AGENDA. The Board is asked to approve the minute of the meeting held on 6 October Page 4

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1 DUMFRIES AND GALLOWAY NHS BOARD Agenda and notice for meeting on Monday 1 December, at 10 am. VENUE: Conference Room, Crichton Hall, Dumfries Jeff Ace Chief Executive AGENDA 134 Chairman s Opening Remarks 135 Apologies for absence 136 Declarations of Interest This item gives members the opportunity to declare an interest in any of the items appearing on today s agenda. 137 Minute of the Meeting held On 6 October The Board is asked to approve the minute of the meeting held on 6 October. Page Matters Arising INVOLVING PEOPLE, IMPROVING QUALITY 139 Improving Safety, Reducing Harm This paper provides an outline of the patient safety walkrounds that have taken place between January and October along with the key themes. 140 Patient Experience Report Page 20 This paper provides information on NHS complaints, Scottish Public Services Ombudsman and Patient Opinion in Dumfries and Galloway for the period 1 July to 30 September. The paper also highlights the improved performance in respect of complaint handling. Page 24

2 141 Prevention and Control of Infection This paper is compiled using a standard template from Scottish Government Health and Social Care Directorate to provide information to the Board and the general public in a format that facilitates comparison with other NHS Boards in Scotland. Page 31 ITEMS OF PERFORMANCE / DELIVERY 142 Financial Performance: 7 Months to 31 October This report provides a high level summary of the Board s expenditure for the seven months to 31 October which reflects an underspend of 931k in line with the Board s forecast to break-even by the end of year. 143 Capital Performance / 2015 Page 47 This paper seeks approval of the changes to the budget following the mid-year review. Page Performance Report This report provides information on the level of clinical activity and access times achieved within services to 31 October, highlights data on efficiency of clinical services as measured against clinical efficiency targets, summarises a wider range of activity and provides data on bed occupancy throughout the system. Page 75 ITEMS FOR APPROVAL / DISCUSSION 145 Board Briefing This paper provides Members with a briefing on a range of health and partnership related issues. Page 97 ITEMS FOR NOTING 146 Minute of the Healthcare Governance Committee held on 10 September The minute of the Healthcare Governance Committee held on 10 September is presented to Board. Page 138

3 147 Minute of the Audit and Risk Committee held on 19 September The minute of the Audit and Risk Committee held on 19 September is presented to Board. Page Minute of the Person Centred Health and Care Committee held on 21 August The minute of the Person Centred Health and Care Committee held on 21 August is presented to Board. Page Minute of the Area Clinical Forum held on 27 August The minute of the Area Clinical Forum held on 27 August is presented to Board. Page Minute of the Area Clinical Forum held on 24 September The minute of the Area Clinical Forum held on 24 September is presented to Board. Page Date of Next Meeting The next formal meeting of the NHS Board will be held on Monday 2 February Any Other Competent Business Members should notify the Corporate Business Manager of any items of business not on the agenda that they wish to raise prior to the commencement of Board Business at 10 am.

4 4 DUMFRIES AND GALLOWAY NHS BOARD Agenda Item 137 Minute of the meeting Dumfries and Galloway NHS Board held on 6 October. Minute Nos: Present Mr P Jones Mr J Ace Mr R Allan Mr J Beattie Professor H Borland Dr A Cameron Mr A Campbell Mrs M Cossar Dr L Douglas Mr A Johnston Mrs K Lewis Mr R Nicholson Miss G Stanyard Chairman Chief Executive Non Executive Member Employee Director Nurse Director Medical Director Non Executive Member Chair of Area Clinical Forum Non Executive Member Vice Chairman Director of Finance Non Executive Member Non Executive Member Apologies Mrs P Halliday Non Executive Member Attending Dr A Eccleston Consultant Paediatrician (for item 121) Mr P McCulloch Capital Services Manager (for item 121) Dr J Robson Director of Medical Education (item 122) Ms C Sharp Workforce Director Mrs V White Consultant in Dental Public Health (item 116) Mrs L Williamson General Manager Women and Children (for item 121) Mrs J Wilson Corporate Business Manager 1

5 5 106 Chairman s Opening Remarks The Chairman welcomed everyone to the NHS Board meeting of 6 October. 107 Apologies Apologies as noted above. 108 Declarations of Interest The Chairman reminded Members that this item gave the opportunity for any interests to be declared. There were no interests declared. 109 Minute of the Meeting held on 4 August The minute of the meeting held on 4 August was agreed as an accurate record. 110 Matters Arising Item 90: Performance Report The Vice Chairman made reference to delayed discharges, noting that these were in the main due to waiting for beds in Annan Hospital and Allanbank. In light of the recent inspection report re Allanbank he sought further feedback. The Chief Executive advised that new transfers from Dumfries and Galloway Royal Infirmary to Allanbank had been suspended to ensure capacity to act on the recommendations of the external report. It is likely to be quite time limited before there is an impact on the flow of patients but there has been no negative short term impact as Allanbank is almost full. If the situation continues over the next few weeks there may be an impact on the flow of patients. 111 Improving Safety, Reducing Harm The Nurse Director presented this paper which focused on significant adverse events (SAE) and invited Members to receive, discuss and advise if they were assured on the management of SAE. Thirty-one events were submitted to the Quality and Patient Safety Leadership Group for consideration of a significant adverse event review (SAER) during the period December 2013 to 31 July. Eight were subject to a review and a detailed report was considered at the Healthcare Governance Committee in May. The Health Improvement Scotland (HIS) report in June 2012 resulted in a number of recommendations for all Boards and each Board is now developing and reviewing their policy in light of the published national framework. 2

6 6 Staff are actively encouraged to report adverse events and the system of categorisation is based on the Global Trigger Tool (GTT) which is used as part of the Scottish Patient Safety Programme (SPSP), meaning events are explicitly linked to levels of patient harm. All SAEs are escalated to a senior manager and a preliminary report and timeline is then submitted to the Quality and Patient Safety Leadership Group. The paper also highlighted some of the actions following these events and colleagues continue to aim to improve family engagement in adverse events. The Nurse Director advised Members that HIS visited the Board last week and confirmed that our processes are in line with other Boards across Scotland. Three key themes are challenging all Boards; how best to spread the learning across the organisation and across Scotland if needed, patient and family involvement and the potential impact of the integration of adult health and social care. It is important to ensure there are robust processes in place to enable adverse events to be identified in the integrated care processes. In response to comments regarding sharing the reports with the public Members were advised:- due to the small number of SAEs it is challenging to share these with the public redaction to allow publication results in unreadable reports; reports are shared with the staff involved, patients and their families and Healthcare Governance Committee; it would be important to understand the purpose of sharing reports with the public and being very clear with patients and families when that was being done; it is important to share the learning as openly as possible DGLearn is open to the public and provides messages on the learning and actions taking place; and staff are supported through reviews to facilitate understanding of the circumstances of the SAE and any learning resulting; The Medical Director commented that he did not believe it was appropriate to make individual details public, suggesting the reassurance required was that the Board had processes in place and were learning from events. The Procurator Fiscal takes an interest in an SAE where a patient has died. The Medical Director suggested this was a reasonable approach providing confidence in processes and preferable to discussing individual cases in public. In the case of a suicide there is a requirement to inform the Mental Welfare Commission and it is completely appropriate for an external body to review cases ensuring appropriate actions / steps are taken. The Chief Executive reminded members of the national focus on adverse events management following events in Ayrshire and Arran. The key is to ensure learning throughout the organisation to avoid similar events occurring again and to be open about errors that caused harm. In a small community this has to be fairly high level to avoid individual identification. We have to hold on to the importance of reviews as a way to learn, to make our systems safer, 3

7 7 to be open and also to recognise and respect the dignity of the patient and their family. The Chairman confirmed that Members were happy to receive the report and the assurances provided with regard to the management of significant adverse events. The Board, following discussion noted the report. 112 Patient Experience Report The Nurse Director presented the regular patient experience and feedback report advising that there was a detailed and constructive discussion at Healthcare Governance Committee in September, setting the key milestone of achieving the national target of 75% of complaints being responded to within twenty working days by the end of December. The Acute and Diagnostics Directorate has shown a 30% improvement in the three months May to July. A revised policy and procedure will be implemented by the end of December. Complaint management is a key element, but only one part, of how we listen to patients and families. Healthcare Governance Committee receive a substantial report at each meeting with details of all closed complaints, any Scottish Public Services Ombudsman reports and Patient Opinion postings and responses. Available data shows a continued improvement in August, demonstrating the impact of the improvement work being undertaken. Further key activity before year end is feedback from complainants regarding the process and a learning event for staff working with patients and families involved in complaints. The Vice Chairman highlighted the work undertaken at Healthcare Governance Committee in relation to this issue and the appropriateness of this report to Board to allow an overview of progress. The Vice Chairman sought assurance that the adequacy of response was not being compromised to deliver targets and that there was confidence in the trajectory for achievement. The Nurse Director confirmed that she had confidence in the process. In response to comments Members were advised:- complaints from prison services tend to be less complex and involve a small team of staff a large portion of the complaints are in relation to non-prescribing; achievement of the national target of 75% will not mean success and work will continue to improve beyond that; and a meaningful way to capture positive feedback across the organisation has not been identified 4

8 8 The Board, following discussion noted the report. 113 Prevention and Control of Infection The Nurse Director presented the regular report and highlighted the key messages including:- compliance with MRSA screening in excess of 95%; none of the Staphylococcus aureus bacteraemia (SAB) have been MRSA; opinion at this point in time is that it is unlikely the Board will achieve SAB and Clostridium difficile infection (CDI) targets at the end of March detailed discussions at both Infection Control Committee and Healthcare Governance Committee; improvement work is taking place to support achievement of the targets; education has been delivered in order to reduce the number of contaminated samples; recent cases have included intravenous drug user population and we are working with the service team to understand possible causes; antimicrobial management is very important and we continue to have a focus on this; potential unintended consequence of sepsis improvement work which is being explored by the Antimicrobial Pharmacist; our surgical site infection (SSI) surveillance reports good performance; cleaning scores continue to be high from an environmental perspective; a report of the unannounced repeat inspection in June has been published, confirming that all recommendations and requirements had been addressed. One further recommendation and one further requirement have also been addressed; some of the Board s norovirus control activity has been put forward as best practice to the rest of Scotland; and there have been no CDI and only two SABS in Galloway Community Hospital for a year. The Chief Executive referred to the high profile Scottish Government target for SAB and CDI which will be a point for discussion at the Board s next annual review. As the Nurse Director advised, the Board is unlikely to achieve the year-end target; however, levels of both SAB and CDI are historically low and Scotland is achieving levels that are equal to the best European healthcare. Performance is at the best ever level and it will be extremely challenging to sustain continued reduction. In response to comment Members were advised:- there is a commitment to maintaining environmental and other standards with a process of risk assessment in place as we take forward the acute services redevelopment; and there is continued major works through wards and other clinical areas to ensure they remain fit for purpose. 5

9 9 The Medical Director added that as we undertake typing of CDI he can confirm that there has been no patient to patient transmission; each case is separate in time and place so there is no environmental contributor to these infections. The Board, following discussion noted the report. 114 Annual Review: 30 June The Chairman confirmed that the performance committee, at their meeting of 1 September, had agreed that the actions detailed in the letter would be incorporated into the relevant workstreams and reported back regularly to the performance committee The Board noted the Annual Review letter. 115 Schedule of Board Meeting Dates: April 2015 March 2016 The Chairman presented the proposed schedule of Board meeting dates for April 2015 to March The Board agreed the proposed schedule of meeting dates. 116 Review of Provision of Routine General Dental Services by the Salaried Dental Service The Medical Director introduced this paper. Salaried dental services were introduced approximately ten years ago when there was difficulty in recruiting to general dental services (GDS) and only 30% of the population were registered with a dentist. This was a quick response to help the position at that time. Over 80% of the population are now registered with a general dental practitioner (GDP) and lists are open with capacity throughout the region. Scottish Government has consistently advised that its preferred model for delivery is through the GDP and Boards have been encouraged to review salaried dental provision with a view to shifting to GDP supply. The Medical Director commended the work undertaken by Mrs White, Consultant in Dental Public Health / Public Health, who has taken this very slowly and worked through excellent engagement with all stakeholders; the endorsement from the Scottish Health Council (SHC) is important. The paper draws attention to deferring any decision in Newton Stewart as there are concerns about the sustainability of general dental practice in the area. This work is not about saving money or service cuts but it does release some resource to support special care dentistry. Mrs White added that she appreciated that this was a difficult decision for the 6

10 10 Board but reassured Members that a systematic process had been followed. The Chairman commented that this was not a cost saving exercise but was an opportunity to release funds for the development of the special care programme. There does seem to be a largely satisfied group of patients across the community and people are happy with the service. The Chairman asked Members to consider if this was the right thing to do and the right time to do it. The process would have to be managed and whilst the process has been very good, concerns have been raised. Member should debate the paper to assure themselves that this is the right strategic direction for the Board. Members raised a number of concerns including:- the privatisation of dental services. The Medical Director clarified that this was not privatisation of dental services. This is an NHS contract, standards of care and arranged payment for the care delivered. The proposals will be delivered over a period of time over the next few years. It is important to recognise the important work that the staff in the salaried dental service delivered during this time. the move to private practice in the past. The Medical Director advised that this was a concern raised by a number of individuals. The situation has changed dramatically since 2004 / 2005 when 70% of patients were not registered and it was attractive to move to private practice. Supply and demand today is much changed. If a practitioner chose not to provide NHS services and change to private practice patients would now simply move to an alternative practice. The strength of supply is the best defence against private dentistry. concerns regarding access for those with a disability, parking, bus routes; the lack of stability in independent contractor provision; and organisational change, redeployment and TUPE (Transfer of Undertakings (Protection of Employment)). The Director of Finance advised that the Board will be required to make some difficult decisions over the next few years. The model of delivery of GDS is through primary care dentistry and this paper does not propose anything radical. The salaried dental service was never intended to be a long term service and there has been a lot of discussion on a national basis. If the Board chooses not to accept this paper as the strategic direction it will need to consider an investment paper at a future meeting for special care dentistry. The review looked to assess what the impact on patients would be. The Chief Executive commented that is what we have is a historic accident of an attempt to solve a problem ten years ago that no longer exists. If a 7

11 11 proposal came to Board today to set up a salaried dental service it would not be supported as there is adequate dental provision in GDS. There is quite a significant opportunity cost in the best use of public funds if this model is retained. Disabled access is a valid point which is why the approach has been taken in respect of Newton Stewart; the impact assessment indicated that the Board cannot answer the fundamental questions on good local disabled access. The facilities in Lochside and Sanquhar will stay and when we move to the individual points of the recommendation that access point does not apply in those areas. Mr Campbell indicated that he was prepared to support the recommendations if there was confidence that people would be able to register with an NHS dentist. The Medical Director confirmed that he was confident and would not propose changes if he was not sure of the supply. There has been significant change made to the dental contract in recent years and a dentist has to have a commitment to delivering NHS services in return for which there are a number of payments linked with that NHS commitment. One practice in Dumfries and Galloway has failed to meet the criteria and is very concerned that they have lost out financially. Premises will not simply be closed; there will be a graduated shift to ensure people are supported to move. Mrs White advised that this proposal is a strategic direction and the timeline is March This supports the plan for the clinics where there would be dispersal, the facility to transfer by the Health Board, confirm with practices with capacity, provide full list so patients can make an informed choice and manage the process. There is not going to be an immediate change; an implementation plan will be developed to support a facilitated transfer. The proposal seeks to lease the premises in Lochside and Sanquhar to an independent contractor who would provide services within those areas. It is hoped that those independent contractors would look to expand registration in these areas. Within Kelloholm and Sanquhar there is a demand for more services and it is anticipated that there may be additional services. Having gone through Equality and Diversity Impact Assessments (EDIA) the salaried service clinics in Newton Stewart, Lochside and Lochmaben are of a good standard but there are suitable alternatives available. The Board will ensure that people can be facilitated to move to the most appropriate service. This service redesign would also support the delivery of the special care programme provided in Dumfries and the Galloway Community Hospital to a more sustainable service, ensuring that those patients who cannot be treated in GDS can be treated appropriately. In response to comment, Mrs White advised that there is more work to be done on options in the Newton Stewart area; however, the long term plan is to move to the independent contractor service. Mr Nicholson and Mr Allan confirmed that they were not minded to approve the 8

12 12 proposals presented. The Medical Director commented that it had been suggested that no change was simple and that is the path the Board should follow. The reality is that salaried dentists have fewer patients on their list, the service is more expensive to Central Government and this is not the preferred model. The Director of Finance commented that it was being suggested that the salaried service is resilient but it is dependent on retaining dentists. If dentists retire or move the service as is currently provided simply presents a different risk than the service provision for GDS. Mrs Cossar advised that the Area Clinical Forum had the opportunity to discuss this issue a number of months ago and commended the report, recognising the challenges, particularly to staff. The feeling was that this was a process that had to be gone through, looking at providing more specialist services but recognising that this would take time. The general opinion was that this change was something that had to happen. Mr Beattie confirmed that the Area Partnership Forum had been consulted throughout the process and understood that there would be further consultation if the Board accepted the recommendations. The Chairman confirmed that a decision was required today. An extremely comprehensive review has been undertaken with appropriate consultation. In view of the discussion, the Chairman proposed a vote on each of the recommendations and Members supported an open vote by a show of hands. The Corporate Business Manager read the recommendations individually and a vote by show of hands was taken following each. Recommendation a. Dumfries Dental Centre - withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to independent contractor practices for continued provision of NHS general dental services at the transferred practices site / premises. Vote: For 10 Against 3 Abstain 0 Recommendation b. Lochmaben withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to independent contractor practices for continued provision of NHS general dental services at the transferred practices site / premises. Vote: For 10 Against 3 Abstain 0 Recommendation c. Newton Stewart further work with local independent dental contractors 9

13 13 and Salaried Dental Service staff to be undertaken to ensure sustainable, accessible routine NHS dental services for patients in this area prior to the complete withdrawal of routine NHS dental services by the Salaried Dental Service. Vote: For 11 Against 2 Abstain 0 Recommendation d. Lochside Dental Clinic continued provision of routine NHS general dental services at the clinic site by the independent dental contractor sector, with further service review to be undertaken if this is not possible. Vote: For 10 Against 3 Abstain 0 Recommendation e. Sanquhar Dental Clinic continued provision of routine NHS general dental services at the clinic site by the independent dental contractor sector, with further service review to be undertaken if this is not possible. Vote: For 10 Against 3 Abstain 0 The Board, following discussion and vote approved, approved Recommendations a to e as noted above; and that the Dental Senior Management Team and Primary Care Development progress development of an implementation plan to achieve the agreed strategic direction. Whilst it is recognised that achievement of the overall direction may take time, work to progress this should commence as soon as possible with a view to full implementation by end of March The Chief Executive summarised, to ensure clarity, that the Board had agreed to the direction of travel with the exception of Newton Stewart where a formal paper would be brought to a future Board meeting. 117 Financial Performance: 5 Months to 31 August The Director of Finance presented the update on the financial position at month 5 and the Quarter One position, reporting an underspend of 619k. A breakeven position on the revenue position for / 2015 remains on track but is not without both challenges and risk, including impact on access targets, medical recruitment challenges, locum costs and overspends on primary care prescribing budgets. The focus remains on delivery of the financial position, particularly while there are some very critical business decisions required in the next few months. The Board will deliver the breakeven position if no further risks emerge and / 2015 is proving to be an incredibly difficult year financially with activity going through the hospital beyond anything seen before. Financial planning for 2015 / 2016 has begun and includes a workshop in 10

14 14 October to begin to further develop draft financial and efficiency plans for consideration at the Performance Committee in November. In response to comment Members were advised:- savings are essential if the Board is to remain in financial balance factors to take into account include fuel costs, staff costs and changes to the pension scheme; the Board has committed to the strategy to continue to deliver the acute services redevelopment project and deliver savings to support that; the new money coming in to the service will be outstripped by the increases in activity, inflation, any pressures and new developments; and the Mental Health Directorate underspend is in the main due to staff vacancies and ensuring staff are recruited to vacant posts. The Board, following discussion, noted the report. 118 Capital Performance / 2015 The Director of Finance presented the update advising that the majority of the resource is in the rolling programme, new developments and the acute services redevelopment. The change to the allocation is the additional resource for equipment planning for the new hospital and part of the planning work ongoing. The Dalbeattie and Dunscore primary care developments are now complete and operational. Acute services redevelopment work is underway with a change around the foul water which is likely not to commence until the next financial year; this has an impact of 0.5.m and the Board will work with Scottish Government to manage any slippage on the programme between financial years. The balance of under 2m is a managed position and slippage from this year to next will support the Women and Children s Hub if the project is approved by Board. This is an affordable project with the resources aligned appropriately. The capital planning for the next five years has been profiled and confirms that 2015 / 2016 will be incredibly tight and leave limited funds for other developments. In response to comment the Finance Director confirmed that appropriate steps are in place to ensure flexibility and delegation in respect of maintenance. The Board, following discussion:- approved the changes to the budget from the approved Local Delivery Plan; noted the allocations received to date; noted the project budget updates; 11

15 15 noted the expenditure incurred to date; noted the revised draft five year plan; and noted the updated Capital Investment Group remit. 119 Performance Report The Chief Executive presented the report highlighting a number of areas. Broadly good Accident and Emergency (A&E) performance with a slight dip in October. This is due to some very complex cases with severely ill individuals being managed in A&E and may be a blip or a reflection of our increased aging population which will become a natural trend. General activity, which is the key data that drives whether the hospital is working efficiently and effectively, is the non elective in-patient. This is the very dominant patient flow trend and is up 4% year on year, last year being the busiest ever experienced as a health system. The service remains effective and safe, managing to move patients through the system safely and smoothly. However, if non elective admissions continue to increase the system will struggle to cope at some point. Delayed discharges have dropped slightly but are occupying a relatively high number of beds compared to our local history. Dumfries and Galloway is one of the best performing Boards in Scotland but compared to previous performance we are seeing an increase. Staff are working closely with Council colleagues in an attempt to resolve this. Scotland is missing its cancer target and the Board has dropped marginally below 95% for the 62-day target, mainly due to patient transfers to specialist services in other areas (one patient) and there is confidence that this is not a sustainable problem. Performance remains within the top five in Scotland and comfortable that local demand and capacity are well aligned. The Board noted the report; and welcomed the high performance. 120 Acute Services Redevelopment The Chief Executive provided an update and advised that work continued with the preferred partners, High Wood Health. There is still a lot of work required before financial close and the team will now go through the most intensive phase of this multi-year project to bring us to that point in December. The Director of Finance advised of meeting tomorrow with financial advisers to look at the output of the financial competition. In response to comment the Chief Executive confirmed he was happy to look again at the communication strategy. There have been a lot of public 12

16 16 meetings with more arranged. There were over forty public engagement events in the run up to the Outline Business Case. Members commented that it was important to make the public aware of the new hospital and also community capacity throughout Dumfries and Galloway, community / cottage hospitals as hubs, integration and designing services for the future. The Board, following discussion, noted the verbal update. 121 Women and Children s Community Hub Development The Director of Finance presented this paper which sought approval of a proposal for a 3.2m capital investment for the Board to deliver a women and children s community hub. The project is still subject to Scottish Government approval and will required to go through the Capital Investment Group (CIG) processes to get signed off. Members were asked to approve the project and support the allocation of the capital and revenue funding against this scheme. A lot of work has been done through the workstreams for the development of the new hospital which conceived integrating services in to this hub with detailed option appraisals at that time and links to the Property Asset Management Strategy (PAMS). Factors taken into consideration were the backlog maintenance issues, the drive to move from the Nithbank Site, opportunities presented and development of the hospice block for this hub. The scheme has developed over time and the outcome of the recent Children s Services Inspection has brought a broader approach in terms of Council colleagues. The model developed can be flexible, grow and expand to deal with the issues. The Nurse Director advised, as Executive Lead working most closely with children s services, that she supported this piece of work in order to grow, develop and deliver quality services on a multi-agency basis for the future. The Medical Director commented that it was important, wherever possible, for patients to be followed up in primary care and it was important to be clear of the justification for bringing patients to a central hub. In response to comment Members were advised:- there will be open plan working and shared accommodation, maximising the use of big spaces; the model is to build up teams in the localities with a hub mainly for Dumfries and Nithsdale with satellites; there will be further discussion with partners and multi-agency colleagues; and will support supervision and opportunities to discuss patients. 13

