NHS DUMFRIES AND GALLOWAY ANNUAL REVIEW 2015/16 SELF ASSESSMENT

NHS DUMFRIES AND GALLOWAY ANNUAL REVIEW 2015/16 SELF ASSESSMENT

Chapter 1 Introduction This self assessment sets out the performance of NHS Dumfries and Galloway for the year April 2015 to March 2016. Included with this self assessment is an At a Glance outcomes and performance table that shows how the Board has performed against key targets. 2015 / 2016 has been another busy and successful year with a number of significant new developments including:- Work on the new District General Hospital progressing on time, aiming to hand over the building to NHS Dumfries and Galloway in autumn 2017. The Board working through the shadow integration year in preparation of the new Dumfries and Galloway Health and Social Care Partnership, overseen by an Integration Joint Board, going live on 1 st April 2016Dumfries and Galloway Integration Joint Board was established as a body corporate by order of the Scottish Ministers on 3 October 2015 as part of the establishment of the framework for the integration of health and social care in Scotland under the Public Bodies (Joint Working) (Scotland) Act 2014. The IJB has responsibility for providing adult social care and defined health care services for the residents of Dumfries and Galloway During 2015/16 the was Strategic Plan developed for approval by the Integration Joint Board. All Dumfries and Galloway health services have been delegated to the Integration Joint Board Since 2014/15 the NHS Board has seen the appointment of seven new Non- Executive Board Members, following the withdrawal of the elective Board Members within NHS Dumfries and Galloway. Continuous development has been undertaken amongst the Board members through a variety of methods, to increase their knowledge and understanding of the services delivered by the NHS Board. This development had also supported NHS Non-Executive Board Members to better understand their role in providing assurance to the general public that we will strive to continue to deliver quality and safety improvements in 2016 / 2017 and to ensure that the NHS Board is able to deliver excellent care that is person-centred, effective, efficient and reliable. This self assessment seeks to set out, in detail, the progress that has been made across NHS Dumfries and Galloway through 2015/16, covering the nine national health and well-being outcomes set out by Scottish Government, which are noted below: People are able to look after and improve their own health and wellbeing and live in good health for longer Page 2 of 18

People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community People who use health and social care services have positive experiences of those services, and have their dignity respected Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services Health and social care services contribute to reducing health inequalities People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being People using health and social care services are safe from harm People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Resources are used effectively and efficiently in the provision of health and social care services All of the achievements and improvements of the last year are a result of the dedication and commitment of everyone working across our healthcare system and the focus on continuous improvement that has become the way we work. Page 3 of 18

Chapter 2 Actions from 2014 / 2015 Annual Review Following the Annual Review for 2015 / 2016, the Cabinet Secretary for Health and Wellbeing wrote to the Chairman of the Board inviting it to:- 1 Keep the Health Directorates informed of progress with its significant local health improvement activity; 2 Continue to review, update and maintain robust arrangements for controlling Healthcare Associated Infection; 3 Continue to deliver on its key responsibilities in terms of clinical governance, risk management, quality of care and patient safety, including a prompt and effective response to the findings of HEI and Older People in Acute Care inspections; 4 Keep the Health Directorates informed on progress towards achieving all access targets; 5 Continue to work with planning partners on the critical health and social care agenda; 6 Continue to achieve financial in-year and recurring financial balance; 7 Keep the Health Directorates informed of progress with redesigning local services in line with the Board s clinical strategy. Work continues on all of the areas above and NHS Board have been kept informed of progress. Page 4 of 18

