HIGHLAND NHS BOARD DRAFT MINUTE of BOARD ......this (‘coffee conversations’) was explained. Evidence from 150200 hospitals over 510 years - - suggested that 37k coffee conversations

Highland NHS Board 31 March 2020

Item 3

HIGHLAND NHS BOARD

Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 www.nhshighland.scot.nhs.uk/

DRAFT MINUTE of BOARD MEETING Board Room, Assynt House, Inverness 28 January 2020 – 8.30am

Present Prof Boyd Robertson, Chair Mr Alex Anderson Ms Jean Boardman Mr James Brander Mr Alasdair Christie Ms Ann Clark Ms Sarah Compton-Bishop Ms Deirdre MacKay Mr Philip MacRae Ms Margaret Moss Mr Adam Palmer Ms Ann Pascoe Dr Gaener Rodger Mr Dave Garden, Director of Finance Mr Paul Hawkins, Chief Executive Ms Heidi May, Nurse Director Dr Boyd Peters, Medical Director Dr Louise Wilson, Interim Director of Public Health

In Attendance Ms Ruth Daly, Board Secretary Ms Fiona Hogg, Director of Human Resources and Organisational Development Ms Deborah Jones, Director of Strategic Commissioning, Planning and Performance Ms Fiona MacBain, Committee Administrator, Highland Council Mr George McCaig, Planning and Performance Manager Ms Joanna MacDonald, Chief Officer, Argyll & Bute Mr David Park, Chief Officer, North Highland Ms Katherine Sutton, Head of Acute Services

Also in Attendance

Prof Sandra MacRury, University of the Highlands and Islands Dr Chris Turner, Civility Saves Lives

Preliminaries

• Mr Paul Hawkins, newly appointed Interim Chief Executive, was welcomed.• Dr Louise Wilson, newly appointed Interim Director of Public Health, was welcomed.• Mr Dave Garden was congratulated on his appointment as Director of Finance• Ms Mary-Jean Devon had resigned from the Board due to pressure of work and was thanked for her

valued contribution.

The Board:

• Noted the implications for NHS Highland Senior Executive leadership as a result of the restructure.

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http://www.nhshighland.scot.nhs.uk/

• Agreed the secondment of Mr Paul Hawkins to the position of interim NHS Highland Chief Executive, effective immediately, for an initial period of one year, and with Specific Accountable Officer status to be thereafter conferred on Mr Hawkins by Scottish Government.

1 Apologies Mr Alasdair Lawton. 2 Declarations of Conflict of Interest Mr Alasdair Christie wished to record that he had considered making a declaration of interest as a member of the Highland Council but felt his status was too remote or insignificant to the agenda items under discussion to reasonably be taken to fall within the Objective Test, and on that basis he felt it did not preclude his participation at the meeting. 3 Presentation by Chris Turner of Civility Saves Lives Dr Chris Turner was an emergency medicine consultant who worked with organisations in the healthcare sector to promote the impact of civility on patients, staff and quality of care. He had been providing workshops for NHS Highland in conjunction with Medical Education and gave a presentation to the Board which included the following points: • The link between the promotion of civility and kindness, and the NHS Highland Culture Programme. • The history and emergence of Civility Saves Lives, which had resulted from the events at Mid

Staffordshire NHS Hospital in the late 2000s. • ‘When we permit rudeness, our patients die unnecessarily’ – the impact of incivility on teams. When

someone is rude there is an estimated 61% reduction in cognitive ability in the recipient and, among onlookers, a 20 % decrease in performance and 50% reduction in willingness to help.

• The benefits of early informal intervention in tackling incivility were highlighted and the mechanism for this (‘coffee conversations’) was explained. Evidence from 150-200 hospitals over 5-10 years suggested that 37k coffee conversations with clinicians about their behaviour had resulted in only 2k repeat offenses, with only 267 of those going on to a more formal HR procedure. 999 medical staff out of 1000 are likely to change their behaviour as a result of a graduated set of informal interventions.

During discussion, the following issues were considered: • People were often unaware they had upset or offended others and were usually keen to rectify the

situation once it was drawn to their attention in an informal manner. Jumping to formal procedures tended to trigger a ‘deny and defend’ response rather than a cooperative one.

