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Delivering for QualityIntegrated Performance Report

January 2016

Contents Page(s)

Executive Summary 3 - 4

Section A – LDP Standards Performance Summary 5 - 7

Targets on Track Short Report 8

Chief Executive’s Performance Escalation

Colour Coding Key 9

Cancer 62-Day RTT 10 - 11

18 Weeks RTT 12

Patient TTG 13 - 14

Outpatient Waiting Times 15 - 16

A&E 4-Hour Waits 17

HAI Sabs / HAI Report 18 - 31

Sickness Absence / Workforce 32 - 41

Dementia 42 - 43

Delayed Discharge 44 - 45

Smoking Cessation 46

Alcohol Brief Interventions 47

CAMHS Waiting Times 48

Psychological Therapies Waiting Times 49 - 50

Section B - Capital Programme 52 - 56

Section C - Financial Position 57 - 63

Section D - Scottish Patient Safety Programme 64 - 72

Section E - FOI 73 - 74

Section F - Complaints 75 - 78

Section G - Programme Management Initiatives 79 - 81

EXECUTIVE SUMMARYOBJECTIVE OF THE REPORT

The object of the Integrated Performance Report (IPR) is to provide assurance to the Board on the overall performance of NHS Fife against the corporate aims relating to National Standards (as described in the Local Delivery Plan), local priorities and significant risks.

INTRODUCTION

This report is comprised of Sections A to G as per the Contents page.

In compiling this report, the most up to date information is used to populate the various sections. Due to different reporting timetables, the most current month’s information is not always available.

The Executive Directors Group reviews the Board’s performance every month prior to presentation to the Board or Finance and Resources Committee. This process is further supported by the scrutiny undertaken by the Acute Services Division and Health and Social Care Services.

KEY PERFORMANCE OBSERVATIONS

In considering the December performance, the following areas for highlighting have been noted:

Section A – LDP Standards:

The continued sustainment of A&E Waiting Times performance above 95%

There is a continuing improvement in Outpatients Waiting Times, with over 93% of patients waiting no more than 12 weeks at month end, the highest figure of the FY to date

There have been no Diagnostics Waiting Times 6-week breaches for the third successive month

There is a continuing improvement against the CAMHS target (now at 80.7% against a target of 90% and Psychological Therapies Waiting Times standards, which have improved from 69.8% in November to 71.1% in December.

There is an improvement in the Cancer 62-Day RTT performance which is now recording 90.8 % in December compared to 87.3% in November

There has been a slight increase, from 43 to 45 patients in delay over 14 days compared to last month

The number of patients failing to meet the 12 week TTG target has increased to 15 in December compared to 8 in November

The increase in HAI Sabs infections rate is continuing from 0.38 in November to 0.4 in December

There has been a significant increase in the number of Alcohol Brief Interventions delivered in Q3, with the total number delivered now at 3916, being above plan and close to the full-year target of 4187.

The nationally produced sickness absence figure for NHS Fife for December 2015 is 5.44% and while this is an increase of 0.15% from the November 2015 figure of 5.29%. NHS Fife’s rate remains below the NHS Scotland average. Both November and December has seen the workforce subject to both norovirus and other

respiratory illnesses that were highly prevalent across the community during this period.

Section B – Capital:

The overall programme continues to be in line with the plan to deliver the target against the CRL.

Section C – Financial Position to 31 January 2016:

The in-month position continues to be in line with previous months reports at an overspend of £1.927m and with the level of outstanding efficiency savings required reducing. The year-end outturn forecast to deliver a break even position continues to be challenging with a further adverse movement this month in prescribing overspend.

Section F – Complaints:

There has been a further improvement in the 20-day complaints response rate from 52% in November to 60% in December.

SECTION A: LDP STANDARDS PERFORMANCE SUMMARYThe source of data in the IPR is either from validated published sources or is local management information from a variety of internal sources. It is important to note that whilst local management information provides a more up to date position, data validation processes may not have been completed and this information may therefore be subject to change.

TARGETS ON TRACKNHS Fife continues to meet or perform ahead of the following National Targets and Standards:

Antenatal Access: at least 80% of pregnant women in each SIMD quintile will book for antenatal care by the 12th week of gestationLocal management information shows that NHS Fife has continued to record a performance level of over 80% in all SIMD quintiles. The lowest-performing quintile for the 3-month period ending October 2015 was Quintile 3 (Quintile 1 is most-deprived, Quintile 5 is least-deprived), with a figure of 83.7%. The highest-performing quintile was Quintile 2 (91.4%), while the overall NHS Fife figure was 88.2%.

HAI: we will achieve a maximum rate of C diff infection in the over 15s of 0.32Local management data for the year ending January indicates a C difficile rate of 0.24, significantly better than the standard of 0.32.

IVF: no eligible patient will wait longer than 12 months for screening following referral from Secondary CareAll NHS Fife patients continue to be screened within 12 months, via the service run by NHS Tayside, with 68 patients having been screened in 2015-16 up to the end of December. The latest management information showed that 16 patients were on the waiting list, none of whom had waited more than 12 months.

Cancer Waiting Times - we will treat any cancer patient within 31 days of decision to treatLocal management information shows that NHS Fife has exceeded the 95% standard in every month of 2015-16 to date, the most recent monthly figures being 95.3% (November) and 99.0% (December).

Drug and Alcohol Waiting Times: at least 90% of clients will wait no longer than 3 weeks from referral to treatmentThe December ISD publication showed that 98.6% of patients were seen within 3 weeks of referral for treatment between July and September. This remains significantly above the 90% standard, a position NHS Fife has sustained since the start of 2013. We remain in the top quartile of Health Boards as far as performance against this standard is concerned, despite first appointments increasing year-on-year by around 20%. For Drugs alone, the increase was almost 40%.

Diagnostics Waiting Times: No patient will wait more than 6 weeks to receive one of the 8 key diagnostic tests - barium studies, non-obstetric ultrasound, CT, MRI, upper endoscopy, lower endoscopy, colonoscopy, cystoscopyNo patients were waiting more than 6 weeks for a test at the end of December, the third successive month the standard has been achieved. The total number of patients on the list rose slightly, with over 85% of the 3,922 patients waiting for a CT Scan, MRI or Non-Obstetric Ultrasound test.Detect Cancer Early: at least 29% of cancer patients will be diagnosed and treated in the first stage of breast, colorectal and lung cancerThe measure for this target covers a rolling 2-year period, and the NHS Fife target of 29% covers 2014 and 2015. Local management information for the 2-year period ending September 2015 shows that we remained slightly behind plan, though improving in both Breast and Lung specialties since the last update. The Stage 1 Detection Rate for Lung Cancer was 20.1%, more than twice the measurement at the base time of December 2011.

CHIEF EXECUTIVE’S PERFORMANCE ESCALATIONIn the following sections, cells in the Recovery Trajectory tables and Recovery Plan charts are shaded as follows:

Recovery Trajectory

Recovery Plan

ACUTE SERVICESCLINICAL ACCESS & SUPPORTCANCER 62 DAY REFERRAL TO TREATMENT

At least 95% of patients urgently referred with a suspicion of cancer will start treatment within 62 days

Key Concerns & Risks

As described in previous reports there are a number of areas of risk in achieving this target, namely around Urology and more recently Gynaecology and Head & Neck Cancers due to liaison with tertiary providers, visiting oncology capacity and surgical capacity.

Performance against the 62-day target remains a significant challenge.

Recovery Trajectory

Recovery Plan

Situational Analysis

In the recovery plan for this target there are 7 actions which have a Red or Amber RAG status.

Challenges with vacancies in Respiratory medicine continue with interim arrangements in place to release capacity to enable urgent outpatients slots to be maintained. A locum has been appointed and targeted additional activity continues which has resulted in improvement in waits to 1st appointment. Respiratory posts are advertised and the timescale for interviews is March. The actions taken have moved the status from Amber to Green.

The review of EBUS provision in NHS Fife is delayed until the current vacancies have been addressed.

A draft Outline Business Case for Robotic Assisted Laparoscopic Prostatectomy within SEAT has been developed. This is being taken forward at a regional Level and a Fife based consultant has been identified to be trained to undertake these procedures. This has moved this status from Red to Amber.

A new administrative support structure has been implemented in urology and it is anticipated that these actions will move the status for action 2.6 from Amber to Green

Patients who have been delayed in the initial part of their pathway are now progressing to treatment however this together with the increased throughput of general urology outpatients has resulted in increased demand for surgery. This will result in deterioration in performance in the next few months. The status remains at Amber for surgical capacity.

Waits for urology oncology appointments continue to be a challenge. The review of oncology provision as a whole is underway and additional capacity is being provided when possible.

A solution to allow electronic referrals between Boards has been investigated and is unlikely until a replacement PAS system is implemented in 2017. An alternative solution has improved the speed of communications and has moved this status from Red to Amber.

The GP direct access to imaging is a national project there has been a delay at national level and there is no revised timescale available. This has moved from Amber to Red.

18 WEEKS REFERRAL TO TREATMENT

At least 90% of planned/elective patients will commence treatment within 18 weeks of referral

Following three successive months when performance was above trajectory, we slipped behind plan in August, and have remained behind since. Performance improved in December.


As previously reported the key specialties at risk of not meeting 18 weeks RTT are Urology, Oral Surgery, General Surgery, Vascular Surgery, Neurology and Respiratory. This is driven by vacancies, increasing demand and an ongoing demand-capacity gap.

Additional activity continues to be undertaken to improve and sustain outpatient, diagnostic and inpatient/daycase waiting times. The positive impact of this was seen in December and should continue for the rest of Quarter 4. NHS Fife continues to meet with Scottish Government regarding resilience around this target and discussion continues regarding the size and resourcing of the demand-capacity gap.

Recovery Trajectory

Recovery Plan

The Recovery Plan for 18 Weeks RTT is covered by the delivery of the Patient Treatment Time Guarantee and Outpatient Waiting Times Recovery Plans shown in the relevant sections on the following pages.

PATIENT TREATMENT TIME GUARANTEE

We will ensure that all eligible patients receive inpatient or day case treatment within 12 weeks of such treatment being agreed

Performance in December and January slipped behind trajectory after 7 months of being on or ahead of plan.


At risk specialties for Inpatients and Day Cases are Orthopaedics, General Surgery, Urology, Ophthalmology and Gynaecology. There is increased demand for inpatient and day case procedures as a result of additional outpatient activity undertaken and balancing elective capacity due to pressure on beds.

Additional activity is being undertaken internally when possible to manage this increase in demand. This is not as resilient as we would wish due to issues such as the availability of anaesthetic cover, use of locums, availability of Operating Department Practitioner (ODP) staff and availability of beds during winter months. It is likely that this pressure will continue until the end of March.

Recovery Trajectory

Recovery Plan


There are 5 actions which have an Amber RAG status.

Efforts continue to deliver sufficient additional activity internally to meet the increased demand for inpatient and day case activity resulting from the outpatient work undertaken. It is a significant challenge to provide the volume of additional activity required internally to meet this demand particularly at a time of increased pressure on beds which is reflected in the continued Amber status.

Active recruitment to a number of consultant posts is underway as potential candidates have been identified. The timescale for recruitment has been extended to March.

The use of other healthcare providers continues to be considered if appropriate but there is currently limited capacity for inpatient and day case work and limited resources available to undertake this. This is reflected in the continued Amber status.

The Day Surgery clinical group continues to meet monthly with the aim of improving usage of the Day Surgery Unit in QMH and improvements are being implemented in terms of theatre utilisation, pre-assessment and procedure selection. It is anticipated that this action will move this measure from Amber to Green RAG within the revised timescale.

The action to transfer Phase 2 to Phase 3 theatres is being explored via the review of theatres as part of the Optimising Surgical Efficiencies project. The timescale for this has been extended.

OUTPATIENT WAITING TIMES

At least 95% of patients (stretch target of 100%) will have their first outpatient appointment within 12 weeks of referral. Additionally, we must eradicate waits over 16 weeks.


Performance in outpatients has improved month on month for the last 6 months.

The at-risk specialties are Urology, Dermatology, Neurology, Gastroenterology, Cardiology and Respiratory Medicine. Recruitment into Consultant vacancies in key specialties is particularly challenging.

Whilst there has been a significant improvement in performance in the at risk specialties, work continues to clear the remaining backlog particularly in Neurology, Gastroenterology, Urology and Respiratory Medicine, as well as sustainable solutions to meet the ongoing gap in outpatient capacity.

Activity is being outsourced and local waiting times initiatives continue in all of the at-risk specialties. Given the size of the challenge the timescale for delivery of improvement has been extended until March.

Recovery Trajectory

Recovery Plan


The recovery plan shows that 3 actions are rated as Amber for delivery.

The focus continues to be on recovery of the backlog in outpatients waiting over 12 weeks and plans are in place for additional activity to deliver further improvements by March. This remains highly dependent on the availability of skilled workforce across a number of specialties and departments.

Work by directorates to identify solutions to meet the gap in outpatient capacity continues but consultant vacancies in a number of key specialities is making planning for this a significant challenge reflecting the continued Amber status.

