THE STATE HOSPITALS BOARD FOR SCOTLAND

Transcription

1 THE STATE HOSPITALS BOARD FOR SCOTLAND Date of Meeting: 23 June 2016 Agenda Reference: Item No: 5 Sponsoring Director: Author(s): Title of Report: Robert Alexander (Interim General Manager) Jacqueline Garrity, Skye Centre Manager Skye Activity Centre Annual Report 1 SITUATION This report provides an update on patient activity services within the Skye Centre. It details service activity levels and key achievements for the period June 2015 to May Key pieces of work undertaken and future developments are also highlighted within the report. Over the past year the Skye Centre service has continued to be involved and support the ongoing work related to the Patient Day Development Group. All staff have remained motivated during this transitional period of change within the organisation and have made concerted efforts towards reviewing and delivering a quality service to patients. 2 BACKGROUND The Skye Activity Centre service is defined by six Activity Centres, including the Atrium where the patients can access the café, library, shop and bank. There are also a variety of other groups facilitated within this environment facilitated by the Involvement & Equality Team (Patient Partnership Group, Christian Fellowship, Multi Faith Services), and the Psychological Therapies Service and AHP staff. Advocacy events and service and strategic meetings which include patient representation are also held in the Skye Centre. It is also important to note that the Health Centre is an integral part of our service and operates closely with the wider activity centres. Steps have been taken over the previous year through the work of the Patient Day Development Group to improve on the multi-disciplinary working and delivery of services in a more integrated way. 3 ASSESSMENT Information is provided in the following categories within the report Governance & Management Arrangements Governance Arrangements Management Arrangements Key Performance Indicators Safe Effective Person Centred Page 1 of 3

2 Key Pieces of Work Undertaken During the Year Expanding Range of Activities Vocational qualifications/courses Health Promotion Social Events Volunteers Carer Involvement Staff Recognition Indentified Issues and Potential Solutions Integrated Multidisciplinary Working Activity Scheduling Sustainable workforce/succession planning Sickness Future Areas of Work and Potential Service Developments Review of supervision model Skye Centre Professional Nursing Forum Using data & gathering outcomes Equity of access to interventions Curriculum Planning Supporting Health Choices Workforce review/efficiency savings targets 4 RECOMMENDATION The Board are invited to agree to the following areas of work and potential service developments as outlined fully in the report. Review of Supervision Model Skye Centre Professional Nurse Forum Using Data and Gathering Outcomes Equity of Access to Interventions Curriculum Planning Supporting Health Choices Consultation Workforce Review/Efficiency Savings Targets Page 2 of 3

3 MONITORING FORM How does the proposal support current Policy / Strategy / LDP / Corporate Objectives Information contained in the report supports the LDP targets for activity, corporate objectives related to Patient Learning and clinical outcomes. Workforce Implications eg Considered in Section 3 of the report Financial Implications No financial implications if approved Route To SMT Which groups were involved in contributing to the paper and recommendations. Risk Assessment (Outline any significant risks and associated mitigation) Assessment of Impact on Stakeholder Experience Equality Impact Assessment SMT No significant risks identified Impact on Stakeholder experience has been considered and options have been considered for capturing the patient voice and improve the quality of information/feedback the service receives from out patients EQIA Screened no identified implications Page 3 of 3

4 THE STATE HOSPITAL BOARD FOR SCOTLAND SKYE ACTIVITY CENTRE BOARD ANNUAL REPORT June 2015 May 2016 Reference Number Issue: Lead Author Contributing Authors Jacqueline Garrity, Skye Centre Manager Tracy Tait, Skye Centre Secretary Approval Group The State Hospital Board Effective Date June 2016 Review Date May 2017 Responsible Officer Mark Richards, Interim Nursing Director (e.g. SMT lead) 1

5 Contents Section 1 Introduction Overview Service Delivery Section 2 Governance & Management Arrangements Governance Arrangements Management Arrangements Section 3 Key Performance Indicators Safe Effective Person Centred Section 4 Key Pieces of Work Undertaken During the Year Expanding Range of Activities Vocational qualifications/courses Health Promotion Social Events Volunteers Carer Involvement Staff Recognition Section 5 Indentified Issues and Potential Solutions Integrated Multidisciplinary Working Activity Scheduling Sustainable workforce/succession planning Sickness Section 6 - Future Areas of Work and Potential Service Developments Review of supervision model Skye Centre Professional Nursing Forum Using data & gathering outcomes Equity of access to interventions Curriculum Planning Supporting Health Choices Workforce review/efficiency savings targets Section 7 Financial Implications Section 8 Next Review Date Appendices Description of Activity Skye Centre Scheduled Activity 2

