Board Meeting 01/02/2018 Open Session Item 4 CHIEF EXECUTIVE`S REPORT Malcolm Wright, Chief Executive 1
INTRODUCTION At today`s Board meeting we will discuss two strategically important projects and seek the Board`s approval to submit the outline business case for the Baird Family Hospital and ANCHOR Centre to the Scottish Government as well as the initial agreement for the modernisation of primary and community care services in Aberdeen City. The Board will also be asked to consider the outcomes and recommendations from the short life working group on inequalities in health as well as a range of important essential performance and governance issues. ANNOUNCEMENTS WINTER UPDATE As with all other health systems in the UK we are continuing to face challenges with winter demand at both ARI and Dr Gray s Hospital. This demand relates primarily to increasing patient acuity in General Medicine and Care of the Elderly, coupled to heightened demand due to slips on ice, as well as flu presentations. This ongoing pressure on the system has resulted in hospital flow challenges and increased numbers of patients boarding out-with parent wards. Our well-rehearsed and revised winter plan has worked well at ARI, Dr Gray s and Community Hospitals despite the ongoing system challenges, although our ED 4 hour performance at ARI has been challenging during December and January. Despite these challenges, the NHS Grampian ED 4 hour performance has been at the upper end of NHS Scotland performance during this period. Our ARI and Dr Gray s elective workload has continued in accordance with the winter planning assumptions, and surgical cancellations have been kept to a minimum. Our waiting list position and trajectories have remained within the predicted ranges for December 17 and March 18. Cross system videoconferencing huddles operate daily and include representation from ARI, Dr Gray s, the three Health and Social Care Partnerships (HSCPs) and Scottish Ambulance Service (SAS). The Director of Acute Services and IJB Chief Officers meet weekly to review and provide leadership to whole system performance and challenges, and to identify any adaptations to plans on a dynamic basis. Each of the HSCPs has agreed winter plan in place and performance is being reported within those structures. NHS Grampian Board and the IJBs will be provided with a winter de-brief with planning and exercising for next winter taking cognisance of the lessons learnt from this year. Festive period hot de-briefs have occurred at ARI and Dr Gray s and adaptations to plans have included: The addition of an additional consultant on duty 9am 2pm each day to cover patients boarding from parent wards. Weekend opening of (day-case) wards, subject to staffing (including agency) availability. Additional SAS crews at weekends to support increased discharges. Further use of supplementary staffing to open additional beds. 2
EXTRA-CORPOREAL MEMBRANE OXYGENATION - ECMO Board members will be aware that Aberdeen Royal Infirmary provides the very specialised ECMO service for the whole of Scotland. The expertise of the clinicians at the hospital have been developed over the past 10 years and the service is internationally accredited. The Aberdeen ECMO service made a significant contribution to the pressures over the festive period when the intensive care unit treated three patients with one retrieval by staff on Christmas Day. I would like to thank the clinicians for their dedication and the support that they provide to patients who require this rare this specialist treatment from all over Scotland. CLINICAL NURSE SPECIALIST MOTOR NEURONE DISEASE Susan Stewart, Clinical Nurse Specialist for Motor Neurone Disease, was recently asked to participate, along with a patient and their wife, in a video produced as part of the NHS Scotland Chief Executive s annual report. This provided an opportunity to highlight how the additional funding for specialist nurses was being used to help patients and families with MND in Grampian. Filming took place at the patient s home and was a very positive and stimulating experience for those involved, providing an opportunity to share their stories from their individual perspectives. This video has been shared widely already and is available at the following link: https://vimeo.com/242770754/f86b23f284 MULTI-STOREY CAR PARK The new multi-storey car park for patients and visitors on the Foresterhill Health Campus re-opened on 20 th December 2017 following resolution of unforeseen issues affecting the resilience of the main electrical supply. The car park is now fully operational and no significant issues have been identified regarding day to day operation. A formal opening will be arranged with The Wood Foundation in due course. GREENSPACE STRATEGY External companies have been identified to take forward the provision of Landscape Design and Project Management services for the first phase (Stage 1) of the NHS Grampian Greenspace strategy for the West of the Foresterhill Campus. These will be formally announced in early course. Meetings of key stakeholder groups will be arranged early February to allow the project to advance through the essential and more detailed consultation and design phases. Once all professional services appointments are made the procurement of the main contractor will follow. The date for completion of the c. 1.65m project has been extended to December 2018 as a result of the delays in concluding the legal process. 3