• ‘Coffee conversations’ were conducted by peers on a one to one basis, these being chosen by a democratic process and appropriately trained. It was often preferable for the early conversations to remain unrecorded to facilitate open and frank discussions. Serious matters would be escalated to a formal process as appropriate.

• In relation to this being built into medical training, it was considered more beneficial to engage with clinicians in the workplace.

• Information was sought on possible metrics to measure behaviour and performance, and reference was made to staff surveys and absence levels, with sickness bills tending to be higher in less civil organisations.

The Board thanked Chris Turner and noted the presentation.

4 Minute of Meeting of 26 November 2019 and Action Plan The Board approved the minute, subject to the replacement of ‘reviewed use of the Highland Outcome Improvement Plan’ with ‘renewed’ at the top of page nine.

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5 Matters Arising • Action 3, renewed presentation of the Finance report was now complete. • Action 1, GDPR update, was included in the CEO report, Item 6.

6 Chief Executive’s and Directors’ Report – Emerging Issues and Updates Iain Stewart, Chief Executive This month’s report incorporated updates on: Introduction from CEO Board Appointments: Chair appointed to the NHS Highland Board Hot Topics/issues: • Caithness General Hospital secures a world first for pioneering environmental work • Health and Social Care Integration

o North Highland o Argyll and Bute

• Highland maintains Baby Friendly status • Fond Farewell to Sandie Macleod • First Contact Physiotherapists Introduced in Argyll and Bute • Raigmore Hospital Car Parking • Argyll & Bute Nurses receive Prestigious Queen’s Nurse Award • Raigmore catering department reduces plastic • Launch of Corporate Induction Portal

During discussion, the following issues were considered: • The Chair expressed the Board’s gratitude to the outgoing Chief Executive, Iain Stewart, for his valued

work, especially in transforming the tone of the organisation, and wished him well for his new position as Chief Executive of NHS Orkney. He welcomed Paul Hawkins as the new Chief Executive, Paul having spent the previous five years as Chief Executive of NHS Fife.

• Attention was drawn to a reference in the report to the outstanding actions from the Internal Audit report and managerial ownership of the actions was urged. All would be presented to the Audit Committee on 25 February and actions that remained outstanding at that point would be escalated to the Board.

• The Cabinet Secretary for Health would be returning to NHS Highland on 10 February 2020, the visit to include Caithness General Hospital.

• Staff at Caithness were congratulated on their award for pioneering environmental work. • Nursing staff in A&B were congratulated on their prestigious Queen’s Nurse Award. • In relation to the renewal of the North Highland Integration Scheme, there had been regular meetings

with the Highland Council, and a two to three week deferral had been agreed to finalise proposals and continue dialogue, with issues to be considered at a special meeting of the Joint Monitoring Committee.

• In relation to improvements to the Raigmore car park, there were no marked parking bays and it was thought this was because work was still ongoing but would be followed up and reported to the Endowments Committee, along with clarification about potential additional costs for signage permission from the Council. It was clarified the intention was for parking bays closest to the building to be reserved for disabled and for other patients, and that staff would be expected to park towards the rear of the car park, although enforcement of this was challenging.

• Preparations for the Coronavirus outbreak would be covered at Item 13, Infection Prevention and Control.

• A future Board discussion on the Highland Quality Approach and Vision and Values was suggested, with reference to information on the corporate induction portal on the intranet.

• In relation to GDPR Data Champions, the Executive team had now nominated staff and training was being cascaded.

The Board noted the Emerging Issues and Updates Report.

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7 Culture Fit for the Future Fiona Hogg, Director of Human Resources and Organisational Development and Programme Senior Responsible Officer The following information was presented: What have we done so far: • Set up CEO bulletin and Team brief • Carried out initial engagement sessions with 350 colleagues • Set up our Culture Programme Board • Initiated the Argyll & Bute review • External support in place for investigations and mediation • Launched Courageous Conversations training • Developed a Corporate Induction portal • Set up a Health and Wellbeing strategy group • Drafted our Culture Commitments and Plan What are we doing: • Recruiting an External Culture Advisor • Developing a Healing Process • Setting up a Guardian Service • Procuring an Employee Assistance Programme • Planning for the issue of the Culture Commitments and Plan in February, supported by a contact

poster, feedback from the engagement sessions and an update on progress with our original action plan