There is an active programme of work in place to redesign the urology DTC with an extended timescale for delivery of March. The number of outpatients waiting over 12 weeks continues to improve.

Recruitment to vacant consultant posts continues to be a challenge. Adverts have been placed for Gastroenterology and Respiratory but there are difficulties in recruiting to Cardiology and Neurology, reflected in the continuing Amber status for this action.

The outpatient redesign work is a three year programme. Resource to support project Management is being put in place to support the development and delivery of this work. Once in place this will move this action to Green.

EMERGENCY CAREA&E 4-HOUR WAITING TIME

At least 95% of patients (stretch target of 98%) will wait less than 4 hours from arrival to admission, discharge, or transfer for accident and emergency treatment

For 9 successive months performance has been ahead of trajectory and is on target to achieve the year end required performance.


A number of risks remain in the system including recruitment to vacant medical posts across the Directorate, admission numbers, flexibility of the ambulance service response to same day discharge and a significant increase in the number of patients in delay.

Recovery Trajectory

Note that the ‘Actual Performance’ figures shown are 12-month averages, not figures for the individual months.

The performance figure for all Fife for the single month of January was 94.1%, with the ED at VHK itself recording a performance of 92.0%, the lowest this year. The combined monthly performance in all A&E and MIU sites has exceeded 95% in every month of 2015-16 to date.

Detailed work is underway to minimize misdirections to the Emergency Department which will encompass internal transfers and primary care.

The additional discharge vehicle and internal transport option have proven invaluable since their introduction in October. This resource is being supplemented on an ad hoc basis by the ambulance service at weekends.

The new assessment model in AU1 continues to discharge 30% of new patients on the day of admission. ECAS continues to expand the range of interventions available preventing short-stay emergency admissions to hospital.

Recovery Plan

BOARD WIDEHAI SABS

We will achieve a maximum rate of staphylococcus aureas bacteraemia (including MRSA) of 0.24


The actions described will support the reductions in preventable (hospital acquired) SAB numbers being maintained and increased. Infections related to invasive devices such as peripheral venous cannulae (PVC) constitute the single biggest preventable cause and are a particular area of focus.

Hospital SABs made up 32% of the total in the last twelve months (35 of 108), with the remainder arising spontaneously in the community. There is a risk that community case numbers may negate gains made through hospital improvement programmes.

Recovery Trajectory

Recovery Plan


Various improvement initiatives have been started in order to address areas of concern in relation to the incidence of SAB infections. It is hoped that these will result in reduced infections in 2016.

The collaborative work is looking at early intervention in needle exchange schemes to see if this can identify localised infection and offer treatment to prevent invasive infection in the intravenous drug population. Other Health Boards will be involved in this study. This work remains at the early stages of implementation.

Where any improvements are noted, areas of good practice will be shared with peers. Continuing and new challenges will also be reported widely.

NHS Scotland HAI Reporting Template (HAIRT)Section 1– Board Wide Issues

1. Key Healthcare Associated Infection Headlines for January 2016

1.1 Achievements

The C difficile HEAT target for March 2015 was surpassed and rates continue to fall; NHS Fife is on target to meet the Local Delivery Plan (LDP) standard for this FY

The MRSA Screening Key Performance Indicator (KPI) was again surpassed by Fife staff

1.2 Challenges

SAB case rates continue to rise (primarily from community sources). PVC related SABs are being identified as an ongoing issue. A number of multi-agency improvement initiatives are being explored specifically relating to community associated SABs.

The 2015-16 winter norovirus season has commenced. To date, only one ward at Victoria Hospital Kirkcaldy has been closed to admissions and transfers as a result of a confirmed Norovirus Outbreak (in November).

In January, Ward 34 at Victoria Hospital Kirkcaldy witnessed an increase in cases of Respiratory Syncytial Virus (RSV), with seven patients affected

2. Staphylococcus aureus (including MRSA)

2.1 Trends NHS Fife had 24 cases in Q4 (0.38 per 1000 AOBDs) down from 37 cases in Q3

(0.56 per 1000 AOBDs)

This remains RED against the Local Delivery Plan (LDP) Standard for SABs; 0.24 cases per 1000 AOBDs (local rate for trajectory @ December 2015 0.28).

This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the ‘Healthcare Associated Infection Report Cards’ in Section 2.

Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:

Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252

NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for NHS Fife overall and by hospital can be found in Section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at:

http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252


On this basis there is a high risk that the Mar 2016 LDP Standard will not be met

2.2 National MRSA Screening Programme NHS Fife remains well ahead of the target of 90% compliance with the Clinical Risk

Assessment (CRA) and well ahead of the national average.

Q1 Jan-Mar 2015 Q2 Apr-Jun 2015 Q3 Jul-Sep 201598% 100% 100%

2.3 NHS Fife Local Targets for SAB Reduction, 2016 At this stage of the year, local targets for 2016 have not yet been set

2.4 Current InitiativesFife-wide Collaborative Improvement Initiatives:

Review every SAB to establish source of infection:

Every PVC SAB entered on Datix and subject to SAER, with a time-limited action plan

Monthly SAB reports to directorates highlighting sources of infection and actions to be taken. Reports will celebrate areas of good practice as well as challenges and improvements required.

SPSP PVC audits reported monthly to wards and directorates

Urinary catheter insertion and maintenance bundles to be rolled out to acute and community wards throughout NHS Fife. Areas where bundle embedded and showing sustained improvement to share areas of good practice with peers; tests of change continue. This programme of work is being reviewed; meeting being convened to discuss process and outcome measures.

Community Improvement Initiatives:

Collaborative work with addiction services: community based research project commissioned to investigate if early intervention in needle exchange schemes can identify localised infection and offer treatment to prevent invasive infection in the intravenous drug user population in Fife

Collaborative work with other health boards to address SAB risk within the intravenous drug user population

Reduction of Other Hospital Acquired SABs

Continue joint action planning with Health Protection Scotland and other Scottish health boards to identify other areas for intervention

Reinforce blood samples guidance to junior doctors to reduce contaminated samples

Target IP&C training based on SAB reports, SAERs and PVC audits

3. Clostridium difficile

Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at:

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for NHS Fife overall and by hospital can be found in Section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at:

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

3.1 Trends

Age 15+, NHS Fife had 19 cases in Q4 (versus 20 the previous quarter). This equates to 0.28 cases per 1000 TOBD.

This quarter is GREEN against the LDP Standard trajectory (0.32) and the 12 month rate of 0.23 was also GREEN.

Fife is below the national average (0.357) for the quarter and below the trajectory for yearly rates to September 2015 (0.25)

As with SABs, community cases averaged 60% of the total during 2015

3.2 Current initiativesContinued follow up of all hospital and community cases.

4 Hand Hygiene

4.1 Trends

From October 2013, reporting of Hand Hygiene performance is based on local data from the Scottish Patient Safety Programme (SPSP). From November 2013, results include a breakdown by staff group.

NHS Fife overall results remain consistent. There is some fluctuation from month to month when broken down to separate staff groups, due primarily to the small numbers involved.

5. Cleaning and the Healthcare Environment

5.1 Trends All hospitals and health centres throughout NHS Fife have participated in the

National Monitoring Framework for NHS Scotland National Cleaning Services Specification. Since April 2006 all wards and departments have been regularly

Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at:

http://www.washyourhandsofthem.com/

NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for NHS Fife overall and for each acute hospital can be found in Section 2. Information on national hand hygiene monitoring can be found at:

http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%.The cleaning compliance score for NHS Fife overall and for each acute hospital can be found in Section 2. Information on national cleanliness compliance monitoring can be found at:

http://www.hfs.scot.nhs.uk/online-services/publications/hai/

Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at:

http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

http://www.nhshealthquality.org/nhsqis/6710.140.1366.html


http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

http://www.washyourhandsofthem.com/

monitored with quarterly reports being produced through Health Facilities Scotland (HFS).

The National Cleaning Services Specification – quarterly compliance report result for October to December 2015 (quarter 3) shows NHS Fife achieving GREEN status with 95.6%; Scottish average for the quarter is 95.7%

The Estates Monitoring quarterly compliance result for October to December 2015 (quarter 3) shows NHS Fife achieving GREEN status with 97.7%; Scottish average for the quarter is 97.5%

5.2 Current Initiatives

Areas with results below 90% for all Hospital & Healthcare facilities have been identified to relevant managers for action.

HFS is making steady progress with the iOS development work.

6. Outbreaks

6.1 NorovirusNil to report since last update

6.2 Other OutbreaksRespiratory Syncytial Virus

During late December and early January 2016 Ward 34 at Victoria Hospital witnessed an increase in cases of Respiratory Syncytial Virus (RSV). Seven patients were affected with one patient acquiring the virus as a result of cross-transmission. This outbreak was reported to Health Protection Scotland and the Scottish Government Health and Social Care Directorate Policy Unit. The majority of patients were potentially acquiring the virus in the community. The outbreak was declared over on 19 January.

Avian Influenza in Poultry

In January 2016 the Scottish Government urged poultry producers to maintain vigilance following the reporting of a suspected case of avian influenza in chickens on a farm in Dunfermline. Initial test results had indicated the presence of a notifiable strain of avian influenza (H5) while the clinical picture suggested a low pathogenic strain. In order to limit the further spread of disease, appropriate restrictions were being imposed on the premises and any identified contact premises. The risk to human health in this case should be considered very low.

There have been a number of recent cases of avian influenza across continental Europe in recent months including three cases in other parts of the UK in 2015.

Other Outbreaks: Global Significance

Ebola: Viral Haemorrhagic Fever

WHO reported a continuing drop of Ebola virus disease (EVD) cases in West Africa but warns that there is growing evidence of persistence of the virus for some months in

This section should give details on any outbreaks that have taken place in the Board since the last report, or a brief note confirming that none have taken place. Where there has been an outbreak then for most organisms as a minimum this section should state when it was declared, number of patients affected, number of deaths (if any), actions being taken to bring the outbreak under control and whether this was reported to the Scottish Government. For outbreaks of norovirus a more general outline of the outbreak may be more appropriate.

recovered patients. The two-year Ebola epidemic that killed more than 11,000 people in West Africa was declared officially over on 14 January.

7. Other HAI Related Activity

Surgical Site Infection Surveillance

NHS Fife continue to perform well under the national rate for orthopaedic procedures

C-Section rates were higher than the national average for Q2 (April to June 2015) in comparison with Q1 and Q3.

Q1 2015 overall SSI rate 1.8% Q2 2015 overall SSI rate 4.7% Q3 2015 overall SSI rate 2.4%

See Table 1 below

2010

Q1

2010

Q2

2010

Q3

2010

Q4

2011

Q1

2011

Q2

2011

Q3

2011

Q4

2012

Q1

2012

Q2

2012

Q3

2012

Q4

2013

Q1

2013

Q2

2013

Q3

2013

Q4

2014

Q1

2014

Q2

2014

Q3

2014

Q4

2015

Q1

2015

Q2`

2015

Q3

0

50

100

150

200

250

300

0

2

4

6

8

10

12

14

16

199194207

217218

243261

241230

206221219

207219

248226

196

221

246249227

236249

Graph Showing Quarterly Trend in Caesarean Sections NHS Fife

Total C sections

Quarter

Num

ber o

f ope

ratio

ns

Num

ber o

f inf

ectio

ns

Exception Report Issued

Table 1

Since 2013, NHS Fife has been issued with 5 Exception Reports for Caesarean Section and this has resulted in a huge amount of work being carried out to improve clinical practice and patients outcomes. As a result of these improvement measures the SSI rate has returned to a more favourable rate in Q3. NHS Fife continues to ensure that these changes are embedded in practice; there are robust feedback mechanisms in place, including reports to relevant clinical teams and attendance at regular clinical meetings.

NHS Fife has been identified as an exemplar in Scotland and has been commended on a national level for in depth feedback sessions which include presentation of SSI rates, analysis of data, recommendations for improvements in clinical practice, case review presentations and microbiology teaching input.

7.1 Healthcare Environment Inspectorate (HEI) inspections

An unannounced HEI inspection was conducted in Victoria Hospital on 25-26 August to follow-up on the requirements and recommendations made following the inspection in December 2014. This follow-up inspection resulted in one new requirement, one requirement unmet from the December 2014 inspection and one unmet recommendation also from the December 2014 inspection.

The 16 week follow-up improvement action plan was returned to HEI on 12 January 2016. This update reported one requirement for Hand Hygiene now being met and the remaining requirement still outstanding – SICPs monitoring. NHS Fife is currently working in collaboration with Health Improvement Scotland (HIS) and Health Protection Scotland (HPS) to review the SICPs monitoring tools currently available in NHS Fife and to support the development of a monitoring tool that is fit for purpose and accurately reflects SICPs monitoring across all care settings. This project is expected to take a minimum of 9 months and therefore completion is anticipated September 2016. The roll out to all clinical areas will progress following completion of project

An unannounced HEI inspection was conducted in Queen Margaret Hospital on 29-30 September, with the final report published 24 November. The inspection resulted in four requirements for which there is an associated improvement action plan for the board.

The 16 week follow-up improvement action plan was returned to HEI on 2 February 2016. This update reported three requirements now met with one requirement partially met – use of PPE by domestic services. Work is ongoing to address this requirement.