6 Section 1 Introduction This report provides an update on patient activity services within the Skye Centre. It details service activity levels and key achievements for the period June 2015 to May Key pieces of work undertaken and future developments are also highlighted within the report. Over the past year the Skye Centre service has continued to be involved and support the ongoing work related to the Patient Day Development Group. All staff have remained motivated during this transitional period of change within the organisation and have made concerted efforts towards reviewing and delivering a quality service to patients. Overview The Skye Activity Centre service is defined by six Activity Centres, including the Atrium where the patients can access the café, library, shop and bank. There are also a variety of other groups facilitated within this environment facilitated by the Involvement & Equality Team (Patient Partnership Group, Christian Fellowship, Multi Faith Services), and the Psychological Therapies Service and AHP staff. Advocacy events and service and strategic meetings which include patient representation are also held in the Skye Centre. It is also important to note that the Health Centre is an integral part of our service and operates closely with the wider activity centres. Steps have been taken over the previous year through the work of the Patient Day Development Group to improve on the multi-disciplinary working and delivery of services in a more integrated way. Service Delivery Staff configuration The Skye Activity Centre service consists of a group of registered Nursing staff and skilled technical staff with an educational, Rehabilitation and Healthcare Support Worker background, who are all dedicated to meeting the clinical, rehabilitation and recreational needs of our patient population. The Skye Centre staffing establishment is presently wte, the actual staff in post is wte due to vacancies. The recruitment process has been concluded for one of these vacancies and it is anticipated that the staff member will take up post within the next month. The second vacancy will not be filled as the decision has been taken that this post will contribute to the recurring savings in line with agreed efficiency savings targets. Adjustments have been made to internal staff deployment to mitigate against the loss of this post. The current Skye Centre service operates Monday to Friday 8.30am to 5pm and activity is also available on a Saturday and Sunday with evening activities provided on 4 of the 6 Saturday evenings within the 6 weekly shift rota. The current workforce establishment for the Skye Centre is required to staff all activity centres including the Tribunal Service and no backfill budget arrangements are in place for this service delivery. There still remains 4 shift workers within the service and the implications of this are that Skye Centre staff require to work jointly with Hub based staff to provide evening and weekend activities. This has been the practice for a number of years. 3

7 Options for integrated working have been successfully tested as part of work related to the Patient Day Development Group. This has informed proposed changes to the service delivery model within the hospital as it relates to patient activity. There are 2 staff due to retire from the service by August 2016 and the succession planning and replacement of these long standing and highly experienced technical and clinical staff is well progressed. Delivery of Interventions There are a wide range of group interventions available to the patient group attending the Skye Centre. In line with the recent work carried out by the Patient Day Development Group, the range of group activities on offer was collated to form the Patient Guide to Therapies and Activities, which was published and circulated to patients in October The is being refreshed and issued again in October Following referral and assessment of needs there is on the range of group activities that are currently available to patients who attend the Skye Centre, Appendix 1. The diagram provides a description of each group intervention including capacity, and duration of each group. The range of groups on offer are defined in the Patient Guide to Activities Booklet under the following categories. These are:- Crafts & Creative Expression Education & Learning Life Skills Physical Health & Fitness Recreation Mental Health & Recovery Vocation & Working Activities Appendix 2 provides a more in depth overview of the group interventions that are available. Upon reading the table it can be observed that there are a wide range of interventions available at varying degrees of complexity to meet our patient needs. The delivery of groups is carried out in a variety of methods. There are regular ongoing group activities such as the animal care, crafts or sports sessions for which there is no restricted time limit. The scope of these activities will be modified depending on the needs of the patients participating. In contrast to this there are a number of planned, time limited groups such as Sports Leadership, Pottery for Beginners. Patients are referred to these group activities after discussion with their respective Clinical Teams. The further progression of the Timetabling work stream, part of the Patient Day Development Group will further enable clinicians to plan and coordinate their treatment interventions in a more efficient and effective manner. This would be greatly assisted by the implementation of an appropriate software system such as CELCAT. 4

8 Section 2 - Governance & Management Arrangements Governance Arrangements Formal reports on Skye Centre activity are reported on an annual basis to The State Hospital Board. Strategic aims and priorities for Skye Centre activity levels are monitored on an ongoing basis by the Skye Centre Manager who reports to the General Manager. Approval for new developments and initiatives are approved by the Senior Management Team at which the Skye Centre service is represented. Future representation at Board level for the Skye Centre service will be through the Nursing & AHP Director. Management Arrangements The Skye Centre Manager is operationally responsible for the Skye Centre service and staff group. The Senior Charge Nurse is managerially responsible for the group of nursing staff located in each centre. Over the past year the Skye Centre Manager s workload has continued to be split between operationally managing the Skye Centre and AHP service. It is anticipated that this will be resolved by the end of the year once the workforce planning arrangements have been confirmed in relation to the Lead AHP position. Section 3 - Key Performance Indicators The Local Delivery Plan targets for activity are: Figure Key performance indicators and comparison with and Performance Indicator Target 15/16 14/15 13/14 Patient will be engaged in off-hub activity centres 90% 81% 73% 79% Patients will undertake 90 minutes of exercise each week (Annual 60% % Audit) Patients will engage in meaningful activity on a daily basis 100% Attendance by all clinical staff case reviews 59% 60% 63% The LDP targets are underpinned by a number of supporting measures, including: Provision of reports for annual review meetings Patient Learning Outcomes Attendance at clinical supervision Safe The nursing staff within the Skye Centre service receive Clinical supervision in line with the nursing supervision model that has been agreed and approved within the organisation. Across the nursing group all trained staff are in receipt of formal supervision - 6 staff members participate in individual supervision and 3 staff members participate in group reflective practice supervision which is facilitated by a Clinical Nurse Specialist allocated from the Psychological Therapies service. A model of supervision for the support staff is currently being explored and this has been included in all support staffs Personal Development Plans for the coming year. 5