Chapter 3 Person Centred Scottish Government has set out nine national health and well-being outcomes, which have been incorporated within all services delivered through health. Noted below are those key outcomes, which we believe to be key to the delivery of delivering person centred care: People are able to look after and improve their own health and well-being and live in good health for longer; People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community; People who use health and social care services have positive experiences of those services, and have their dignity respected. As part of the establishment of the Dumfries and Galloway Health and Social Care Partnership, NHS Dumfries and Galloway have accepted the terms of the Integration Joint Board s Strategic Plan and the impact this will have on the services we deliver moving forward. The 2016-2019 Health and Social Care Strategic Plan lays out how we currently provide health and social care and support, highlights potential areas of improvement and describes our key areas of focus over the next three years. Below is a summary of key areas of focus in relation to person-centeredness where resources and activity was directed toward throughout 2015/16 Enabling people to have more choice and control There is a need to enable people to have more choice and control of their lives, drawing on support from their families, friends and communities to make the most of their potential and abilities. New approaches must be much most person-centres, with the person being in control of their own care and support and being an equal partner in making decisions about their care. Supporting Carers Providing support to Carers is an increasing local and national priority. They are the largest group of care providers in Scotland, providing more care that the NHS and Council combined. NHS Dumfries and Galloway are committed to creating a supportive working environment for Carers within the Dumfries and Galloway Partnership Page 5 of 18

Developing and strengthening communities There is evidence that using low level community and social support can greatly increase a person s potential to better manage their health, live well in their homes and communities for longer, and reduce loneliness. Identifying and making best use of the assets and resources that exist at both an individual and community level is, therefore, a valuable starting point to do this. The value of volunteers to communities is well documented, as are the benefits of volunteering to the individual. There is evidence that volunteering can improve well-being, increase confidence and strengthen someone s links with their community. This way of working encourages real partnerships, which mean listening to what people say they need and what would make a difference. It also means involving people in decision-making, so that they can be in control rather than passively receiving services. To demonstrate that NHS Dumfries and Galloway are providing a person-centred service, highlighted below are three of the key achievements made in 2015/16: Carers Support Plans are now available for those Carers who want them. These are plans developed with the Carer to help ensure that the needs of the Carer, as an individual in their own right, are met NHS Dumfries and Galloway achieved the Engaged level of the Carer Positive award ensuring flexibility and support for staff who work in the organisation who have Caring responsibilities. Building Healthy Communities (BHC) is a community development programme across Dumfries and Galloway, which supports and encourages individual and community resilience. A key aspect of the agenda is community engagement and working closely with local people to develop their understanding and skills around improving and maintaining good health. A recent external evaluation has reported that the large majority of users of BHC reported spending more time with people, gaining new skills and having better health and more self confidence. A new volunteer co-ordinator for the new hospital has been recruited. In contrast to the key achievements noted above, we must consider how the services will develop going forward. Below are the key challenges NHS Dumfries and Galloway face in 2016/17: Working together with Carers, we need to identify with them, how we can further improve support to Carers; Page 6 of 18

We need to consider how we can better identify and utilise community assets; We seek to increase the number of volunteers we have in the region; BHC will move from Public Health into the localities as part of the integration of Health and Social Care to work directly with communities. There is a need to maximise effective practice to support community resilience in an equitable way across the region. Individual health behaviours are also important in contributing to resilience and demands on services. We plan, over 2016-17, to review current services aimed at supporting health behaviour change to make these more generic and personcentred. Page 7 of 18

Chapter 4 Safe Below are the national outcomes, key to delivering care that is safe: Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services; People using health and social care services are safe from harm. Below is a summary of key areas of focus in relation to safety where resources and activity was directed toward throughout 2015/16 Maintaining safe, high quality care and protecting vulnerable adults This is a key priority for the health board and more specifically going forward for the Integration Joint Board. National policy to protect people has moved forward significantly over the last 10 to 20 years with new laws for adults with incapacity, mental health care and treatment and, most recently, adult support and protection. Under the Adult Support and Protection (Scotland) Act 2007, public sectors have a duty to report concerns relating to adults at risk and the council must take action to find out about and, where necessary, intervene to make sure vulnerable adults are protected. Key partners have been made fully aware of their responsibilities in the protection of vulnerable adults. There are a number of programmes aiming to reduce the risk of harm to people. The Scottish Patient Safety Programme (SPSP), launched in 2008 is one of these. While at first the programme was focused on acute (hospital bases) care, it now encompasses acute adult care, maternity and children s care, mental health care and primary care. To demonstrate that NHS Dumfries and Galloway are providing a safe service, highlighted below are three of the key achievements made in 2015/16: Scottish Patient Safety Programme maintaining all the streams of the programme whilst building the will within teams to develop further. Risk development of an Executive Risk group, which has overseen the corporate risk register update and supported Directorates to ensure their risk registers are current. Page 8 of 18