An unannounced HEI inspection was conducted in Cameron Hospital on 21-22 October, with the final report published 12 January 2015. The request for the 16 week follow-up improvement action plan is expected to reach the board by 11 February 2016.

Actions will be monitored via the clinical directorates involved in the inspections, the NHS Fife Inspection Coordinating Group and the Infection Control Committee.

8. Assessment

SAB numbers continue to fluctuate from quarter to quarter, but the latest data shows the fall in cases seen earlier this year is not being sustained, and further work is needed if the March 2016 HEAT target is to be achieved.

Continuing low levels of C difficile indicate that the initiatives in place to reduce infection rates are working long-term.

Healthcare Associated Infection Reporting Template (HAIRT)

Section 2 – Healthcare Associated Infection Report Cards

The following section is a series of ‘Report Cards’ that provide information, for each NHS Fife acute hospital, on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics.

Understanding the Report Cards – Infection Case NumbersClostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. SAB cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). More information on these organisms can be found on the NHS24 website:

Clostridium difficile : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=1

Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1

For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out of hospital” report card.

TargetsThere are national targets associated with reductions in C.diff and SABs. More information on these can be found on the Scotland Performs website:

http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance

Understanding the Report Cards – Hand Hygiene ComplianceHospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used.

Understanding the Report Cards – Cleaning ComplianceHospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website:http://www.hfs.scot.nhs.uk/online-services/publications/hai/

Understanding the Report Cards – ‘Out of Hospital Infections’Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to NHS Fife which are not attributable to a hospital.




http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1


http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=1

NHS FIFE REPORT CARDStaphylococcus aureus bacteraemia (SAB) monthly case numbers

Feb 201

5

Mar 201

5

Apr 2015

May 201

5

Jun 201

5

Jul 2015

Aug 201

5

Sep 2015

Oct 201

5

Nov 201

5

Dec 2015

Jan 2016

MRSA 0 0 1 1 0 1 3 0 0 0 0 2

MSSA 1 7 8 14 6 11 10 10 7 8 9 9

Total 1 7 9 15 6 12 13 10 7 8 9 11

Clostridium difficile infection (CDI) monthly case numbers

Feb 201

5

Mar 201

5

Apr 201

5

May 201

5

Jun 201

5

Jul 2015

Aug 201

5

Sep 201

5

Oct 2015

Nov 201

5

Dec 2015

Jan 201

6Ages 15-64 0 0 0 1 1 2 0 4 3 2 2 0

Ages > 65 6 5 2 4 8 2 7 2 6 2 4 3

Total 15+ 6 5 2 5 9 4 7 6 9 4 6 3

Hand Hygiene Monitoring Compliance (%)

Feb 2015

Mar 2015

Apr 201

5

May 201

5

Jun 201

5

Jul 2015

Aug 201

5

Sep 201

5

Oct 2015

Nov 2015

Dec 2015

Jan 201

6AHP 98 98 99 96 97 99 99 98 98 100 96 99

Ancillary 95 97 97 95 95 97 90 88 97 94 92 95

Medical 93 95 94 95 94 98 94 97 96 95 97 96

Nurse 97 98 99 97 98 98 99 97 97 98 98 98

Overall 97 97 98 96 97 98 97 96 96 96 97 97

Cleaning Compliance (%)

Feb 201

5

Mar 201

5

Apr 201

5

May 2015

Jun 201

5

Jul 2015

Aug 201

5

Sep 2015

Oct 2015

Nov 2015

Dec 201

5

Jan 201

6Overall 96.4 96.9 95.0 96.2 96.1 94.8 95.5 95.8 95.9 95.0 96.0 95.6

Estates Monitoring Compliance (%)

Feb 2015

Mar 2015

Apr 201

5

May 2015

Jun 2015

Jul 201

5

Aug 2015

Sep 201

5

Oct 2015

Nov 201

5

Dec 2015

Jan 201

6

Overall 96.4 97.5 94.4 96.8 96.9 97.2 97.8 97.7 97.5 97.7 98.0 97.9

VICTORIA HOSPITAL, KIRKCALDY REPORT CARDStaphylococcus aureus bacteraemia (SAB) monthly case numbers

Feb 201

5

Mar 2015

Apr 201

5

May 201

5

Jun 201

5

Jul 201

5

Aug 201

5

Sep 2015

Oct 201

5

Nov 201

5

Dec 201

5

Jan 201

6MRSA 0 0 0 1 0 0 1 0 0 0 0 0

MSSA 0 3 2 4 2 3 4 2 2 1 1 4

Total 0 3 2 5 2 3 5 2 2 1 1 4


Feb 201

5

Mar 201

5

Apr 201

5

May 201

5

Jun 201

5

Jul 2015

Aug 201

5

Sep 201

5

Oct 2015

Nov 201

5

Dec 2015

Jan 201

6Ages 15-64 0 0 0 0 0 0 0 2 1 1 0 0

Ages > 65 2 3 0 1 1 1 0 0 1 0 1 1

Total 15+ 2 3 0 1 1 1 0 2 2 1 1 1


Feb 201

5

Mar 2015

Apr 201

5

May 2015

Jun 201

5

Jul 201

5

Aug 2015

Sep 201

5

Oct 201

5

Nov 201

5

Dec 201

5

Jan 201

6Overall 96 96 95 96 96 95 96 96 95 96 95 96


Feb 201

5

Mar 2015

Apr 2015

May 2015

Jun 2015

Jul 201

5

Aug 201

5

Sep 2015

Oct 2015

Nov 201

5

Dec 201

5

Jan 201

6Overall 97 97 97 97 97 98 98 98 97 97 97 98

QUEEN MARGARET HOSPITAL, DUNFERMLINE REPORT CARDStaphylococcus aureus bacteraemia (SAB) monthly case numbers

Feb 201

5

Mar 2015

Apr 201

5

May 201

5

Jun 201

5

Jul 201

5

Aug 201

5

Sep 2015

Oct 201

5

Nov 201

5

Dec 201

5

Jan 201

6MRSA 0 0 1 0 0 0 0 0 0 0 0 1

MSSA 0 0 0 0 0 0 0 0 1 0 2 0

Total SABS 0 0 1 0 0 0 0 0 1 0 2 1


Feb 201

5

Mar 201

5

Apr 201

5

May 201

5

Jun 2015

Jul 201

5

Aug 2015

Sep 201

5

Oct 2015

Nov 201

5

Dec 201

5

Jan 2016

Ages 15-64 0 0 0 0 0 0 0 0 0 0 0 0

Ages > 65 0 0 0 0 0 0 0 0 0 0 2 0

Total 15+ 0 0 0 0 0 0 0 0 0 0 2 0


Feb 201

5

Mar 201

5

Apr 201

5

May 2015

Jun 2015

Jul 201

5

Aug 201

5

Sep 201

5

Oct 201

5

Nov 201

5

Dec 201

5

Jan 201

6Overall 99 98 98 98 98 98 99 98 99 99 99 98


Feb 201

5

Mar 201

5

Apr 201

5

May 2015

Jun 2015

Jul 201

5

Aug 201

5

Sep 201

5

Oct 201

5

Nov 201

5

Dec 201

5

Jan 201

6Overall 98 98 98 98 98 98 99 99 99 99 100 99

NHS FIFE COMMUNITY HOSPITALS REPORT CARDStaphylococcus aureus bacteraemia (SAB) monthly case numbers

Feb 2015

Mar 201

5

Apr 201

5

May 201

5

Jun 2015

Jul 201

5

Aug 2015

Sep 201

5

Oct 201

5

Nov 2015

Dec 201

5

Jan 201

6MRSA 0 0 0 0 0 1 0 0 0 0 0 0MSSA 0 0 0 0 0 0 0 1 0 0 0 0Total SABS 0 0 0 0 0 1 0 1 0 0 0 0


Feb 2015

Mar 2015

Apr 201

5

May 201

5

Jun 201

5

Jul 2015

Aug 201

5

Sep 201

5

Oct 2015

Nov 2015

Dec 2015

Jan 201

6Ages 15-64 0 0 0 0 0 1 0 0 0 0 0 0

Ages > 65 0 0 1 0 2 1 0 1 0 0 0 0

Total 15+ 0 0 1 0 2 2 0 1 0 0 0 0

OUT OF HOSPITAL INFECTIONS REPORT CARDStaphylococcus aureus bacteraemia (SAB) monthly case numbers

Feb 201

5

Mar 2015

Apr 201

5

May 201

5

Jun 201

5

Jul 201

5

Aug 201

5

Sep 2015

Oct 201

5

Nov 201

5

Dec 201

5

Jan 201

6MRSA 0 0 0 0 0 0 1 0 0 0 0 1MSSA 1 4 6 10 4 8 6 7 4 7 6 5

Total SABS 1 4 6 10 4 8 7 7 4 7 6 6


Feb 2015

Mar 2015

Apr 201

5

May 201

5

Jun 201

5

Jul 2015

Aug 201

5

Sep 201

5

Oct 2015

Nov 2015

Dec 2015

Jan 201

6Ages 15-64 0 0 0 1 1 1 0 2 2 1 2 0

Ages > 65 4 2 1 3 5 0 7 1 5 2 1 2

Total 15+ 4 2 1 4 6 1 7 3 7 3 3 2

National StatisticsNational surveillance data for C difficile and for SABs (including data for MRSA) has been published by Health Protection Scotland (HPS) for the period to September 2015, and is illustrated in Figures 1, 2, 5 and 6, below. NHS Fife is denoted by ‘FF’.

For C difficile, the NHS Fife quarterly rate was 0.29 cases per 1,000 Total Occupied Bed Days (TOBD). This is below the Scottish quarterly average of 0.36

For all SABs the NHS Fife quarterly rate rose to 0.56 cases per 1,000 Acute Occupied Bed Days (AOBD), above the Scottish quarterly average of 0.32

SICKNESS ABSENCE

We will achieve and sustain a sickness absence rate of no more than 4%


Each of the operational parts of the system have developed action plans in partnership or are reviewing existing plans to reflect the move to the Health & Social Care structure. At a time of significant change, this is more difficult to manage and monitor for services in the community.

The three biggest risks to sustaining the planned reductions are:

Management and HR capacity Any community outbreak of illness (e.g. norovirus) which can impact on short term

absence Increased pressure on the system in terms of patient numbers which in turn increases

pressure on staff capacity and can result in increased absence

Recovery Trajectory

NOTE – the figures quoted are 12-month rolling absence rates, not those for the individual month. This is a better way of demonstrating an improvement trend.

THE DECEMBER FIGURE HAS BEEN CALCULATED LOCALLY AS PROBLEMS WITH THE NATIONAL SWISS SYSTEM HAVE DELAYED ITS AVAILABILITY FROM ISD

1. INTRODUCTION

1.1 The NHS Fife sickness absence rates have been below 5% for five out of the first nine months of the 2015/16 financial year, with an average rate in the year to date of 5.01%. The Board’s position is 0.13% better than the equivalent period of 2014/15. This is detailed in Graph 1.

Apr May Jun Jul Aug Sep Oct Nov Dec0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%

NHS Fife Sickness Absence% comparison of hours lost between April

to November 2014 and 2015

2014/152015/16

1.2 This is as a result of improvements in the Acute Services Division (ASD) sickness absence rates prior to November and to a reducing long term sickness absence trend for the Board as a whole. This is demonstrated by an 11.87% reduction in long term sickness absence over the first nine months of the current financial year. The NHS Fife sickness absence trend is illustrated in Graph 2.

1.3 The Scottish Workforce Information Standards System (SWISS) sickness absence figure for NHS Fife for December is 5.44%. This is an increase of 0.15% from the

Graph 1

Graph 2

November figure of 5.29%. The NHS Fife rate is 0.04% below the NHS Scotland average rate for December and is 0.02% below the NHS Scotland average rate for the first nine months of the year.

2. NHS FIFE LOCAL ABSENCE STATISTICS

2.1 Locally produced comparative sickness absence information for 2015 for each area of NHS Fife is summarised in the tables below for ease of reference.

Table 1

Area Jan 2015

% Rate

Feb 2015

% Rate

Mar 2015

% Rate

April 2015

% Rate

May 2015

% Rate

June 2015

% RateAcute Services 5.78 5.05 5.55 4.39 4.39 4.42Corporate Services 5.74 4.85 5.45 4.61 4.74 4.90Health and Social Care 6.63 5.72 6.11 5.34 5.30 5.51NHS Fife 6.10 5.27 5.75 4.79 4.80 4.93

Area July 2015

% Rate

Aug 2015

% Rate

Sept 2015

% Rate

Oct 2015

% Rate

Nov 2015

% Rate

Dec 2015

% RateAcute Services 4.80 4.45 4.55 4.68 5.04 5.36Corporate Services 5.45 4.91 4.77 5.52 5.45 5.29Health and Social Care 5.75 4.58 5.15 5.18 5.53 5.84NHS Fife 5.29 4.58 4.82 5.03 5.30 5.52

2.2 The reason for the increase in December is due to slight increases in the ASD rate (0.32%) and Health and Social Care (0.31%), balanced by a reduction in Corporate Services (0.16%).

