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1 March 2018 Contents Staff awards and achievements Ayrshire Achieves Quality improvement in action awards Learning and development Quit your way Bowel screening event NHS Board update 26 March 2018 Chief Executive s report Chairman s report Quality Service Performance Decision / Approval Minutes Other business Next meeting Keep sending your news to comms@aaaht.scot.nhs.uk ** Please note that some of the links in this document are to items on AthenA, NHS Ayrshire & Arran s intranet, and so may not work for external users. If you require a copy of any information, please comms@aaaht.scot.nhs.uk ** Staff awards and achievements British Journal of Midwifery Awards - Early Pregnancy Assessment Unit The Early Pregnancy Assessment Unit, led by Elaine Pirrie, Fetal Services and Early Pregnancy Lead, was shortlisted Team of the year at the recent British Journal of Midwifery (BJM) Awards. The team was recognised for the the quality and innovative nature of the work they are doing. Reception at Buckingham Palace for nurses Three NHS Ayrshire & Arran nurses were invited to Buckingham Palace to attend a reception hosted by His Royal Highness the Prince of Wales, to recognise nurses at the point of care. Barbara McFadzean, District Nurse, Julie Barrett, Clinical Nurse Manager, and Queens Nurse Jan Thompson, Senior Charge Nurse, attended the reception. University Hospital Crosshouse Maxwell Suite Janice Gillan, Head of Clinical Support Services (East), along with the extended team at University Hospital Crosshouse, has been highly commended by the Intercollegiate Speciality Board, who recently

2 used the Maxwell Suite to hold the national Intercollegiate Speciality Examination in Oral & Maxillofacial Surgery. The team was praised for the facilities, as well as their assistance and service to the 25 patients, 25 examiners and 15 candidates involved. This event provided an opportunity for NHS Ayrshire & Arran to showcase the Maxwell Suite facilities, and Janice is hopeful the facilities will be used again for future exams. Stonewall Scotland - Workplace Equality Index special recognition Award NHS Ayrshire & Arran has been given a special recognition award for the excellent work to promote Lesbian, Gay, Bisexual and Trans (LGBT) rights across the organisation. Stonewall Scotland awards organisations who have excelled in their Workplace Equality Index (WEI), and they were impressed with our submission, in particular the community engagement and service users section. This is the first time we have completed the index. Patricia Leiser, HR Director, and Elaine Savory, Equality and Diversity Adviser, accepted the award on behalf of the organisation. iese Public Transformation Awards - East Ayrshire HSCP team The East Ayrshire Health and Social Care Partnership (HSCP) Community Health and Care team were presented with a silver award at the recent iese Public Transformation Awards for its innovative front door approach. The new approach is changing conversations with local people and seeing a real improvement in health and wellbeing. This multidisciplinary team, working with community partners, is a new single point of access that focuses on having the right conversations with people about what is most important to them. The team connects people with community resources, assists to coordinate support by putting people in charge of their own care and building on their strengths. NHSScotland event poster submission 38 poster submissions from NHS Ayrshire & Arran and the three partnerships have been selected for display at this year s NHSScotland event. With 235 posters on display in total, this is recognition of the fantastic work going on across Ayrshire and Arran. Let us know about your achievements If you, or a member of your team, have won an award or have been recognised for your work, please let us know. We can then share your successes around the organisation. StaffNews@aapct.scot.nhs.uk. Ayrshire Achieves Do you work with someone who always goes the extra mile to help their patients? Perhaps your team has introduced a new service which has benefited patients. Or, you may know someone whose work embraces the staff governance standards of our organisation.

3 Now you have the chance to recognise the contribution of your colleagues and volunteers through the Ayrshire Achieves 2018 awards scheme. There are nine award categories: Building relationships Caring for people - incorporating the Isabella Kimmett Compassionate Care Award Caring for our staff Light bulb moments - creativity and innovation Behind the scenes Leading by example Young employee of the year Volunteer of the year Team of the year To find out how you can nominate your health hero, click here. Ayrshire Achieves is supported by NHS Ayrshire & Arran's Area Partnership Forum, and funded by NHS Ayrshire & Arran s Charity Fund. The award scheme is sponsored by Bauer Holdings (West Sound and West FM). Quality improvement in action awards 2018 The application process is now open for the Quality improvement in action award The closing date for applications is Friday 30 March Building on the success of the Quality improvement in action award in 2017, the process has been reviewed and there will now be four categories for the 2018 awards: Excellence in quality improvement award Quality improvement champion award Quality improvement top team award Quality improvement inspiring leader award For more info and to access an application form, click here. Learning and development PDR Reviewers Training new date available Spaces are now available on the revised PDR Reviewers Training on Thursday 12 April 2018 in the Skills Lab, MacDonald Education Centre, University Hospital Ayr. Nominations should be sent from your line manager through emanager. Where this is not possible please nominations to elaine_connor@aapct.scot.nhs.uk. Click here for alternative PDR Reviewers Training sessions taking place throughout the year. SVQ Healthcare Support (Clinical) The new SVQ cohort for Healthcare Support (Clinical) is starting in September If you are interested please Billy Gibson billy.gibson@aapct.scot.nhs.uk for an application form. If you have any questions call extension The closing date for applications is 13 April 2018.