17 17 The Board, following discussion, approved:- the Initial Agreement for the proposed Women and Children s Community Hub project for onward submission to the Scottish Government Capital Investment Group for approval; the capital funding of 3.143m be allocated in the capital plan over / 2015 and 2015 / 2016 to fund the capital costs of the development; and the revenue financial consequences of the development of 61k recurring to be allocated in the 2015 / 2016 financial plan. 122 Medical Education in Dumfries and Galloway Dr Robson, GP and Director of Medical Education, presented the report and highlighted the significant challenges around recruitment, noting that if that could be solved the remaining areas would resolve themselves. The Medical Director commented that the Education Committee had come alive in the last few years with Dr Robson as Director. The feedback from under-graduate and post-graduate trainees demonstrate that Dumfries and Galloway is doing well and at the very top grouping of training posts. This is very important as higher skilled and better trained doctors look after patients better and also support recruitment. The work Dr Robson has undertaken has enhanced Dumfries and Galloway s reputation. Recruitment is challenging as you move away from the Central Belt but feedback from students and trainees is that you have a good experience in Dumfries and Galloway. The Medical Director advised that three Pathologists have been appointed and there have been approaches from a further three doctors who are interested in consultant posts locally. Three doctors have also been appointed to the Galloway Community Hospital in the last three weeks and a further application has been received. The Chairman commented that it was important to champion and promote this good performance and complemented Dr Robson on the work and for ensuring our training and education programme was alive and well. The Board, following discussion, noted the report. 123 NHS Scotland Bed Planning Toolkit The Chief Executive presented this item giving members first sight of a national programme being hosted in Dumfries and Galloway to consider if more scientifically robust principles on future bed plans can be implemented, particularly acute beds across Scotland. Cabinet Secretary is taking an interest in this piece of work. The Board noted the development of the toolkit and proposals for the pilot phase of 14

18 18 the development; and further engagement with a wide range of stakeholders. 124 Board Briefing The Chief Executive highlighted the Blood Bike Donation received recently which was extraordinarily generous and quite important in terms of our service model. This donation supports the movement of blood samples between Stranraer and Dumfries much more effectively and is run by recruited volunteers. The School for Health and Care Radicals is a disruptive and innovative type redesign; that is how we can support disruptive thinking that challenges thinking. Two staff graduated (the only two in Scotland) and this means we are developing staff to question the status quo. The staff are from Mental Health which is clearly one of our more advanced services in terms of constant redesign and self improvement. The Chairman advised Members he had been appointed to the Health and Work Service Programme Board which aims to deliver occupational health services through the NHS to the whole of Scotland. The Board noted the briefing. 125 Minute of the Audit and Risk Committee held on 16 June The Board noted the minute of the Audit and Risk Committee held on 16 June. 126 Minute of the Performance Committee held on 21 July The Board noted the minute of the Performance Committee held on 21 July. 127 Minute of the Performance Committee held on 1 September The Board noted the minute of the Performance Committee held on 1 September. 128 Minute of the Healthcare Governance Committee held on 7 July The Board noted the minute of the Healthcare Governance Committee held on 7 July. 15

19 Minute of the Community Health and Social Care Partnership Board held on 28 August The Board noted the minute of the Community Health and Social Care Partnership Board held on 28 August. 130 Minute of the Older People s Consultative Group held on 26 March The Board noted the minute of the Older People s Consultative Group held on 26 March. 131 Minute of the Older People s Consultative Group held on 10 June The Board noted the minute of the Older People s Consultative Group held on 10 June. 132 Any Other Competent Business There was no other competent business. 133 Date of Next Meeting The next formal meeting of the NHS Board will be held on Monday 1 December,. 16

20 20 DUMFRIES and GALLOWAY NHS BOARD Agenda Item December Improving Safety, Reducing Harm Leadership Walkrounds Author: Alice Wilson, Associate Nurse Director Sponsoring Director: Hazel Borland, Nurse Director Date: 13 November RECOMMENDATION The Board is asked to note the process of and themes arising from Leadership Walkrounds. SUMMARY Leadership Walkrounds are an important part of supporting the Scottish Patient Safety Programme. NHS Dumfries and Galloway has a structured programme throughout the year with Executive Directors leading the walkrounds and engaging with front line staff across the organisation. This paper gives an outline of the walkrounds and key themes. Key Messages: Thirty walkrounds have taken place between January and October. GLOSSARY OF TERMS SPSP PS&I MRI Scottish Patient Safety Programme Patient Safety & Improvement Magnetic Resonance Imaging

21 21 MONITORING FORM Policy / Strategy Staffing Implications Financial Implications Consultation / Consideration Risk Assessment Sustainability Compliance with Corporate Objectives Single Outcome Agreement (SOA) Best Value Delivering Scottish Government Health Department Scottish Patient Safety Programme (SPSP) Encouraging staff across NHS Dumfries and Galloway to take forward learning from patient safety activities. None at this time No consultation required at this time as this is a nationally agreed programme. Patient safety and risk management are connected activities. Improving patient safety reduces the risk to patients, staff and the organisation. Embedding continuous improvement enables us to ensure sustainability and reliability of processes and outcomes for patients Corporate Objective 2 Improving patient safety within acute services impacts on keeping our population safe. Vision and Leadership: Commitment and leadership Sound governance at strategic and operational level Sustainability A contribution to sustainable development Impact Assessment No Equality Impact Assessment required as this is a programme that impacts on all patients receiving care and treatment.

22 22 Background: The Scottish Patient Safety Programme (SPSP) Leadership Walkround process supports the delivery of SPSP goals through connecting senior leaders with frontline teams, providing staff with an opportunity to raise Patient Safety and Quality Issues. A programme of weekly walkrounds are scheduled across the year and each walkround is attended by an Executive Director and either a Deputy or Associate Director or a General Manager. Themes: The walkround conversation is intended to engage staff in order that: they can discuss what they do well and are proud of they can raise safety or quality concerns the participants can agree actions and timescales to address any concerns The Patient Safety and Improvement (PS&I) Team provide administrative support to the walkround, scribing and ensuring that the area visited and the visiting team receive a copy of the notes and actions. The PS&I Team have developed a database of themes from walkrounds and these are noted below. Through the 30 walkrounds which have taken place, these issues have been raised on a number of occasions but often with different focus: Pride 16 Environment 12 Staffing - 17 Safety 3 Issues for patients 16 Equipment 5 Paperwork/data collection 2 Pride: Staff described their feelings of delivering a high quality service with willing and capable staff. They discussed where they have been at the forefront of developments and how they support one another. Environment: Issues range from lack of privacy for patients and storage space as well as more minor environmental concerns such as temperature control. Staffing: Staffing comments range from a perception of a lack of staff due to recruitment or sickness issues through to movement of some staff groups. Safety: Issues of safety were raised in relation to security of staff, in particular within Mental Health, and some issues specific to certain departments or procedures i.e. ensuring that the Magnetic Resonance Imaging (MRI) team are aware if a patient attending has a pacemaker.

23 23 Patients: Issues directly affecting patients range from difficulties with transport to potential gaps between physical and mental health care for individuals. Equipment: The main comments around equipment were about the length of wait for repair and contingencies and the number of electronic systems in use. There was a desire to see all electronic systems linked for ease of use. Paperwork/Data Collection: Two areas commented on the volume of paperwork required and a desire to reduce this where possible. Actions: In the majority of walkrounds there will be actions agreed with the team and a lead nominated to take forward within an agreed time frame. Graph 1 illustrates the outcome of the 60 agreed actions Follow up: Where actions are allocated the named lead receives agreed reminders from the PS&I Team administrative support. Any actions not completed within the agreed timescale are reported through the Nurse Director who is the Executive Lead for Patient Safety. Conclusion: The Walkround process continues to be a useful element of SPSP and for staff at the front line to engage with senior leaders. There are limitations in that covering such a variety of wards, departments, hospitals and teams restricts the frequency with which each team can experience this particular walkround. Staff report that they find it useful and the outcomes of the Walkrounds are reported to the appropriate Management Boards and Management Team.

24 24 DUMFRIES and GALLOWAY NHS BOARD Agenda Item December INVOLVING PEOPLE IMPROVING QUALITY Patient Experience Report Author: Yvonne Christley, Patient Experience and Communications Manager Sponsoring Director: Hazel Borland, Nurse Director Date: 7 November RECOMMENDATION The NHS Board is asked to receive this paper describing patient experience activity recorded through Formal Complaints, Scottish Public Services Ombudsman correspondence and the Patient Opinion website. SUMMARY This paper includes report on NHS complaints, Scottish Public Services Ombudsman and Patient Opinion in Dumfries and Galloway for the period 1 July 30 September Key messages: Complaint handling performance has improved significantly, with 65% of complainants receiving a response within 20 working days over this 3 month reporting period. GLOSSARY OF TERMS Scottish Public Service Ombudsman - SPSO 1

25 25 MONITORING FORM Policy / Strategy Staffing Implications Financial Implications Consultation / Consideration Risk Assessment Sustainability Compliance with Corporate Objectives Single Outcome Agreement (SOA) Best Value Healthcare Quality Strategy Complaints Policy Ensuring staff learn from patient feedback in relation to issues raised. Not required Not required Actions from feedback followed through and reported to General Manages and Nurse Managers who have a responsibility to take account of any associated risk. Not required To promote and embed continuous improvement by connecting a range of quality and safety activities to deliver the highest quality of service across NHS Dumfries and Galloway Health inequalities Commitment and leadership Accountability Responsiveness and consultation Joint Working Impact Assessment Not undertaken as learning from patient feedback applies to all users 2

26 26 1. Introduction The NHS Scotland Can I help you? guidance outlines the requirements for handling and reporting on feedback, comments, concerns and complaints. For the purposes of monitoring the Patient Rights (Feedback, Comments, Concerns and Complaints) (Scotland) Directions 2012 require that complaints data to be reported in quarters. This report provides a commentary and summary statistics on complaints handling throughout NHS Dumfries and Galloway for the period 1 July 30 September. It looks at complaints resolved locally and by the Scottish Public Services Ombudsman (SPSO). Data from prior reporting periods have been included in some instances for comparative purposes. 1.1 Complaints A total of seventy nine complaints were received during the reporting period, with fifty eight percent being upheld or partially upheld. Table 1 provides a summary of the number of formal complaints received between 1 July 30 September 2013 and the combined overall totals. Thereafter, the figures included in this table refer to completed complaints and the associated outcomes. Table 1 Formal Complaints Data for July September July Aug Sept Total Complaints received Complaints acknowledged in 3 working days 24 (100%) 32 (97%) 22 (100%) 78 (98%) Complaints completed in (54%) 23 (70%) 16 (73%) 52 (65%) working days Complaints not completed in 20 9 (38%) 8 (24%) 3 (14%) 20 (25%) working days Complaints still ongoing 2 (8%) 2 (6%) 3 (14%) 7 (9%) Outcome of Complaints Upheld 12 (50%) 12 (35%) 6 (27%) 30 (38%) Upheld in Part 2 (8%) 7 (22%) 7 (32%) 16 (20%) Not Upheld 8(34%) 11 (33%) 6 (27%) 25 (32%) Complaints withdrawn 0 1 (4%) 0 1 (1%) Irresolvable - Expectation Complaints Transferred to another department The national target for acknowledging complaints within 3 working days is 95%. The Board achieved 100% compliance in June and September, with an overall compliance rate of 98% for this reporting period. Complaint handling performance has also improved with 65% of complainants receiving a response within 20 working days. This figure falls short of the Board s target of 75% and the NHS Scotland target of 70%. Chart 1 shows a significant improvement on the previous reporting period with 7 improving data points. 3

27 27 Chart 1 Percentage of Complaints Responded to in 20 days Table 2 provides a breakdown of the number of complaints received by Directorates and their performance against the 20 day target. As indicated significant improvement in response time has been achieved across all of the directorates. Table 2 - Complaints completed in 20 working days by Directorate Complaints completed in 20 Jul Aug Sep working days In Out In Out In Out Acute & Diagnostics 8 4 (50%) (73%) 8 6 (75%) Prison Services 4 4 (100%) 4 4 (100%) 2 2 (100%) Women and Children's Services 3 0% 3 0% 4 3 (75%) PCCD 6 1 (17%) 5 2(40%) 5 4 (80%) Mental Health, Learning Disability, Psychology 4 2 (50%) Corporate (100%) 3 1 (33%) Operational Services 2 2 (100%) 1 1 (100%) 0 0 NB: Corporate Directorate includes, Finance, NMAHP, Public Health, IM&T and Workforce Directorate 1.2 Breakdown of Complaint Categories The top five categories of complaint received by NHS Dumfries and Galloway for this reporting period remains consistent with previous months and relate to clinical treatment, staff attitude and behaviour, communication (oral) and appointment dates. These are consistent with national themes from across Scotland and the UK. Table 3 provides a breakdown of the issues attracting most complaints. Table 3 Complaint Categories Jul Aug Sep Total % Clinical Treatment % Staff communication (oral) % Staff attitude and behaviour % Waiting time for date for appointment % Policy and commercial decisions of the Board % 4

28 28 Other % Total Communication issues are mainly related to verbal communication between staff and patients and / or relatives and often come down to differences in interpretation of what was said and what was understood. These are often linked to complaints about staff attitude - in many cases the complaints about attitude is linked to a perception of whether or not information was appropriately communicated or received. The Healthcare Governance Committee continues to receive a report at each meeting which provides detail of all the closed complaints and concerns for the previous month. SPSO reports from other Boards are also presented with a description of the current position in NHS Dumfries and Galloway compared to each of the issues. It also receives any SPSO report relating to NHS Dumfries and Galloway, together with the associated action plan. Further information on the number of complaints received and response times is presented in Appendix Scottish Public Services Ombudsman Individuals who are dissatisfied with NHS Dumfries and Galloway s complaint handling or response can refer their complaint, for further investigation to the Scottish Public Services Ombudsman (SPSO). The SPSO will advise on completion of their processes of any actions, if any are required by the Board in relation to these cases. The Board currently have nine complaints which are under investigation by the SPSO and we currently await the Ombudsman s decision on these complaints. The Board have received decision letters from the Ombudsman on seven further complaints; one was withdrawn by the complainant; two were not upheld; two were not upheld however the SPSO made recommendations to the Board in relation to these complaints and two complaints were upheld and seven recommendations were made to the Board. All of the recommendations have been implemented and a detailed report on these recommendations has been presented at HealthCare Governance Committee. 2. Reports to the Procurator Fiscal There have been no complaints reported to the Procurator Fiscal in this reporting period. The Medical Director meets with the Procurator Fiscal regularly with regard to any other issues or cases out with complaints. 3. Feedback - Patient Opinion Patient Opinion is an online approach, actively supported by Scottish Government, which enables the public to provide and view feedback on the services they have received. 5

29 29 For the reporting period 1 July 3 September, seven stories have been posted on the Patient Opinion website about care experiences at NHS Dumfries and Galloway. Four of these stories were very positive. The authors of the three stories in relation to negative experiences were encouraged to contact the Board directly to discuss their concerns further. All of the stories and their responses can be reviewed in full by visiting 3. CONCLUSION This report provides a commentary and summary statistics on complaints handling throughout NHS Dumfries and Galloway for the period 1 July 30 September. The Board is asked to note the progress made in responding to complainants within 20 working days. 6

30 30 Appendix 1 Complaint Response Times 7

31 31 DUMFRIES and GALLOWAY NHS BOARD 1 December Involving People, Improving Quality Prevention and Control of Infection Agenda Item 141 Author: Elaine Ross, Infection Control Manager Sponsoring Director: Hazel Borland, Nurse Director Date: 6 November RECOMMENDATION The Board is asked to consider this healthcare associated infection report and note the position of NHS Dumfries and Galloway with regard to the SAB and C Diff HAI HEAT targets. SUMMARY This report is compiled using a standard template from SGHSCD to provide information to the NHS board and general public in a format that facilitates comparison with other NHS boards in Scotland. This paper is placed on the public website following discussion at Board. The following information is included in this report: Clostridium difficile infections Staphylococcus aureus bacteraemia (SAB) Hand Hygiene Cleanliness This important topic is also discussed in detail at the Healthcare Governance Committee at each meeting. Key messages: It is now unlikely that we will meet the HAI HEAT targets to be achieved at March This has been fully discussed by the Healthcare Governance Committee. A successful Infection Prevention awareness week was held during October. 1

32 32 GLOSSARY Clostridium difficile Infection (CDI) Healthcare Associated Infection (HAI) Infection Control Team (ICT) Infection Control Public Involvement Group (ICPIG) Meticillin Sensitive Staphylococcus Aureus (MSSA) Meticillin Resistant Staphylococcus Aureus (MRSA) Staphylococcus aureus bacteraemia (SAB) 2

33 33 MONITORING FORM Policy / Strategy Implications Staffing Implications Financial Implications Consultation Consultation with Professional Committees Risk Assessment Best Value Sustainability Compliance with Corporate Objectives Single Outcome Agreement (SOA) Impact Assessment Not required. Update paper only Healthcare Quality Strategy Achievement of HAI HEAT targets Nil Nil Update paper only consultation not required Update paper only. Contents are agenda items for discussion at PCCD and HMG and SCN meetings Also presented to APF at each meeting. Addressed through the corporate risk register Governance and Accountability sound governance at a strategic and operational level Fewer infections will reduce bed occupancy and use of resources 7. To meet and where possible, exceed goals and targets set by the Scottish Government Health Directorate for NHS Scotland, whilst delivering the measurable targets in the Single Outcome Agreement. Keeping the population safe 3

34 34 NHS Dumfries and Galloway Healthcare Associated Infection Reporting Template (HAIRT) Section 1 Board Wide Issues This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the Healthcare Associated Infection Report Cards in Section 2. A report card summarising Board wide statistics can be found at the end of section 1 Key Healthcare Associated Infection Headlines It is now unlikely that we will meet the HAI HEAT targets to be achieved at March This has been fully discussed by the Healthcare Governance Committee. A successful Infection Prevention awareness week was held during October. 1. Staphylococcus aureus (including MRSA) Figure 1 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: 4

35 35 The Board will be aware that the HEAT targets equate to very small numbers of cases of infection. In October there were 4 cases of SAB. Causes are thoroughly investigated and are reported to Hospital Management Board and the Healthcare Governance Committee where they are subject to scrutiny and supportive actions agreed. Figure 2 Whilst the data presented above is disappointing it is important to consider the national picture which is illustrated in the funnel plot produced by Health Protection Scotland overleaf (Figure 3) Figure 3 Funnel plot of S. aureus bacteraemia rates for all NHS boards in Scotland against acute occupied bed days (x ), 1 April to 30 June 5

36 36 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 in section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at: Figure 4 The Board will be aware of continued actions taken to address Clostridium difficile infection which include an emphasis on antimicrobial prescribing and cleanliness of the environment. The Health Protection Team and Infection Control Team continue to review all cases and to work together to identify causes and any further actions that may be taken to reduce incidence of CDI in any setting. Figure 5 6

37 37 The funnel plot illustrating recent performance against all Scottish Health boards demonstrates that in terms of the over 65 s we perform similarly to many other health boards being on the midline (Figure 6). However NHS Dumfries and Galloway is the Board with the highest number of cases in the age range. This data is being interrogated locally with support from Health Protection Scotland. Figure 6 Funnel plot of CDI incidence rates in patients aged 65 years for all NHS boards in Scotland during Q2. HPS Following routine ribotyping of Clostridium difficile specimens, three cases featuring the same 078 ribotype were identified. This is one of the most common ribotypes seen in Scotland at present. A problem assessment group meeting was held to establish whether there were any possible links in time, place or person between cases. There is no apparent link between the three cases which have arisen over the past 3 months. This assessment has been supported by Health Protection Scotland. The Infection Control Team is working together with Public Health and the Hospital Management Team to identify actions that can be taken to address any possible causative factors. These include enhanced surveillance of the use of antibiotics and the use of a chlorine releasing agent (Actichlor) for routine cleaning of the environment and equipment. Further ribotyping has been requested for additional specimens. 3. Hand Hygiene Hand hygiene data is collected and entered by wards and departments following the Scottish Patient Safety Programme methodology. The detail for this element of the report is included in the report cards as the appendix to this report. This is quality assured by the Infection Control Team and if an area fails to report their data, this is subject to scrutiny by the Hospital Management Board. 7

38 38 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 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: All areas are audited in accordance to the National Cleaning Specification and these results are included in the report card as an appendix to this paper. 5. Infection Prevention Awareness week Each year the Infection Control Team uses international Infection Prevention Week as an opportunity to raise awareness amongst staff and visitors of the part they play in reducing HAI. This year was no exception and activities included; A comprehensive educational programme with 20 minute sessions on hot topics Clinical and non clinical staff quiz Win a Kindle Promotional packets of tissues to raise awareness of the 3rd standard infection control precaution- Respiratory hygiene Awareness stands for Staff Awareness stand and Have your say survey by the Infection Control Public Involvement Group (ICPIG). 8

39 39 ICPIG members Ray Muir, Harry Anderson and ICN Ross Darley Elaine Ross, Infection Control Manager, Quiz winner Lorna Handley, Catering and Jackie Machling, ICPIG Chair. 6. Conclusion The focus of national attention is not unreasonably on achievement of the two HAI HEAT targets. However, there are other indicators of high standards of infection prevention and control with which we perform well. These are; low number of Norovirus outbreaks and the length of the resulting ward closure, low rates of surgical site infection, high compliance with MRSA screening and surveillance which indicates the lack of transmission of MRSA between patients. This combined with the continued attention to audit and surveillance data should provide the Board with the confidence that no stone will be left unturned in addressing the causes of Staphylococcus aureus bacteraemia and Clostridium difficile infection. 9

40 40 10

41 41 Healthcare Associated Infection Reporting Template (HAIRT) Section 2 Healthcare Associated Infection Report Cards The following section is a series of Report Cards that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. 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. Staphylococcus aureus bacteraemia (SAB) casesare further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). More information on these organisms can be found on the NHS24 website: Clostridium difficile : Staphylococcus aureus : MRSA: For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the out of hospital report card. Targets There are national targets associated with reductions in C.diff and SABs. More information on these can be found on the Scotland Performs website: Understanding the Report Cards Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group. Understanding the Report Cards Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: Understanding the Report Cards Out of Hospital Infections Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and. The final Report Card report in this section covers Out of Hospital Infections and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital. 11

42 42 NHS BOARD REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Ages Ages 65 plus Ages 15 plus Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Board Total Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Board Total

43 43 13

44 44 NHS HOSPITAL REPORT CARD - DGRI Staphylococcus aureus bacteraemia monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Ages Ages 65 plus Ages 15 plus Cleaning Compliance (%) Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Board Total Estates Monitoring Compliance (%) Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Board Total

45 45 NHS HOSPITAL REPORT CARD Galloway Community Hospital Staphylococcus aureus bacteraemia monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Ages Ages 65 plus Ages 15 plus Cleaning Compliance (%) Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Board Total Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Board Total

46 46 NHS COMMUNITY HOSPITALS REPORT CARD The community hospitals covered in this report card include: Annan Hospital Castle Douglas Kirkcudbright Lochmaben Moffat Newton Stewart Thomas Hope Thornhill Allanbank Staphylococcus aureus bacteraemia monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Ages Ages 65 plus Ages 15 plus NHS OUT OF HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct MRSA MSSA Total SABS Clostridium difficile infection monthly case numbers Nov 2013 Dec 2013 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Ages Ages 65 plus Ages 15 plus

