Contents. Health Protection and Screening 14 Patient Experience 18. Chairman and Chief Executive Foreword 4

Transcription

1 Annual Report 2014

2 Contents Contents Chairman and Chief Executive Foreword 4 Service Developments and Improvement 6 Improving Health 12 Health Protection and Screening 14 Patient Experience 18 Quality and Patient Safety 20 Volunteers and Involvement 22 Donations and Fundraising 24 Staff Awards and Achievements 25 Our Year in Pictures 27 Performance: HEAT Targets and Standards 31 Annual Accounts 34 Annual Review Letter 36 Elected Board Pilot Board Members 41 42

3 Chairman and Chief Executive Foreword Chairman and Chief Executive Foreword This has been another busy and successful year for NHS Dumfries & Galloway and we have much to report in terms of developments, achievements and challenges. NHS Dumfries & Galloway has delivered on many of the targets and standards set by the Scottish Government and made significant progress on a number of landmark projects. In 2013/14 our investment in improving primary care facilities has culminated in the official opening of the Lochfield Road Primary Care Centre. This new facility brings together the Charlotte Medical Practice, Cairn Valley Medical Practice Satellite Surgery, the Specialist Drug and Alcohol Services and the Nithsdale Health Improvement Team. Construction work is also underway on a further two new primary care centres at Dalbeattie and Dunscore and are expected to welcome patients in These new primary care facilities will deliver more comprehensive services that more closely meet the needs of patients and communities they serve. In 2013/2014 a significant amount of focus has been placed on preparing for the future. The outline business case for the Acute Services Redevelopment Project was presented to the NHS Board in April 2013 and sets out a vision for re-shaping health services across the region. At the heart of the project is our commitment to redesign health services so that patients are able to access high quality care as close to home as possible. The Acute Services Redevelopment Project also includes the provision of a new District General Hospital, in Dumfries. The Board s plans for the new hospital have achieved a number of milestones and following a detailed evaluation process two bidders have reached the competitive dialogue stage. This new hospital is expected to provide the region with a modern, well equipped and purpose-built acute hospital facility and represents the single biggest investment in healthcare in Dumfries and Galloway. Work remains ongoing to develop the full business case for this exciting development. Our commitment to partnership is an essential aspect of how we deliver health and care services and in 2013/2014 we strengthened these partnerships. Health and Social Care integration presents an exciting opportunity to bring together the collective resources, skills and expertise of the council, NHS and Third Sector. An Integration Programme Board has been formed and plans to integrate health and social care by April 2015 are in the process of development. In 2013/2014 we confronted a number of challenges, in particular those relating to key financial and waiting time targets. These financial challenges were addressed by the implementation of a range of savings plans and resulted in us being able to end the year in financial balance. This has been a significant achievement and like other NHS Boards we will be expected to make further savings in 2014/2015. We have continued to focus on improving the quality and safety of our services through a number of developments and initiatives and throughout 2013/14 our staff and services have been recognised with a number of awards and achievements. We would like to take this opportunity to thank all staff who contributed to our culture of continuous improvement. Your hard work is our success. Finally, we would wish to assure our patients and communities that we will strive to continue to deliver quality and safety improvements in 2014/2015, so that NHS Dumfries & Galloway continues to provide excellent care that is person-centred, effective, efficient and reliable. We would like to take this opportunity to thank all staff who contributed to our culture of continuous improvement. Your hard work is our success Phil N Jones Chairman Jeff Ace Chief Executive 4 5

4 Service Developments and Improvement Service Developments and Improvement Throughout the year NHS Dumfries & Galloway continued to develop and improve a wide range of services for patients and their families. This section highlights a number of the key developments taken forward in 2013/14. Acute Services Redevelopment Project The design and procurement of the Acute Services Redevelopment project has progressed significantly in the past year. The Board s Reference Design received planning consent in principle in March 2013 and the outline business case was approved in June The competitive dialogue process began in October 2013 and interim proposals were received in December The Board is currently preparing to close Competitive Dialogue and it is anticipated that a preferred bidder will be selected in autumn Construction of the new hospital is expected to be completed in late 2017 with patients being admitted in early In February 2014 separately procured Enabling Works at the new hospital site commenced. These contracts were awarded to local construction companies and reflect the Board s desire, where possible, to maximise community benefits. A dedicated project stakeholder reference group has been established and a significant amount of engagement work has taken place with local stakeholders and communities. The reference group will be invited to regular updates and will be offered the opportunity to provide feedback as proposals develop. They can also share the developments with their communities and advise on local views. Patients will benefit from healthcare delivered within a unified health and social care system Artist s impression of the new Dumfries and Galloway Hospital. High Wood Health 6 7

