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Delivering for QualityIntegrated Performance Report

March 2016

Contents Page(s)

Executive Summary 3 - 4

Section A – LDP Standards Performance Summary 5 - 7

Chief Executive’s Performance Escalation

Colour Coding Key 8

Cancer 62-Day RTT 9 - 11

18 Weeks RTT 12

Patient TTG 13

Outpatient Waiting Times 14

A&E 4-Hour Waits 15

HAI Sabs 16

Sickness Absence 17 - 20

Dementia 21 - 23

Delayed Discharge 24 - 25

Smoking Cessation 26

Alcohol Brief Interventions 27

CAMHS Waiting Times 28

Psychological Therapies Waiting Times 29 - 30

Section B - Capital Programme 32 - 37

Section C - Financial Position 38 - 43

Section D - Scottish Patient Safety Programme 44 - 50

Section E - FOI 51 - 52

Section F - Complaints 53 - 56

Section G - Programme Management Initiatives 57 - 59

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.

The Healthcheck, which is presented at each Board Meeting, contains some areas of duplication, and a review of this is in progress, with a view to producing an overarching Quality Report in its place.

KEY PERFORMANCE OBSERVATIONS

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

Section A – LDP Standards:

The continued sustainment of A&E Waiting Times performance above the 95% Standard (rolling 12 month average), despite an increase in attendance of almost 1,300 patients in comparison to the first 3 months of 2015; while continuing to be challenging throughout March, no 12-hour breaches were recorded and the number of 8-hour breaches fell

The percentage of patients treated within 18 Weeks of referral remaining just under the 90% standard (89.9% and 89.3% in January and February, respectively)

An improvement in the Outpatients Waiting Times performance, with 95.7% of patients having waited less than 12 weeks at the end of March (against 91.8% at the end of January and 94.2% at the end of February); the numbers of patients waiting over 12 and 16 weeks continued to decrease

No patient waiting more than 6 weeks for a Diagnostic Test at the end of March

A continuing small improvement against the CAMHS Waiting Times standard, with the percentage of patients starting treatment within 18 weeks of referral increasing to 83.6% during March (from 83.0% in February)

A marginal improvement against the Psychological Therapies Waiting Times standard, with the percentage of patients starting treatment within 18 weeks of referral increasing to 72.2% in February (against 72.17% in January)

Continuing challenges in meeting the Cancer 62-Day Referral-to-Treatment Standard, with 87.1% of patients starting treatment within the timescale during February (86.2% in January)

A recovery in the performance against the Cancer 31-Day Decision-to-Treat-to Treatment Standard, with 97.6% of patients starting treatment within the timescale during February (91.9% in January

A breakdown for all Cancer Treatment is supplied on Page 12, to show the performance across the different clinical specialties

A further reduction in the number of patients in delay for over 14 days, from 37 at the February Census to 29 at the March Census; both the total number in delay and the number in delay for more than 14 days were at their lowest level since April 2015

A further increase in the number of patients failing to meet the 12 week TTG target, from 23 in February to 60 in March

A marginal increase in the HAI Sabs infections rate, from 0.431 in February to 0.438 in March; for the whole year, there were 117 cases, against 83 in 2014/15

A fall in the HAI C Diff infections rate, from 0.261 in February to 0.243 in March; for the whole year, there were 67 cases, against 80 for 2014/15

Sustained quarterly performance against the Drugs & Alcohol Treatment Waiting Times Standard, with over 98% patients seen within 3 weeks during the final quarter of 2015 (against 98.7% for the previous quarter)

A further small reduction in the 12-month average sickness absence rate, down from 5.11% to 5.09%, with significant monthly improvements in Emergency Care, Planned Care and the Fife East Health and Social Care Division

Section B – Capital:

The Board delivered a capital investment programme of £12.646m during 2015/16, an underspend of £0.002m against the available Capital Resource Limit. The position is subject to external audit review through the annual accounts process.

Section C – Draft Financial Position to 31 March 2016:

The draft financial outturn for 2015/16, subject to External Audit review through the annual accounts process, is an underspend of £234k. This compares with an overspend of £489k at the end of February and is a huge achievement for NHS Fife given the extent of the financial challenges seen during the year.

Section F – Complaints:

The complaints completion rate has been sustained at a rate above the trajectory for the fifth successive month, with 25 out of 34 complaints (74%) being completed within the timescale in February. This is also above the end-year target of 70% for the second successive month.

All February complaints were acknowledged within 3 days, against a target of 95%.

The IPR does not include the Hospital Associated Infection Reporting Template (HAIRT). This information is reported through the Infection Control Committee and the Clinical Governance Committee.

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 final quarter of 2015 was Quintile 3 (Quintile 1 is most-deprived, Quintile 5 is least-deprived), with a figure of 86.3%. The highest-performing quintile was Quintile 5 (95.7%), while the overall NHS Fife figure was 91.0%.

HAI: we will achieve a maximum rate of C diff infection in the over 15s of 0.32Local management data for the whole FY indicates a C difficile rate of 0.24, confirming a sustained performance 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 80 patients having been screened in 2015-16 up to the end of February. The latest management information showed that 22 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 performance for February recovered to 97.6%. Surgical capacity within Gynaecology and Urology still remains an issue - until stability is achieved, maintaining the target will still be at risk.

Drug and Alcohol Waiting Times: at least 90% of clients will wait no longer than 3 weeks from referral to treatmentThe March ISD publication showed that 98.4% of patients were seen within 3 weeks of referral for treatment between October and December 2015. This remains significantly above the 90% standard, a position NHS Fife has sustained since the start of 2013. Only one Mainland Health exceeded this figure, and the Scottish average was 95.2%.

