2 NHS HIGHLAND RESPONSE TO ANTICIPATED INDUSTRIAL ACTION

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1 Highland NHS Board 6 December 2011 Item 4.8 CHIEF EXECUTIVE S AND DIRECTORS REPORT EMERGING ISSUES AND UPDATES 1 NHS HIGHLAND ANNUAL REVIEW 3 OTOBER 2011 NHS Highland had its Annual Review with the Minister for Public Health, Michael Matheson, at Eden Court Theatre, Inverness on Monday 3 October The Annual Review letter dated 3 November 2011 has now been received from the Scottish Government as is attached as Supplementary Paper 1. The Actions for NHS Highland will be monitored via regular reports to the Improvement Committee. 2 NHS HIGHLAND RESPONSE TO ANTICIPATED INDUSTRIAL ACTION A number of Trade Unions Unison, Unite, British Dietetic Association, Society of Chiropodists and Podiatrists, Society of Radiographers, Chartered Society of Physiotherapists and GMB, have balloted their members regarding support for Industrial Action in relation to the UK Government s plans for changes to the NHS Pension Scheme. It is planned that the first day of Industrial Action will take place on 30 November In response to the planned Industrial Action, NHS Highland has set up a Strategic Business Continuity Group meeting, chaired by Dr Ken Oates, Consultant in Public Health. General Managers are implementing our Business Continuity Plans across the Board area and the decision to plan to run the equivalent of a hospital Sunday service has been made. However, we will be maintaining all emergency services and core clinical services as identified in our Board Business Continuity Plan, which includes cancer treatments and renal dialysis. However, to maintain safe services we have cancelled most non urgent activity including most outpatient clinics, day surgery and elective surgery. We are working closely with staff side representatives and staff themselves to clarify arrangements for cover. We are also working with our partner agencies, NHS24 and the Scottish Ambulance Service, to clarify what services they will be running. It is anticipated however that the planned Industrial Action will have an impact of planned care, but that essential and emergency services will continue as normal. 3 REGIONAL PLANNING NORTH OF SCOTLAND PLANNING GROUP AND WEST OF SCOTLAND PLANNING GROUP A copy of the Briefing from the North of Scotland Planning Group for September 2011 is circulated as Supplementary Paper 2 to this update. A copy of the Briefing from the West of Scotland Planning Group for November 2011 is circulated as Supplementary Paper 3 to this update.

2 4 REVIEW OF PATIENT FOCUS PUBLIC INVOLVEMENT (PFPI) In October 2011, Maimie Thompson took up post as Head of Public Relations and Engagement for NHS Highland. The post now reports directly to the Chief Executive. The post has a wide-ranging portfolio including media management, external communications (including internet and social media), public relations, internal communications, and issues management, strategic advice to the Board as well as patient and public engagement. Since coming into post, the Head of PR and Engagement has been asked to review the main elements of the portfolio and, in particular, identify key strategic actions to support Public Engagement work. In particular robust arrangements need to be instigated and implemented to support much more pro-active public engagement and two-way communications. Some areas for consideration include: Can each locality/service/chp have a communications and engagement plan which is responsive to local need but consistent with strategic objectives Can each locality/service/chp have a core group of informed public partners engaged with NHS Highland on an ongoing basis Process in place to support wider engagement including with schools, colleges, other agencies and voluntary sector Ensure clear and active process in place to recruit and support public members to participate in NHS Highland Committees and Groups Ensure process is in place to be able to identify all public representatives on Groups and have mechanisms to support two-way feed-back Ensure process in place to be able to identify all patient representatives (individuals and Groups) and mechanisms to support two-way feed-back How to ensure the work are outcomes focussed and clear criteria for success. Although an update paper on Patient Focus and Public Involvement was drafted in September, it was felt premature to bring this to the Board until the new Head of PR and Engagement had a chance to review the current status of the work, the team and structure. In addition there are a number of vacant posts within the department and also some overlap with other elements of Corporate Services including Public Health, Clinical Governance and Board Services. The plan is to bring a review paper to the next Senior Management Team and a full paper to the next Board Meeting in February