4 Shared learning event Friday 6 April All specialities, grades and professions welcome. Click here to find out more. Vale of Leven Scholarship Scheme In commemoration of those who died as a result of the C. difficile outbreak at the Vale of Leven Hospital, an opportunity has arisen for nurses, midwives and allied health professionals in Scotland to apply for support for research activity, that aims to make improvement(s) to patient care in line with recommendations of the Vale of Leven Hospital Inquiry Report An application form and guidance is available on the NMAHP Research Unit website, The closing date for applications is 31 May Quit your way Quit Your Way launched on Wednesday 14 March and is the new name for your local smoking cessation and advice service. Fresh Air-shire is now known as Quit Your Way. You can get all the same support and advice on smoking cessation from your local team. Contact them by on QYWAyrshire@aapct.scot.nhs.uk or freephone Celebrating 10 years of bowel screening in Ayrshire and Arran Join us on 25 April 2018 to celebrate the tenth anniversary of bowel screening in Ayrshire. Find out about the new test and about the importance of prevention, screening, early diagnosis and treatment. For more information, click here. To book a place contact Fiona McTaggart, Bowel Screening Audit Facilitator on or Fiona.McTaggart2@aapct.scot.nhs.uk

5 NHS Board update The NHS Board met on Monday 26 March 2018 in Common Rooms, Macdonald Education Centre, University Hospital Ayr. Here is a summary of topics discussed, with links to all the Board papers. Chief Executive s report The Chief Executive updated the Board on his recent involvement in a range of activities: This year s adverse weather brought significant disruption across the country. While Ayrshire was not affected as badly as some areas, we were impacted by the weather conditions affecting other parts of the country. The Chief Executive thanked staff across health and social care for their commitment to ensuring patient care was maintained throughout. Regional planning: The Chief Executive advised that the first draft plan will be submitted to Scottish Government at the end of March. The draft plan will look at our resourcing model, population health, and the overall model of care for West of Scotland. We will then embark on a programme of engagement and discussion to further develop the plan. By the end of May, we should have a more formed status of the plan, and how this will fit with local, regional and national work. The Chief Executive took part in the recent resilience planning exercise, Quattro 2. This exercise involved more than 400 people from NHS Ayrshire & Arran and our partner agencies and tested both hospitals, in terms of how we would react both tactically and strategically in the event of a major incident. Chairman s report The Chairman updated the Board on his recent involvement in a range of activities: The Chairman congratulated Stephen Brown on his appointment as Chief Officer for the North Integrated Joint Board. The Chairman welcomed Crawford McGuffie to the Board as Joint Medical Director. The Chairman encouraged Board members to consider nominating staff for an Ayrshire Achieves award, and also encouraged non-executive members to come along to the event. The Chairman also thanked staff for their efforts during the recent bad weather. He has filmed a vlog to acknowledge the efforts of our staff both in acute and community services and across the partnerships. Click here to access the vlog. Quality Patient story This month s patient story was from Sylvia. Sylvia has lived with diabetes for more than 25 years. She had always struggled to keep her weight down and despite several attempts over the years, she had not been able to sustain any weight loss. Sylvia was referred to the dietetic service team and received dedicated support, which allowed her to feel both empowered and supported to achieve a sustained weight loss. This story demonstrates that a self management approach can allow patients to understand their condition and make informed choices. Sylvia s story will be used to educate and inspire staff to reflect on the positive impact that adopting a person-centred approach can have on those using our services, and how it helps contribute to positive