5 Service Developments and Improvement Clinical Change Programme The Outline Business Case (OBC) for the Acute Services Redevelopment Project was presented to Board in April The OBC sets out a vision for re-shaping health services across NHS Dumfries and Galloway. At its heart are high quality services redesigned to meet the needs of patients and to facilitate the delivery of clinical activity as close to home as possible. In order to successfully deliver on the Board s ambition to re-shape the way services are provided and the provision of a new District General Hospital, significant changes to the way we deliver services within the acute and primary care settings are required. Within the OBC for the new hospital the Board went through a rigorous options appraisal exercise (financial and non-financial) to confirm the preferred way ahead. The main ethos of the Clinical and Service Change Programme will be to support the health system in the delivery of new models of clinical care to better meet the future health needs of the local population. The programme will also focus on facilitating approaches to change and nurturing a culture whereby change is embraced by all our staff and key partners. Analysis of future demographics illustrates that there will be greater demands on the social and healthcare systems. There will also be a potentially reduced workforce to provide the traditional models of care. It is important therefore to establish new models of care to address this challenge. The over arching principle is that if the individual does not require acute hospital inpatient care then care will be provided in their own home or as near to their home as possible. Those who require admission can be seen, fully investigated and treated as quickly as possible. supporting the health system in the delivery of new models of clinical care to better meet the future health needs of the local population The Clinical and Service Change Programme will align with and build upon the following four key principles: 1 Shifting the Balance of Care Acute facilities should only provide acute care. Alternative models of care are developed with primary and community care which will include clearly defined pathways of care. Patients will benefit from healthcare delivered within a unified health and social care system. 2 Best Clinical Practice: Improved clinical outcomes, through standardisation and consistency of practice, delivered by dedicated integrated teams. Improved person centred quality care for all patients, tailored to meet individual needs. Identifying change of working practice, through redesign and implementation of new knowledge and technology, to reduce acute hospital inpatient activity. 3 Workforce Planning: Challenge embedded cultures, change behaviours and promote visible leadership together with a team approach to successfully deliver programmes of change. Workforce development will be a crucial element in delivering new models of care and ensuring a safe, skilled and effective workforce. Future focus will be on the development of integrated team working and the provision of a flexible workforce that can easily adapt to the changing environment. 4 Financial Stability: Achievement of statutory financial targets to deliver a break even position year on year, including cash releasing efficiency savings. Robust financial management and planning to ensure stability in the longer term and maintaining balance whist dealing with competing challenges and risks. Taking account of the enormity of the clinical and service change agenda, and the importance of this to the successful delivery of both the new Acute Hospital and the Integration of Health and Social Care, it will therefore be important that there is a strong focus on delivery of the already agreed initiatives and changes outlined in the Clinical and Service Change Programme. Clinically necessary services will be available over a 24 hour period and must support a seamless patient pathway across primary, community and secondary care. A number of critical areas across the whole system where change is required have been identified. An Aerial view of the site for the new Dumfries and Galloway Hospital. High Wood Health 8 9

6 Service Developments and Improvement Maternity Care NHS Dumfries & Galloway s maternity service has been very successful in improving the service for pregnant women. NHS Dumfries & Galloway is meeting the antenatal access HEAT target of at least 80% of women booking for antenatal care by the 12th week of pregnancy. As part of the work related to this we have participated in national and local campaigns and have developed a website The Quality Champion Midwife continues to lead the team, along with the Obstetric and Anaesthetic Champions, to achieve compliance with the quality measures set out by the Maternity and Children Quality Improvement Collaborative (McQIC). More staff are now involved in this and a number of small tests of change are underway across the maternity service. Maternity services staff are also involved in the Person Centred Health and Care and Early Years Collaboratives. As a consequence women in Dumfries and Galloway now have access to a full range of pain relief options in labour following the introduction of an epidural service in December Midwifery, obstetric and anaesthetic teams collaborated well to develop this service and to train staff to safely implement this in clinical practice. Maternity Link, the maternity services liaison committee, has been working to develop patient education and promote the positive birth experience campaign. Midwives and service leaders in Wigtownshire met women and other family members to discuss service improvements and how to encourage mums-to-be to make use of Stranraer s Clenoch Birthing Centre. The MPower campaign, which grew out of the focus on normal birth programme, supports women to take control of their pregnancy, labour and birth. It also encourages birth partners to support women s choices and aims to prevent traumatic experiences which can lead to a fear of labour. Midwives also work with pregnant women to help them make their own birth plans. Community Rehabilitation and Day Hospital Provision A review of the Community Rehabilitation and Day Hospital provision has created an opportunity to provide a more streamlined, integrated model of care. By removing unnecessary obstacles in the care process, the delivery of nursing interventions will be more responsive and efficient. The successful repatriation of patients from out of area placements has required significant changes to the in-patient rehabilitation unit, with recruitment and training for the in-patient nursing staff group within Dalveen inpatient unit. Community Learning Disability Team The Community Learning Disability Nursing Team and Support Service Team are developing their assessment and risk assessment support. They are also developing training in the management of behaviours that are perceived as being challenging. There is considerable focus on providing education and support for Carers in the management of dementia and challenging behaviour. Staff are involved in Strengthening the Commitment - the national review of learning disability nursing and what future delivery will look like, including a national workforce scoping exercise and there is ongoing nursing commitment to the Learning Disability Champions course. Flexible Visiting Flexible visiting times were introduced in all hospitals across NHS Dumfries & Galloway in January The new visiting arrangements give people more choice about flexibility when visiting family and friends. This new approach allows people to visit the majority of inpatient wards anytime between 11.30am and 8.00pm. NHS Dumfries & Galloway is meeting the antenatal access HEAT target of at least 80% of women booking for antenatal care by the 12th week of pregnancy 10 11

7 Improving Health Improving Health NHS Dumfries & Galloway is committed to improving and protecting the health of local people and reducing health inequalities. DG Health and Wellbeing (formerly known as the Joint Health and Wellbeing Unit) is a collaboration between NHS Dumfries & Galloway and Dumfries and Galloway Council. The unit s main purpose is to commission actions to improve health and reduce health inequalities. It works to support optimum health and wellbeing across Dumfries and Galloway through the creation of environments which support healthy choices and build resilience across communities. Activities are wide ranging and the following section describes a number of priorities. Healthy Weight Working with children, young people and families since 2008 to promote healthy weight has shown that people often face a number of additional complex issues. Go 4 It! Programmes aim to provide a person centred service that is flexible enough to meet individual needs. It is particularly important to build good relationships with young people and their families with a focus on making manageable changes to their health behaviour. Physical Activity Physical activity remains a public health priority and we have worked hard to increase participation levels. Examples include working with Communities Healthy Dalbeattie Schools Sport and Leisure Services Our efforts focus on increasing opportunities and targeting population groups where levels of physical activity are known to be low. Building Healthy Communities Building Healthy Communities (BHC) aims to empower people to enhance their own health and wellbeing. It supports people to take up new self development and learning opportunities and gain more control of their own lives. It was also designed to reduce social isolation, promote learning options and increase community capacity to be able to tackle the physical and psychosocial conditions that affect health and wellbeing. Reducing health inequalities is a key element of the work, so the programme operates primarily in the more disadvantaged areas. BHC offers a range of options, particularly supporting local people by increasing opportunities for volunteering. Activities include Tai Chi, Tambourelli, creative writing, arts and crafts, as well as a project for growing local garden produce. Keep Well Keep Well is a person-centred programme that combines health checks with support to enable people to improve their own health. The programme works with peoples existing strengths and abilities and recognises their particular circumstances and needs. It is aimed at improving mental health and wellbeing as well as physical health. In 2013 / 14 the Keep Well team saw 955 people from target population groups across Dumfries and Galloway. The team saw people in a range of venues including Third Sector premises, workplaces, community venues and their own homes. If a health need is identified during a Keep Well check, people are referred onwards as appropriate. This is done in parallel with cognitive behaviour therapy aimed at empowering people to manage their own health and wellbeing. Oral Health NHS Dumfries & Galloway continues to implement the Childsmile Oral Health Improvement Programme. This programme includes; providing support to nurseries and schools across the region in the delivery of the supervised toothbrushing programme, provision of the nursery and school fluoride varnish programme in priority nurseries and schools and support to families to encourage registration with a dental practice from a young age. empower people to enhance their own health and wellbeing 12 13