9 Appendix 3 provides an overview of the Skye Centre completion of mandatory and statutory training. There were 14 health and safety incidents (6 behavioural incidents, 7 verbal incidents and 1 sexual incident) reported involving the Skye Centre over the last 12 months. No aggressive incidents were recorded. The number of reported incidents remains low and this can be attributed to the very well established safe working practices and risk assessments that are in place across the service. In particular within the Vocational areas, where delivery of activity is risk assessed and modified to ensure that patients have access to tools and equipment at a level appropriate to their needs i.e. induction sessions, low tool and tooled sessions. Effective The progress of individual patients is monitored in a number of ways. This can be achieved subjectively using non standardised methods such as observation of behaviours, interactions with peers/staff and the recording of staff clinical reasoning and judgement, documented using the electronic patient record (RIO). The options available for relevant clinical standardised outcome measures that would be appropriate for use within the activity centres is being explored. There are presently a range of Patient Learning Outcomes and KPI s in place across the service and these are reported annually in a separate report to the Board. This report was received in February 2016 and detailed the progress made and the recommendations related to patient learning for the coming year. It is important to note that these outcomes related to patient learning are an integral part of the Activity Centres and support the selection and development of the patient timetable. Skye Centre staff currently attend clinical team meetings as and when the clinical need is indicated. During the period of the report there were 87 annual reviews and the Skye Centre VAT forms completion was 100%. Skye Centre reports were provided to 83% (n=72) of annual case review meetings, compared with 64% the previous year. 1 report was not done with no reason recorded and 14 were not done as the patients did not have a Skye Centre placement. Skye Centre nursing staff attendance at annual case reviews remains low. There has been a slight increase up to 7% (compared to 4% recorded in 2015). Whilst efforts have been made to enable nursing staff to attend for specific patients, the staffing is prioritised to ensure that activity centres remain open. The reasons for non attendance include staffing levels (77%) and no Skye Centre placements (16%). To ensure patient participation each profession should discuss their annual report prior to submission for the annual report. On discussion with staff and patients this practice is carried out however it is not recorded within the VAT forms. A request has been made to amend the VAT form to assist with monitoring this. Until such times as this occurs solutions to support the monitoring of this data are being explored. As noted earlier in the report Appendix 2 provides an overview of the range of group activities that are currently on offer. Groups vary from being regular/ongoing activities to planned groups, with time limits established at the outset. The table provides a description of the activity, the capacity for each group and the number of patients engaged. 6

10 Person Centred There have been no formal complaints from patients regarding the Skye Centre within the last 12 months. In previous years a number of complaints were received from patients regarding access to services and centre closures. The increased number of complaints that were recorded over the year in 2013 was directly related to the closure of Woodcraft and the staffing resource issues being experienced at that time. On a positive note there has been no complaints raised over the last year. Figure 2 Formal Complaints Received Upheld Partly upheld Not upheld The Skye Centre staff participated in the What matters to you campaign on 6 th June This campaign was supported by the Scottish Government and Healthcare Improvement Scotland with the aim of encouraging and supporting more meaningful conversations between people who provide health and social care and the people, families and carers who use health and social care. Assistance was provided from the Involvement & Equality team who devised a proforma to ensure consistency of the responses, data entry and inform the analysis report which will be shared late June. The data will also be presented to the Clinical Governance Committee via the quarterly Learning from Feedback Report and the Skye Centre service will take cognisance of the feedback in order to support the ongoing development of our service based on stakeholder feedback. Work is also ongoing to develop a patient questionnaire in order to obtain feedback from the patient group regarding how their involvement in Skye Centre Activities is supporting their care and treatment and Recovery. Figure 3 below provides detail of the number of planned sessions over the past 3 years in comparison to the actual number of sessions attended. The number for both planned sessions and actual attendances has improved over the past 12 months and is trend in improvement over the past 3 years Figure 3 Planned attendance at sessions sessions attended % between planned & attended 2015/ % 2014/ % 2013/ % 7