CARBON ENERGY FUND (CEF) PROJECT The CEF Project has reached Practical Completion stage. This is the first project in Scotland to link the heating and electrical infrastructure distribution networks of two large hospital campuses. This service change and improvement provides a significant carbon and maintenance backlog reduction along with cost avoidance benefits. FLU-IMMUNISATION UPDATE The programme commenced at the beginning of October with the NHS Grampian Influenza Advisory Group coordinating the immunisation effort. There are two distinct elements to the programme - Population in high risk categories, e.g. over 65 years, under 65s with chronic underlying medical conditions, pregnant women and health and social care staff. Each year, new initiatives to promote uptake among staff as well as in the at risk patient groups are implemented this year these included 75,000 reminder cards distributed to all community pharmacies for inclusion with repeat prescriptions. Uptake rates of those vaccinated at GP practices are being reported four-weekly and currently there remains just over 77,000 eligible NHS Grampian patients unvaccinated. Key vaccination uptake figures to highlight: 71% of over 65s (up 0.6% on same time last year). 40.7% of those under 65 years in clinical risk groups (down 0.6% on same time last year). 56.9% of pregnant women who are also in another clinical risk group (up 6.7% on same time last year). 36.8% of pregnant women who are not in another clinical risk group (up 2% on same time last year. There has been a 10% increase in the uptake of the influenza vaccine by NHS Grampian staff compared to 2016-2017. As of January 9 3009 doses had been provided. HEPATITIS B VACCINE The global shortage of Hepatitis B vaccine, which was caused by problems in the manufacturing process, continues with no confirmed date for vaccine availability. Supply remains on hand for post exposure and other priority groups including first and second doses for Exposure Prone Procedures (EPP) workers. HEALTH AND SAFETY EXECUTIVE (HSE) There is ongoing provision of operational support, guidance and assistance surrounding ligatures, falls, waste management, sharps, skin, immunisation clearance screening and manual handling. A meeting has been arranged with the HSE in January to review progress and provide an update. 4
PARTNERSHIP WORKING The team is looking forward to joint working with the newly elected Health and Safety lead, Carolyn Venters. Work is ongoing with Health and Social Care Partnerships surrounding the Health and Safety Gap Analysis which will be released in February 2018. HRSC Payment as if at work (PAIAW) is a term and condition for Agenda for Change staff, to ensure that they are paid the correctly during periods of annual leave, based on an average reference period of previous shifts worked. NHS Grampian has been taking this issue forward on a prospective and retrospective basis in partnership. Prospectively, a module within the national workforce system SSTS (Scottish Standard Time System) is being used. A retrospective process has been agreed and was being implemented on a phased basis. Following discussion with Scottish Government, NHS Grampian is now committed to concluding the prospective process by the end of the 2017 calendar year, and the retrospective process as near to the end of the 2017/18 financial year as possible. The remaining work locations will adopt the SSTS prospective module on 1 January 2018; this will conclude this part of the exercise. In terms of the retrospective process, shared learning has been gained from NHS Greater Glasgow & Clyde in terms of their local solution. Agreement has been reached with staff side colleagues in terms of broad principles and processes, and the finer detail, including local development of a database is being progressed at speed. The level of arrears due in respect of the PAIAW retrospective process is unknown at this point in time, but it will be significant. The PAIAW team continue to work closely with Finance colleagues in this respect as payment of arrears will bring significant financial challenges at year end. NATIONAL RADIOTHERAPY COORDINATOR NHSG SECONDEE TO THE SCOTTISH GOVERNMENT, SECURES FUNDING FOR FIRST CONSULTANT THERAPY RADIOGRAPHER IN THE NORTH-EAST The Scottish Government's new cancer strategy Beating Cancer: Ambition and Action was published in March 2016. The Government s first step in rolling out the Strategy plan was to appoint a National Radiotherapy Coordinator, Nicola Redgwell, Radiotherapy Manager at ARI. Nicola s role is to bring all the radiotherapy workstreams together, working between Scotland s 5-centres to achieve equitable access to a modern radiotherapy service for patients across Scotland. This post will be able to facilitate radiotherapy working across geographical boundaries within NOSCAN, helping to provide sustainable care and improved clinical service developments, particularly related to techniques such as VMAT and SABR. MAKING EVERY OPPORTUNITY COUNT (MeOC) Making every Opportunity Count (MeOC) is an ambitious, inclusive and transformative 3- tiered approach for cultural shift with every person, system and service doing a little to enable service users and providers to keep well. It is 5