Older People working with Alzheimer Scotland, Dumfries and Galloway Council and other 3 rd sector organisation as a key partner in the Dementia Friendly Communities Initiative funded over 3 years through a Life Changes Trust grant award. In contrast to the key achievements noted above, we must consider how the services will develop going forward. Below are the key challenges NHS Dumfries and Galloway face in 2016/17: Scottish Patient Safety Programme ensuring we can support the move from testing change to full implementation across all appropriate areas within a reasonable timeframe. Risk Supporting the integration of health and social care risk strategy. Older People drawing together, clarifying for staff and ensuring appropriate action on the various standards which apply to the care of older people in and out of hospital e.g. care of older people in hospital, dementia, food fluid and nutritional care standards and the 9 national outcomes. Page 9 of 18

Chapter 5 Effective Below are the national outcomes, key to delivering care that is effective: Health and social care services contribute to reducing health inequalities; People who provide unpaid care are supported to look after their own health and well-being, including to reduce any negative impact of their caring role on their own health and well-being; People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide; Resources are used effectively and efficiently in the provision of health and social care services. Below is a summary of key areas of focus in relation to safety where resources and activity was directed toward throughout 2015/16 Making the most of well-being Making the most of and maintaining health and well-being is always better than treating illness. Where possible the aim is to prevent ill health or, where health or social care needs are identified, to make sure there are appropriate levels of planning and support to prevent further deterioration. A proactive approach is required to achieve this aim, including o Action from an early age and across the whole of a person s life; o An awareness of potential impacts of physical, spiritual, psychological and social influences on a person s well-being; o Identification of issues that can impact negatively on a person s overall well-being, such as loneliness, isolation and financial poverty. Shifting the focus from institutional care to home and community based care New models of care and support should reflect and promote the shift towards greater choice and control for people and make a positive difference to their outcomes. As a result, it is crucial that people who use services, and their Carers and families are involved in designing them, specifically through the development of clinical and care pathways. Page 10 of 18

Reducing health inequalities Health inequalities are unjust differences in health outcomes experienced by people. They can arise from circumstances in which people live, the long term conditions that they have and the opportunities they have for health and social well-being. People from minority communities or with protected characteristics may experience health inequalities, for example in accessing care and support. Reducing health inequalities involves action on the broader social issues that can affect a person s health, including education, housing, loneliness and isolation, employment and income. Partnership working across the Local Authority, Health, the Third Sector, the Independent Sector and local communities is vital to addressing the inequalities that lead to health inequalities. Well-being is not achieved by focusing only on improving the health of individuals. It is important that services are designed and delivered in a way that enables those most in need to have easy access. It is this approach, at both a strategic and locality level, which will lead to healthier adults able to live fulfilling and independent lives. As well as focusing specifically on health and social care for adults, programmes of work are being developed to improve the health and well-being of children and young people to make sure they grow into healthy adults. Making the best use of technology Using technology to help achieve our aims is a basic building block to delivering the 20:20 vision for Scotland. In the future, the vast majority of care and support will be provided in community settings. Developing and delivering information and communication technologies and a programme of Technology Enabled Care is critical to achieving seamless and sustainable care and support across the entire health and social care spectrum. To demonstrate that NHS Dumfries and Galloway are providing an effective care through health services, highlighted below are three of the key achievements made in 2015/16: As part of the Integration planning process all of our four localities now have locality plans 2016-19, these were developed in consultation with key stakeholders and in particular the communities that form our localities. Specific initiatives that have developed from these plans involving re-ablement, pharmacy, intermediate care and technology enabled care are all directed at keeping people in their own homes for longer or being able to safely discharge people from hospitals to their communities more timeously. Page 11 of 18