6 outcomes. For more information on Sylvia s story, click here. Healthcare Associated Infection (HAI) report Healthcare Associated Infections (HAIs) are reported at each Board meeting. The report provides an overview and update of what we are doing to prevent and control HAIs: Staphylococcus Aureus Bacteraemias (SABs), including MRSA Clostridium Difficile Infections (CDIs) Meticillan resistant Staphylococcus aureus (MRSA) Outbreaks / incidents update From 1 April to 31 January 2018, there were 87 SABs, 17 above the locally set monthly maximum trajectory. Of these, 38 were hospital acquired, 15 were healthcare associated, and 34 were community acquired. There is a risk that we may not meet our target for the year. Peripheral vascular catheters (PVC) related SABs remain one of the most common potentially preventable cause of SABs (14 per cent), and so it remains the focal point of our SAB reduction strategy. From 1 April to 31 January 2018, there were 93 CDI cases, seven below the monthly maximum trajectory. Of these, 60 were healthcare associated, 24 were community acquired, and nine were unknown cases. The 2017/18 flu season has been the most significant, both in terms of GP consultation and number of outbreaks in care homes and hospitals, and has resulted in six outbreaks since the last report. The outbreaks were managed by closing the affected rooms, with three wards requiring full closure. For more information on our HAI activities, click here. Patient experience: Feedback and complaints report This report is for quarter three 2017/18 (October to December 2017). The number of concerns in quarter three dropped from 103 in quarter two to 71 in quarter three. This is partly due to the reclassification of some concerns to stage one complaints. This also accounts for the continual rise in the number of complaints: from 270 in quarter two, to 306 in quarter three. Compliance with the 20-day target for responding to complaints remains a challenge. We had seen an improvement in November However, this dipped to 24 per cent in December 2017, which can be attributed to increased pressures on services at that time of year. The top five complaint themes remain clinical treatment; attitude and behaviour; date for appointment; oral communication; and written communication. Of the 138 stories posted on Care Opinion during quarter two, 77 per cent were seen as not or minimally critical. For more information on how we use feedback and complaints to improve the quality of our services, click here. Scottish Patient Safety Programme: Mental health The aim of the Scottish Patient Safety Programme (SPSP) in mental health services is primarily to reduce avoidable harm to people using mental health services, while also reducing harm to staff working in the service. The Board noted the progress of the workstreams in respect of improvement activity. The five workstreams are: safer medicine management; risk assessment and safety planning; communication at transition; restraint and seclusion; and

7 leadership and culture. For more information on the Scottish Patient Safety Programme for mental health, click here. Equality outcomes : One year update NHS Ayrshire & Arran published the equality outcomes for in April 2017 in partnership with other public bodies in Ayrshire. The Board approved the processes put in place to drive forward a collaborative approach to ensure delivery of the agreed equality outcomes. There are four equality outcomes: 1. In Ayrshire, people experience safe and inclusive communities. 2. In Ayrshire, people have equal opportunities to access and shape our public services. 3. In Ayrshire, people have opportunities to fulfil their potential throughout life. 4. In Ayrshire, public bodies will be inclusive and diverse employers. To find out more about the equality outcomes and the progress made, click here. Service The state of child health: Adversity is not destiny - Population lens on adverse childhood experiences The evidence that Adverse Childhood Experiences (ACEs) are key drivers of morbidity and mortality among our populations has a significant impact on healthcare need and demand. ACEs refer to specific stressful events occurring in childhood (between 0 to 18 years). Addressing the issue of ACEs is therefore fundamentally important to achieving transformational change and upholding the United Nations Convention on the Rights of the Child. The Board received an update on how ACEs can impact on overall health outcomes, and agreed to support NHS Ayrshire & Arran, along with the health and social care partnerships, community planning partnerships, and partners to become more resilient trauma-informed, trauma-sensitive organisations. The Board endorsed the creation of a pan-ayrshire ACEs / trauma-informed community of practice across Ayrshire. For more information on the state of child health report and ACEs, click here. Delivering the new 2018 General Medical Services (GMS) contract The new General Medical Services (GMS) contract agreed in January 2018 outlined the requirement for Integration Authorities to develop a three-year primary care improvement plan by 01 July The Board agreed that within Ayrshire and Arran, there should be one coordinated primary care improvement plan, with a focus on local priorities and delivery where services are commissioned within the Health and Social Care Partnerships (HSCPs) based on population need. This will be an overall introductory plan that meets both the national and pan-ayrshire requirements with three distinct sections for each of the HSCPs to deliver the local needs of each Integration Joint Board. For more information on the GMS contract, click here. Performance Unscheduled care