3 5 PRISON HEALTHCARE Section 110 of the Criminal Justice and Licensing (Scotland) Act 2010 removed Scottish Ministers responsibility for providing prison healthcare and transferred responsibility to Health Boards from 1 November The key objectives of the transfer are to reduce health inequalities, ensure prisoners receive services equivalent to that delivered in the wider community and contribute to the wider work on re-offending by improving health through opportunities for lifestyle changes. In addition, the transfer will help prevent potential professional isolation amongst prison healthcare workers. At a national level, the transfer was overseen by a Programme Board with supporting Local Implementation Groups established by each Health Board to facilitate local transfer through stakeholder engagement. Each LIG produced an Implementation Plan for consideration and approval. The Highland LIG was co-chaired by the General Manager for SE Highland CHP and the Inverness Prison Governor. The agreed local plan set out arrangements for services including medical, nursing, mental health, dental, ophthalmic, e-health and throughcare, Prison Healthcare service delivery will be the responsibility of the Prison s Clinical Manager who will report to the Inverness Locality Manager within the SE Highland CHP Management structure. Within Highland, the transfer happened seamlessly on 1 November. It has been agreed that the previous LIG meeting will continue as a joint operational group to oversee the first months of the change and continue the good working relationship with Prison colleagues. In particular, the group will oversee the ongoing transfer, induction and development process of prison healthcare staff. 6 UPDATE ON REVALIDATION The General Medical Council (GMC) have informed the NHS that Enhanced Appraisal will commence in 2012, with the first cohort of doctors being put forward for Revalidation in The system has been greatly reduced over the 2 years consultation and Revalidation will consist of the following over a 5 year cycle: Annual Enhance Appraisal x 5 covering the scope of individual practice Multisource Feedback (MSF 360 /Appraisal) x 1 Evidence of Patient Feedback x 1 The structure of the Revalidation process will include a Performance Appraisal and Revalidation Group for both Primary and Secondary Care, accountably to a Board wide Revalidation and Appraisal Steering Group. This group will drive the strategy and oversee the implementation of Revalidation. This group will advise the Responsible Officer who will put forward individual doctors for Revalidation to the General Medical Council. It is decided that there will be an internal Board Quality Assurance System of the process of Revalidation, while Health Improvement Scotland have been charged with quality assuring the Governance of the Health Board Revalidation process. This will commence in December While the GMC have indicated implementation of this process in early 2012, a final scope Domains and Attributes of the GMC Good Medical Practice have yet to be finally agreed, the documentation to underpin this process will be available by February 2012, the single Scottish Multisource Feedback tool will not be available until May 2012 and the adapted Scottish Online 3

4 Appraisal Resource electronic database, currently used in Primary Care, will not be adapted for Primary and Secondary Enhanced Appraisal until June The basis of this system is Enhanced Appraisal of the individual doctors scope of practice and this will include a discussion of the following information; a current Job Plan, activity data and clinical outcomes, complaints, adverse incidents, litigation, research and audit data, outcomes from teaching and training, previous and next year s Personal Development Plan. Therefore there will be a significant increase in the content and process, and this will require appropriate administrative support; input from the Clinical Governance Team, implementation by the IT team of the electronic database, the appointment of a Secondary Care Appraiser Lead and the ongoing Enhanced Appraiser Training. It is hoped that this process will be fully implemented by February WINTER PLANNING Summary of Key Areas for Winter Plans 2011/12 The planning continues to be focussed on acute services and strengthening the links with organisational business continuity planning with the key issues to be addressed being: Key Points: Ensure locality plans are integrated into whole system business continuity plans Boarding to be reduced will be monitored via weekly winter reporting data Escalation plans - increase link with community hospitals bed usage - efficient utilisation of capacity and to optimise patient flow Delayed Discharges- ensure EDD implemented, links with SW to ensure anticipated levels of care packages in place to support timely discharge. Proactively plan to minimise disruption to delivery of 18RTT targets Ensure preparatory and control measures in place for Norovirus outbreaks Utilise SPARRA and ACPAs to identify vulnerable patients at risk of admission and support proactive care and facilitate timely discharge Two 4 day holiday periods to be covered by OOH services Staff flu vaccination levels to be increased, especially A & E, ITU, HDU Exception reporting includes: o closure of a hospital to emergencies for any reason, o unplanned closure of a ward or a number of beds, o cancellation of elective procedures because of a lack of capacity, o trolley waits exceeding 12 hours, o significant outbreak of infection, or o significant increase in expected demand A&E access performance to be maintained Any decisions to suspend electives as part of ongoing pressure management/escalation plans to be discussed with Scottish Government Health Department Falls information being shared discussions locally with local authority and other partners regarding gritting, transport etc Mortuary business continuity and capacity Reporting: Weekly reporting of activity data is in place from e-health department covering acute activity, admissions, A&E attendance, boarding and delayed discharges. 4