Reducing inequalities is a priority for both the NHS and the Integrated Joint Board. For NHS Dumfries and Galloway it is included in the corporate risk register. In 2015/16 the Public Health directorate led on the development of an Inequalities Framework and Toolkit. The Inequalities Framework is aimed at supporting all those involved in developing policies, guidelines, interventions, programmes and services by providing information and tools necessary to address inequalities In 2015/16 work has developed through the Health and Social Care Integration agenda which seeks to strengthen the connection between housing and health and social care. Partnerships and structures have been established to take forward work linking housing and health. To inform future housing and health related work and ensure local activity is based on best evidence, local intelligence arrangements have been made to undertake a Housing and Health Needs Assessment (HHNA). The HHNA will build upon the Housing and Health Needs Assessment Scoping Study which was completed in early 2016 and link to the recently completed Dumfries and Galloway Housing Needs and Demand Assessment. Links have been made with other NHS Boards and ScotPHN in order to share information and knowledge. Reducing inequalities is a priority for both the NHS and the Integrated Joint Board We have secured funding through the Scottish Government Technology Enabled Care Programme that will support the use of technology in the delivery of care and support In contrast to the key achievements noted above, we must consider how the services will develop going forward. Below are the key challenges NHS Dumfries and Galloway face in 2016/17: We need to ensure that services are designed and delivered in a way that enables those most in need to have easy access We must ensure that people are able to realise the benefits that technology enabled care can provide by developing a programme of work in this area We will continue to work to ensure that more people are effectively supported through preventative and early intervention approaches shifting focus away from a crisis management approach Page 12 of 18

Chapter 6 Workforce The Staff Governance Standard provides a statutory framework for the continuous improvement of policies and practices in relation to staff management. The five Staff Governance Standards are; Well informed Appropriately trained Involved in decisions which affect them Treated fairly and consistently Provided with an improved and safe working environment The staff governance standards support delivery of the Scottish Government s 2020 Workforce Vision and action plan, within which specific actions were defined for Board delivery during 2015/16 in relation to the following 5 workforce themes; Healthy organisational culture Sustainable workforce Capable workforce Integrated workforce Effective leadership and management Our continuous improvement goals for 2015/16 in relation to the staff governance standards and the 2020 vision workforce themes were set out in our Staff Governance Action Plan, which was approved and monitored by the Staff Governance Committee. As in previous years, we have benefited from very positive partnership working relations with our representative Trades Unions. By working together through our Area Partnership Forum structure we have led a comprehensive programme of work to continuously improve the engagement of our staff, and meet the Staff Governance Standards. In 2015 we undertook another national staff survey, and the results of this, and the previous survey in 2014 have given the Partnership Forum focus on areas for improvement to enhance our staff s overall experience of working in NHS D&G. Organisational culture Person Centred As part of our programme of preparation for integration, during this shadow year we worked with our partners to undertake a very significant diagnostic exercise to understand better our organisational culture, and that of each of our partners. Through this exercise we have identified both our current culture profile - how we do things round here and also the ideal culture profile that will best serve to deliver our patients and clients needs across the integrated Health and Social Care system. Page 13 of 18

During 2014 the Board confirmed its CORE values as; Compassionate Open Respectful Excellent The diagnostic results have confirmed that these values remain relevant and appropriate across the health workforce, and thus have, and will continue to be an anchor for our NHS culture development programme going forward over the next 3 years. During 2015/16 we recognised the need for staff to be well informed and involved in decisions, given the level of transformational change being undertaken both in relation to the new build hospital, clinical redesign and health and social care integration. Working with staff side colleagues we have increased the frequency, volume and impact of staff focused communications at both local and corporate levels over the past year, to seek to ensure that all staff have the information that they need about the changes and how they will affect them. We recognise that communications is a challenging and complex area of staff engagement, and whilst we have made progress this year, we are not complacent and are continuing to work on this as part of our 2016/17 Staff Governance Action Plan. Sustainable workforce Safe and effective The Board experienced significant challenges in recruiting to a number of specialties and vacancies within the medical workforce during 2015/16, and this has been recognised as one of the key risks for our organisation in the coming years. Whilst it is acknowledged that many of the issues affecting the medical workforce are national issues relating to the supply of trained and junior doctors across the UK and internationally, our medical director, working with our Director of Medical Education have maintained a strong focus on our local needs in 2015/16, and have sought to address local issues that have affected our competitiveness and attractiveness as an employer relative to other Boards in Scotland. This focused and person centred approach, working with individual posts and applicants, was successful and resulted in a number of new appointments over the year. The challenge remains ongoing however, as the turnover due to retirement and transfers to other Boards remains, along with an increasing pressure on General Practice medical provision within primary care. During 2015/16 we focused our workforce planning activity on the requirements for our new build hospital, due to open in 2017, and the workforce planning needs of the collective heath and social care workforce. Detailed workforce planning continues for the new build, and is integrated with the service and financial planning also being undertaken. Page 14 of 18