8 Health Protection and Screening Health Protection and Screening Over the last year, there have been several important developments in health protection and screening in Dumfries and Galloway. Examples include: Immunisation In winter 2013 / 14, a successful pilot programme for the delivery of the new Fluenz nasal flu vaccine was carried out in seven primary schools and, at 76% uptake, it achieved the highest uptake in Scotland. Building on this, a multi agency steering group was established to deliver the programme to all primary schools. The benefit of the nasal vaccine is that it is administered simply by squirting the vaccine into the nostrils making it suitable for use in primary schools as a universal programme. Routine vaccinations for children and adults continue to be delivered with high uptake rates in Dumfries and Galloway. High levels of protection have been maintained with the MMR vaccine and other childhood immunisations, as well as introducing a number of schedule changes and new vaccinations. New vaccines recently introduced include shingles vaccine for the over 70s, whooping cough vaccine for pregnant women and rotavirus for babies. Information Technology The year has been a busy one for the implementation of new technology to health protection. In December 2013, a new Health Protection and Screening website ( was introduced which brings information about these two areas together in one place. The site is aimed at health professionals and members of the public as well as colleagues in other professions such as the care sector, environmental health and education. It has received several thousand visits and has had positive feedback. We update the site regularly. Routine vaccinations for children and adults continue to be delivered with high uptake rates in Dumfries and Galloway 14 15

9 Health Protection and Screening Children enjoying Dalbeattie Forest Cycling Newton Stewart Hospital Community Gardens Locality Health Improvement Teams There are four Locality Health Improvement teams, one each in Annandale and Eskdale, Nithsdale, Stewartry and Wigtownshire. All four teams have developed strong partnerships across the NHS, Council, Third and Independent Sectors. They have also established Community Partnerships to engage with communities about the planning and delivery of activity which will meet individual and community needs. Region wide programmes running in the localities include Lets Cook, Child Healthy Weight and Alcohol Awareness. These activities meet key priorities identified in the Dumfries and Galloway Single Outcome Agreement which aims to promote joint working between the public, Third and Independent Sectors to create an ambitious, prosperous and confident Dumfries and Galloway where people achieve their potential. Wigtownshire Annandale and Eskdale The Annandale and Eskdale Health Improvement Team has engaged with communities in Annan, Kirkpatrick Fleming and Gretna. The feedback from these sessions has been shared with partners and will be used to inform planning around living and keeping well. It is important that local people are actively involved in identifying and sharing information about community assets and developing activities, groups and services that meet their needs. A Community Link Worker role was developed to assist and support people to live life to the full, take back some control of their lives, better manage their health and connect back into the community. As a result Stewartry Nithsdale Annandale and Eskdale of this a number of initiatives have been developed including dementia friendly communities, best practice in dementia care, walking groups, long term condition groups, confidence building, arts and craft groups, Afore Ye Go sessions, and Carers support. Nithsdale Discussions with staff in Ward 7 at Dumfries and Galloway Royal Infirmary showed that while the majority of them did enquire about a patient s alcohol intake most admitted to lacking in knowledge and confidence about how to take this discussion forward. A pilot project involving the Nithsdale Health Improvement team was developed to provide training for appropriate ward staff to help with the early identification of hazardous drinkers. Stewartry Healthy Dalbeattie is a community led initiative aimed at improving community health and wellbeing through increased physical activity. Over the past twelve months the community has come together with support from the NHS, Council, Third Sector, Forestry Commission and private businesses to deliver a number of activities including Dalbeattie Forest Cycling and Walking event, the Give Me Space Campaign and Jog Leader Training. In addition a community consultation exercise led to the submission of several funding bids to improve infrastructure for active travel and recreational activity. creating an ambitious, prosperous and confident Dumfries and Galloway where people achieve their potential Wigtownshire Grounds 4 Better Health is a community garden project co-ordinated by Wigtownshire Health Improvement Team. There are two community gardens; one at the Galloway Community Hospital and one at Newton Stewart Hospital and they are open to anyone who wants to use and enjoy them. The people involved in the development of the community gardens benefit from the physical, mental, social or educational aspects of working on a development project. A referral form has been developed for GPs, Health Professionals, Schools, Statutory and Voluntary agencies if they want to refer someone to the community garden project