• Focusing on Civility and Kindness • Improving our People Processes • Taking part in the NHS Dignity at Work project What do we still need to do: • Develop our Communication and Engagement Strategy • Continue our Engagement sessions across the organisation • Refresh our Vision and Priorities and communicate this • Focus on embedding the NHS Scotland Values • Launch a Recognition process, linked to the Values • Develop and launch our Health & Wellbeing strategy • Create a development proposition for our People Leaders What are our key challenges: • To individually commit to making a difference • To be realistic about capacity and timescales • More resource to support the programme to deliver • To listen and hear what our colleagues tell us • To communicate and engage better • To have the courage to see this work through • Change will take time but it can happen How can the Board support Culture: • Focus on creating our vision and priorities and setting the “tone from the top” • Think about what we do and if we are the right people to do it, to try and address the pressure on

colleagues • Provide feedback and challenge on our plans and progress • Promote and be advocates of what we are trying to do

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• Role model our Culture and Values at all times • Ensure we have the resources to deliver this programme The Healing Process: • Since we shared our principles in November, we have listened to colleagues, external parties and

those with lived experience • This is a complex piece of work and something that has never been done before, so we need a lot of

advice and input • We must get it right first time as the people who want to engage with us need to be confident and trust

in the process • We’ve agreed that the assessment as well as the provision of Psychological Therapies should be

sourced externally • We’ve considered different options and routes of access to reflect the individual situations and

preferences for how to participate • We will continue to engage with a range of stakeholders to ensure the design and the delivery of the

process meets these needs • We are proposing that we open the scheme for applications in late February, to ensure we can plan

for the demand • We are also requesting the resource required to deliver the process.

During discussion, the following issues were considered: • There had also been considerable discussion on the detail of the programme at the Culture Programme

Board (CPB). • The scale and scope of the work required, and the need for additional resources to tackle many aspects

of it, was strongly emphasised, with reference to ensuring staff had manageable workloads and do-able jobs. Engagement was being undertaken with the Scottish Government on this and it was anticipated that some additional resource would be forthcoming, noting that additional resource had been provided for the financial recovery programme.

• The new Staffing Scotland Act would be valuable in ensuring safe levels of staffing and escalation procedures.

• In relation to the Healing Process, the wording should reflect the emphasis on the openness of the process, with specific reference to avoiding the use of the word ‘application’.

• In response to concerns about timeline slippage, a one-page infographic of the various processes and pathways for staff to follow for different issues was being produced and would be distributed electronically and in paper format for noticeboards etc as soon as possible and hopefully within a few days. This would be updated as new elements of the project became functional, such as the Guardian Service.

• In relation to concerns that bullying was still taking place within the organisation, these were being supported through the normal informal or formal procedures. Reference was made to recent Once for Scotland policies which included bullying and harassment, and discipline and grievance. Implementation of these would serve as a valuable refreshment of organisation knowledge and behaviour.

• A presentation had been provided to the NHS Chairs’ meeting the previous day on the national whistleblowing standards with which all Boards had to be compliant by July 2020, which would be a substantial piece of work. In relation to the potential connection between this and the Guardian Service initiative, it was thought the confidential contact officer for the whistleblowing would be appointed internally but that this process could work in conjunction with the Guardian Service.

• Concern was expressed at the slower than anticipated pace of progress and that affected staff or ex-staff had still not received the support required. The need for additional resources and expert professional help from the Scottish Government was re-emphasised. It was pointed out that the Cabinet Secretary had also met with the whistleblowers and planned to do so again.

The Board noted the updates in the report.

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8 Attraction, Recruitment and Retention Strategy Update Sharon Hammell, Resourcing, Strategy and Planning Lead, on behalf of Fiona Hogg, Director of Human Resources During a summary of the report, various issues were highlighted including: • The highly competitive marketplace for staff. • The NHS Highland website required updating and the organisation’s digital footprint could be improved,

with assistance being provided on this from Highlands and Islands Enterprise. • The importance of retaining staff, and expanding the use of exit interviews to obtain data. • The usefulness of process mapping for medical workforce. • The need to streamline and speed up the recruitment process to minimise use of locum staff. • The need to consider accommodation, childcare and similar issues, ideally in conjunction with other

public or third sector organisations who all faced similar issues, especially in remote and rural areas. • The possible expansion of apprenticeships. • The need for stakeholder engagement on the issues, with a meeting planned with partners the

following week.