5 This report monitors aspects of service delivery which can indicate pressure on systems some of which are expected to be directly addressed through winter plans, e.g. boarding. Exception Reporting on a weekly basis will be active from December only true exceptions, e.g. Infection outbreaks, ward closures, closure to admission, cancelled electives are required to be reported. A process is in place as in previous years for reporting exceptions to SG out of hours and at public holidays. Winter Plans for NHSH are completed or in the final stage of completion including those for Dental OOH, Raigmore, RGHs, GP OOH. Plans for SAS & NHS24 are awaited. Festive period rotas are being filled in all areas. In OOH some gaps remain and efforts continue to ensure that cover is maintained including through implementation of contingency plans. Preparedness Summary For Winter 2011/12 the normal operational plans for winter are supplemented by specific business continuity plans which link directly to organisational and locality business continuity plans, escalation plans and major incident plans Plans and arrangements are in place for business continuity in the event of severe weather, this is incorporated into winter period and festive business continuity plans for all aspects of service delivery Rotas, amended or extended working patterns or alternative locations are identified and plans in place for the festive period for GP OOHs, Hub, NHS24, Pharmacy etc. These are also linked in with business continuity plans to maintain service delivery in all situations. Plans are in place for exception, regular reporting and being finalised for ad hoc SITREPs in the event of severe weather. Chief Executive s Office Assynt House 25 November

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13 NORTH OF SCOTLAND PLANNING GROUP NHS Board Briefing September 2011 A meeting of the NoSPG Executive was held on 7 th September The following briefing has been prepared to update the North NHS Boards on the outcome of the meeting. NoSPG Projects Emergency Care Network The Emergency Care Network group have developed a workplan which identifies four main areas of work: Primary care unscheduled care, inpatient environments, clinical decision support and logistics. There was good engagement from NHS Grampian, NHS Highland, NHS Orkney, NHS 24 and SAS and it remained the intention to submit a business case to NoSPG by 31st March This had a huge significance around the sustainability of services for all Boards but particularly those with remote and rural services and it was important Boards supported the aims of this work and demonstrated organisational commitment to establishing the ECN. Sustaining Paediatric Unscheduled Care in RGHs An overview of this project, aimed at ensuring access to high quality advice for paediatric unscheduled care within the RGHs was provided by Mr James Ferguson, Clinical Lead for the Scottish Centre for Telehealth and Telecare (SCTT). Dr Ingram is chairing the Project Board which aims to establish a single point of contact for decision support when children are admitted to RGHs out of hours. Only one RGH has any locally available paediatrics expertise available out of hours and this project aims to establish access to specialist expertise, including clinical decision support by videoconference and, if necessary, onward transfer to definitive care, through a single point of contact, hosted through NHS 24. It was also noted that the remit of the Scottish Centre for Telehealth had been extended to include Telecare and the title of SCT had changed accordingly. SCTT were working with a number of Boards to establish demonstrator projects, which would significantly improve those requiring support to remain in their communities through the DALLAS project. NoS Weight Management Implementation Group The National Planning Forum have undertake a Scotland wide review of the requirements for Obesity Treatment, which the NoS Weight Management Implementation Group have been involved in. The NoS group proposed that the NoS Boards should adjust the criteria agreed for bariatric surgery, in line with those suggested by the National Planning Forum (NPF) and this as agreed. Members also agreed that the date for implementation of the new criteria would be 1 st April 2012, or the date agreed by the NPF, which ever is later. It was proposed the NoS Boards prioritise the development of Tier 3 services to ensure that, as a minimum, plans are in place for access to sustainable Specialist Weight Management Services in time for the implementation of the new criteria. Members noted the challenge that the development of comprehensive Tier 3 services would bring and agreed and that the NoS Weight Management Group North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

14 should seek to articulate both the challenges for Boards, together with the cost implications. Members agreed that there may be some opportunity for aspects of Tier 3 to be provided regionally. Hub Procurement Developing Financial Expertise NoSPG approved a proposal to host a workshop for finance colleagues in the autumn, which will focus on how Boards might collaborate to ensure that the relevant financial expertise is developed within the NHS to support projects supported by the hub initiative. National Work Streams Scottish Ambulance Service Scheduled Care Programme Mrs Heather Kenney, Director of Planning for Scottish Ambulance Service reported on a significant change programme within SAS to reconfigure patient transport services to deliver a standardised and consistent service, operating from a new technological platform. North Boards would be the first Boards to benefit from this initiative early in National Update An update report was noted. The NSAG application for Sleep Disorders was currently being considered by NoSPHN following which it would be discussed at the IPG meeting on 12 th October The NSAG meeting was prior to the next NoSPG meeting and sought approval that a response from IPG could be submitted to NSAG, with retrospective approval by NoSPG and this was agreed. NoSPG Business Management Workplan 2011/12 Progress against the NoSPG workplan was noted. Date and time of next meeting The next meeting will be held on 30th November 2011 at 10:30 am in the Conference room, Summerfield House, Aberdeen, followed by a joint meeting of all members of the NoSPG Executive and NoS Chairs. Dr Annie Ingram Director of Regional Planning & Workforce Development North of Scotland Planning Group 26 September 2011 G:\NOSPG\Dundee\NoSPG Mtgs\070911\Outcome\Board_Briefing_September_FINAL.doc North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