10 Patient Experience Table 1 Summary Complaints Data by Quarter & Annual Total Annual Q1 (Apr-Jun 2013) Q2 (Jul-Sept 2013) Q3 (Oct-Dec) Q4 (Jan-Mar 2014) Total Complaints received Complaints 48 (100%) 62 (95%) 62 (99%) 75 (94%) 247 (97%) acknowledged within 3 working days Complaints completed 23 (48%) 36 (60%) 34 (53%) 21 (27%) 114 (47%) within 20 working days Complaints where alternate dispute resolution was used Patient Experience NHS Dumfries & Galloway considers patient experience to be key to improving patient care. Feedback from patients, families, Carers and the public is sought both formally through the complaints process and informally through a range of methods. The information gained from these sources helps the Board to ensure that the services provided are in line with the quality strategy ambitions. This approach will continue to develop as we progress with the Person-Centred Health and Care Collaborative (PCHC). Significant work is being undertaken within services and with public partnership volunteers to identify, plan and implement change that will benefit patients and staff. The methodology of the PCHC collaborative is easily understood and staff are increasingly aware of and are using the Must Do With Me approach to ensuring that service delivery is in line with patient need. During 2013 / 2014 NHS Dumfries & Galloway has built on longstanding methods of obtaining feedback in an attempt to be more wide ranging with a view to involving the more hard to reach members of the population. The last 12 months has seen a focus on improving dementia care in our acute and community hospitals. Our Alzheimer Scotland Dementia Nurse Consultant has been working closely with our many dementia champions and is building a supportive framework to enable them, in conjunction with others, to improve the delivery of services for people with dementia. Four key dementia improvements have been identified and we are currently working towards implementation of these across the region. Our partnership working continues with all those involved in service delivery and we continue to strive to have a person centred care model at the forefront of our service delivery. Feedback, Comments, Concerns and Complaints NHS Dumfries & Galloway continued to gather feedback and suggestions from patients and service users throughout the year using a wide variety of methods. These included regular inpatient surveys which are carried out to find out the views of hospital patients on a wide range of issues, complaints, online feedback received via s, social media, our website and Patient Opinion ( uk) an independent website where patients can share their experiences of healthcare and health services. Feedback from all sources was shared with relevant staff and used to inform the design and development of new and existing services. During the year a total of 255 complaints were received and, while this is an increase on the previous year s total of 227, it still represents a very small percentage of the total number of patients treated during the period. 47% of these complaints were responded to within 20 days and work is underway to improve response times to ensure that patients receive feedback on the issues they have raised as quickly as possible. Table 1 provides a summary of complaints data by quarter for 2013/2014. Each complaint is thoroughly investigated and action is taken, if appropriate, to address any issues identified and ensure lessons are learned. The issues raised are also monitored to identify any patterns, trends or areas of potential concern. Frontline staff are closely involved in the complaints process and the outcomes of any investigations are shared with them to support ongoing education, learning and development. In addition, feedback and learning from complaints is shared with senior staff and discussed at a number of key meetings and committees across the organisation. While we fully recognise that sometimes we don t get things right, the vast majority of our patients have a positive experience and this is reflected in the feedback we receive. That s why this section not only includes a complaints summary, but also highlights some of the positive feedback received from patients and their families during 2013/

11 Quality and Patient Safety Quality and Patient Safety NHS Dumfries & Galloway continued to make good progress across the Scottish Patient Safety Programme improvement areas acute adult, maternity and children, mental health and primary care. Successful delivery of these programmes enables us to achieve all three ambitions of the Healthcare Quality Strategy for NHS Scotland; safe, effective and person-centred care. Scottish Patient Safety Programme: Mental Health The programme was rolled out to all wards in Midpark Hospital and the success of the pilots in phase one were spread across the adult service. This included improvements in risk management and safety planning, use of safety briefs, improvements in medicines safety and more effective communication processes. Technological Advances and Innovations Technology has the potential to transform the way we deliver health and care services. In 2013/14, NHS Dumfries & Galloway introduced a number of ehealth programmes. These programmes are designed to ensure services are more efficient, easier to access and safer for both patients and staff. In 2013/14, NHS Dumfries and Galloway: Commenced the process of transferring paper based medical notes to a new electronic document management system, called ecasenote. ecasenote will provide our medical staff with easy and secure access to relevant information about their patients. Introduced high speed electronic communications systems that allow our hospitals to communicate quickly and efficiently with dentists and high street opticians, which is a great benefit to patients in need of their specialist services. Clinicians are now able to request X-rays, laboratory tests and prescribe medications electronically, all of which reduce unnecessary administration. Community nurses are using electronic pens to take notes when visiting patients, which saves time and increases security. Technology has the potential to transform the way we deliver health and care services In addition, we are in the process of developing a new health and social care IT strategy. The strategy is designed to ensure information is shared effectively between partner organisations. NHS Dumfries & Galloway is also exploring new ways of delivering services for the future and Telehealth and Telecare are expected to have a major role. A number of tests of change are being carried out including remote monitoring of patients with Chronic Pulmonary Obstructive Disorder (COPD) to reduce unplanned hospital admissions, teleclinics where patients can use video conferencing equipment to attend clinics rather than travelling and the Community Respiratory Early Warning System (CREWS) which enables patients to monitor their symptoms so they know when they need help. In addition, we are using technology to make sure hospitals and GPs can share information about patients quickly and securely. To achieve this we are investing in ipad and epen applications so information is automatically added to patients ecasenotes and we continue to develop new ways for patients and their families to communicate with hospital staff and GP surgeries. Primary Care Thirty-two practices (94%) across Dumfries and Galloway signed up to take part in the Warfarin Local Enhanced Service which started in September Practices are making steady progress towards applying parts of the Warfarin requirements but it is too early for all six elements to show reliable implementation. Staff at Midpark took part in a series of training sessions designed to explain the programme s expectations and the tools and techniques to use. We worked closely with service users, Carers and Third Sector partners to ensure that their views and experiences will inform improvement priorities over the next phases of the programme. The national aim is for 95% of practices to adhere to systems for the reliable prescribing and monitoring of high risk medications, including Warfarin, by Local practices are currently at 25%

