next report. Serious Untoward Incidents Ms Tyrrell emphasised that NHS Highland have a clear policy for investigating any incidents and full reports and all key learning is addressed through the CHP Clinical Governance and Risk Management Group. External Reviews Inspection of Children s Services in Argyll & Bute Ms Tyrrell referred to the detail in the circulated report regarding the forthcoming inspection by the Care Inspectorate which is due to commence in March The review will focus specifically on the outcomes for all children and young people to evidence the quality of services, particularly for those in vulnerable situations. The public report will be published within four weeks of the inspection. Quality Person Centred Care The national launch of the Scottish Person Centred Care Programme took place at end November 2012 and will tie in the Patients Rights (Scotland) Act All NHS Boards are expected to implement the requirements of the programme and Heidi May, Board Nurse Director is leading this work for NHS Highland. The Committee: Noted the content of the Clinical Governance & Risk Management Report 4

7 7.2 Infection Control Report Staphylococcus Aureus Bacteraemia (SAB) Ms Tyrrell advised that since the last report to the Committee, there has been one further community acquired SAB case attributed to Lorn & Isles Hospital. The total of five cases for LIH in all appear to have been community acquired, two of which may have been healthcare associated. Ms Tyrrell confirmed that each case was subjected to enhanced surveillance and HEI standards within Primary Care are currently being reviewed. Clostridium Difficile Infection (CDI) Ms Tyrrell reported that for 2012/13 there have been 4 reported case of CDI in the CHP : o Lorn & Islands Hospital - 1 o Cowal Community Hospital - 2 o Campbeltown Hospital - 1 Quality assurance and compliance with good hygiene continues to be monitored. Ms Tyrrell confirmed that the involvement of the Public Partnership Forum in compliance initiatives for staff and the public will be progressed in early Norovirus Ms Tyrrell highlighted the start of the Norovirus season and reported three recent outbreaks in NHS Highland. There was also one outbreak in Ward B of Lorn & Isles Hospital when 4 patients and 8 staff were affected. The information sharing pathway is utilised during such outbreaks and Lorn & Islands were complimented on the actions taken in implementing infection control procedures. Ms Tyrrell and Mr Ritchie will discuss a Press release providing public information relating to infection control procedures when attending/visiting in hospitals. HEI Inspections Heidi May, Board Nurse Director recently undertook a programme of visits to all hospitals in the CHP to support and discuss with staff the continuing work being undertaken to ensure all HAI standards are implemented and sustained in all settings. The feedback from the visits has been positive and helpful. A task forced, chaired by Mr Leslie, has been established to address the key issues within Argyll & Bute Hospital. An action plan is in place and fortnightly monitoring meetings are ongoing. Infection control nurses are delivering sessions for staff to prepare them for the inspection process and to share good practice across the CHP. The Committee: Noted the content of the Infection Control Report 5

8 8. Financial Governance 8.1 Finance Report Mr Morrison spoke to the circulated report and advised that at end November 2012 the CHP recorded an underspend of 197,000. Mr Morrison advised on the budgetary performance across the CHP and the CHP s satisfactory financial position which is mainly as a result of the achievement in savings in the prescribing budget. This position is due to falling prices of off-patent drugs, with a reported underspend on the prescribing budget of 470k at end November Mr Creelman asked Mr Morrison for further details regarding prescribing costs. Mr Morrison replied that for the following drugs, Quetiapine, Donepezil. Olanzapin and Atorvastatin, volumes prescribed have remained fairly static, however prices have dropped significantly, creating an underspend on the prescribing budget. Although there had been an awareness of possible price reductions in drugs, the extent of the cost reduction was unexpected and therefore resulted in savings beyond the level anticipated. Mr Leslie commented on the continuing cost pressure resulting from medical locum cover for vacancies, which is a challenge in all remote and rural areas. Mr Morrison reported that agreement has been reached with NHS Greater Glasgow & Clyde on an SLA value for 2012/13 of m, which is in line with the CHP s budget. However, negotiations will resume next year regarding NHS Greater Glasgow & Clyde's claim that the agreed value represents a significant underpayment against the true cost of services provided. Mr Leslie credited staff and managers, particularly the prudent stewarding within the Finance Department, for their work and commitment in achieving the efficiencies enabling the reported underspend. Mr Martin queried the CHP s forecast underspend of 200k in the context of NRAC funding which is allocated by NHS Highland. Mr Leslie emphasised that the CHP is not disadvantaged by the funding received and this was confirmed by Mr Creelman. The Committee Noted the content of the of the Finance Report STAFF GOVERNANCE 9.1 Argyll & Bute CHP Partnership Forum Draft Minute 15 November 2012 The draft minute was previously circulated for information. Mr Creelman noted that the Minute reflected the variety of discussion at Partnership Forum meetings and that he was impressed by the very healthy atmosphere in which the meetings were conducted. The Committee: Noted the contents of the Argyll & Bute CHP Partnership Forum Draft Minute of 15 November

9 9.2 PDP/R and eksf Implementation Mr Logue reported that at end November 2012, 24.14% of all AfC staff had reviews and personal development plans signed off in eksf, which signifies an increase in activity since the last reporting period. Managers have reported that the figure of 80% completion by end March 2013 is achievable and efforts are continuing to achieve this target. Mr Creelman asked if there is a quality indicator around the eksf process which informs on staff feedback and the benefits to training and the skills essential as part of the provision of patient care. Mr Logue advised that there is a focus group, in conjunction with the Partnership Forum, and he will incorporate quality assurance details as part of his next report to the Committee. Mr Leslie commented that there is a common responsibility by staff and managers to ensure delivery of the target for completion. The Committee: Noted the content of the PDP/R and eksf Implementation Report 10. Director of Public Health Annual Report 2012 Ms Garman commented that the report should be seen in the context of a story of good news as people are living longer, healthier lives. Improving life expectancy is the result of improvements in health care and changes in the wider environment, with a majority of older people living independently and actively and this trend should be encouraged. However, it should also be recognised that an increasing number of elderly people are living with long term conditions and service providers and staff need to recognise this and support older people to lead the lives they want as far as possible. Ms Tyrrell emphasised the need to recognise the positive aspect of the report and that older people are an asset to a community. The ongoing work for Reshaping Care for Older People within the CHP looks at how services are provided in communities. Mr Whiston commented that the report provided a good indication of trends and the current services provided within the community. Ms Garman advised on the recommendations for NHS Highland to include or consider as it is developing its strategic commissioning plan for older people over the next year. The Committee: Noted the content of the Public Health Annual Report Director of Operations Report Mr Leslie provided a brief update on a number of issues not featuring as substantive papers at today s meeting. These included : An update on performance against the target set for the staff flu immunisation programme 2012/13 7

10 Confirmation of ongoing discussions with the GP community on Islay to establish workable transition arrangements to ensure continuity of, in particular, the provision of out of hours and hospital medical services. Continuing engagement with community stakeholders in partnership Argyll & Bute Council and West Highland Housing in regard to a number of operational issues arising from the commissioning of the Mull & Iona Progressive Care Centre. The centre is now operational and particular issues requiring clarification were primarily in connection with the social care element of the service. PMS referred to initially in a reflection on business discussed at the meeting of the NHS Highland Board and reaffirmation of the anxiety that implementation of the preferred solution will introduce/compromise equity of priority/access through perhaps the need to have an additional hurdle within the clinical management of the patients pathway. Discussions with all parties continuing to identify and resolve the anxiety. Locality Reports - Helensburgh & Lomond/Cowal & Bute - 24/7 Review (subject of substantive paper on today s agenda) Model of care a group has been established to examine a whole range of issues associated with the model of care for the older adult. Visit from the Director of Nursing to Cowal & Bute in connection with HEI issues had a positive outcome. Cowal catering proposals approved, with domestic services proposals under review. Examination of issues causing the use of additional nursing hours and bank staff in Cowal. A number of service level agreement reviews covering mental health, out of hours, dietetics and physiotherapy services to the Helensburgh & Lomond Area. Mid Argyll, Kintyre & Islay Bed modelling continuing in relation to Campbeltown community hospital. A continuing examination of the challenges associated with establishing a substitute prescribing service in Kintyre in light of changes to the medical staffing in the community. Progress of establishing a MacMillan Cancer information and support service to allow people living with and beyond cancer to improve their quality of life by ensuring they receive the right information and support at the right time, regardless of where they are on the cancer journey or where they live in Argyll & Bute. Clinical lead appointed for Islay and Jura. Phase 2 of the planned building work has commenced in Islay hospital. This is related to shifts and changes that were required following the establishment of the GP surgery in the hospital to establish new outpatient consulting areas and the re-provision of the physiotherapy department. Acknowledgement that the cost of administering biological drugs (treatments used as supporting therapies in cancer, but also administered for a range of clinical conditions, including rheumatoid arthritis, Crohn s Disease and UIcerative Colitis) in Mid Argyll Hospital will be included in the financial plan for the coming year. This improves the patient experience by reducing the need for travel to Glasgow. Oban, Lorn & Isles Provisional start for the new dental project is 7 January 2013, to complete in August

11 Progress made in partnership with Raigmore to support the local urology service while preserving existing specialist patient pathways to Glasgow. Locum medical staff currently supporting the delivery of surgical and general medical services. The Committee: Noted the Director of Operations update. 12. Review of Management Structure Cowal & Bute/Helensburgh & Lomond Ms Smith summarised the background to the report and, following the recent interim management arrangements in Cowal and Bute and Helensburgh and Lomond, the proposal to redesign the management and leadership structure, together with the roles and responsibilities for the two localities. This would enable the existing structure to be adapted to enable the best use of limited senior management resources. Locality management have identified a number of issues which hinder the delivery of corporate and operational objectives and performance targets, and it is anticipated that the proposals detailed in the report would address these concerns and improve the quality of services and reduce variation and waste. Mr Leslie advised that the review would need to be carried out with a consistency of approach, robustness of management and application of governance to ensure improved patient outcomes. The proposals would also require to be cost neutral as a minimum. Ms Gillies expressed concern regarding the removal of the Practice Development Nurse post from the proposed structure. Ms Tyrrell provided assurance that the role of the Practice Development Nurse would continue but would be reconfigured to be delivered in a different way. The post title would be different but the role would be the same. There will be full staff engagement during this process of management restructuring. The Committee: Considered and endorsed the recommendation detailed in the report. 13. Assessment of the Viability of a Hospital Dialysis Service in Argyll & Bute CHP Mr Whiston advised that the purpose of the circulated paper is to provide an update on the findings of the viability assessment conducted to provide a local dialysis unit in Oban and for members reference provided a reminder of the conclusion of the previous report in May Work undertaken to assess the viability of a service, considered : Existing service demand and future projections of activity 9

12 Feedback from users and referrers on the current service include its operation and accessibility Clinical assessment on suitability of service and size of dialysis unit. Identifying a site within LIH to locate the unit and any knock on impacts Identifying the indicative capital cost to build and the indicative revenue cost to run a unit Identifying sources of capital funding and their likely availability Assessing the affordability and value for money of the service including benchmarking to other units Identifying any additional sources of activity and income Considering alternatives - Capacity and demand profile in other units, alternative provision, mobile unit, flexible provision across units, transport implications- use of local air services Considering any other service implications e.g. transport, recruitment, training, Laboratory support, clinical governance etc CHP s strategic view re prioritisation of service development Indicative timescale- from decision to proceed to actual opening Mr Whiston emphasised that the report is not a formal business case for representation and approval, but a written report outlining the findings to establish if a viable unit could be provided in Oban and summarised the findings as follows : o o o o o o o o o o Following advice received from the NHS Greater Glasgow & Clyde Physician and the Renal Consultant at Belford hospital, it is acknowledged that a 4 station unit will meet the future projected demand of the catchment area, operating 3 days a week. Providing a unit in Oban would not necessarily provide equity of access to the catchment population it would serve. It was noted that renal patients from Cowal and Bute and Helensburgh and Lomond localities receive a renal service from Inverclyde Hospital or the Vale of Leven Hospital. Significant patient benefits have been identified for having a local unit and there is also support from GPs The capital cost of the unit is significant and it is unlikely the NHS Board would be able to consider its expenditure until 2014/15 and it is therefore not affordable at this time Providing a local unit would result in significant savings in transport costs and cost incurred in sending patients to Belford and this could be reallocated to meet the running costs of a local unit Opportunities exist to align and coordinate renal staffing resource and support between the Belford and LIH if a unit is located in Oban The value for money assessment illustrates that, based on related level of activity, the local unit would not rate well against other units. It would also be poorly utilised outside its core 3 day a week window. It does however offer opportunities to increase dialysis capacity in exceptional circumstances. Establishing a unit in Oban or Lochgilphead would affect the cost efficiency of the Belford unit. There are opportunities now to review existing transport arrangements and look to improve this service to patients and reduce cost. Mr Whiston reported that following discussion and consideration of the report to the CHP Management Team meeting on 11 December 2012, it was agreed that the following points required further deliberation : A local unit would provide improved access to services for those in the proximity to the locality. 10

13 The provision of a mobile unit on the face of it offers gains for patients, but there are a range of logistical and operational issues which do not suggest this is an elegant solution. The capital cost of a fixed unit s significant and there is not currently funding available for this. At the earliest if prioritized by the Board this would be April In revenue terms a local unit does not offer value for money. It is however affordable if the cost savings in transport and repatriation of activity can be made. How important a priority is this for the CHP with regard to service provision? The top service priority issues facing the CHP and targeting its investment in services are : o o o Mental Health modernisation Reshaping Care for Older People Sustaining our Community and Rural General Hospital core services re acute care, trauma and Out of hours services There are high quality renal dialysis units which have the capacity and capability to support patient need at this time and into the future. In these terms a local unit is not perhaps a priority at this time. There are issues regarding current transport arrangements which could be improved and these should be reviewed and alternatives examined to provide better quality of service to patients. Mr Whiston acknowledged the extensive public interest in this issue, particularly in the Oban and Taynuilt area, and in order to support the viability study a patient survey was prepared to ascertain the opinions of patients who currently receive dialysis at the Belford Hospital and Vale of Leven Hospital. The survey also asked their opinion on what would make the biggest improvement to their experience of renal replacement therapy services. The survey was submitted to the Belford Hospital and Vale of Leven Hospital on 23 November 2012 for distribution by staff to renal patients. A total of 7 out of 16 forms were completed and returned by the deadline of 7 December The key points raised by patients were : Outward journey is tiring, return journey traumatic, 3 times a week Service keeping me alive Kind, courteous and knowledgeable staff instils confidence Worry that local staff do not have much knowledge about the illness Worry that renal professionals are so far away Reduced waiting time after treatment Patients were also asked where they would prefer to receive their dialysis. 3 patients (2 Helensburgh and 1 Oban) stated they would prefer to receive dialysis within NHS Greater Glasgow & Clyde, 2 Oban patients would prefer a local satellite unit in Oban, 1 Kintyre patient indicated a preference for Lochgilphead as central to Argyll patients. 1 Oban patient did not respond to this question. It is acknowledged that improvement to a patient s experience of renal replacement therapy services is personal for each patient but it is apparent that reduced travelling time is very important for all patients. Mr Creelman thanked Mr Whiston for the detail and thoroughness of the report and enquired about the availability of home dialysis in the CHP. Mr Leslie provided an assurance that where appropriate a home dialysis unit will be available for patients but advised that this option is, on occasions, not clinically feasible. 11

14 Mr Creelman asked what would be the determining factors for the location of a satellite unit in Argyll & Bute. Mr Whiston replied patient activity and projection figures will continue to change significantly. If it was decided to take forward the assessment into a business case proposal an equality and diversity assessment would require to be undertaken to identify how location and operation of a fixed or mobile unit would affect catchment populations. Councillor Robertson requested that when considering future activity and projection figures consideration is given to the recently published census results. Ms Garman commented that it is not possible to accurately predict figures. She stated that in terms of level of access to treatment, the needs of renal patients are being met. In terms of the level of experience, the needs of renal patients are not being met and further work is required to improve the patient experience. Mr Leslie advised that on considering the detail of the report and discussions, the conclusion of the Committee on the way forward for the review and outcome needed to the CHP wide, and not for a particular locality. Mr Leslie reiterated that at present this service was provided to a modest number of seriously ill patients who live throughout the whole of the CHP area. Mr Leslie referred the Committee to the other service priority issues which are facing the CHP, as detailed in the report, and which need to be considered when reaching a conclusion to this proposal. In concluding the discussion, the Committee agreed that the provision of a satellite unit in Oban or indeed elsewhere in the Argyll & Bute CHP s geographical area was not straight forward in terms of identifying a safe geographical location or likely to attract capital or revenue priority in the present climate, but recognised fundamentally that further work is required to improve patient experience, particularly with regard to transport. The Committee provided a commitment to ensure that this was taken forward as a matter of urgency. The detail of the paper and the outcome will be communicated to patients and their communities. The NHS Board will be advised of the outcome of the report. Mr Martin enquired about the CHP s view on the suggestion by a local community that it may consider fundraising for the provision of a dialysis unit to be situated in Oban. Mr Leslie replied that he welcomed such initiatives proposed by the public and was agreeable to having discussions with those involved and working appropriately in partnership with them. The Committee: Considered and noted the terms of the report and specifically the viability and challenges associated with prioritising the establishment of a satellite unit in Oban and whilst progress with the establishment of such a unit was not a priority in the immediate term that CHP should work with individual patients with a view to enhancing their current experience in accessing existing services as well as addressing disproportionate travel costs. Mr Creelman welcomed the members of the public in attendance, particularly for agenda item 14, and invited them to participate in discussions. 12

15 14. Cowal 24/7 Report Mr Whiston presented the previously circulated report on the outcome of the Cowal 24/7 review. He explained that the review had examined the issues relating to the future provision of GP out of hours arrangement for Cowal, as well as reviewing the medical input into the Cowal Community Hospital particularly the clinical management of inpatient and accident and emergency activity. Mr Whiston s presentation set out the background to the review which included an examination of : o o o o o Day time Medical Input in Cowal Community Hospital (CCH) Casualty and out of hours medical input in CCH GP Out of Hours arrangements Dunoon & East & South Cowal GP Out of hours Arrangements Rural Cowal (Tighnabruaich & Strachur) GP Out of hours Arrangements Lochgoilhead Mr Whiston described the inclusive and widespread composition of the Review Group, the option appraisal methodology followed, which initially involved the identification of a long list of 17 options, reduced through the process to a short list of 7 potential, viable options. The process then appraised the options by considering benefits delivered, risk, value for money and affordability. The process had been managed in accordance with Treasury Green Book guidance in collaboration with the Scottish Health Council and the guidance contained in CEL 4 (2010) concerning informing, engaging and consulting. Mr Whiston set out the various milestones in the process, leading to an outcome recommending a variation to the original option 11 (option 11b), which resulted from all the previous engagement. Mr Whiston outlined reservations expressed by those key stakeholders in the Cowal 24/7 Review Group which included the impact on medical staff groups providing the current service, concerns over continuity of service provision and medical staffing levels during the day. He explained that this had led to a pause in the project so that further specific information on these reservations could be collated, and again these were described comprehensively from a stakeholder s perspective. In conclusion, Mr Whiston explained that the Project Group had considered all of this information at its meeting on 22 November 2012 and had given a detailed assessment to the evidence presented and reflected on the lack of consensus on the preferred option. The Group had acknowledged that some of the concerns and reservations were valid but there were clearly solutions that would address some of these concerns. In light of this lack of consensus, and whilst there was a majority in the Group which supported option 11b, the fact that the medical stakeholders did not support the model and the changes proposed to medical staffing, the Group felt that it could not finalise the option appraisal process or make a final recommendation and agreed that all the work and findings should be remitted to the CHP s Core Management Team and subsequently the CHP Committee to establish a way forward. Mr Whiston concluded by asking Committee members to : Note the status of the review Consider the issues with regard to the identified preliminary preferred option 11b for service delivery o benefits of the model proposed o the medical stakeholders unanimous rejection of Option 11b o reservations from other stakeholders Consider the conclusion of the Cowal 24/7 Project Group 13