15 SUPPLEMENTARY PAPER 3 Briefing Paper WEST OF SCOTLAND REGIONAL PLANNING GROUP The following is a resume of the key points from the West of Scotland Regional Planning Group Meeting held on the 4 th November National Review of Vascular Services Implications for West of Scotland Boards The WoS RPG received a presentation from Dr Jennifer Armstrong which detailed: The remit of the Vascular Services Quality Steering Group The method used by the group The definition of Vascular Services The Case for change Current service provision Summary of findings The proposed model of care Proposed population-based vascular services. The RPG were posed the following questions: Does the RPG accept the case for change based on the information and evidence provided? Should NHS Scotland take forward a reconfiguration of vascular services in Scotland? If so, what would the next steps be for implementation in the West of Scotland? Following consideration the WoS RPG supported the case for change recognising the need for further work to be done on sizing of units in the west, the geographical practicalities of potential sites, implementation in the West of Scotland would be challenging the need for a formal consultation exercise, alternatively, communication and engagement with the public, (transport and access issues) was required. Dr Armstrong responded saying that the steering group would have to provide a full submission to the SGHD and then await the Cabinet Secretary s decision. Mrs Porterfield was taking this work forward and that this topic would be discussed at the Chief Executives meeting on 16th November. It was also agreed that Ms Knox bring a regional group together to consider WoS implications and it was also agreed that Ms Knox should engage with Professor Mackenzie regarding the Forth Valley position. 2. Neonatology Feedback from Regional MCN Dr Skeoch and Mrs Tait from the Neonatal MCN attended the meeting in order to provide an update of discussion with individual neonatal units around the proposed Quality Framework. Dr Skeoch then delivered a presentation which provided details of: Quality Framework Common Themes Financial support Data support Medical staffing Nursing staffing Repatriation /cot management AHP services The RPG considered the wider political understanding of the issues and advice on how best to move things forward now that gaps had been identified.

16 One of the issues was around support for families; another fundamental point was the importance of ensuring babies were appropriately placed according to their dependency needs. Members commented that the crux of the issue was to test the Quality Framework for the NPF in units and modelling capacity and its ability to flex to meet peaks across the system. It was requested that the MCN does a bit more work on such service modelling benchmarked against the quality framework. 3 Radiotherapy Services NHS Scotland The RPG received an update on plans to look at improving access to radiotherapy services across the central belt of Scotland. In the short term, the plan up to 2013 was to provide additional capacity in the West of Scotland to meet emerging demands. The medium term plan for the central belt would be to develop a central belt satellite facility, which would be located to allow better access when additional capacity was in place. NHS Lothian had committed to joint working on a more central location for a better medium term solution. 4 Obesity Treatment Review Implications for West of Scotland Boards The Obesity Treatment Subgroup was established by the National Planning Forum (NPF) to set out options for a common approach to planning the provision of weight management services and surgical intervention for the treatment of people with severe and complex obesity. A key aim was to improve equity as it was apparent that there was significant variation in eligibility criteria and provision of services across Scotland. The NPF approved the following: To set up a small group (with clinical representatives from the SCOTS group, Scottish Government representation and representation from each of the 3 regional planning obesity groups) to develop patient pathways by April 2012 Boards to work within regional planning to review current services in light of recommended criteria for surgical centres; to agree phased increase in bariatric surgery capacity (to achieve a rate of 9/100,000 within 3 years) to review provision of tier 3 weight management services The WoS RPG agreed to bring together a small working group to examine the implications and feed into the national process. 5 Spinal Services Review Group The RPG received the report from the Spinal Review Group a short life working group made up of experienced clinicians and managers - has worked closely with the National Access Support Team over recent months to produce this report. The group was asked to review the evidence, provide a national pathway for low back pain, including thresholds for surgery, and make recommendations for service reconfiguration. The findings and recommendations in the report were now out to wider consultation with the National planning forum and regional planning groups. The WoS RPG considered what the implications were and acknowledged that further regional planning work was required to inform the development of a service model proposal to support the redesign of service identified. Stephen Whiston Head of Planning, Contracting and Performance Argyll & Bute CHP 23 rd November