11 A summary of the reasons for non attendance over the past 12 months are detailed in Figure 3 below. Overall the figures related to non attendance have continued to decrease with the exception of centre closures that have slightly increased ( this the can be attributed to decreased staffing levels across the service due to sickness and other leave). Also discharge/transfers sessions where the numbers of rehabilitation/transfer outings have slightly increased over the past year. The ongoing work related to scheduling of patient activities across all disciplines has begun to support a more consistent approach to coordinating activity. Figure 4 Reasons for non attendance at Scheduled session 2015/ / /14 Deterioration in Mental Health Physical Health Problem Appointments with other Health Care Professional External appointments Tribunal/CMT/CPA Appointments Patient refuses to attend Service Closed/Reduced Service Patient seeing external visitor Visit on ward Discharge/Transfer/rescheduled sessions Bad Weather Other Patient choosing to Attend other Skye Centre activities using Drop in Referrals - There were 136 referrals received for 58 patients to attend a range of activities within the Skye Centre. 8

12 Figure 5 below provides the number of referrals received from each hub following discussion and approval from the respective Clinical Teams. Figure 5 Patients Patient Referrals received from Hubs Arran Iona Lewis Mull Referrals received by Hub Over the last 12 months 40 patients were identified as eligible to participate in the Skye Centre Induction programme which takes place twice a week over a 4 week duration. This group consisted of new admission patients and hard to reach patients with no current placements - 57% (n=23) of the patients in this group completed the induction programme. Figure 6 below details the number of patients engaged in Skye Centre interventions for the period June 2015 to May There is a decrease in the number of patients in March and April of this year which can be attributed to the number of patients who were discharged who regularly attended the Skye Centre and the number of new admissions. At the time of collating the data for this report the number of patients has slightly increased again with 90 patients engaged in activity provided by the Skye Centre service. Figure No. of patients engaged in Skye Centre interventions Engaged in Skye Centre Activity services Total number of patients in the Hospital 0 9

13 Figure 7 provides an overview of the planned/scheduled activity for each activity centre and the actual attendance by patients during the period June 2015 to May Figure Patient Attendance at Skye Activity Centres PAC Sports Crafts Woodcraft Gardens PLC Scheduled Attendance Many patients attend more than one activity centre and they may be involved in individual tasks or participate in group projects. The diagram in Appendix 1 provides an overview of the activities that are timetabled across the week in each of the activity centres. Taking into account the activities detailed in Appendix 1 the following charts have been developed to demonstrate the range of Skye Centre activities that individual patients are scheduled to attend across each Hub. It is evident upon reading the information detailed that each hub varies greatly in relation to individual patient engagement at the various activity centres. The data presented is reflective of the patients weekly Skye Centre timetable and does not include the time spent attending the Health Centre which varies or Patient Shop which the majority of patients attend one morning per week. It also does not include groups facilitated by the Involvement and Equality team some of which are supported by Skye Centre staff. The numbers of sessions patients attend are recorded over the period 9am 4pm Monday to Friday. The patients normally attend for a full morning session and the afternoons are currently split into two sessions with patients having the option to stay at the Skye Centre all afternoon. 10

14 Arran Interventions Planned Skye Centre Activities Arran Patients Woodcraft Crafts Sports PAC Gardens PLC Iona Interventions Planned Skye Centre Activities Iona Patients Woodcraft Crafts Sports PAC Gardens PLC 11

15 Lewis Planned Skye Centre Activities interventions Lewis Patients Woodcraft Crafts Sports PAC Gardens PLC Mull Planned Skye Centre Activities interventions Mull Patients Woodcraft Crafts Sports PAC Gardens PLC 12

16 Section 4 Key Pieces of Work Undertaken During the Year Induction/Hard to Reach Patients Patient Access Centre (PAC) This centre have continued to evolve over the past year with 29 patients involved in activity. The range of activities on offer provide a level of flexibility that meets the needs of our more chronically unwell or hard to reach patients allowing them to engage in a low stimulus environment where a range of structured social and practical activities are provided (Appendix 1). A data base has been devised with assistance from the Clinical Effectiveness Department and implemented. Vocational qualifications/courses The Patient Learning Centre, Gardens and Sports have been instrumental in achieving the objectives set and progress made which was outlined in the recent Patient Learning Annual Board report received in February The Skye Centre staff have been dedicated to ensuring that patient learning is integrated within each of the activity centres and supports the strategic aim to deliver the core values of Curriculum for Excellence across all activity centres. The Woodcraft centre has successfully developed and had the Practical Woodworking Skills (SQA National 4 unit) approved. There were 6 patients identified to participate in November 2015 with 4 currently undertaking the qualification. A second course is planned for September The Craft and Design centre is in the process of developing an approved SQA unit and it is anticipated that this will be in place by the end of the year. There are 5 staff members who are undergoing the SQA Assessor training and all staff are on track to successfully complete this by the end of August The Sports staff updated the Sports Leadership Level 1 Award and are now able to independently and proficiently deliver the course. Patients will also have the opportunity to participate in other structured learning opportunities such as and Elementary Food Hygiene Certificate (REHIS) with a series of courses planned commencing the middle of June Health Promotion The Skye Centre service was involved within the Healthy Choices work that has recently been underway and a member of Sports staff was invited to attend the Steering Group providing a valuable resource in terms of experience and knowledge in the area of physical health and fitness. Along with our Involvement and Equality colleagues, Skye staff also assisted with facilitating Road Shows to promote involvement during the consultation period. These were successfully held in the Skye Atrium and attended by a number of patients from across the hospital. Social Events The Skye Centre service continues to provide a series of planned social events throughout the year and hosted a number of events over the last 12 months. These included the Patient Learning and Achievement Ceremony, the Sportsman s Dinner. The format of both events has evolved and improved over the past few years and both acknowledge the successes and achievements of our patients. The Patient & Carer Christmas lunches and Christmas social and spiritual events were again delivered successfully and many positive responses were received from patients and carers regarding the enjoyment and quality they experienced. All of these events are accessed by patients and their carers. The success of these events can be attributed to the dedication and commitment of the Skye Centre and Involvement and Equality staff group. The Skye Centre has also organised a programme of activities to celebrate the European Football Championship commencing in June 2106 facilitated by Patient Learning Centre staff. A 12 week 13