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, cystoscopyLocal Management information shows that no patient had waited more than 6 weeks for a Diagnostic Test at the end of March, the backlog for MRI tests having been addressed during the previous two monthsDetect 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. There are capacity issues for outpatients and surgery for Gynaecology and Urology. Head & Neck, Lung and Upper GI cancers remain at risk due to a combination of complexity, 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 9 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 outpatient slots to be maintained. A locum has been appointed and targeted additional activity continues. Of the two new Respiratory appointments, it is expected that one will take up post in June. Capacity for urgent cancer appointments is prioritised but can still pose a challenge. The status for this has moved from Green to Amber.

The review of EBUS provision in NHS Fife has been delayed until the current vacancies are filled.

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. This is now up and running and remaining issues are around capacity rather than process. This change has moved the status 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, continues to result in increased demand for surgery and as such deterioration in performance in the next few months is still expected. The status remains at red 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. Recruitment of a second Acute Oncologist with an interest in Uro-Oncology is currently at interview stage, with an anticipated start date of May.

For Gynaecological cancer (4.1 and 4.2) there are ongoing discussions around capacity and review of job plans with gynae-oncology; the status of these remains at Red.

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 to Green.

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. However Lead Cancer GPs have been asked to take this forward in their localities. This has moved from Red to Amber.

Cancer Performance Trend by Specialty

The Performance Trend for both Cancer Treatment measures, broken down by Specialty, is shown in the tables below. (In certain specialties the numbers are very low ie <5 so are not disclosed as actual numbers)

62-Day RTT

31-Day DTT

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, albeit with a narrowing gap.


The key specialties currently at risk of not meeting 18 weeks RTT are Urology, Oral Surgery, General Surgery and Neurology. This is driven by vacancies, increasing demand and an ongoing demand-capacity gap.

Additional activity continues to be undertaken when available to improve and sustain Outpatient, Diagnostic and Inpatient / Day Case waiting times. NHS Fife continues to meet with Scottish Government regarding resilience around this target and work continues to review 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, January and February 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 Oral Maxillo Facial. The increase in demand for procedures in Oral Maxillo Facial and Urology as a result of additional outpatient activity undertaken is still evident.

It has not been possible to undertake sufficient additional activity to manage this increase in demand due to issues such as the availability of anaesthetic cover, use of locums, availability of Operating Department Practitioner (ODP) staff and availability of beds. It is likely that this pressure will continue in the first quarter of 2016.

Recovery Trajectory

Recovery Plan


There are 5 actions which have an Amber or Red RAG status.

It has not been possible to provide sufficient additional activity internally to clear the backlog of Inpatient and Day Case procedures resulting from the additional outpatient work. This is reflected in the Red status. It is anticipated that this will not be recovered until the end of Q1 in 2016

Recruitment to a number of consultant posts has been successful and a number of Consultants will take up post in the summer but challenges remain in some specialities.

The use of other healthcare providers continues to be considered if appropriate but there is limited capacity and resources for Inpatient and Day Case work. This is reflected in the continued Amber status.

The Optimising Surgical Efficiency project is focusing on delivery of improvements in theatre utilisation, pre-assessment and procedure selection.

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.

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 improved month on month from July to December. The performance in January slipped but recovered again in February and is expected to be sustained into March.

The at-risk specialties are Neurology, Dermatology, Gastroenterology, Oral, Cardiology and Orthopaedics. Recruitment into Consultant vacancies in Neurology is particularly challenging.

Whilst there has been improvement in performance in the at-risk specialties, work continues to identify and secure sustainable solutions to meet the ongoing gap in outpatient capacity. Neurology remains a significant challenge in this respect.

Activity is being outsourced and local waiting times initiatives continue in all of the at-risk specialties to sustain and improve performance beyond March.

Recovery Trajectory

Recovery Plan


The recovery plan shows that 4 actions are rated as Amber for delivery.

The focus is on sustaining the improvement in outpatients waiting over 12 weeks whilst continuing to manage the capacity issues in Neurology. There are difficulties in securing the volume of additional activity required for Neurology and this is reflected in the continued Amber status.

The demand capacity work will be finalised in April 2016 and will identify the size of the gap in outpatient capacity. Work continues to identify solutions to meet the current and future gap. Vacancies remain in a number of key specialities reflecting the continued Amber status.

There is an active programme of work in place to redesign the urology DTC. The number of outpatients waiting over 12 weeks has improved greatly and the focus is now on sustaining this.

The outpatient redesign work is a three year programme. Resource to support project Management will be in place in Q1 2016 and will enable the development and delivery of this work.

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 11 successive months performance has been ahead of trajectory and the year end required performance of 95% was surpassed.


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 March was 95.5%, with the ED at VHK itself recording a performance of 93.7%, a slight drop in comparison to February. The combined monthly performance in all A&E and MIU sites exceeded 95% in every month of 2015-16.

From the beginning of October through to the end of March (a 27-week period), the NHS Fife performance in the Emergency Department was better than the Scottish Emergency Department average in all but four weeks.

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, which supports hospital discharges and transfers.

The new assessment model in AU1 continues to discharge 30% of 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 37% of the total in the FY (43 of 117), 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. Reducing the number of PVC related SAB infections will be a particular focus in the coming months with a re-introduction of an improvement package to support safe harm-free care.