During discussion, the following issues were considered: • The Medical and Nurse Directors welcomed this important contribution towards achieving sustainable

services. Reference was made to concerns expressed by medical colleagues about the unfair distribution of trainee-grade doctors, especially in secondary care, and that this could result in knock-on unfair recruitment issues. This would be discussed further outwith the meeting.

• Exit interviews were vital not only to obtain information from people when they left but to discuss other opportunities, such as part time work in a different area or volunteering. This was particularly relevant given the age demographic of current staff, especially in the ward environment, and the need to plan to manage the ageing workforce. Consideration could also be given to approaching those who expressed an interest in a vacancy but did not apply, to find out their reasons for not following through. It was explained there was a workstream in place to tackle the ageing workforce and to encourage people to stay on longer by offering a change of area or reduced hours, and to hold proactive conversations about this.

• People who were educated and trained locally were more likely to stay and work in the Highlands. • The importance of engaging with school children was emphasised, not only at secondary level, and

work was underway on this, although it would benefit from additional resource. • The University of the Highlands and Islands was investigating apprenticeships for Associated Health

Professionals and representatives would be attending the planned workshop on 10 February 2020. • Reference was made to a recent recommendation from the Scottish Government for a national remote

and rural health and social care education centre, and to a possible training and education initiative on Skye, both of which were subject to ongoing discussion.

• Sharon Hammell had been invited to attend the Area Clinical Forum, whose members were keen to engage on the issues raised, particularly recruitment and retention in rural areas.

• Reference was made to a successful annual NHS careers programme in Sutherland that had been rolled out to secondary schools through the Community Planning Partnership covering many disciplines, the learning from which was recognized by SVQ.

• The North Coast 500 route had increased the visibility and profile of those areas, and those involved in its administration might be in a position to offer support.

• In relation to performance measurement for improvements, this was challenging but work was ongoing to test marketing changes to find out what worked and had an impact.

• The recent practice of recruiting nurses prior to them completing their studies had proved helpful and could be rolled out to other specialisms.

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• Further coordination between public and third sector, and community organisations, was urged. A joint summer recruitment fair was planned.

• There could be regional or digital solutions to some of the posts that were challenging to recruit. • In relation to expansion of volunteering, improved infrastructure for this was required, which would

require the strategic commitment of resources and training.

The Board noted progress and provided feedback as detailed.

9 Finance Dave Garden, Director of Finance The Month 9 Finance report, in a new format, was summarised: Current Ledger Position at Month 9 • For the nine months to December 2019, NHS Highland had overspent against budget by £10.3m. • Approximately £8.5m of this deficit was part of the approved brokerage for the year while the remainder

related to cost pressures which had not been mitigated for in areas including prescribing and premium staff costs, most notably at Raigmore.

Forecast Ledger Position at Month 12 • The year-end forecast position was a deficit of £13.9m of which £11.4m was planned and approved

brokerage. • The budget was £2.5m adrift of the target deficit for the year (£13.9m - £11.4m). • A potential additional cost pressure which was not reflected in the ledger of £1.5m related to a proposed

uplift in our Service Level Agreement with NHS Greater Glasgow and Clyde (GGC). This remained subject to discussion between the parties.

• The approach to bridging the remaining gap was detailed in the report. A summary was provided of progress with savings, cost pressures and risks. The final gap being reported by the PMO was £1.9m. During discussion, the following issues were considered: • The situation with NHS GGC was due to be considered at the A&B IJB on 29 January 2020, with a

proposal for a joint letter from the NHS Highland Board Chair and the IJB Chair to the Chair of Greater Glasgow & Clyde Health Board. The significant work undertaken by the PMO and all staff was welcomed and congratulated.

• A simple one page explanation of the financial situation was requested for the next Board meeting, to help explain the finances to others.

• In response to concerns from clinical and operational staff, raised via the Area Clinical Forum and the Clinical Governance Committee, that Quality Improvement resources had been moved into PMO work, it was explained that QI work was still ongoing throughout the organisation and that the work of the PMO, while having a financial focus, also facilitated quality and safety improvements, and with increased rigour. QI work would be covered in the Clinical and Care Strategy that was being developed. It was also considered important to align QI work with the Highland Quality Approach and to clarify the alignment between quality and safety. Engagement with clinicians on this would be undertaken and an integrated performance report on quality issues was sought for the Board in due course.