16 Identify the way forward for the review and outcome Mrs Grier, Co-Chair of the 24/7 Review Group advised the Committee that it was her belief that the process undertaken by the Group had been thorough, transparent and inclusive. Mr Bell (member of the public) asked if there were any strategies available to the CHP to encourage GPs to undertake out of hours work. Mr Leslie advised that the CHP is required to work in compliance with extant policies and terms and conditions of employment. This requires the deployment of strategies of influence and negotiation rather than direction with GPs (independent contractors) working within the terms and conditions of new GMS rather than those who have salaried practitioner conditions of service. Mrs Grier summarised the endeavours and efforts of the Group to facilitate the engagement and involvement of GPs in the process. Mr Law, Hunters Quay Community Council Representative, stated his opinion that the CHP had created a dysfunctional service and the public wanted the best use of Cowal Community Hospital. He advised that he has requested and had been granted a meeting with Mr Alex Neil, Cabinet Secretary for Health & Wellbeing and this was noted. Mr Law asked about the number of referrals being made to Inverclyde Hospital from the Cowal Peninsula. Dr Hall advised that a recent audit of the acute ward had been undertaken to look at referral patterns which concluded that patients were being referred to Inverclyde appropriately. Mrs Grier advised that Dr Brian McLachlan, Helensburgh GP and Co-Chair of the Group had also undertaken extensive work for the review which had been presented to the Cowal GPs. Mr Leslie appreciated the attendance, interest and contributions of public members, and indeed the Review Group, at today s meeting and expressed disappointment that the review had been unable to reach a final consensus on the best way forward. Hence the referral of the outcome to the Core Management Team. Mr Leslie conveyed his thanks and appreciation to Mrs Grier and Dr McLachlan for their leadership and contribution to what had been a long, challenging but robust and transparent process. He felt that a detailed and comprehensive assessment of the issues had been undertaken in accordance with relevant guidance. The outcome had been to identify option 11b as the option preferred by the majority. Mr Leslie also reported that the CHP had received notice from the GPs in Dunoon that in light of the identification of option 11b as the preferred option of the majority, and other challenges and pressures, that they intended to cease providing a service to the Cowal Community hospital wards from the end of February In view of this and current vacancies in elements of the hospital service a prompt decision was required to preserve continuity of service to enable an appropriate recruitment process to be commenced. Mr Leslie confirmed that at the their meeting on 17 December 2012, the Core Management Team had considered the findings of the Cowal 24/7 Review Group and recorded its appreciation and thanks for the inclusive and thorough assessment work done by the Review Group which has led to the identification of the preferred Option 11b and the Group s subsequent consideration of the concerns raised by stakeholders as detailed in the written evidence presented. The Core Management Team was naturally disappointed by the rejection of Option 11b by the medical community and having noted their intention to cease provision of medical services to the Cowal Community hospital, acknowledged the need for a timeous decision to ensure the continuation of service provision and the commencement of recruitment as soon as possible. 14

17 In light of the challenges facing the current service, Mr Leslie set out the recommendations from the Core Management Team which Committee members endorsed as follows : The option appraisal process is stopped. Locality management look to progress the implementation of the integrated inpatient and casualty hospital service model as detailed in Option 11b through recruiting salaried medical staff as well as offering individual GP practices/gps the opportunity to participate in the service. Locality management progresses with the implementation of a single out of hours service for Cowal with a mix of on duty and on-call staff. A lead clinician is appointed for all aspects of the service out of hours, hospital wards and casualty (as is the model in the rest of the CHP). Nurse practitioner competencies are enhanced so that their full capability and capacity can be utilised which will release medical staff time to provide the inpatient and casualty service on a 24/7 basis. The service is configured to operate within the current budget with any efficiencies realised, used to support other locality service pressure/priorities e.g. mental health crisis support It was also recommended that a short life (1 year maximum) service implementation and monitoring group is established to report to the CHP Committee. This group will include relevant representatives from the Cowal 24/7 Working Group stakeholders. The role of the Group will be to review the implementation and delivery of the service to ensure the operating characteristics of Option 11b are met as detailed (such as the use of rural GP surgeries for rural Primary Care Emergency Centre appointments). In addition the group will undertake a process of community engagement and feedback on the service to ensure it meets service standards. 15. Mental Health Modernisation Update The report provided an update on the key issues and progress against the action plan. Mr Leslie highlighted the following points. Project Governance/Stage 1 Submission and Approvals - following discussion and a review of comments from advisors and the Project Director at the recent Capital Project Board regarding the Hubco stage 1 submission, it was agreed that significant work is required by Hubco on the stage 1 submission prior to it being accepted by NHS Highland. This has resulted in the approvals timetable being reviewed by the Project Team. A revised stage 1 report is expected to be submitted by Hubco in January 2013 Inpatient Services the bed compliment has reduced to 30 beds, plus 3 minimal supervision places in the refurbished Firgrove building on 10 December Tigh na Linne is now closed and staff have been redeployed within the inpatient service. Community Mental Health Team Bases it has been confirmed that 300k of capital funding will be available in 2012/13 to undertake hospital conversion work in Campbeltown and Dunoon to accommodate the CMHS teams. The Committee: Noted the current key issues and progress against the action plan. 15

18 16. PARTNERSHIP WORKING 16.1 Argyll & Bute CHP Public Partnership Forum Draft Notes 27 November 2012 The draft note was previously circulated for information. Mr Martin and Mr Roberts referred to specific discussion points from the last meeting. Patient Central Booking System - Moira Newiss, CHP Business Transformation Manager presented the outcome of the Options Development/Appraisal process which considered the future provision of the patient central booking system. Helensburgh Locality PPF - it was reported that at a recent meeting the Patients Group had decided to support the role of the locality PPF, but would not host it. Other options will now be explored to ensure the locality PPF is established as soon as possible. The Committee: Noted the contents of the Argyll & Bute CHP Public Partnership Forum Draft Notes of 27 November PERFORMANCE MANAGEMENT 17.1 Delayed Discharge/Joint Performance Report The circulated report recorded that as at 15 November 2012 there were 16 delayed discharges, 15 <6 weeks and 1 >6 weeks, all of which had legitimating coding. The Committee: Noted the contents of the Delayed Discharge Report. 18. Papers for Noting 18.1 Argyll & Bute ehealth Steering Group Draft Minute Mr Leslie referred the Committee to the following points from the circulated Minute : TrakCare Implementation Update Use of Intranet Immediate discharge letter The Committee: Noted content of the above paper. 19 AOCB Distribution of Committee Papers Mr Leslie apologised for the late distribution of papers which was due to capacity issues within administration services. 16

19 Mr David Whiteoak, Locality Manager, Oban, Lorn & Isles Mr Leslie advised members of Mr Whiteoak s retirement on 4 January 2013 and recorded the CHP s and the Committee s best wishes to Mr Whiteoak and his family. Mrs Moira Newiss, Business Transformation Manager Mr Leslie reported on Mrs Newiss s resignation from the CHP to take up post as Business Manager with the Taynuilt GP Partnership and recorded his appreciation for her work with the CHP. Abdominal Aortic Aneurysm Screening Mr Roberts enquired about the uptake figures for this screening programme within the CHP. Ms Garman will provide feedback to Mr Roberts. Social Media Ms Lorna Alquist (member of the public) asked about the CHP s usage of social media sites, i.e. Facebook, Twitter. It was acknowledged that this would provide a fresh approach to communication with the public and Mr Ritchie advised that NHS Highland are currently reviewing the use of media sites and an NHS Highland Facebook site is available. Ms Alquist will discuss this further with the CHP Communications Team. 20 DATE, TIME & VENUE FOR NEXT MEETING: Wednesday 20 February 2013 at 1pm in J03-J07 Mid Argyll Community Hospital & Integrated Care Centre 17

20

21 Argyll & Bute CHP Committee Date of Meeting: 20 February 2013 Agenda item: 7.1 Argyll and Bute CHP Clinical Governance and Risk Management Report Report by Pat Tyrrell, Lead Nurse and Fiona Campbell, 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 NHS Highland s mission is to provide patient-centred services tailored to people s needs in a systematic and consistent way to provide quality care to every person every day. The Board approach embraces the Healthcare Quality Strategy for Scotland and also takes account of the priorities within the NHSScotland Efficiency and Productivity Framework for SR10. NHS Highland vision is to: Provide quality care at all times; Support people and communities to maximise their own health; Develop precisions driven services so that when people need our care they experience timely, focussed, effective services that minimise the duration and frequency of contact; Ensure that every health pound spent delivers maximum health gain. 2. RISK MANAGEMENT 2.1 Incidents The following information relates to incidents reported in Quarter 3, the period from September to December 2012.

22 FIGURE 1 Argyll and Bute Incidents Last 13 months A total of 438 incidents were reported within Argyll & Bute during quarter 3. This is a slight decrease from quarter 2 (442). Broken down in locality: Cowal & Bute 115 (26.25%) Helensburgh 10 (2.28%) Mid Argyll & Kintyre 183 (41.78%) Oban Lorn & Isles (25.57%) Outwith NHS Highland 18 (4.11%) (patients transferred in) FIGURE 2 Category by Locality from October to December 2012 In the last financial quarter slips trips and falls remained the highest reported category of incidents for Argyll & Bute. The top category was also slips trips and falls for each of the following localities: Cowal & Bute (33) Mid Argyll & Kintyre (51) Oban, Lorn & Isles (43) For Helensburgh the top category remained medication (4). 2

23 FIGURE 3 Grade of Incidents by Locality During Quarter 3 of 2012/13 the incidents reported in Argyll & Bute were graded as follows: Low 224 (51.14%) Medium 137 (31.28%) High 3 (0.68%) The remaining incidents have not yet been graded. FIGURE 4 Incidents with a Major or Extreme Consequence There were 3 major / extreme incidents all from Mid Argyll & Kintyre: 1 violence & aggression incident 1 pressure ulcer 1 self harm There is currently 1 death reported under treatment, from November, that has not yet been graded and does not appear on this graph. 3

24 FIGURE 5: INCIDENTS BY LOCALITY WITH OUTCOME Overall outcome for Argyll & Bute: No injury 258 (58.90%) Near miss 38 (8.67%) Injury 125 (28.54%) Death 2 (0.46%) Damage / loss 15 (3.42%) FIGURE 6 RIDDOR REPORTABLE INCIDENTS There were no RIDDOR reportable incidents recorded for Argyll & Bute during quarter 3. 4

25 2.1.2 Pressure Ulcer Prevention Implementation of NHS Highland Zero Tolerance approach to preventable pressure ulcers continues with a range of measures being taken to improve the identification and management of those patients at risk of developing pressure ulcers in all settings. These include: - staff training using the NHS Education Scotland Module in Pressure Ulcer Prevention - more rigorous application of prevention standards - raised awareness and scrutiny by managers across all sites - increased availability of pressure ulcer prevention equipment - root cause analysis of each Grade 3 and 4 pressure ulcer Further work is planned to improve understanding and knowledge among carers and patients as well as the wider community. Recruitment to the Argyll and Bute Tissue Viability Nurse post will take place in the next two months which will provide additional capacity to progress the improvements. The following graphs highlight trends from January to December 2012 FIGURE 7 NHS Highland Number of Patients with Hospital Acquired Pressure Ulcers from January to December 2012 A total of 114 patients developed hospital acquired pressure sores during Quarter 3 of 2012/13. This is a slight decrease from the previous quarters: Quarter Quarter

26 FIGURE 8: Operational Units: Numbers of Patients with Hospital Acquired Pressure Ulcers from January December 2012 Raigmore remains the operational unit with the most reported patients hospital acquired pressure ulcers. Argyll & Bute 13 (11.40%) North & West 22 (19.30%) Raigmore 65 (57.01%) South & Mid 14 (12.28%) FIGURE 9: Location where Pressure Ulcer Developed October- December

27 FIGURE 10: Operational Units: Patients Admitted to Hospitals with Pressure Ulcers from January to December 2012 Patients were admitted from the following locations: Argyll & Bute 21 (23.33%) (9 out of area transfers) North & West 14 (15.55%) Raigmore 5 (5.55%) (all out of area transfers) South & Mid 50 (55.55%) (out of area transfer) For the 90 patients admitted with a pressure sore a total of 126 pressure sores were recorded. It was noted that 24 of these 90 patients were known to the district nursing teams, however it was not recorded that the ulcer was known prior to admission. TABLE 2: Pressure Ulcer Grade for those admitted to Hospital from elsewhere A&B NW H Raig SM H Total Grade unspec Grade Grade Grade Grade Grand 7

28 FIGURE 11: Operational Units: Number of Patients with Pressure Ulcers developed in Community Operational unit breakdown: Argyll & Bute 17 (19.10%) North & West 28 (31.46%) South & Mid 44 (49.44%) For the 89 patients discovered with a pressure sore in the community across NHS Highland, a total of 105 pressure sores were identified TABLE 2: Grades of Pressure Ulcer developed in the Community A&B NWH SM H Tota l Pressure Sore (grade not specified) Pressure sore Grade Pressure sore Grade Pressure sore Grade Grand Total TABLE 3: Patients with Pressure Ulcers transferred from outwith Argyll and Bute Operational Units Hospital Pt Transferred From Number Argyll & Bute Royal Alexandra Hospital 3 Inverclyde 4 Southern General 1 Royal Infirmary 1 8

29 TABLE 4: Pressure Ulcers Rates per 1000 OBDs and CQI Compliance Rates for each Hospital in Argyll and Bute CHP Falls Prevention As with Pressure Ulcer prevention considerable amount of work is underway to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn and Islands Hospital in Oban. The graph below illustrates trends across NHS Highland. FIGURE 12 NHS Highland Patient Falls in Hospitals from January to December

30 FIGURE 12: NHS Highland Patient Falls in each Hospital October- December 2012 TABLE 5 Rate of Falls with Harm per 1000 Occupied Bed Days and Falls Prevention CQI Compliance Scores for each Hospital 10

31 2.2 Serious Untoward Incidents (SUI) A serious untoward incident is a situation in which staff, or one or more patients are involved in an event which is likely to produce significant clinical, legal, media or other interest. If not managed effectively it may result in the loss of life or the loss of organisation's assets or reputation. NHS Highland has SUI Procedures, with specific timescales, in place which must be followed in these cases. There has been one SUI since the last report this relates to an unplanned discharge from hospital which could have had very serious consequences for the patient involved. This is being reviewed under the SUI Management Policy and a full report and action plan will be developed after the review meeting with all staff involved scheduled to take place on March 4 th. 3 COMPLAINTS TABLE 6 Argyll and Bute Complaint Performance report Sep- 12 Oct-12 Nov- 12 Target Amber Red Number of complaints ved 4 5 ~ 6 7 and over Achievement against 20 day 80% 70-79% Under 69% 0% 0% 25% Number of complaints over 40 working days old * 0 ~ 1 or more Number of further correspondence over 20 working days old * 0 ~ 1 or more Number of complaints categorised as high risk and over As part of the Highland Quality Approach, and in response to the Patients Rights Act, NHS Highland is reviewing its overall performance in relation to complaints management. Representatives from the CHP will attend Kaizen event in Inverness in early March. 4. EXTERNAL REVIEWS 4.1 Joint Inspection of Children s Services in Argyll and Bute Work is underway in preparation for the Care Inspectorate Inspection of Children s Services. Argyll and Bute is one of four partnerships in which the new inspection methodology is being tested by the Care Inspectorate. The inspection will be in line with the principles of Getting it right for every child, will be childcentred and based around the experience of the child s journey, will support improved selfevaluation and will focus on how well services are working together to improve the lives of children. 11

32 The inspection team, with members drawn from all key agencies and including two young inspectors, is currently working to scope out the requirements for the inspection. In order to do this they have accessed a range of nationally available information in relation to performance of key partners in delivering positive outcomes for children and young people. In addition nine position statements which identify our progress in improving outcomes for Children for Young People in Argyll and Bute across a range of indicators have been requested by the Care Inspectorate The two statements already submitted relate to Corporate Parenting and Involvement and Participation of Children and Young People. Each statement is accompanied by the evidence which supports the self evaluation. All statements will be signed off by Community Planning Partnership prior to submission. We have also submitted an activities diary to enable the inspectors to programme the meetings and fora which they wish to attend when they are on site. This includes a range of single and inter agency meetings as well as training and education sessions. The inspection team has identified 90 children and young people whose records they wish to review as part of the inspection scoping. Based on the findings from the case file audits they will decide which areas they wish to focus on in more detail. In addition for 19 of these cases the inspectors will run focus groups with the professionals who have worked with the children and young people. They will also run a number of other focus groups with both Senior Leaders, managers and professionals from across the agencies. They will also hope to meet with children, young people and parents. Initial feedback of their findings will be presented to the CPP on May 1 st and this will be followed by a written report towards the end of May. 4.2 HEI Inspection of Community Hospitals In their annual report for the HEI have announced that their plans for 2013 include the following: Continue to focus on acute hospitals Develop proposals for inspecting community and non-acute hospitals Focus attention on hospitals that (according to our information which includes national data on infection rates) present a higher risk to patients Make sure most of our inspections are unannounced Carry out announced inspections if we think it is necessary, and Start inspecting community hospitals from mid All Argyll and Bute Hospitals are working hard to implement the HAI Standards and to reduce the risk of infection to patients. 4.3 MHRA Inspection of LIH, Oban Laboratories Follow up inspection is due to take place in April

33 5. QUALITY 5.1 Catering and Nutritional Services Specification Compliance The results of the December 2012 audit are shown in Appendix One. A 100% compliance with the standards was recorded. Actions will now focus on monitoring and maintaining 100% compliance. 6. HEALTH AND SAFETY 6.1 Biological Agents Risk Assessment Following work undertaken in relation to COSHH, Health and Safety Managers identified a need for the CHP to undertake assessments related to biological agents. This includes both intentional work with agents such as in laboratories and also unintentional exposure e.g. ward staff. To facilitate this, the Health and Safety Managers have developed a new biological risk assessment form, this complements the forms used alongside the Sypol system for other Coshh assessments. The form has initially been used by the Microbiology section in the Oban Laboratory and it is expected to be adopted across NHS Highland in due course. 6.2 COSHH Audit The CHP Health and Safety Managers have developed a new set of audit questions around the implementation of the COSHH Regulations, to be used with the CHASE audit system. This follows on from all the work that has been undertaken to improve compliance with the Regulations since the HSE Improvement Notice was issued on NHSH. It is anticipated that the audits will be undertaken early in the next financial year across a number of departments within the CHP. 7. FIRE SAFETY 7.1 Fire Risk Assessments Fire risk assessments using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay and Lorn and Islands Hospital are complete and have been issued to managers. 7.2 Fire Alarm and Detection Upgrades Funding has also been allocated to update fire alarm systems to L1 standard in Cowal Community Hospital and Lorn and Islands Hospital and this work has been scheduled. 7.4 Fire Extinguisher Training for Kitchen Staff Risk assessment has highlighted the need for additional fire extinguisher training for kitchen staff. Training has now been delivered to kitchen staff in Lorn and Islands Hospital; Argyll and Bute Hospital; Cowal, Islay and Rothesay, and Mull and Iona Community Hospitals. A date for Campbeltown Hospital is in the process of being arranged. 13