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

SICKNESS ABSENCE

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


As previously reported, 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 February sickness absence rate for NHS Fife was 5.06%, a decrease of 0.15% from 5.21% in January. The rate for the year to date is 0.21% below the equivalent period of 2014/15, with an average rate of 5.02% from April 2015 to February 2016.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%

NHS Fife Sickness Absence% comparison of hours lost between April 2015

to February 2016

2014/152015/16

Despite the levels of sickness absence increasing in November and December 2015, rates have remained lower for the months of December, January and February than those of the corresponding period in the 2014/15 financial year.

Long Term / Short Term Trend Analysis

Detailed analysis of the sickness absence trends between April 2015 and February 2016 show that while the deterioration in the level of sickness absence between October and December was as a result of increases in both long and short term absence, the February data shows a slight increase in long term absence, with a reduction in short term absence; however, we are aware that some wards and departments have been affected by norovirus which has had an impact on short term absence.

Apr-15

May-15

Jun-15Jul-1

5

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

05,000

10,00015,00020,00025,00030,00035,00040,00045,000

Sickness Absence Trend April 2015 to February 2016

Hours Lost by Short and Long Absence

Long TermShort Term

Tota

l Hou

rs

The February sickness absence data indicates that the decrease in the overall Board rate is due to reductions in the level of short term sickness absence, with the breakdown of long term and short term absence for the Board indicating that long term hours lost increased by 432 hours and short term hours lost decreased by 2,078 hours in the month, compared with the January position.

Following further analysis of the information detailed in the graph above, it is evident that the increasing trend within short term absence in the year to date, combined with the increase in long term absence over the months of August to November 2015, contribute to the sickness absence trajectory still not being met.

Mar-15

Apr-15

May-15

Jun-15Jul-1

5

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

0.001.002.003.004.005.006.007.00

NHS Fife Sickness Absence Data by Operational Unit

March 2015 to February 2016Acute ServicesCorporate ServicesHealth and Social Care NHS Fife

Analysis of the Sickness Absence trends within NHS Fife in the current financial year shows that the sickness absence levels within the Acute Services Division have remained within the 4% range for nine out of the eleven month period, and is below 5% again at 4.99% in February. In contrast, the Community Services areas have been above 5% for each month, with the exception of August 2015.

Next Steps

An action plan to support the implementation of the Board Health & Well Being Strategy for the Board has been developed and agreed. Activity since the last report has focused on the planning and preparation for the Gold Healthy Working Lives Award Assessment site visits on Wednesday 20 and Wednesday 27 April.

All areas of the Board, supported by HR and the Programme Management Office, continue to review their Action Plans detailing the recovery steps required within their areas to ensure NHS Fife as a whole achieves the agreed 4.81% sickness absence trajectory by 31 March.

These recovery plans continue to build on the following points:

Dates for Review & Improvement Panel meetings to be set for all areas throughout 2016 to review short and long term absence cases:

Identification of the core reasons for sickness absence within Divisions and Directorates, and what supportive steps can be implemented to minimise absences occurring in future;

Analysis of the sickness absence trends (e.g. are instances of short term sickness absence increasing, or are the duration of instances increasing);

Identification of steps to be taken to prevent increases in short term absence during the first two years of continuous service;

What steps are to be taken to support the return to work of staff on long term absence;

Whether there is a correlation between sickness absence trends within the Divisions and Directorates and an employee's Occupational Sick Pay entitlement, and what steps are to be taken to address this.

Roll-out of Management of Attendance Resource pack on a targeted basis continues and to all areas thereafter.

Recovery Plan

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 have reviewed existing workforce/budgets and devised a management arrangement which provides a functional level of coordination, standardisation and quality assurance.

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

This is not available at present, pending further guidance from the Scottish Government around predicted dementia prevalence and the support target.

In the absence of a meaningful measure and improvement trajectory, we are able to provide some relevant data from the monthly Management Reports produced by ISD. At the end of March, the summary position was as shown below.

Month EndCumulative Referrals for

Dementia PDS

12 Months PDS Completed

Referrals, yet to Start or Complete

PDSPDS Ongoing

Mar-16 1091 187 904 474

These figures date back to March 2014, when data was first collected.

A number of patients who have been referred to the service will either be waiting to be allocated a Link Worker, waiting for first contact with a Link Worker, have refused support or have died.

Recovery Plan


Task 1.3 We have been unable to identify additional capacity within the existing workforce. However, new management arrangements have been put in place, and this has enabled a review of existing provision and implementation of systems and processes which will ensure a more flexible and efficient use of the existing resource.

Small month on month improvements in the form of shorter waits are anticipated from the beginning of April.

A revised Action Plan is being developed for 2016-17.

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. From 1st April, the target will change that no patient will be delayed in hospital beyond 72 hours of 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.

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. Plans are in place for the STAR facility to be delivered within Ostlers Way Care Home in Kirkcaldy, and it is hoped this will commence in mid-March.

The START programme, which supports people to leave the acute hospital within 72 hours with a care package, has been introduced. Evidence has shown that people have been able to leave hospital quickly and feedback from families has been positive, so a plan is now in place to deliver this within a range of community hospital sites. The delivery plan is closely monitored and every effort will be made to mitigate any risk.

A joint report on Delayed Discharge was presented to the Health and Social Care Integrated Joint Board on 7th April.

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. The data trend, however, suggests we will not achieve 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. It is expected that the impact of these initiatives will become more visible in 2016-17.

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.

The end-year figure (which we are confident will exceed the target, as in previous years) will be available towards the end of April.

Recovery Plan


Task 1.2 A meeting with various social groups to discuss ABI activity in wider settings was initially scheduled for February but did not take place and is yet to be re-arranged. This has had no impact on the delivery of the target, but it remains a requirement for 2016-17 when the same number of interventions will have to be completed.