12 Volunteers and Involvement The Public Partnership Forum (PPF) continued to contribute to the patient and public perspective and participated in a number of activities: Members of the Infection Control Public Group held sessions in Dumfries & Galloway Royal Infirmary and Galloway Community Hospital to raise awareness of Infection Control, antibiotic use and correct hand hygiene. Visitors had the opportunity to review their hand hygiene technique using the Glow Box. PPF members attended the first Chest, Heart and Stroke Scotland Voices training day. The course was designed to provide the public with knowledge, skills and confidence to work in partnership with the NHS to help plan new and better services. The course has been adapted for adults with learning disabilities. Volunteers provide an important link between patients and staff in a wide range of wards and departments across the organisation Volunteers and Involvement People living with chronic pain were given the opportunity to attend a Chronic Pain Public Engagement Event. During the event people identified strengths and weaknesses of the current service. People expressed an interest in becoming public representatives on the chronic pain improvement group. NHS Dumfries & Galloway is grateful for the invaluable support received throughout the year from our many volunteers. This section highlights just a few examples of their wonderful work and the important contribution they make to local healthcare. Volunteers provide an important link between patients and staff in a wide range of wards and departments across the organisation, including Building Healthy Communities, cancer information and support, breastfeeding support and the welcome desk at Dumfries and Galloway Royal Infirmary. In November 2013 NHS Dumfries & Galloway renewed its accreditation with Investing in Volunteering. The process obliges organisations to meet rigorous requirements around quality, management, involvement and effectiveness of collaborations with volunteers. The award recognises the Board s significant investment to ensure volunteers are engaged in effective and meaningful programmes. Below: Infection Control Week presentation

13 Donations and Fundraising / Staff Awards and Achievements Donations and Fundraising The Bell family organised a Sporty September and raised for the Children s Ward. The money will be used to buy items to make childrens time in hospital more comfortable and less daunting. A group of final year University of the West of Scotland mental health nursing students took on a series of challenges and raised 900 for Midpark Hospital. Staff Awards and Achievements The dedication, commitment and expertise of staff across the organisation were recognised throughout the year with a number of key awards. It s not possible to mention them all but here are a few highlights from 2013/14. Caroline Frieslick, Biomedical Scientist, completed the London Marathon and raised 300 for Alzheimer Scotland. Creative Baking for Macmillan Biggest Ever Coffee Morning: Events included raffles, auction and a Bake Factor competition with prizes for the tastiest cakes. These took place at The Dumfries Health and Social Care Hub, Nithbank, High East, Crichton Hall and Dumfries Dental Centre. These events raised over 900 for Macmillan Cancer Support. Donna Coulter winner in the Support Worker category at the Scottish Health Awards 2013 Dementia Champions - Annual Event the Moore family presenting the cheque NHS Dumfries & Galloway Asthma Endownment Fund received a cheque for 5000 from the Moore Family. The money was raised at a family fun day organised by the Moore family. The money will be use to provide additional support and training for people living with the condition. James Wilson raised a fantastic for the Paediatric Speech and Language Therapy department. Staff complete the dementia champions programme Richard Smith NHS D&G Public Health Healthy Working Lives Lead with Young s Seafood Presented with Healthy Working Lives Award at the Scottish Health Awards

14 Our Year in Pictures Our Year in Pictures Celebrating Excellence Awards - NHS D&G biannual event which is similar to the Scottish Health Awards but on a local level Staff from care homes across Dumfries and Galloway attend the first organised Training Day for Falls Awareness Health Minister, Alex Neil MSP s Summer visit to site for Dalbeattie Primary Care Centre UNICEF Baby Friendly Award The STARS relaunch celebrated the NHS/Council integration of the service NHS Dumfries and Galloway s maternity service achieved accreditation through UNICEF s Baby Friendly Initiative, a programme designed to promote breastfeeding, in February As part of the process UNICEF examined infant feeding policies, training programmes and staff knowledge and skills before assessing how this work translates into patient experience. Andrew Johnston and Alison Burns Jeff Ace makes a pledge for NHS Change Day Vice chairman Andrew Johnston and Locality General Manager Alison Burns plant a tree to officially open the community garden at the Galloway Community Hospital. LGBT Charter awarded to Learning Disabilities and the Operations Directorate 26 27

15 Our Year in Pictures Our Year in Pictures George Thomson, Chief Executive Officer of Volunteering Scotland, and Andrew Johnstone, Vice Chair of NHS Dumfries & Galloway, with the Investors in Volunteering plaque. Safer Medicines Week Safer Medicines Week launches with a competition to design a logo to highlight the event pictured with the winning UWS student Newton Stewart Walking football health improvement initiative Abdominal Aortic Aneurysm Screening launched in the region At the dg science festival with staff from the Healthcare Science team Enhanced Patient Experience event Ann Hill with the Queen of the South Team Falls awareness week Tai Chi session held at Midpark Quilter in residence at DGRI Ann Hill with the Queen of the South Quilt (and Team) for Alzheimer Scotland s Hamden Park Quilt Project 28 29

16 Performance: HEAT Targets and Standards Multi agency Alcohol Conference involving police, health, council and third sector Celebrating volunteers group Performance: HEAT Targets and Standards Bidders for the New Build were invited to a special event In 2013/2014 NHS Dumfries & Galloway has achieved many of the Health, Efficiency, Access and Treatment (HEAT) targets and standards set by the Scottish Government. NHS Dumfries & Galloway has made progress against many of our significant HEAT targets and standards and across a wide range of strategic programmes. Key highlights include: Exceeding our health improvement targets in relation to smoking cessation, child healthy weight interventions and early access to antenatal care. Delivering our 18 weeks Referral to Treatment waiting time guarantee for 93% of patients. Improving access to our Child and Adolescents Mental Health Services, with 100% of patients receiving treatment within 18 weeks of referral. Maintaining financial balance and delivering on our efficiency saving targets. Simon and Kathleen Oliphant Lochfield Road Primary and Community Care Centre is officially opened by Simon and Kathleen Oliphant son and wife of the late Stuart Oliphant who was involved in the planning and development of the centre. Meeting the cancer waiting times for both 31 day and 62 day referral to treatment for 100% of patients. Exceeding the drug and alcohol waiting time target, with 100% of patients being seen within the three week waiting time period