8 This section is focussed on unscheduled care, with the following three themes: reduce emergency admissions by providing accessible community alternatives; reduce occupancy and length of stay by improving systems and processes within the acute hospital; and reduce delays in discharge by providing appropriate community capacity. The Board received a new format report on unscheduled care performance, which shows progress over the past three years. Unscheduled care demand continues to increase within the Ayrshire Health and Social Care system. This results in increased demand for community services and hospital care beyond current resources. Improvement has been made on many health and social care indicators since the 2015 baseline when HSCPs were formed, resulting in many more people being cared for at home than in previous years. However, pressure on our acute hospitals remains high resulting in additional bed capacity being deployed to meet needs of patients within the hospital system. For more information on our unscheduled care performance, click here. Planned care This section is focussed on planned care. At the end of January 2018 there were a total of 710 patients who had waited more than 84 days for treatment. For 18-weeks Referral to Treatment (RTT), performance remains below target: we achieved 77.4 per cent in January 2018, against a target of 90 per cent. This is linked to the issues with stage of treatment performance and recruitment difficulties. The 31-day cancer waiting time was 97.5 per cent for December We were below the 62-day cancer target, with performance of 87.5 per cent. There is no consistent trend across the cancer specialties and drops below target tend to be as a result of specific issues with individual patient journeys. In Mental Health Services, the target for drug or alcohol treatment is three weeks from referral. We achieved 97.8 per cent for January 2018, against a target of 90 per cent. For Child and Adolescent Mental Health Services (CAMHS), we achieved per cent against a target of 90 per cent for January For Psychological Therapies, we achieved 84.1 per cent against a target of 90 per cent for December A whole system review of psychological services is underway supported with additional Scottish Government funding and investment in improving access. Waiting times for Musculoskeletal (MSK) were at 87.7 per cent for February The reduction in patients being added to the waiting list and increases in clinical resource available has produced a steady improvement in performance over the last year. However, since January 2018, demand has increased on the same period for last year, and so continued improvement will be challenging. For more information on our planned care performance, click here. Financial management report At month 11, NHS Ayrshire & Arran has an overspend of 21.1 million, and therefore the projected outturn at year end is 23 million deficit. The main issues are unfunded unscheduled care beds remaining open in acute hospitals and efficiency savings not yet identified. It is essential that everyone considers how the decisions they take impact on spend and ensure best value at all times. The North Integrated Joint Board (IJB) is projecting a health deficit due to unachieved efficiency savings of 1.57 million. East and South IJBs are forecasting to break even. For a copy of the financial management report to 28 February 2018, click here.

9 Decision / Approval Capital programme The Board endorsed the capital programme 2018/19 to enable allocations to be issued for the start of the financial year. For more information on our capital programme, click here. Allocation and funding available for The Board noted the position regarding funding for 2018/19, and approved a rollover of existing budgets (including to Integration Joint Boards). An updated budget will be presented for approval at a future Board meeting. For more information on allocation and funding available, click here. Minutes The Board received the following minutes: Ayrshire and Arran NHS Board 29 January 2018 (draft) Audit Committee 21 February 2018 (draft) Healthcare Governance Committee 5 March 2018 (draft) Information Governance Committee 19 February 2018 (draft) Performance Governance Committee 12 March 2018 (draft) Staff Governance Committee 24 January 2018 (draft) East Ayrshire Integration Joint Board 25 January 2018 (approved) North Ayrshire Integration Joint Board 18 January 2018 (approved) and 15 February 2018 (approved) South Ayrshire Integration Joint Board 14 February 2018 (approved) Other business Brokerage from the Scottish Government The Board approved of the decision by the Chairman and Chief Executive to submit a letter to Scottish Government seeking brokerage of 23 million. This is to fund the deficit for 2017/18. Quality improvement masterclass Employee Director, Stewart Donnelly, attended a recent quality improvement masterclass, along with other Board members. The event allowed delegates to share best practice, and consider safety across NHSScotland. He encouraged Board members to attend future events. Integration Joint Boards Ayrshire Integration Joint Boards were established on 1 April 2015 and on 31 March 2018 it will be three years since a number of NHS Ayrshire & Arran Board Members were appointed to the three Ayrshire IJBs. Under the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 and the three

10 Ayrshire Integration Schemes, the term of office of a member of the integration joint board is not to exceed three years. The Act advises that at the end of a term of office, a member may be reappointed for a further term of office. The Board confirmed the reappointments to the Ayrshire Integration Joint Boards and noted the reappointment dates for all members in line with the three year appointment process. Bob Martin has been appointed North Ayrshire Integration Joint Boards Chair and Dr Martin Cheyne has been appointed as a member of the North Ayrshire IJB. Next meeting The next meeting will take place on Monday 21 May at 9.15am in Greenwood Conference Centre, Irvine.