In relation to the identified risks, a discussion regarding ABI training has taken place and a meeting to discuss ABI planning and the embedding of ABIs across NHS Fife is to be held. A workplan will then be agreed, and this will involve targeted training where necessary.

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)


Improvement plans initially focused heavily on investing in additional staff, with part of our small allocation through the mental health innovation fund being 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.

The Scottish Government are still devising their allocation strategy for additional new funding, some of which is specifically to improve access to CAMHS. The 2015-16 improvement plan and trajectory was contingent upon receipt of this second, larger tranche of new funding.

In reaction to an increase in demand, CAMHS restructured its management and 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, and are focusing on increasing activity within current resources. This is being done 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


All outstanding tasks have been assigned a RED assessment as they have been heavily reliant on additional funding. A revised Action Plan is being developed for 2016-17.

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

The improvement plan initially focused heavily on investing in additional therapists utilising the Scottish Government new funding, some of which is specifically to improve access to Psychological Therapies. This in turn drove the predicted improvement trajectory, which saw us achieving the standard by the end of March.

The plan and trajectory will be reviewed during the next period, but 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.

In general, all actions have not progressed as planned at the start of the year. A revised Action Plan is being developed for 2016-17.

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 Finance26 April 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 March 2016 / Major Scheme Progress;

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 / MAJOR SCHEME PROGRESS

2.1 The expenditure position shown is for the period to 31 March 2016. This is currently a draft position and is subject to the year-end audit process. Appendix A provides details of the current expenditure.

2.2 The expenditure to the financial year-end date amounts to £12.646m. This represents an underspend of £0.056m against the available budget. The position reflects the transfer to revenue £0.5m of both the budget and expenditure for schemes which do not add capital value. Within the overall underspend there are various small over and underspends which have been managed across the whole budget and will result in some small transfers between budgets for 2016/17. The main areas where expenditure has been incurred in the last two months since the previous report to the Board are as follows:

Stratheden IPCU £0.983m General Hospitals and Maternity Services £0.968m Information Technology £0.839m Statutory Compliance/Backlog Maintenance £0.800m Radiology £0.700m Minor Capital Schemes £0.263m Equipment £0.241m

2.3 The actual spend for the year is shown against the original estimated spend profile in Appendix B.

2.4 Both of the Board’s major construction Capital Schemes are due for completion in the next Financial Year. Work on the Stratheden IPCU is progressing well being approximately 93% complete as at the end of March. The project was due for completion by the contractor on 29 April 2016 but is running 1 week behind plan with an estimated completion date of 5 May 2016. Equipment for the unit has been ordered and is now starting to be delivered. The project remains within budget.

2.5 The final element of the funded General Hospitals and Maternity Services Project is the completion of the Carnegie Unit on the Queen Margaret Hospital site. The project is currently running to timescale with a completion date of the end of July. Although the project is running within budget, remaining contingencies are low and careful monitoring of progress is required to ensure the budget is not breached.

2.6 The Replacement Telephone System is a scheme costing £4.3m in total. The project has started with the installation of the Core Kit and the first of the deployments on the Lynebank Hospital site. The system is due to go live at Lynebank in mid April with deployment then being rolled out to other premises with the final community hospitals live in February 2017.

3. CHANGES TO CAPITAL RESOURCE LIMIT

3.1 Since the previous report to the Board there have been no new allocations received.

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 two major changes in individual budgets. Firstly unallocated funding in the Radiology budget of £193k has been transferred to the Equipment budget to allow the purchase of equipment which was already prioritised for purchase in 2016/17. Secondly the estimated spend profile of the new Telephone System changed requiring a re-profiling of IT Expenditure of £70k to ensure no in year overspend. Also included is the reduction of £500k in respect of the Capital to Revenue transfer for expenditure which has not added Capital value.

5. CAPITAL RECEIPTS

5.1 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. Receipts for the year result in an under-recovery of £0.054m against the budget. To cover this, an underspend of £60k had been planned on the against the Capital Expenditure budget.

6. CAPITAL EXPENDITURE OUTTURN

6.1 Based on the £0.056m underspend against the Capital Expenditure budget and the shortfall of £0.054m on Capital Receipts the Board is showing an estimated underspend of £0.002m against the Capital Resource Limit.

7. RECOMMENDATION

7.1 The Board is asked to:

note the Draft Capital Expenditure to 31 March 2016;

note the current Draft Capital Resource Limit position;

note the changes in Planned Expenditure;

note the Draft Capital Expenditure outturn; and

note the Capital Receipts position.

NHS FIFE - TOTAL REPORTS SUMMARY

CAPITAL PROGRAMME EXPENDITURE REPORT - MARCH 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 3,759,585 3,791,407 3,791,407 31,822 Statutory Compliance 360,949 409,086 409,086 48,137Capital Minor Works 275,371 277,453 277,453 2,082Capital Equipment 170,597 171,290 171,290 693Condemned Equipment Total Commnity & Primary Care 4,566,502 4,649,236 4,649,236 82,734 ACUTE SERVICES DIVISION Capital Equipment 852,200 846,416 846,416 (5,784)GHMS - Tasks 3,265,950 3,222,855 3,222,855 (43,095)Statutory Compliance 1,050,063 1,061,936 1,061,936 11,873Total Minor Works 156,011 158,457 158,457 2,446 Total Condemned Equipment 131,211 131,211 131,211 Total Acute Services Division 5,455,435 5,420,875 5,420,875 (34,560) NHS FIFE WIDE SCHEMES Condemned Equipment Information Technology 1,563,000 1,571,098 1,571,098 8,098Radiology Equipment 890,309 839,054 839,054 (51,255)Vehicles 70,300 68,677 68,677 (1,623)Scheme Development 17,584 14,177 14,177 (3,407)Capital Receipts Shortfall 54,413 (54,413)Total Fife Wide Statutory Compliance 84,455 82,457 82,457 (1,998) Total NHS Fife Wide 2,680,061 2,575,463 2,575,463 (104,598) TOTAL ALLOCATION FOR 2015/16 12,701,998 12,645,574 12,645,574 (56,425)

0

5000

10000

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

Cum

ulat

ive

£000

's

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Capital Spend Profile 2015/16

Actual

Forecast

SECTION CDRAFT FINANCIAL POSITION TO 31 MARCH 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.