47 47 Agenda Item 142 DUMFRIES and GALLOWAY NHS BOARD 1 December Financial Performance: 7 Months to 31 October Author: Graham Stewart, Deputy Director of Finance Sponsoring Director: Katy Lewis, Director of Finance Date: 12 November RECOMMENDATION The Board is asked to discuss and consider this report. SUMMARY This report provides a high level summary of the Board s expenditure for the seven months to 31October which reflects an under-spend of 931k. This is in line with the Board s forecast to break-even by the end of the year. Key Message The Board has a statutory financial target to deliver a breakeven position against its Revenue Resource Limit (RRL). The Board has banked 7m of funding in total from the last two years that will be drawn down in future years to support the Acute Services Redevelopment Project transitional costs. This report reflects the YTD performance for the first seven months of the financial year /15, which is a 931k favourable variance, and provides a summary of the main financial issues during this period. The main issues faced by the Health Board in the remaining five months of this financial year will continue to be the recurrent delivery of efficiency plans, on-going pressures within the Acute and Diagnostics directorate around access targets, as well as the growing pressure on medical locum costs and prescribing pressures. This month s report follows on from the Mid-year Review paper presented to the Performance Committee in November, which summarised the key movements from the opening financial plan and identified the level of flexibility in the current position. Page 1 of 12

48 48 GLOSSARY OF TERMS ADTC CNORIS CRES CRU DGRI IM&T IPTR LDP QOF PFI RRL SGHSCD SMC UNPACS WTR YTD Area Drugs and Therapeutics Committee Clinical Negligence and Other Risks Scheme Cash Releasing Efficiency Scheme Compensation Recovery Unit Dumfries and Galloway Royal Infirmary Information Management and Technology Individual Patient Treatment Request Local Delivery Plan Quality and Outcomes Framework Private Finance Initiative Revenue Resource Limit Scottish Government Health & Social Care Directorates Scottish Medical Consortium Unplanned Activity Working Time Regulations Year To Date Page 2 of 12

49 49 MONITORING FORM Policy / Strategy Implications Staffing Implications Financial Implications Consultation / Consideration Risk Assessment Sustainability Compliance with Corporate Objectives Supports agreed financial strategy in Local Delivery Plan Not required Financial reporting paper presented by Director of Finance as part of the financial planning and reporting cycle Management Team Financial Risks included in paper Financial plan supports the sustainability agenda through the delivery of efficient solutions to the delivery of CRES. To maximise the benefit of the financial allocation by delivering efficient services, to ensure that we sustain and improve services and support the future model of services. To meet and where possible exceed Scottish Government goals and targets for NHS Scotland. Single Outcome Agreement (SOA) Best Value Not required This paper contributes to Best Value goals of sound governance, accountability, performance scrutiny and sound use of resources. Impact Assessment Financial decisions are impact assessed at the point service and financial planning and therefore no specific action required for this paper. Page 3 of 12

50 50 Summary Financial Position -15 Summary Overview 1. The Board is forecast to achieve its statutory financial target to deliver a breakeven position against its Revenue Resource Limit (RRL) as at the end of October. This is in line with the Mid-Year Review process, where a detailed review of each of the directorates financial position as at the end of September/October has taken place. 2. The report provides a narrative on a range of financial analysis which are presented as appendices to this report and based on the overall Board financial position. In addition it highlights the financial risks and challenges which we must manage as a Board, including delivery on the efficiency savings necessary to ensure a break-even position. 3. As part of the organisation s performance and financial management processes, the directorates have been asked to identify what the key financial risks are around the delivery of breakeven. 4. The Board is reporting an under spend of 931k against budgets based on the seven months expenditure to 31 st October (as per Appendix 2). It is important to highlight that there are a number of growing pressures underlying this improved position at this time and these are highlighted in more detail below. 5. The key financial risks for /15 for NHS Dumfries and Galloway are identified as follows: Delivery of in-year Cash Releasing Efficiencies, in particular the gap on the recurring plans. Delivery of balanced position by the Directorate teams, particularly Acute and Diagnostic Services whilst continuing to deliver services in line with access targets. Costs associated with medical locums and cover of medical staffing rotas, (this has involved a review of the potential level of funding required to support the increased level of expenditure in this area, over and above what was assumed in the LDP). GP prescribing and the uncertainty of possible future unknown costs. Revenue Resource Limit (RRL) 6. The Revenue Resource Limit is notified monthly by the Scottish Government Health and Social Care Directorates (SGHSCD) and once the baseline allocation has been issued, further allocations are issued in year. 7. The forecast RRL for /15 (excluding Family Health Services allocation) is m. This includes a confirmed revenue allocation of m based on the October allocation schedule, with 192k included in anticipated Page 4 of 12

51 51 allocations which relates to funding movements we have been advised to expect but where the Scottish Government Health and Social Care Directorates have not yet confirmed formally in the allocation schedule. 8. In addition Family Health Services Non Discretionary allocation of m has been added to this schedule to provide an overall projected Revenue Resource Limited for /15 of m. 9. Appendix 1 provides the details of allocations received during October. Efficiency Delivery Plan (CRES) 10. The financial plan for /15 identified the need to deliver recurring efficiencies of 7.79m. This plan is split between 7.5m cash releasing efficiencies and 290k productivity savings. A plan has been agreed by the Board which identified efficiency schemes and this will be used to monitor and manage plans against in year. 11. Whilst it is expected that CRES plans will be delivered this financial year through non-recurring measures, there still now remains a recurring gap of 750k overall. This will now be the focus of directorates recovery plans to identify in full by the year end, recurring schemes which identify the remaining balance. Table 2 below highlights the recurring gap by directorate: Table 2 Directorate Recurring Gap k Acute & Diagnostics Directorate 350 Operational Services Directorate 50 Primary & Community Care 189 Women & Childrens Directorate 134 Corporate Services 27 Total Further details on efficiencies are included in Appendix 3 which includes analysis of the target of 7.79m. It also confirms the target is allocated across directorates and progress to date for /15 and includes the productivity savings of 0.29m. 13. The graph at Table 3 below compares the actual CRES savings with both the LDP planned trajectory and a trajectory based on an equal level of savings each month. This shows that the actual savings to October exceeded the LDP target by 0.348m whilst being under the flat trajectory by 0.328m. 14. Whilst Prescribing is showing a YTD under achievement on its CRES plan of 226k, it is expected that with the recent recruitment to key pharmacist posts Page 5 of 12

52 52 over recent months, this position can be recovered non-recurrently this year and identified in full recurrently for next year. Table The plan now reflects a number of significant gaps in terms of recurring delivery in 2015/16 which totals 750k. The Acute and Diagnostic Services directorate is the most significant element of this but they are still expecting to achieve their target, using non-recurring measures in /15 and they are still forecasting a recurring gap of 350k carried forward into 2015/16. The Directorate continues to work on identifying this remaining balance by the end of this financial year. 16. Women s and Children s Directorate are still forecasting a recurring gap of 134k. 17. The mid-year review of the Primary Care Directorate CRES position has identified a recurring gap of 189k, a slight improvement on the previous month s position by 15k. The Directorate continues to work on identifying further recurring schemes to make good this shortfall later in the year with nonrecurring schemes ensuring that the target is achieved in full for As part of the workstreams progressing the mid-year reviews, the risk analysis of the deliverability of the current CRES plan has been reviewed as at end of month 7 and shows that 12% of schemes are now high risk, 18% are medium risk and 70% are low risk. 19. Detailed monitoring of all the efficiency schemes is carried out on an ongoing basis by the Efficiency and Finance Group, supported by the Senior Finance Team, to assess and highlight risks of CRES delivery. Page 6 of 12

53 53 Operating Directorates Summary 20. The operating directorates, under the leadership of the Chief Operating Officer are reporting an under spend of 399k, as at the end of October, inclusive of 312k adverse forecast variance on primary care prescribing budgets. The main pressure within prescribing budgets is within the budgets allocated to the localities which is reporting a cumulative overspend of 224k year to date. All localities continue to have been impacted from a higher than anticipated increase in the volume of prescribing, plus the impact of price rises and the increased use of some new drugs 21. The table below highlights the summary variance by operating service as at the end of October; Directorate YTD Budget YTD Actual YTD Variance k k k Acute & Diagnostics Directorate 46,986 47,158 (172) Mental Health Directorate 11,348 11, Primary & Community Care 35,546 35, Women & Childrens Directorate 10,881 10, Operational Services Directorate 9,551 9, Sub Total Operating Directorates 114, , Acute and Diagnostic Services 22. Acute and Diagnostic Services are reporting a similar over spend of 172k at 31 st October compared to 170k over spend at September. The main pressure within Acute and Diagnostic Services continues to relate to the increased level of activity undertaken YTD in achieving the Access Targets. As part of the Mid-year Review, a further 400k has been agreed to be made available to continue to deliver the Access Targets. Non-pay is now 319k above plan, mainly related to the cost of the activity undertaken YTD, with hospital drugs accounting for 122k of this YTD. This is caused partially by the variability of expenditure on vaccines, plus increased spend on Renal Services and Rheumatology drugs in-month. 23. There continues to be a large number of consultant vacancies throughout the directorate, (20 wtes, mainly across both the Medicine and Surgical Specialties), which will have to continue to be filled by locums until substantive solutions are found. The overall underspend across Pay has increased to 138k. The improvement in the month mainly relates to the funding the delivery of access target pay costs this month ( 39k), combined with lower nursing costs within the critical care unit ( 42k in-month) and lower middle-grade medical costs within Anaesthetics ( 22k). 24. As noted above there is currently a recurring gap of 350k on the Directorate s savings target. The directorate continues to be supported by the finance team Page 7 of 12

54 54 working together to produce plans to deliver targeted recurring efficiencies for the directorate for / Additional funding has been made available to the Directorate since the Quarter One Review, offsetting the increased costs of locum cover ( 1.96m now drawn down year to date). Mental Health Directorate 26. The Mental Health Directorate is reporting an under spend of 236k at October ( 197k under spend at September), with 223k within staffing budgets. Whilst there was an increased level of expenditure associated within learning difficulties due to staffing issues in the social care houses, this was off-set with under spends across in-patients services in Annan and Stranraer. However pressures across in-patient wards continue within Mid-park Hospital, reflecting the continued level of complexity and activity across the Mental Health Inpatient service. Operational Services 27. Operational Services are reporting an under spend of 64k at October ( 102k under spend at September). The YTD position continues to be mainly comprised of continuing pressures across the laundry service ( 30K) and under spends across utilities. Perversely the under spend on utilities, specifically related to energy consumption, is off-set with an under-recovery of income relating to the carbon reduction credit tariff. Primary and Community Care Directorate 28. Primary and Community Care Directorate is reporting an overall under spend of 194k to October ( 11k under spend at September). With the Primary Care Prescribing budgets now being reported into the Directorate summary, this enables an overall view of Primary Care resources, in advance of integration. As described below, the main movement this month relates to the additional funding released within Primary Care Prescribing and the on-going level of nursing vacancies. 29. Primary Care prescribing reflects the largest area of overspend ( 312k) within non-pay, offsetting the underlying favourable position within Pay ( 512k) across the Directorate. This represents the current level and complexity of activity across the community hospitals. Whilst recruitment to nursing and admin clerical staff continues, there still remain levels of vacancies across these areas within Primary Care. 30. The cumulative overspend within Primary Care Prescribing budgets have reduced this month due to the release of the GP Prescribing reserve ( 130k YTD). However the main pressures within Primary Care prescribing budgets (based upon 5 months worth of expenditure data) continue to be; Page 8 of 12

55 55 Slow start to achieving efficiencies (now 226k behind plan YTD, an improvement of 46k compared to September); Higher than expected volume increases (we targeted growth to be under 1.8%, it is currently 2.4%); Negative impact of price rises as discussed previously (giving an adverse effect to date of around 190k). 31. A small part of the prescribing budget has been retained centrally within the Directorate. This includes a variety of things such as: fees to pharmacy contractors for certain services (stoma, methadone), VAT on medicines, discounts, etc. Due to a much lower discount rate than anticipated this budget is overspent by 88k YTD, an improvement on last month by 4k around better discounts and fees. 32. The ongoing level of vacancies in the Primary and Community Care Directorate, mainly across the Community Hospitals, is reflective of the occupancy rates currently experienced, however this level of vacancy will reduce over the coming winter months as occupancy rates across these hospitals increase in line with the demands on the service. Women and Children s Directorate 33. The Women and Children s Directorate is reporting an overall under spend of 77k to October ( 120k under-spend at September). The movement inmonth is almost entirely down to increased drug costs due to patients previously being treated at Yorkhill now being treated at DGRI and pressure within Paediatric medical staffing associated with additional hours worked by consultants this month. Corporate Services 34. The Corporate Services position is under spent by 521k at October, ( 498k under spend at September). 35. The most significant under spend continues to be within the Medical Directorate which is showing an under spend of 232k, mainly related to Pays 337k under-spent (with continued vacancies in the community and salaried dental service ( 175k). This is off-set with increasing expenditure across nonpay within E-health ( 80k) and continued over-spends related to increased service contract costs and telephone expenditure. 36. The cumulative position within public health is now 57k favourable. The main variance on pay relates to the vacancy of the Director of Public Health, being backfilled through existing staff in-post. The non-pay under-spend of 127k below plan reflects the level of slippage on the JHWB projects, which is matched by an equal level of under-achievement across income YTD. 37. The Nursing Directorate is showing an under spend of 70k relating to vacancies in the Spiritual Care and Infection Control Services. The Spiritual Care post has been appointed to now and will start in early November. Page 9 of 12

56 As detailed above, the current position on efficiency savings reflects a 27k recurring gap (in Medical Directorate and Nursing). The finance team continues to support the Directors in identifying these savings recurringly for Strategic services 39. Strategic services are under spent by 11k at October ( 16k over spend to September). 40. Central income reduced slightly in October mainly due to a reduction in the level of RTA income of 29k. 41. The externals budget, which covers the treatment of Dumfries and Galloway patients out of region, is now 123k under-spent ( 67k over spend at September). This is due to reduced levels of activity billed from England, combined with an increasing level of patients from England being treated by DGRI. This is unusual and is currently being investigated to understand the reasons for this shift. Non-core Expenditure 42. Non core expenditure comprises spend on depreciation, PFI charges, certain provisions and building impairments and is funded by a separate Revenue Resource Limit. 43. The non-core budget is m, with a breakdown of the expenditure as follows: Table 6 Area Annual Budget 000 PFI Depreciation 173 Depreciation 4,591 Annually Managed Expenditure (impairments) 22,100 Total 26, The large value against impairments in year reflects the write down of the existing DGRI which will occur once financial close has been achieved for the new hospital. Key Financial Risks 45. The NHS Board is asked to note the following key financial risks as at the end of October; The main risk associated with delivering a break-even position in -15 continues to be the delivery of Cash Releasing Efficiency Savings (CRES). As summarised above the potential risk of non-delivery is now 750k on a recurring basis. Whilst this is a slight improvement of 25k on the previous Page 10 of 12

57 57 month s gap, it is imperative that new schemes are identified that achieve the CRES target in full on a recurring basis. An Efficiency Workshop was held at the end of October with Directors and General Managers to consider the main challenges facing NHS Dumfries and Galloway. This will form the basis of on-going work to identify new workstreams and innovative ideas in tackling the challenge of finding CRES in 2015/16. Activity and access pressures with Acute and Diagnostics. The current forecast over-spend position within this Directorate across the Non-pays reflect the extent to which the costs are in proportion to the increasing demands on the services. The projected resource required to support delivery of the targets for /15 of 400k is reflected in the directorate outturn position. Locum costs continue to increase in line with increasing levels of senior medical posts. Recent drives to recruit to senior posts look promising, however the on-going risk of using temporary locum will continue to represent a significant over-spend that will put significant pressure on the funding set aside to cover these costs this year. The Q1 review s recommendation to set aside an additional 1.1m of funding has now been formally agreed by the Performance Committee. After the review of the month 7 position alongside the updated forecast outturn position, it is anticipated that the level of locum expenditure on medical staff will increase by a further 750k. This continues to be down to the level of medical vacancies in the system that are still to be recruited to and are currently being filled with expensive locum doctors. Whilst Primary Care Prescribing budgets continue to forecast a year end overspend position, this is at a slightly reduced level of 525k overspent. The level of risk going forwards however remains high and the opportunities to maximise CRES in and beyond will need to be identified and delivered. Summary of Mid-Year Review 46. As was undertaken at quarter one review, a stock take of any financial planning assumptions and any reserve movements has been completed to understand any opportunities/ risks and threats to the year-end position. This review has looked at any movements from the opening financial plan, any slippage and additional cost pressures in year both considering the recurring and non recurring impact. 47. The mid-year review has identified a further 1.2m of flexibility for /15 from slippage on commitments against the cost pressures reserve ( 0.7m) and a further 0.5m from the high cost drugs reserve. However a review of medical locum costs has identified an additional requirement of 0.8m required to be invested in locum costs for /15 (over and above the additional resource supported at the quarter one review). This brings the total non recurring Page 11 of 12

58 58 resource used to support locum costs for /15 (over and above recurring budgets) to 3.7m. 48. In addition it is proposed that the projected overspend within the Acute and Diagnostics Directorate of 400k is supported to allow the Directorate to manage pressures in delivery of access targets for / The contingency reserve of 2m is held centrally to manage any additional unplanned pressures or movements in the financial position for /15 over and above those identified in the current position. This could support any further pressures not covered by normal budgets, any unanticipated movements in acute activity or further worsening of the financial position over the winter period. 50. The report includes the following appendices: i. Appendix 1 provides details of all revenue allocations received during the current month. It also highlights anticipated allocations and the Board s expected final RRL. ii. Appendix 2 provides a detailed analysis of the budgeted and actual financial position by operating directorate for period to 31 st October. It identifies variances against budget and also highlights where CRES targets have not been allocated to operating budgets. iii. Appendix 3 summarises the CRES plan for /15 and identifies the phased delivery trajectory for the year. iv. Appendix 4 provides a summary of expenditure variances across the organisation by expenditure type. This provides a more detailed analysis of expenditure patterns per directorate. v. Appendix 5 provides further detail behind the under and overspends in nursing pay budgets. vi. Appendix 6 provides details of expenditure on locum staff. Page 12 of 12

59 59 Appendix 1 NHS DUMFRIES AND GALLOWAY REVENUE RESOURCE ANALYSIS At 31st October Baseline Earmarked Non Non Recurring Recurring Recurring Core Total 000s 000s 000s 000s 000s Revenue Allocation as at 31st October 259,750 29,019 (2,286) 26, ,347 October Allocation Letter Bundles None 0 Other Golden Jubilee top sliced 90% (Hospital Activity Marginal Costs) (746) (746) Mental Health Assess (QuEST) Specialist Childrens services NPD CYP Non Core 0 None 0 Total Allocations 0 (251) 43 0 (208) Revenue Allocation as at 31st October 259,750 28,768 (2,243) 26, ,139 Anticipated Allocations (62) Total Revenue Allocation (excl FHS) 259,750 28,706 (1,989) 26, ,331 Family Health Services Non Discretionary Allocation 15,367 Total Revenue Allocation (incl FHS) 328,698

60 60 NHS DUMFRIES AND GALLOWAY EXPENDITURE ANALYSIS 7 Months Ended 31 October Annual Budget Pays Ytd Non Pay Ytd Income Ytd Total Ytd CRES not allocated Appendix 2 Total Ytd Pay Non Pay Income Total Area Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Variance Variance 's 000's % Operating Directorates Acute & Diagnostics Directorate ,383 Access Target (0) 0 1,228 1, % (2) 178 Acute Allied Health Prof (7) (1) (1) (2) (7) -7% 2,017 (129) (78) 1,810 Acute & Diagnostics Gen Man (25) (75) (49) (52) (96) -12% 2, (13) 2,374 Admin 1,373 1, (2) (13) (15) 2 1,387 1, % (4) 936 Audiology/ECG (0) (2) (2) (0) % 1,996 3,033 (66) 4,963 Cancer Services 1,181 1, ,782 1,773 9 (64) (69) 4 2,899 2, % 11,322 3,011 (29) 14,304 Critical Care 6,744 6, ,770 1,842 (72) (17) (18) 1 8,497 8, % 5,313 2,376 (86) 7,603 Labs 3,207 3, ,405 1,412 (7) (55) (54) (1) 4,556 4, % 10,520 5,334 (10) 15,845 Medicine 6,271 6,348 (76) 3,182 3,231 (49) (8) (7) (1) 9,445 9,571 (126) -1% 9,325 2,706 (23) 12,008 Perioperative 5,675 5, ,578 1,694 (116) (21) (19) (2) 7,233 7,312 (79) -1% 3, (6) 3,987 Radiology 2,051 2,108 (56) (4) (4) 0 2,446 2,476 (30) -1% 10,646 2,655 (9) 13,293 Surgery 6,310 6, ,547 1,582 (35) (8) (9) 1 7,850 7, % 58,429 20,579 (325) 78,683 34,782 34, ,446 12,765 (319) (242) (250) 8 46,986 47,158 (172) 0 (172) 0% Mental Health Directorate 2, (953) 1,369 Learning Disabilities Dir 1,260 1,284 (24) (2) (540) (541) (25) -3% (0) 392 Mental Health Admin (3) (0) (0) (2) -1% 3, (70) 3,359 Mental Health Community 1,769 1, (42) (40) (2) 1,963 1, % 6, ,381 Mental Health Inpatient 3,626 3, (24) 0 (0) 0 3,720 3, % (54) 604 Mental Health Management & Govern (32) (33) % 2, (33) 2,333 Mental Health Medical 1,339 1, (1) (19) (19) (0) 1,361 1, % (48) 772 Mental Health Occ Therapy (33) (32) (1) % Prison & Police Custody H/C (0) % 2, (322) 2,073 Psychology Directorate 1,283 1, (3) (188) (194) 6 1,174 1, % 1, (93) 1,554 Substance Misuse (2) (54) (54) (0) % 19,234 1,881 (1,573) 19,542 11,172 10, ,084 1,078 7 (908) (914) 6 11,348 11, % Operational Services Directorate Business Management (16) (13) -9% 1,526 7,561 (760) 8,327 Property Services ,888 3,958 (70) (397) (323) (75) 4,376 4, % 6,492 2,939 (759) 8,673 Support Services 3,747 3, ,715 1,778 (63) (431) (417) (14) 5,031 4, % 8,189 10,576 (1,519) 17,246 4,732 4, ,646 5,796 (150) (828) (740) (88) 9,551 9, % Primary & Community Care 1, (16) 1,343 Regional Services (82) (9) (17) % 7,126 8,348 (89) 15,385 A&E Locality 4,144 3, ,876 4,939 (63) (53) (52) (0) 8,967 8, % 6,725 11,700 (829) 17,595 Nithsdale Locality 3,979 3, ,826 6,871 (45) (489) (516) 27 10,316 10, % 7,025 5,273 (452) 11,846 Stewartry Locality 4,075 3, ,061 3,116 (55) (279) (279) 0 6,857 6, % 7,979 6,983 (256) 14,705 Wigtownshire Locality 4,703 4, ,082 4,187 (105) (152) (150) (1) 8,633 8,635 (1) 0% 30,064 32,452 (1,642) 60,874 17,597 17, ,931 19,282 (351) (982) (1,014) 33 35,546 35, % Womens & Childrens Directorate (2) 599 W&C Admin (1) (1) (1) (0) % 1, (323) 1,310 W&C Ahp (178) (177) (1) % 1, (251) 1,192 W&C Cmhs (154) (153) (0) % (4) 119 W&C Gynaecology (2) (65) (4) (4) (67) -93% (208) 616 W&C Learning Disability (104) (104) % (28) 706 W&C Management & Governance (16) (28) (28) (14) -5% 3, (8) 4,052 W&C Medical 2,377 2,403 (26) (7) (8) (8) 0 2,406 2,439 (33) -1% 4, (21) 4,407 W&C Midwifery 2,276 2, (13) (13) 0 2,502 2, % W&C Neonatal % 2, (108) 2,617 W&C Public Health Nursing 1,480 1, (16) (57) (59) 2 1,546 1, % (2) 751 W&C Sexual Health (5) (4) (1) (1) (0) (9) -2% 1, (50) 1,498 W&C Ward (16) (29) (30) % 18,276 1,516 (1,005) 18,787 10,569 10, (70) (576) (578) 2 10,881 10, % 134,192 67,004 (6,064) 195,132 Sub Total - Operating Directorates 78,852 77,531 1,321 38,995 39,877 (882) (3,535) (3,496) (39) 114, , %