designed to support a common way of preventive working, suitable for all public and third sector services, with a simple adaptable approach to the how. Each local area is creatively using MeOC tests of change to support transformation, with an emphasis on tier 1 (brief/simple), tailoring indicators of success accordingly. Progress so far step 1 - awareness, step 2 - testing change, step 3 - embedding the MeOC approach - and scale, are significant. Across Aberdeen hospitals, 23 clinical areas are at step 3, with new areas coming on stream. Over 10,000 people have benefited from wellbeing conversations. In Aberdeen City HSCP, five partner agencies/services are at step 3, nine partner agencies/services at step 2 with five other partner agencies at step 1. In Aberdeenshire HSCP, 30 multi-disciplinary teams are at Step 1, 19 at step 2 and four at step 3. In Moray HSCP, 13 teams/agencies are at Step 1, seven at step 2 and four at step 3. Public and third sector partners and service users are contributing to the transformation journey by progressively making public health everyone s business. Previously, we had over 10,000 wasted opportunities in ARI alone. Pockets of good practice did exist and momentum is building to create the conditions for sustainable changes in practice. HEAD AND NECK EDUCATION EVENTS In November 2017, the Oral and Dental Health Managed Clinical Network (MCN) hosted two Continued Professional Developments (CPD) events in Aberdeen and Elgin raising awareness of head and neck cancer, attended by more than 80 GPs, Dentists and other health professionals. Informative presentations were given by Mr. Terry Lowe, Mr. Shaukat Mahmood and Dr. Manjit Dhillon from the Maxillofacial Department covering risk factors, signs and symptoms, referral pathways, diagnosis and treatment. The events were also supported by colleagues providing services for smoking cessation and alcohol support, with presentations focusing on how to refer. Initial feedback from attendees has been very positive. The MCN is also planning a campaign for the general public, focusing on risk factors for oral cancer and signs and symptoms to be aware of. It will also encourage people to routinely check their own mouths in between attending regular dental check-ups. MOUTH CANCER AWARENESS MONTH AT ARI For Mouth Cancer Awareness Month, Public Health and Aberdeen City s Oral Health Team wanted to raise awareness of self-checking for mouth cancer and know who to turn to with any concerns with a stand based in the ARI concourse each week of November. It generated interest from patients, visitors and staff with the main discussions around self-checking for mouth cancer, but also opportunities to promote NHS dental registration and toothbrushing. 6
GRAPES AS A CHOKING HAZARD VIDEO DEVELOPMENT A short video has been produced following a paper The Choking Hazard of Grapes A Plea for Awareness from Dr Maria Rossi, Consultant in Public Health Medicine which focused on grapes as a particular choking hazard for young children, with sometimes fatal consequences. Staff worked with the University of Aberdeen s Medical Illustration Department to film the narrative, including demonstrating how to cut grapes and other small foods, such as cherry tomatoes, in the way advised. A number of media outlets have promoted the video, resulting in several follow-up interviews. As of 12 th January, the NHS Grampian Facebook article had generated 75 comments, 139 likes, 529 shares and the video had been viewed over 25,000 times. The video and key messages are now being shared with all staff via global email and to all relevant groups such as health visiting, education, nurseries and childminders. CALENDAR Meeting of North of Scotland Chief Executives 7 th November 2017: I chaired the meeting of the North of Scotland Chief Executives. Items discussed included North of Scotland Trauma Network, ehealth Priorities, Regional Delivery Plan and Radiology Services. Meeting of NHS Boards Chief Executives` Group 7 th November 2017: I attended the meeting of the NHS Boards Chief Executives` Group. Items discussed included Children & Young People (Information Sharing) (Scotland) Bill, National Specialist Services Committee Business Developments Updates, Payroll Services and Finance. Health and Social Care Delivery Plan