The draft financial outturn for 2015/16, subject to external audit review, is an underspend of £0.234m. This compares with an overspend of £0.489m at the end of February and is a huge achievement for NHS Fife given the extent of the financial challenges seen during the year. The key movements in the position during March include improved operational performance within both acute and community services. Further details are provided in the supporting narrative on the following pages.

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

500

Financial Performanceagainst Trajectory 2015/16

Plan Actual

£000

Recovery Trajectory

Month May June Jul 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

) (489) 234

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) (345)

Overall Target 0 0 0 0 0 0 0 0 0 0 0


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 were signed off by the relevant Executive Director.

2. Allocations

2.1. Since the previous report to the NHS Board, we have received a reduction in core allocations from the Scottish Government Health and Social Care Directorate (SGHSCD) of £0.051m. These include a reduction in earmarked recurring funding of £0.399m and additional non-recurring funding of £0.348m. The new allocations include £0.150m for Unscheduled Care Planning with the main reduction in allocations being for the Fife share of national PET Scanning costs of £0.387m. An additional Non-Core Allocation of £2.297m has also been received in respect of changes in Early Retirement and Injury Benefit Provisions. A full list of allocations received is shown in Appendix A. 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 £9.123m with the main area of increase being CNORIS £8.568m – non recurring (offset by matching expenditure).

3. Analysis of Financial Performance to Date

Budget Expenditure FY CY YTD Actual Variance Variance

£'000 £'000 £'000 £'000 £'000 %Acute Services Division 181,154 186,908 186,908 193,854 6,946 3.72%Integration Services - Community & Primary Care 137,705 148,520 148,520 147,469 (1,052) (0.71%)- FHS 35,889 40,396 40,396 40,396 0 0.00%- Prescribing 72,336 74,213 74,213 75,949 1,736 2.34%- PMS 46,859 49,033 49,033 49,030 (3) (0.01%)Estates & Facilities 65,236 65,576 65,576 64,765 (811) (1.24%)Board Services 31,981 62,725 62,725 58,588 (4,137) (6.60%)Other Healthcare Providers 97,087 105,851 105,851 105,378 (474) (0.45%)OHSAS 3,769 4,681 4,681 4,572 (109) (2.33%)Depreciation 18,028 19,390 19,390 19,339 (51) (0.26%)Reserves - Impairments & provisions 10,000 1,689 0 0.00%

- General 29,973 5,099 5,099 (5,099)(100.00%

)

Efficiency Savings (2,914) (3,627) (3,627) 3,627(100.00%

)Total Expenditure 726,104 760,455 758,766 759,340 574 0.08%

Miscellaneous Income (64,266)(96,888

) (96,888) (97,696) (808) 0.83%Net position 661,838 663,567 661,878 661,644 (234) (0.04%)

Acute Services

3.1. The Acute Services Division is reporting an overspend of £6.946m for the year. Whilst this is a significant variation from the budget available, it is positive movement from forecasts earlier in the year and the outturn in the previous financially year. The key drivers for this overspend includes the purchase of healthcare from other providers, medical staffing, nursing and drugs and efforts continue in terms of managing these cost pressures down as we move into the new financial year. Points to note include:

There is an overspend (£707k) on the use of independent healthcare providers for Orthopaedics, Dermatology, Laboratories and Radiology. The measures put in place to control the use of the independent sector capacity to address treatment time guarantees reduced the rate of overspend.

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

The overspend reported within nursing (£3.2m) 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 have reduced the level of additional expenditure.

High cost drugs, particularly in Emergency Care specialties, contributed to the overspend in this area.

Integration Services

3.2. The full year outturn across the community services budgets, primary medical services, primary care emergency service (PCES) and family health services, is an overspend of £0.68m. This position comprises overspends across both prescribing and PCES amounting to £1.888m, offset in part by an underspend within community services of £1.208m.

3.3. The overspend within prescribing is principally due to an increase in the average cost per item, coupled with the impact of undelivered cash efficiency savings.

3.4. In addition there was an ongoing issue within the Primary Care Emergency service due to sessional rates.

3.5. The community services budgets report an increased underspend across a range of budgets (vacancies in community nursing, health visiting, school nursing, administrative posts, and dental services; surgical sundries and sexual health and rheumatology drugs) which continue to offset some of the cost pressures (level of expenditure on complex care packages, incremental progression within the Palliative Care service, medical locums, and the transfer in of Wards 5 and from the Acute Division).

Corporate Services

3.6. Within the Board’s corporate services, including Estates & Facilities, there is an underspend of £4.137m due mainly to a change in the accounting treatment for Injury Benefits and Early Retirements, as well as ongoing vacancies across a number of departments. This masks a pressure within Estates & Facilities on energy and equipment costs relating to service contracts across the system.