61 61 NHS DUMFRIES AND GALLOWAY EXPENDITURE ANALYSIS 7 Months Ended 31 October Annual Budget Pays Ytd Non Pay Ytd Income Ytd Total Ytd CRES not allocated Appendix 2 Total Ytd Pay Non Pay Income Total Area Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Variance Variance 's 000's % Corporate Services Corporate Services Chief Executive (2) % 2, (190) 2,118 Dir Nursing, Midwifery & Ahp's 1,204 1, (169) (170) 0 1,121 1, % 2,299 1,271 (146) 3,423 Finance Directorate 1,334 1, (79) (94) 15 1,440 1, % 8,732 7,410 (1,029) 15,113 Medical Director 5,052 4, ,289 4,388 (99) (470) (464) (6) 8,871 8, % (15) 980 Non Recurring Projects (15) (15) % 2,870 1,108 (782) 3,195 Public Health 1,667 1, (457) (274) (183) 1,643 1, % 1,004 1,896 (67) 2,834 Strategic Planning ,389 1, (56) (56) 0 1,935 1, % 1, (261) 1,702 Workforce Directorate (149) (107) (43) % 19,431 13,203 (2,490) 30,144 11,245 10, ,127 6, (1,395) (1,179) (216) 16,978 16, % 19,431 13,203 (2,490) 30,144 Sub Total - Corporate Services 11,245 10, ,127 6, (1,395) (1,179) (216) 16,978 16, % Strategic Strategic (4,958) (4,958) Central Income 0 0 (2,880) (2,868) (12) (2,880) (2,868) (12) (12) 0% 32,356 (2,916) 29,440 External & Resource Transfer 0 16,818 16, (1,618) (1,653) 35 15,199 15, % 824 3,553 4,377 Minor Capital Projects (30) 1,676 1,771 (95) 0 2,157 2,281 (125) (125) -6% ,110 (1,869) 38,622 Primary Care ,278 23, (1,090) (1,090) (0) 22,410 22, % 1,205 76,019 (9,743) 67, (26) 41,772 41, (5,589) (5,611) 22 36,886 36, % 1,205 76,019 (9,743) 67,481 Sub Total - Strategic (26) 41,772 41, (5,589) (5,611) 22 36,886 36, % Non Core Expenditure Non Core Expenditure 26,864 26,864 Non Core Expenditure 0 2,721 2, ,721 2, % 0 26, , ,721 2, ,721 2, % 0 26, ,864 Sub Total - Non Core ,721 2, ,721 2, % 154, ,089 (18,297) 319,621 Total Operating Budgets 90,801 88,924 1,877 90,615 91,329 (713) (10,519) (10,286) (233) 170, , % Reserves Reserves 4,492 4,585 9,077 Reserves % 4,492 4, , % 4,492 4, ,077 Sub Total - Reserves % 159, ,674 (18,297) 328,698 Grand Total 90,801 88,924 1,877 90,615 91,329 (713) (10,519) (10,286) (233) 170, , %

62 62 Appendix 3 Efficiency Delivery Plan -15 Position at 31st October Savings Plan Forecast Outturn Savings CRES GAP Delivered Savings -15 In Year -15 Full Year Recurring In Year - 15 Recurring YTD plan YTD actual YTD Variance Description Operating Divisions Acute Services & Diagnostics 988, , , , , ,078 0 Mental Health Directorate 529, , , , ,588 0 Operational Services 455, , , , , ,426 0 Primary and Community Care Directorate 663, , , , , ,743 0 Womens and Children 365, , , , , ,926 0 Operating Divisions Total 3,000,000 3,000,000 2,276, ,304 1,648,761 1,648,761 0 Corporate Chief Executive & Chief Operating Officer 15,000 15,000 15, ,750 8,750 0 Finance Directorate 82,000 82,000 82, ,838 47,838 0 Medical Director 92,000 92,000 92, ,662 53,662 0 Medical Director: ehealth 117, ,000 92, ,874 68,257 68,257 0 Director of Nursing 58,000 58,000 58, ,831 33,831 0 Public Health 69,000 69,000 69, ,257 40,257 0 Strategic Planning 29,000 29,000 29, ,919 16,919 0 Workforce Directorate 52,000 52,000 49, ,360 30,366 30,366 0 Corporate Total 514, , , , , ,880 0 Other Pharmacy & Prescribing (Primary & Secondary care drugs) 2,500,000 2,500,000 2,500, ,458,338 1,231, ,847 Procurement Contractual 300, , , , ,000 0 Depreciation (assumed) 159, , , ,750 92,750 0 Review of Central Reserves 250, , , , ,831 0 Externals 500, , , , ,669 0 Prior Year: Over-achievement against 7.5m Plan 277, , , , ,581 0 Other Total 3,986,000 3,986,000 3,986, ,325,169 2,098, ,847 Total 7,500,000 7,500,000 6,749, ,538 4,273,810 4,046, ,847 Productivity Savings 290, , , , ,169 0 Combined Total 7,790,000 7,790,000 7,039, ,538 4,442,979 4,216, ,847

63 63 NHS D&G: Subjective Report Appendix 4 Year Variances - Year To Date Month: October Acute Services Directorate Ytd Variance Mental Health Directorate Operational Services Dir Primary & Community Care Ytd Variance Womens & Childrens Directorate Ytd Variance Corporate Services Strategic Non Core Expenditure Account Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Account Summary Type Pay Admin & Clerical (3) Ahp (62) 17 1 (5) 19 3 (27) Ancillary (6) (4) (4) (7) 335 Health Science Services (1) Med/Dental Support Medical & Dental (28) 94 (28) 141 Miscellaneous 0 (15) Nursing Senior Managers 0 (0) Pays (26) 0 1,877 Total Non Pay Clinical (45) 2 (66) (80) (63) 56 (16) (212) Drugs (61) (17) (0) 20 (25) (18) (102) Equipment & Service Contracts (59) (9) 79 (32) (16) (147) (202) (386) Externals (3) Family Health Services 0 (319) (0) (1) 19 (301) General Services (31) (16) 0 6 Hotel Services (11) 2 (84) (27) (0) (11) 1 (130) Other (42) 48 (99) 87 (7) 200 (82) 105 Property (29) (1) (33) (29) (6) (8) Publicity & Advertising (1) (1) (2) (7) (0) 29 (3) 15 Travel/ Training/ Recruitment (51) (17) (4) 3 20 Non Pay (319) 7 (150) (351) (70) (713) Income Fhs Income 7 (18) (0) (11) Hch Income 0 6 (6) 25 1 (231) 24 (181) Other Operating Income 8 0 (82) (1) (41) Income 8 6 (88) 33 2 (216) 22 0 (233) TOTAL (172) CRES Not Allocated to Budgets TOTAL (172) The total reconciles with the "Total Operating Budgets" line in Appendix 2.

64 64 Appendix 5 Nursing: Variance Report October 4CCN - Level 4 Cost Centre Name 5CCN - Level 5 Cost Centre Name Apr Variance 000 June YTD Variance 000 Sept YTD Variance 000 Oct YTD Variance 000 Oct YTD Variance % m7-m6 YTD Av Diff Acute & Diagnostics Dir Mental Health Directorate Learning Disabilities Dir Mental Health Community Mental Health Inpatient Mental Health Management Prison & Police Custody H/C Psychology Directorate Substance Misuse Mental Health Directorate Primary & Community Care Regional Services A&E Locality Nithsdale Locality Stewartry Locality Wigtownshire Locality Primary & Community Care Womens & Childrens Directorate W&C Cmhs W&C Gynaecology W&C Learning Disability W&C Management & Governance W&C Midwifery W&C Neonatal W&C Public Health Nursing W&C Sexual Health W&C Ward Womens & Childrens Directorate Corporate Services Chief Executive Dir Nursing, Midwifery & Ahp'S Medical Director Non Recurring Projects Public Health Strategic Planning Workforce Directorate Corporate Services Strategic

65 65 Appendix 5 Comments The underspend is due to vacancies and ongoing redesign of the nursing structure. Previous month underspend in nursing pays was offset by invoices paid to Key Housing for their staff - these invoices came under Non Pays. This has been amended to be included within Pays as they are staff costs. Underspend relates to vacancies in year. Underspend relates to current service at Treastaigh having a change in demand. Currently no staff paid through Treastaigh budget as they are working on other projects. Underspend relates to senior nurse vacancy. Prison Healthcare staff budget now shown within Nursing - recruitment for one post underway. Underspend relates to STARS. Band 8a nurse vacancy filled by non nursing Council employee. Also nursing vacancies at Band 3 filled by council employees. Underspend in Thomas Hope, Lochmaben, Moffat and Annan Hospitals due to efficient rostering in ward in line with activity levels. =F13/7 District Nursing has an underspend of 8k,recruitment underway. 20k underspend in Band 8a due to retiral - replacement started July. Majority of this underspend relates to Newton Stewart Hospital - efficient rostering in line with activity. There are also 3 vacancies at Band 5 which were advertised May 14-2 appointed to July. Also Band 8a vacancy. Underspend to due full time Band 7, this is being reviewed and recruitment process will progress shortly. 2 Band 3 vacancies have been appointed to with August and September start dates. Band 3 vacancy - interviews Sept 14. Underspend due to efficient rostering on the ward in line with activity levels. Band 7 vacancy due to recent promotion to Nurse Manager. Band 2 vacancy - postholder starts June 14. Vacancies within Nithsdale Home Support Project - posts apponted to with an August start date. Vacancies in Health Visiting - 3 Band 6 posts, interviews held September. Underspend due to 2 part time Band 5 posts - these have now been recruited to and both postholders start June 14. Underspend due to efficient rostering on the ward in line with activity levels. There was a Band 6 vacancy in Looked After Nurse at start of year. Vacancies in Infection Control have now been replaced. PEFs post reduced hours, covered by other staff doing extra hours but lower than budget. Occ Health B5 nursing linked to winter flu campaigns.

66 66 Appendix 6 NHS D&G: Locum Costs Actual Locum Costs: Internal & External Directorate Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Ytd Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Total Acute & Diagnostics ,133 4,133 Mental Health Primary & Community ,176 1,176 Womens & Childrens Other Total , , , Directorate Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Ytd Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Total Acute & Diagnostics , ,155 5,302 Mental Health (14) (2) Primary & Community ,467 Womens & Childrens Other (3) Total , ,401 7,581 Cumulative (Over) / Under (249) (609) (896) (1,039) (1,534) (2,034) (2,362) (2,362) Locum Funding from Reserves -15 Actual Projection Directorate Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Ytd Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Total Acute & Diagnostics , ,962 Mental Health Primary & Community Womens & Childrens Other Actual Ytd and Projection , , Locum Reserve Funding 3, Directorate Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Ytd Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Total Acute & Diagnostics , ,314 Mental Health 0 0 Primary & Community Womens & Childrens Other 0 0 Total , ,695

67 67 DUMFRIES and GALLOWAY NHS BOARD Agenda Item December CAPITAL PERFORMANCE /15 Author: Susan McMeckan Deputy Director of Finance Sponsoring Director: Katy Lewis Director of Finance Date: 19 November RECOMMENDATION The Board is asked to approve: The changes to the budget following the Mid Year Review. The Board is asked to note: The allocations received to date The project budget updates The expenditure incurred to date The revised draft five year plan SUMMARY Allocations of 8.880m have been received from Scottish Government Health and Social Care Directorate (SGHSCD) to the end of October. Expenditure of 2.033m has been incurred to the end of October. As previously reported income of 0.375m from disposal of Netherlea has been received which has been returned to SGHSCD in line with current guidance. No further sales are anticpated. GLOSSARY OF TERMS SGHSCD - Scottish Government Health and Social Care Directorate LDP - Local Delivery Plan YTD - Year to Date IM&T - Information Management & Technology CIG - Capital Investment Group MYR - Mid-Year Review ASRP - Acute Services Redevelopment Project Page 1 of 8

68 68 MONITORING FORM Policy/Strategy Implications Capital Plan, Property Strategy & IM&T Strategy Staffing Implications Not Applicable Financial Implications Capital charge and recurring revenue consequences built in as part of the financial planning and reporting cycle Consultation / Consideration Capital Investment Group, Management Team and Performance Committee Risk Assessment No Sustainability The capital plan supports the sustainability agenda through the delivery of capital schemes in line with the property strategy and efficiency procurement of equipment. Compliance with Corporate Objectives To maximise the benefit of the financial allocation by delivering efficient services, to ensure that we sustain and improve services and support the future model of services. Single Outcome Agreement (SOA) Not applicable. Best Value This paper contributes to Best Value goals of sound governance, accountability, performance scrutiny and sound use of resources. Impact Assessment Not Applicable Page 2 of 8

69 69 Allocations Update 1. To the end of October a capital allocation of 8.880m has been received, an increase of 62k to that previously reported in October. The increase is an allocation for a piece of equipment funded from the Detecting Cancer Early Programme of 0.062m. 2. An increase in allocation is still anticipated with respect to HFS Equipping for ASRP estimated at 0.148m and an allocation deduction to reflect a carry forward of funds to agreed with SGHSCD. Budget Update 3. The table below shows the revised budget position for -15 which has been adjusted to reflect additional allocations received from SGHSCD and the outcome of the midyear review process. Details of the changes are provided below. 4. The Board are now asked to approve the change to the budget from that previously presented in October following the Mid Year Review. This will set the final budget position for Capital Budget Approved October Return to SGHSCD MYR Adjustment Revised December 000s 000s 000s 000s Primary Care Modernisation - Dalbeattie Primary Care Modernisation - Dunscore Acute Services Enabling Works 3,940 (1,000) 0 2,940 HEPMA Replacement programme 3,200 (1,450) (174) 1,576 Developments 950 (550) (55) 345 Detecting Cancer Early HFS Equipping Unallocated to be prioritised GROSS CAPITAL EXPENDITURE 9,341 (3,000) 62 6,403 Less Capital Income NBV (375) 0 0 (375) NET CAPITAL EXPENDITURE 8,966 (3,000) 62 6, Discussions have taken place with SGHSCD to agree the deferral of 3m of capital funding from -15 to as highlighted above. 1m in relation to the Acute Service project as a result of timing changes, and 2m from the remaining plan to support the Board approved investment in the Women and Childrens HUB. 6. The midyear review process identified a number of pieces of equipment within the replacement programme which had approval which no longer required capital funding and a small number of price changes. In addition the level of expenditure which has been required from the contingency allocation is far less than in previous years, and as a result this balance has been reduced. The Page 3 of 8

70 70 replacement programme budget has been reduced to reflect the revised commitments of 1,476k and a contingency sum of 100k is available for the remainder of the financial year to deal with unplanned replacements. 7. All developments which were approved by CIG are proceeding and expected to be completed by the end of the financial year with the exception of one item which has been reclassified as revenue. The budget has been reduced to reflect the commitments already approved. 8. The allocation received from Detecting Cancer Early of 62k will be used to purchase a Scope Guide which will be used in the Endoscopy service at DGRI and GCH. 9. An unallocated balance of 229k remains within the capital plan following midyear review. It is anticipated that work will begin on the next CIG priority which is the reconfiguration of Cree West ward within the CRH building to allow the transfer of services from Huntingdon as part of that service redesign. Tenders are expected to be returned late November which will allow the work to start in early Any underspend from closing of the final accounts for the Dalbeattie and Dunscore projects will be added to the unallocated balance for CIG to prioritise. 11. No changes are expected to capital income for the remainder of the year, no further receipts are anticipated. YTD Expenditure Update 12. The table below shows the expenditure to date against actual commitments made by the Board. EXPENDITURE TO END OCTOBER Approved Budget YTD Expenditure Outstanding Expenditure 000s 000s 000s Primary Care Modernisation - Dalbeattie Primary Care Modernisation - Dunscore Acute Services Enabling Works 2, ,558 HEPMA Replacement Programme 1, Developments Detecting Cancer Early HFS Equipping Uncommitted GROSS CAPITAL EXPENDITURE 6,403 2,033 4,370 Less Capital Income NBV (375) (375) 0 NET CAPITAL EXPENDITURE 6,028 1,658 4,370 Page 4 of 8

71 m has been incurred to the end of October on capital projects. An increase in expenditure is now being incurred on the equipment programme as would be expected for this time in the financial year. Draft 5 Year Plan 14. A number of factors require to be updated in the indicative 5 year plan previously presented to the Board: The Full Business Case for Acute Services includes an updated capital profile. The approval by Board of the Initial Agreement for the Women and Children HUB. Approval is still outstanding from SGHSCD. Agreement with SGHSCD of deferral of 3m. 15. Appendix 1 sets out an indicative 5 year plan based on the changes highlighted. Areas of risk 16. The challenging national position for capital in is an area of risk that the Board require to be aware of. No flexibility will be available from SGHSCD to support any unplanned issues that the Board may have to deal with. This will require strong management by CIG to ensure that if the HUB project is approved that all other programmes remain within allocated budgets. 17. The backlog maintenance issues at DGRI continue to be a risk and require expenditure during the period that the existing hospital remains operational. The resources available to fund backlog maintenance are restricted and areas of investment will require to continue to be prioritised. 18. There is limited flexibility within the in year capital plan to deal with any unplanned events which require immediate action. Contingency within the rolling statutory compliance budget of 100k will provide some support. 19. Within the Acute Services budget an element of the budget is related to works that Transport Scotland have carried out on behalf of the Board, at this time a final cost has not been produced therefore there is an element of risk that this budget may be overstated. It will be challenging for the Board to manage this risk if it materialises. Open dialogue continues with Transport Scotland to ensure the Board are aware of the final cost and allocation transfer which will be required to pay for this work. Page 5 of 8

72 72 Summary 20. The approved capital plan is monitored by CIG and budgets prioritised within delegated limits. Any further changes that take place through CIG will be reported to the Board in due course. Page 6 of 8

73 73 Anticipated Allocations APPENDIX 1 SOURCE TOTAL 000s 000s 000s 000s 000s 000s Formula allocation 3,536 3,840 3,840 3,840 3,840 18,896 Project specific funding - Dalbeattie Project specific funding - Dunscore Project specific funding - Acute Services 4,128 1,647 26,553 15,428 9,662 57,418 Project specific funding - Property Strategy Implementation Project specific funding - Clinical Change Programme 0 4,000 4,000 4,000 12,000 Prior Year Brokerage 1,000 1, ,000 Proposed brokerage (14/15) - Women & Children (2,000) 2, Proposed brokerage (14/15) - ASRP (1,000) 1, Detecting Cancer Early HFS Equipping TOTAL AVAILABLE FOR COMMITMENT 6,403 9,927 34,578 23,268 17,502 91,678 APPLICATION TOTAL 000s 000s 000s 000s 000s 000s Rolling Programmes - IM&T, Equipment & Property 1,576 3,200 3,200 3,200 3,200 14,376 Developments - Committed Developments - Balance ,042 Developments - HEPMA Developments - Women & Children Hub 0 3, ,143 Clinical Change Programme 0 0 4,000 4,000 4,000 12,000 Dalbeattie Primary Care Centre Dunscore Primary Care Centre HFS Equipping Acute Services Redevelopment Enabling Works 2,940 2,647 26,553 15,428 9,662 57,230 Detecting Cancer Early Unallocated TOTAL EXPENDITURE ANTICIPATED 6,403 9,927 34,578 23,268 17,502 91,678 BALANCE Page 7 of 8

74 74 Page 8 of 8

75 75 DUMFRIES and GALLOWAY NHS BOARD Agenda Item December Performance Report Author: Chris Sanderson Efficiency and Productivity Manager Sponsoring Director: Julie White Chief Operating Officer Date: 12 November RECOMMENDATION The Board is asked to discuss and note the contents of this report. SUMMARY This report is split into three sections. Section 1 provides information on the level of clinical activity and access times achieved within services to 31/10/. Section 2 highlights data on efficiency of clinical services as measured against clinical efficiency targets. Finally, section 3 summarises a wider range of activity and provides data on bed occupancy throughout the system. Key Messages: The month of October has seen a very slight rise in inpatient TTG breaches and an increase in outpatient breaches compared to the previous month. Diagnostics breaches reduced based on the 6 week national standard. 18 week RTT performance remains above target as does Emergency Department performance based on the interim 95% HEAT target. Although 31 day cancer performance is above target, the 62 day performance level dipped just below the 95% target. GLOSSARY OF TERMS HEAT - Health Improvement, Efficiency, Access and Treatment Quality and Patient Experience ED - Emergency Department BADS - British Association of Day Surgery DNA - Did not attend TTG - 84 Day Treatment Time Guarantee AMU - Acute Medical Unit ISD - Information Services Division Page 1 of 22

76 76 QoF - Quality Outcome Framework DGRI - Dumfries and Galloway Royal Infirmary GCH - Galloway Community Hospital LDP - Local Delivery Plan LUCAP - Local Unscheduled Care Action Plan INR - International Normalised Ratio ENT - Ear Nose and Throat PCCMB - Primary and Community Care Management Board HMB - Hospital Management Board STARS - Short Term Assessment and Reablement Service Page 2 of 22

77 77 MONITORING FORM Policy / Strategy Staffing Implications Waiting Times Additional demand may impact on staffing levels, however this is managed within the operational teams. Financial Implications Discussed with Director of Finance and Chief Operating Officer Consultation / Consideration Risk Assessment Sustainability Compliance with Corporate Objectives Single Outcome Agreement (SOA) Best Value As above Not applicable A risk assessment has been undertaken with regards overdue return appointments. This was assessed initially as high but control measures are now in place and this currently remains assessed as medium. Complies with to deliver excellent care that is person-centred, safe, effective, efficient and reliable. to reduce health inequalities across Dumfries and Galloway. Not applicable Complies with key principles: Commitment and leadership Sound governance at a strategic, financial and operational level Sound management of resources Use of review and option appraisal Impact Assessment Not Required Page 3 of 22

78 78 1. CURRENT POSITION AGAINST ACCESS TARGETS Appendix 1 shows the status of patients treated in the month of October under the 84 day Treatment Time Guarantee (TTG). The appendix also shows waiting times for stage of treatment targets at 31/10/ for out-patient appointments and key diagnostic tests which the Scottish Government continue to monitor us on. Please note that this data is provisional management information. In-patients/Day Cases There were 939 in-patients / day cases in the month of October and of these, there were 4 TTG breaches (0.4%). The patients have been informed in writing. The 12 month rolling trend is shown in the table below. Trend There have now been a total of 187 TTG breaches since October 2012 when the legal guarantee came into place. During this time, a total of 20,546 patients have been treated, with TTG breaches representing 0.9% of this total. Fin.Year To Date 31/10/2013 Fin. Year To Date 31/10/ Inpatient/Daycases Treated Outwith Guarantee Date Inpatient/Daycases Treated Within Guarantee Date TTG Breach % 0.5% 1.1% The service is now moving towards an internal standard of 9 weeks to improve the achievement of the 12 week target. By booking to 9 weeks this will provide a 3 week window to address any unforeseen circumstances. Note: Current Scottish Government guidelines mean that a TTG breach is recognised on the day that the patient is treated, beyond the 84 day guarantee period. As the Performance Report cycle has to cut off at every month end and report the position at the last day of each month a scenario can arise whereby the 84 day period can have elapsed but the patient has not received treatment until into the next reporting month. The reporting convention is therefore that patients who breach the TTG will be reported against the month in which they were actually treated. Page 4 of 22