We established a workforce transition partnership group to lead and manage the policies, practices and processes required for the transition to the new hospital, and this group is contributing significantly to the planning for the new hospital, to ensure that staff are well informed and involved in decisions which affect them. Through the work of our Organisation Development (OD) Integration Transition group we developed our first integrated workforce plan for the Integrated Joint Board, working with partners from the Council, Third and Independent sectors and staff side. Whilst at an early stage of development, our approach involving all of our partners in its development and ambition was recognised as amongst the most ambitious in Scotland, and was acknowledged accordingly. The OD transition group have also led on a wide range of training and OD interventions across the localities, to support staff, managers and leaders to develop the skills and knowledge they require to work within integrated teams. We have continued to invest in a wide range of training and development programmes for staff at all levels on the organisation this year, to support staff to develop both technical, professional, front line management and leaderships skills and abilities they require to undertake their current roles, and develop for future roles within the organisation. Examples of programmes undertaken through the year include the second cohort of our ASPIRE to lead front line nurse development programme, and dementia champions training and carer awareness training. We have also invested in development sessions for our Board and its members over the past 12 months to enable them to undertake their collective strategic leadership role more effectively. Our sickness absence levels, whilst running slightly below the national average of 5.16%, have exceeded the NHS Scotland 4% target, running at 5.08% for the year average. We recognise that we must refocus our efforts during 2016/17 on this important area of operational sustainability, and our Staff Governance Committee are committed to scrutinising our performance in order to identify and support opportunities for improvement. To demonstrate that NHS Dumfries and Galloway has an engaged and motivated workforce that deliver high quality services to the region we have noted below three of the key achievements that were made within 2015/16: Engaged our staff with partners to establish our base line for our Culture development programme Increased the scope, frequency and impact of our staff communications in support of the key transformation programmes we are undertaking over the next 3 years. Designed and developed our workforce transition plan and processes through effective partnership working Page 15 of 18

In contrast to the key achievements noted above, we must consider how the services will develop going forward and highlight below the key challenges NHS Dumfries and Galloway will face in 2016/17: Recruiting and retaining sufficient skilled and experienced doctors and other scarce resources to fulfil our service requirements Reducing sickness absence levels in line with Scottish Government targets Increasing staff engagement and consequent patient experience through our culture development programme over the next 3 years Page 16 of 18

Chapter 7 Finance NHS Dumfries and Galloway continued its recent successful trend of delivering a secure financial position by breaking even once again in 2015/16 and achieving all its financial targets. The Board has continued to make good progress on its major infrastructure projects. These included the completion of a new women and children s services hub at the Crichton campus and the ongoing development of the region s new acute hospital on the outskirts of Dumfries. The Scottish Government Health and Social Care Directorates set three financial targets at Health Board level on an annual basis. These limits are: Revenue Resource Limit a resource budget for ongoing operations; Capital Resource Limit a resource budget for net capital investment; and Cash requirement a financing requirement to fund the cash consequences of the ongoing operations and net capital investment. The following table highlights the Boards delivery against these targets 2015/16 Target Delivery Variance Actual (Over) / Outturn Under 000 s 000 s 000 s Limit as set by SGHSCD Revenue Resource Limit Core 299,389 299,329 60 Non-Core 7,098 7,098 0 Total 306,487 306,427 60 Capital Resource Limit Core 60,075 60,058 17 Non-Core 0 0 0 Total 60,075 60,058 17 Cash Requirement 317,768 317,768 0 To demonstrate that NHS Dumfries and Galloway is performing well against all targets and within budget we have highlighted below three of the key achievements that were made within 2015/16: Delivery of a break-even financial position once again. On-going delivery of significant efficiency savings (3% in 2015-16) Page 17 of 18