Non Fife and Other Healthcare Providers

3.7. The budget for healthcare services provided out with NHS Fife is showing an underspend of £0.474m for the financial year. This is based on an underspend of £1.543m on Service Level Agreements with other Health Boards and an overspend of £1.084m on Unplanned Activity (UNPACs) and Out of Area Treatments (OATS) activity. The major driver of this overspend is the increased UNPACs activity with NHS Lothian for cancer and other high cost drugs and an increase in bone marrow transplants.

Reserves

3.8. The Board has incurred £2.7m on AME provisions for Clinical and Medical Negligence Claims and Pension and Injury Benefit obligations during 2015/16. Final impairment figures are still awaited following year-end property valuations. The actual costs of any property Impairments are matched with additional funding from SGHSCD.

3.9. Slippage of £5.099m from financial plan commitments and new allocations received provides a significant offset to the financial position across the system.

Miscellaneous Income

3.10. An over-recovery in income of £0.808m is shown for 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 financial year end, cash releasing schemes totalling £6.516m had been identified. This left a shortfall of £3.627m outstanding which has been included in the overall year end position.

4.2. The graph below highlights that the planned trajectory had assumed back-loading of savings toward the second half of the year and delivery of savings was 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

Plan Act/F'cast

Period

Value(£k)

5. RECOMMENDATION

5.1. The Board is asked to:

note the draft financial position for the financial year 2015/16, subject to external audit review.

Appendix A

New Allocations Received

BaselineEarmarked Non -

DescriptionRecurring Recurring

Recurring Total

£ £ £ £

Local Unscheduled Care Plan 150,000 150,000Urgent Care Transformation Programme 70,000 70,000Flu,Shingles and Rota Vaccine 52,886 52,886National Enhanced Recovery Colorectal Initiative 37,035 37,035Detect Cancer Early 32,750 32,750Nurse Prescribing 21,000 21,000Disability and Management Training 8,000 8,000Development of PDSA system 4,212 4,212HS Vitamin Trial 4,197 4,197Cancer Treatment Helpline (16,564) (16,564)Scottish Health Survey (27,500) (27,500)

Position Emission Tomography Scans (386,806)(386,806

)

Total New Allocations Received 0 (399,173) 348,383 (50,790)

SECTION DSCOTTISH PATIENT SAFETY PROGRAMME REPORT

NHS FIFE BOARD VALUE: Safety First

We aspire to be Clinically excellent

We will:

ensure there is no avoidable harm; embed patient safety consistently across all aspects of healthcare provision

1. Purpose of the Report

1.1. This report covers March 2016. Its purpose is to provide assurance to the Board on the Scottish Patient Safety Programme provided across NHS Fife.

1.2 The SPSI harms identified by the Scottish Patient Safety Indicator (SPSI) are:

Cardiac arrests Falls Pressure ulcers CAUTI

1.3 We report on the following measures:

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

1.4 The revised measurement plan highlights a change to the pressure ulcer indicator, which is seeking a 50% reduction in the pressure ulcer rate by December 2017.

2. Discussion of Key Areas

2.1 HSMR

Title Hospital Standardised Mortality Ratio (Victoria Hospital/Queen Margaret Hospital)

Numerator Total number of in-hospital deaths and deaths within 30 days of discharge from hospital

Denominator Predicted total number of deaths Goal Reduce HSMR by 20% by December 2015Source ISD Scotland

Chart 1

Table 1

2.1.1 No new data has been published since the last report.

Chart 1 demonstrates NHS Fife’s current position with regression line. The percentage reduction since October December 2007 is 22.9% and the HSMR ratio is 0.89 as illustrated in Table 1.

Chart 2

2.1.2 Chart 2 demonstrates NHS Fife’s HSMR position in comparison to the aggregated performance across NHS Scotland. The data contained in the chart was released in February.

2.2. Falls

Title Falls and Falls with HarmGoal To reduce falls with harm by 20% by December 2015

To reduce falls by 25% by December 2015Source Datix

Chart 3

Chart 4

2.2.1 The aggregated NHS Fife data for

NHS Fife (All Falls), Chart 3, demonstrates common cause variation NHS Fife (Falls with Harm), Chart 4, demonstrates improvement

2.2.2 Focused work will continue in all clinical areas to further progress the reduction in falls and falls with harm.

2.3 Cardiac Arrest

Title Cardiac Arrest Rate per 1000 DischargesGoal 50% reduction in cardiac arrest rate by December 2015Source

Chart 5

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1.91.8

1.51.2

1.1

2.42.2

Cardiac Arrest Rate per 1000 DischargesAcute Services Division Only

Number of cardiac arrests rate

Median (based on 2013 data) Target (50% reduction by end Dec 2015)

Trajectory

Num

ber o

f Car

diac

Arr

ests

Rate

Chart 6

2.3.1 Chart 5 shows the number of cardiac arrests in the Acute Services Division.

2.3.2 Chart 6 demonstrates a “count” of the number of cardiac arrests across the Community. The processes around cardiac arrests differ considerably from those within the Acute Hospitals and also incorporate data from GP practices and therefore the data methodology differs from Chart 5. The data in this chart demonstrates a “count” of the events only with no denominator values attributed.

2.4 Pressure Ulcers

Title Pressure ulcers reported grade 2-4 (Hospital Acquired)Goal To reduce pressure ulcer rate by 50% by December 2017 Source Datix

Chart 7

2.4.1 Chart 7 demonstrates Pressure Ulcers grade 2 to 4 that developed across NHS Fife within our care. Work is ongoing (as it is within other Health Boards) to address some

of the duplicate reporting of Pressure Ulcers which can occur due to the complex nature of reporting these during a patient’s journey across different care provisions.