National Programme Board 9 th November 2017: I attended the National Programme Board meeting. Items discussed included Shifting Balance of Care, Realistic Medicines and Delivery Plans Update. Visit to NHS Tayside 9 th November 2017: I met with the Chief Executive and Senior Team to discuss regional working. NHS Scotland Implementation Leads Meeting 10 th November 2017: I participated in the Implementation Leads Meeting. Items discussed included Communication and Engagement Plan update, Feedback from the Audit Scotland Report Parliamentary Debate, Major Trauma and Sharing Devolution Manchester. Scottish Directors of Public Health Meeting 10 th November 2017: I was invited to attend the meeting of the Scottish Directors of Public Health to discuss Regional Working. 7
North of Scotland Regional Delivery Board 13 th November 2017: I chaired the North of Scotland Regional Delivery Board. Items discussed included Radiology, e-health Priorities, Regional Delivery Plan and Regional Organisational Development Support Plan. 3 rd Medical Education Conference 17 th November 2017: I was invited to be a panel member at the 3 rd Medical Education Conference. The panel discussion was on What does it mean to work in a teaching board. Meeting of North of Scotland Chief Executives 5 th December 2017: I chaired the meeting of the North of Scotland Chief Executives. Items discussed included North of Scotland Workforce Services, Elective Care Programme, Regional Financial Position and Regional Delivery Plan. Meeting of NHS Boards Chief Executives` Group 5 th December 2017: I participated in the meeting of the NHS Boards Chief Executives` Group. Items discussed included Workforce and Effective Prescribing. NHS Boards Chief Executives` Group Strategy Meeting 6 th December 2017: I attended the NHS Boards Chief Executives` Group meeting. Items discussed included Public Health Reforms, Mental Health, Review of the National Planning Arrangements, National Programme Board Update and National and Regional Delivery and Implementation Plan Updates. NHS Scotland Implementation Leads Meeting 8 th December 2017: I participated in the Implementation Leads Meeting. Items discussed included Engagement with Communities and Workforce Planning element of National and Regional Delivery Plan. North of Scotland Regional Delivery Plan Meeting 8 th December 2017: I participated in a meeting with members of the Senior Leadership Teams from the North of Scotland Board and members of the North of Scotland Regional Delivery Board. Items discussed included the Development of the Regional Delivery Plan, Finance Update and Focus on Priorities. This was followed by a discussion session. Ministerial Strategic Group for Health and Community Care 13 th December 2017: I attended the Ministerial Strategic Group. Items discussed included the Current state of play for Integration of Health and Social Care, Understanding progress under Integration and Mental Health. 8
Audit Scotland Round Table Discussion Health and Social Care Integration 13 th December 2017: I attended the round table discussion. There was a discussion session on Integration Authorities including lessons learned and key features of success and what the main areas of tension in relation to changing how resources are used. Post Budget Briefing 14 th December 2017: I was involved in a briefing session following the announcement of the Budget. Meeting with Principal and Vice-Principal of Robert Gordon University 20 th December 2017: Together with the Chairman and Professor Amanda Croft, I met with Professor Von Prondzynski and Professor John Harper of Robert Gordon University. Improving Outcomes for Children Transformation Board 20 th December 2017: I chaired the meeting of Improving Outcomes for Children Transformation Board. Items discussed including Child and Maternal Health Operational Planning Group Update, Neonatal Services, Early Years Review and Vulnerable Groups. Meeting with Police Scotland 8 th January 2018: Together with some members of the Senior Leadership Team I met with colleagues from Police Scotland including Chief Superintendent Campbell Thomson to discuss Custody Healthcare provision. Visit to Custody Suite 9 th January 2018: I visited the Custody Suite at Kittybrewster, Aberdeen with Adam Coldwell, Chief Officer, Aberdeenshire Health and Social Care Partnership. North of Scotland Planning Group Regional Elective Care 10 th January 2018: I participated the Regional Elective Care Meeting. Items discussed included National Programme Board update and Regional Elective Care Strategy. North of Scotland Chief Executives Meeting 16 th January 2018: I chaired the North of Scotland Chief Executives Meeting where items discussed included Shared Services Briefing, Regional Delivery Plan and Major Trauma. NHS Boards Chief Executives` Group 17 th January 2018: I attended the NHS Boards Chief Executive Group. Items discussed included CHI Programme Update, Forensic Report and National Specialist Services Committee (NSSC) Update. 9