34 Appendix One: Food in Hospitals June 2012 and December 2012 (% compliance) Standard Nutritional Needs of Population Menu Planning Food based Standards Menu Planning Guidance Therapeutic Diet Provision Special and Personal Diet Patient Experience Totals Site June Dec June Dec June Dec June Dec June Dec June Dec June Dec June Dec Argyll and Bute Hospital Cowal Hospital / Victoria Hospital Islay Hospital Lorn and Islands Campbeltown Bandings 90% or higher 70% - 90% less than 70%

35 APPENDIX TWO

36

37 Argyll & Bute CHP Committee Date of Meeting : 20 February 2013 Agenda item : 7.2 INFECTION CONTROL REPORT Report by Pat Tyrrell, Lead Nurse The CHP Committee is asked to: Note the contents of the report. 1 Aim The purpose of this paper is to update CHP Committee members of the current status of Healthcare Associated Infections (HAI) and infection control measures in Argyll and Bute CHP and NHS Highland. 2 Scaling factor used in reporting incidence rates To ensure consistency with wider UK and European Centre Disease Prevention & Control (ECDC) reporting and in light of decreases in the observed rates, Health Protection Scotland (HPS) have changed the scaling factor used in reporting incidence rates to per 100,000 bed days instead of the previously used per 1000 bed days. The Clostridium difficile target for example, now shows as 39 rather than It should be noted that NHS Highland figures for Staphylococcus aureus bacteraemia (SAB) and Clostridium difficile are provisional until validated by Health Protection Scotland (HPS) on a quarterly basis. 3 Summary This report provides an overview for the of Infection Prevention and Control across NHS Highland with particular reference to the incidence of Healthcare Associated Infections (HAI) against Scottish Government HEAT targets, together with results from cleanliness monitoring, hand hygiene audit results and surgical site infections. Table 1 NHS Highland infection prevention & control targets and performance data Clostridium difficile Group Target NHS Scotland Age 65 and over 39.0 (100,000 OBDs) 31.9 For period July Sept 12 NHS Highland 21.1 For period July Sept 12. Green Staphylococcus aureus bacteraemia Age 15 and over 26.0 (100,000) OBDs 29.3 For period July Sept For period July Sept 12. Green Hand Hygiene 95% 95% 98% Green

38 Cleaning 90% 96% Green Estates 90% 97% Green Antibacterial prescribing Hospitalbased Empiric prescribing 95% AMAU - 96% Ward 4A 95% Green Green Surgical antibiotic prophylaxis Primary Care empirical prescribing Compliant Yes Green Compliant Yes Green Source: - Health Protection Scotland/ISD/Local data. 4. Contribution to Board Objectives Our key objective 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 CHP Committee. 5. Governance Implications 5.1 Staff Governance As additional information is distributed more widely it should ensure staff are better informed in respect of current issues relating to Infection Prevention & Control and the management of HAI in our healthcare premises - Infection Prevention is Everybody s Business. 5.2 Patient and Public Involvement The distribution of regular information to the patient/public sector should increase awareness and facilitate increased participation of patient/public representatives in the Infection Prevention & Control agenda. 5.3 Clinical Governance By improving infection prevention & control practices, we will endeavour to provide a healthcare environment for patients that minimises the risk of HAI. 5.4 Financial Impact By reducing the incidence of HAI in our healthcare premises, financial savings can be achieved through lower rates of infection. 5.5 Better Health, Better Care, Better Value By improving infection prevention & control practices, we will endeavour to provide a healthcare environment for patients that minimises the risk of HAI. 2

39 6 Risk Assessment By risk assessing infection prevention & control practices, we will endeavour to minimise the risk of HAI. 7 Planning for Fairness As Infection Control policies are updated they are impact-assessed for equality and diversity. 8 Communications and Engagement Work is ongoing around raising awareness with staff to make sure they consistently apply the principles of Standard Infection Control Precautions. Hand hygiene is the single most important procedure for preventing cross infection, as hands are of special significance in the transmission of infections. All Health Boards are required to demonstrate, every two months, a minimum of 95% compliance with the five moments and technique for hand hygiene. A Hand hygiene module is now available online. The module is mandatory for all staff. There are two public representatives on Argyll and Bute CHP Infection Control Group. In addition regular Infection Control reports are presented to the PPF at CHP and locality levels. 3

40 Argyll and Bute CHP Healthcare Associated Infection Report February 2013 Section 1 NHS Highland Board Wide and Argyll and Bute Issues 1. Staphylococcus aureus (including MRSA) Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at: Staphylococcus aureus : MRSA: 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: Trends National data published by Health Protection Scotland identifies that NHS Scotland Staphylococcus aureus bacteraemia rate July September 2012 was 29.3 per 100,000 acute occupied bed days (AOBDs). NHS Highland s rate was 12.8 per 100,000 AOBDs (8 SABs), this is a decrease on the previous quarters, (January March 2012, 23.4 (15 SABs), April June 2012, 30.3 (19 SABs). October December 2012 (not yet validated by HPS) per 100,000 AOBDs (13 SABs). The annual rate (not yet validated by HPS) for NHS Highland, January December 2012 is 21.8 per 100,000 AOBDs (National target March 2013, 26 per 100,000 AOBDs) A report prepared by Dr Adam Brown, Consultant Microbiologist for the December 2012 Infection Control Improvement Group indicates there is no ongoing upward trend in SABs in quarters 2-4 line-related SABs constitute a small but significant and potentially preventable proportion of all SABs (19%, 6 SABs) Of the 6 line related SABs, 4 are associated with Peripherally Inserted Central Catheters (PICC lines) One third of all SABs for Q2 Q4 were community-associated with no prior healthcare involvement. 4

41 1.2 Current Initiatives A group will meet in January 2013 to lead on the reliable implementation of the Central Line Insertion and Maintenance Bundle and the reliable implementation of a PICC Maintenance Bundle and to understand more around Midlines and Hickman lines and validate results around PVC insertion and maintenance. The Infection Control Improvement Group will monitor progress. Figure 1 Staphylococcus aureus bacteraemia (MRSA and MSSA) cases per 100,000 occupied bed days, all ages, with 95% confidence interval (vertical lines), linear trend (Black line) and target (Red line) = 26, CI = Confidence Interval Figure 2 Funnel Plot of SAB rates for all NHS Boards against acute occupied bed days 01/07/ /09/2012 HG = Highland 5

42 Figure 2 shows that in the current reported quarter ending September 2012 that the Highland SAB rate was significantly lower than that of other Scottish Boards. TABLE 2 shows the cumulative totals for SAB within Argyll and Bute CHP for the years since : Hospitals 09/10 10/11 11/12 12/13 Lorn and Islands, Oban Victoria Hospital, Rothesay Mid Argyll Hospital, Lochgilphead Argyll & Bute Hospital, Lochgilphead Campbeltown Hospital Dunaros, Mull Islay Hospital, Bowmore Cowal Community Hospital, Dunoon There have been no new cases of SAB in Argyll and Bute since the last report. 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: 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: Trends Clostridium difficile in patients aged 65 and over National data published by Health Protection Scotland identifies that NHS Scotland Clostridium difficile rate July September 2012 was 31.9 per 100,000 occupied bed days (OBDs). NHS Highland s rate was 21.1 per 100,000 OBDs (10 cases), this is a decrease on the previous quarters, January March 2012, 44.0 (23 cases), April June 2012, 32.8 (16 cases). October December 2012 (not yet validated by HPS) per 100,000 OBDs (9 cases). The annual rate (not yet validated by HPS) for NHS Highland, January December 2012 is 29.2 per 100,000 OBDs (National target March 2013, 39 cases per 100,000 OBDs) which means the Board is well on track to meet the National HEAT Target. Please note that the numbers for Clostridium difficile in patients age 65 and over in the HAIRT differ from HPS July September 2012 quarterly report. The reason being, that the HPS protocol for surveillance takes the number from the assigned laboratory which, in this quarter, was 1 from the Southern General and 2 from Inverclyde Hospitals. These are, however, included in the out of hospital infections report for Argyll & Bute CHP. 6

43 Figure 3 Clostridium difficile cases per 100,000 occupied bed days, 65 years and over, with 95% confidence interval, linear trend and target = 39. The graph shows that NHS Highland has achieved a sustained downward trend in Clostridium difficile rates despite some variation quarterly. The Board is well on track to meet the HEAT target. Figure 4 Funnel Plot of CDI incidence rates in patients aged 65 and over for all NHS Boards in Scotland, July September

44 Clostridium difficile in patients aged years National data published by Health Protection Scotland identifies that NHS Scotland Clostridium difficile rate July September 2012 was 41.6 per 100,000 occupied acute bed days (AOBDs). NHS Highland s rate was 60.8 per 100,000 AOBDs (10 cases), January March 2012, 40.0 (7 cases), April June 2012, 66.4 (12 cases). October December 2012 (not yet validated by HPS) 60.8 per 100,000 AOBDs (10 cases). The annual rate (not yet validated by HPS) for NHS Highland, January December 2012 is 57.1 per 100,000 AOBDs. There is no national HEAT target for Clostridium difficile in patients aged years. Despite NHS Highland having a slightly higher rate from the national average, the rate remains well within expected levels as demonstrated in Figure 6. Figure 6 Funnel Plot of CDI incidence rates in patients aged years for all NHS Boards in Scotland, July September 2012 There have been no reported cases of CDI in Argyll and Bute since the last report. TABLE 3 shows the cumulative CD Toxin Positive Cases in each CHP Hospital for the years since Hospitals 09/10 10/11 11/12 12/13 Lorn and Islands Hospital, Oban Cowal Community Hospital, Dunoon Victoria Hospital, Rothesay Dunaros, Mull Argyll & Bute Hospital, Lochgilphead Mid Argyll Hospital, Lochgilphead Campbeltown Hospital Islay Hospital, Bowmore

45 TABLE 4 shows the cumulative CD Toxin Positive Cases in community for the years since /10 10/11 11/12 12/13 North and West Unit 22 South and Mid Reported as CHPs 21 Argyll & Bute CHP Hand Hygiene Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at: 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: Trends NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining an average of 98% compliance for November and December The November 2012 National Hand Hygiene Audit report shows NHS Highland compliance as 98%, National compliance was 95%. 3.2 Initiatives Hand hygiene audits continue to be undertaken monthly by all clinical areas, the results displayed and any non compliance addressed. All areas in Argyll and Bute continue to demonstrate compliance with the standards- the results for each hospital are included within the charts in section 2 of the report. 4. Cleaning and the Healthcare Environment 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: Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at: 9

46 4.1 Current Rates Domestic Service teams continue to carry out monthly cleaning and estates audits as per NHS Scotland National Cleaning Services Specification sustaining an average of 96% compliance in November and December 2012 for Domestic monitoring; the average Estates compliance was 96% in November and 97% in December Current initiatives Two hospitals were below the target of 90% for Estates monitoring in November 2012, County Community Hospital Invergordon 88.6% and Mid Argyll Hospital Lochgilphead 89.1%. Local action plans were implemented resulting in 96.1% and 98.5% respectively in December In December 2012 one hospital was below target for Domestic monitoring, St Vincent s Hospital Kingussie 89.7% and one for Estates monitoring in Argyll & Bute Hospital 89.1%.Local action plans have been implemented. Results for all Argyll and Bute Hospitals are highlighted in the charts in Section 2 of this report. 5. Outbreaks/Incidents 5.1 Norovirus Norovirus is prevalent in the community therefore there is a high risk of transmission to hospitals. In comparison with national figures since 2009, NHS Highland ward closures are low. The Health Protection Team informs the Infection Prevention & Control Team of community outbreaks in hotels, care homes, ships etc. Between 01/09/ /12/2012, there have been outbreaks in 9 care homes, 4 hotels and 1 small cruise ship. Hospital Staff are now familiar with following the norovirus protocols and are supported by the Infection Prevention & Control Team. Since the last report there has been one ward closure in Ward 3A Raigmore Hospital. By closing the ward to admissions and minimising movement of staff spread was prevented to other wards. 6. Inspections 6.1 HEI Unannounced Inspection of Raigmore Hospital An unannounced HEI inspection to Raigmore Hospital was undertaken on Wednesday 21 November They found evidence that NHS Highland has implemented a number of changes and taken positive action to address the requirements made following the last inspection in June The final report and action plan were published on Monday 28 January The report contained one requirement and two recommendations as follows: Requirement 1: NHS Highland must ensure that all staff follow the peripheral vascular catheter (PVC) and central venous catheter (CVC) maintenance bundles and complete the accompanying documentation. This will provide assurance that PVCs and CVCs are being appropriately managed, reducing the risk of infection to patients. 10

47 Recommendation a: NHS Highland should reinforce to staff the need to make sure that clinical fridges are kept locked at all times when not in use and that keys are kept in a secure place. This will ensure that staff adhere to safe and secure handling of medicines and avoid any risk to patients. Recommendation b: NHS Highland should make sure that any new methods of working or changes in practice are effectively communicated to, and understood by, staff. This will ensure that staff are clear on their roles and accountability to effectively implement these changes in practice All hospitals in Argyll and Bute have been asked to ensure that the findings from the Raigmore report have been reviewed and actions taken locally to address any issues identified. 6.2 Preparation for Inspection Visits Over the past three months the Board Nurse Director, CHP Lead Nurse and Infection Control Nurses have carried out visits to each of the mainland Argyll and Bute Hospitals. Further dates are planned for visits to Mull and Islay. Overall the visits were very positive with the focus being on supporting managers and staff to continue the delivery of improvements in the environment and in practice. Some estates issues, particularly in relation to Argyll and Bute Hospital, were identified as needing immediate address and work is underway to rectify these. 6.3 HSE The HSE confirmed in December 2012 that NHS Highland have complied fully with the Improvement notice in respect to infection control in the community. Managers from Lochaber will attend the March meeting of Argyll and Bute Infection Control Group to discuss the findings from the visit and the actions that have been taken. All Community Nurse Team Leads have been invited to attend this meeting as there are specific implications for Community Nursing practice and education. 6.4 HEI Annual Report The HEI published their third annual report in February 2013 and the full report can be accessed through the following link: /hei_annual_reports/chief_inspector_report_ aspx Summary of the findings within the report: The improvements HEI have seen, which they think (from the anonymous patient survey responses) matter most to patients, include: cleaner patient environments, for example wards cleaner patient equipment fewer maintenance, repairs and refurbishment issues an increase in the number of staff complying with the national dress code, and better access to training and education in infection control for all staff. 11

48 What is Improving? Staff within NHSScotland were aware of their roles and responsibilities for preventing and controlling infection. Hand hygiene audits are carried out in all hospitals and services. All hospitals and services carry out checks to make sure wards and departments are clean and safe. All hospitals and services inspected had an infection control manual with policies and procedures for staff to follow All hospitals and services inspected had policies and procedures in place for prescribing antibiotics appropriately. All hospitals and services inspected had systems in place for assessing the risk of infection to patients. Overall, NHS boards are actively involving members of the public in infection prevention and control activities. All NHS boards have a public representative on their infection control committee. Public representatives, with NHS board staff, are also involved in monitoring the cleanliness of wards and departments. NHS boards have made sure all staff, when first starting work with the hospital or service, have induction training, which includes infection control. Most NHS boards are now consistently providing update training for staff who had been working in the hospital or service for some time. What Still Needs to Improve: Ward staff not being kept informed about the status of repairs on their wards 15 hospitals and services where one or more standard infection control precautions were not implemented More attention to detail required for high-level dusting, such as tops of curtain rails More attention to detail required for low-level dusting, such as the underside of beds, and hard-to-reach areas, such as floor corners. In nine hospitals, attention to detail when cleaning patient equipment could be improved. Cleaning schedules for both patient equipment and the ward environment were often poorly completed and not routinely signed off by appropriate senior or supervisory staff once the cleaning had been done. Cleaning schedules should detail what, and when, cleaning tasks should be carried out and who should do them. This was not always the case. In nine hospitals and services, the frequency of environmental cleaning in the cleaning schedules did not meet the NHSScotland National Cleaning Services Specification5. Patients in nine of the hospitals inspected reported that they had not received any written information on healthcare associated infection. Plans for 2013 HEI will: Continue to focus on acute hospitals Develop proposals for inspecting community and non-acute hospitals Focus attention on hospitals that (according to our information which includes national data on infection rates) present a higher risk to patients Make sure most of our inspections are unannounced Carry out announced inspections if we think it is necessary, and Start inspecting community hospitals from mid

49 7. Infection Control Risk Register The CHP Risk Register is currently being updated. Added to the register as a risk will be our ability to ensure compliance with HAI standards in Primary Care settings. With the rising number of vulnerable people with complex medical conditions being cared for in the community and the increasing number of interventions being undertaken in primary care we need to review the systems and processes that are in place for ensuring compliance. This will be raised at the next NHS Highland Infection Control Improvement Group. 8. Infection Prevention & Control Education A uniform approach to infection prevention & control training and the recording of training is being taken across Highland. An education sub group of the Infection Control Improvement Group is being convened in January 2013 to ensure patient safety is achieved in relation to infection prevention & control by standardising HAI education and training, targeted at different staff groups across NHS Highland in hospitals, community, care homes, Adult Day Care Centres, Learning Disability and Bank and Social Care staff. 9. Highland Quality Approach To ensure that there is a co-ordinated approach to harm reduction; Infection Prevention & Control Team will participate in the Harm Reduction work stream within the Highland Quality Approach and the Scottish Patient Safety Programme. 10. IC Net Infection Control Electronic Surveillance System The IC Net Infection Control Electronic Surveillance System which will improve our ability to interrogate data and understand trends went live in North Highland in January Because Argyll & Bute CHP interface with laboratories in NHS Greater Glasgow & Clyde, IC Net will not be live until later this year. 13

50 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 Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month and the community hospitals within each CHP. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data is presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website: Clostridium difficile : Staphylococcus aureus : MRSA: 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-ofhospital report card. Understanding the Report Cards Hand Hygiene Compliance Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland s national hand hygiene campaign website: 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. 14

51 Understanding the Report Cards Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: The Report Cards show the hospitals cleaning compliance percentage in both graph and table form. 15

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63 AMT AMAU CHP CDI CNO CVC CSM ECDC GDP HAI HAIRT HEAT HEI Hemi arthroplasty ICU JAG MSSA MRSA PICC PPI PVC QUAD RIDDOR SAB SCN SHPN SHTM 64 SPC SAPG SICPs SPSP VAP Abbreviations Antimicrobial Prescribing Team Acute Medical Admissions Unit Community Health Partnership Clostridium difficile Infection Chief Nursing Officer Central Venous Catheter Clinical Services Manager European Centre for Disease Prevention & Control General Dental Practitioner Healthcare Associated Infection Healthcare Associated Infection Reporting Template Health Improvement, Efficiency, Access, Treatment Healthcare Environment Inspectorate An operation used to treat fractured hip similar to a total hip replacement, but involves only half of the hip. Intensive Care Unit Joint Advisory Group Meticillin Sensitive Staphylococcus Aureus Meticillin Resistant Staphylococcus Aureus Peripherally Inserted Central Catheter Proton Pump Inhibitor Peripheral Venous Catheter Quality Assurance Document Reporting of Injuries, Diseases and Dangerous Occupational Regulations 1995 Staphylococcus aureus Bacteraemia Senior Charge Nurse Scottish Health Planning note Scottish Health Technical Memoranda Sanitary assemblies. Statistical Process Chart Scottish Antimicrobial Prescribing Group Standard Infection Control Precautions Scottish Patient Safety Programme Ventilator Associated Pneumonia 27