2.3 The sickness absence figures for each operational unit of NHS Fife for 2015/16 to date are detailed in graph format in Graph 3.

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15Jul-1

5

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

01234567

NHS Fife Sickness Absence Data by Operational Unit

January to December 2015Acute ServicesCorporate ServicesHealth and Social Care NHS Fife

2.4 Analysis of the Sickness Absence trends within NHS Fife in the current financial year shows that the sickness absence levels within the ASD have remained within the 4%

Graph 3

range for seven out of the nine month period ending at 31 December, with an increase to 5.36% in December. This has been attributed to an outbreak of Norovirus and staff being affected by respiratory infections. In contrast, Health and Social Care areas have been above 5% for each month apart from August.

2.5 The ASD sickness absence for 2015/16 is detailed in Graph 4 and shows that the sickness absence rate has been below the NHS Fife rate for the period of this report.

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15Jul-1

5

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

Acute Services DivisionSickness Absence Data per Directorates

January to December 2015Acute Services

Planned Care

Emergency Care

Clinical Support and Access

NHS Fife

Please note that areas within Planned Care and Clinical Support and Access (formerly Ambulatory Care) have changed with effect from October 2015.

2.6 Attendance Management activity within the ASD has been focused on Review and Improvement panels, Management Teams, the Acute Services Division Staff Governance Board and Performance Review meetings. The Emergency Care Directorate is the area of most concern within Acute Services with a rate of 6.50% in December, predominately clinical staff.

2.7 The sickness absence figures for Health and Social Care are shown in Graph 5.

Oct-14

Nov-14Dec-

14Jan

-15Feb

-15

Mar-15

Apr-15

May-15

Jun-15Jul-1

5

Aug-15Sep

-15Oct-

15

Nov-15Dec-

150.00

4.00

8.00

Health and Social Care PartnershipSickness Absence Data per HSCP Division

- January to December 2015NHS FifeHSCP East DivisionHSCP West DivisionHSCP Fife Wide DivisionHSCP Total

2.8 Within the Health and Social Care Partnership, the focus on attendance management has been through local management teams and their respective attendance management group meetings, which meet regularly. All areas of the Health and

Graph 4

Graph 5

Social Care Partnership now have Review and Improvement meetings in place. The East Division is the area of most concern, with long term sickness absence cases and several wards with specific issues, which are being addressed and supported.

2.9 Attendance Management activity within Estates, Facilities and Capital Services is focused via regular “Direct Reports” meetings and the Directorate also has Review and Improvement panels in place. Within Support Services in Central Fife, the rate has reduced to the lowest this year at 5.36%, with a reduction from an average of 6.42%, due to reductions in long term sickness.

3. ABSENCE TRENDS

3.1 The long-term / short-term trend for NHS Fife is detailed in Graph 6.

Apr-15

May-15

Jun-15Jul-1

5

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

010,00020,00030,00040,00050,000

Sickness Absence Trend 2015Hours Lost by Short and Long Absence

Long TermShort Term

Tota

l Hou

rs

3.2 Detailed analysis of the sickness absence trends between April and December indicates that the improvements achieved in the Summer months have not been sustained. The deterioration in the level of sickness absence between October and December have been as a result of increases in short term absence with an additional 4,624 hours lost in the short term category. However, there has been an improvement in the long term absence category, with a reduction of 2,571 hours lost in December.

3.3 The hours lost as a result of short term sickness absence has increased from 22,284 hours in April 2015 to 33,745 hours in December. This increase equates to 69.46 WTE staff per month. For long term sickness absence the total hours lost has reduced from 36,500 hours in April to 31,742 hours lost in December. This represents a reduction of approximately 4,758 hours, or 28.83 WTE staff per month.

3.4 On-going work is being undertaken in respect of the reasons for absence, the age profile and trends within the reasons. Details of the “top ten” known reasons for absence by hours lost within NHS Fife within the year to date are detailed in Table 2.

Table 2

Absence Reason Description Hours Lost

Graph 6

1. Anxiety / stress / depression / other psychiatric illnesses 13364.522. Other musculoskeletal problems 6852.413. Gastro-intestinal problems 5005.574. Other known causes 4924.035. Back problems 4082.116. Injury, fracture 4009.467. Cold, cough, influenza 3053.608. Chest & respiratory problems 2159.509. Genitourinary & gynaecological disorders 2131.0010. Ear, nose, throat 1529.26

This data shows we need to consider providing additional support for staff suffering from mental health related illnesses and musculoskeletal problems. This will be addressed through the Health and Well-being Strategy.

3.5 The NHS Fife absence figures for December, broken down into staff bands and age range, are detailed in Tables 3 and 4.

Table 3

Band Headcount Absence %Band 1 117 5.70%Band 2 283 7.43%Band 3 158 6.52%Band 4 83 4.18%Band 5 353 6.12%Band 6 184 5.00%Band 7 72 2.93%Band 8 and above 65 2.18%

There will be more detailed analysis undertaken to understand the causes for the high absence rates within Band 2 and Band 5 staff groups, which are our largest staff groups and predominately nursing staff.

Table 4

Age Range Headcount Absence %16-19 3 0%

20-24 50 2.19%25-29 114 3.29%30-34 124 4.11%35-39 137 3.92%40-44 146 4.63%45-49 213 4.96%50-54 238 6.38%55-59 184 7.06%60-64 79 6.35%

Age Range Headcount Absence %65+ 18 6.50%

This data shows that future Staff Well-Being activities need to be directed towards staff in the age 50+ age groups.

4. ACTIONS

4.1 An Attendance Management Resource pack for managers to use at ward and department level has been developed with the support of the Programme Management Office and will be initially distributed on a priority basis, based on the identification of areas where absence is a significant issue. Additional support will be offered to managers in these areas. This will be rolled out across the whole organisation.

4.2 As part of the Well@Work Project, managerial competencies for managing attendance are being developed and will be used to support improved practice in managing sickness absence.

4.3 Monthly Attendance Management Training sessions, delivered in partnership, have been undertaken within NHS Fife, together with bespoke sessions as required. Dates for regular monthly sessions have been set for 2016. 280 Managers / Supervisors were trained during 2015 and 68 managers and supervisors participated in eLearning.

5. APPROACH TO STAFF HEALTH AND WELL-BEING

5.1 Improving the health and well-being of staff is a key priority moving into 2016. The Health & Well Being Strategy, being formally launched in February, along with a Staff Well@Work Handbook, provides a foundation for the Board to move forward, coupled with the ambition to achieve the Gold Healthy Working Lives Award in Spring 2016.

5.2 The focus thereafter will be on the transformation of the Occupational Health and Safety Service to become a Staff Health and Well-being Service and this means developing the future service into a bespoke model which will deal with each episode of staff absence on a pro active basis. For example, the Board’s absence levels peak in July, October, December and January each year. Modernising the occupational health provision combined with the ability to understand reasons for and timing of absence will provide the basis to ensure that the opportunities to improve staff health and well being are maximised.

5.3 In addition, the Well@Work project has detailed plans in place in terms of assisting the Board to submit for assessment for the Gold Healthy Working Lives Award this year. Assessment is planned for Spring 2016.

WORKFORCE – CONSULTANT RECRUITMENT

1. INTRODUCTION

1.1 As at 31 January, NHS Fife has 30.49 wte Consultant vacancies, (taking account of confirmed appointments). Some specialties have had notable recent success in recruiting, with 38 new substantive Consultants taking up post during 2015. There are inherent risks in posts being vacant in terms of capacity, service delivery, potential impact on ability to provide training for junior medical staff and costs of internal and agency locum cover.

1.2 There is a requirement to ensure that the Board has a plan in place to recruit to vacant posts. Most other NHS Boards across Scotland and the wider UK experience similar issues, resulting in significant competition for the same candidates. Data available shows that the majority of candidates are recruited from within NHS Scotland, with a handful of applicants from South of the Border / overseas. Other avenues have been explored to date, with limited success.

2. HISTORICAL POSITION

2.1 From mid 2014, NHS Fife has participated in a number of initiatives to attract Consultants to vacant posts including a campaign within the British Medical Journal in July 2014, a social media campaign in the Autumn of 2014 and has used Global Medical Careers and Doctors.net to promote posts. This has been supplemented by promotions within the NHS Scotland Medical Recruitment Micro Site and generic rolling adverts on Scotland’s Health on the Web throughout 2015. These efforts resulted in limited appointments.

2.2 Emergency Medicine and Radiology pursued the agency / overseas doctor route, with limited success in the recruitment and retention of EU doctors. There have been additional costs and disruption to service from this approach – for example, extended leave to return home for family reasons. Family and housing / “settling in” issues were also experienced and there has been attrition from the cohort of doctors recruited, with only one of these Consultants now remaining in post.

2.3 NHS Fife has also participated in recent Scottish Government and EURES (European Job Network) initiatives, for example our hard to fill posts were included at a recruitment fair in the Netherlands in May 2015, (due to an EU Government convention, at governmental level member states do not seek to recruit Consultants in each others’ territories, but individual employers can do so). This did not generate any suitable candidates.

2.4 In July 2015, NHS Fife participated in an online European initiative also run by EURES, advertising Consultant posts in the areas listed below and GP opportunities available at Linburn Road Health Centre. In addition, NHS Fife participated in the Scottish Medical Training Careers Fair in 2014 and 2015, and was represented at the Irish Medical Careers Fair in October 2015. The latter did not provide any suitable candidates.

2.5 Posts in the following specialties were successfully filled from standard advertising during the course of 2015: Anaesthetics, Care of the Elderly, Dermatology, Endocrinology, Emergency Medicine, General Surgery, Microbiology, Obstetrics & Gynaecology, Occupational Medicine, Oncology, Ophthalmology, Orthopaedics, Palliative Medicine, Pathology, Psychiatry, (Child & Adolescent, Forensic, General and Old Age), Radiology, Rehabilitation Medicine and Rheumatology. The majority (38) of these new Consultants have now taken up post, and a further 6 Consultants (5.4 wte), including those from the December interviews, scheduled to start during 2016.

2.6 The graph below details the current percentage Consultant establishment and vacancy information by whole time equivalent:

Consultants (229.37 wte) in post

86.5%

Vacancies (30.37 wte) 11.45%

Appointments (5.4 wte) due to start

2.05%

Consultant Workforce(Establishment - 265.14 WTE)

3. CURRENT POSTITION

3.1 In December, posts in the following specialties were advertised in the BMJ and Doctors.net: Acute Geriatric Medicine, Acute Medicine, Gastroenterology, Paediatrics, Pathology, Radiology and Respiratory Medicine. Applications have been received for all posts with the exception of Pathology and Radiology and interviews are scheduled for these vacancies in February and March. An advert has also been placed for Consultants in Urological Surgery.

3.2 The current advertising plans and recruitment update in respect of the remaining main areas of vacancies / hard to fill posts are detailed below.

Table 1

Post Current Recruitment UpdateAnaesthetics(2.0 wte vacancies)

Adverts placed in the BMJ and SHOW in February 2016

Cardiology(1.6 wte vacancies)

Intention is to advertise in the BMJ and SHOW in February 2016, timed to secure trainees approaching CCT

Emergency Medicine

(3.0 wte vacancies)

Intention is to re-advertise the full-time posts in February 2016, as it is anticipated that recent new appointees will make service more attractive to potential candidates

Neurology (2.0 wte vacancies)

Clinical Director reviewing service provision, outcome anticipated in March 2016. External cover in place.

Graph 1

Post Current Recruitment UpdatePathology (1.7 wte vacancies)

No applications received in response to recent advertisement and agency locums now secured from April 2016 as well as NHS Forth Valley providing assistance, with a view to making posts more attractive. Consideration of Healthcare Scientist input to reduce reliance on Consultant Workforce. Will re-advertise in Summer 2016.

Radiology (5.27 wte vacancies)

One further resignation received. Links being explored with St Andrews and other Universities prior to next advertisement. Two overseas locums are at pre-employment check stage. NHS Fife is working with the National Shared Services agenda for Radiology provision.

4. ASSESSMENT

4.1 None of the options for overseas recruitment tried so far, (standard and non standard advertising, EURES and Netherlands events, agencies etc), have generated appropriate interest, with there continuing to be vacancies for some time within following specialties: Anaesthetics, Cardiology, Neurology, Paediatrics and Radiology. It is clear that predicted trained Consultant output, attrition and participation rate within NHS Scotland does not meet the numbers of Consultant posts and the anticipated bulge in numbers has not materialised. There is national work ongoing on tracking where Scottish medical trainees seek employment on completion of higher specialty training, (CCT).

4.2 The Medical Workforce Group, chaired by Dr Elliot, has the overview of Consultant recruitment and planning. Services are also exploring the opportunity for joint appointments with other Boards, which may be more attractive to certain specialties. Contingency arrangements and service redesign where we have an inability to recruit are also in place, e.g. Emergency Medicine and Radiology, together with the development of joint appointments with St Andrews and other Universities.