79 79 Out-patients At the end of month snapshot, there were 5,960 people waiting for a consultant-led new out-patient appointment. Of this total there were 329 breaches (5.5%) of the 12 week out-patient standard. Analysis The main reason for the high number of breaches is due to difficulties in finding cover for consultants due to unanticipated leave in a number of specialties. We have a working group set up who are analysing the demand and capacity factors across each speciality but focussing initially on Orthopaedics. Trend It should be noted that July was the first month in which measurement of out-patient waiting times changed to mirror that of in-patient waiting times, i.e., following the calculation rules described within the TTG regulations. Diagnostics At the month end snapshot, there were 949 patients waiting to undergo key diagnostic tests. Of this total, there were 9 breaches of our internal 4 week treatment standard (0.9%). Note: We operate and report to a 4 week standard for diagnostic tests, although the national target we are held accountable for is 6 weeks. Against the national 6 week target there was 1 breach (0.1%). Trend Page 5 of 22

80 80 Recent breaches of the 4 week internally target occurred predominantly within MRI, and were largely attributable to a recent increase in referrals to the service and capacity issues. This in turn has meant that images have to go to external sources to be reported on which can cause delays and breaches. Extended working days and use of capacity at the Golden Jubilee National Hospital means that this has largely been brought back under control. Cancer Treatment Monthly Trend management information Most recent period of measurement September (Management Information) Waiting Time Standard Target Actual 31 days from decision to treat to first cancer treatment 62 days from urgent referral with a suspicion of cancer to first cancer treatment 95% 100.0% 95% 92.3% Page 6 of 22

81 81 Analysis The last 11 months performance has averaged at 96.6% for the 62 day target, however pathway revision work is being taken forward in conjunction with Scottish Government and the other health boards to ensure 62 day performance consistently meets target. 18 Week Referral to Treatment Standard Measure Period Target Actual Linked Pathways October 90% 92.6% Performance October 90% 91.1% Analysis Both linked pathways and performance have been consistently above the 90% target for the last 12 months. An action plan has been developed to maximise 18 week compliance which includes a rolling programme of training for medical secretaries and the Patient Access Team. The training is initially aimed at improving the use of the Unique Care Pathway Number which support our ability to measure the linked pathways and prioritising areas which will deliver the biggest improvement in performance. Performance dropped due to the impact of the recent rise in outpatient waits for new appointments as described earlier in the report. Note: The 18 week standard is different to the Treatment Time Guarantee and also the out-patient and diagnostic stage of treatment standards in that it is a measure of the whole pathway from referral up to the point the patient is treated. The target is 90% for both measures (90% for Performance and Linked Pathways). Linked Pathways is a measure of the percentage of patient journeys for which we have data relating to the entire journey or pathway from referral to treatment. Performance measures the percentage of complete journeys which have taken no more than 18 weeks to complete. The Unique Care Pathway Number is a unique identifier allocated to new referrals to a consultant led service, to enable identification of patient pathways. Page 7 of 22

82 82 Emergency Department (ED) Performance Indicator Most recent period Target Actual of measurement % of ED waits under 4 hours October 95%* 95.8% Attendances per 100k population (rolling 12 month average) October ** 2,591 *.An interim ED 4 hour compliance HEAT target commenced in April The HEAT Standard of 98% remains in place. ** The T10 HEAT Target ended in March. The attendances per 100,000 population (rolling 12 month average) is shown as an internal performance measure only and is subject to review. ED 4 Hour Performance Trend ED 4 Hour Performance - Analysis In the last 12 months, ED 4 hour performance has stabilised to between 95% - 98% on a consistent basis. Our local Unscheduled Care Action Plan contains a number of measures aimed at pushing this on and stabilising performance to the 98% level which became the new target after September. Breach Reasons There were 158 four hour breaches in October. Breach reasons are very different between DGRI and the Galloway Community Hospital and are shown in the tables below. Page 8 of 22

83 83 The four hour waiting times within the emergency department is seen as a measure of how well the system is working together to support provision of urgent care to people in times of crisis. Locally work towards delivering 98% against the four hour target is driven by the Local Unscheduled Care Action Plan (LUCAP). The LUCAP has actions against five key workstrands: Workstrand 1: Making the Community the Right Place and Developing the Primary Care Response. This is the workstrand which supports actions in the community to avoid attendance / admission in the first instance and earlier transfer back to community resources to maintain flow for admissions. Delivery against the reduction in ED attendances will be supported by this workstrand. Page 9 of 22

84 84 ED Attendances Trend Month ED Attendances Population Base ED Attendance Rate 12 Month Rolling Average Nov , ,270 2,287 2,542 Dec , ,270 2,496 2,549 Jan 3, ,270 2,439 2,556 Feb 3, ,270 2,303 2,560 Mar 3, ,270 2,632 2,568 Apr 3, ,141 2,632 2,576 May 4, ,141 2,780 2,586 Jun 4, ,141 2,747 2,593 Jul 4, ,141 2,807 2,585 Aug 4, ,141 2,740 2,578 Sep 4, ,141 2,721 2,586 Oct 3, ,141 2,508 2,591 A number of actions continue to be progressed under the General Manager responsible for the community section of the Local Unscheduled Care Action Plan (LUCAP) an example of which is outlined below: STARS are currently testing changes in working practices to improve service provision and outcomes for service users. One of these tests involves changing the former model of exclusive Nursing clinical skills to test the impact of complimentary AHP hybrid skills and roles within the team. The aim is to optimise rehabilitation and reablement opportunities, promote independence and consolidate outcomes focused approaches across the multidisciplinary team. Key to this test is the development of two AHPs, PT and OT hybrid roles within the STARS community environment providing expertise at the right place and right time, in partnership with Nursing and Social Work colleagues. Page 10 of 22

85 85 To date this test of change has created and demonstrated best use of resources, enabled whole system responsive practice to deliver outcomes that matter around improved level of functioning for the individual and a reduction on ongoing care requirements for the organisation. Workstrand 2: Flow and the Acute Hospital Actions within this workstream are focussed on the management of inpatients with the hospital and ensuring that patients are moving smoothly through their inpatient stay. Examples of actions within this flow are as follows: a. We continue to work with Scottish Ambulance Service and their developing Scheduled Care Programme to support timely access to ambulance transport for discharge and transfer with our next meeting scheduled for 10 th November. On a day to day basis we are in regular contact with both the local team and the day co-ordinator to maximise our use of available transport resource. b. Scottish Ambulance Service will continue to provide a vehicle to support discharge and transfer at weekends until November c. The capacity management escalation plan is currently being updated and we are planning to run a table top exercise in November 14. d. The nurse template for ward 4 has been adjusted to support 7 day opening from November to March. Workstrand 3: Assuring Effective and Safe Care 24/7 at the Hospital Front Door Actions within this workstream are focussed on the management of inpatients within the hospital and ensuring that patients are moving smoothly through their inpatient stay. Examples of actions within this flow are as follows: a) An ambulatory care area opened within ward 7 on the 20 th October which will support alternatives to inpatient assessment for patients who would have otherwise been referred for admission. b) LEAN tests of change are planned for the ED week beginning 27 th October and the assessment area in ward 7 week beginning the 17 th of November. Workstrand 4: Promoting Senior Decision Making This workstream aims to provide timely access to senior decision making for patients both at presentation and also throughout their journey. Examples of actions within this workstrand include: a) The development of electronic flag for referrals for endoscopy for inpatients. Endoscopy referral is frequently made for patients within the early hours of their inpatient admission. If this is a medical patient they will present to ward 7 and then move to downstream wards. Page 11 of 22

86 86 We are exploring the use of the Cortix system to flag that a referral has been made and received and to ensure that communication from the endoscopy service is made easier as the use of the Cortix system ensures that the team are always updated of the current whereabouts of the patient. Improvement in communication will improve access to diagnostics and reduce potential delay. b) We plan to increase the services available for rehabilitation and discharge by introducing AHPs and Social Work availability at weekends for three months from 1 st November. Workstrand 5: Cross Cutting themes The final workstrand is about information management, leadership and management and workforce development. Medical recruitment is a key area of focus within this workstrand. The Acute and Diagnostics Directorate has invested in a project lead to support medical recruitment for DGRI. Current focus is around improving our visibility within the jobs market with review of adverts using existing routes within SHOW and BMJ and planning to adopt more creative approaches e.g.: o Use of full page Splash Adverts within the BMJ and the Irish Medical Journal for a collection of positions o Attendance at specialty conferences recently the project lead and key clinicians took a stand at a Care of the Elderly Conference with information about Dumfries and Galloway and job descriptions for our Care of the Elderly Consultant vacancy. Delayed Discharge Performance The chart below shows delayed discharges over the last 12 months expressed as bed days lost. Page 12 of 22

87 87 Delayed Discharges are discussed on a monthly basis at the Primary and Community Care Management Board chaired by the Chief Operating Officer and including all of the key stakeholders who influence delayed discharge performance. Priority actions include: A paper regarding the implementation of the revised Scottish Government Choice Guidance was submitted and agreed at the Community Health and Social Care Partnership Board in August. Training on implementation of guidance for frontline staff is to commence from mid November onwards. Work is being undertaken to improve flows within DGRI and out to Cottage Hospitals, for example, the review of the admission, transfer and discharge policy, tests of seven day discharge approaches, criteria led discharge, introduction of Patient Flow Co-ordinators and the testing of a transport hub. Capacity issues in relation to care packages are being escalated every Wednesday to Commissioning colleagues which also takes into account the positioning of the STARS re-ablement team. Patient Access Use of Patient Unavailability Code As part of our commitment to meeting the recommendations of the recent internal audit into management of waiting times, we have developed a suite of indicators to allow executive and non-executive directors to challenge board performance. The following charts show the extent to which patient unavailability is being recorded within inpatients, diagnostics (scopes) and outpatients and includes a breakdown of the reasons for unavailability. Percentage unavailable in all specialties - 12 months to October Inpatient/Daycases Page 13 of 22

88 88 New Outpatients (Consultant-Led) Page 14 of 22

89 89 Diagnostics (Scopes) 2. CURRENT PERFORMANCE AGAINST CLINICAL EFFICIENCY TARGETS The table below shows the current performance against our internal clinical efficiency targets. Efficiency Targets Internal Target Actual Performance (July) RAG Status Day Case rates (BADS procedures) 81.5% 79.9% Amber Non elective In-patients Average Green Length of Stay (days) Review per new out-patient attendance (ratio) (year to date) Amber Out-patient DNA rates New 4.8% 6.3% (year to date) Amber Return TBC 6.4% (year to date) TBC Pre-operative Length of Stay (days) Green Elective Operations cancelled by 7% 8.5% Amber Theatre No of Sleepers TBC 162 TBC Page 15 of 22

90 90 ALOS based on all non routine episodes and not completed hospital stays Pre-operative LOS is for elective surgical procedures. Cancelled Operations on Mon-Fri scheduled morning / afternoon sessions Elective Cancellations The following chart shows the trend over the last 12 months. Month Actual Performan ce (%) Target (7%) DNA/ Patient Refusal Patient Not Fit/ Prepared List Overrun/ Equipment Not Ready Op. No Longer Required Nov % 7.0% Dec % 7.0% Jan 8.9% 7.0% Feb 8.3% 7.0% Mar 8.1% 7.0% Apr 9.1% 7.0% May 8.3% 7.0% Jun 8.7% 7.0% Jul 10.8% 7.0% Aug 8.0% 7.0% Sep 8.6% 7.0% Oct 8.5% 7.0% Other No.of Cancellations The data continues to be shared at the Theatre Users Group where the agenda has been focussed on theatre efficiency with a particular emphasis on turnaround times between patients which will help to reduce the number of cancellations. The patient access team are also currently working with the day surgery team on how to reduce the DNAs and the patient refusal. Recent benchmarking data shows that NHS Dumfries & Galloway was placed 4 th best amongst the Scottish Boards in terms of percentage of elective cancellations. Performance ranged from 4.9% to 20.2% so our current performance would indicate that we are not an outlier; however the local team are not complacent and recognise that there is significant room for improvement. Page 16 of 22

91 91 3. ACTIVITY The activity tables below show year to date activity levels to the month of October v the same time period in previous fiscal year across a range of measures. Activity Activity Type Financial Year To Date 31/10/2013 Financial Year To Date 31/10/ % Change Source A&E Attendances (Planned) % EDIS/TED A&E Attendances (Unscheduled) % EDIS/TED Non-Elective Admissions % Topas Elective Daycases % Topas Elective Inpatients % Topas Births % Scottish Birth Record Obstetric Admissions % Topas New Outpatient (Dr-Led) % Topas New Outpatient (Dr-Led) DNAs % Topas Return Outpatient (Dr-Led) % Topas Return Outpatient (Dr-Led) DNAs % Topas Radiology % RIS Mental Health Admissions % Topas Occupied Beds Ward Set Description Financial Year To Date 31/10/2013 Financial Year To Date 31/10/ % Change Source Community % Topas DGRI Day Surgery % Topas DGRI Main Wards % Topas External eg GJ, Carrick Glen % Topas Galloway % Topas Maternity % Topas Mental Health % Topas Return Out-patient Appointments At the end of October, there were 7,217 patients waiting for a Doctor-led return out-patient appointment, of which 1,477 were in the Before Latest Date category. Appendix 2 contains a chart showing a full specialty breakdown for the month of October. The following chart and table shows the trend in the last 12 months. Page 17 of 22

92 92 Month 0-6 Weeks Beyond Latest Date 6-9 Weeks Beyond Latest Date 9-12 Weeks Beyond Latest Date 12+ Weeks Beyond Latest Date Total Beyond Latest Date Nov , ,412 4,905 Dec , ,584 5,436 Jan 2, ,620 5,037 Feb 2, ,669 4,952 Mar 2, ,816 5,352 Apr 2, ,959 5,495 May 2, ,057 5,700 Jun 2, ,227 6,104 Jul 2, ,358 6,216 Aug 2, ,183 5,787 Sep 2, ,357 6,064 Oct 2, ,294 5,740 Note: Patients are given a ticket for their return appointment with a target date. The appointment itself should be in a window within a tolerance of 5% before the target date (the earliest date) and 15% after the target date (the latest date). The term before latest date is a reference to the latest date of the window as previously described. 0-6 weeks and beyond refer to those waiting in excess of the latest date of the tolerance window. One of our new Assistant General Managers has been tasked at looking at the overall challenges that we are facing with return outpatient appointments. Close links will be made with the national Transforming Outpatients work and local initiatives including questioning the value of return outpatient appointments; referral pathways; management of test results and alternatives such as telemedicine and one stop clinics. The top three impacting specialties in terms of +12 week waits beyond the tolerance window are Ophthalmology, Dermatology and Gastroenterology. The following actions are being taken to reduce these backlogs: A full action plan for Improvement within the service has been implemented. The initial priority of recovering the OP position has been progressed with focus being placed on consultant reviews of return patients. This is still in its early stages but along with additional actions should provide an improvement in figures We have a retired consultant working part-time to cover this service which is not providing sufficient capacity to meet demand. Productive discussions have taken place and a local GP with special interest will b increasing support to the service between September 14 and January 15. Permanent appointment is hopeful from April In the short term additional clinics will be arranged to control backlog. Ophthalmology Dermatology Gastroenterology This is a focus of the newly established working group and an action plan with be put in place with the team Page 18 of 22

93 93 4. Conclusions The month of October has seen a very slight rise in inpatient TTG breaches and an increase in outpatient breaches compared to the previous month. Diagnostics breaches reduced based on the 6 week national standard. 18 week RTT performance remains above target as does Emergency Department performance based on the interim 95% HEAT target. Although 31 day cancer performance is above target, the 62 day performance level dipped just below the 95% target. Page 19 of 22

94 94 APPENDIX 1 WAITING TIMES POSITION AT END October In-patients / Day Cases treated - in month calculation Specialty 0-6 Weeks 6-9 Weeks 9-12 Weeks 12+ Weeks Total General Surgery Oral - MaxFac Medical Paediatrics Community Dental Anaesthetics GP-Acute Gastro-Enterology Haematology Cardiology Urology General Medicine Orthopaedics Gynaecology Ear Nose & Throat Ophthalmology Total Diagnostics waiting list analysis at month end Internal 4 Week Target Description 0-4 Weeks 4+ Weeks Total Magnetic Resonance Imaging Cystoscopy Colonoscopy Computer Tomography Endoscopy Flexible Sigmoidoscopy Non-obstetric Ultrasound Total National 6 Week Target Description 0-6 Weeks 6+ Weeks Total Magnetic Resonance Imaging Cystoscopy Colonoscopy Endoscopy Flexible Sigmoidoscopy Non-obstetric Ultrasound Computer Tomography Total Page 20 of 22

95 95 New Outpatient (Consultant-Led) waiting list analysis at month end Specialty Total Weeks Weeks Weeks Weeks Orthopaedics Orthodontics General Surgery Rheumatology Dermatology Gastro-Enterology Gynaecology Ophthalmology Diabetes Respiratory Medicine Anaesthetics Urology Oral - MaxFac Endocrinology & Diabetes Neurology Medical Paediatrics Cardiology General Surgery (Excl.Vascular) Clinical Oncology Community Dental Palliative Medicine Rehabilitation Medicine Communicable Diseases Nephrology General Medicine Haematology Geriatric medicine Endocrinology Clinical Chemistry Ear Nose & Throat Total Page 21 of 22

96 96 APPENDIX 2 - Out-patient Return Appointments (Dr. Led) waiting list Based on October month end snapshot Specialty Before Latest Date 0-6 Weeks Beyond Latest Date 6-9 Weeks Beyond Latest Date 9-12 Weeks Beyond Latest Date 12+ Weeks Beyond Latest Date Total Beyond Latest Date Ophthalmology ,291 Dermatology Gastro-Enterology Orthopaedics Ear Nose & Throat Urology Neurology Orthodontics General Psychiatry (Mental Health) Medical Paediatrics Cardiology Diabetes Psychiatry of Old Age Respiratory Medicine General Surgery Rheumatology Clinical Oncology Endocrinology Gynaecology Child Psychiatry Oral - MaxFac General Medicine Endocrinology & Diabetes Geriatric medicine Nephrology Learning Disability Haematology Podiatry Rehabilitation Medicine Clinical Psychology Anaesthetics Adolescent Psychiatry Orthoptists Total 1,477 2, ,294 5,740 Note: Patients are given a ticket for their return appointment with a target date. The appointment itself should be in a window within a tolerance of 5% before the target date (the earliest date) and 15% after the target date (the latest date). The term before latest date is a reference to the latest date of the window as previously described. 0-6 weeks and beyond refer to those waiting in excess of the latest date of the tolerance window. Page 22 of 22

97 97 DUMFRIES and GALLOWAY NHS BOARD Agenda Item December BOARD BRIEFING Author: Rachel Hinchliffe, Communications Assistant Sponsoring Director: Jeff Ace, Chief Executive Date: 17 November RECOMMENDATION The Board is asked to Note the briefing. SUMMARY CONTENTS Putting You First Time Banking Update Bringing Communities Together Engaging and Involving Communities Physiological Measurement Training for Residential Care Home carers Digital Health and Care week Virtual Conference Programme Update Community Senior Charge Nurses Maternity services success with What IF? Funding Quality Improvement Huddle Relationship Centred Care The Hungry Mannequin Shining Example NHSScotland Pension Scheme is changing Improvement Cafe Dyslexia Awareness Week 3 9 November Fraud Awareness Week November Pancreatic Awareness Month November Children in Need Annual Staff Carol Service Charity Choir of the Year Report Records Improvement in Dental Health of Local School Children Social Media Update Achievements New Appointments Loyalty Awards in September & October

98 98 REGULAR FEATURES Retirals New from the Scottish Executive including HDLs Freedom of Information Current Consultations Chief Executive s Diary Chairman s Diary Key Messages: Annual Staff Carol Service 16 December, 7pm at Crichton Church GLOSSARY OF TERMS

99 99 MONITORING FORM Policy / Strategy Staffing Implications Financial Implications Consultation / Consideration Risk Assessment Sustainability None None None None. However, Briefing is populated with items of interest provided by any member of staff. Not applicable. Not applicable. Compliance with Corporate Objectives Corporate Objective 4 Single Outcome Agreement (SOA) Best Value Not applicable. Not applicable. Impact Assessment Not applicable.

100 100 Putting You First Time Banking Update Bringing Communities Together Time Banking was formally launched at event held at the Cairndale Hotel in Dumfries on the 26 th October. Time banking aims to tackle social problems by helping people to share skills and resources and be rewarded in time credits. People can use these credits when they need help or they can donate them to another person. Time banking runs in over 40 countries world-wide. It is now taking off in Dumfries and Galloway with 8 active groups across the region, over 130 members and 1800 hours of time already shared. The project is helping to build stronger communities and generating higher levels of community resilience. It crosses generations bringing back the value of caring and sharing within neighbourhoods. The project is also working with existing Third Sector organisations such as the Stroke Support Group in Lockerbie, Kate s Kitchen which provides hot meals for vulnerable people in Annan, the Hard of Hearing group, the Catstrand and Connecting in Retirement project, Dalbeattie Community Initiative and has led to job creation with Action for Children in Upper Nithsdale Third Sector Dumfries and Galloway held an event in Stranraer on October 3rd to provide further information to the community in Wigtownshire. Engaging and Involving Communities Actively engaging and involving people in identifying what enables them to keep and live well and to feel they are in control so that they can live life to the full is absolutely essential and is key to the work taken forward in Annan by the Health Improvement Team. This work has been enhanced by the Community Link Worker role which supports people to access services and activities to promote good health, independent living and peace of mind. For further information on the work of the Community Link Worker, please see The learning from this is supporting Annandale and Eskdale to develop the vision to support the work going forward through integration of Health & Social Care. To read more on this work over the past three years, please read blog by Elaine Lamont, Annandale & Eskdale Health Care Practitioner: Physiological Measurement Training for Residential Care Home carers PYF are supporting a test of change in the form of a structured competency based training course for senior staff in Annan residential care homes during November. The training aims to support a sustainable model of Step

101 101 Up/Step Down care. The two day course, which is mapped to Level 2 & Level 3 SVQ units, will be delivered by the Care Training Consortium. Carers are offered the opportunity to be trained to undertake physiological measurements of vital signs i.e. blood pressure, pulse, temperature, respiratory rate, blood sugars, urinalysis and saturation levels. In addition, the workforce will be trained to manage some common conditions in their service users, such as COPD, heart disease/heart failure, diabetes, urinary tract infections, stroke and pressure area care. Digital Health and Care week Virtual Conference Putting You First is hosting another Virtual Conference designed to keep staff and members of the public up to date with the latest tests of change in applying digital technology to health, care and support services in Dumfries and Galloway. The Virtual conference was available on-line for Digital Health and Care week, 3rd - 7th November. This can be viewed on: gital_health_and_care_week_ Programme Update As the Putting You First change programme enters its final few months, the PYF Team is focussing on the evaluation of the individual tests of change and taking the learning from the programme as a whole and considering how we might build on the work and effort of the last four years as we move forward toward integrating health and social care. Public Health Directorate achieve LGBT Charter Gold Interim Director of Public Health, Michele McCoy was presented with the Gold LGBT Charter Mark Award in October. She received the award on behalf of the Public Health team from LGBT Youth Scotland Chief Executive Fergus McMillan. The LGBT Charter of rights was created following a project run by young people from the Phoenix LGBT Youth Group in Dumfries. This group explored a range of topics including education, social and health issues and concluded that LGBT people were often denied their rights due to prejudice and discrimination. Community Senior Charge Nurses At a time when across Scotland a second phase Impact Evaluation is under way on Leading Better Care, we are delighted to be able to share the exciting news that the Senior Charge Nurse role will be implemented within Community Nursing in NHS Dumfries and Galloway. This is a significant change within the Board area, as this post has not been utilised into Community Workforce Planning since Agenda For Change. This means that we will be appointing SCN s within our teams who will, as directed by Leading Better Care, and as per our Hospital SCN s be working in the context of the LBC components: - To ensure safe and effective clinical practice - To enhance the patients experience - To manage and develop the performance of the team - To ensure effective contribution to the delivery of the organisations objectives