The Board: • Considered the financial position of the Board to Month 9 noting the overspend of £10.3m • Noted the continued expectation of the need for £11.4m of financial brokerage • Noted the capital position of breakeven. • Acknowledged the financial position as set out in this report and appendices. • Agreed to bring a future integrated performance report to the Board on quality-related issues. • Agreed to produce a one-page simple summary of the financial situation to the Board on 31 March

2020.

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10 Clinical and Care Strategy Update Chris Morgan, Programme Manager on behalf of Deborah Jones Director of Strategic Commissioning Planning and Performance (Strategy Development SRO) Following early engagement on the strategy, a month-long listening exercise had been undertaken, and the report summarised the proposed changes to the programme as a result, as well as outlining the milestones achieved to commence the development of the strategy. Attention was drawn to the revised programme structure and the proposed change to the workstreams, previously nine, now five (planned care; unplanned care; mental health; maternity obstetrics and the first 1000 days; and complexity, frailty and end of life care). Reference was also made to the whole system approach and to the cross cutting themes (adult social care; ehealth and digital; estates and facilities; and clinical and care role redesign). The aim was to present the strategy to the Board for approval in September 2020. During discussion, the following issues were considered; • With regard to engagement in remote and rural communities, a physical presence would be aimed for

as much as possible but would be supplemented with some virtual or proxy representation. Non-Executives offered support if required and urged that the strategy was not only relevant to urban areas. Advice and support had been sought from the Scottish Health Council on engagement with remote and rural areas, and there was an expectation that clinical and workstream Leads would have an engagement responsibility.

• In relation to the plan to focus on four detailed areas, information was sought and provided on how these would be prioritised and evidenced, and that a health economics approach would be taken.

• It was pointed out that the prominence of Public Health could be improved, and this was being considered by the steering group, with the intention that it would become a cross cutting theme. A Public Health strategy might be required.

• The communication strategy was welcomed, and suggestion made that it be tied in with the Chief Executive’s weekly message and team briefs.

• Information was sought and provided on why Adult Social Care was a cross cutting theme and also an example of one of the workstreams. Attention was drawn to the need to include Argyll &Bute and North Highland in the strategy, and the impact and prominence of ASC in many different pathways.

• It was disappointing that after the listening exercise, patient experience had not been prominent enough to become one of the cross cutting themes. However, reference was made to the summary of comments in which patient centred care had been prominent.

• There was little slack in the timetable to meet the requirement that the strategy be approved by the Board in September 2020. It was possible a Board development session might be required in August 2020.

The Board approved changes to the structure of the programme, noted the progress update and milestone plan, and provided feedback as detailed.

11 Performance Report George McCaig, Performance Manager, on behalf of Deborah Jones, Director of Strategic Commissioning, Planning and Performance Feedback was sought on the format and level of detail in the report, and key issues were summarised. Updated figures were provided for outpatients, now 330 over target, and Treatment Time Guarantee, now 411 over target, these both being for North Highland only. Argyll &Bute was on track to meet those targets. Attention was drawn to the reduced performance against the 4-hour A&E wait compliance for Raigmore, and this was attributed to pressure of numbers over the winter months and the loss of a ward during November 2019. Two particular areas, mental health and cancer, had been a focus in the report, and work was underway with eHealth on how to facilitate making performance data more readily available on the intranet. During discussion, the following issues were considered:

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• Attention was drawn to some of the longer outpatient waits and it was thought this was partly related to pain control services and the inability of some patients to attend clinics due to their circumstances and the system being configured to show them as breaches until they were able to attend.

• It was suggested that during certain periods, A&E waits had been high because the hospital had been busier than normal, and the Nurse Director referred to a briefing on actions taken during these challenging periods to mitigate clinical risks and improve flow. The situation had been exacerbated due to a ward being closed for infection control reasons and the closure of a care home in Inverness at the end of October, rather than to an increase in the number of admissions. The situation had improved significantly over the festive period and a new care home was due to open in January 2020. Executives were asked to thank staff who had worked hard in difficult circumstances.

• Sustainability of Out of Hours services had been discussed at the previous day’s meeting of NHS Chairs.

• It was hoped the relatively high level of occupancy at Raigmore would be streamlined and measures within the 2019-20 winter plan had helped with this. The flow of the whole system required to be considered to help understand many of the issues discussed, not only the direct flow in and out of Raigmore, as the situation was complex and affected by many factors.