17 programme will be facilitated looking at the history of the championship, open discussions, and quizzes. The patients who are involved will receive an accredited qualification following completion of the programme. Volunteers The Skye Centre service continues to work alongside the Involvement & Equality Team to develop the volunteer role within the activity centres and Skye Centre staff are very supportive of the process around developing volunteer roles. The volunteers continue to support activity within the Patient Learning Centre, Atrium Cafe, and the Multi Faith Centre. There are also five volunteers who help facilitate the Christian Fellowship group within the Skye Centre on a weekly basis. Within the past 12 months, 1 Skye Centre volunteer has secured full time employment in the Scottish Courts & Tribunal Service. The volunteer stated that they considered the experience gained whilst working in the hospital was a key factor in being short listed for the post. Carer Involvement The Skye Centre staff in conjunction with our Involvement and Equality colleagues supported the recent national Carers Week initiative by hosting a range of planned activities within our within our Sports, Patient Learning, Gardens and Craft & Design centres.. The national theme this year was Building Carer Friendly Communities and both teams ensured that a customary warm welcome was given to our patients and their carers throughout their involvement providing the carers with the opportunity to experience firsthand the environment and range of activities on offer to their family members. Staff Recognition Mr. Alec Bertram, Rehabilitation Instructor based within the Gardens & Animal Assisted Therapy Centre was recognised in the Queen s New Year Honours List 2016 and awarded the British Empire Medal for his dedication and commitment to mental health services. Alec along with his colleague David Newbigging, Senior Rehab Instructor who was previously awarded and MBE have both worked within the State Hospital Gardens department for many years and are both due to retire this summer. They both demonstrate an ongoing dedication and commitment to the Skye Centre and their experience and knowledge of the service and the wider hospital will be a loss when they leave. Section 5 Indentified Issues and Potential Solutions Clinical Model - Integrated Multidisciplinary Working In an attempt to establish sustainable links between the hubs and Skye Centre, key members of Nursing staff with an interest in patient activity were identified and time was facilitated within their shifts to work in the Sports and Crafts activity centres. This test of change model proved to be resource intensive and was not able to be sustained within the existing staffing framework. The positives gained in relation to improved communication and greater understanding of staff roles. The engagement process that is underway regarding the review of the Clinical Model will hopefully take the positive learning outcomes from both projects into account and better support integrated working. Despite the challenges encountered implementing a revised workforce model to support the delivery of activity there remains a commitment to supporting integrated working with the Skye Centre and AHP staff in relation to individual patient outcomes. The OT staff continue to deliver 14