102 102 Ensuring that the nursing care provided by their teams is: - Safe - Effective - Person centred I am sure you will all welcome and support these Senior Charge Nurses as they are appointed into the Localities of NHS Dumfries and Galloway. Maternity services success with What IF? Funding. Maternity services received funding from What IF? at the end of 2011 to help them work towards an increase in spontaneous vaginal births and a decrease in caesarean section rates. The aim was to increase spontaneous birth and decrease caesarean section rates by 3% over a three year period. Consultant Midwife Karen King who drew up the proposal felt the aim would be challenging but achievable. However when the practicalities kicked in the goal started to seem less achievable! Just getting started took some time due to processes for appointing the Midwife Facilitator, but once Viv Watson was in post the whole project gained momentum. Midwives were trained in aromatherapy massage others attended a 2 day workshop on the promotion of normal birth facilitated by Professor Denis Walsh. Viv raised awareness with the multi-disciplinary team and motivation and enthusiasm was heightened. Viv undertook work with service users utilising social marketing principles and the MPower campaign was born. Every woman over a one year period would receive an MPower bag of labour and birth information and goodies. As the project developed and following feedback from women the emphasis became much more about positive birth experiences rather than outcomes. It is about women having the best experience they can to make their birth memorable for all the right reasons. So did we achieve our goal? Well yes and no! We are pleased and proud to report our figures for 2013/14 of 70% spontaneous vaginal birth rate an increase of 3% in two years. This is by far the highest rate in Scotland with the average being 58.7%. This is a rate not seen in Scotland for 17years or 14 years in Dumfries and Galloway. But what about our caesarean section rate well we have achieved a decrease of 1.1% in two years so we still have another year to achieve our goal. Our rate for 2013/14 was 22.9% the lowest in Scotland and well below the Scottish average of 28.5%. As the cost per case difference is estimated at around 952 this achieves the What IF? aims of reducing costs. However far more important for us is that less women are having unnecessary interventions/surgery and outcomes are improved. Quality Improvement Huddle

103 103 The Quality Improvement Huddle is a new group, which was formed in January. The aim is for all the group members (Infection Control, Practice Education Facilitators, Care Home Education Facilitators, Clinical Educators, Mental Health Improvement Advisor, Dementia Consultant Nurse, Scottish Patient Safety Improvement Advisors, Clinical Education Lead, Leading Better Care / Releasing Time to Care Facilitator (LBC /RTC) and LBC/ RTC Coordinator) to link with each other and discuss the quality improvement work that they are involved in and which areas are participating in the said work. It also provides a venue where all the staff can support each other with any particular issues they may be experiencing and seek advice. The group also provides a forum where the group discusses where projects interlink and therefore can arrange to have joint meetings with the SCN s, therefore reducing the number of meeting the SCN needs to have. Relationship Centred Care Collecting patient, relative and staff experience is an important aspect to reviewing care and quality within our Health Board. This is currently captured by either using the Positive Inquiry tool or the creative Emotional Touch Point tool. The Emotional Touch Point tool enables staff within wards and departments to capture in depth knowledge in a non confrontational way, it has also been seen as being cathartic for the participant who is explaining their experience, as commented on by one participant whose experience was not positive. Once the participant has confirmed their story, which has been typed up, as a true reflection and confirm they consent to their story being used for learning, the staff can then share the story with other staff / multidisciplinary teams, enabling them to review what has worked well and what they can improve upon. The Hungry Mannequin The Clinical Education Team have taken receipt of a Hungry Manikin, due to the generosity of the League of Friends, it cost 699. It is a see through torso which shows the lungs and stomach and will benefit patients by allowing staff to practice techniques in passing nasogastric tubes and giving drugs to patients who are unable to swallow, this will increase nurses confidence and ability to ensure that patients are given the best care possible. A Shining Example As part of the Scottish Patient Safety Programme, a survey was recently carried out at Midpark, to establish how safe patients felt in the wards. Included in the positive feedback, was the important role that the Domestic Services Staff provide in the wards. Your NHSScotland Pension Scheme is changing On 1 April 2015, a new NHSScotland Pension Scheme (known as the 2015 Scheme) will be introduced. From this date, the current Scheme will be closed to new members. Existing members will be affected in one of the following ways: If you are a member who was within 10 years of your normal pension age on 1 April 2012, you will have your current pension provisions protected and will not have to move to the new Scheme.

104 104 If you are a member who was between 10 years and 13 years 5 months from your normal pension age as at 1 April 2012, you will have what is known as tapered protection. This means the date you have to move to the new Scheme will be after 1 April The closer you were to your normal retirement age on 1 April 2012, the longer you can stay in your current pension Scheme before having to move to the 2015 Scheme. All other NHSScotland Pension Scheme members will move to the new Pension Scheme on 1 April Although the changes set out above will be automatic, some NHSScotland Pension Scheme members will be able to make further choices about aspects of their pension benefits, after the introduction of the 2015 Scheme. Different choices may suit different members better, depending on their particular situation and how they see their career progressing. If you are affected, we will contact you nearer the time and provide you with information to help you make your choice. Further information on these forthcoming changes is available on the Scottish Public Pensions Agency (SPPA) website: Improvement Cafe The Patient Safety and Improvement Team held a drop in Improvement Cafe at DGRI throughout November. Dyslexia Awareness Week 3 9 November Staff Nurse Emma Groves encouraged people in Dumfries and Galloway to wear a blue ribbon to show their support for UK Dyslexia Awareness Week. An information stand was set up in the foyer at Dumfries and Galloway Royal Infirmary (DGRI) with lots of information on the condition, the affect is has on the people living with it and what employers can do to help support them. Fraud Awareness Week November Detected fraud cost NHS Scotland 2.91m over the last five years, although the true figure, including undetected frauds, will be much higher. Fraud Awareness Week organised by Chief Internal Auditor Julie Watters. The week got off to a good start when the head of NHS Scotland s Counter Fraud Unit, Gordon Young, attended a meeting with Directors and senior managers to discuss strategies for tackling fraud in our area. Pancreatic Awareness Month November November was Pancreatic Cancer awareness month. Pancreatic Cancer UK is raising their profile through their "Purple lights for hope" and "Host for hope" events across the country. The Purple Lights for Hope is aimed at lighting up prominent landmarks/buildings/venues or even your back garden in purple lighting for the whole of November. DGRI Cancer Services hosted a Host for Hope event through a baking sale at D&GRI and an afternoon tea in the Cancer Information & Support Centre where for patients and families with all proceeds going to Pancreatic Cancer UK.

105 105 Children in Need Ward 15 held their annual fund-raiser for Children in Need, selling cakes, bric-a-brac, tombola etc as well as dressing up and encouraging colleagues to support the cause. Annual Staff Carol Service The annual staff carol service is taking place on Tuesday 16th December at 7pm, Crichton Church. Charity Choir of the Year A group of NHS staff sang for votes in the Charity Choir of the Year event which was held at Easterbrook Hall on the 21 and 22 November. Money raised was divided amongst the nominated charities. Report Records Improvement in Dental Health of Local School Children The National Dental Inspection (NDIP) report was released on the Tuesday 28 October. The report details the oral health of children in primary one (P1) in Scotland. The NDIP programme is carried out on annual basis by NHS Boards across Scotland. The Dumfries and Galloway figures for the school year 2013/14 show that 66.2% of P1 children have no obvious tooth decay experience. This figure represents an improvement of 4.1% on the figure from 2012 and continues the steady improvements seen in the region since 1996 when the figure was 33%. Social Media Update To date the Twitter account has 3,056 followers, have posted or re-tweeted 3,509 tweets relating to our own news, awareness events or retweeting other organisations health message and follow 283. There are 934 people liking our Facebook page Achievements Congratulations to Kirsty Bell, Project Management Officer on passing The APM Project Management Qualification Examination. Congratulations to Helen Coles, Respiratory Nurse Specialist has successfully completed an MSc and graduated in November. Congratulations to Laura White who has successfully completed an MSc Critical Care. At the Annual Institute of Healthcare Managers Awards held in Glasgow in October, Nicole Hamlet was awarded the accolade of Manager of the Year in NHS Scotland. Nicole is our General Manager of Acute and Diagnostic Services and reports to Julie White, Chief Operating Officer. It is the first time that a manager of NHS Dumfries and Galloway has won this prestigious award and reflects her outstanding leadership of acute services over the past very challenging year.

106 106 New Appointments Consultant Dr Stanford Mathe has been appointed in Pathology and is due to start in January 2015 Consultant Dr Aida Isabel Molero Bermejo has been appointed in Pathology following a period of being a locum effective 27/10/14 Appointments in IT include: Nigel Gammage, IT Delivery Manager Sharon Lynch, Office Manager/PA to Graham Gault, Head of IM&T Sharon Thomas, IT Facilitator - Permanent Post Loyalty Awards in September & October Helen Kearney Hospital at Night ANP DGRI 23/01/1989 Morag Irving Staff Nurse Day Surgery, DGRI 02/05/1988 Isabel Irving Domestic Supervisor Newton Stewart 22/08/1989 Hospital Nancy Craik Sewing/Linen Room DGRI 27/06/1989 Assistant Rose Marie Dietitian DGRI 02/10/1989 Roberts Deborah Stevenson Audit & Surveillance Officer Infection Control 27/11/1989 Retirements Dr Joshi Consultant ENT Surgeon at DGRI retired in November after more than 20 years of service Adam Scott, Transport Manager based at the Crichton retired in November after 20 years of service Hazel Dykes Associate Director AHPs/Patient Experience Lead, retired in October after more than 30 years of service Sammy Little will be retiring from his post as Engineer in the Maintenance Department in January 2015, after 35 years service working at Crichton, Nithbank and DGRI.

107 107 New from Scottish Executive Health Department SGHD/CMO25: GUIDANCE FOR NHS SCOTLAND STAFF WANTING TO VOLUNTEER TO SUPPORT THE EBOLA VIRUS DISEASE (EVD) RESPONSE IN WEST AFRICA: To provide guidance for NHS Scotland staff who may interested in volunteering to support the Ebola Virus Disease (EVD) response in West Africa. SGHD/CMO22: Triple - lymphoedema : Boards were asked to identify a key individual who would be responsible for leading on the SMASAC report s recommendations within their area. PCA (P)19: PHARMACEUTICAL SERVICES AMENDMENTS TO DRUG TARIFF IN RESPECT OF REMUNERATION ARRANGEMENTS FROM 1 OCTOBER : This Circular advises of changes in the Drug Tariff to remuneration arrangements with effect from October dispensings consistent with the Global Sum set for community pharmacy remuneration. PCA (P)20: PHARMACEUTICAL SERVICES AMENDMENT TO DRUG TARIFF DISCOUNT CLAW BACK RATE PT 7 GENERIC DRUGS: This Circular advises of arrangements in the Scottish Drug Tariff with respect to the discount clawback rate in respect of reimbursement for items listed at Pt 7 for dispensings from 1 September onwards for non ZD items. PCA(P)21: Pharmaceutical Services: Amendment to Pt 11: Discount Clawback Scale for Proprietary Drugs: This Circular advises of an amendment to the Drug Tariff Part 11 concerning the discount clawback rate to apply in respect of reimbursement of proprietary drugs to community pharmacy contractors taking effect for dispensings from 1 September. CEL 19: MENTAL WELFARE COMMISSION REPORT: SPECIFIED PERSON MONITORING: The purpose of this letter is to draw to Health Boards attention the recently published report by the Mental Welfare Commission on Specified Person monitoring. PCA(D)10: PRACTICE PREMISES REVALUATION EXERCISE /15: This letter advises NHS Boards and Practitioner Services of an exercise to update valuations of GDP practice premises for the purposes of reimbursement of practice rental costs under Determination XV of the Statement of Dental Remuneration. CMO 26: EBOLA OUTBREAK IN WEST AFRICA: Update on the current outbreak of Ebola virus disease (EVD) in West Africa, and to remind you of the need to remain vigilant for cases imported to Scotland. The recently imported case in the USA has emphasised the importance of taking a full travel history when assessing relevant patients and ensuring that this information is subsequently acted on as part of any EVD clinical assessment. PCS(AFC)2: REIMBURSEMENT OF EMPLOYEE NHS BUSINESS TRAVEL

108 108 COSTS CHANGE OF RATES FROM 1 JULY : PCS(AFC)2013/3 put in place a new system for reimbursing Agenda for Change staff for travel costs incurred in the course of their work. This was based on a UK Staff Council agreement. PCA(P) 23: Additional Pharmaceutical Services Public Health Service Directions : This Circular advises of revisions to Directions in respect of the Smoking Cessation Service available through Community Pharmacy following recent revisions to the Service Specification and issue of the varenicline Patient Group Direction (PGD). PCS(AFC)3: TEXTUAL CHANGES TO AGENDA FOR CHANGE HANDBOOK: This circular informs NHSScotland of various textual changes to the NHS Terms and Conditions Handbook which have been agreed by the NHS UK Staff Council. PCA(P) 24: PHARMACEUTICAL SERVICES AMENDMENTS TO DRUG TARIFF IN RESPECT OF ADVANCE PAYMENT ARRANGEMENTS FROM 1 DECEMBER : This Circular advises of changes in the Drug Tariff to advance payment arrangements with effect from advance payments for December dispensings paid January 2015 with final November payments. PCA(P) 25: Community Pharmacy Contract: Infrastructure support - Staff Training: This circular provides NHS Boards and community pharmacy contractors with details of the financial support being made available for staff training for the financial year -15. PCA(P)26: PHARMACIST ASSISTANT TRAINING GRANT FUNDING: This Circular provides NHS Boards and community pharmacy contractors with details of the financial support being made available for Pharmacist Assistant training for the financial year /15.

109 109 Freedom of Information 1 September 31 October A total of 96 requests were received in this reporting period September (36) and October (60). October saw the highest number of requests recorded. There have been three breaches of the 20 working day timescales. Ref Received Record name /09/14 Andrew Hermiston Status Description Closed Other The date when Ms Alice Wilson Depute Nurse Director was commissioned to undertake an external peer review on behalf of NHS Tayside. - The time in working hours Ms Wilson spent on the review. - The date the review was completed /09/14 Dina Lary Business Within your organisation how many patients are currently [in the last 12 months] being treated for Parkinson s Disease? What type of service does your trust run for Parkinson s Disease? If you operate a service; How many Parkinson s Disease Specialist Nurses are based at your trust? How many Neurologists or other physicians who initiates/changes treatment are there? How many patients are being treated for Parkinson s Disease with the following treatments in the last 12 months: Levodopa (co-beneldopa or co-careldopa) Pramipexole (Mirapexin) lkh Ropinirole (ReQuip) Rotigotine (Neupro) Apomorphine (APO-go) Pen and Infusion Levels Duodopa [carbidopa/levodopa] intestinal gel Deep Brain Stimulation Amantadine Hydrochloride Pergolide Mesilate Tolcapone Selegiline Hydrochloride Cabergoline Entacapone Pramipexole (Generic) Rasagiline Mesilate Any other drugs used in treatment of Parkinson s Does your trust carry out response tests for apomorphine, if so how many in the last 12 months? /09/14 Jacqualine Cooksey Business Does your organisation treat the following conditions, and if they are treated, how many have been treated in the last 4 months? Patients Wet Age Related Macular Degeneration (wamd) Visual impairment due to Diabetic Macular Oedema (DMO) Retinal Vein Occlusion - Central or Branch (CRVO or BRVO) Visual impairment due to choroidal neovascularization (CNV) secondary to pathologic myopia (mcnv) /09/14 John West Political 1. Records of how many prescriptions for Desiccated Thyroid Hormone have been transacted in your board area 2. To which GP practices 3. Which GPs within the practices /09/14 Gemma Hartley Media 1) The total number of clinical Never Event that have occurred within the last three years, broken down into yearly figures. 2) The number of never events which correspond to each of the following categories over the last three years, broken down into yearly figures a) Surgery performed on the wrong body part b) Surgery performed 24/09/14 30/09/14 09/10/14 24/09/14 24/09/14

110 110 on the wrong patient c) Wrong procedure performed on the patient d) Unintended retention of a foreign object after surgery or a procedure /09/14 Victoria Allen Media This is a Freedom of Information request regarding people who have been given tests over fears they may have contracted HIV or hepatitis, or any other blood-borne infection, while in hospital. Can you tell me how many patients have had to be tested in the last ten years for this reason. In each case, can you tell me which disease the patient was tested for and how they were feared to have contracted it. If possible, although I am aware this may be confidential, can you please tell me how many tests were positive and how many negative. Can you also tell me how much was paid out in compensation in these cases. 30/09/ /09/14 Victoria Allen Media 1.Can you tell me please how many patients aged over 65 were sent home from hospital between 9pm and 9am in and can I have separate figures for , and How many of these, for each year separately, were aged over For each year, can you give me a breakdown of those discharged between these hours who were sent home, to a care home, to another hospital and to any other destination (please specify). 4.For each year, can I please have a breakdown of how many over-65s sent home between 9pm and 9am were sent home by ambulance, how many were sent by taxi, how many were picked up by relatives and how many travelled by public transport. 30/09/ /09/14 Victoria Allen Media 1.Can you tell me please how many oxygen masks were given to obese people in the health board area in each of the following years separately /14, 2012/13, 2011/12 and 2010/11. 2.Can you tell me how many were given in each of those years to children. 3.For each individual year, can you please tell me how much it cost to provide oxygen masks to obese adults - and separately to obese children. 30/09/ /09/14 Victoria Allen Media 1.Can you please tell me if this has been introduced in the health board area. 2.If so, how many crack pipes have been given out in total and to how many patients. 3.What is the cost of having provided this service. 4.If this has not happened, please provide a list of drugs paraphernalia or substitute drugs provided to addicts by the health board. 5.For each drug or item of drugs kit, please provide the number of people given each item in the last five years and the cost of providing each individual item. 30/09/ /09/14 Victoria Allen Media 1.For each hospital in the health board area, can you please provide a list of food outlets which are in the hospital grounds. 2.Are there any serving fast food, eg pies, pizza or burgers? If so, can you please specify which outlets. 3.For each outlet serving fast food, can you please provide a list of the fast food available and the estimated calorie content of each. 4.For the three most calorific, please provide a full description 30/09/14

111 /09/14 Helen Raine /09/14 Victoria Allen /09/14 George Watson /09/14 Jennifer Salisbury- Jones /09/14 Rachel Watson Other Media of the ingredients, appearance and make-up of the food. 1.Are you paying a local Recruitment / Retention premium to any Estates / Facilities staff? 2.If so, what are the job titles of the roles receiving the premium? This is a Freedom of Information request on the cost of locum and agency staff. 1.Can you please provide the cost of locum doctors separately for each of the following years 2013/14, 2012/13, 2011/12 and 2010/11. 2.Can I have the same figure for each year for agency nursing staff and separately for bank doctors and bank nurses. 3.If the cost for any of these groups of staff has increased over any of those years, can you please explain why for example because of problems covering out of hours services or problems filling vacancies. 30/09/14 06/10/14 Other Data breaches 16/09/14 Other Media I am writing to obtain information about the number of your employees who received remuneration of more than 100,000 in Remuneration includes, but is not limited to: salary, fees, allowances, bonuses, benefits in kind, compensation for loss of office and employers pension contributions. Please not that whilst some of the information may be in the public domain in accounts and on your website, the information requested is not fully available from your annual reports, websites etc. Many public sector organisations publish senior management salaries online or a produce a table showing employees in remuneration bands of 5,000 in their annual accounts. It is not possible to answer the questions below with that information alone. Employer pension contributions are excluded from these bands and there can be employees who are not senior managers who received more than 100,000. Please make it clear if you are responding on behalf of more than one organisation. To outline my query as clearly as possible, I am requesting: The total number of employees who received remuneration equal to, or in excess of 100,000 in For those who received remuneration in excess of 150,000: i. The employee s name ii. The employee s job title iii. The remuneration received by the employee iv. An itemised list of expenses claims made by the employee. If an itemised list is not available, please provide the amount the employee claimed in expenses in Please provide a list and details of all bariatric items and equipment which have been bought by the health board in the last five years for use on maternity wards.-could you also provide the cost of each item. Please breakdown this information by year and if possible hospital. 08/10/14 15/10/14

112 /09/14 Rachel Watson /09/14 Victoria Allen /09/14 Judith Addleston /09/14 Diana Pilkington /09/14 Rachel Hinds Media Media Please provide a list of the number of mothers on maternity wards who have been classed as obese for the last five years. Please breakdown this information down by year and ward. 1.Can you tell me please, for each hospital in the health board area, how many complaints about hospital food there were from patients or their relatives in each of the following years separately /14, 2012/13, 2011/12, 2010/11, 2009/10 and 2008/09. 2.For each year can you please break down the complaints into types, eg food temperature, appearance, nutrition and taste. 3.Has compensation been paid out to any patients over food in the last five years? If so please give details of how much each patient was paid and the details of the complaint. 4.Have any foods been taken off hospital menus following patient complaints? If so which foods/dishes and why? Other 1. How many of your existing patients have been prescribed the following in i and ii.? a. Anoro b. Relvar c. Symbicort d. Seretide 2. How many of your new patients since April have been prescribed the following (please also provide total number of new asthma and COPD patients since that time): a. Anoro b. Relvar c. Symbicort d. Seretide 3. Have you begun prescribing Relvar and/or Anoro for your patients? If so, what were the reasons for adding it to your formulary? If not, why not? 4. Please can you provide your prescribing guidelines for COPD and asthma including cost comparator information for inhaler device options. 5. Please can you provide any feedback on the following drugs from your specialist respiratory consultants. a. Anoro b. Relvar c. Symbicort d. Seretide Other How many incidents of theft have there been from patients at the trust in the last three financial years? Could I have the figures broken down by per year and per each hospital in the trust? Can you break them down to show how many were inpatients and how many were outpatients? Where possible could you please list the items that were reported stolen and the value of the items? How many times during this time frame have you had to call in the police to investigate a theft? Political I would be obliged if you could treat each one as a separate request. Minutes, agendas and papers for meetings of the NHS Chief Executives and Scottish Government Ministers/Officials/Special Advisers for the last year ie 1 September 2013 to 1 September Any and all information relating to the leaked paper entitled Chief Executive Meeting 6 August Single Narrative Paper revised. This could include: Minutes, agenda, drafts, records of phone calls Previous revisions to or versions of the paper Original versions of the feedback which informed the revisions Feedback prior to the 6 August draft paper from professional groups consulted Director of Finance perspective paper Minutes of the 31 July meeting of Human 14/10/14 08/10/14 14/10/14 14/10/14 16/10/14

113 113 Resource Directors Actions taken as a result of the leak of the paper Actions undertaken from the Priority Actions list on the final page /09/14 Helen Puttick Media For the months of July and August 2012, 2013 and please can you tell me the following, broken down by year and month: The number of patients recorded as a delayed discharge (excluding code 9s and delays of 3 days or less). The number of patients whose discharge was delayed by more than six weeks, more than four weeks and more than two weeks (excluding code 9s). For the months of July and August, please can you tell me: The highest bed occupancy rate (percentage of beds occupied) recorded for your acute hospitals for the months of July and August in, broken down by month and by hospital. If possible please give the date and time when the percentage was taken. The average bed occupancy rate (percentage of beds occupied) recorded for your acute hospitals for the months of July and August in, broken down by month and by hospital. The number of patients recorded as a delayed discharge (excluding code 9s and delays of 3 days or less broken down by reason for delay using ISD code categories. 16/10/ /09/14 Helen Puttick Media For the months of July and August, please can you tell me the following broken down by month: The number of medical patients recorded as boarding (being placed in) a non-medical bed. (A figure that reflects the total number of patients who experienced boarding during their hospital stay.) The maximum number of medical patients recorded as boarding (being placed in) a non-medical bed, and the time and date that number was recorded. The number of admitted patients who were transferred to a different ward or hospital between the hours of 10pm and 7am excluding those moved because of a change in their condition. The number and percentage of patients who spent more than four, eight and 12 hours in accident and emergency departments, as collected for the four hour A&E waiting times target. In addition: The number of medical patients recorded as boarding in a non-medical bed on Monday August 25 at noon. (or the nearest available time.) 14/10/ /09/14 Damian Holland Other The estimated total annual spend on electrical materials for estates and facilities. E.g Lamps, HVAC, cable, batteries etc Provide the top 10 lines used for example lamps, cable, batteries etc Detail any potential energy efficiency project you are considering if possible and any carbon reduction target you have Detail any major new electrical work you are considering including new building projects. 16/10/ /09/14 Kate Foster Media All minutes and associated papers from your health board's Sexual Health Strategy Implementation Group/Sexual Health Strategic Programme Board/Sexual Health Team or other committee/group concerned with Sexual Health. Please supply 14/10/14