4.3 One of the important lessons is making NHS Fife an attractive place for existing trainees to consider for their long term career, linked to what can be offered within job plans. Clinical Leads have been successful in networking with trainees approaching CCT and established Consultants who wish to relocate to Fife.

HEALTH & SOCIAL CARE INTEGRATIONThe Chief Officer (Director of Health and Social Care) reports to the Chief Executive, NHS Fife and the Chief Executive, Fife Council. Joint performance review meetings involving both Chief Executives and the Director of Health and Social Care take place on a regular basis in accordance with each organisation’s normal performance management arrangements. The Director of Health & Social Care has overall responsibility for the delivery of the Standards reported in this section and for determining further activity, commissioning and performance data for measuring progress in delivering the aims and objectives of the partnership.

DEMENTIA REGISTRATION AND POST-DIAGNOSTIC SUPPORT

We will have a QOF-registered proportion of diagnosed dementia patients consistent with the European measure of prevalence, all of whom will have a minimum of a year’s post-diagnostic support and a person centred support plan

Post-Diagnostic Support Background

The offer of Dementia Post-Diagnostic Support (PDS) which meets the Alzheimer’s Scotland (5 Pillars) standard is relatively new and is in direct response to the national standard having been set. It is in addition to other support/care/treatment which would have been taking place as a matter of routine work.

The current workforce identified for the task comprises a mixture of mental health, psychology, Alzheimer’s Scotland and other resources operating from three geographically based hubs. There has been success in clearly articulating and streamlining pathways to diagnosis and to PDS. This success has now left us with the challenge of managing high referral volumes.

In order to future proof the offer of Dementia PDS in Fife we need to do two things:

Identify additional resources (from within our existing workforce/budgets) Devise a management arrangement which provides a functional level of coordination,

standardisation and quality assurance

Identifying additional resource is currently proving challenging but recent clarification of responsibilities for the Dementia target should make the second action easier to achieve.

Post-Diagnostic Support Performance

Guidance for measuring and reporting on this target, and the target itself, was expected to be available in December, possibly as part of the guidance for the 2016-17 Local Delivery Plan. The latter was not issued until mid-January, but guidance regarding PDS performance was not included. This is being pursued with ISD and the SGHSCD.

It is likely that the focus of the PDS measure will be on patients diagnosed with dementia and their initial contact with a link/support worker, rather than the previous focus of having 1-year post-diagnostic support and a support plan. When this is clarified, we expect to be able to provide some local performance information and to then consider what type of recovery/improvement is required.


Dementia Registrations

The main risks to achieving the standard are:

Failure to respond adequately to demands for PDS (as it is the existence of PDS which has been used to incentivise GPs and others to refer early to secondary care for diagnosis)

Failure to keep the profile of dementia and dementia registration high with Primary Care colleagues

Dementia Post-Diagnostic Support

The main risk to achieving this target is:

Managing demand and capacity

Dementia Registration

Recovery Trajectory

Recovery Plan

Dementia Post-Diagnostic Support

Recovery Trajectory

Not available at present, pending further guidance from the Scottish Government around prevalence and the target.

Recovery Plan


Task 1.3 We have been unable to identify additional capacity within the existing workforce. As of the December ISD report, there were 273 people waiting for post-diagnostic support in Fife, in comparison to 300 the previous month. Until additional workers can be found we are focusing on maximising efficiencies.

A short piece of scoping conducted by a Senior Nurse has been concluded. An action plan is being created to establish a Fife-wide Team leader from within current resources, to manage and report performance, and to provide a Fife-wide consistent approach to PDS which enhances flexibility and efficiencies.

DELAYED DISCHARGE

No patient will be delayed in hospital for more than 2 weeks after being judged fit for discharge


The actions described in the recovery plan below are expected to support a working solution to the target that no patient will be delayed in hospital 2 weeks beyond being clinically fit for discharge.

The joint Delayed Discharge Task Group continues to monitor and manage the demand for placements and services across the partnership on a weekly basis. A significant amount of modeling work has been undertaken to try to understand the pressures across the system and in particular the reason people are in delay, and this has resulted in additional funding being made available to support discharge. A memorandum of understanding has been signed by both NHS Fife and Fife Council which highlights a number of actions and requirements, and this has resulted in significant movement of patients from both acute and community hospitals.

A short term support model to enable a person to recover from an acute illness at home with support has been developed in conjunction with a private care agency and initial feedback has been positive. The project is due to finish in February, and a full evaluation will be available.

As part of the Delayed Discharge Action Plan there will be an increase in STAR facilities over the winter and work is underway to determine the capacity available across Fife. This will ensure people will be supported to return home following a period of reablement. A Coordinator is in post to ensure that people move through the system as quickly as possible.

The START programme, which will support people to leave the acute hospital within 72 hours with a care package, has now been introduced. This is at an early stage and will be evaluated closely to determine the capacity.

The delivery plan is closely monitored and every effort will be made to mitigate any risk.

Recovery Trajectory

Note that the ‘Actual Performance’ figures relate to the situation at the monthly census, generally taken around the 15 th of the month – the number in delay will vary from day to day.


The actions listed in the plan on the next page are largely on track.

Task 8.1 has been deferred pending the discharge of the existing patients in Step down beds at which point the charging policy will be further considered.

Recovery Plan

SMOKING CESSATION

We will deliver a minimum of 602 post 12 weeks smoking quits in the 40% most deprived areas of Fife


The actions described will ensure NHS Fife delivers good outcomes in relation to quit rates. This may not however mean we meet the target of successful quits by March.

There are a number of risks that must be considered:

Pharmacy changes which require a new follow-up model to become embedded The increasing rise of e-cigarettes which are being seen by smokers as a stop

smoking aid

These challenges are addressed at a monthly task meeting and actions are put in place where possible.

Recovery Trajectory

The service completed a mapping exercise based on capacity and community needs as measured by smoking prevalence and SIMD data, and clinic activity has been re-orientated accordingly. In addition six new clinics have been established in the Glenrothes area within GP practices due to additional capacity as a result of the move to the Fife-wide model.

The redesign to a Fife wide model with East and West Divisions and a single management structure has been completed, with local coordinators for each Division in place.

New pathways are being developed in populations with highest smoking prevalence which include clients with mental health issues, teenage parents, pregnant woman from SIMD 1 & 2 and patients with diabetes.

Recovery Plan

ALCOHOL BRIEF INTERVENTIONS

We will deliver a minimum of 4,187 interventions, at least 80% of which will be in priority settings


The actions described are to ensure that NHS Fife will deliver the required number of ABI during the year.

There are a number of risks that must be considered:

Embedding of alcohol brief interventions in geographical areas of multiple deprivation No identified ABI training co-ordinator post Funding provided from SG in previous years no longer ring fenced for ABI activity

Recovery Trajectory

In Q3, there was an increase in the number of alcohol brief interventions undertaken, resulting in the overall performance being above trajectory.

Recovery Plan


Task 1.2 A meeting with various social groups to discuss ABI activity in wider settings has been scheduled for 19th February

In relation to the identified risks, a meeting to discuss the embedding of ABI activity across Fife is required. As training will be required, Health Promotion input will be required.

CHILD AND ADOLESCENT MENTAL HEALTH SERVICE WAITING TIMES

At least 90% of clients will wait no longer than 18 Weeks from referral received to treatment for specialist child and adolescent mental Health Services (CAMHS)


Current improvement plans have been focused heavily on investing in additional staff. Part of our small allocation through the mental health innovation fund will be invested in additional capacity. This will have the greatest impact on therapeutic services for looked after children and in the training of the school nurses. In addition, the Scottish Government are still devising their allocation strategy for the new funding (£85M over 5 years), some of which is specifically to improve access to CAMHS.

The current improvement plan and predicted trajectory has been contingent upon receipt of this second, additional larger tranche of new funding.

However, in reaction to an increase in demand, CAMHS has restructured its management and have introduced better electronic systems to support the gathering of accurate demand and activity data. We are now able to accurately measure the current staffing capacity, waiting list and referral demand rate. We are now focusing on an attempt to increase activity within current resources. We are doing this by reducing non-patient facing activity and removing the generic waiting list and proportionately allocating all waiting cases and all new referrals to individual clinicians.

Once the allocation strategy for this new funding has been determined and shared it will be possible to predict more accurately when the target can be achieved. In the current absence of significant new investment there is now a focus on improving the productivity of the clinical staff working with the high volume low intensity cases.

Recovery Trajectory

Note that the ‘Actual Performance’ figures shown are for 3-month periods ending those months, not for the individual months themselves.

Recovery Plan


While planning redesign in many areas is underway, and waiting times have improved due to changes to current working practices, sustained improvement resulting from the completion of the RED tasks on the Recovery Plan is reliant on the availability of additional funding from the Scottish Government. This will not be available in the current FY.

PSYCHOLOGICAL THERAPIES WAITING TIMES

At least 90% of clients will wait no longer than 18 weeks from referral received to treatment for psychological therapies


Poor performance against this target is primarily the result of a lack of overall capacity. This assertion has been confirmed by work that was done with Scottish Government QuEST

Current improvement plans are focused heavily on investing in additional therapists utilising the Scottish Government new funding (£85M over 5 years) some of which is specifically to improve access to Psychological Therapies.

The current improvement plan and predicted trajectory - which sees us achieving the target by the end of the financial year – is based on using this funding. More accurate plans can now be determined as to when the target can be achieved. In the meantime strategies are being progressed for:

diverting referrals at an earlier stage towards self help expanding our group work programme (appropriate for a proportion of new referrals

for people with anxiety and depression).

A recent success in relation to self help has been the rollout of computerised CBT ('Beating the Blues') as part of an EU wide programme being organised and supported in Scotland by NHS24. Within Fife 647 people have been referred to 'Beating the Blues' since it was first made available a year ago.

The main risks to achieving the standard are as follows:

Inadequate capacity to meet demand An absence of other signposting options for referrers leading to high referral volumes An absence of suitable community venues across Fife

The risks are being managed by bidding for anticipated additional nationally (Scottish Government) allocated resources; and by supporting developments such as an investment in a European wide initiative widening access to computerised CBT as an alternative to referral.

Recovery Trajectory

Note that the ‘Actual Performance’ figures shown are for 3-month periods ending those months, not for the individual months themselves.

Recovery Plan


Task 1.4 Although clinic space has been identified, the completion of this task is contingent on aligning staff to run the therapeutic group work. This ties in therefore with task 1.5.

Task 1.7 Progress has been made with this task. The main problem area for under-provision is Levenmouth, and work is ongoing to attempt to resolve this. The Psychological Therapies Development Lead has joined an H&SC group set up to allocate accommodation across the partnership.

RECOMMENDATION

The Board is asked to:

Note the key items of information highlighted within the Integrated Performance Report, in particular those listed in the Executive Summary

CHRIS BOWRINGDirector of Finance23 February 2016

SECTION BCAPITAL PROGRAMME 2015/16

1. INTRODUCTION

1.1 This report provides an update on the 2015/16 Capital Programme as approved by the Board at its meeting on 24 February 2015.

1.2 The report provides information on the following:

Expenditure to 31 January 2016;

Changes to the Board’s Capital Resource Limit (CRL);

Details of changes in Planned Expenditure;

Estimated Capital Expenditure outturn; and

Capital Receipts

2. EXPENDITURE TO DATE

2.1 The expenditure position shown is for the period to 31 January 2016. Appendix A provides details of the current expenditure.

2.2 For 2015/16 each of the Project Leads have provided an estimated spend profile against which actual expenditure is being monitored.

2.3 The estimated spend profile for the period to 31 January 2016 is £9.309m (70% of the total allocation).

2.4 The expenditure to date amounts to £8.276m. This represents 63% of the estimated annual expenditure (Appendix B). The main areas where expenditure has been incurred since the previous report to the Board are as follows:

Stratheden IPCU £0.680m General Hospitals and Maternity Services £0.422m Equipment £0.334m Information Technology £0.411m

2.5 Total expenditure to date is £1.032m behind the profiled trajectory and this is primarily due to the Statutory Compliance/Backlog Maintenance, Minor Capital Works schemes and Radiology Equipment slipping from their projected timescales.

3. CHANGES TO CAPITAL RESOURCE LIMIT

3.1 Since the previous report to the Board a reduction in allocation of £0.500m has been received. This is in respect of a Capital to Revenue transfer for capital expenditure which does not add to the overall value of an asset. To ensure budgetary control any such projects continue to be managed in full with expenditure transferred to revenue at the completion of a project or at the financial year end.

4. CHANGES TO PLANNED EXPENDITURE 2015/16

4.1 Appendix C shows the changes in the plan resulting from changes in allocations and from updated estimates for schemes already approved. Since the previous report there have been no significant changes to the plan.

5. CAPITAL EXPENDITURE OUTTURN

5.1 At this stage of the financial year it is currently estimated that the Board will spend the Capital Resource Limit in full.

6. CAPITAL RECEIPTS

6.1 With the SGHSCD providing additional funding to cover the slippage in sale of Lynebank land and Forth Park Hospital, the Board was left with a requirement to securing capital receipts of £150k. Current estimates suggest that a shortfall of £76k against the budget will exist at the year end. To cover this an underspend of £76k will be required to be made on the expenditure budget. To date £68k of the required underspend has been identified.