64 Staphylococcus Aureus Bacteraemia (SAB) criteria Contaminated blood culture Hospital acquired infection Community onsethealthcare associated infection True community infection Staphylococcus aureus isolated from blood, and SAB diagnosis incompatible with clinical picture, i.e. no or minimal clinical signs and symptoms indicating SAB. 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 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. 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 28

65 Argyll & Bute CHP Committee Date of Meeting : 20 February 2013 Agenda item : 7.3 Argyll and Bute CHP Health Improvement Elaine Garman, Public Health Specialist Recommendation The CHP Committee is asked to: Note this paper Introduction This paper focuses on three areas of public health work: smoking cessation, child healthy weight and delivery of the Keep Well. Each is a stretching HEAT target. Smoking Cessation Performance for 12/13 has exceeded targets set. As well as seeing an agreed number of patients who wish to quit smoking an agreed number also have to be from areas of socio-economic deprivation. This target is also being met. A range of smoking cessation services are provided in GP practices, directly employed CHP staff and community pharmacists Argyll & Bute Successful One Month Quits & Inequalities Cumulative one month quits Actual (1 month quit) - cumulative Trajectory (1 month quit) - cumulative 100 Inequalities Actual equalities Trajectory 0 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 Months

66 Child Healthy Weight X programmes have continued to be offered and run during 2012/13. A specific promotion is being delivered in February and March where swim passes will be given out to those signing up for the X programme. More details are in the next section. 275 Argyll & Bute - Child Healthy Weight Interventions 250 Actual Trajectory Cumulative Interventions Mar-12 Jun-12 Sep-12 Dec-12 Months Keep Well Throughout 2012/13 we have been undertaking a considerable programme of community development work which is laying the foundations for the implementation of Keep Well health checks in April/May 2013 in Campbeltown. To coincide with the British Heart Foundation heart health month in February (Rock Up in Red) we are engaged in a positive delivery of heart health. We have teamed up with Local Producers which is local project in Kintyre to promote the health benefits of using good wholesome local food. Getting out and meeting producers, looking at production methods are all key areas to promote a good healthy lifestyle and not least of all a good healthy local economy. Where possible, events are being held in local Community Gardens, with trained staff on hand to answer any questions the public may have on growing their own fruit and vegetables. The aim is to have at least one large scale local producer available at each event to answer questions and to allow the public to put a face to the person who is providing local high quality food. An Argyll based chef will be on hand to cook samples of good local food and at the same time demonstrate how fresh foodstuffs are much easier and more nutritious to cook than frozen or preserved produce. 2

67 It s all about good wholesome local food and getting us all to be aware of where our food comes from and the benefits of using local produce and at the same time raise awareness of heart health and the up and coming Keep Well CHD checks - In addition we have also organised for The Barrowband to be appearing to draw the crowds and emphasize positive aspects of the healthy eating message. Experience across the country is that they engage well with an audience and get people talking about health promotion to others. Throughout our efforts to promote child healthy weight we have been keen to locate it firmly in the healthy weight of all the family. Initiatives such as this provide an opportunity and each of the areas that host a Rocking Red Heart Show will have a target of 10 children to sign up for the X programme. Summary These HEAT targets are very stretching for the CHP to achieve but important to continue to work on for the overall population health gain. Elaine C Garman Public Health Specialist 11 February

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69 FINANCE REPORT Argyll & Bute CHP Committee Date of meeting: 20 February 2013 Item No 8.1 REPORT BY GEORGE MORRISON The CHP Committee is asked to: Note the financial position at month 9 1. Argyll & Bute CHP - Financial Position at Month 9 For the nine months ended 31st December 2012, Argyll & Bute CHP recorded an underspend of 194,000. This is consistent with the position reported at month 8 which was an underspend of 197,000. No significant movements were noted in December and it appears that the CHPs overall financial position is stabilising as we move towards year-end. Table 1 below provides a summary of budgetary performance across Argyll & Bute CHP for the nine months ended 31 December Table 1: Budget analysis for the 9 months ended 31 December 2012 Year to Date Budget Annual Budget Budget Actual Variance Forecast Outturn Oban, Lorn & Isles Locality 18,419 13,722 13,826 (104) (201) Mid Argyll, Kintyre & Islay Locality 16,560 12,382 12,398 (16) (109) Mental Health In-Patient Services 7,610 5,585 5, Cowal & Bute Locality 12,686 9,471 9,538 (67) (100) Helensburgh & Lomond Locality 4,915 3,637 3, Other Clinical Services 4,847 3,178 3,201 (23) (29) General Medical Services 15,314 11,509 11,611 (102) (100) Prescribing 17,053 12,773 12, Dental, Ophthalmic & Pharmacy 12,471 8,496 8, Services from NHS GG & C 46,930 35,208 35, Commissioned Services 3,880 2,911 2,959 (48) (169) Resource Transfer 4,538 3,404 3, Depreciation 3,303 2,477 2, Management & Corporate 8,980 5,631 5, Budget Reserves Total Expenditure 177, , , Income (1,324) (1,054) (1,051) (3) (4) Net Budget Position 176, , , As reported in previous months, a number of budget overspends are being experienced. The most significant are; - Medical locum cover for vacancies in Dunoon, 218k overspent. - Medical locum cover for a vacancy in Lorn & Islands Hospital, 61k overspent. 1

70 Argyll & Bute CHP Committee Date of meeting: 20 February 2013 Item No GMS budget overspend due mainly to locum cover for GP vacancies in Bowmore, Jura and Inverary, 102k overspent. - Increased drugs costs at Lorn & Islands Hospital, 69k overspent. - An overspend on commissioned services relating to increased patient referrals to Raigmore & Belford Hospitals, which are internally cross-charged on a cost per case basis, and also new individual care packages, 47k overspent. - An overspend on hospital and community nursing pay costs on Bute, 44k overspent. However the benefit from reduced prescribing costs and other budget underspends is more than offsetting the cost pressures noted above. 2. Cost Improvement Programme 2012/13 The CHP approved budget for 2012/13 contained a requirement to achieve savings of 5m. Several of these savings will arise naturally e.g. prescribing drugs coming off-patent, restricted uplift to SLA values etc, however a balance of 1.56m requires to be delivered through management action. Table 2 below identifies recurring targets by budget manager, sums declared achieved to date, forecast achievements based on current information, and likely shortfalls. Recurring Savings Targets Table 2: Argyll & Bute CHP Cost Improvement Programme 2012/13 Responsible Manager Target ' 000 Achieved ' 000 Outstanding '000 Forecast 000 Shortfall 000 Oban, Lorn & Isles V Kennedy Mid Argyll, Kintyre & Islay C West Cowal & Bute V Smith Helensburgh & Lomond V Smith Unfunded Displaced Staff D Leslie Pharmacy F Thomson E-Health J Brass Lead Nurse P Tyrell Public Health E Garman Human Resources D Logue Practitioner Services J Robinson Finance G Morrison Procurement G Morrison Planning S Whiston Totals 1,560 1, , Table 2 indicates that, based on current information, there is likely to be a shortfall of 326k against savings targets. Managers are being encouraged to take action to deliver on savings targets where a shortfall is being predicted, as failure to do so will result in a recurring deficit being carried forward into 2013/14. 2

71 Argyll & Bute CHP Committee Date of meeting: 20 February 2013 Item No Highlands and Islands Travel Scheme (HITS) Further to previous advice, SGHD has advised that the transfer of HITS from re-imbursement to baseline funding has been delayed by one year to 2015/16. This means that from 1 st April 2015, Argyll & Bute CHP will be required to manage the costs of the HITS scheme and be accountable for any overspend on this budget. 4. Forecast Outturn for 2012/13 Argyll & Bute CHP is now forecasting a 200,000 year-end underspend. It seems likely that the exceptional benefit arising from prescribing cost reductions will be sufficient to more than compensate for the in-year cost pressures being experienced and any shortfall against savings targets. It should be noted also, it is assumed that the non-recurring allocations for the Change Fund, e-health and Localities will be fully utilised. Any underspend on these budgets will increase the year-end outturn. George Morrison Head of Finance Argyll & Bute CHP 12 th February

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73 Argyll & Bute CHP Committee Date of Meeting: 20 February 2013 Item :8.2 ARGYLL & BUTE CHP FINANCE DEPARTMENT 2013/14 REVENUE BUDGET REPORT BY GEORGE MORRISON The CHP Committee is asked to; Approve the provisions for cost increases to be included in the 2013/14 revenue budget (Table1) Approve the savings plan for 2013/14 to achieve a balanced budget (Table2) 1. Budget Setting 2013/14 NHS Highland receives funding from SGHD and, in turn, a share of this funding is provided to Argyll & Bute CHP to manage the provision of health services to the resident population of Argyll & Bute. Budget setting within Argyll & Bute CHP is an integral part of the overall NHS Highland Board-wide budget setting exercise and figures quoted in this report will therefore become part of the overall NHS Highland budget for 2013/14. Budget setting within Argyll & Bute CHP follows an established approach. Service delivery tends to be fairly consistent year on year with limited changes being implemented, therefore incremental budget setting is considered to be an appropriate methodology. This system has several positive features; it is administratively straightforward, it provides consistency of approach year on year which is helpful for managers and it reflects the fact that the majority of costs are relatively predictable. Under incremental budgeting, the previous year s budget is used as a base which is then adjusted to allow for; pay awards and inflation, approved service changes and a required savings target to balance to available funding. It should be noted that the proposed revenue budget relates to base recurring funding only. During the course of 2013/14, SGHD will release a number of funding allocations most of which will be non-recurring. These are outwith the scope of the CHPs base revenue budget proposal. It should also be noted that although the budget setting exercise is intended to be comprehensive, it is impossible to know with certainty the financial impact of events which may arise in the future. As such, it should be recognised that risks will exist over and above budget setting. Potential examples include; locum costs, individual patient treatment referrals and withdrawal of support for externally funded posts. Any risks which do materialise will be reported as cost pressures in finance reports produced during the course of financial year 2013/ Funding Uplift for 2013/14 The funding uplift being provided by SGHD to NHS Highland in 2013/14 is 2.8%. A share of this uplift will pass through to Argyll & Bute CHP amounting to 4.072m. This uplift is available to cover pay awards, inflationary pressures, growth in service

74 demand and any new developments. Any excess costs, beyond the level of funding uplift provided, will require to be met from internal savings. 3. Forecast Cost Growth and Anticipated Service Developments Table 1, below, itemises the various provisions which are proposed for inclusion in the 2013/14 budget. As can be seen, at 6.472m, the total exceeds the funding uplift of 4.072m by 2.4m. Therefore, if the content of Table 1 is approved, it will create a need for a savings programme of 2.4m to be implemented to achieve a balanced budget. Table 1 : Forecast cost growth and anticipated service developments Budget/Service ' 000 Comment GG&C Patients' Services SLA 1,318 Based on a 2.8% increase in costs Prescribing 529 Based on a 3% volume/cost increase GG&C Patients' Services SLA 500 Activity related - Gap claimed to be 5.8m per GG&C GG&C Patients' Services SLA - new cancer drugs 500 Service development Pay awards 482 Based on a 1% uplift Savings Targets not achieved in 2012/ Recurring budget deficit b/f from 12/13 Incremental drift 289 Based on analysis of incremental pay growth Depreciation /13 capital programme plus revaluations/indexation Superannuation autoenrolment 241 Based on analysis with assumed 40% uptake Islay medical services 238 Negotiated local agreement Energy (Oil/Electricity/Gas) 205 Based on a 10% uplift New care packages 200 Impact of commitments made in 12/13 Insulin Pump Therapy for Type 1 Diabetes 140 Pumps and consumables + nurse 1.0 wte + dietitian 0.8 wte Other Commissioned Services 108 Based on a 2.8% increase in costs Local Drug Treatments 100 Anticipated service development costs NSD risk shares 100 Annual funding top-slice Resource Transfer 90 Based on a 2% uplift Drugs costs LIH 80 Cost pressure in 12/13 General Supplies inflation 78 Based on a 1% increase in costs Mull PCC 75 Additional revenue running costs Fusions 68 Loss of income from A&B Council PFI Contract (MACHICC) 68 Based on a 3.8% RPI linked increase Primary Mental Health Workers 50 New posts - part funded from service redesign Children's services redesign 50 Provision for increased costs - review ongoing New immunisation programmes 50 Staffing implications Respiratory medicine clinics 48 Provided by GG&C Service Input SLAs 46 Based on a 1% increase in costs Hospital drugs 42 Based on a 3% cost increase PD/MS Nurse Post 30 P. Tyrrell - CMT 23/11/12 Vehicle fleet insurance 30 Cost pressure plus anticipated cost increase Rates % increase anticipated Medical Services Business to Business Contracts 23 Based on a 1% uplift MRSA testing - LIH Laboratory 21 Previously funded by SGHD Labs on call 21 New AfC agreement TAVI development - RIE 20 Based on assumed 1 patient per annum Mull medical services 11 Conversion to a Business to Business Contract Dunoon bandwidth increase - annual line rental 9 Revenue consequences of bandwidth upgrade 6, Savings Plan for 2013/14 2

75 In order to achieve a balanced budget, it will be necessary to implement a savings plan in 2013/14 of 2.4m. Table 2, below, provides details of proposed savings targets by budget. Table 2: Required savings programme Recurring Savings Targets ' 000 Comment Oban, Lorn & Isles Locality 365 2% of budget Mid Argyll, Kintyre & Islay Locality 331 2% of budget Cowal & Bute Locality 252 2% of budget Helensburgh & Lomond Locality 102 2% of budget Prescribing 1,000 2% of budget + 650k prior year benefit Corporate services 76 2% of budget Public Health/Health Promotion 21 2% of budget Lead Nurse 20 2% of budget Commissioned Services 77 2% of budget Depreciation 65 2% of budget Displaced Staff 90 Relates to specific staff displacements Grand Total 2,400 In most cases, the proposal is to achieve cost reductions of 2% on budgets. 5. Action Required The Committee is asked to approve the provisions for cost increases and savings plan for the 2013/14 CHP revenue budget. George Morrison Head of Finance Argyll & Bute CHP 12 th February

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77 Directorate for Finance, EHealth and Pharmaceuticals John Matheson, Director abcdefghijklmnopqrstu T: F: E: Nick Kenton Director of Finance NHS Highland Assynt House Beechwood Park Inverness IV2 3BW abcdefgh Our ref: A December 2012 Dear Nick HIGHLANDS AND ISLANDS TRAVEL SCHEME (HITS) Further to my letter of 18 May that advised you of changes to the funding arrangements for HITS, I am now writing to outline the current position with regard to the transfer of baseline funding. You will recall that I acknowledged that there was an element of risk identified to this baseline transfer, and following discussions with colleagues, I am willing to extend the level of protection from two to three years. This will mean that the transfer of funding to your baseline will now be actioned from To manage the transitional period between and , we will continue to seek information from you on an annual basis on the level of expenditure incurred by the Board with HITS. We will then arrange to allocate this funding on an earmarked basis during this period, as was previously the case. The period between now and should be used to actively ensure appropriate plans and actions are in place to maximise the opportunities to mitigate against the risks of this transfer of resources to your baseline. A revised assessment of the the level of funding to be transferred to your Board s recurrent baseline will be made at the end of We will ensure there is appropriate discussion in the lead-up to setting these figures. In terms of NRAC, we will also ensure that this addition to your Boards recurrent baseline will have a neutral effect. St Andrew s House, Regent Road, Edinburgh EH1 3DG abcde abc a

78 I trust you find this letter helpful. Yours sincerely JOHN MATHESON St Andrew s House, Regent Road, Edinburgh EH1 3DG abcde abc a

79 Argyll & Bute CHP Committee Date of Meeting : 20 February 2013 Agenda item : 9.1 PDP/R AND e-ksf IMPLEMENTATION 2012/13 The CHP Committee is asked to: Note the current progress against trajectory Note the actions being undertaken to monitor and achieve progress against trajectory. Note the qualitative aspects of e-ksf implementation 1. BACKGROUND AND SUMMARY The CHP is making considerable progress in working towards achieving the NHS Highland target for 2012/13 that ALL Agenda for Change staff reviewed against a KSF post outline, with at least 80% of reviews being carried out and recorded online using e-ksf. Levels of activity are consistency higher month by month than in 2011/12 showing that the review and development process is becoming more mainstreamed and embedded in the culture of the CHP. 2. TARGETS 2012/13 The actual performance against the CHP trajectory for 2012/13 are shown in Appendix 1. While the figures continue to be below planned trajectory, they have significantly improved, reflecting the expected pattern of more reviews being carried out in the latter half of the year. This increased level of activity will need to be sustained, and accelerated, to ensure achievement of the end of year target. The e-ksf Lead is meeting Locality Managers to discuss the figures and particular issues in their areas to review progress and address any outstanding issues or difficulties and is available to answer questions from any member of staff or manager on the e-ksf process. 3. MONITORING PROGRESS The position across NHS Highland at 2 February 2013 is as follows (figures in brackets are those last reported to CHP Committee 30 November 2012): Area All AfC staff Review signed off % of AfC staff (all) % of AfC staff (excl bank) Argyll and Bute CHP (500) 39.84(24.14) 54.74(32.72) Corporate Services (91) 20.68(24.01) 21.06(24.43) Mid Highland (72) 29.68(14.84) 44.95(21.62) North Highland (145) 21.09(4.49) 31.29(20.92) Raigmore Hospital (558) 31.50(17.21) 41.38(22.06) South Highland (117) 26.71(15.66) 34.44(20.28) Note : Extract from e-ksf A&B CHP overall has currently 39.84% of all staff that have had reviews and personal development plans signed off in e-ksf (see Appendix 2). The total percentage for NHS Highland is 30.11% (39.58% excl bank posts). Argyll and Bute CHP is therefore performing at a higher level than all other units in NHS Highland. At this time last year only 28.21% of staff had a review completed.