• Information was sought and provided to the relationship between Argyll &Bute and NHS Greater Glasgow and Clyde in relation to the acute services.

The Board reviewed the performance detailed in the report and identified areas requiring further information, and agreed to focus on whole system flow, escalation and areas of pressure in a future development session.

12 Community Planning Cathy Steer, Head of Health Improvement, on behalf of Hugo Van Woerden, Director of Public Health At a Development session in October 2019, a Short Life Working Group had been agreed to consider responsibilities in relation to Community Planning and to make recommendations for the future. The main issues identified and detailed in the report were: • Inequity of input into Community Planning between North Highland and A&B. • The role of Non-Executive Directors. • Information reporting and governance including the need to align NHS Highland priorities with

Community Planning priorities. Commitments to support Community Planning and representation on locality and thematic delivery groups.

• Succession planning. The report listed detailed recommendations from the Working Group, as follows: • There should be Non-Executive Director of the Board on the Highland CPP Board and the Argyll and

Bute full partnership group. • There should be Officer representation from the Operational Units and from Public Health on the nine

Community Partnerships in Highland and the four area community planning groups in Argyll and Bute and this should be built into job plans and objectives.

• To ensure that we meet commitments we have made to the Highland CPP, NHS Highland should identify and clarify resources for the two Community Partnerships that NHS Highland leads on. This should include identifying the Chairs, ensuring that District Managers are supported to provide appropriate leadership and committing to provision of the range of resources the Community Partnerships have identified as being required to be effective.

• NHS Highland should ensure that it meets its commitment to produce an ‘asset register’ that describes the resources available to support Community Planning within the Highland CPP.

• Non-Executive Directors can take on the role of Chair of a Community Partnership/Delivery Group/Area Community Planning Group or be a member of these groups where they have the interest, skills and capacity to do so.

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• An information/induction pack on Community Planning should be developed to support new staff andNon-Executive Directors to take up roles to support NHS Highland’s contribution to Community Planning.

• Community Planning and delivery of the CPP Outcome Improvement Plans should be reported andmonitored through the Argyll and Bute Integrated Joint Board and the Highland Health and Social CarePartnership.

• Community Partnership Locality Plans should be reported and monitored through Operational Unitmanagement structures.

• Adults Plans for the Highland Community Partnerships should be reported to, and monitored through,the strategic planning group.

• There should be at least annual reporting on Community Planning and delivery of the OutcomeImprovement Plans for Highland and Argyll and Bute to the NHS Highland Board.

• NHS Highland representatives should be identified for the Community Safety and Resilience DeliveryGroup and the Infrastructure Delivery Group in the Highland CPP.

• NHS Highland should consider how it will respond to the priorities within the Highland and the Argylland Bute Outcome Improvement Plans and build this into strategic and operational plans.

• NHS Highland endorses the proposal to disband the Highland CPP Chief Officer Group, formalise thePartnership Coordinating Group and agree the draft terms of reference for the CPP Board (attached).

• NHS Highland should ensure that its communication and engagement strategies are in line with theprinciples of the Community Empowerment (Scotland) Act.

During discussion, the following issues were considered:

• Attention was drawn to problems of pressure, capacity and resources, with staff trying to tacklecommunity planning on top of their day to day tasks. Additional resource was required but it wasuncertain where this would come from.

• A further amendment had been made to the Terms of Reference, therefore approval could not beundertaken at this time.

• It was suggested that the private nature of the CPB required change to stop it being a ‘show and tell’meeting of public agencies but instead to become a group that could tackle issues in communities,with the support of the communities, such as housing initiatives or adult social care. Further fundingwas urged on a spend to save basis to improve the usefulness of the CPB.

• Information was sought and provided on the robustness of clinical engagement in relation to communityplanning. It was acknowledged the level of clinical engagement was variable, although ongoing work,especially with primary care, was highlighted. This would be discussed outwith the meeting.

• Reference was made to the role of community nurses, compassionate communities and the need forconnectivity between community groups and leadership.

• There were significant differences between the community partnerships in North Highland comparedto in Argyll &Bute, and the Argyll & Bute Community Planning Partnership lacked a Non-ExecutiveDirector, which was a missed opportunity for sharing good practice. The benefits of communityplanning were emphasised and should be embedded into people’s day jobs and not viewed asadditional, although resources for this were required.