7. RECOMMENDATION

7.1 The Board is asked to:

note the Capital Expenditure to 31 January 2016;

note the current Capital Resource Limit position;

note the changes in Planned Expenditure;

note the Capital Expenditure outturn; and

note the Capital Receipts position.


NHS FIFE - TOTAL REPORTS SUMMARY

CAPITAL PROGRAMME EXPENDITURE REPORT - JANUARY 2016

FOR FINANCIAL YEAR 2015/16

CRL Total Projected

NewExpenditur

eExpenditur

e Projected Funding to Date 2015/16 VarianceProject £ £ £ £ COMMUNITY & PRIMARY CARE Stratheden Hospital - IPCU 3,757,000 2,808,217 3,757,000 Statutory Compliance 387,170 170,198 387,170 Capital Minor Works 366,832 127,399 366,832 Capital Equipment 171,616 157,698 171,616 Condemned Equipment Total Community & Primary Care 4,682,618 3,263,512 4,682,618 ACUTE SERVICES DIVISION Capital Equipment 640,783 618,389 640,783 GHMS - Tasks 3,279,000 2,297,144 3,279,000 Statutory Compliance 1,291,321 909,381 1,291,321 Total Minor Works 204,011 136,221 204,011 Total Condemned Equipment 131,211 131,211 131,211 Total Acute Services Division 5,546,326 4,092,346 5,546,326 NHS FIFE WIDE SCHEMES Condemned Equipment Information Technology 1,563,000 731,697 1,563,000 Radiology Equipment 1,083,076 138,813 1,083,076 Vehicles 75,000 11,722 75,000 Scheme Development 25,000 3,872 25,000 Capital Receipts Shortfall 67,525 (67,525)Total Fife Wide Statutory Compliance 159,455 34,055 159,455 Total NHS Fife Wide 2,973,056 920,159 2,905,531 (67,525) TOTAL ALLOCATION FOR 2015/16 13,202,000 8,276,017 13,134,475 (67,525)

Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar0

5000

10000

15000

20000

Capital Spend Profile 2015/16

Actual Forecas t

Months

Cum

ulat

ive

£000

's

Capital Expenditure Proposals 2015/16 Board Dec F & R Board 22/12/2015 Adj 26/01/2016 Adj £'000 £'000 £'000 £'000 £'000 Specific Schemes Dunfermline & West Fife CHP Glenrothes & North East Fife CHP Kirkcaldy & Levenmouth CHP Stratheden IPCU 3757 3757 3757 Acute Services Division General Hospitals & Maternity Services - Aseptic Suite VHK 984 984 984General Hospitals & Maternity Services - QMH Carnegie 1664 1664 1664General Hospitals & Maternity Services - QMH Dental 109 109 109General Hospitals & Maternity Services - QMH Audiology 112 112 112General Hospitals & Maternity Services - VHK White Space 230 230 230General Hospitals & Maternity Services - General 180 180 180 Fife Wide Telephone System 511 511 511 7547 7547 7547Routine Expenditure Community & Primary Care Minor Capital 379 -1 378 -11 367Capital Equipment 140 30 170 2 172Statutory Compliance 432 -40 392 -5 387Condemned Equipment Acute Services Division Capital Equipment 648 -7 641 641Minor Capital 197 197 7 204Statutory Compliance 1269 9 1278 13 1291Condemned Equipment 131 131 131 Fife Wide Vehicles 75 75 75Information Technology 1052 1052 1052Radiology Equipment 1083 1083 1083Backlog Maintenance/Statutory Compliance 174 174 -14 160Condemned Equipment Scheme Development 37 37 -12 25Fife Wide Equipment Capital Receipts Shortfall 38 9 47 20 67 5655 5655 5655 13202 13202 13202

SECTION CFINANCIAL POSITION TO 31 JANUARY 2016

REVENUE RESOURCE LIMIT

Health Boards are required to work within the revenue resource limit set by the Scottish Government Health & Social Care Directorates (SGHSCD). This is monitored by SGHSCD via the monthly Financial Performance Return.

Performance at the end of January remains ahead of trajectory. The month on month trend continues to be very positive; however there is an increasing likelihood that this improvement may not be sufficient to deliver a break even position at the year end.


The Revenue Resource Limit position for NHS Fife for the ten months to 31 January 2016 is showing an overspend of £1.927m compared with the £2.140m estimated overspend as set out in the Board’s Local Delivery Plan at the start of the year. The continuing improvement in the monthly expenditure position is encouraging and tighter control of cost pressures is clearly evident. However, GP prescribing costs have seen a marked increase over recent months. This is driven by an increase in both the volume and average unit price of prescriptions, compounded by the difficulty in delivering the anticipated level of savings. This increase has been offset to an extent as a result of an improving forecast outturn within the Acute Services Division, Estates & Facilities, Fife-wide community services, and a number of corporate areas.

Delivery of a breakeven position at the year end is a statutory requirement, however due to the change in the cost of prescribing this is becoming ever more challenging.

May June July Aug Sept Oct Nov Dec Jan Feb March

(3,500)

(3,000)

(2,500)

(2,000)

(1,500)

(1,000)

(500)

0

Financial Performanceagainst Trajectory 2015/16

Plan Actual

£000

Recovery Trajectory

Month May June July Aug Sept Oct Nov Dec Jan Feb Mar

Actual (1,294) (1,848) (2,238) (2,234) (2,465)(2,263

) (2,231) (2,139) (1,927)

Plan (1,131) (1,696) (2,134) (2,581) (3,104)(3,045

) (2,994) (2,758) (2,140) (1,023) 0Forecast Outturn 0 0 (2,705) (1,458) (1,712) Overall Target 0 0 0 0 0 0 0 0 0 0 0

Recovery Plan

There is an increasing risk to be able to breakeven by 31 March 2016. This is predominantly due to the difficulty throughout the year in identifying and delivering the level of efficiency savings required across the system, on top of the reduction in operational budget overspends being achieved. The new additional pressure driven by GP prescribing expenditure (as noted in the Key Concerns section above) is having a significant impact on the overall forecast outturn.

The Executive Director Group continues to scrutinise the position and to consider what options might be available to manage the position as we head into the final weeks of the year. It is likely that further discussion will be required with Scottish Government colleagues through the formal monthly performance monitoring process.


An overview of the overall financial position is set out below.

1. Financial Framework

1.1. The Financial Framework for 2015/16 was approved by the NHS Fife Board on 28 April 2015, subject to further action to close the gap in the level of savings identified at that time. Approval of the Financial Framework by the NHS Board enabled Executive Directors to receive details of their initial annual budgets for 2015/16. All opening budgets have been signed off by the relevant Executive Director.

2. Allocations

2.1. Since the previous report to the NHS Board, we have received additional core allocations from the Scottish Government Health and Social Care Directorate (SGHSCD) of £1.917m. These include a reduction in recurring funding of £1.276m and additional earmarked recurring funding of £0.694m and non-recurring funding of £2.499m.

2.2. The new allocations include £1.5m for Delayed Discharges and £0.500m for a Capital to Revenue transfer to cover the cost of expenditure within the Capital Programme which does not add capital value. Also included is £0.407m in respect of Distinction Awards for Consultants, £0.252m from the New Medicines Fund and £0.203m for the final tranche of funding for the Family Nurse Partnership Project.

2.3. Included in the above is a reduction in allocation of £1.247m in respect of recharges for national risk share services.

2.4. A full list of allocations received is shown in Appendix A.

2.5. In addition to allocations from SGHSCD the Board also received miscellaneous income from other sources. Since the previous report to the Board additional sources of income amounted to £0.898m with the main area of increase being CNORIS £465k.

3. Analysis of Financial Performance to Date

3.1. A summary is shown in the table below.

Budget Expenditure FY CY YTD Actual Variance Variance £'000 £'000 £'000 £'000 £'000 % Acute Services Division 180,988 186,247 154,504 161,059 6,556 4.24%Integration Services Community & Primary Care 137,851 148,317 123,373 123,073 (300) (0.24%)FHS 35,889 40,389 33,662 33,662 (0) 0.00%Prescribing 72,336 74,131 61,985 63,020 1,035 1.67% PMS 46,859 48,985 40,772 40,733 (39) (0.10%)Estates & Facilities 65,236 65,146 54,119 53,624 (496) (0.92%)Board Services 31,871 51,505 44,530 43,065 (1,465) (3.29%)Other Healthcare Providers 97,087 105,380 88,820 88,907 88 0.10%OHSAS 3,815 4,591 3,830 3,744 (86) (2.24%)Depreciation 18,028 19,361 16,315 16,315 (0) 0.00%Reserves Impairments & provisions 10,000 23,166 0 0.00%

General 29,089 6,962 4,704 (4,704)(100.00%

)

Efficiency Savings (2,914) (4,193) (1,868) 1,868(100.00%

)Total Expenditure 726,136 769,987 624,745 627,202 2,457 0.39%Miscellaneous Income (64,266) (87,765) (75,168) (75,698) (530) 0.71%Net position 661,870 682,222 549,577 551,504 1,927 0.35%

Acute Services

3.2. The Acute Services Division is reporting an overspend of £6.556m for the period. The list of key drivers for this overspend continues to include the purchase of healthcare from other providers, medical staffing, nursing and drugs:

There is an overspend (£460k) on the use of independent healthcare providers for Orthopaedic activity, Dermatology activity, Laboratories and Radiology. The measures put in place to control the use of the independent sector capacity to address treatment time guarantees continue to reduce the rate of overspend.

The use of agency and locum medical staffing to meet the recruitment challenges continues to have a major impact within Orthopaedics, General Surgery, Anaesthetics, Urology, General Medicine, Paediatrics, Neurology, Obstetrics & Gynaecology and Ophthalmology.

There is a relatively significant overspend reported within nursing (£2.6m) which is attributed to both bank and agency usage, and the residual impact of incremental progression. The pressures continue across a number of specialties including: Orthopaedics, Obstetrics & Gynaecology, Elderly Medicine, Theatres and Critical Care. Strict controls on the use of agency staff are now in place and whilst any specific requests on the grounds of patient safety need to be considered, this action is reducing the level of additional expenditure with the rate of overspend continuing to slow down.

High cost drugs, particularly in Emergency Care specialties, are contributing to an overspend in this area.

Integration Services

3.3. Across the former CHP budgets, primary medical services, primary care emergency service (PCES) and family health services, the budgets are showing a net overspend of £696k for the period to date. This position comprises overspends across both prescribing and PCES, offset in part by an underspend across the former CHP budgets.

3.4. The overspend has increased in month and is principally due to an increase in prescribing spend. This reflects an increase in volumes being dispensed and an increase in the average cost per item, coupled with the impact of delay to the delivery of anticipated cash efficiency savings.

3.5. There also remains an issue within the Primary Care Emergency service due to sessional rates.

3.6. The former CHP budgets continue to report an underspend across a range of budgets (vacancies in community nursing, health visiting, school nursing, administrative posts, and dental services) which continue to offset some of the cost pressures (level of expenditure on complex care packages, incremental progression within the Palliative Care service, Mental Health nursing and medical locums, and the transfer in of Wards 5 and 6 (with an associated overspend) from the Acute Division).

Corporate Services

3.7. Within the Board’s corporate services, including Estates & Facilities, there is an underspend of £1,959k due mainly to vacancies across a number of departments. However, this continues to mask a pressure within Estates & Facilities on energy and equipment costs relating to service contracts across the system.

Non Fife and Other Healthcare Providers

3.8. The budget for healthcare services provided out with NHS Fife is showing an overspend of £88k for the period. This is based on an estimated underspend of £848k on Service Level Agreements with other Health Boards and an overspend of £948k on Unplanned Activity (UNPACs) and Out of Area Treatments (OATS) activity. The major driver of this overspend is the estimated increased UNPACs activity with NHS Lothian for cancer and other high cost drugs and an increase in bone marrow transplants. The OATS expenditure has increased due an additional Learning Disability patient being treated in England. These remain estimates at this point in the year pending ongoing discussions.

Reserves

3.9. Current estimates suggest that the Board could incur a further £2.6m on property impairments and provisions during 2015/16. The actual costs are matched with additional funding from SGHSCD. Similarly, an estimate of £20.6m is included in the reserve balance, as the NHS Fife share of the national Clinical Negligence & Other Risks Indemnity Scheme (CNORIS) increase in provisions.

3.10. Funding of £4.704m has been recognised from the Fife-wide general reserve, offsetting the overall financial position across the system. This takes account of slippage from financial plan commitments and new allocations received.

Miscellaneous Income

3.11. An over-recovery in income of £530k is shown for the first ten months of the financial year.

4. Efficiency Savings

4.1. The Board’s Financial Framework set out the need to deliver a total of £10.143m cash efficiency savings to support financial balance. At the end of January, cash releasing schemes totalling £5.950m had been identified. There are developed plans in place to deliver a further £0.633m of savings, leaving a balance of £3.560m to be achieved. At the time of reporting, this is assumed in the overall year end forecast.