80 . 4. ACTIONS FOR 2012/13 There are still a number of staff who do not have one or more of the following: named manager, address, no KSF outline or no review. Specific actions are being undertaken to address this. 5. QUALITATIVE BENEFITS OF KSF Staff receiving regular development reviews and agreeing personal development plans supports service quality, improvement, staff and clinical governance. Examples are: E-KSF is used to support redesign and service improvement processes by using the KSF outlines to support staff in changing roles, and identifying differences in knowledge and skills required. The use of Foundation outlines for staff moving into new roles as part of service change/redesign should ensure supported development into these roles leading to more confident staff more efficient and effective services. As KSF/e-KSF has become more used and staff are becoming familiar with the systems, managers are reporting that they appreciate the value and benefits of having a mechanism to promote regular interaction and discussions on performance and development with staff. Case studies: Health records and administration within A&B CHP have benefited from the practice of KSF and e-ksf over recent years, and continue to do so. This has included a more systematic appraisal and development system, leading to staff having more ownership of their own development needs and plan in discussion with their manager. Completion of KSF reviews and PDPs has ensured the identification of individual and departmental development needs and managers have worked together to identify the training and development available to this group of staff. They subsequently accessed funded training for 3 trainers and 27 places (500 were available in Scotland), for a national government training scheme for this group of staff; the Certificate of Technical Competence (CTC) The KSF procedures identified potential accountability and governance issues within a defined group staff who provide Dental nursing cover on a bank basis for the Dental OOH service. The application of the KSF process resulted in changes to the employment arrangements so that the management and professional supervision for this group was clearly structured. Continuation of monitoring of the quantitative impact of KSF includes arrangements for Focus Group discussions in March this year. The Workforce Development Facilitator for the CHP reports that many queries now relate to quality of evidence submitted for PDPs and staff are becoming more accustomed to entering and updating this. Sally Munro Workforce Development Facilitator

81 The KSF process provides early opportunity for managers and staff to discuss development concerns and work on addressing these and can thereby avoid progression to formal capability discussions.. Personnel staff actively remind staff of the need for reviews as part of good practice and professional development as they work with staff in localities. 6 CONTRIBUTION TO BOARD OBJECTIVES The achievement of the target is in line with the NHS Highland Board objectives. 7 GOVERNANCE IMPLICATIONS Staff Governance KSF and e-ksf are vital components of meeting Staff Governance standards. Patient focus and public involvement The KSF process enables performance management to assist with improved patient focus and public involvement where appropriate for roles. Clinical Governance KSF process provides the opportunity to monitor development activities of staff including clinical skills and ensures that staff develop and apply the appropriate knowledge and skills in order to be effective in their work. Financial Governance This is part of normal management processes. In addition, workforce costs are a large proportion of the allocated budget. KSF PDP/R and e-ksf support the effective use of staff, in particular through service change and redesign. 8. IMPACT ASSESSMENT The KSF and e-ksf processes are impact assessed at National level. David Logue Head of HR Argyll and Bute CHP February 2013 Sally Munro Workforce Development Facilitator

82 Argyll and Bute CHP Appendix 1 Trajectory for e-ksf /01/ /13 Profiled trajectory - all staff No of reviews No of reviews required required - this month cumulative % Trajectory 2012/ / /13 Actual % 2012/13 No of staff (all) 2043 Month End April Target 80% all 1634 May Even spread(feb-march) 817 per month June July August September October November December January February March A&B CHP e-ksf trajectory 2012/13 compared to Actual % Reviews April May Jun July Aug Sep Oct Nov Dec Jan Feb Mar Month % Trajectory 2012/13 Actual % 2012/13 Prepared by sally.munro 15/02/2013

83 e-ksf Reviews Report by Operational Unit For Period 01/04/ /03/2013 e-ksf Reviews 2 nd February 2013 Total Posts 1 No Post Outline No Review Reviews 'Started' 1 Reviews 'Completed & Not Signed Off' 1 Reviews 'Completed & Signed Off' 1 Reviews at all stages 1 NHS Highland % % % % % 39.58% % A&B Mental Health Services % % % % % 70.37% % Argyll & Bute Central Services % % % % % 34.85% % Cowal and Bute Area % % % % % 61.24% % Dental Service (Argyll & Bute) % % % % % 72.22% % Helensburgh and Lomond Area % % % % % 50.00% % Mid Argyll Kintyre & Islay % % % % % 57.33% % Oban Lorn & Isles Area % % % % % 46.13% % Argyll and Bute CHP % % % % % 54.74% % Notes 1. From e-ksf Current position if Bank Posts are removed from 'Total Posts' - data from Workforce Information Staff List Page 1 of 1 01/02/2013

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85 Argyll & Bute CHP Committee Date of Meeting: 20 February 2013 Item :10.1 MINUTE of MEETING of ARGYLL AND BUTE COMMUNITY PLANNING PARTNERSHIP FULL PARTNERSHIP 28 NOVEMBER 2012 Held in the Council Chambers, Kilmory, Lochgilphead Present Derek Leslie (Chair) Jane Fowler Eileen Wilson Shirley MacLeod Bruce West Cllr George Freeman Andrew Campbell Douglas Cowan Theresa Correia Dave Pettigrew Frazer Durie Bill Stewart Donald Henderson (via vc) NHS Highland Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Scottish Natural Heritage Highlands and Islands Enterprise Scottish Enterprise Strathclyde Police Argyll College ABSEN Scottish Government In Attendance Sonya Thomas (Minutes) Judy Orr (Item 6) Chris Carr (Item 8) Louise Long (Item 9) Janne Leckie (Item 10) Apologies Elaine Garman Sally Loudon Cllr John Semple Cllr Roddy McCuish Robert Pollock Neil Francis Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council NHS Highland Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Scottish Enterprise Item No Detail 1. WELCOME / APOLOGIES Action Derek Leslie chaired the meeting and apologised for the delay in starting. Derek welcomed Theresa Correia from Scottish Enterprise, Frazer Durie from Argyll College and noted that Donald Henderson from the Scottish Government has replaced Jonathon Pryce and will be joining us via vc shortly. Donald joined the meeting at and gave a brief overview of his remit, he is

86 the Head of Public Health Policy and the Community Planning Partnerships link with the Scottish Government. Donald is planning a visit in mid-december when he hopes to meet some of the Partners 2. MINUTES OF THE FULL PARTNERSHIP MEETING HELD ON 20 JUNE Matters Arising Ag Item 3: NEW COUNCIL It was noted that environment now recognised within the job titles of Councillors. Ag Item 7: STRATEGIC GUIDANCE FOR COMMUNITY PLANNING PARTNERSHIPS COMMUNITY LEARNING AND DEVELOPMENT This item has been further deferred to Management Committee meeting in the new year. Donald MacVicar has indicated that further information is yet to be received from the Scottish Government. Ag Item 8: CITIZENS PANEL The survey was collated sent out and a full report of findings will be going to Management Committee in December. Minutes were agreed as a true record. 3. MANAGEMENT COMMITTEE MEETINGS VERBAL UPDATE Derek Leslie MEETING HELD ON 22 AUGUST 2012 MEETING HELD ON 17 OCTOBER 2012 Derek Leslie gave a verbal overview of the last two Management Committee meetings noting that all issues were making good progress and that some items would be further discussed at this meeting. 4. SCOTTISH GOVERNMENT REVIEW OF COMMUNITY PLANNING INCLUDING FEEDBACK FROM COSLA MEETING HELD ON 19 OCTOBER Jane Fowler, Head of Improvement and HR. The report updates the CPP on the progress of the Scottish Government review of Community Planning and the timescales involved along with background information and links to documents on the Scottish Government website. Although we are still waiting for details on the new Single Outcome Agreement a National Group has been established, the groups remit is a leadership role which will be pivotal in implementing and communicating the vision for community planning and SOA s The National Group had its first meeting on 14 August 2012 where terms of reference were agreed, with a second meeting on 23 October 2012 where they agreed the following 6 key national priorities Early years and early intervention Outcomes for older people

87 Employment Economic recovery and growth Health improvement Safer and stronger communities Following discussion, the National Group - Agreed the proposals, set out in the paper and Annexes A and B, for what Community Planning Partnerships must do and the approach to new SOAs for 2013, and that this should form the basis of guidance to CPPs. A note of the meeting is now on the Scottish Government website - This item links into the new Community Plan paper for discussion at this meeting. Report Noted. 5. AREA COMMUNITY PLANNING GROUP UPDATES Shirley Macleod, Area Governance Manager. A report covering the progress made by each ACPG (Area Community Planning Group) as they work to become key partnership groups for each of their local areas was presented. The ACPG s will continue to focus on issues of concern that reflect their local priorities whilst also covering broader subject matter such as the Community Resilience Project, Population Projections, Economic Development and NHS Screening. Work continues with building the positive momentum of the Groups, which in turn should further enhance attendance of Partners and community representatives. It was noted that the NHS are attending the meetings on a more proactive basis. The four Groups are all functioning well but differently; Oban has scheduled some meetings for evenings and afternoons in a bid to achieve better representation and has set up a Short Life Working Group to look at the whole CPP framework and how it fits together. MAKI successfully used video conferencing yesterday in Jura and it was generally felt to be the way forward. Report noted. 6. WELFARE REFORM Douglas Hendry, Executive Director of Customer Services/Judy Orr, Head of Customer and Support Services. Judy Orr presented the paper which outlines the biggest changes to the welfare system in 60 years that are being introduced and highlights the impact that these reforms will have on Argyll and Bute.

88 The main objectives of the Welfare Reform are: To reduce worklessness and make work pay. To support financial inclusion and independence helping to end child and adult poverty. To simplify the welfare system and reduce the ever increasing cost of welfare in the UK. The UK Government is introducing a new simplified benefit from October 2013 which will be known as Universal Credit (UC), a number of restrictions have already been introduced to reduce the cost of Housing Benefit (HB) and Council Tax Benefit (CTB), which are currently administered by local authorities on behalf of the Department of Work and Pensions (DWP). HB will be abolished and delivered through UC which will come into force incrementally from 1 October 2013 to 31 March From 1 April 2013 CTB is being replaced by a new Local Tax Reduction Scheme (LTRS) which also be implemented locally. The changes in the benefit schemes, amounts payable and their administration will mean a reduction in income of nearly 600K for claimants and Argyll and Bute. Housing Benefit Restrictions Some cuts have already been made to the amount of HB that can be paid to claimants; the removal of the 15 excess Local Housing Allowance (LHA) which claimants could previously keep, the LHA has also been reduced from 50% to the lowest 30% of market rents, and is set for one year and increased by CPI rather than RPI. A Size Criteria / Bedroom Tax is being introduced as the government is trying to achieve better value from the social sector housing stock. The size criterion affects working age social tenants who are under occupying their homes, (restriction of 14% for 1 bedroom and 25% for 2 or more). Argyll and Bute has a high level of households that will only require one bedroom under the new rules, coupled with a shortage of one bedroom properties in the area will have significant impacts for the Council and RSL s regarding strategies, policies and tenancy agreements. At present we have an estimated 928 households that could be affected, both the Council and the RSL s are contacting affected tenants and looking at ways that we can support them. The DWP has pledged 30M nationally to mitigate against these reductions, of which we will see a small share. In April 2012 we saw an increase in the shared room calculation from age 25 to 35. There will also be an overall cap on benefits of 500 pw by April 2013 and at present there remain 12 households within Argyll and Bute that are potentially affected by the cap. As a result of changes and restrictions coming into force this is creating a significant amount of work for both the Registered Social Landlords (RSL s) and the welfare rights team. Universal Credit This is a new simplified benefit replacing 6 of the current benefits and will be

89 administered by the DWP through the Job Centre Plus offices. Universal Credit (UC) will be digital by default and online only with payments made monthly via BACS to a single member of the household. The issue of one member of the household receiving the direct payment is of great concern for the Council, RSL s and Social Services due to the significant risk of rent and council tax arrears and increasing the hardship and vulnerability of claimants. Three significant concessions have been agreed in Northern Ireland, payments will be made fortnightly, they can be made to more than one member of the household and will be made direct to RSL s, No similar concessions have been made for Scotland. The timetable for migration to UC is being done in stages from October 2013 to March 2017 with an expected 80% still being administered by the Council in March 2015, although there are no assurances regarding the level of administration subsidy that will be paid in the future. Council Tax Reduction Scheme Council Tax Benefit (CTB) will be replaced with a local Council Tax Reduction Scheme (CTRS); the Scottish Government has been working with COSLA to come up with a national scheme. Councils are currently tasked to ensure the software is in place prior to February 2013, we are currently in talks with our software provider regarding this issue. Local Authority administration of the discretionary elements of the Social Fund As from 1 April 2013 this will become the responsibility of local authorities, the Scottish Government and COSLA are working together to implement a national scheme with some local flexibility. Work still needs to be done to ensure that the Social Fund (SF) can be implemented locally. Discretionary Housing Payments As from 1 April 2013 there will be additional funds for Discretionary Housing Payments (DHP) to specifically address the issues that may arise relating to HB / Benefit Cap / Size Criteria. We expect to know how much we will receive by 31 December 2012 but it is unlikely to cover our 556K reduction in HB. The DWP have issued guidance to assist local authorities with writing a new DHP policy which is being taken forward by the Welfare Reform Working Group (WRWG) Replacing Disability Living Allowance with Personal Independence Payments The reform will start to be phased in from 1 April 2013 and from March 2016 all claimants will be on Personal Independence Payments (PIP). We expect there to be a significant loss of income some to households. New Single Fraud Investigation Service The Council currently employs 3 FTE to investigate Housing and Council Tax Benefit Fraud, in 2013 the team will become part of the Single Fraud Investigation Service (SFIS), initially employed by the Council but working to SFIS policies and procedures. There is uncertainty surrounding the longer-term position of these posts which is now being challenged by COSLA. A Welfare Reform Working Group (WRWG) has been set up to mitigate the proposed changes. The Group is multi-agency and has met 4 times to respond

90 to government consultations and look at the impact of the proposed changes. The Council has recently agreed to dedicate resources for a project team which will report into the WRWG Discussion followed the report and it was acknowledged that the Scottish Government has little impact on the proposed changes and there may be a greater impact on the economy and environment in some areas more than others. It was generally felt that the full impact of the proposed changes are not realised by everyone at present and although we are not disproportionately affected our geography could increase our challenges. It was noted that at present there is no Police representation on the WRWG but felt it would be of benefit. Dave Pettigrew agreed to be the representative and would be sent the previous minutes of the meetings. Action Points Report Noted Judy Orr to send all previous WRWG minutes to Dave Pettigrew, Strathclyde Police Judy Orr 7. NEW COMMUNITY PLAN Bruce West, Head of Strategic Finance. The report set out the progress to date, the approach to developing outcome planning and the timescales involved. We should ensure the Plan is multipartner and shows clear evidence based outcomes linking to the national outcomes and improve our performance management reporting at both Argyll and Bute level and the 4 area levels. Appendix 1 notes that although we are behind schedule at present it is expected the Plan will be available in March Appendix 2 notes the progress to date of the Strategic Needs Assessment. Working is currently underway on this, there has been a fairly good response but as anticipated the analysis will take some time and this will need to come to the Management Committee meeting in December. Appendix 3 notes the proposed engagement and consultation approach. Action Points Progress noted Item on the CPP Management Committee agenda for December. CPP Admin 8. POPULATION PROJECTIONS Chris Carr, Improvement and Organisational Development Project Officer. Chris gave a presentation on Argyll and Bute population projections. In February the National Records of Scotland (NRS) produced 2010 based projections which are projected forward 25 years. It was agreed that this information is very useful to inform future policies and service planning. Argyll and Bute s projected population is set to decline, it was agreed that it would be helpful to calibrate this data with the 2011 census data which should be available in Spring It was noted that these projections do not take into account the increase in population that The Maritime Change Programme will bring and that although these projections are assumptions situations can change that would change the projections and that all partners can have an influence on raising the profile of

91 Argyll and Bute making it a choice to live and work here. It was agreed that as a partnership we need to have clear goals and therefore develop a Strategic Action Plan. Action Point All Partners take this back to their organisations presentation to all Partners Item to come back to Management Committee early 2013 CPP Admin 9. INSPECTION OF CHILDREN S SERVICES AND CORPORATE PARENTING Louise Long, Head of Children and Families. Inspection of Children s Services Louise Long tabled this item at the meeting. The Care Inspectorate developed an inspection plan for a pilot phase of 5 Community Planning Partnership areas, Argyll and Bute is included in this initial pilot phase. We have been informed that we will have a full inspection of our Children s Services in March 2013; the approach is a multi-agency, multi-disciplinary one building upon the successful model of the joint inspections of services to protect children with the aim of achieving the following - improves outcomes for all children and young people provides assurance about the quality of services for children (particularly vulnerable children and young people) helps to improve services and build capacity After the inspection report is published the CPP will have 6 weeks to present a joint action plan. Partners will shortly be invited to attend a briefing meeting attended by inspectors The Partners agreed that this was a very useful presentation and would welcome the opportunity to link outcomes from the CPP SOA to the Children s Services Plan Action Point presentation to all Partners CPP Admin Corporate parenting Louise Long presented this report which advised the CPP of the recent signing of Give Me a Chance Be Fair to a Child campaign and requested the CPP endorsement. The Leader of the Council Cllr Roddy McCuish and the Chief Executive of Argyll and Bute Council, Sally Loudon signed the promise to reduce and combat the stigma of looked after children. Action Point All Agree CPP signed up to Promise New promise to be written up with new signatories Look at the possibility of a public ceremony focusing on young people Signing information and details to come back to the CPP Louise Long

92 10. LOW CARBON VEHICLE PROCUREMENT SUPPORT SCHEME Janne Leckie, Integrated Transport Manager. Low carbon vehicle procurement support scheme This is tabled as a reminder of the decisions made at CPP in May where the CPP agreed to continue to support the scheme and encourage partners to explore opportunities for funding and the introduction of Low Carbon vehicles. The Council has drawn down funding and procured low carbon and then electric vehicles Plugged-in-place electric vehicle charging infrastructure procurement support scheme phase two This report is to bring to the attention of the CPP phase two of the scheme, which has now been renamed the Plugged in Places Electric Vehicle Charging Infrastructure Procurement Support Scheme. The CPP are being asked to consider the viability of pursuing an application for phase 2, the focus of which is Infrastructure, and note their commitment to participate. There is up-to 85,000 of funding available to be drawn down for Partners who agree to electric vehicle chargers being located at their premises, the public can use the chargers for free and the cost of the electricity will be met by the Partner. The charging facilities are quick charging, between 20 mins to 30 mins. And cost approx. 1 to charge a car. There are currently enough funds for 3 charging units and the Scottish Government would agree their location, the priority would be the best 2 or 3 places geographically. It was mentioned that the siting of the chargers may be better placed at commercial premises, if this is the case an approach would need to be made by the Chief Executive. Action Points The CPP endorsed its continued support of the green agenda. A follow-on paper to go to the CPP Management Committee meeting in December Enquire as to the location and number of electric vehicles currently owned / operated within Argyll and Bute ½ HOURS Derek Leslie, Director of Operations. Dave Pettigrew Presentation by Derek Leslie A Health Improvement Message The simple powerful message that has many health benefits - is to try to limit your total sleeping and sitting time to 23½ hours per day. Having been shown at some meetings previously this message is already being is now being circulated as widely as possible, being taken forward by the following:- Sally Loudon previously noted she would bring this to the attention of her Strategic Management Team Shirley McLeod agreed to take forward to the ACPG s Glenn Heritage agreed to take forward to AVA The presentation was accessed via You Tube which could cause access issues

93 for some Partners AOCB - none 13. DATE OF NEXT MEETING 27 MARCH Meeting closed at 12.30

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95 Argyll & Bute CHP Committee Date of Meeting: 20 February 2013 Item :10.2 ARGYLL AND BUTE COMMUNITY PLANNING PARTNERSHIP MINUTES of CPP MANAGEMENT COMMITTEE MEETING held in the COUNCIL CHAMBERS, KILMORY, LOCHGILPHEAD on WEDNESDAY 12 th DECEMBER 2012 Present Sally Loudon Eileen Wilson Joyce Cameron (Minutes) Derek Leslie Andrew Campbell Glenn Heritage Graham Whitefield Jane Fowler Aileen Goodall Louise Long Douglas Cowan Anne Paterson Chris Carr Shirley MacLeod Donald Henderson Katriona Carmichael Bruce West David Pettigrew Fergus Byrne Jim Scott Moya Ingram Cleland Sneddon Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council NHS Highland Scottish Natural Heritage Third Sector Partnership/Argyll Voluntary Action Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Highlands and Islands Enterprise Argyll and Bute Council Argyll and Bute Council Argyll and Bute Council Scottish Government Scottish Government Argyll and Bute Council Strathclyde Police Strathclyde Police Strathclyde Fire & Rescue Argyll and Bute Council Argyll and Bute Council Apologies: Eileen Wilson Argyll and Bute Council ITEM DETAILS ACTIONS 1. WELCOME AND APOLOGIES Derek Leslie welcomed everyone to the meeting and intimated apologies. 2. MINUTES OF THE MANAGEMENT COMMITTEE MEETING HELD ON 10 th OCTOBER 2012 The minutes of 10 th October were approved as an accurate record.