114 114 documents from 30/10/13 to present /09/14 Christine Lowe Organisation Name and Address of Audiology Department Have you started to develop a local implementation plan for See Hear: A strategic framework for meeting the needs of people with a sensory impairment in Scotland? Yes / No Has the budget for your audiology service been reduced in the last 2 years? (This includes if your budget has not risen with inflation) Yes/ No If yes, what has been the impact of these budget reductions? Reduced follow up appointments / Reduced aftercare service / Reduced length of appointments / Reduced information provision / Increased time to reassessment / Change to policy on bilateral hearing aids / Increased waiting times / Reduced availability of domiciliary visits / Reduced number or qualification level of specialist staff for complex cases / Reduced overall number of staff / Reduced average qualification level of professional staff/ Reduced tinnitus services / Other (please specify) Have you noticed any of the following changes over the last 2 years for a reason other than budget reductions? Reduced follow up appointments / Reduced aftercare service / Reduced length of appointments / Reduced information provision / Increased time to reassessment / Change to policy on bilateral hearing aids / Increased waiting times / Reduced availability of domiciliary visits / Reduced number or qualification level of specialist staff for complex cases / Reduced overall number of staff / Reduced average qualification level of professional staff/ Reduced tinnitus services / Other (please specify) If you have noticed any of the above, what was the reason for these changes? Increased demand / Other (please specify) Are you aware of any budget reductions planned for the next 12 months? Yes/ No / Not sure Audiology Waiting Times The national target in Scotland is 18 weeks for Referral to Treatment. Using your latest recorded figures please state the percentage (%) of patients that were seen within the national target waiting time and the time period to which this figure refers. Bilateral hearing aid provision What is your policy on bilateral hearing aid provision? Where clinically appropriate we always offer two hearing aids / We offer one hearing aid in the first instance unless someone specifically requests two hearing aids / We only offer one hearing aid per patient. Comments (optional) Individual Management Plans Do you develop an Individual Management Plan with patients? Yes with all patients / Yes with some patients / No we develop Individual Management Plans but do not involve the patient in the process / No we do not develop Individual Management Plans. Comments (optional) If yes, do you measure the outcomes of the Individual Management Plan? Yes always / Yes sometimes / Never. If yes, please describe how you measure outcomes Followup appointments What followup arrangements do you generally offer for patients fitted with hearing aids? Facetoface followup appointments / Telephone 30/09/14

115 115 followup appointments / Followup by post For each of the above, please state if they are offered to all patients, a particular group of patients, patients who request it, or not offered. Aftercare In which settings do you offer a hearing aid repairs and replacement service? At a hospital dropin clinics / At a hospital by appointment only/ At local health centres / GP surgeries dropin clinics/ At local health centres/ GP surgeries by appointment only/ At a nonhealthcare setting in the community (e.g. libraries) dropin clinics / At a nonhealthcare setting in the community (e.g. libraries) by appointment only / In care homes dropin clinics / In care homes by appointment only / At a person's home / By post / Via third sector volunteers / We do not offer a hearing aid repairs and replacement service Reassessment Do you offer a reassessment of patients hearing needs: Automatically after a certain number of years / On patient request If you offer an automatic reassessment, after how many years does this take place for noncomplex patients? Hearing therapy Do you offer hearing therapy: For everyone with hearing loss/ For patients with severe/profound hearing loss / For patients with complex needs / For patients with tinnitus / Not offered Signposting and referrals Do you provide patients with information about and / or formal referral to: Hearing aid repairs and replacements service / Communication training / Lipreading classes / Hearing therapy / Counselling / Local authority / council sensory services / Equipment and products that can help people with hearing loss / Benefits that people with hearing loss may be able to apply for / Voluntary organisations that help people with hearing loss / Peer support groups Tinnitus Services Are tinnitus patients seen by: A specially trained audiologist / An audiologist / A hearing therapist / We do not provide a service for tinnitus patients in house but refer patients to another tinnitus service / We do not provide a service or referrals for tinnitus patients Which of the following services are patients with tinnitus offered, where clinically appropriate? Tinnitus retraining therapy / Specialist tinnitus support / Cognitive behavioural therapy (CBT) / Information about products and other services / We don t routinely offer tinnitus services /09/14 Sam Walker Media How much was taken in parking charges in hospital car parks over the last three years, from March 31, 2012, to April 1,. Could any additional penalty charges also be included. I would also like to know how much was spent by the trust chasing unpaid penalties. Could that figure be broken down into years, individual hospitals and a separate figure for addition penalty charges? 16/10/ /09/14 Grace Malonga Other Currently conducting a market research on the emergency and urgent services and would be grateful if you could provide me with the following information please: 1. How many vacancies do you currently have within the emergency department (A&E) for all grades of doctors? 2. What are those positions? 3. How many vacancies do you 14/10/14

116 116 expect to have available a year from now (all grades of doctors)? 4. What positions do you have most difficulty filling? According to House of Commons Health Committee report issued in regards to the urgent and emergency services (second report of session 2013-) A minimum of 10 consultants are required in order to deliver a 16 hour presence during working week in the emergency department 5. Is the trust currently meeting this minimum requirement? 6. How many locums do you currently have working within the emergency department (A&E)? 7. Do you often hire from outside sources? 8. Would you be willing to try a new recruiter? 9. What percentage do you pay? /09/14 Claire Miller Media Under the Freedom of Information Act, please could you provide me with copies of questionnaires and results, including response rates, from any staff surveys that the health board has carried out since /09/ /09/14 Kieron Higgins Political The number contracts won by Bupa to provide services to, or on behalf of, your organisation. The value of those contracts individually. What services were provided by these contracts. Between 1 September 2012 and present (25th September ). 15/10/ /09/14 Elaine Robison Other Could you provide me with NHS Dumfries and Galloway Health Board Reports and Minutes of the Meeting held in 2013/14 29/09/ /09/14 Elaine Robison Other I am requesting information regarding how many Doctors have been employed at the Galloway Community Hospital in the Past 6 years, I would also like to know how many have left in the past 6 years. Full time, Part Time and Locums. 28/10/ /09/14 Steven Donlon Other 1) Do you automatically follow advice from the Scottish Medicines Consortium and include approved medicines on formulary. 2) Please can you provide the joint formulary positions of the following drugs used in the treatment of pain according to their status as: suitable for primary care; suitable for secondary care initiation with follow up prescribing by a GP without a shared care agreement; suitable for secondary care initiation with follow up prescribing by a GP under a shared care agreement; suitable for secondary care prescribing only; not recommended/nonformulary. a. Palexia tablets b. Palexia oral solution c. Palexia SR d. Targinact e. Longtec f. Lynlor g. Oxycontin h. OxyNorm i. OxyNorm Liquid j. OxyNorm Conc k. Reltebon l. Durogesic Dtrans m. Fencino n. Matrifen o. Opiodur p. Morphgesic SR q. MST Continus r. MXL s. Oramorph t. Sevredol u. Zomorph v. Recivit w. Abstral x. Actiq y. Breakyl z. Effentora aa. Instanyl bb. Pecfent cc. Tramacet dd. Tramal Oral Drops ee. Tramal Suppository ff. Zydol Capsules gg. Zydol Injection hh. Zydol SR ii. Zydol XL jj. Transtec kk. Versatis ll. Lyrica mm. Neurontin nn. Duloxetine oo. Capsaicin 8% patch pp. Capsaicin cream qq. Arcoxia rr. Celebrex 3) Do you plan 21/10/14

117 117 on reviewing your formulary for pain medication in the next 12 months? 4) How do you review and implement SIGN guidance and updates on medicines? 5) What Hospital Trusts are covered by your Health Board? 6) Do you currently commission a pain management clinic? 7) Are you currently tendering, or plan to issue a tender in the near future, for a pain management service? 8) Please can you provide me with a link to your formulary? 9) Please can you provide me with a link to any additional pain medication prescribing guidelines that sit alongside the formulary? /09/14 Tom Owens Business Within your organisation how many patients have been treated with a botulinum toxin A drug in the past 6 months; split by the brand used (Botox, Dysport or Xeomin) for the following conditions; - Focal spasticity - Spasmodic torticollis (Cervical Dystonia) - Blepharospasm - Hemifacial spasm - Paediatric cerebral palsy spasticity - Chronic Migraine - Idiopathic overactive bladder If possible, please enter the information into this table; Condition Total Patients Botox Dysport Xeomin Focal spasticity Spasmodic torticollis Blepharospasm Hemifacial spasm Paediatric cerebral palsy spasticity Chronic Migraine Idiopathic overactive bladder 21/10/ /09/14 Rachel Watson Media How many times in the past three years the health board have had to call out exterminating services/pest prevention, and the reason for this (ie. type of rodent spotted - please name rodent or animal if applicable).-the cost of this. Please break all information down by year and hospital/area. 27/10/ /09/14 Greg Christison Media 1. In the past two years (October 1, 2012 September 30 ), on how many occasions has your health board employed the services of a locum doctor/consultant/other senior medical official who is based outwith Scotland? For each case, please provide details from every department of your health board and specifically provide details of: Dates the person in question was employed ; For how long they spent working for your health board ; How much the person in question was paid in wages ; How much the person in question received in expenses (including hotel, restaurant, car, taxis, flight bills) ; Where the person in question is normally based (IE, India, London, etc) ; The reason this person was brought in (IE illness cover, holiday cover) ; Their title (IE consultant) ; Where they were working during their time in Scotland (IE XX hospital) 2. In the past two years (October 1, 2012 September 30, ), on how many occasions has your health board paid relocation fees to members of your staff? I am defining relocation fees as additional payments given to employees on top of their regular salary in order to help them facilitate their move from one job in the NHS to another. Your response should include (but should not be limited to): any financial assistance given to staff to help them purchase or rent a property, legal fees paid directly to the employee or paid directly to lawyers acting on 29/10/14

118 118 behalf of the employee, or any additional payment offered to a potential new recruit in order to tempt them to take a job within your health board. In your response, please include: The member of staff s title (IE consultant, doctor) ; Where they were moving from ; Where they were moving to ; Position they were taking up within your health board ; Relocation fees paid by your health board ; Details of what the fees included (breakdown of figures) ; Reasons for the fees being paid ; Date the fees were paid (IE month) /10/14 Alexander Lerche Media Please provide me with: Details for the amount (cost) spent by your respective Board on translation services for patients between , and 2013-, or up to the most recent figures available. 27/10/ /10/14 Rachel Watson Media Please provide the number of people who have been treated for malnutrition in the past five years. Could this please be broken down by year, and also provide a breakdown by age - ie. Under 16 and Over 16 would be enough. -Please provide the number of people who have died from malnutrition in the past five years. Again could this be broken down by year and age. 22/10/ /10/14 Marc Ellison Media By financial year, since 2009/2010 to present, how much your board spent on regular (i.e. not locum staff) medical staff expenditure. Please break this down by hospital. By financial year, since 2009/2010 to present, how much your board spent on internal locum doctors. Please break this down by hospital. By financial year, since 2009/2010 to present, how much your board spent on agency locum doctors. Please break this down by hospital. By financial year, since 2009/2010 to present, give me a numbered breakdown (by hospital) of internal locum doctors used. This should include grade (i.e. specialist training, consultant etc) and specialty (i.e. radiology, psychiatric etc). So for example, in 2009/2010 hospital X, employed X consultants in radiology, Y consultants in pediatrics, and Z specialists in training in cardiology. By financial year, since 2009/2010 to present, give me a numbered breakdown (by hospital) of agency locum doctors used. This should include grade (i.e. specialist training, consultant etc) and specialty (i.e. radiology, psychiatric etc). So for example, in 2009/2010 hospital X, employed X consultants in radiology, Y consultants in pediatrics, and Z specialists in training in cardiology. By hospital and by financial year, since 2009/2010 to present, what was the minimum and maximum hourly rate paid to (a) internal locum staff, and (b) agency locum staff?by hospital and by financial year, since 2009/2010 to present, what was the highest paid shift by (a) internal locum staff, and (b) agency locum staff? This should include date of shift, shift length, and specialty. 31/10/14

119 /10/14 Euan McLelland /10/14 Euan McLelland /10/14 Victoria Allen /10/14 Victoria Allen Media Media Media A full, comprehensive list of every travel expense over the sum of 20 paid for by the health board to permanent, temporary or locum staff in each of the last five years. The data supplied should include the following: a) the person s role (e.g doctor/consultant/other), b) whether they were permanent, temporary or locum staff, c) where they travelled from and to, d) the form of transport used (e.g bus, train, taxi, plane), e) the date of travel (month and year), f) the total cost of the travel, and g) how many members of staff are currently employed in that person s role (i.e Travel expense paid was for a consultant. We currently have 10 consultants. ). A full, comprehensive list of every accommodation expense over the sum of 50 paid for by the health board to permanent, temporary or locum staff in each of the last five years. The data supplied should include the following: a) the person s role (e.g doctor/consultant/other), b) whether they were permanent, temporary or locum staff, c) the name and address of the accommodation in which they stayed, d) the dates they stayed in said accommodation (month and year), f) the total cost of the accommodation, and g) how many members of staff are currently employed in that person s role (i.e Travel expense paid was for a consultant. We currently have 10 consultants. ). 1. Can you please tell me the longest time a patient had to wait in A&E to be seen for each of the following years , , , and and tell me which hospital this happened in and the injury/affliction in this case. 2. For each year, please give the average waiting times from arrival to being seen in A&E. 3. For each year, please give the average waiting times from arrival to being treated in A&E. Media 1.can you tell me please how much the chief executive of the board earned in and how much the chief executive or previous chief executive earned in and Can you tell me the value of the chief executive s pension pot its value if sold on the open market to buy a lifetime annuity and how much that would pay out as a lump sum and in payments per year. 3.Can I have the same information please for the next two levels of senior managers within the trust. Can you provide their names, roles and wage and pension information too and the salary comparison with 10 years ago and five years ago /10/14 Jon Ryan Other Request 1) How many patients are referred to physiotherapy for musculoskeletal (MSK) conditions each year in your area? Request 2) What is the average waiting time to access MSK physiotherapy in your area? Request 3) Please confirm/deny that patients can access MSK physiotherapy through each of the following pathways: - By referring themselves directly to the physiotherapy service - By seeing a GP and 27/10/14 27/10/14 27/10/14 29/10/14 27/10/14

120 120 being given the details to book a physiotherapy appointment themselves - By seeing a GP who arranges the referral to the physiotherapy service. - Other If other - 3 (a) If you answered other to the question above (request 3), please provide details of how patients access MSK physiotherapy in your area. Request 4) Please confirm/deny that patients can access physiotherapy for their existing long-term condition through each of the following pathways: - By referring themselves directly to the physiotherapy service - By seeing a GP and being given the details to book a physiotherapy appointment themselves - By seeing a GP who arranges the referral to the physiotherapy service. - Other If other - 4 (a) Please provide details of how patients access physiotherapy for their existing long-term condition in your area. Public interest arguments There is a clear public interest for disclosure of this information, in that disclosure will: Further the understanding of and participation in the public debate of issues of the day, and will allow a more informed debate of issues under consideration by public bodies Promote accountability and transparency by public authorities for decisions taken by them. Promote accountability and transparency in the spending of public money. Allow individuals to understand decisions made by public authorities affecting their lives and, in some cases, assisting individuals in challenging those decisions. I wish to receive the information requested via to response@csp.org.uk. Further to Section 15 of the Freedom of Information (Scotland) Act 2002 (duty to provide advice and assistance), if you have any queries relating to these requests or need clarification on any issue, I would be grateful if you could contact me. I reference the Scottish Ministers Code of practice on the discharge of functions by Scottish public authorities under the Freedom of Information (Scotland) Act 2002 and the Environmental Information (Scotland) Regulations 2004, particularly that, 1.4 Authorities must provide appropriate advice and assistance to enable applicants to describe clearly the information they require. 1.5 Authorities should not delay in seeking clarification. 1.8 Providing advice and assistance where a fee is payable. 1.9 Providing advice and assistance when the upper cost limit applies /10/14 Guillaume Lefevre Business 1. Has any of the equipment in your diagnostics imaging department been sourced under a Managed Equipment Service (MES)? [ Y / N ] MES is broadly defined as the outsourcing of the long term asset lifecycle management of diagnostic imaging equipment, often for a fixed yearly fee. This includes the provision and installation of the equipment (on a leased basis), maintenance, upgrades and replacements during the life of the contract. a) If Yes, please complete the table below with the relevant details. Imaging modality (E.g. CT / MRI) Number of machines Original Equipment Manufacturer MES service provider MES contract start date MES contract length b) If Yes, what asset replacement agreement is included within the MES 27/10/14

121 121 contract? Guaranteed State of the art upgrades as and when latest technology becomes available [ Y / N ] Defined replacement & upgrade dates throughout contract [ Y / N ] Other Please specify c) If No, do you have plans to procure any imaging modalities through MES in the next 12-months? [ Y / N ] d) If Yes, are these for existing or new (additional) machines? [ Existing / New / Both] 2. Does the Trust currently provide any diagnostic imaging services in community settings? [ Y / N ] a) If Yes, please fill in the table below with the requested details of these services. Service location Provider Name (e.g. The Trust / 3rd party / independent provider) Modality (e.g. MRI / CT) Service type (Static / mobile) Number of scans processed in last 12 months b) If No, are you planning such a service in the next 12 months? [ Y / N ] 3. Please provide the number of inpatient, outpatient and GP direct access scans for MRI and CT in the last twelve months. Please use the table below. Modality MRI CT Referral type Inpatient Outpatient GP direct access Inpatient Outpatient GP direct access Number of scans /10/14 N Mackay Other How many senior clinical fellows were employed in you hospital within the trauma and orthopaedic department on the dates below? (A clinical fellow is a non-standard NHS grade and I am referring to fellows employed as post-cct fellows and usually on short term contracts of 6 months to one year duration. I am not referring to junior clinical fellows (i.e. senior house officer or junior registrar grade) or associate specialists). a) 1st of March b) 1st of March 2011 c) 1st of March 2008 c) 1st of March How many fulltime equivalent trauma and orthopaedic consultants did you have working in your hospital on the dates below? a) 1st of March b) 1st of March 2011 c) 1st of March 2008 d) 1st of March What is the annual salary of a fulltime clinical fellow as of 1st March at your hospital? 4. Could you provide a breakdown of the subspecialty area of orthopaedics or trauma that each of your senior clinical fellows work in: a) Spinal fellow b) Trauma fellow c) Foot and ankle fellow e) Arthroplasty fellow e) Upper limb fellow f) Hip fellow g) Knee fellow /10/14 Kate Foster /10/14 Kate Foster Media Media Please could you supply information regarding any incidents of potentially harmful bacteria found in birthing pools in your health board maternity units over the past 12 months. Please give details on the nature of the bacteria, the number of patients infected or affected and the infection control measures put in place. Please supply information detailing the number of 'boarders' in your acute hospitals over the past 12 months. Please supply information about why these patients were classed as 'boarders'. 27/10/14 27/10/14 27/10/14

122 /10/14 Carole Ewart /10/14 Shona Tierney Business I am seeking information under S1 of the Freedom of Information (Scotland) Act I am asking for information about the application of the Human Rights Act 1998 across your work and services as well as your use of the various tools, which exist in Scotland, to enable you to comply with your human rights duties. I am making this information request to inform a report I am writing for three NGOs. Specifically, I am seeking the following information: Is there a lead official for human rights within your organisation? If yes, can you provide the name, designation and business address of the official? I understand there are already lead officials for equality, data protection, health and safety and freedom of information. Does your organisation have a specific guide for staff on complying with the Human Rights Act 1998? If yes, please provide a copy. Also, can you advise if all staff have received it or have access to it? Has your organisation discussed the publication of Scotland s National Action Plan on Human Rights (SNAP) on 10th December 2013? If yes, please provide a copy of the Minute of the meeting and any background papers written to inform the discussion. 4. Has your organisation produced guidance for staff on how to implement SNAP? For example applying the PANEL principles? If yes, please provide a copy of the Guidance. Following publication of the Equality and Human Rights Impact Assessment tool by EHRC Scotland and SHRC, has your organisation discussed using this tool? If yes, provide a copy of the Minute of the meeting and any background papers written to inform the discussion. Has your organisation completed an Equality and Human Rights Impact Assessment (EqHRIA)? If yes, can you provide a copy of each one? If your organisation is in the process of undertaking EqHRIAs can you provide a list of them? Please also provide a copy of the internal guidance or manual, staff refer to when completing the EqHRIA. In the last three completed financial years, can you advise how many times legal proceedings have been initiated against your organisation by individuals who assert specific human rights as part of their legal case? In these specific cases, please advise how many proceedings have resulted in: A ruling in favour of your organisation? A ruling against your organisation? Given the content of my S1 information request detailed in Questions 1-7, if there is any other information you consider relevant then I would be happy to receive that too. Business Could you provide the following information for the below drugs for your Health Board? The total spend in the last financial year 2013/14? The total projected spend for this financial year /15? The current spend to date financial year /15? If possible, please enter the information into this table: Total spend 2013/14 Projected total spend /15 Current spend to date /15 Abatacept (Orencia); Adalimumab (Humira); 27/10/14 27/10/14

123 /10/14 John-Paul Breslin /10/14 Greg Christison /10/14 Rhys Donovan /10/14 Tommy Kane /10/14 Tommy Kane Anakinra (Kineret); Certolizumab pegol (Cimzia); Etanercept (Enbrel); Golimumab (Simponi); Infliximab (Remicade); Rituximab (MabThera); Tocilizumab (RoActemra); Tofacitinib (Xeijanz); Ustekinumab (Stelara); Media How many hospital patients were in casualty for more than 12 hours, for more than 24 hours and what the longest waiting time in 2011/12, 2012/13 and 2013/14? Please break the figures down for each year. How many patients spent 12 or more hours on trolleys in casualty units in 2011/12, 2012/13 and 2013/14? Please break the figures down for each year. Media Business Political Political Under FOI legislation, please tell me, in the past year (October 1, 2013 September 30, ): How many primary school aged children (11 and under) have been hospitalised with: Alcohol-related illness Drug-related illness How many secondary school aged children (18 and under) have been hospitalised with: Alcohol-related illness Drug-related illness Does your trust use/perform Viscosupplementation injections? If so, how much does your trust spend each year on viscosupplementation? 3. Which (brand) Viscosupplement do you use? To make your research easier, I have listed all commonly used viscosupplements that you can cross reference: Arthrum H Orthovisc Crespine Gel Durolane Euflexxa Fermathron Ostenil Ostenil Plus RenehaVis Suplasyn Synocrom Synocrom Mini Synolis Monovisc Synopsis Synvisc (Hylan G-F20) Synvisc ONE (Hylan G-F20) The total number of women who, during the period 6 November 2013 and 17th June, were implanted,, with polypropylene mesh medical devices as part of their treatment for Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). The total number of women who, during the period 6 November 2013 and 17th June, had either partial or complete explants of the polypropylene mesh medical devices which they had implanted as part of their treatment for POP and/or SUI. The total number of women who, during the period 17 June and 8th October, were implanted, with polypropylene mesh medical devices as part of their treatment for Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). The total number of women who, during the period 17 June and 8th October, had either partial or complete explants of the polypropylene mesh medical devices which they had implanted as part of their treatment for POP and/or SUI. A list of, and details (monetary worth, partners, duration and numbers of women involved etc) of all clinical trials of Transvaginal mesh devices that your board has been involved in since Details of any other research funding, relating to 28/10/14 28/10/14 28/10/14 03/11/14 04/11/14