17 NHS boards are required to monitor and report performance against these key HEAT targets and standards and are summarised in the table below. HEAT Target Performance At a Glance Outcome Indicators Performance: HEAT Targets and Standards Outcome Indicator Performance Direction D&G Scotland Data Date 1 Quality Indicators Overall Healthcare Experience No change Staff Attendance 95.5% 95.2% 2013/14 Declining Target Latest Performance Status Actual Planned Data Date Health Improvement Healthy Weight of Children Dec 2013 Amber Smoking Cessation 1,514 1,373 Dec 2013 Green SIMD Child Fluoride Varnishing 9.4% 60% Sept 2013 Red Detect Cancer Early No data N/A Antenatal Access 80.4% 83.5% Sept 2012 Green Staff reporting positive experience KSF 45% 39% 2013 No change review, PDP or equivalent Prevalence Healthcare Associated Infection 12.7% 4.9% 2011 No Trend (HAI) - DGRI Emergency Admissions all ages 9,726 10,042 Mar 2013 Declining (Rate per 100,000 population) Emergency Bed Days all ages 80,304 72,327 Mar 2013 Improving (Rate per 100,000 population) Hospital Standardised Mortality Ratios - DGRI Improving Efficiency and Governance Improvements Financial Performance ( 000s) 3,046 - Mar 2014 Green Reduce CO2 emissions (tonnes) Dec 2013 Green Reduce Energy Consumption (GJ) 160, ,144 Dec 2013 Green Premature mortality all causes Improving (Rate per 100,000 population) Personal Outcome Measure /14 Improving Self-assessed General Health 72.2% 75.7% 2008/11 No Trend (Very good/good) combined Access to Service Faster access to Mental Health Services (CAMHS) 100% 100% Dec 2013 Green End of Life Setting 93.4% 91.2% 2011/12 Improving Early Years Healthy Birth weight 90.4% 89.9% 2011/12 Improving Faster access to Psychological Therapies 79.1% 85.5% Dec 2013 Amber IVF waiting times No data N/A 4 Hour Accident and Emergency Waiting Times 95.2% 95% Mar 2014 Green Health Outcomes Life Expectancy at Birth (yrs) Males Improving Life Expectancy at Birth (yrs) Females Improving Treatment Appropriate to Individuals Rate of attendance at A&E 2,558 2,529 Mar 2014 Red (Rate per 100,000 population) MRSA/MSSA Bacteraemias Dec 2013 Amber C.Difficile infections ages Dec 2013 Amber Delayed Discharge (14 days) 9 0 April 2014 Amber Dementia Post Diagnostic Support No data N/A Emergency Bed Days for 75+ 4,775 4,274 Nov 2013 Amber Alcohol-Related Hospital Admissions (Rate per 100,000 population) /13 Improving Older People with Complex Care Needs 47.6% 34.1% 2013 Declining Cared for at Home Cancer waiting times (62 days) 97.6% 94.5% 2013 Improving Cancer waiting times (31 days) 98.8% 97.9% 2013 Improving Outpatients waiting longer than 12 weeks 63 4,561 Mar 2014 Improving for appointments 18 Weeks Referral to Treatment 93.3% 90.5% 2013/14 Declining Treatment Time Guarantee (% seen) 97.2% 94.4% 2013/14 Declining 1 Annual data unless stated 32 33

18 Annual Accounts Consolidated Statement of Comprehensive Net Expenditure and Summary of Resource Outturn Consolidated 2012 Board Endowments Consolidated Restated * Restated* Note 000 s 000 s 000 s 000 s 000 s Clinical Services Costs Hospital and Community 4 229, , , ,833 Less: Hospital and Community 8 (11,899) 0 (11,899) (12,354) (11,071) Income 217, , , ,762 Family Health 5 70, ,702 69,516 70,880 Less: Family Health Income 8 (1,974) 0 (1,974) (1,827) (1,958) 68, ,728 67,689 68,922 Total Clinical Services Costs 286, , , ,684 Administration Costs 6 3, ,154 2,912 2,868 Other Non Clinical Services 7 6,216 1,031 7,247 7,275 9,153 Less: Other Operating Income 8 1,348 (949) 399 (7,634) (5,499) Net Operating Costs 296, , , ,206 Other Comprehensive Net Expenditure s 000 s 000 s 000 s 000 s Net (Gain)/Loss on revaluation of (633) 0 (633) 3,901 (1,584) Property Plant and Equipment Net (Gain)/Loss on revaluation of Intangibles Net (Gain)/Loss on revaluation of available for sales financial assets Other Comprehensive Expenditure (633) 0 (633) 3,901 (1,584) Total Comprehensive Expenditure 296, , , ,622 * Prior year figure has been restated due to the requirement to consolidate the Endowment Funds, details can be seen in note 30 Consolidated Balance Sheet Annual Accounts Intra 2014 Consolidated Consolidated Board Endowments Group Consolidated Restated* Restated* 000 s 000 s 000 s 000 s 000 s 000 s Non-current assets: Property, plant and equipment 11d 118, , , ,493 Intangible assets Financial assets: - Trade and other receivables 13 5, ,493 11,414 8, , , , ,542 Current Assets: Inventories 12 1, ,240 1,281 1,291 Financial assets: - Trade and other receivables 13 4, (89) 4,653 4,435 4,515 - Cash and cash equivalents , ,203 2,173 2,324 Available for sale financial assets , ,462 6,680 5,929 Assets classified as held for sale 11c ,108 8,914 (89) 14,933 14,569 14,059 Current liabilities Provisions 17 (1,174) 0 0 (1,174) (1,680) (232) Financial liabilities: - Trade and other payables 16 (30,367) (155) 89 (30,433) (32,964) (32,030) (31,541) (155) 89 (31,607) (34,644) (32,262) Total Assets less Current Liabilities 99,383 8, , , ,339 Non-current liabilities Provisions 17 (7,945) 0 0 (7,945) (13,801) (12,485) Financial liabilities: - Trade and other payables 16 (8,655) 0 0 (8,655) (9,096) (9,500) (16,600) 0 0 (16,600) (22,897) (21,985) Total Assets less Total Liabilities 82,783 8, ,542 86,734 89,354 Taxpayers Equity General fund 53, ,438 48,752 48,176 Revaluation reserve 29, ,345 29,146 32,973 Other reserves (5) 0 Funds Held on Trust 0 8, ,759 8,841 8,205 Total taxpayers equity 82,783 8, ,542 86,734 89,354 * Prior year figure has been restated due to the requirement to consolidate the Endowment Funds, details can be seen in note