18 activity within the Sports & Fitness centre supported by the staff there and plans are in place to provide 2 separate groups facilitated by the Art Therapist supported by the PAC and Crafts staff commencing July Activity Scheduling The Activity Scheduling work that was initiated by the Patient Day Development Group is ongoing and whilst there has been progress made with regards to identifying what activity takes place across the hospital a solution is still required to ensure a more consistent and effective method for scheduling activity across all disciplines. This would enable the Skye Centre along with the other services to plan patient activity in a more efficient manner. The discussions related to the business case related for the electronic scheduling system CELCAT are still ongoing. Sustainable work force/succession planning There are 2 staff due to retire within the service by August 2016 and plans have been approved to support the succession planning and replacement of these long standing and highly experienced technical and clinical staff. A previous vacancy was relocated in January to the Gardens department to enable a planned approach to supporting a new staff member within the existing service under the guidance and mentoring of the skilled and highly experienced staff members that presently provide the horticultural and animal/pet based activities. Recruitment is underway to replace the Senior Rehabilitation post within the Gardens. This post has specific responsibility for the ongoing assessment verification and ongoing development of the SQA modules that are currently on offer within this area. There is a potential risk to the delivery of these qualifications during the interim period whilst the recruitment process is being concluded however a solution has been identified to mitigate this. Sickness The staff sickness levels across the service have significantly improved over the past 12 months, averaging 5.05% in comparison to 9.14% the previous year. Long term sickness has reduced from 7.42% to 2.80% however short term sickness has increased slightly from 1.72% to 2.25%. Despite the success in this area it remains a focus for the Skye Centre Manager to drive improvement in this area. Section 6 - Future Areas of Work and Potential Service Development Review of Supervision Model The provision of good quality supervision is a necessity not only for the purposes of professional registration but also for the personal development or our staff. This assists in equipping staff with the skills, knowledge and experience to adequately deal with the progressing clinical and environmental changes that they may encounter in their everyday practice. Formal Clinical Supervision is in place for our registered nursing staff but unfortunately not for the support staff group. Whilst all staff are supported on a daily basis by the nursing staff across the service discussions are planned with our practice development colleagues regarding appropriate models of formal clinical supervision for this staff group. Using Data and Gathering Outcomes The importance of gathering evidence of impact and clinical outcomes remains an area that requires further development and growth in the coming year and has not been progressed within the timescales previously indicated. Whilst Skye Centre staff gather data related to Patient Learning outcomes and support the assessment process of other disciplines i.e. AHP staff, there is presently no specific clinical assessment tool in place to measure the outcomes of activity offered within the activity centre. To progress this work specific staff have been identified and 15

19 clear objectives have been identified through the PDR process to ensure the appropriate support is in place and monitoring of progress will occur. The Induction Programme and Gardens & Animal Assisted Therapy have been identified as the pilot areas. Equity of Access to Interventions As part of the Patient Day Development group a short life working group has been established to consider the referral process between the Hubs and Skye Centre and to identify available options for scheduling an agreed level of activity for patients to engage in, paying particular attention to fitness, wellbeing and education. This work will take cognisance of the methods adopted nationally for services in relation to standards provided for levels of treatment and engagement and explore the methods available to identify patient needs that will inform what activity and at what level this is required. The Mental Health Practice Steering Group is presently reviewing the patient pathway for new admissions and this group will link in with this work to inform their outcomes. Curriculum Planning The Skye Centre service will support the outcomes of the Clinical Model engagement process and the work of the Patient Day Development Group in particular the Activity Timetabling subgroup. This group aims to support the delivery of meaningful and therapeutic patient activities through development and implementation of an integrated and collaborative approach to the planning and scheduling of programmes and activities across all disciplines and services. The Skye Centre supported the creation and implementation of the Patient Guide to Therapies and Activities and will support the update and delivery of the handbook which is due in October Until an agreement is reached regarding an appropriate software solution for the timetabling and coordination of activity the Skye Centre service will continue to support the development and implementation of a six monthly multi disciplinary patient activity timetable format, outlining room usage and resourcing. This timetable incorporates the Skye Centre, Hubs, AHP and Psychological services, Supporting Health Choices Consultation The Supporting Health Choices consultation has been contributed to by the Sports & Fitness staff and shop staff. Each of these services will continue to demonstrate their support and deliver the agreed priorities for this plan of work. The physiotherapy service continues to be provided by a senior physiotherapist from NHS Lanarkshire one afternoon per week. Discussions are presently taking place regarding how the focus of the service can be adapted to promote a more integrated service with the Sports & Fitness staff which in turn will support the Health Choices agenda and promote physical activity for our patients who are experiencing chronic physical health issues. The shop staff supported by the Lead Dietitian will implement the new Retail Health Care Standards within the Hospital Shop which requires to be completed by the end of September Workforce Review/Efficiency Savings Targets Discussions are ongoing with the General Manager regarding the current workforce numbers and skill mix to ensure succession planning is built into future service delivery and that the current service meets the needs of our patients. The importance of ensuring that agreed efficiency targets are achieved is also recognised. The Skye Centre service has achieved and in fact exceeded the agreed savings target over the past 2 years on a non recurring basis. For the financial period 2016/17 the agreed savings target is 134,000. The necessary steps have been identified to meet the agreed savings target with 58,000 being identified as recurring savings. 16

20 Section 7 Financial Implications There are no major financial implications with regards to delivering the service developments described above, however it will require new, innovative and integrated models of practice and staffing to be agreed and implemented. The desired change, ensuring that the most appropriate range of activities are delivered safely and effectively. Section 8 Next Review Date The next annual report will be provided to the Board in June