• The importance of alignment of strategic objectives between community planning partnerships, theNHS Highland Board and the IJB was emphasised.

• The Chief Executive referred to the need to evaluate costs and consider the matter further in thecontext of the Annual Operational Plan.

The Board agreed the recommendations in this report to:

• Clarify roles, remits and resources to support Community Planning.• Support succession planning for taking on roles in Community Planning.• Strengthen governance within NHS Highland in relation to Community Planning.

And further agreed to delegate authority to the Chairs’ Group to approve the updated Terms of Reference, and for the Finance Director to evaluate the costs and future resourcing of community planning against the priorities in the Annual Operational Plan.

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13 Infection Prevention and Control Report Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control

Local Target NHS Highland rate

Clostridium difficile

HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/20

April – Dec 2019/2020 20.4

Green (NHSH data)

Staphylococcus aureus bacteraemia

HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by year ending 03/20

April – Dec 2019/2020 26.6

Red ( NHSH data)

Clinical Risk assessment Compliance

90% screening target July–Sept 2019 (last data received from HPS) Meticillin resistant Staph. Aureus (MRSA) 95% Carbapenemase-producing Enterbacteriaceae (CPE) 97%

Green (validated data)

C-Section Surgical site infection

Target rate of 2% or below

Jan-Oct 2019 combined rate of 1.8%

Green (NHSH data)

Orthopaedic Surgical site infection


Jan-Oct 2019 combined rate of 0.6%

Green (NHSH data)

Colorectal Surgical site infection


Jan-Oct 2019 rate of 6.5% Green (NHSH data)

Hand Hygiene 95% July – Sept 2019 rate of 97% Green (NHSH data)

Cleaning 92% July – Sept 2019 rate of 96% Green (NHSH data)

Estates 95% July – Sept 2019 rate of 95% Green (NHSH data)

The staphylococcus aureus bacteraemia (sabs) target was unlikely to be achieved, although performance was within expected limits. New targets had been set and were detailed in the report. Improvement on sabs was required and would be challenging due to the relatively low numbers of cases. Areas of improvement were blood culture contamination performance and device-related contamination. The annual workplan would be presented to the Board in March 2020. Summaries were also provided on preparedness for haemorrhagic fever and corona virus, of which there were no current cases in Scotland. During discussion, reference was made to the higher levels of sabs in the community, which meant that the infection had not been caused in hospital. Monitoring took place of the originals of cases. New targets would focus on hospital-acquired infections rather than community cases. The Board noted the position and the update on the current status of Healthcare Associated Infections (HAI) and Infection Control measures in NHS Highland.

14 Asset Management Strategy Eric Green, Head of Estates, on behalf of Dave Garden, Interim Director of Finance.

The North Region Asset Management Plan covered NHS Highland, Tayside, Grampian, Western Isles, Orkney and Shetland, and aimed for consistency and the avoidance of duplication, with reference to the challenging capital budget situation across Scotland. Considerable work had been undertaken to tackle

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high risk maintenance, and with a significant thrust of investment in electrical infrastructure over the previous five years, results were now forthcoming. During discussion, the following issues were considered: • Information was sought and provided on the plans for the Community Midwife Unit at Raigmore, which

was still at an early stage and required consultation. • In response to a reference in the report to NHS Highland having an increase in costs associated with

carbon emissions, it was explained that this was in part because of the lack of mains gas in the Highlands and in part because if a facility had been due to be replaced, older heating systems had not been replaced, for example the new hospitals that were being built. Savings in this area would be apparent in due course.

• The dramatic drop in the high-risk backlog maintenance to only £2m was welcomed. • The report on equipment would go first to the Senior Leadership Team and then to the Board. • It was intended the Regional Asset Management groupings would mirror other regional groupings

and it was emphasised that although Argyll & Bute had a different asset profile, all areas would be treated fairly and without discrimination.

• Asset planning was becoming increasingly complex, in part due to a more technology-based environment, and also due to changing accountancy rules around revenue and capital funding.

• Approximately 60-70% of estates activity was planned, and around 30% reactive.