96 Matters Arising:- No matters arising. 3. INSPECTION OF CHILDREN S SERVICES Louise Long, Head of Children and Families at Argyll and Bute Council updated partners on the forthcoming children s services joint inspection. She highlighted the important role that CPP have strategic lead for the Children s Service Inspection. It was noted that Inspectors want to meet with the CPP partners on 21 st January. Prior to the meeting Louise Long is happy to meet to answer any questions with regard to challenges facing young people in Argyll and Bute. Action Points:- Cross section of participants to be identified for a sub group of Community Planning Partners to meet inspectors on 21 January Louise Long Jim Scott of Strathclyde Fire & Rescue to advise a representative. Glenn Heritage to represent third sector. Cleland Sneddon to liaise with Housing Associations re a representative Carol Evans to represent education. Andrew Campbell to represent SNH It was agreed that each partner would prepare a Corporate Parenting Statement including the Third Sector forum, which is due to meet in early January. Louise Long to meet with Glenn Heritage. Louise Long All Partners Community Planning statements will be issued to the CPP for comments once it is endorsed at the Young People Forum. Louise Long to provide an update report to Management Committee on 6 February on progress for inspection. Cleland Sneddon Dates to be identified for sub groups to meet. Louise Long Cleland Sneddon

97 4. SCOTTISH GOVERNMENT REVIEW OF COMMUNITY PLANNING AND SINGLE OUTCOME AGREEMENTS This report updates the CPP with progress made to date and in particular the newly established National Group. Scottish Government have published guidance for the next SOA. Statement of Ambition was agreed on 15 March 2012, when the National Group agreed set of priorities and considered approaches on Cultural Leadership, policy priorities. Approaches are very important and very clear guidance has been given. Community Planning to look at a 10 year programme of outcomes. It was agreed that good examples of co-production are being carried out and they should be promoted in order to improve and develop partnership working. The timescale of the SOA is April 2013, and we are well within timescale. Douglas Cowan suggested that we should look at the 10 year horizon as we develop the plan. Andrew Campbell advised that statistics around population are on a 20 year horizon and we should take this into consideration and find the gaps. 5. NEW COMMUNITY PLAN Bruce West advised that feedback from the exercise that has been taking place over the last month. Chris Carr took the partners through the presentation, she advised that the headings were not necessarily the ones that would be used. Key priorities have been detailed as the plan has developed. For each return that was received, information was sorted by range of criteria. Each of the key priorities had been coloured differently on the diagram presented for ease of interpretation. Emphasis was on partnerships, coproduction, models of service delivery and align housing with health and social services. It was advised that there was very positive feedback with regards to police presence. Andrew Campbell intimated that there were very positive outcomes in the environment theme. Protecting and enhancing the environment that we have, remains a long term priority.

98 Sally Loudon pointed out that the survey is only as good as the data that s been input but if it doesn t reflect this, how do we as a partnership look at the challenges we have collectively? Bruce West intimated that the first stage in this exercise is to identify people that we need to have discussions with to enhance the information and ensure that we have identified the challenges. Action Points:- Draft proposals to February Management Committee to include Issues from consultation and any final partner comments. Sally Loudon urged partners to attend the February meeting. Bruce West b) Report and Presentation on Consultation Bruce West will be developing some questions to put forward to the Area Community Planning Group meetings. Plans will be distributed to partners offices. Document to be put on the CPP website and local tv. Bruce West is also planning to carry out webchat session and to have some form of webcast where a representative can access the CPP website. Glenn Heritage agreed to carry out consultation with harder to reach groups. If partners have any key messages, it would be helpful if they could be received as soon as possible. It was agreed that the plan should be promoted/consulted on via partners intranet sites. Action Points:- Bruce West will bring feedback back to Management Committee on 6 th February Bruce West 5. MEDI VAC FACILITIES ON COLL/COLONSAY Moya Ingram advised that issues had been raised regarding the local aerodrome be utilised. Derek Leslie thanked Moya for her attendance.

99 I Action Points:- It was agreed that the Scottish Ambulance Service, NHS and the Coll Local Voluntary Fire Service would work in partnership to agree suitable protocols for medical air evacuations on Coll and investigate potential funding streams for any infrastructure upgrades that are required. Scottish Ambulance Service, Strathclyde Fire & Rescue 6. FUTURE GOVERNANCE ARRANGEMENTS This update builds on a report that went to Management Committee in October. In future the Full Partnership would meet once a year, looking at mid- year progress. The Meeting would take place in Sept/Oct. Chief Officers Group will report to the Full Partnership. Councillors and Non-Exec members would be invited to future meetings of the Full Partnership. The Community Planning Partnership considered the issue raised by Shirley MacLeod relating to MAKI and recognised that with a new administration in place at the Council, a further discussion will need to take place. In the meantime the Management Committee endorsed the current position. Action Point:- Bruce West to draft a set of terms of reference for each group, outline agendas, structures, more detailed plan for each of the meetings. Bruce West 7. OUTCOME PLANNING Report noted. 8. OPPORTUNTIES FOR ALL ARGYLL AND BUTE COUNCIL PAPER ON SKILLS PIPELINE AND YOUTH PIPELINE AND YOUTH EMPLOYMENT ACTION PLAN Aileen Goodall updated partners on the work being done on youth employment. Organisations came together through Employability group

100 to tackle this issue. The aim is to try to improve opportunities for young people. 2010/11 figures show that almost 10% are in a negative position due to unemployment not being in further education. Skills pipelining has been put together in 5 stages. It is a working document so feedback on any gaps was invited. Partners welcomed the initiative, discussed the plan and made some comments. Cleland Sneddon had a meeting with ACHA on 11 th December, and was advised that they require 9 individual work experiences. Derek Leslie advised that he will take proposals back to NHS. Action Point:- Individual Community Planning Partnership organisation to consider how they could contribute to work experience. Item to come back to Management Committee on 6 th February. All CPP Admin 9. EARLY YEARS COLLABORATIVE NOMINATION OF EARLY YEARS CHAMPION FOR ARGYLL AND BUTE Anne Paterson was delighted to hear Early Years being mentioned throughout the morning as we want Scotland to be the best place for our children to be brought up in. Anne Paterson took the partners through the Early Years presentation. Early Years is very much on a journey in each local authority, and partnership working with Community Planning Partnership is essential to get the best deal in our communities for our children. Sally Loudon proposed Louse Long as the Early Years Champion, all partners were happy to endorse. Action Point: Similar to the list that Louise provided early. Provide nominations to Anne/Louise week commencing 17 January. Most senior representation requested. Cleland Sneddon advised that partners should be appointed for 21/22. All Partners

101 10. ARGYLL AND BUTE COUNCIL BUDGET PRESENTATION ON COUNCIL BUDGET CONSULTATION Bruce West advised that there are proposed savings from the Council s budget. The consultation this year will be based on general views around expenditure on services. It was intimated that information can be accessed on the Council s website. Action Point Presentation to be circulated to partners. CPP Admin 11. ARGYLL AND BUTE LOCAL SERVICES INITIATIVE A project that has been joint funded built on better relationships with third sector and Carnegie. It was proposed and agreed by the partners that we have an event in March to launch the findings of this collaborative project. Action Point Paper to come back to Management Committee on 6 th February. CPP Admin 12. STRATHCLYDE POLICE AND STRATHCLYDE FIRE & RESCUE a) PATHFINDER UPDATE b) STRATEGIC POLICE PRIORITIES CONSULTATION Pathfinder event had been recently held in Edinburgh. There is no change proposed in front facing service and same policing plans will be in place across 32 councils. Jim Scott advised that he was attending the next pathfinder event in Edinburgh and would update partners in due course. Action Point:- The Council has a paper in next Council meeting once papers become public. Argyll and Bute Council to circulate around partners advising any comments to chair. CPP Admin

102 13. PLUGGED IN PLACES ELECTRIC VEHICLES Report was noted. Action Point David Pettigrew has not yet got a response but will chase up. David Pettigrew 14. EMERGENCY RESPONDERS UPDATED POSTAL CODES AND ADDRESSES Graham Whitefield raised an issue regarding emergency services, postcodes and addresses in rural areas. Action Point Invite to go to Scottish Ambulance Service for Management Committee attendance on 6 th February. Joint letter to go to Scottish Ambulance Service with a copy of letter to be sent to Donald Henderson. Graham Whitefield to liase with Jim Scott, Strathclyde Fire & Rescue. Jane Fowler/Eileen Wilson Graham Whitefield/Jim Scott, SFR 15. CITIZEN S PANEL Survey was carried out in September and the report from Hexagon. If anyone requires a copy of the report please advise Chris Carr Chris.Carr@argyll-bute.gov.uk All partners were asked to provide questions/themes for the Spring Citizen s Panel Survey. Action Point:- Questions for Spring to come back to Chris Carr. All Partners

103 16 ACPG UPDATES It was noted that extra meetings had been put in place for all of the groups for January to carry out consultation on the Council s budget and on the new Community Plan. Bute & Cowal Concerns had been raised about projectitis and the need for mainstreaming of work by the Third Sector rather than short term projects/contracts. Concern had also been raised about lack of consultation with communities over health and social care integration. 23 half hours presentation went to B & C. MAKI There was concerns that the report on future governance of Community Planning Partnership does not fully address how this would be taken forward within the MAKI context. H & L There was no concerns raised. OLI No concerns raised. All groups had focussed on agenda items on Health Screening Programmes, Economic Development Activity and the Economic Development Action Plan, and on the local issues including Broadband/mobile coverage in the MAKI area, key partnership groups in Helensburgh and Lomond, and core paths/national cycle paths and the opportunity for these to be key economic/tourism drivers in Oban, Lorn and the Isles. NHS won t be ready to discuss Budget at January meetings. 17. SOA SCORECARD (1 ST AND 2 ND FQ) THEME LEADS Action Point:- Defer to 6 February and put to top of agenda. CPP Admin a) ECONOMY b) SOCIAL AFFAIRS c) ENVIRONMENT

104 d) THIRD SECTOR AND COMMUNITIES 18. CPP BUDGET It was agreed that the partners would remain the same as in previous years. Police/Strathclyde Fire and Rescue/Argyll and Bute Council and NHS happy to contribute. A more detailed budget proposal would be tabled at the next meeting. Action Point:- Paper to go to Management Committee on 6 February CPP Admin 19. REVISED MEETING DATES FOR 2013 Paper Noted. The meetings on 6 th March and 11 th March are subject to change. 20. AOCB Health Inequalities in Scotland CPP short presentation to a MC in 2013 Jane Fowler advised that the Communications Team have been involved in the feature on Oban Airport to be televised in the BBC Landward programme on Friday, 14 December Operation Archer attendance 23 January 21. DATE OF NEXT MEETING Wednesday 6 th February, 2013

105 NHS Highland - "At A Glance" HEAT Targets Summary of the Operational Units performance as per the Balanced Scorecard reported to the Improvement Committee on 7th January 2013 Targets with a delivery date by the end of March 2013 Argyll & Bute CHP Committee Date of Meeting : 20 February 2013 Agenda item : 11.1 Board Position Target Month reported Raigmore North & West South & East Argyll and Bute Delivery Date Financial Performance Oct-12 Mar-13 Cash Efficencies Oct-12 Mar-13 Drug & Alcohol Treatment: Referral to Treatment Jun-12 N/A N/A N/A N/A Mar-13 Faster Access to Specialist CAMHS Oct-12 Mar-13 90% of patients diagnosed with stroke admitted to a stroke unit Nov-12 Currently reported at Board Level Only Mar-13 Delayed Discharges - 28 days Nov-12 Mar-13 MRSA/MSSA Bacterium: 30% reduction Jun-12 Currently reported at Board Level only Mar-13 C. Diff Infections: 30% reduction Jun-12 Currently reported at Board Level only Mar-13 Reduction in Emergency bed days for patients aged 75+ Jul-12 N/A Mar-13 Targets with a delivery date beyond March 2013 Board Position Target No Trajectory Early Access to Antenatal Services Mar-15 Data sources being developed No Trajectory Detect Cancer Early Apr-15 Data sources being developed Child Healthy Weight Interventions Sep-12 N/A N/A N/A Mar-14 Smoking Cessation - 2 most deprived data zones Sep-12 N/A urrently reported at Board Level On Mar-14 Smoking Cessation - general smoking population Sep-12 N/A N/A N/A Mar-14 Child Fluoride Varnish Applications Jun-12 N/A urrently reported at Board Level On Mar-14 Month reported Raigmore North & West South & East Argyll and Bute Delivery Date Reduce Carbon emmissions Sep-12 Currently reported at Board Level Only Mar-15 Reduce Energy Consumption Sep-12 Currently reported at Board Level Only Mar-15 No Trajectory Faster Access to Psychological Therapies Dec-14 Trajectory in development Rate of attendances at A&E Oct-12 N/A Mar-14 NHS Highland - "At A Glance" Standards Board Position Target Alcohol \Brief Interventions Oct-12 N/A Inequalities Targeted Cardiovascular Health checks Oct-12 N/A N/A Breastfeeding at 6-8 week- Target 36% Mar-12 N/A N/A N/A MMR uptake rates - target 95% at 5 years old Jun-12 N/A N/A N/A Month reported Raigmore North & West South & East Argyll and Bute Sickness Absence - 4% target Aug-12 N/S SMR return rate - 90% of SMR1 returns received within 6 weeks Sep-12 Complaints - 80% of complaints completed within 4 weeks Sep-12 Complaints - No. over 40 working days - Target 0 Aug-12 Complaints - No. of complaints received Target less than 33 Aug-12 Complaints - No. categorised as High Risk - Target less than 7 Aug-12 Day case rates - Target 78.9% Oct-12 N/A Outpatients - DNA rate - Target 6.9% Sep-12 Reduce Pre Operative stay - Target 0.65 days Oct-12 N/A New to Return Outpatient attendance Ratio - Target 2.02 Sep-12 eksf & PDP's - Target 80% Oct-12 Suspicion of cancer referrals (62days) (Due for Delivery Dec 2010) Jun-12 Reported at Board Level only Dec-11 All Cancer Treatment (31days) (Due for Delivery Dec 2010) Jun-12 Reported at Board Level only Dec weeks Referral to Treatment (Due for Delivery Dec 2010) Oct-12 Currently reported at Board Level only Dec-11 New Outpatient Waiting times - 12 weeks (all referral sources) Oct-12 N/A N/S Inpatient/Day Cases Waiting times - 9 weeks Oct-12 N/A N/S Cataract Waiting Times - assessment - 9 weeks Oct-12 N/A Hip surgery - 98% of patients treated within 24 safe operating hrs Nov-12 N/A N/A N/A Angiography - 4 week waiting time Oct-12 N/A N/A N/A Daignostic tests waiting times - 4 weeks for 8 key tests Oct-12 N/A A&E Waiting times - 4 hours Oct-12 N/S Annual Advance Booking - GP's N/S N/S : National Standard Cervical Screening - 80% uptake of yr old women screened Sep-12 N/A Reduce Occupied Bed days for long term conditions Jul-12 N/A Dementia (Unvalidated - validated position available annually) Oct-12 N/A N/S

106

107 Executive Summary. Joint Performance Report: December For Older People, in-depth data, by area, is available on Pyramid and can be found under Joint Planning & Performance Balance of Care. The overall balance of care describes people aged 65+ who receive funded care provision from the Partnership. In December % were cared for in the community and 31% in an institutional setting. The target is 70%/30% The in-year Balance of Care shows the outcomes of care decisions made within the financial year. As at December % of the older people who receive funded social care are being cared for in the community, the target is 80%. Emergency admission and re-admission data have routinely been provided for Argyll & Bute and Vale of Leven hospitals. There are patients regularly admitted on an unplanned/emergency basis to Glasgow and Inverclyde hospitals, from this month we have a full data set for these admissions. The data are included in this report but will be shown as a separate data set for the remainder of the financial year, in order to maintain the integrity of the 10% reduction target. The new reporting system in GG&C Health Board no longer shows re-admission data, so this not available for Vale of Leven or Glasgow hospitals. At the November census date there were a total of 13 delayed discharges. 7 were delayed less than 4 weeks. We had 3 patients coded 9/51x (Adults with Incapacity) all delayed over 6 weeks. We also had 3 patients exemption coded 100, these are patients ready for discharge from Argyll & Bute hospital, but who need to be discharged to a specialist facility. No appropriate facility exists. Once again we met the national target of zero delays for non-exempt patients at 6 weeks. We had a total of 70 permanent and 7 respite care home vacancies across the area at the end of December The majority of vacancies are in Cowal. 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 as opposed to residential care. The Balance of Care for MH Service users is 97% cared for in the community as opposed to residential care. Data for Mental Health unplanned admissions in shown in this report, for the current financial year. 1

108 The Joint Planning and Performance Officer will seek to establish improved, monthly performance updates on substance misuse services working with the ADP Coordinator and Information Officer. JOINT PERFORMANCE ACTION PLAN: Action 1 Carry out analysis of current LD day service provision and dialogue to ascertain service user aspirations as part of LD Re-design Responsible person Service Manager Learning Disability Timescale Status Part 1 (analysis) August Complete. Green 2 Re-design ADP Pyramid scorecard using data from national database and change data interval to monthly. 3 Achieve a 10% reduction in unplanned hospital admissions during the financial year 2012/13 (will be monitored monthly on Pyramid for reduction on the 2011/12 data) Joint Planning & Performance Officer/ADP Coordinator & Information Officer CHP Director of Operations and Lead Nurse Part 2 ( dialogue) Timescale to be agreed May st March 2013 Amber Amber Amber 4 Each locality will report progress against their action plan to reduce emergency hospital admissions and re-admissions on a quarterly basis. 5 Carry out further bed modelling in Campbeltown in October 2012 CHP Locality Managers/Lead Nurse CHP Locality Manager Quarterly during 2012/13 Complete see page 11 Amber Green 2

109 1. Joint Performance and Balance of Care, Older People. Table 1.1 Emergency Hospital Admissions and Re-admissions December Area Total Number of Readmissions Age Age Cumulati Target 65+ emergency these with ve and RAG admissions or more as a % of Variance status emergency admissions the total YTD in 12 months Lorn % Mull & Iona Tiree & Coll Cowal % Bute % Mid Argyll % Kintyre % Islay & Jura % Helensburgh 38 * * (Vale of Leven) Totals % GG&C have adopted a new reporting system which no longer provides re-admission data. It does however provide data for the Argyll & Bute admissions to all the Glasgow hospitals and these are now shown at table 1.1a Table 1.1a Glasgow Hospitals Emergency Admissions December Re-admission data is not provided in the new GG&C reporting system Area Total emergency Age 65+ Age 75+ admissions IRH RAH SGH Victoria Infirmary