21 Apppendix 1 Skye Activity Centre Currently 90 patients (Pts) are scheduled to attend the Skye Centre Activity Centre over the course of a week Patients Learning Centre Room Capacity 12pts Sports and Fitness Room Capacity 25pts Woodcraft Centre Room Capacity 8pts Craft Centre Room Capacity 12 pts PAC Centre Room Capacity 12 pts Gardens, Horticultural Animal Therapy Centre Room Capacity 12 pts Current Patient Caseload 41 pts Open Learning Activity (full sessions) Activity Capacity 10pts Open University Course (full session) Activity Capacity 8pts Themed Learning (full session) x 12 weeks Activity Capacity 12pts Basic Computer Skills (full session) Activity Capacity 12pts Basic Numeracy Skills (full session) Activity Capacity 12pts Communication Skills (full session) Activity Capacity 12pts Core Skills Session (full session) Activity Capacity 12pts Current Patient Caseload 60 pts Block fitness session (Short Sessions) x 12 weeks Activity Capacity 15pts Patient Football (Full Sessions) Activity Capacity 15pts Sport Leadership accredited Course (Full Sessions) x 12 weeks Activity Capacity 12pts Bike Ability accredited Course (Full Sessions) x 12 weeks Activity Capacity 12pts Patient Volleyball (Short Sessions) Activity Capacity 15pts Patient Gym Session (Short Sessions) Activity Capacity 14pts Patient Bowls Session (Short Sessions) Activity Capacity 14pts Hard to Reach Patients on Hub / Skye Centre Full Session Activity Capacity 8pts Gym and Main Hall activities Full Session Activity Capacity 25pts Currently Patient Caseload 27 pts Woodcraft Induction (Full Session) 5 week Activity Capacity 6pts Woodcraft Low Tools (Full Session) Activity Capacity 6pts Woodcraft Tools session (Full session) Activity Capacity 6pts Woodcraft Tools session (Full session) Activity Capacity 6pts Currently Patient Caseload 31 patients Crafts Induction (Full Session) 5 week Activity Capacity 6pts Crafts Low Tools (Full Session) Activity Capacity 12pts Craft Tool Session (full session) Activity Capacity 12pts Pottery Class (full session) 12 weeks Activity capacity 9pts Art Therapy Class (full session) 12 weeks Activity capacity 9pts Currently Patient Caseload 29 patients Relaxation Group (Short session) Activity Capacity 6pts Induction (Short session) 4 weeks Activity Capacity 5pts Hard to Reach Patients (Short session) Activity Capacity 1/2pts Book Club (short session) Activity Capacity 12pts Chess Club (full session) Activity Capacity 12pts Project Group (full session) 12weeks Activity Capacity 10pts Movie Group (Full session) Activity Capacity 15pts PAC Centre Ad hoc Activities Social / Games activity (Full session) Activity Capacity 20pts Currently Patient Caseload 46 patients Tools sessions / animal care Full Session Activity Capacity 12pts Low tools sessions (Short Session) Activity Capacity 12pts SVQ Course (Short Session) 12 weeks Activity Capacity 6 pts Ward Activities (Short Session) Activity Capacity -1-2 pts Slim and Trim Group (short session) Activity Capacity 25pts

22 Appendix 2 Description of Activity Intensity: High Medium Low Access Tools required / Patients Low Tools required / Patients No Tools required Patient Learning Centre Name of Intervention Description Intensity Capacity Numbers Current number of patients involved in intervention (May 2016) Length of Group Time of Course times this activity is available over the course of week courses ran (June 2015 May 2016 Computer Learning Patients will learning basic IT skills Low 12 each 18 n/a 2-3 hours 2 n/a n/a Sessions session Numeracy Learning Patients have the opportunity to Low n/a 2-3 hours 1 n/a n/a Session improve their numeracy skills Core Skills Session Themed learning in communication Low n/a 2-3hourrs 1 n/a n/a Communication Patients have the opportunity to Low n/a 2-3hours 1 n/a n/a Group improve their literacy skills Open Learning A range of patients learning activities Low 12 each 17 n/a 2-3hours 2 n/a n/a are available within these session session Themed Learning Group Patient have the opportunity to learn about a specific topic i.e. Scottish Low weeks 2 Hours Open & Distance Learning heritage Provide patients with the opportunity to take part in further and higher education Low 8 8 n/a 2-3 hours 1 n/a n/a patients completed (June 2015 May 2016

23 Appendix 2 Sports and Fitness Centre Name of Intervention Description Intensity Capacity Numbers Sports Leadership Course Hard to Reach Patient session Gym and Main Hall activities Football Session Gym Indoor Carpet Bowls Block fitness session Hub Interventions Bike Ability Course Volleyball Patients have the opportunity to develop basic skills in leadership within a Sporting environment Staff will interact with patients with low stimuli to encourage them to participate in physical activity Give patients full access to the sports and fitness department. Patients have access to all gym equipment as well as a variety of sporting activities within the main hall, including badminton, table tennis etc Patients have the opportunity to play football Patients have the opportunity to use the equipment within the Gym Patients participate in indoor carpet bowls This sessions covers a large range of Activities including metafit, touch rugby etc This allows sports and fitness staff to attend the hub to provide interventions with patients who are unable to attend the Sports and Fitness Centre Patients have the opportunity to complete adapted bike ability course Patients have the opportunity to participate in volleyball Current number of patients involved on intervention (May 2016) Length of Group Low weeks Time of Course times this activity is available over the course of week course ran (June 2015 May hours Low 8 10 n/a 2-3hours 1 n/a n/a Low 25 each session 30 n/a 2-3hours 2 n/a n/a Low n/a 2 hours 1 n/a n/a Low 14 each 22 n/a 1 hours 2 n/a n/a session Low n/a 2 hours 1 n/a n/a Low n/a 2 hours 1 n/a n/a Low 1 / 2 1 n/a 1 hour 1 n/a n/a Low weeks 2-3 hours Low n/a 2-3hours 1 n/a n/a patients completed (June 2015 May 2016