19 Annual Review Letter Annual Review Letter Mr Philip Jones Chair NHS Dumfries and Galloway Crichton Hall Bankend Road Dumfries DG1 4TG July 2014 NHS DUMFRIES AND GALLOWAY: 2014 ANNUAL REVIEW 36 Cabinet Secretary for Health and Wellbeing Alex Neil MSP T: E: 1. This letter summarises the main points and actions in relation to NHS Dumfries & Galloway s Annual Review, held in Dumfries on 30 June. 2. As you know, I want to ensure the rigorous scrutiny of NHS Boards performance whilst encouraging as much direct dialogue and accountability between local communities and their Health Boards as possible. As one of the Boards that did not have a Review chaired by a Minister this year, you conducted the Review meeting in public on 30 June. You clearly outlined progress and challenges in key areas and gave local people the opportunity to question yourself and the Chief Executive. I asked Government officials to attend the Annual Review in an observing role. This letter summarises the main points and actions in terms of NHS Dumfries & Galloway s performance in 2013/14, as organised under the six Health Quality Outcomes. Introduction and opening comments 3. As in previous years, all Boards are expected to submit a written report to Ministers on their performance over the previous year, together with plans for the forthcoming year. This selfassessment paper gives a detailed account of the specific progress the Board has made in a number of areas and is available to members of the public via the NHS Board s website, alongside this letter. 4. I understand that you opened the meeting on 30 June by presenting a helpful summary of the progress that NHS Dumfries & Galloway has made in a number of areas over the last year. You reiterated the Board s clear focus on patient safety, effective governance and performance management; and on the delivery of significant improvements in local health outcomes, alongside the provision of high quality, safe and sustainable healthcare services. Everyone has the best start in life and are able to live longer healthier lives 5. The Board is to be commended for its sustained achievement against both the 31-day and 62-day cancer access standards. I want to put on record my thanks for NHS Dumfries & Galloway s excellent performance against the smoking cessation targets to date. The Board achieved the March 2014 HEAT target (2,959 one month quits against a target of 2,100) with a significant proportion of this total (1,514) recorded from 40% of the most deprived local areas. An updated HEAT target has been agreed and I note that NHS Dumfries and Galloway s target is to help 357 local smokers achieve stopped smoking status at three months by March I also want to recognise that NHS Dumfries & Galloway has delivered over 12,082 Alcohol Brief Interventions (ABIs) between 2008 and 2014: this represents a 131% achievement against the Board s target of 9,244. This level of achievement and sustained delivery will support the HEAT standard for 2014/15 and our long term aim of embedding ABIs into routine practice. NHS Dumfries & Galloway, as part of the local Alcohol & Drugs Partnership, is making strong progress with the embedding of ABIs as a key activity in challenging alcohol related harm, including established delivery in the priority settings as well as developing delivery in wider settings such as arrest referral services. Health care is safe for every person, every time 7. Rigorous clinical governance and robust risk management are fundamental activities for any NHS Board, whilst the quality of care and patient safety are of paramount concern. Considerable work has been undertaken at all levels in recent years to ensure that Boards effectively respond to the findings and lessons to emerge from numerous high profile reviews such as the Francis Inquiry and previous reports in relation to events at Mid-Staffordshire NHS Trust. I am very pleased to note some of the local achievements which have been overseen by the Board s Health Governance Committee which carefully scrutinises performance in patient services and pathways to ensure they are fit for purpose and of the highest quality: a 46% reduction from May 2010-April 2011 to April 2013 March 2014 in confirmed cardiac arrests at Dumfries and Galloway Royal Infirmary (DGRI); a 74% reduction in surgical site infections within DGRI between 2007 and 2014; no central line bloodstream infections since June 2012; and a fall of 15.3% in the Hospital Standardised Mortality Ratio for DGRI since last October. 8. I am aware that there has been a lot of time and effort invested locally in effectively tackling infection control and that the Board has asked Health Protection Scotland to support the local approach and suggest areas for further action. It is also encouraging to note the Board s active participation in a research study examining the epidemiology of community submitted Clostridium difficile samples. I expect all Health Boards, including NHS Dumfries & Galloway, to remain fully committed to meeting the March 2015 HEAT targets for the reduction in incidence in Clostridium difficile and MRSA/MSSA. The Healthcare Environment Inspectorate (HEI) was set up by the former Cabinet Secretary for Health and Wellbeing with a remit to undertake a rigorous programme of inspection in acute hospitals. The first inspection took place at the end of September There has been one HEI unannounced inspection locally in the period under consideration: at Dumfries & Galloway Royal Infirmary on January and 22 January The Board has given me the assurance that all the requirements and recommendations identified as a result of the inspection have been properly addressed. Everyone has a positive experience of health care 9. I commend the Board for its strong performance over 2013/14 in terms of the 18 weeks referral to treatment target and against the 12 week Treatment Time Guarantee (TTG). I understand that there were a small number of breaches against the TTG in 2013/14, in the specialties of orthopaedics and ophthalmology and that, in the latter specialty, the breaches were paediatric cases for which no alternative capacity solutions were available in either the Golden Jubilee National Hospital or in the independent sector. I understand, however, that the Board has recently been successful in recruiting a new consultant in ophthalmology with a sub-specialty interest in paediatrics. The Board has also generally done very well against the stage of treatment targets. 10. A number of Health Boards across Scotland have struggled to meet and maintain the 4 hour A&E Waiting HEAT target over the last year though NHS Dumfries & Galloway has performed comparatively well in this regard. You have assured me that meeting the target and working towards meeting and maintaining the National Standard remains a key priority for the Board, with robust plans in place to address this, including sufficient additional staffing and bed capacity as reflected in the Board s updated Local Unscheduled Care Action Plan. As with all Health Boards, I expect a steady and sustained improvement in this critical area. 37