4.2. This balance comprises a range of initiatives, some of which had been scoped as options at the time of the Financial Framework sign off last May, and the more recent £1.5m target set by EGD for operational budgets in November, which had not been fully worked into specific proposals:

£'000

Original proposals which will not deliver this year:Medicines and Prescribing 367Voluntary Organisations 150Workforce 250Original proposals which are now delivering through operational performance (run rate):Sickness Absence 500Endowments 100Procurement 446Other 37Balance of £1.5m target 710

Asset Disposal 1,000

Shortfall in savings 3,560

4.3. The graph below highlights that the planned trajectory assumes back-loading of savings toward the second half of the year and delivery of savings is behind trajectory for the period, as the commentary above has indicated.

Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-160

2,000

4,000

6,000

8,000

10,000

12,000Cash Releasing Efficiency Savings Delivery Against Trajectory

PlanAct/F'cast

Period

Value (£k)

5. RECOMMENDATION

5.1. The Board is asked to:

note the financial position for the ten month period to 31 January 2016


Appendix A

New Allocations Received

Baseline Earmarked Non -

Description Recurring RecurringRecurring Total

£ £ £ £

Delayed Discharges 1,500,000 1,500,000Capital to Revenue Transfer 500,000 500,000Distinction Awards for Consultants 407,116 407,116New Medicine Fund 252,000 252,000Family Nurse Partnership 203,000 203,000Outpatient Waiting Times 100,000 100,000Pre-Registration Pharmacist Scheme 84,049 84,049National Ophthalmology Workstream 75,000 75,000Fit for Work 34,632 34,632Implementation of Nursing Revalidation 19,469 19,469Eyecare Integration 6,175 6,175Demand Capacity Bed Model 5,000 5,000Disabled Graduate Scheme 4,849 4,849IT Toolkit 1,500 1,500Managed Diagnostic Networks (29,012) (29,012)National Risk Share - Bone Marrow (236,397) (236,397)National Risk Share - Specialist Services (1,010,112) (1,010,112)

Total New Allocations Received (1,275,521) 694,165 2,498,625 1,917,269

SECTION D

THE SCOTTISH PATIENT SAFETY PROGRAMME (SPSP)

1. PURPOSE

The purpose of this report is to update the NHS Fife Board of the ongoing activity underway across NHS Fife to implement the Scottish Patient Safety Programme (SPSP). This report incorporates progress in December.

2. SITUATION

The aim of the SPSP is to reduce the HSMR by 20% by December 2015; and to ensure that 95% of patients receiving acute care should be free from harms as identified by the Scottish Patient Safety Indicator (SPSI).

The (three) SPSI harms are:

Cardiac arrests Falls Pressure ulcers

A revised measurement plan has been released in response to feedback from NHS Boards on the challenges in providing adequate support across the broad SPSP agenda. The amended measurement plan focuses on elements of work which will best support the aims of reduction in mortality and harm. To facilitate this, measures have been separated in to core and supplementary for the purpose of national reporting.

Core:

Outcome measures relating to the harms of SPSI (including CAUTI) Process measures relating to the harms of SPSI (including CAUTI and Sepsis) Measures relating to Medicines

Supplementary:

Process measures relating to VTE, Heart Failure and Surgical Site Infection

One of the key changes to the measurement plan is the amendment to the pressure ulcer indicator. The revised aim is seeking a 50% reduction in the pressure ulcer rate by December 2017.

The “Cauti” harm which was removed from reporting temporarily is expected to join the suite of outcome measures in December since a new definition has been agreed.

2.1 HSMR

Chart 1: HSMR (Fife v Scotland)

Chart 1 shows the NHS Fife HSMR in comparison to NHS Scotland. The most recent HSMR data, released in November demonstrated a reduction of 22.7% since December 2007 with a HSMR of 0.92, unchanged from the previous quarter. The next release of the HSMR data is due for publication on 16th February.

Chart 2: HSMR (Fife and Regression Line)TARGET REACHED

Chart 2 demonstrates NHS Fife’s HSMR with regression line.

2.2 SPSI HARMS

Chart 3: Cardiac Arrests (Acute Hospitals)SUSTAINED DETERIORATION

Chart 3 demonstrates an increase in the median from January 2014 when it increased from 1.3 to 1.6. The daily hospital huddle was introduced during July 2015. The data points for July, August and November sit just on and under the median. The data has been extracted from the Resuscitation Officer database.

Chart 4: Fall With Harms (Acute Hospitals)RANDOM VARIATION

Chart 4 demonstrates random variation. However although run chart rules cannot be applied yet, the performance from November 2014 appears visually more stable. Data has been extracted from the Datix system.

Chart 5: Pressure Ulcer Rate Grade 2 to 4 “Developed” in Acute HospitalsRANDOM VARIATION

Apr 1

3M

ay 1

3Ju

n 13

Jul 1

3Au

g 13

Sep

13O

ct 1

3No

v 13

Dec 1

3Ja

n 14

Feb

14M

ar 1

4Ap

r 14

May

14

Jun

14Ju

l 14

Aug

14Se

p 14

Oct

14

Nov

14De

c 14

Jan

15Fe

b 15

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15

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Median 1 is based on the first 12 months’ data (to provide a benchmark); Median 2 is based on a new median from month 14 (April 2014) to provide a more stable benchmark of activity (recording of pressure ulcers on Datix began with Phase 2 of SPSP which may explain why the first 12 months appear artificially low).

The Associate Director of Nursing leading on the tissue viability improvement work is currently reviewing data from April 2014 onwards to determine that the amendments and prompts made to Datix for this particular measure has made the reporting more robust across NHS Fife. The outcome will be reported at the Quality Safety and Governance Group in March.

3. BACKGROUND

3.1 In September 2013, CEL 19 outlined ten patient safety interventions “ten essentials” that should be reliably delivered to every patient in NHSScotland that can benefit from them.

The ten patient safety essentials are:

1. Hand washing2. Leadership walkrounds3. Communications: surgical pause and brief4. Communications: general ward safety brief5. ICU daily goals6. VAP bundle7. Early warning scores8. CVC insertion9. CVC maintenance10. PVC maintenance

3.2 Healthcare Improvement Scotland has stipulated that external assurance of the reliable implementation of the ten essentials will be sought via the new Quality of Care Reviews, within the scope of the annual review processes and through ad hoc Ministerial updates. Boards are expected to have internal processes in place to ensure internal assurance.

3.3 An NHS Fife dashboard is currently being created to provide a NHS Fife overview of process and outcome compliance. “Hand hygiene” and “ward safety briefs” are the first two process measures that have been implemented across NHS Fife using the Lanqip system. Ward staff enter data via the Lanqip system and this is then extracted automatically onto the dashboard. The outcome measures “Staphaureus bacteraemias” and “Clostridium difficile” are now also displayed on the system. Work is progressing to ensure that all of the process and outcome measures are incorporated into the dashboard. The Team are currently focusing on testing the reporting of pressure ulcer data and consideration of Patientrack data

3.4 A number of dashboard reports are currently being tested and include: Rag status overview of process compliance for every inpatient area sorted by site and Directorate, compliance overview covering 13 months and exception reports detailing clinical areas with low compliance, failure to record and inadequate sample sizes. These automated reports should reduce duplication by staff that currently provide some of this data manually. The reports which are viewed via the “Microstrategy” portal are accessed by staff in both the Acute and Community Hospitals . The reports will be refreshed at the end of each month and should facilitate a more timely improvement intervention if this is required.

3.5 In the meantime, the RAG reports previously developed will continue to be used locally to provide an overview of the implementation and spread of the ten essentials within the Acute and Community Hospitals.

3.6 The Leadership Walkround process is being reviewed to increase capacity and to ensure that the system is more capable of identifying themes for improvement.

4. ASSESSMENT

4.1 SPSI HARMS

Cardiac Arrest / Deteriorating Patient

The Deteriorating Patient Short Life Working Group was established to oversee actions in relation to the this workstream. The group on five initial priorities:

Robust processes are in place to ensure that Patientrack is embedded. Appropriate management of patients that trigger FEWS by ensuring that the

correct skills and education around Acute Illness Management Training are available to staff

Clear escalation processes in every clinical area Improved decision making around DNACPR and clear management plans Standardised review processes for patients that have previously triggered

Improvements to date include:

The use of the Scottish Structured Response is embedded in practice and has actions in relation to patients with a FEWs score of 4+ discussed at the daily safety huddle

The DPSLWG with support from relevant clinical teams has developed a Hospital Anticipatory Care Plan to support the appropriate care of deteriorating

patients, and in particular offer specific guidance for patients who are not appropriate for cardio pulmonary resuscitation. The document had been approved for pilot in 2 clinical areas within VHK. In addition the VHK hospice is keen to pilot its applicability within this care setting also.

A proposal has recently been agreed to introduce mandatory reporting of cardiac arrest via DATIX as a major harm event to allow a specific SBAR review by the responsible clinical team, followed by an independent review from the emergency bleep group, with internal investigation through an emergency bleep meeting as required. The implementation of this new approach is expected by April 2016.

Ongoing review of all cardiac arrests will continue in the interim until the emergency bleep process is introduced.

Patientrack has now been implemented in inpatient wards across VHK. Compliance performance with observation timeliness is reported in the Directorate Performance Reports.

5. FALLS – PROCESS

A “Falls Call to Action” Update and Review took place on 11th December. The Inpatient Falls Prevention Group delivered a revised Falls Pathway across the Organisation and a new Falls Toolkit was launched at this event.

Going forward, any new change ideas relating to falls will be tested on Ward 15 as part of the Older People’s Collaborative, led by Dr Aylene Kelman. Inpatient wards across Fife should implement the toolkit in their respective areas.

As part of the improvement work, Ward 15 is testing a revised process measure to simplify recording. The staff are also improving learning opportunities for all of the staff by ensuring that the outcome of “falls investigations” are shared with staff.

6. PRESSURE ULCERS - PROCESS

The improvement work around pressure ulcer care is being led by the Associate Director of Nursing/Head of Service Delivery GNEF. The group have progressed a number of interventions which include:

A new national pressure ulcer grading tool was introduced in December across NHS Fife

Guidance for Reporters and Reviewers developed

Development of Pressure Ulcer REI tool

Discussions held with the University of Dundee re Undergraduate training

Amendments to Datix to reduce duplicate reporting of pressure ulcers across primary and secondary care

The Cluster review process is embedded in practice and from January meetings will happen monthly to review incidents of major harm “real time” to improve opportunity for learning and clinical improvement

The introduction of the “Tissue Viability Times” to provide a froum for Fife wide communication in relation to pressure ulcer prevention and management, and shared learning /actions following cluster reviews

Leading Better Care event planned for January focussing on pressure ulcer prevention and management for nurses across NHS Fife.

The “Be aware of pressure area care” poster was introduced across NHS Ffie to illustrate the process of pressure ulcer risk assessment and appropriate action and management, identifying key learning points identified from cluster review meeting outcomes.

Substantive recruitment to specialist tissue viability nursing posts in the acute and community setting underway which will allow the stability of the clinical teams across NHS Fife.

Review of Datix to improve reporting fields to inform clinical practice and reflect new criteria following introduction of the new national pressure ulcer grading tool.

7. CAUTI

The improvement work around CAUTI care is being led by the Associate Director of Nursing NHS Fife. A SLWG has been formed to progress improvements:

The NHS Fife CAUTI Prevention, Insertion and Maintenance bundles have been developed for use across inpatient areas in both Acute and Community hospitals

The group has identified that the improvement work should not focus solely on patients with “urinary catheters”, but should consider the wider improvement initiatives relating to patients with continence issues, the prevention of urinary catheter insertion if appropriate, optimal maintenance and early removal.

The group identified an apparent under use of urinary catheter packs that are available at no cost for patients being discharged from hospital

A “CAUTI Drop In” session for staff took place on November 12 th at VHK. The aim of the session was to provide a forum for staff to discuss the bundles and any other issues pertaining to the reduction of CAUTI.

8. NINE PRIORITIES

1. Sepsis - Improvement work around sepsis began in 2012.

Chart 6: A & E Sepsis 6

Patients who triggered the Sepsis Six Tool in Resus A & EDec 2012 - Nov 2015

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Chart 6 demonstrates the overall increase in patients triggering the Sepsis tool.

Chart 7: Average time Antibiotic Administered

Chart 7 demonstrates the average time taken for patients to receive their antibiotic if the sepsis 6 is triggered. The target is 60 minutes. The data spans from 2013 to 2015.

2 Deteriorating patients - covered earlier in the report

3 Heart failure - embedded

4 Pressure ulcers – covered earlier in the report

5 Surgical site infections

6 Venous thromboembolism (VTE) - the assessment bundle has been implemented within AU1, and the reassessment bundles have been implemented within Ward 52 (Surgical). Plans to implement the VTE improvement interventions more widely are currently being developed.

7 CAUTI – covered earlier in the report

8 Falls with Harm – covered earlier in the report

9 Safer Medicines - the Pharmacist based in AU1 is measuring compliance with medicines reconciliation on admission within AU1.

8.1 Forthcoming Events

SPSP Medicines Learning Session 1 on 24th February

SPSP Healthcare Associated Infections Learning Session 21st March

RECOMMENDATIONS

The Board is asked to:

Note the overview of progress for each work stream.