24 Appendix 2 Woodcraft Centre Name of Intervention Woodcraft Induction Woodcraft low tooled session Woodcraft full tools access Description Intensity Capacity Numbers Patient will attended induction programme prior to moving into low tooled session Patient will have access to a variety of tools classed as low tools and will take part in projects Patients will have access to a variety of Tools and take part in projects Current number of patients involved on intervention (May 2016) Length of Group Time of Course times this activity is available over the course of week course ran (June 2015 May2016) Low weeks 11/2 hours Medium High 6 each sessions 6 each session 4 n/a 2-3 hours 2 n/a n/a 18 n/a 2-3 hours 5 n/a n/a patients completed (June 2015 May 2016) Crafts and Design Centre Name of Intervention Description Intensity Capacity Numbers Craft Induction Crafts Low Tools Session Craft Full Tools Access Pottery Session Patient will attended induction programme prior to moving into low tooled session Patient will have access to a variety of tools classed as low tools and will take part in projects Patients will have access to a variety of Tools and take part in projects Patients will participate in pottery making Current number of patients involved on intervention (May 2016) Length of Group Time of Course times this activity is available over the course of week course ran (June 2015 May 2016) Low weeks 1hour Medium 12 each session 10 n/a n/a n/a High 12 each 20 n/a n/a n/a session High weeks patients completed (June 2015 May 2016)

25 Appendix 2 Gardens, Horticulture & Animal Assisted Therapy Centre Name of Intervention Description Intensity Capacity Numbers SVQ Course Garden Low Tools Session Tooled sessions/ Animal Care Hard to Reach Patients/outreach Patient will participate in SVQ Accredited courses Patient will have access to a variety of tools classed as low tools and will take part in projects Patient will have access to a variety of tools classed as low tools and will take part in projects. Patients will also work with the animals This allows gardens staff to attend the hub to provide interventions with patients who are unable to attend the Gardens Centre Current number of patients involved on intervention (May 2016) Length of Group Time of Course times this activity is available over the course of week course ran (June 2015 May 2016) High weeks 1-2hours Medium High 12 each session 12 each session 28 n./a 1-2hours 6 n/a n/a 22 n/a 2-3hours 4 n/a n/a Low n/a 1hour 1 n/a n/a patients completed (June 2015 May 2016) Patient Access Centre Name of Intervention Induction Description Intensity Capacity Numbers Patients will participate in an induction course. This will give patients taster sessions at each activity centre Current number of patients involved on intervention (May 2016) Length of Group Time of Course times this activity is available over the course of week course ran (June 2015 May 2016) Low weeks 1 hour Relaxation Group Patients participate in relaxation group Low weeks 1 hour Hard to Reach Staff will interact with patients with Low n/a ½ hour 1 n/a n/a Patients low stimuli to encourage them to Chess Club Movie Club Project Group Book Club participate in physical activity A group of patients will take part in the weekly Chess challenge Patients have the chance to enjoy different movies every week Patients will select project to discuss for a 12 week period Patients select a book, which they read and then discuss Low 12 6 n/a 2-3hours 1 n/a n/a Low n/a 2-3hours 1 n/a n/a Low 10 7 n/a 1-2 hours 2 n/a n/a Low 12 8 n/a 1-2 hours 1 n/a n/a patients completed (June 2015 May 2016)

26 Appendix 3 Skye Centre Staff - Completion rate of Mandatory / Statutory Training Equality, Diversity & Rights Fire Fighting Equip Health & Safety Manual Handling Personal Safety Breakaway PMVA Refresher Adult Support & Protection Keeping Children Safe REHIS Elementary Food Hygiene VRAMP 100% 100% 97% 81% 100% 94% 92% 94% 75% 62% Completion rate of Mandatory / Statutory On-Line Training DSE Awareness Equality, Diversity & Rights Fire Safety Food Safety Info Gov 1 Overview Inf Gov 2 Confidentiality Inf Gov 3 Data Protection Inf Gov 4 Records Management Manual Handling Essentials PMVA Personal Safety In the Workplace Adult, Support & Protection Blood Borne Viruses Complaints & Feedback Hand Hygiene Keeping Children Safe Responding to Medical Emergencies Safe Administration of Medicines Safeguarding from Harm Tackling Bullying and Harassment NHS Scotland Counter Fraud 30% 95% 89% 94% 100% 100% 100% 97% 76% 76% 74% 84% 54% 84% 73% 100% 90% 97% 84% 86%