20 Annual Review Letter 11. I was encouraged to hear that NHS Dumfries and Galloway is fully subscribed to Patient Opinion as one of the methods by which the Board can reflect on the patient experience, with all postings on the site being reviewed by the Board s Governance Committee. I was also interested to note that local student nurses are now using electronic tablets to help patients provide real-time feedback to the Board. People are able to live well at home or in the community 12. I understand you presented a helpful overview at the Review of the progress the Board has made with the local, co-terminus, council in addressing the critical health and social care integration agenda. This includes the agreement to proceed locally under a body corporate model with 4 integrated localities across the region. Whilst you acknowledge that there remains much work to do on effective integration, you are confident that the existing, strong partnership working has established a solid platform for further progress. Indeed, this is reflected in the fact that the Dumfries & Galloway Partnership is one of the best performers in relation to delayed discharge, consistently recording low numbers of delays. I know you will ensure that the Board and its planning partners remain committed to fully involving local staff and their representatives as this important work progresses. Best use is made of available resources 13. It is vital that NHS Boards achieve both financial stability and best value for the considerable taxpayer investment made in the NHS. I am therefore pleased to note that NHS Dumfries & Galloway met its financial targets for 2013/14 alongside the Efficient Government target for the year and, based on the current in-year position, remain in line with the Board s financial plan in 2014/15. All efficiencies made through this programme are reinvested in health care. Conclusion 17. I would like to thank you and your team for hosting the Review. I understand the meeting was well received by attendees, and hope the approach helps in encouraging as much direct dialogue and accountability as is practicable. I thank the Board and its staff for an impressive performance in 2013/14: it is clear that the NHS Dumfries & Galloway is making significant progress in taking forward a challenging agenda on a number of fronts, including improving access, maintaining tight financial control and developing services in line with the 2020 Vision. The Board has very good relationships with its planning partners, and is fully aware that effectively building on such relationships will be crucial in continuing to progress the local health and social care integration agenda. 18. Whilst I am happy to acknowledge the many positive aspects of performance in NHS Dumfries & Galloway, I know you are not complacent and recognise that there remains much to do. I am confident that the Board understands the need to maintain the quality of frontline services whilst demonstrating best value for taxpayers investment. We will continue to keep progress under close review and I have included a list of the main performance action points in the attached annex. ALEX NEIL MSP 14. In terms of local capital projects, site preparation works are underway for the region s new 200m acute hospital in Dumfries. It is planned for construction work to commence in April 2015 and the facility is expected to open during 2017/18. The new primary care health centre in Dunscore was completed ahead of programme and on budget in June, and the new Craignair Health Centre in Dalbeattie is due to open in September. 15. Clearly, overall economic conditions mean that public sector budgets will continue to be tight whilst demand for health services will continue to grow. Nonetheless, you confirmed that the Board continues to actively monitor the achievement of all local efficiency programmes and, whilst the position is challenging, NHS Dumfries & Galloway remains fully committed to meeting its financial responsibilities in 2014/15 and beyond. 16. Whilst there is a record high number of consultants in our health service, Health Boards are looking to expand capacity and I want to recognise the on-going challenge NHS Dumfries & Galloway is facing in terms of filling some vacant consultant positions locally. Whilst NHS Dumfries & Galloway recognises that such challenges exist across the country, and that this is most pronounced in certain clinical specialties, the Board does have a higher percentage of vacancies than most other areas in Scotland, not least due to the geographical isolation of the region. I know the Board is making every effort to address the position, including the forthcoming launch of an international web-based recruitment campaign, in addition to marketing the advantages of working in Dumfries and Galloway to UK and Irish doctors. Similarly, I would also want to recognise the excellent medical training provided at DGRI, noting that in a survey conducted last year of trainees completing posts, Dumfries had the highest rating in Scotland. The Scottish Government will continue to work closely with the Board to try and effectively address these pressures, and in promoting Dumfries and Galloway as a great place in which to live and work

21 Annual Review Letter / Elected Board Pilot ANNEX NHS DUMFRIES & GALLOWAY ANNUAL REVIEW 2014 Elected Board Pilot ACTION POINTS The Board must continue to review, update and maintain robust arrangements for controlling Healthcare Associated Infection. The Board must continue to make progress on delivering against its health improvement objectives, including meeting and maintaining the relevant HEAT targets and standards. The Board must continue to deliver on its key responsibilities in terms of clinical governance, risk management, the quality of care and patient safety. The Pilot Elected Health Board came to an end on 31 December 2013 and the interest of all those who stood for election and the commitment of those individuals elected to the Board, is very much acknowledged and appreciated by colleagues across the organisation. Following an independent evaluation the Scottish Government announced that this approach was not the most effective way to engage with local communities and the elected Board was disbanded in December The Board must continue to promptly and effectively respond to the HEI and Older People in Acute Hospitals inspection reports. We remain grateful for the elected members hard work and dedication and wish them well for the future. The Board must keep the Health Directorates informed on progress towards achieving the HEAT access targets, including the 4-hour A&E target and standard. The Board must continue to work with planning partners on the integration agenda, and to ensure that local staff are fully engaged and involved in this process. The Board must continue to achieve financial in-year and recurring financial balance, and keep the Health Directorates informed of progress in implementing the local efficiency savings programme. 1. Penny Halliday 2. Tommy Sloan 3. George Willacy 4. David Hannay 5. Andrew Walls 6. Robert Allan 7. Anna Kelly 8. Lesley Garbutt 9. Alf Hannay 10. Dr John Moore

22 Board Members Board Members Non Executive Members Ronnie Nicholson, Local Authority 2. Moira Cossar, Chair Clinical Area Forum 3. Andrew Campbell 4. Andrew Johnston 5. James Beattie Employee Director 6. Dr Derek Cox, Director of Public Health 7. Dr Angus Cameron, Medical Director 8. Craig Marriott, Director of Finance 9. Jeff Ace, Chief Executive 10. Hazel Borland, Executive Nurse Director Executive Directors