2.4.2 A report has been written for consideration by Quality Safety and Governance Group. In order to work towards achieving the 50% reduction in pressure ulcers, there are a number of recommendations within the report for consideration on how this work should be taken forward. General themes from the report include:

Alignment of Quality Improvement resource to support focused improvement work in areas identified through the Pareto analysis

Education for staff Focused improvement work relating to the development of pressure ulcers in the

community Education targeting patients, families and carers around prevention and ongoing

care of pressure ulcers Better use of data to support improvement interventions Clear strategies for sharing learning

2.5 SepsisChart 8

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec00:00

00:07

00:14

00:21

00:28

00:36

00:43

00:50

00:57

01:04

A & E - Average time/month first antibiotic administered

2.5.1 Chart 8 demonstrates the amount of time it takes for patients to receive their first dose of antibiotic when the sepsis screening tool is triggered within A&E. The chart displays comparative data from 2013 to our current position.

2.5.2 The monthly average for administering antibiotics on time in A&E is shown in the table beneath the chart (average time for March was 37 minutes).

Chart 9

Jan-13

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3

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Patients who triggered the Sepsis Six Tool in Resus A & EDec 2012 - March 2016

Patie

nts

2.5.2 Chart 9 provides an overview of the patients that trigger the Sepsis Six tool in A&E. A sustained increase in the number of patients triggering the bundle was achieved from January 2014 based on the mean created from January to December 2013 (21.1).

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 March 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 March was 29, the same as in March 2015. The number of requests responded to in the 20-day timescale so far is 18, with 2 requests having missed the 20-day deadline. This means that 92.9% of responses in March were provided on time. One request was withdrawn and the remaining 8 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

Mar 2016 29 4 3 10 12 29 18 2 ** 92.9% **

Mar 2015 29 7 0 13 9 29 29 0 100.0%

** Two responses incomplete and already over the 20-day deadline, so % completion calculated as 92.9% (26 out of 28, including thosenot complete but on schedule to be complete within the timescale, and excluding the one which was withdrawn)

MonthNumber of Requests

Source of Requests Responses

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

Table 2

SECTION FCOMPLAINTS

We will achieve and sustain response times of no less than 95% (acknowledged within 3 working days) and 70% (responded to fully within 20 working days).

Key Concerns and Risks

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

There are currently 34 complaints open and outstanding (38 in previous month), 3 of which are beyond 40 days and 9 of which are beyond 20 days (and are being reviewed weekly). Of the two 40+ complaints, one is subject to a SAER; the other two complaints are delayed at point of approval, (Fifewide Division).

Recovery Plan

Performance has improved significantly following the successful implementation of all identified actions within the Recovery Plan. The improvement trajectory has been stretched to drive further improvement in performance against the 20-day standard.

There is still outstanding work to agree the single points of contact across the Community areas. It is now much easier to identify the areas of delay in the system as a result of the introduced changes. The sign off process within Community areas is the single, most significant issue.

Complaints, Concerns, Compliments and Comments

AprilMay June

July

August

Septem

ber

October

November

December

January

February

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ComplimentsCommentsComplaintsConcerns

Context of Complaints in Relation to Other Forms of Feedback

The F&R Committee have requested additional reporting information about concerns; however currently concerns are not coded with the same level of detail as complaints. A new complaint handling procedure due to be introduced in late 2017 will require the majority of concerns to be logged as Stage 1 complaints and this will allow for the additional capture of information and analysis of the data. The focus on Stage 1 complaints will be early resolution, within 5 working days.

A few examples of concerns and how these are currently dealt with are listed for information:

Problems with appointments (delay in notification of appointment/re scheduling/decision following DNA/continuity/issues with consultation). Liaison between departments takes place to bring about resolution.

Family members lack understanding and require explanation of care. With the patient’s consent it is often possible to resolve such issues by arranging an early meeting with key clinical staff.

Third party raises a complaint without the consent of the patient. In this situation there needs to be clear discussion about the requirements. The Patient Relations Team adopts a helpful approach and aims to overcome issues rather than put obstacles in the way of those seeking to raise a complaint.

Patient disagrees with treatment and seeks a second opinion. Again in a situation like this it is normal to encourage dialogue to ensure an adequate

explanation and understanding of situation. Where required a second opinion can be sought.

Car parking is a common issue identified as a concern. The Board have seen an increase in the number of concerns received as a result of changes introduced to parking areas (particularly Whyteman’s Brae). A standard response has been prepared by the Director of Estates and Facilities.

Patient Opinion

Patient Opinion provides a route for people to share their experience of NHS care anonymously. The graph below shows the distribution of stories received with a marked increase during February. Work is ongoing to promote awareness of Patient Opinion and to introduce new responders.

One example

A great experience for us bothMy dad has Parkinson's and dementia, it was thought rather than putting him through the stress of going to theatre it was suggested to carry out the procedure in a quiet room, where the surgeons and nurses came there. I was able to stay with him and help him through it. The Surgeons and specialists nurses were fantastic, it turned out to be a great experiencefor us both. So thank you to everyone who helped make this happen

Scottish Public Service Ombudsman (SPSO) Decisions and reports concluded:

The SPSO upheld a case concerning a GP Practice who failed to reach a diagnosis of diabetes despite Practice attendances over a period of two years. The SPSO recommended that the Practice review their protocols for the management of abnormal diabetic results to ensure they are in line with WHO Guidance. The GP was also been asked to consider the WHO Guidance and identify any learning as part of an Appraisals process. The Practice is required to confirm compliance with the recommendations by 18 April 2016.

SECTION GPROGRAMME 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, below, 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 May 2016, which will be reported to the June 2016 meeting of the Board.