110 We have an agreed target of 10% reduction in unplanned hospital admissions during the financial year, with monitoring commencing from 1 st April In the year-to-date there is a reduction in unplanned admissions of 211, as compared to the 2011/12 total for the same period. The target reduction at this point in the year is 194. Much of the reduction was achieved during September and October 2012, when Oban and Kintyre achieved large reductions. The overall reduction in unplanned admissions is now exceeding target, although only Oban and Kintyre hospitals are above target, whilst the other 5 hospitals are failing to achieve the target. For Note: Argyll & Bute s CHP s senior analyst has queried the emergency admission data for LIGH and has advised the there may have been an error in Medical Records where a number of admissions have been wrongly allocated a non-emergency code. The coding is currently under review and a revised report will soon be available. This may impact on the data in Table 1.1 and on performance against the reduction target. A monitoring tool has been devised by the CHP Lead Nurse and is being applied in Campbeltown, to ascertain the reason for each emergency admission, date and time of admission, alternatives considered etc. The tool will be utilised by scrutiny groups in all Argyll & Bute Hospitals. In order to ensure that there is a concerted focus on reducing avoidable emergency admissions/re admissions a specific workstream has been established under the Reshaping Care for Older People programme. All areas will be asked to focus initially on unplanned readmissions as these comprise a significant percentage of the overall unplanned admissions rate. With improved anticipatory care and discharge planning it should be possible to reduce the number of unplanned readmissions. Action: All localities will report progress against their action plans to the CHP Lead Nurse on a quarterly basis. 4

111 Emergency admissions by month/financial year 2011/12 Table 1.2 Total unplanned admissions 65+ Argyll & Bute and Vale of Leven, showing linear trend Total unplanned admissions 2012/ Total unplanned admissions 2012/13 Linear (Total unplanned admissions 2012/13) 0 Total unplanned admissions in December 2012 were 207, as compared to 156 in November 2012, an increase of 51. In the year to date there continues to be a downward linear trend, despite seasonal variations. It should be noted that emergency admissions to LIGH may have been wrongly coded and re-coding when completed may affect performance on this measure. 5

112 Table 1.2a Total unplanned admissions 65+ Argyll & Bute and Vale of Leven, showing 2011/12 comparators Total unplanned adm. 2012/13 Total unplanned adm. 2011/12 Linear (Total unplanned adm. 2011/12) Linear (Total unplanned adm. 2012/13) 50 0 apr may jun jul aug sep oct nov dec jan feb mar Total unplanned admissions in December 2012 were 207, as compared to 154 in December The target reduction year to date is 194, whilst the actual reduction is 211. Table 1.3 Bute & Cowal 65+ unplanned admissions Bute 2012/13 Bute 2011/12 Cowal 2012/13 Cowal 2011/12 Linear (Cowal 2011/12) Linear (Bute 2012/13) Linear (Cowal 2012/13) Linear (Bute 2011/12) 0 apr may jun jul aug sep oct nov dec jan feb mar Unplanned admissions in Cowal and Bute have risen in December and are both above the levels shown for December

113 Table 1.4 Helensburgh (Vale of Leven) 65+ unplanned admissions VoL 2012/13 VoL 2011/12 Linear (VoL 2011/12) Linear (VoL 2012/13) apr may jun jul aug sep oct nov dec jan feb mar The number of emergency admissions to Vale of Leven hospital has risen slightly since last month, but is lower than the comparative period in Table 1.5 MAKI 1.5a Mid Argyll 65+ unplanned admissions Mid Argyll 2012/13 Mid argyll 2011/12 Linear (Mid argyll 2011/12) Linear (Mid Argyll 2012/13) 5 0 Apr may jun jul aug sep oct nov dec jan feb mar Unplanned admissions in Mid Argyll have continued to increase since September 2012, and are higher than the comparative period in

114 1.5b Kintyre & Islay 65+ unplanned admissions apr may jun jul aug sep oct nov dec jan feb mar Kintyre 2012/13 Kintyre 2011/12 Islay 2012/13 Islay 2011/12 Linear (Kintyre 2011/12) Linear (Islay 2011/12) Linear (Kintyre 2012/13) Linear (Islay 2012/13) Unplanned admissions in Kintyre have risen slightly again in December 2012, whilst December 2011 was the lowest point in the 2011/12 financial year. In Islay unplanned admissions have fallen over the last month, to the same level as at December Table 1.6 OLI 65+ unplanned admissions LIGH 2012/13 LIGH 2011/ Linear (LIGH 2011/12) Linear (LIGH 2012/13) apr may jun jul aug sep oct nov dec jan feb mar Unplanned admissions to LIGH increased to 53 in December, bringing the monthly total to slightly below the figure for December An audit of coding has been carried out and it 8

115 is possible that incorrect coding could account for the low admission figures from September to December, no corrections have yet been issued. There were a total of 12 patients admitted for surgery. 1 of the general surgical admissions was a patient originating out of Scotland. Table 1.7 Lorn Admissions by specialty: Gen medical Gen surgical Geriatric assessment Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 9

116 Table 1.8 Total Emergency Re-admissions Rolling 12 month period to December Area Total patients readmitted as emergenc y in the last 12 months Age d Age d 75+ Admitted from care home Admitted from Sheltered Accommo dation Admitted from own home Total compare d to last month Bute Cowal Helensburg h & Lomond* Mid Argyll Kintyre Islay & Jura Lorn Mull Tiree & Coll OOA/not known to SW Totals Variations in the numbers of emergency re-admissions, measured over the last 12 month rolling period, are shown in the right-hand column of this table. Some re-admissions, particularly where they are numerous, frequent and for the same condition, suggest an opportunity for community based intervention. 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. 10

117 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 September 2012 Occupied October 2012 Occupied November 2012 Occupied December 2012 C101H Argyll & Bute Hospital C106H Cowal Community Hospital * 2* 2* 2* C108H Islay Hospital C113H Rothesay Victoria Hospital C114H Rothesay Victoria Annexe C121H LIGH 2 1+2* 1+2* 1+2* 1+2* C122H Campbeltown Hospital H224H Mid Hospital Argyll Total *Patients placed in Cara Ward, Mid Argyll hospital, but shown in their home area. Usage of Continuing Care Beds in Campbeltown has remained low for a long period of time. Bed modelling was planned for with a report due in December A meeting was undertaken 10 th January 2013 and agreement reached that Campbeltown Community Hospital will operate with 19 acute GP beds and 2 continuing care beds. The 2 continuing care beds have been retained as they are currently occupied, though clinicians and case managers have been asked to review patient assessments to determine whether 11

118 or not their needs continue to be met in an NHS continuing care setting. There was general acknowledgement that when these 2 remaining patients no longer require continuing care in Campbeltown Hospital, these beds will not remain available. Initially therefore twelve of the 14 continuing care beds will be closing with the resulting resource release to be discussed and agreed. Action: Complete Table 1.10 Social Care bed vacancies, by area as at There were 70 social care vacancies across the area, plus 7 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 MAKI OLI LA Total Private sector Cowal Bute Helensburgh MAKI OLI Private Sector Total

119 Total vacancies Total A&B vacancies 70 Respite vacancies (not included in table above) 7 % of permanent beds available in A&B % Table 1.10 a Planned stay in a care home by referral type Bute & Cowal - People aged 65+ in Care homes RC NC SC/ERC Bute and Cowal are the only areas where the numbers of people in residential care continue to be greater than in nursing or single care. Helensburgh & Lomond - People aged 65+ in Care homes 13

120 RC NC SC/ERC In Helensburgh the take up of nursing care exceeds other institutional care options. MAKI - People aged 65+ in Care homes RC NC SC/ERC 10 0 In MAKI the number of people in nursing care started to exceed those in residential care in June OLI - People aged 65+ in Care homes 14

121 RC NC SC/ERC In OLI the highest level care use is focussed on nursing care, with lower levels in residential and single care. Delayed Discharges at the December 2012 census date. (10 th December 2012) 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. From April 1 st 2012 we implemented a local target of zero at 4 weeks for non-exempt patients, ahead of national implementation in April We are taking the opportunity to identify any issues that could prevent achievement of the national target in We plan to implement a local target of 2 weeks in April 2013, again to work ahead of the national target decreasing to 2 weeks. Some challenges are anticipated in achieving a zero target at two weeks, so the reduction of admissions and readmissions is crucial to success in this measure. There were 0 non-exempt delays at 4 weeks. There were 0 non-exempt delays at 6 weeks, the national target, as measured at the December census date. We have 3 AWI patients (code 9/51x) who have been delayed more than 6 weeks. Work via Reshaping Care for Older People will encourage all older people, but particularly those with a diagnosis of dementia, to make Power of Attorney and Guardianship arrangements whilst 15

122 they have capacity, thus later avoiding delays in hospital, which are never in the patient s best interests. Code 100 relates to 3 patients who have had long stays in Argyll & Bute Hospital. They are now fit for discharge, but need to be relocated to a specialist facility. There is no suitable facility available. The total number of delays (including those less than 6 weeks and with exemption codes) decreased to 13. Table 1.11 Description Delayed under 4 weeks Delayed 4-6 weeks (local target 0) Delayed over 6 weeks (national target 0) Total A&B no exemption code A&B Exemption 100 A&B Exemption 9/51x A&B Exemption 9/71x Out of area no

123 exemption code Out of area Exemption 9 Out of area Exemption 9/51x Out of area Exemption 9/71x Total delayed discharges Exemption Code 9 are complex cases the 51x suffix indicates an adult with incapacity (AWI) Exemption code100 detained MH patients who require reprovisioning/recommissioning of services. 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 homebased care. The Reshaping Care for Older People work builds on this requirement, by providing additional funding to enable and support the shift towards care in the community. The overall Balance of Care targets in Argyll and Bute are 70% cared for in the community and 30% of people cared for in an institutional setting. The measure represents people aged 65+ who receive a funded service from the Partnership. The performance is weighted by a number of people who have resided in care homes across Argyll & Bute for a long period of time, with the highest concentration in Cowal. Within current guidelines for care provision many of these people would have remained, with support, in their own homes and communities, however, it was practice some years ago for people to identify residential care as an option of choice at an early stage The in-year Balance of Care shows care decisions taken within the financial year; the target for 2012/13 is 80% in the community and 20% in an institutional setting. This target 17

124 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. Table 1.12 Overall Balance of Care by area, December 2012: Area Clients cared for in the community Clients cared for in an institutional setting Trend for CiC Number % Number % Helensburgh & Lomond % % Bute & Cowal % % Bute % 53 25% Cowal % % Mid Argyll, Kintyre & The Islands % % Mid Argyll % 51 27% Kintyre % 64 35% 18

125 Islay & Jura 59 75% 20 25% Oban, Lorn & The Isles % % Oban % 97 34% Colonsay 5 100% 0 0% Mull & Iona 48 92% 4 8% Coll & Tiree 5 45% 6 55% Overall delivery % % Target 70% 30% Source: Pyramid, Joint Planning & Performance The overall Balance of Care shows people aged 65+ who receive formal (funded) care from the Partnership. Care in the community includes Homecare, ICTs, Overnight Teams and Extra Care Housing. To avoid double-counting Meals on Wheels, respite care, daycare and Telecare are not currently included. It is recognised that some people are supported on an on-going basis by Community Nurses, but we have not, to date, been able to gather reliable data to include this provision. Care in an institution includes permanent and temporary/emergency stays in a care home and NHS Continuing Care. Delayed Discharges awaiting care provision are also included in the Balance of Care calculation. Table 1.13 In-year Balance of Care by area, December 2012: Area Clients cared for in the community Clients cared for in an institutional setting Trend for CiC against previous month 2011/12 Totals (for comparison) Number % Number % CiC Inst Helensburgh Lomond & % 42 19% 87% 13% Bute & Cowal % 41 24% 73% 27% Bute 55 77% 16 23% 74% 26% Cowal 73 75% 25 25% 73% 27% Mid Argyll, Kintyre & The Islands % 54 28% 67% 33% 19

126 Mid Argyll 75 75% 25 25% 67% 33% Kintyre 50 67% 25 33% 72% 28% Islay & Jura 11 73% 4 27% 71% 29% Oban, Lorn & The Isles 45 61% 29 39% 61% 39% Oban 34 56% 27 44% 63% 37% Colonsay 1 100% 0 0% 0% 100% Mull & Iona 10 91% 1 9% 38% 62% Coll & Tiree 0 0% 1 100% 0% 100% Overall delivery % % 75% 25% Target 80% 20% 70% 30% 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 2011/12 percentages for comparison. Care in the community includes Homecare, ICTs, Overnight Teams and Extra Care Housing. To avoid double-counting Meals on Wheels, respite care, daycare and Telecare are not currently included. It is recognised that some people are supported on an on-going basis by Community Nurses, but we have not, to date, been able to gather reliable data to include this provision. Care in an institution includes permanent and temporary/emergency stays in a care home and NHS Continuing Care. Delayed Discharges awaiting care provision are also included in the Balance of Care calculation. Individual data for each area and type of service can found on Pyramid, on the In-year Balance of Care scorecard. The overall Balance of Care has improved to 69% of people cared for in the community, just short of the 70% target. The in-year Balance of Care is again below target at 75%. Helensburgh is above target at 81% cared for in the community. Bute and Cowal are below target and showing a downward trend that relates to Cowal, where admissions to care homes have been comparatively high during 20

127 November and December (+6 in November and +4 in December), whilst numbers cared for in the community have decreased by 11 during December, due to low numbers referred to the ICT. MAKI is still below target, but showing an upward trend, there have only been 4 new admissions to care homes during the month, which is within the average range, but numbers accessing care in the community are low. OLI is below target with a downward trend, Oban being the area with the greatest problems, whilst small overall numbers on the islands always cause statistical swings. Oban is experiencing temporary difficulties during a period of significant change. The Integrated Care Team ceased to be operational at the end of November 2012, staff are now be being upskilled in readiness for the roll out of the Model of Care, when Extended Community Care Teams will begin to take forward the Reshaping Care for Older People agenda. In addition there is a temporary shortage of capacity within homecare, as the newly appointed external providers do not commence their contractual obligations until 21 st January 2013 and are currently recruiting to care-worker posts. In the interim it is difficult to commence new homecare packages and this is impacting the Balance of Care in the area. 2. Integrated Community Based Services. Integrated Occupational Therapy Services: Table 2.1 OT Active Caseload Area Active caseload September 2012 Active caseload October 2012 Active caseload November 2012 Active caseload December 2012 Bute & Cowal Helensburgh & Lomond MAKI

128 OLI Table 2.2 OT Waiting list for assessment Source: Local Teams whilst awaiting the AWT Database. Area Waiting list September 2012 Waiting list October 2012 Waiting List November 2012 Waiting List December 2012 Bute & Cowal Helensburgh & Lomond MAKI OLI Source: Local Teams whilst awaiting the AWT Database. Table 2.3 OT Service Users awaiting major adaptations Area Awaiting major adaptations September 2012 Awaiting major adaptations October 2012 Awaiting major adaptations November 2012 Awaiting major adaptations December 2012 Bute & Cowal Helensburgh & Lomond MAKI OLI

129 Source: Local Teams whilst awaiting the AWT Database. Occupational Therapy is a crucial element of service in maintaining people at home and increasing the numbers of people who are cared for in the community. Accurate data and information is essential to inform strategic decisions about Occupational Therapy and other key services, as well to as to enable operational delivery. The Lead AHP is pursuing an updated report from the AWT database to provide breakdown by age and 75+, however, she has advised that it is unclear whether AWT is able to provide this data and processing the request is likely to take a considerable time. We do not currently have data on length of wait for assessment, or length of wait for adaptations, type of adaptation etc. It was hoped that AWT would provide this data, but to extract this from the database requires equity of use by the OT Teams, who are at present unable to fully agree the process. Lead Occupational Therapists advise that people awaiting major adaptations will have ongoing service from the OT Teams and will be supported with equipment and advice until their adaptation is complete. They will provide some further detail for a future report. 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. 23

130 Table 2.4 Service Users/Number of visits December 2012: Area Number of service users/visits under 65s Number of service users Number of service users 75+ Number of visits to service users aged 65+ Bute Cowal 10 clients/154 visits Helensburgh Mid Argyll 2 clients/2 visits Kintyre 3 clients/84 visits Islay Oban 2 clients/13 visits Mull All areas use the service to provide temporary care at home, (Helensburgh also benefits from an evening and overnight nursing service). The aim of this care is 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. There is variation in how this service is used by GPs or hospital/a&e staff to directly avoid admission or return a patient home from A&E. Promotion of the service needs to be ongoing to ensure that it is being used appropriately and that demand and capacity are aligned. Table 2.5 Service users aged 65+, Purpose of visit December 2012: Area Prevent hosp. adm. Return from A&E Support discharge Temp. care at home Resolved alarm activity Unable to resolve alarm activity & referred Respond to enhanced T care Support assessmen t 24

131 on system Bute Cowal H burgh M. Argyll Kintyre Islay Oban Mull Table 2.6 Service users aged 65+, Referral source December 2012: Area Ambulanc e or Police GP Hospital District Nurse/ CPN ICT SW/HCO Alarm Calls/Other Bute Cowal H burgh M. Argyll Kintyre Islay

132 Oban Mull Source: Carr-Gomm monthly report We try to analyse referrals for point of origin, so that we can ascertain whether a case originates with a GP or District Nurse. However, anecdotal evidence suggests that some GPs do refer indirectly to the service, using District Nurses or ICTs to make the referral, but without there being any official indication that it is being made on behalf of the GP. Table 2.7 Percentage use/capacity of Overnight Teams, December % client contact time % travel time % available time 10 0 All of the teams were active 31 days during the month. Kintyre had less than the 40% capacity that we consider desirable to ensure a rapid response to unplanned calls, Cowal had 39% capacity, all other areas had adequate capacity. 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 2012 Total active LD Service Users Number in residential care % Number case managed in community % 26

133 % % 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. To demonstrate this we would wish to see fewer people choosing a Resource Centre only and Resource Centre plus alternative activities, whilst a higher number would choose to either access community based day opportunities or to plan and carry out daytime activities by other means. These might include paid work, work experience, volunteering, use of a Personal Assistant or accessing community activities independently. Table 3.2 Percentage of people with a Learning Disability attending Resource Centre only day opportunities The Learning Disability data is currently undergoing a CareFirst verification process, so data for October to December is pending. Area Sept Oct 2012 Nov 2012 Dec 2012 Bute & Cowal 0% Helensburgh & Lomond 0% MAKI 14% 27

134 OLI 3% Table 3.3 Percentage of people with a Learning Disability attending mixed Resource Centre and alternative day opportunities Area Sept.2012 Oct 2012 Nov 2012 Dec 2012 Bute & Cowal 4% Helensburgh & Lomond 0% MAKI 52% OLI 39% Table 3.4 Percentage of people with a Learning Disability attending supported community based day opportunities. Area Sept.2012 Oct 12 Nov 12 Dec 2012 Bute & Cowal 79% Helensburgh & Lomond 82% MAKI 34% OLI 58% The Service Manager Learning Disability is undertaking analysis of day opportunities and dialogue with service users, within the framework of the Learning Disability Re-design, to design services that enable more people to choose independent, individually supported and community based day activities. Action: Analysis of current day service provision to be completed and dialogue with service users re their aspirations to be drawn from this and completed as part 2 of the exercise. Service Manager Learning Disability. Part 1 - August Part 2 - to be agreed. 28