124 /09/14 Julie Hamilton Legal Transvaginal mesh devices, received by your board since A list of all manufacturers who supply, or have in the past supplied, Transvaginal mesh devices to your board and details of the product(s) supplied. We understand that various NHS Health Boards across Scotland have been sent Freedom of Information Requests relating to the use, implantation and removal of Transvaginal Mesh Implants by the relevant NHS Health Board. However, we have been unable to find the details of such Freedom of Information Requests from the website of NHS Dumfries and Galloway. We should therefore be grateful if you could let us have the following information in respect of every Freedom of Information Request that NHS Dumfries and Galloway has received in relation to Transvaginal Mesh Implants: the date(s) of such Freedom of Information Request(s); the information requested in such Freedom of Information Request(s), including the exact wording of such Request(s); whether you have responded to such Request(s) and your full response. To the extent that any of the requested information is exempt by virtue of Section 25 of the Freedom of Information (Scotland) Act 2002, please advise where this information is accessible. In so far as any of the requested information contains personal data, the disclosure of which is exempted under Section 38 of the Act, we request that the information is provided with the personal data redacted /10/14 Baker Tilly Business As a Freedom of Information request, we would also be grateful if you would provide the following details to ensure our records are up to date: 1 Current VAT and Taxation adviser. 2 Contract renewal date. 3 Contact details of your :financial officer(s) with responsibility for VAT and Tax /10/14 Victoria Allen Media 1. For each hospital in the health board area, can you tell me please if the Liverpool Care Pathway is still being used. 2. If so, can you tell me if there are any changes to the way it is being used, if it is being phased out, and if so when the hospital will stop using the Liverpool Care Pathway. 3. For each hospital, can you tell me how many patients approximately have currently been placed on the Liverpool Care Pathway. 4. For each hospital, can you please tell me how many complaints have been received in the last year about patients being placed on the LCP and what these entailed for example relatives or friends not being informed? 5. For hospitals where the LCP is no longer used, can you please tell me what system is being used instead? 6. For each of these hospitals, can you please tell me if medication, food or water are withdrawn from patients who are close to dying? Can you tell me how many complaints have been received in the last year about the system which has replaced LCP and provide details of those complaints. 7. Can patients be placed on the LCP, or the system which has replaced it, without their relatives being informed? If so, please specify in what 09/10/14 04/11/14 04/11/14

125 125 circumstances. 8. Can you please provide information about how relatives are informed about patients who have been placed on the LCP or the system which has replaced it /10/14 Victoria Allen Media 1. Can you tell me please, in the last 20 years, how many sex change operations have been reversed in hospitals by the health board and how many of these were male-to-female operations and how many female-to-male. 2. Can you provide the average cost per operation and the total cost to the health board of all reversals during this period. 3. Can you please break down the reversals into those where the patient had their original sex change operation on the NHS and those where they did not. 4. Can you please provide the number of people given sex change operations in each of the last five years and for each of those years, separately, the number of under-21s and the number of under-18s (if this is permitted) given sex change operations. 04/11/ /10/14 Tommy Kane Political Information pertaining to any current or past contract your board has with Medinet. This should incorporate, The financial costs of any current or past contract with Medinet. The type of work carried out by Medinet E.G Any services, operations, specialities they have been hired to provide cover for /10/14 David Gardiner Political 1. Transport costs incurred by locum doctors who have come from outside of Scotland for the purposes of performing duties for your NHS Board. 2. As an extension of the above, the details of any flights paid for or expensed by the NHS Board for locum doctors including relevant dates, specific cost per flight, travel class if not standard and airport of origin. 3. Any accommodation costs incurred by locum doctors and paid for by the Board, including the names of any hotels utilised for that purpose. 07/11/ /10/14 Andrew Nicoll Other copy of the actual statement from the NHS Board Dumfries and Galloway which removes this NHS podiatry treatment /10/14 Victoria Allen Media 1.Do you currently employ any locum doctors or consultants who reside overseas? 2.For each employed, please provide the country they live in, their specialism and title, if they are male or female, and shift pattern. 3.Please provide details of how much they are currently paid per shift, per hour, per week and the equivalent salary for the year. If the same shift were covered by a staff member of the same title and specialism, please provide the figure for pay per shift, per hour, per week and the salary for the year. 4.For each locum doctor or consultant from overseas, please provide details of whether their travel costs or accommodation are paid for by the health board. 5.If their travel costs are paid, please provide details of the cost per shift and the form(s) of transport used. For accommodation, please provide details of where they stay and the cost per night. 6.Also, have you employed any locum doctors

126 /10/14 Marc Ellison /10/14 Marc Ellison Media living overseas in the past 12 months? If so, please provide the country they lives in, their specialism and title, if they are male or female, and the shift pattern they worked. 7.For each person employed in the last 12 months, please provide details of how much they were paid per shift, per hour, per week and the equivalent salary for the year. If the same shift were covered by a staff member of the same title and specialism, please provide the figure for pay per shift, per hour, per week and the salary for the year. 8.Please provide details of whether their travel costs or accommodation were paid for by the health board. 9. If their travel costs were paid, please provide details of the cost per shift and the form(s) of transport used. For accommodation, please provide details of where they stayed and the cost per night. How much is currently owed to the board by overseas patients not entitled to free NHS treatment? Please tell me which city/country each person is from, how much they owe, the date of their treatment, or how much has been written off on the amount owing. Media How many people have requested liver transplants between 1 Jan 2010 and 16 October ; How many of these requests, by year and month, were denied; How many of these requests, by year and month, were denied on the grounds of ongoing alcoholism /10/14 Jim Hume Political How many patients in a) and b) had to wait more than i) 18 weeks, ii) 26 weeks, iii) 52 weeks, iv) 78 weeks and v) 104 weeks to begin their treatment following initial referral (RTT) How many patients in a) and b) awaiting treatment on an inpatient or day case basis had to wait more than i) 9 weeks, ii) 12 weeks, iii) 26 weeks, iv) 52 weeks, v) 78 weeks and vi) 104 weeks /10/14 Claire Mckim Media Under FOI I would like to request, broken down by age and gender, the numbers of people diagnosed with liver disease in your health board. I would like these figures year by year for the past five years, separated by gender and also in age brackets (for e.g , 25-29). I would like it also separated by each liver ailment /10/14 Nitin Pillai Business NHS Software, Hardware and Infrastructure Questions IT resources Does the trust manage and support its own IT functions in house or outsource it to an ICT partner? If outsourced, who does the trust outsource its IT functions to? If available, please provide an organigram If available, please provide a list of all live and current IT contracts Desktop PC and laptop hardware How many desktop PCs and laptops does the trust have? Which brands of PCs/Laptops (and percentage of PC fleet) does the trust use? Which vendor/reseller(s) does the trust use to purchase the majority of its desktop PCs and laptops? How much did the trust spend and plan to spend on

127 127 purchasing desktop PCs and laptops in , -15 and ? What is the trust's PC refresh policy? When does the trust plan to next refresh its PCs? Desktop PC and laptop software Operating systems What operating system software is used and how many licenses does the trust have for each one? Which vendor(s) or software reseller does the trust use? How much did the trust spend and plan to spend on purchasing desktop PC operating system licenses in , -15 and ? What is the trust's operating system software upgrade policy or plans? Desktop PC and laptop software - Office What PC office software does the trust use and how many licenses does the trust have for each software version? Which vendor(s) or software reseller does the trust use? How much did the trust spend and plan to spend on purchasing PC office software licenses in , -15 and ? What is the trust's office software upgrade policy or plans? Does the trust use Software As a Service (SAS) services? If so, which supplier provides it? And what SAS services or products does the trust use? Servers - hardware How many physical servers does the trust manage onsite and offsite? Which vendor(s) does the trust use? How much did the trust spend and plan to spend on purchasing server hardware in , -15 and ? What is the trusts server refresh policy? When does the trust plan to next refresh or procure new servers? How many of the trust s staff (FTE) manage the trusts servers? How much does it cost the trust annually to run its server room(s)? Servers - OS software What server operating system software does the trust use and how many licenses does it have for each? Which vendor(s) does the trust use to purchase server OS software? How much did the trust spend and plan to spend on purchasing server OS licenses in , -15 and ? Data centres Does the trust run/manage its own data centre or is this managed externally? Is the data centre on site, off site (another NHS trust), off site (private site in UK), off site (private site outside UK) or other (please specify). Which vendor(s) supplies the trust s data centre? How much did the trust spend and plan to spend on data centre services in , -15 and ? How much did the trust spend and plan to spend on staff expenses to run its data centre in , -15 and ? When was the contract awarded? When does the contract expire? Does the trust use Infrastructure As a Service (IAS) services? If so, which supplier provides it? And what IAS services or products does the trust use? Networks - fixed line telecoms, ISP/Broadband/WAN/data connectivity Which vendor(s) does the trust use for fixed line telecoms and data network connectivity? How much did the trust spend and plan to spend on fixed line telecoms and data network connectivity services in , -15 and ? When did the contracts start and when do they expire? Mobile phone network and handsets Which mobile telecoms network provider does the trust use? How many mobile phones does the trust have? Are mobile handsets

128 /10/14 Stephen Stewart /10/14 Adam Morris /10/14 Adam Morris Media Political Political provided as part of contract with telecoms network provider? If not, which vendor(s) does the trust use to procure mobile phone handsets? What mobile handsets does the trust use? How much did the trust spend and plan to spend on mobile network services in , -15 and ? When did the trust s mobile network contract start and when does it expire? Does the trust use a mobile device management solution? How many mobile device management licenses does the trust have? Which vendor(s) does the trust use for its MDM software solution? How much did the trust spend and plan to spend on MDM software in , -15 and ? If none currently used, are plans in place to procure an MDM system in future? Does the trust currently have a BYOD policy in place? Does the trust currently have a CYOD policy in place? Mobile devices: tablets, COWs, digital pens For each of the above 3 types of mobile devices: How many does the trust have? Which vendor(s) does the trust use to procure? What brand of device does the trust use? How much did the trust spend and plan to spend on the mobile device in , -15 and ? Are plans in place to procure more mobile devices? (if so, how many) Printers Does the trust use a managed printer service? If so, who provides it? How many printers does the trust have? Which brands of printers does the trust use? How much did the trust spend and plan to spend on printers in , -15 and ? What is the trust s refresh policy for its printers? How many people have been treated for alcohol related liver disease in each of the last three years (ie from 2011 to the present)? I wish to receive the data broken down into age groups - six yrs and under; 6 to 8; 8-12; 21-14; 14-16; and 16 to 18. In the past three years, could you tell me how many patients in your area have been admitted to hospital after taking performance and image enhancing drugs (PIEDs). Could this be broken down by i) year ii) type of drug and iii) age group of patient. Below is a list of drugs I would like you to consider as examples of PIEDs as part of the response. Anabolic-androgenic steroids (AAS) Stimulants (ephedrine, caffeine etc) Insulin/IGF 1/Daonil Human Growth Hormone (hgh) Diurestics Beta Blockers Oestrogen antagonists Human chorionic gonadotropin (HCG) Erythropoietin (EPO) Aminoglutethimide Botox In the past three years, on how many occasions have maternity units within your health board area had to close to admissions because of either a lack of staff, or a lack of capacity. This could either include a full closure, or simply diverting women to other maternity units. Could this please be broken down by i) year and ii) maternity unit (if your health board has more than one unit).

129 /10/14 Adam Morris /10/14 Gordon Blackstock /10/14 Alicia Queiro /10/14 Julian Hendy /10/14 Julian Hendy /10/14 Jamie Beatson Political Media Media Media Media Media Over the past three years, how many patients have been admitted to hospital in your health board area suffering from an animal bite. Could this be broken down by i) year ii) type of animal and iii) age of patient 1) Can you tell me the number of scans (CT and MRI) your health board was asked to carry out in 2013/14? Please specify if they are requests from GP, Out-Patient requests or A&E requests. 2) Out of this total can you tell me how many were sent to private 3rd party firms to read/give definitive report? And if they were GP requests, OP requests and A&E requests. 3) Out of this total can you tell me what the 3rd party firms are and where they are based? If you are unable to provide the company/other HB s name please supply location. 4) To the total number of scans (answer to question 2), can you tell me how much money was given to these firms for completion of the work and who it was paid to? For the following two questions can you answer as a snapshot for the date: 21/07/ 5) Can you tell me how many scans were marked as unread for this date. 6) And can you detail what these scans were for? E.g an A&E request, GP request or OP request. 7) Can you tell me what if any scans (GP requests, A&E requests and OP requests) in 2013/14 went over deadlines for definitive reports being filed. 8) For each of the questions above can you please supply answers for the years 2011/12 and 2012/13 I m looking for figures for number of people in Scotland suffering from asbestos-related illnesses or medical conditions, preferably over the last 10 years. a) the number of patient homicides your health board has reported to the National Confidential Inquiry for each of the last five years. b) the total number of patient homicides your health board has reported to the Inquiry over the last five years c) the total number of patient homicides your health board has reported to the Inquiry over the last ten years This is a Freedom of Information request for all Significant Adverse Event Reviews (or similar) for homicides committed by patients of your health board who were in receipt of mental health services, over the last three years. Please disclose the number of bariatric/weight loss surgeries carried out in your area over the past five years, broken down by year and the type of surgery (e.g gastric banding, gastric bypass etc) performed. Please also disclose the total cost to the health board for these surgeries over that five year period, again broken down by year /10/14 Victoria Media Can you please tell me how much the health board spends a year outsourcing hospital 23/10/14

130 130 Allen /10/14 Tom Owens /10/14 Rachel Watson /10/14 Steven Donlon /10/14 Andrew Liddle /10/14 DrRichard Simpson Business Media Business Media Political catering, for example buying in food from companies like Brake Bros? Would it then be possible to receive the total patient numbers for the aforementioned conditions and, if possible, the total prescriptions for the listed drugs? Details of all foreign trips made by doctors and consultants which have been paid for by the health board. (This should also include trips which have been paid for by doctors or consultants which they have then claimed back.) I would like to know the destination, the hotels stayed in, how many days the trip has lasted and the cost. Could this information be broken down by the year for the past three years please. Please also detail why the trip is being made, for example a conference, and also the department the doctor/consultant works in. 1. Does the hospital follow NICE/SMC or AWMSG guidance or is there a separate process for inclusion on formulary. 2. Is the hospital part of a wider Area Prescribing Committee or similar regional group that decides the formulary status of products, and if so, which one? 3. Does the hospital use Patient Controlled Analgesia and if so for which procedures? 4. If yes are these pumps, owned, rented or part of a contract/purchase volume deal? 5. If yes to question 3, how many of these pumps are in active use? 6. What types of operations are these pumps used for? 7. Does your hospital run an Enhanced Recovery Programme and if yes what types of operations are included? 8. Does the hospital have guidelines in place for use of Patient Controlled Analgesia? 1. How much did you spend on pornography - purchased for medical and/or sperm donation purposes - in the financial years 2013/14, 2012/13 and 2011/2012? 2. How many pornographic magazines were purchased in the financial years 2013/14, 2012/13 and 2011/2012? 3. How many pornographic films were purchased in the financial years 2013/14, 2012/13 and 2011/2012? 4. How much was spent on sperm donation/sampling specific lubricant in the financial years 2013/14, 2012/13 and 2011/2012? 5. Who was responsible for selecting the type and quantity of pornography purchased in the financial years 2013/14, 2012/13 and 2011/2012? 6. Can you provide a list of all pornographic publications/material purchased during each of the years? 7. Can you provide a list of reasons for purchasing pornographic material? Question 1: How many Gastric banding operations were carried out on patients for which your Health Board was responsible for in year; 2011/2012, 2012/2013 and 2013/? Question 2: How many of those were carried out; a) At hospitals within your Board Area (please specify the numbers for each year undertaken by each

131 /10/14 DrRichard Simpson /10/14 Brian Shipton /10/14 Sarah Atherton /10/14 Sarah Atherton Political Other surgeon). b) Commissioned elsewhere - please specify the hospital (and Board if applicable) where the procedure was undertaken Question 3: How many gastric banding operations are you budgeting for in the current financial year? Question 1: How much was spent over and above normal or budgeted expenditure by your Board in meeting the Patient Rights Act Treatment Time Guarantee of 12 weeks in each year since the Act came into force in April 2012? Question 2: How much was spent in tackling the problem of providing treatment to those for whom your Board was unable to meet the legal guarantee in each year since the Act came into force in April 2012? Question 3: How much was spent, in each year since the Act came into force, either on locums or overtime payments a) to consultants; b) to other staff; c) in payments to other Health Boards; d) to the Golden Jubilee hospital; e) to the private sector; f) to English or other providers not in Scotland; to meet the guarantee or tackle the problem of those whose guarantee had not been met? Please note a) and b) should Include Bank staff and Agency staff using NHS facilities. 1) Is this service provided "in-house" by the Hospital/Trust; by a regional NHS ambulance service or by an independent contractor? 2) If not by the Hospital/Trust then the name of the provider. 3) What is the total annual cost/contract Value to your organisation? 4) What is the renewal date of any agreement? 5) What was the Contract spend in the last full financial year? 5) What is the Contracted/annual mileage by type of vehicle; Ambulance, Wheelchair Accessible Vehicle Car? 7) What is the Contract activity by patient mobility code? 8) What are the Service Levels - Timeliness KPI definitions for Inbound performance and reported achievement over the last 12 month? 9) What are the Service Levels - Timeliness KPI definitions for Outbound performance and reported achievement over the last 12 month? 10) What Is the Number of Aborted Journeys per annum? 11) What is the Number of complaints received per month, or per annum? 12) What is the total carbon footprint of the patient transport fleet over the last 12 months? Political Spend on mental health services for financial years 2011/12; 2012/13 and 2013/14. The number of individuals sent to a different NHS board for treatment for mental ill health in 2011/12; 2012/13 and 2013/14. Political The number of individuals signed off for stress-related reasons broken down by the length of time they are signed off for: (a) under 1 month (b) 1 to 3 months (c) 3 to 6 months (d) longer than 6 months (e) longer than 12 months for the financial years 2012/13 and 2013/14. The number of individuals signed off for mental ill health (except stress) broken down by the length of time they are signed off for: (a) under 1 month (b) 1 to 3 months (c) 3 to 6 months (d) longer than 6 months (e) longer than 12

132 /10/14 Oliver Cohen /10/14 Shona Tierney /10/14 David Shaw /10/14 DrRichard Simpson /10/14 Sarah Atherton /10/14 Sarah Atherton Other Business Other Political Political Political months for the financial years 2012/13 and 2013/14. How many appendectomies do you carry out annually? Which type of appendix ligation devices do the Trust currently use and from which manufacturer? (e.g. Ethicon Endoloop, Stapler) How many appendix ligation devices do the Trust use annually? What price is the Trust currently paying for your appendix ligation devices? Are the appendix ligation systems on contract(s) and if so when do they end? How many NEW patients (de novo) were diagnosed in your Health Board with Ulcerative Colitis or Crohn s disease in the last financial year 2013/14? How many of those patients were treated with infliximab and/or another biologic? Please use the table below if possible: Ulcerative Colitis and Crohn s Disease Patients Total new patients 2013/14 New patients treated with Infliximab New patients treated with other biologic I would like to know how many unfilled GP shifts (both total number and vacancy rate) there have been in the Dumfries and Galloway Out of Hours GP service in the period 1/10/2013 to 1/10/14. I would also like a copy of any contingency plan for service failure of the Dumfries and Galloway Out of Hours GP service due to a lack of medical cover. Question 1: How many patients in each of the quarters since the Act came into force in April 2012 did not have this legal guarantee met? Question 2: What was the median and maximum time that they then had to wait after breech of their rights? Question 3: Which departments were the ones where the failures/breeches were greatest? Question 4: What were the consultant shortages/posts vacant in those departments named in question 3 in each year for which question 1 above applied? Question 5: What procedure is adopted by your Board in communication with patients where a breach of their legal right is going to, or has occurred? Information on how long it took the health board in to provide secondary treatment for cancer patients following that patient s first cancer treatment (which would have been subject to the 31 day/62 day treatment time target). 1. How many patients between the ages of 10 and 18 were treated for intravenous illegal drug related illnesses or incident in each of the last 3 years (2011,2012,2013) 2. How many patients under the age of 10 received treatment for intravenous illegal drug related illnesses or incident in each of the last 3 years 3. How many patients between the ages of 10 and 18 were treated for non-intravenous illegal drug related illnesses or incident in each of the last 3 years (2011,2012,2013) 4. How many patients under the age of 10 received treatment for non-intravenous illegal drug

133 /10/14 Adam Clarke /10/14 Ben Robinson /10/14 Elise Campbell Political Media Organisation related illnesses or incident in each of the last 3 years What arrangements does the health board have for removing and destroying prescription medicines that are returned unused to pharmacies in the area? What was the annual cost of this in each of the last 5 financial years? Are there figures available regarding the (a) quantity and (b) value of prescription medicines that are returned unused to pharmacies? "For each of the past five financial years 09/10, 10/11, 11/12, 12/13 and 13/14, how many girls aged under 16 had abortions? For each of the past five financial years, I would like to know the number of girls aged under 16 who had undergone more than one abortion. This should include the number of abortions the girl had had and the person s age at their last abortion. " 1) Please confirm or deny whether cerebral palsy is categorised and/or treated in your NHS board as: i) A long-term condition a) Please supply a list of all the specific conditions which are included in your NHS board s list of long-term conditions 2) Please state how many adults (21+) there are in your NHS board with: i) Cerebral palsy ii) A physical disability iii) A learning disability iv) A neurological condition v) A long-term condition (only if confirmed in question 1i) 3) Please confirm or deny that current resources (e.g. local plans, toolkits etc) have been mapped in your NHS board for: i) Adults with cerebral palsy ii) Adults with physical disabilities iii) Adults with learning disabilities iv) Adults with neurological conditions v) Adults with long-term conditions (only if confirmed in question 1i) a) If confirmed, please supply details 4) Please list the overall expenditure in each of the last 3 financial years in your NHS board for: i) Treatment for adults with cerebral palsy by Allied Health Professionals ii) Treatment for adults with a physical disability by Allied Health Professionals iii) Treatment for adults with a learning disability by Allied Health Professionals iv) Treatment for adults with neurological conditions by Allied Health Professionals v) Treatment for adults with long-term conditions by Allied Health Professionals (only if confirmed in question 1i) 5) Please supply any agreed referral processes in your NHS board for: a) Adults with cerebral palsy without a learning disability for: i) Physiotherapy ii) Occupational therapy iii) Speech and language therapy b) Adults with cerebral palsy with a learning disability for: i) Physiotherapy ii) Occupational therapy iii) Speech and language therapy 6) Please confirm or deny that your NHS board has made an assessment of the average waiting time for a follow-up appointment for: a) Adults with cerebral palsy without a learning disability for: i) Physiotherapy ii) Occupational therapy iii) Speech and language therapy b) Adults

134 /10/14 Victoria Allen Media with cerebral palsy with a learning disability for: i) Physiotherapy ii) Occupational therapy iii) Speech and language therapy (Please note, if this information cannot be provided for adults with cerebral palsy, please provide average waiting times for a follow-up appointment for adults in general). 7) Please confirm or deny that professionals in your NHS board are provided with quality information and training opportunities to help with care provision for individuals with: i) Cerebral palsy ii) Longterm conditions iii) Neurological conditions a) If confirmed, please supply details 8) Please confirm or deny that your NHS board provides information to support selfmanagement for adults with: i) Cerebral palsy ii) Long-term conditions iii) Neurological conditions a) If confirmed, please supply this information 1. Can you please tell me in each of the last five years how many babies of a high birth weight were born in the health board area. 2. Please provide the normal range for a baby s weight when born and provide the figures which would be considered a high birth weight. 3. How much did the heaviest 10 babies in each year weigh? Did any babies need medical intervention, or a Caesarean, because of their size? If So, for each year, please provide a list of interventions and the number of babies where these interventions were required. 4.How many babies were born in total in each of the five years? And what percentage were born at a high birth weight in each of the five years please?

135 135 Freedom of Information Requests 1 st September to 31 st October The Chart below relates to the directorate handling the requests, Information Services is incorporated into Acute/Community The following chart relates to the source of requests with the majority coming from media and political parties.