3. WORK COMPLETED TO DATE3.1 NHS Fife Optimising Efficiencies in Surgery project - The first part of the Optimising

Efficiencies in Surgery project has been completed with data analysis shared with specialities. List booking for general surgery and gynaecology was chosen as the implementation project. Two workshops were held in the week commencing 7 March 2016 with GE and a multi disciplinary team from general surgery and gynaecology. A detailed action plan for this project was developed.

3.2 Demand & Capacity project – Demand and Capacity work completed to date for Acute Services including Diagnostics (Radiology and Endoscopy). 2016/17 Demand & Capacity projections are in the process of being signed off by services for acute and diagnostic services. Initial discussions with colleagues at a national level have begun for Mental Health and Learning Disabilities services but there are no nationally agreed frameworks or methods.

3.3 Clinical Strategy project – Workstream meetings for all seven meetings are progressing well with good engagement from a wide variety of stakeholders. All workstreams are on track to deliver a workstream report in line with the agreed timeline using the report format already distributed. The Communication and Engagement Plan 2015/16 and the Participation and Engagement Plan are being delivered with a wide variety of awareness raising and stakeholder engagement ongoing - including Clinical Strategy pop-up sessions across ten sites. Engagement from staff, patients and visitors to date has been excellent.

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. Discussions with services are underway to describe potential options for repatriation of services taking into account issues in workforce, scale of services and locations.

3.6 Well at Work project – The roll out has commenced of the Attendance Management Resource Pack, which has been aligned to priority areas in Acute Services and across the HSCP based on an analysis of sickness absence data and hotspots/trends. A mapping exercise has been completed to compare Well at Work

activity against the Gold Healthy Working Lives award criteria. Dates have now been set for the Gold Healthy Working Lives award assessment, which will now take place on 20 April 2016 and 27 April 2016. Planning for the assessment visits has been completed. Work to plan the separation of the services currently provided jointly with NHS Tayside commenced in March 2016 with a number of meetings held to clarify issues to allow the separation of the existing SLA for OHSAS.

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 continues to meet with the focus now on generating cleaner mail and on reducing the number of franking machines. The Fleet Vehicle usage group has continued to meet to consider the initial outputs from the Routemonkey analysis. This analysis highlights opportunities for re-routing of vehicles but the final report is still awaited, which will drive the definitive actions.

3.8 Prescribing Efficiencies project – The Scriptswitch (GP IT prescribing system) rollout is now completed with £59k efficiencies delivered in the first 8 weeks. Recruitment for a number of funded invest to save projects is underway (prescribing support nurses for diabetes, respiratory, woundcare/stoma/catheters) awaiting completion of pre-employment checks.

3.9 Workforce Strategy project - The Project Plan is being delivered and monitored by a project team and the overarching steering group. The Workforce Strategy template is continuing to be populated. The work to conclude the evaluation of references, tables and diagrams is complete to inform the presentation of the analysis of current workforce information. Work to incorporate an Education, Training and Development workstream into the project has commenced with a draft project initiation document produced and considered by the Programme Management Steering Group.

4. WORK SCHEDULED FOR COMPLETION BY THE END OF MAY 20164.1 NHS Fife Optimising Efficiencies in Surgery project – The actions from the general

surgery and gynaecology project will be nearing completion. A high level plan for optimising theatres will be developed and monthly update reports will be discussed at the Acute Services Division (ASD) scheduled care programme board.

4.2 Demand and Capacity project – Work will be finalised on population projections and future demand profile for acute services. Potential options will be presented to capture Health and Social Care services activity for mental health and learning disability services.

4.3 Clinical Strategy project - All workstreams will continue to meet with all seven workstreams scheduled to complete their scheduled meetings by the end of April 2016. The Clinical Strategy Event, held on 23 March 2016, allowed further discussion on emerging themes; the consideration of challenging questions and consideration of next steps. 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. Draft workstream reports will be produced for each of the seven workstreams and these will be used to shape the development of the draft Clinical Strategy for NHS Fife.

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 – Completion of an options paper, which takes into account the recommendations from the Clinical Strategy workstream reports, workforce and capacity issues.

4.6 Well at Work project – The overarching Well at Work Project Steering Group will meet for the first time to oversee all workstreams. The Healthy Working Lives Gold Award assessment will be carried in April 2016 and implementation of the delivery plan will commence to support ongoing compliance. The delivery plan for absence management will be formally approved by the overarching steering group and work will commence to deliver the actions designed to improve absence management performance towards the defined targets.

4.7 Prescribing Efficiencies project – Work to develop a new Pharmacy Strategy will be planned. The new Effective and Efficient Prescribing Project Steering Group will meet for the first time on 13 April 2016. Membership will include representation from Clinical Directors and Senior Managers. A new and ambitious Prescribing Efficiency Plan for 2016/17 will be prepared by the end of April 2016. Projections have revised to reflect delays in approval to recruit additional staff for homecare medicines and the current 16% practice pharmacist vacancy rate.

4.8 Workforce Strategy project - Work will be completed on an analysis of the current workforce. Work will commence work 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. A meeting has been arranged in April 2016 to ensure appropriate linkages between the Workforce Strategy project and the Clinical Strategy and Workforce Efficiencies projects. Work to secure the formal approval of the Education, Training and Development workstream PID will be finalised.

5. RECOMMENDATIONThe Fife NHS Board is asked to:

Note the progress to date in completing the stages scheduled for completion by 31 March 2016 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 May 2016.

theadmin.fifedirect.org.uk/weborgs/nhs/uploadfiles/... · web viewdetailed analysis of the sickness...

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