135 4. Mental Health Services. Table 4.1 Balance of Care for MH service users. Total MH Service Users Number in residential care % Number case managed in community % % % Source Pyramid: Adult Services, Mental Health The majority of Mental Health service users are cared for in the community, as opposed to residential care. Table 4.2 Mental Health unplanned admissions (totals) Financial year 2012/13 29

136 Bute & Cowal MAKI OLI Other 2 0 A monthly report is now available to show mental health unplanned admissions. Table 4.2 shows unplanned admissions of all ages (adults), a breakdown by age is shown in table 4.3 Table 4.3 Mental Health unplanned admissions by age group Financial year 2012/ under 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 area of origin is shown at table 4.4 Table 4.4 MH unplanned admission by area of origin. Financial year 2012/13 30

137 other OLI MAKI Bute & Cowal Table 4.5 MH unplanned admissions supporting data, Financial year 2012/13 Month Total admissions Re-admissions Percentage readmissions Ave Length of Stay ( days) April % 31 May % 34 June % 23 July % 24 August % 33 September % * October % * November % * December % * To be inserted later numerous patients not yet discharged. 5. Integrated Substance Misuse Services. 31

138 There is no further data yet available for Substance Misuse services, however a new ADP Coordinator and Information Officer have now been appointed and they took up post in August. The ADP Co-ordinator and Joint Planning & Performance Officer have met and will work closely 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 after April 2013, 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: Joint Planning & Performance Officer/ADP Co-ordinator and Information Officer: May

139 Benchmarking data (Source: Scottish Community Care Benchmarking Network, December 2012) Benchmark Identifier Legend Aberdeen City CCP H1 Highland CCP J8 Aberdeenshire CCP H2 Inverclyde CCP J9 Angus CCP H3 Midlothian CCP K1 Argyll & Bute CCP H4 Moray CCP K2 Clackmannanshire CCP H5 North Ayrshire CCP K3 Dumfries & Galloway CCP H6 North Lanarkshire CCP K4 Dundee City CCP H7 Orkney Islands CCP K5 East Ayrshire CCP H8 Perth & Kinross CCP K6 East Dunbartonshire CCP H9 Renfrewshire CCP K7 East Lothian CCP J1 Scottish Borders CCP K8 East Renfrewshire CCP J2 Shetland Islands CCP K9 Edinburgh, City of CCP J3 South Ayrshire CCP L1 Eilean Siar CCP J4 South Lanarkshire CCP L2 Falkirk CCP J5 Stirling CCP L3 Fife CCP J6 West Dunbartonshire CCP L4 Glasgow City CCP J7 West Lothian CCP L5 Emergency admissions to hospital: Emergency admission to hospital benchmarked at 2009/10 (provisional data) shows that the number of admissions in Argyll & Bute is low, this is of course population related. When compared by 100,000 of population the area is slightly below average. 33

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141 Balance of Care: Argyll and Bute sits just below average for homecare and very slightly above average for care homes, indicating that our aspiration to improve the Balance of Care to an 80/20 percent level is justified and would bring us above the average measure, although in achieving that we would still not compete with the best performer, East Renfrewshire. In terms of NHS Continuing Care Argyll & Bute sits at the lower end of the range, with 8 local authorities having fewer NHS Continuing Care patients. The CCP with the lowest number of patients is Moray. 35

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143 Argyll & Bute CHP Committee Date of Meeting : 20 February 2013 Agenda item : 11.3 LOCAL DELIVERY PLAN and CHP OPERATIONAL UNIT DELIVERY ACTION PLAN 2013/14 Report by Stephen Whiston, Head of Planning, Contracting & Performance The CHP Committee is asked to: To Note that in 2013/14 the CHP is to produce an Operational Unit Delivery Plan which is aligned with NHS Highland LDP, NHS Highlands Performance standards and Highland Quality Approach To Note the structure and timeline for finalisation of the Operational Unit Delivery plan To Note the HEAT targets and service planning/priorities for the CHP in 2013/14 To Note that progress against the plan will be recorded by regular updates using the familiar traffic light system, balance score card reports to NHS Highland Improvement Committee and partnership reporting via Pyramid and HQA monitoring reports. To Note The approved plan will be brought to the next CHP Committee meeting in April 1 INTRODUCTION NHS Highlands 2013/14 Local Delivery Plan is informed by Scottish Government s guidance which specifies: A revised core set of key objectives, targets and performance measures The format and content of the Local Delivery Plan The four overarching key objectives remain as before: Health improvement for people of Scotland improving life expectancy and healthy life expectancy Efficiency and Governance improvements continually improve the efficiency and effectiveness of the NHS Access to services recognising patients need for quick and easy use of NHS services Treatment appropriate to individuals ensure patients receive high quality service that meets their needs For 2013/14, the HEAT targets are detailed below: o o To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25%, by 2014/15 At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12 th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours o Reduce suicide rate between 2002 and 2013 by 20% o To achieve 14,910 completed child health weight interventions over the three years ending March 2014 Working with you to make Highland the healthy place to be

144 o o o o NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% mostdeprived within-board SIMD areas over the three years ending March 2014 At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014 NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009 Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) from March 2013; reducing to 18 weeks from December 2014; and 18 weeks referral to treatment for Psychological Therapies from December 2014 o Eligible patients will commence IVF treatment within 12 months by 31 March 2015 o o o o o To deliver expected rates of dementia diagnosis and by 2015/16, all people newly diagnosed with dementia will have a minimum of a year s worth of post-diagnostic support coordinated by a link worker, including the building of a person-centered support plan Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by at least 12% between 2009/10 and 2014/15 No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013, followed by a 14 day maximum wait from April 2015 Further reduce healthcare associated infections so that by 2014/15 NHS Boards staphylococcus aureus bacteriamia (including MRSA) cases are 0.24 or less per 1000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 15 and over is 0.25 cases or less per 1,000 total occupied bed days To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14 NHS Highland will also continue to monitor performance against the following HEAT standards : Cancer Waiting Times 18 Weeks Referral to Treatment (RTT) & 12 Week Treatment Guarantee (TTG) 12 Weeks First Outpatient Appointment Drug and Alcohol Treatment (RTT) GP Access Ambulance Response Times Accident and Emergency Waiting Times Sickness Absence Rate Alcohol Brief Interventions 2 ARGYLL AND BUTE CHP OPERATIONAL UNIT DELIVERY PLAN (OUD) To operationalise NHS Highland s LDP each operational unit has been asked to produce an OUD Plan, the format of which is outlined in Appendix 1. The plan will also detail how the CHP will be implementing the Highland Quality Approach (HQA) in the CHP including initiatives and organisational development. 2

145 The OUD Plan is written to ensure closer alignment between the LDP Service, Finance and Workforce plans and that risk in these areas is also identified with mitigation measures. The plan is currently in the process of being drafted for submission as per the timetable. 3 CHP SERVICE PLANNING PRIORITIES 2013/14 The following planning priorities have been identified and sit within a number of other key CHP Objectives: o o o o o o Mental Health modernisation Reshaping Care for Older People- programme of initiatives Sustaining our Community and Rural General Hospital core services re acute care, trauma and Out of hours services: o Community Hospital strategy Refresh 2012 o Approach to Building Sustainability of Health and Care Services in Remote and Rural Areas NHS Highland SGHD funded Programme Workforce and financial modelling o GP Business to Business contract renegotiation for 01/04/14 o Implementing the outcome of the Islay Community Hospital & OOHs review Primary Care redesign Including GMS contract modernisation, workforce recruitment (Inveraray, Kilmun, looking forward Kintyre Medical Group) and enhancement of roles of GMS to provide locality wide services. Preparing for Integration Health and Social Care Partnership Financial balance 4 SUMMARY & NEXT STEPS The Operational Unit Delivery plan will be an extensive document detailing the significant amount of work the CHP is conducting and its purpose is to monitor and record the CHPs performance against its targets, objectives and plans. CHP Leads for all the LDP objectives and HQA initiatives have been identified and performance monitoring re delivery of the plan will utilise the familiar traffic light system. The Operational Unit Delivery plan will provide the CHP committee and management team with a performance baseline as to progress against objectives it will be updated on a quarterly basis. The timescale for the finalisation of the plan is; o Final Draft OUD Plan considered by SMT 28 th February 2013 o Final OUD Plan considered by NHS Board 9 th April GOVERNANCE IMPLICATIONS Financial: Staff Governance Patient Focus & Public Involvement Clinical & Risk Equality & Diversity Impact: Relevant indicators within HEAT targets Identifies areas and actions require staff involvement and monitors performance Identifies areas and actions require public involvement and monitors performance QIS standards Plans and initiatives requiring impact assessment will be actioned 3

146 Appendix 1 - NHS HIGHLAND OPERATIONAL UNIT DELIVERY PLAN OUTLINE 1. Description of Unit Population size Age Profile Map of area No. of GP Practices, Dentists, Optometrists, Pharmacies No of Hospitals and services provided Integrated Team Structure Epidemiology - Health of Population information. 2. Highland Quality Plans/Charters for 2013/14 What are the key quality improvement initiatives for the Operational unit in 2013/14? What are the initiatives expected to deliver? Key matrix 3. Finance Plans 2013/14 Current budget 2012/13 Efficiency Plans for 2013/14 onwards 4. Workforce Plans 2013/14 Workforce Profile in Whole Time Equivalent (WTE) Workforce Age Profile in WTE Difficult to recruit to posts Workforce anticipated requirements as a result of implementation of Quality Improvement Initiatives / Service Redesign New roles required Workforce development required Summary of workforce risks arising from Quality Improvement Initiatives / Service Redesign (e.g. sustainability of services; succession planning of individual specialist posts; recruitment and sustainability of workforce) Description of the Health and Safety processes within the Operational Units. 5. HEAT Target 2013/14 (including key standards) For Each Target detail - Risks & Management of Risks against: Delivery & Improvement, Workforce, Finance, Equalities, Trajectory- performance 6. Engagement Plans 2013/14 How the unit plans to regularly engage key public/patient groups Practice Participation Groups, Local Partnership Fora, District Partnerships etc. How the unit plans to engage with public/patients on specific issues/quality plans. 4

147 Argyll & Bute CHP Committee Date of Meeting: 20 February 2013 Agenda item: 12 Modernisation of Mental Health Services Update Report (February 2013) (1) Report by John Dreghorn The meeting is asked to: Note current key issues and progress against the action plan 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 Capital Project Board met on 23 January. At this meeting progress on reviewing the site and content of the support services building was reported by the Capital Project Director. This piece of work is expected to be completed early in February. OBC still under development; and the resubmission of the stage 1 report by hubco is expected in early April, this was included in a revised draft project programme. Stage 1 Approvals The approvals timetable is being revised as a result of the stage 1 submission needing to be amended and the building design being some way off RIBA stage C completion. New target approvals dates have yet to be confirmed. Inpatient Services Kirk Hopewell recently joined the inpatient team as the new Senior Charge Nurse. The bed compliment remains at 30 beds plus 3 minimal supervision places in the refurbished Firgrove building. HEI related works continue in Succoth to upgrade the shower/toilet facilities and the en-suite facilities for the single rooms Upgrade work in IPCU will result in improved single room facilities for patients and a reduction in beds from 7 to 6. This work is due for completion by the end of March. Other planned works include: upgrade of OT toilets: the relocation of physiotherapy to Argyll Ward on the ground floor; and a partial resurfacing of the main driveway. Staff Redeployment Establishment proposals for Estates, Hotel Services, Laundry and Stores establishments will be reviewed by the workforce planning group in February. New Posts - The Mid Argyll Kintyre & Islay Primary Mental Health Care Worker post has been shortlisted with interviews to follow in February. - The Neuro/Older Adult Clinical Psychologist job description remains with AfC for banding. - Discussions with Clinical Psychology have commenced with regard to the best use of the remaining funding allocated for services in the Oban Lorn & Isles locality. Budget - Bridging: The bridging requirement for 2013/14 is currently under review. There will be a significant increase in the bridging requirements for the capital project possibly in excess of 400k for the completion of hub stage 1 & 2 leading to financial close. However, balancing this will be a significant reduction in the operational service bridging requirements. The exact requirements will be reported in the March Update. Resettlement Group

148 Resettlement plans for 4 patients IPCU patients with very complex needs continue to be developed in collaboration with Argyll & Bute Council Social Work Department. This is likely to include a requirement for commissioned services. New Hospital Development During January the architects issued 4 new design options for consideration by the clinical user group. A design workshop is scheduled for 15 th February where a preferred option will be identified. A key feature of the latest designs is the positioning of the building, due to the need to move the building away from the Mid Argyll PFI land to remove the need to negotiate a transfer of land from the PFI co to hubco. Community Mental Health Service (CMHS) As reported previously the Community Service Operational Guidelines are being reviewed by a joint NHS and council working group. Once changes have been agreed this document will be considered by the joint management group for introduction across all of the CMHS teams. This has not progressed since the previous report. CMHS Team Base As reported in January, capital funding has now been approved for the Campbeltown and Dunoon CMHS bases. Tenders have been received and the work will commence during February, with completion of works expected by the end of March. Transfer of Detained Patients The option appraisal exercise will be completed by 11 th February and the preferred option will be presented for approval by the Programme Board on 15 th March. Place of Safety Review Summary of findings Review visits to each site were undertaken by Programme Director and Acumen Service Manager between October 2012 and January Islay: Some minor works required to bring rooms x 2 up to required standard. Rooms well positioned in ward close to nurses station/office. Has en-suite toilet facilities. Staff had good understanding of requirements and appear to manage cases well. No policy/protocol in place. Transfers can be problematic and subject to long delays due to reliance on ferries to transport patients to mainland and lead time for staff from mainland to travel across to provide escort. - Campbeltown: Room well positioned in Casualty Dept next to ward. Some very minor changes required. Has en-suite toilet facilities. Staff had good understanding of requirements and appear to manage cases well. No policy/protocol in place. MH admissions can occasionally cause operational problems but transfers are usually completed timeously. - Bute: Purpose designed room, fairly basic but fully anti ligature compliant. Well positioned in ward. Has en-suite toilet facilities. Some clear difficulties in terms of staffing arrangements with expectation that community services (often social work staff) will provide the supervision. No policy/protocol in place. MH admissions seen as a significant problem and arranging transfers can often be problematic and subject to long delays due to reliance on ferries and lead time for staff from mainland to travel across to provide escort. - Dunoon: Purpose designed room, fairly basic but fully anti ligature compliant. Has en-suite toilet facilities. Problem with privacy as clear glass window out to car park and no blind/curtain. Poorly positioned at far end of A&E Dept. Significant staffing problems worse out of hours when only one member of staff is on duty. CMHS often provide the supervision, but not out of hours. Policy/Protocol in place. MH admissions seen as a significant problem and arranging transfers can be problematic and subject to long delays. - Oban: Room fairly well positioned in A&E Dept. Minimal adaptation of an existing room which also is used for meetings etc. Not particularly designed for place of safety purpose. No ensuite toilet facilities. Clear evidence that MH patients were regarded as a problem, impacting MH Services Modernisation Update Report February /02/2013 (1)[1] J. Dreghorn Page 2 of 3

149 on ability to care for needs of general A&E cases. Transfers can be problematic and subject to delays - Mull: Part of new integrated care centre. Room positioned some distance from the nurses office/base. No en-suite toilet facilities. Room is multi functional, but primary use is a viewing room for mortuary. Reviewers considered this to be an inappropriate combination of uses, and recommend that one of the signal rooms is modified for use as a place of safety as on Islay. As this is the most recently created place of safety it was disappointing to see such a poorly designed facility. No policy/protocol in place. Transfers can be problematic and subject to delays due to reliance on ferries to transport patients to mainland and lead time for staff from mainland to travel across to provide escort. A Vision for Mental Health Service in Argyll & Bute Building on Our Experience: A Vision for Mental Health Service in Argyll & Bute was published in 2007 at the start of the mental health redesign work. As part of the ongoing work to modernise the service, we are currently revisiting and updating this document. It will form part of our evaluation of progress to date; and be the basis for further work on staff and service development. The working group which met in December will meet again in February and a mental health services conference is scheduled to take place on 29 th April to both celebrate our achievements in delivering much of the 2007 vision; and to refocus on what needs to be done to ensure that the modernisation project achieves all its aims and objectives over the next 2 years and beyond. Service Users Reference Group As part of the ongoing engagement with stakeholders, it has been agreed with Acumen that a service users reference group will be established. First meeting will take place in March where service users will have the opportunity to review and comment on the latest building designs and on the preferred option for the transfer of detained patients. 3. Summary During January 2012 the capital project team continued to work with hubco to take forward the design development and the stage 1 submission. Hospital design development continues with input from clinical users, with the expectation that a building design and floor layout will be agreed in February allowing further work in the building detail to progress to a full stage C design for the OBC. Progress continues on a range of service modernisation activities including: the option appraisal for the transfer of detained patients; upgrade of the existing facilities at A&B Hospital; review and revision of the service vision document; and upgrade of community team bases. The review of places of safety confirmed that there is a mixed picture in terms of the quality of the facilities available and the effectiveness of local arrangements to look after patients awaiting transfer to the A&B Hospital. From this review it is clear that further work is required on staff training & development and the quality of the facilities to ensure that patients receive a consistent level of care and service regardless of location in Argyll & Bute John Dreghorn Programme Director Mental Health Modernisation MH Services Modernisation Update Report February /02/2013 (1)[1] J. Dreghorn Page 3 of 3

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151 Code of Practice for Joint Inspection of Services for Children 1. Purpose and Background 1.1. In September 2011, Scottish Ministers requested that Social Care and Social Work Improvement Scotland known as the Care Inspectorate lead on the development and coordination of a new model for the scrutiny and improvement of services for children and young people. As required under section 115(8)(b) of the Public Services Reform (Scotland) Act 2010, henceforth defined as the 2010 Act, this Code of Practice is issued by Scottish Ministers to provide general guidance on matters relating to joint inspection of services for children. This Code of Practice relates specifically to joint inspections of services for children as defined in section 115(12) of the 2010 Act and sets out how confidential information including personal records will be accessed and handled during the process of joint inspection in compliance with the requirements of the 2010 Act and regulations made there under, the European Convention on Human Rights (ECHR) and the Data Protection Act At the request of Scottish Ministers, the Care Inspectorate tested out a process for inspecting services for children between April and June 2012 with a view to finalising a methodology and commencing a series of pilot inspections from September The Care Inspectorate has a plan to inspect services for children across the whole of Scotland through inspections of all 32 local authority areas by the end of March The persons and bodies taking part in each inspection will include the Care Inspectorate, Education Scotland, Her Majesty's Inspectorate of Constabulary for Scotland (HMICS), and Healthcare Improvement Scotland. The Care Inspectorate will also collaborate with Audit Scotland in relation to its scrutiny work. The scheduling of joint inspections will be intelligence-led and take account of the Shared Risk Assessment process and National Scrutiny Plan for local authority services published annually by Audit Scotland Section 115 of the 2010 Act together with regulations made under the 2010 Act and this Code of Practice provide the framework for the conduct of joint inspections of services for children and the lawful exercise of powers to access and share information by inspectors during the process of a joint inspection In carrying out a joint inspection of services for children, the Care Inspectorate will deploy teams of inspectors as authorised persons. These teams will comprise a mix of staff with the relevant skills and experience drawn from the relevant persons and bodies detailed in Page 1 of 13