Investment in appropriate infrastructure in ensuring a successful start to the building of the new hospital project, implementing the clinical change programme and finalising the costs of the new staffing models in time for the opening of the new hospital. In contrast to the key achievements noted above, we must consider how the services will develop going forward and highlight below the key challenges NHS Dumfries and Galloway will face in 2016/17: Impact of workforce challenges and the ability to recruit and retain medical staff in particular, with increasing levels of reliance on temporary staff. Innovative solutions have been identified and agreed in trying to ensure key staff groups are attracted to securing employment within the Region. This continues to remain a key risk for the Health Board. The significantly increased level of challenge in the delivery of on-going efficiency savings, with the level required for 2016-17 at unprecedented levels (5%). Whilst NHS Dumfries and Galloway have proven to have a good track record on achieving CRES, the challenge of continuing to identify recurring savings at this level remains high. Implementation of infrastructure to support the Integrated Joint Board and report on key issues as one corporate body. Page 18 of 18

NHS Dumfries & Galloway: At a Glance Outcome Indicators Outcome Indicator D&G Performance Scotland Data Date 1 Direction Quality Indicators Overall Healthcare Experience 85% 84% 2016 Improving Staff Attendance 94.9% 95.0% 2015 / 16 No change Staff reporting positive experience KSF review, PDP or equivalent Emergency Admissions all ages (Rate per 100,000 population) Emergency Bed Days all ages (Rate per 100,000 population) Hospital Standardised Mortality Ratios DGRI Premature mortality all causes (Rate per 100,000 population) 45% 43% 2014 No change 10,468 10,335 2014 / 15 Declining 88,037 73,597 2014 / 15 Declining 0.88% 0.97% Jan Mar 2016 Improving 393.7% 437.5% 2013 No change Early Years Healthy Birth weight 91.4% 90.0% 2014 / 15 Improving Health Outcomes Life Expectancy at Birth (yrs) Males 78.0% 77.1% 2012-14 No change Life Expectancy at Birth (yrs) Females 81.5% 81.1% 2012-14 No change Alcohol-Related Hospital Admissions (Rate per 100,000 population) People with Complex Care Needs Cared for at Home Cancer waiting times (62 days) 95.7% 90.2% Cancer waiting times (31 days) 100% 94.9% 408% 671% 2014 / 15 Improving 65.9% 61.8% 2014 No change Jan - Mar 2016 Jan - Mar 2016 Declining Improving New outpatients see within 12 weeks 93.1% 85.6% Jun-16 Improving 18 Weeks Referral to Treatment 90.2% 87.0% Jun-16 Declining Treatment Time Guarantee (% seen) 83.9% 91.2% Apr - Jun 2016 Declining 1 Annual data unless stated

NHS Dumfries & Galloway: HEAT Target Performance Target Health Improvement Actual Latest Performance Planned Data Date Status Smoking Cessation (40% most deprived SIMD) 167 353 2014 / 15 Amber Detect Cancer Early 26.1% 24% 2014 /15 Green Antenatal Access 84.5% 83.5% 2015 / 16 Green Efficiency and Governance Improvements Financial Performance ( 000s) 61 --- Mar-16 Green Reduce CO 2 emissions (kg CO 2 /m 2 ) 111.4 116.9 Mar-16 Green Reduce Energy Consumption (kwh/m 2 ) 448.0 455.5 Mar-16 Green Access to Service Faster access to Mental Health Services (CAMHS) Faster access to Psychological Therapies 97.7% 90% Jun-16 Green 73.4% 90.0% Jun-16 Red IVF waiting times 100% 100% Jun-16 Green 4 Hour Accident and Emergency Waiting Times 95.1% 95% Aug-16 Green Treatment Appropriate to Individuals MRSA/MSSA Bacteraemias 0.24 0.24 Mar-15 Green C.Difficile infections ages 15+ 0.37 0.32 Mar-15 Red Delayed Discharge (14 days) 23 457 Jun-16 Red Emergency Bed Days for 75+ per 1,000 population 4609 4,274 Mar-16 Amber