Advise on aspects of the report that they found valuable and if they would value continuing reports in this format

SECTION EFREEDOM OF INFORMATION REQUESTS

1. INTRODUCTION

The purpose of this report is to update the Board on the Freedom of Information requests received for the month 1st – 31st January 2016.

2. BACKGROUND

The Freedom of Information (Scotland) Act is an Act of Scottish Parliament which came into force in January 2005, and gives everyone the right to ask for any information held by a Scottish Public Authority. NHS Fife has received a steadily increasing number of requests every year.

All Public Bodies are required, by law, to respond to all reasonable requests, within 20 working days. There are however, certain conditions and exemptions which are set out in the Act, for circumstances where a response would be inappropriate.

3. CURRENT POSITION

Table 1 shows that the number of requests received in January was 58, compared to 42 in the same period last year. The number of requests responded to in the 20 day timescales so far is 28. Two of the remaining 30 requests have missed the 20 day deadline therefore the percentage of responses is 96%. The remaining 28 are in line to respond to, within the timescales.

Table 1

MP / MSP / SGHSCD Commercial Media Other Total <= 20 Days > 20 Days % Within 20

Days

Jan 2016 58 12 13 21 12 28 28 0 ** 96% **

Jan 2015 42 9 2 16 15 42 41 1 97.3%

** Two responses incomplete and already over the 20-day deadline, so % completion calculated as 96% (56 out of 58, including thosenot complete but on schedule to be complete within the timescale)

MonthNumber of Requests

Source of Requests Responses

Table 2 shows the distribution across Executive Directors responsible for collating the individual responses.

Table 3 also shows the main source of requests.

SECTION FCOMPLAINTS

We will achieve and sustain response times of no less than 95% (acknowledged within 3 working days) and 65% (responded to fully within 20 working days).

Key Concerns and Risks

Each of the operational parts of the system is developing action plans in partnership with Patient Relations Team.

The actions described will ensure that response times improve whilst the quality of responses are maintained.

The biggest risks to achieving and sustaining the planned improvements are:

Complexity of complaints which cross different organisational units Ownership of complaints Patient Relations Capacity

Recovery Trajectories

3-day Acknowledgement

20-day Completion

Recovery Plan

Performance is improving following the successful implementation of all identified actions within the Recovery Plan. There is still outstanding work to establish the single points of contact across the Community areas.

Complaints, Concerns, Compliments and Comments

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Context of Complaints in Relation to Other Forms of Feedback

The Patient Relations Team deal with concerns from patients, their families and the general public. In many instances, this promotes local resolution and prevents issues being progressed to formal complaints. It often involves meeting with people at an early stage to identify what can be done to resolve an issue early on. There is no related target to this work although this forms a significant part of the Patient Relation Team daily workload.

There was a significant increase in the number of concerns received in November as a result of issues being raised about changes made to manning the car park at Whyteman’s Brae Health Centre. Action has been taken to review the parking situation and to improve accessibility.

Patient Opinion provides a route for people to share their experience of NHS care anonymously. Nine posts were received in December compared to seven in the previous month. 56% of the posts provided positive feedback; 22% provided minimal/mild criticism and a further 22% were moderately critical. One of the Board’s challenges relates to receiving anonymous critical feedback, where there is no opportunity to look into the specifics raised. The approach of the Board is to seek dialogue to ensure appropriate follow up can be arranged.

A range of stories were posted in December including stories about; Cameron Hospital, Glenrothes Hospital, Queen Margaret Hospital and Victoria Hospital (A/E/Dermatology/Orthopaedics/Cardiology/Ward 54).

Scottish Public Service Ombudsman (SPSO) Decisions and reports concluded in November (following date of report submission) and December 2015

The SPSO published one report concerning the standard of care provided by mental health services in the Community and in Stratheden Hospital. The Ombudsman made a number of recommendations, all of which have been actioned to the satisfaction of the SPSO.

http://www.spso.org.uk/investigation-reports/2015/november/fife-nhs-board

The SPSO reached decisions on the following cases:

The SPSO considered a case about unreasonable care and treatment when a patient was being cared for by the Hospital at Home Team. In considering the case the SPSO recognised that the Board had identified failings in relation to processing a blood sample and apologised appropriately for the failing. Following the complaint the Service developed a Standing Operating Procedure for obtaining blood samples and actioning results which was viewed as acceptable by the SPSO advisor.

The SPSO did not uphold a complaint about an avoidable delay by clinicians at the Victoria Hospital in diagnosing hypersensitivity to a medication used to treat urinary tract infections. The SPSO concurred with the Board’s view that the reaction to the medication was extremely rare and that the care and treatment provided was in accordance with appropriate clinical guidance.

The SPSO did not uphold a complaint about inappropriately discharging a patient following gall bladder surgery and failing to provide appropriate treatment following a further referral from the GP. The SPSO did however make a recommendation in relation to the provision of information to patients at the point of discharge. As a result of this the Unit concerned is reviewing all written patient information leaflets.

The SPSO upheld a complaint that staff at the Victoria Hospital failed to adequately monitor a patient following surgery and asked the Board to ensure the case was discussed in a multi disciplinary setting and to offer an apology to the patient. All recommendations by the SPSO have been completed and the SPSO have confirmed their satisfaction with the actions taken by the Board.

The SPSO considered a complaint concerning the standard of nursing care, communication about the patient’s condition, an issue in relation to dressing a wound and the amount of time taken to respond to the complaint. The SPSO upheld the complaints about the standard of nursing care and complaint handling; noting that appropriate action had been taken by the Board in offering an apology and identifying improvements in relation to complaint handling performance.

The SPSO upheld a complaint about an avoidable delay in a GP Practice diagnosing toxicity to a medication used in the treatment of urinary tract infections. As the Practice had already undertaken a Significant Review and apologised to the patient and reviewed other patients in the Practice; the SPSO had no recommendations to make.

http://www.spso.org.uk/investigation-reports/2015/november/fife-nhs-board

The SPSO upheld a complaint about a GP Practice failing to appropriately assess a patient at a consultation and failing to appropriately manage a telephone request. Despite the Practice having undertaken a Significant Review the SPSO recommended an apology and made specific recommendations to the GP in relation to managing patients with Chronic Obstructive Airways Disease. The GP was also asked to discuss the case at next appraisal. All recommendations have been actioned and the SPSO have confirmed their satisfaction with this.

The final decision reached by the SPSO concerned a GP practice and a number of complaints including, failure to diagnose a damaged bowel prior to hospital admission, failure to provide appropriate medication following development of a urinary tract infection, failure in the transfer of information between primary and secondary care, inappropriate advice by GP and refusal to prescribe a medication. One of the five complaints was upheld; failure to diagnose damage to bowel. The Practice was asked to offer an apology and provide an assurance that the GP would discuss the case at their next appraisal. All actions have been completed by the Practice and the SPSO have confirmed their satisfaction with this.

SECTION GNHS FIFE

Report to the Fife NHS Board on 23 February 2016

PROGRAMME MANAGEMENT OFFICE UPDATE

1. INTRODUCTION1.1 The purpose of this report is to provide an update on the work of the Programme

Management Office (PMO) to support the delivery of the Strategic Programme 2015-2018.

2. BACKGROUND2.1 The report forms a component of the governance arrangements for delivering the

corporate priorities set out in the Board’s Strategic Framework.

2.2 Section 3 summarises the work completed to date (split across the various projects) and Section 4 sets out the work scheduled to be completed by the end of March, which will be reported to the April meeting of the Board.

3. WORK COMPLETED TO DATE3.1 NHS Fife Optimising Efficiencies in Surgery project - Work completed to date has

largely been focused on data analysis, supplemented by stakeholder interviews, observations, a culture survey and short working sessions to explore booking and pre-assessment processes. In addition an orthopaedic options appraisal has been carried out, which can be used to support a business case for future delivery of orthopaedic elective surgery.

3.2 Demand & Capacity project – Work completed to date includes the creation of demand and capacity tables which capture Acute elective, emergency and diagnostics activity, capacity and demand for Outpatients and Inpatients / Daycases, including tertiary activity (both primary and secondary). This is currently being validated with the services.

3.3 Clinical Strategy project – The inaugural meeting of the Clinical Strategy Steering Group took place on 5th February. All seven of the Clinical Strategy workstreams have now met at least once, with a number having met twice. These meetings have considered the existing arrangements for service provision, emerging models of care and their evidence base. A Communications and Engagement Plan 2015/16 has been developed for the Clinical Strategy, which will be taken forward alongside the Participation and Engagement Plan and the Workforce Strategy Communications Plan.

3.4 Workforce Efficiency project – Key activities completed include carrying out an analysis of current data collection systems around vacancy management / recruitment / nurse bank. A Nursing and Midwifery Recruitment Short Life Working Group has been established together with a Workforce Efficiency Project Management Steering Group. In addition, links have been developed with a number of higher education bodies regarding return to practice programmes.

3.5 Outfacing Activity project - Detailed analysis has been undertaken of the outfacing activity to other NHS Boards from NHS Fife. This analysis requires to be lined up with the demand and capacity project to consider any activity that could be repatriated to NHS Fife taking into account resource and workforce issues.

3.6 Well at Work project – An analysis has been completed on sickness absence data and hot spots / trends per operational unit and an option appraisal has been completed to identify areas for improvement. There has been a specific focus around developing a resource pack to support managers in dealing with local absence management issues. A mapping exercise has been completed against the Healthy Working Lives Gold Award criteria to identifying gaps and a delivery plan has been developed to achieve and maintain the award.

3.7 Estates & Facilities Management Efficiencies project – Work to date has been focused around two distinct workstreams; namely Central Mailroom and a Transport Review of fleet vehicle usage. The Central Mailroom project group met twice during December. The Fleet Vehicle usage group has met once to consider the initial outputs from the Routemonkey analysis. Work to identify and scope other change workstreams is already underway with a specific focus on the delivery of cash releasing savings.

3.8 Prescribing Efficiencies project – The Prescribing Efficiency plan is on track to deliver the target level of efficiencies for 2015/16. Funded invest to save projects are underway (such as prescribing support nurses for diabetes, respiratory, woundcare / stoma / catheters and care home medicines waste). The Scriptswitch (GP IT prescribing system) commenced rollout to practices Fife-wide on 11 th January. Recruitment of staff for homecare medicines governance is being progressed.

3.9 Workforce Strategy project - A Project Steering Group has been established to oversee delivery of the Workforce Strategy project, including specific work on Training and Development which is currently being finalised. Evaluation of Workforce Strategies from other Boards areas has been undertaken together with an evaluation of workforce policies and procedures.

4. WORK SCHEDULED FOR COMPLETION BY THE END OF MARCH 20164.1 NHS Fife Optimising Efficiencies in Surgery project – An implementation plan is being

devised using a combination of the data available, overlaid with local knowledge around culture and constraints. The new anaesthetic rota will be included in 2016 job plans, but may be subject to further revision. Work continues on a list building project, which is examining options for the reconfiguration of the Phase 2 Elective Theatres.

4.2 Demand and Capacity project – Work to capture Health and Social Care services activity will be progressed with a specific focus around mental health and learning disabilities. Work will be completed on population projections and future demand profile for services.

4.3 Clinical Strategy project - All workstreams will continue to meet with most workstreams scheduled to complete meeting 4 of 5 by the end of March. Workstream meetings have been well attended with high levels of engagement from both clinical and non-clinical staff. Common themes are emerging which will help to shape the Clinical Strategy. A Clinical Strategy Development Conference has been scheduled for 23rd March, which will provide an opportunity for workstreams members to discuss emerging themes across workstreams. Work will continue to deliver the Communications and Engagement Plan 2015/16 and the Participation and Engagement Plan to maximise the engagement of staff, patients, carers and the public in developing the draft Clinical Strategy.

4.4 Workforce Efficiency project – The workforce review utilising the national tools will be completed. In addition, work to review the utilisation of bank and agency will be completed together with a review of the impact of recruitment activity.

4.5 Outfacing Activity project – Work to examine the opportunities for repatriation of services to NHS Fife is being progressed as an integral part of the workstream activity for the Clinical Strategy project.

4.6 Well at Work project – The Healthy Working Lives Gold Award assessment will be carried and implementation of the delivery plan will commence to support ongoing compliance. The delivery plan will be finalised and work will commence to deliver the actions designed to improve absence management performance towards the defined targets.

4.7 Prescribing Efficiencies project – The inaugural meeting of a new Managed Service Drugs and Therapeutics Committee is scheduled to take place in February. Work to develop a new Pharmacy Strategy will be planned.

4.8 Workforce Strategy project - Work will be completed on an analysis of the current workforce. Work will commence on quantifying the future demands on the workforce and on shaping the consultation process with staff. An important aspect of this work will be the flow of information to and from the Clinical Strategy workstreams as well as other projects within the programme.

5. RECOMMENDATIONThe Fife NHS Board is asked to:

Note the progress to date in completing the stages scheduled for completion by 31st January for each of the projects in the Strategic Programme 2015-2018;

Note the next steps required to complete the project stages scheduled for completion by the end of March 2016.

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