The Board noted: • The first Regional Asset Management Plan. • The continued progress on reducing risk in backlog maintenance • The challenges faced by rising backlogs in Medical equipment. • The static nature of capital funding and the pressures that brings. 15 NHS Boards - Model Standing Orders Ruth Daly, Board Secretary, on behalf of Paul Hawkins, Chief Executive Originating from the Blueprint for Good Governance, the model standing orders were to be rolled out across Scotland as part of the Once for Scotland policies. There were improvements to content, tone and clarity. Although the model recommended a legal minimum of 3 days’ notice for agenda distribution, continuation of current practice was recommended. Attention was drawn to the inappropriateness of using an accelerated procedure to achieve agreement between Board meetings. In future, smarter working practice would be required to foresee requirements and either hold special meetings, using technology, if required, or to delegate authority for decision making. The Board: • Agreed to adopt revised Standing Orders based on the model ‘Once for Scotland’ Standing Orders • Noted that the Model Standing Orders includes reference to the legal minimum notice for agenda and

papers distribution of 3 clear days; and • Agreed to retain the existing time period for issuing Board Agendas and Papers of 10 days prior to

Board meetings.

16 Clinical Governance Committee of 3 December 2019 • Concern had been expressed by the committee about clinical risks from the pause to the eHealth order

comms project, an initiative which had been recommended by the Radiology Short Life Working Group to move away from a paper-based system and improve clinical safety. Assurance was provided by the Director of Strategic Commissioning, Planning and Performance that the project would be restarted in 2020-21.

• Concern had been expressed about the reporting of the Scottish Patient Safety Programme, the report on the adult programme having failed to be submitted to the last three meetings. Concern had also been expressed about the loss of Quality Improvement staff to PMO work and the need to clarify the

12

connection with the Highland Quality Approach. The Medical Director confirmed that data on quality-related issues was being sought and would be reported to the committee. National work on SPSP was also ongoing. QI work was ongoing throughout the organisation and required better communication to raise awareness.

17 Integration Joint Board of 27 November 2019 The next IJB was on the following day, 29 January 2020. There had been significant changes to senior management and similar issues were being raised at the IJB as at the Board, many relating to Finance, Culture and the Service Level Agreement with Greater Glasgow and Clyde. 18 Area Clinical Forum of 21 November 2019 • Key standing items were the Clinical and Care Strategy, the Annual Operational Plan, and Culture. All

advisory committees were now represented on the ACF. • Monitoring of Quality and Patient Safety issues would continue to be undertaken by the ACF. • Issues were raised about the possible impact of the Health and Care Scotland Staffing Act on clinical

and care staff. The Board was asked to note that investment would be required to ensure this was implemented for all staff groups.

• Non-Executives were invited to attend the ACF by rotation and feedback was that this was useful for the Non-Executives and for the ACF, and demonstrated a commitment from the Board to engage with clinical staff.

19 Audit Committee of 17 December 2019 • There would be an update on the Internal Audit for 2019-20 following discussion with the External

Auditor. • Outstanding Internal Audit actions would be considered on 25 February and it was anticipated would

be heavily reduced. • Changes had taken place to the Risk Management Steering Group and a Risk Manager had been

engaged. • The Chair and Vice Chair had met with the External Auditor and were due to attend the Public Audit

Committee on 2 March 2020 in Inverness. Other senior team members would also be required to attend.

20 Finance Sub-Committee of 20 November 2019 There had also been a meeting the previous week at which the detail of the current financial position had been discussed. 21 Asset Management Group of 19 November and 17 December 2019 • A Board Development Session on replacing equipment was requested. • There was a need for consistent clinical representation on the group and the Medical Director would

take this to the Senior Leadership Team. • Information was sought and provided on progress with the new hospital in Badenoch and Strathspey

which was slightly ahead of schedule. • Information was sought and provided on the reasons service redesign was such a lengthy process,

with attention drawn to the number of stakeholders and the amount of consultation required. For such major changes, it was important to ensure the correct decisions were taken.

• Attention was drawn to typos in the spelling of attendees’ names. 22 Any Other Competent Business 23 There was a meeting of the Board In-Committee immediately following the open Board meeting.

24 Date of next meeting: 31 March 2020

25 Close of meeting 1.25pm

13

14

FOLLOW UP FROM BOARD ACTIONS Highland NHS Board 31 March 2020, Item 4

Meeting Item Action / Progress Lead Status/Timeframe

10 Board 28/1/20

21 AMG Consistent clinical representation was required Boyd Peters to take to EDG

9 Board 28/1/20

12 Community Planning

Agreed to delegate authority to Chairs’ Group to approve the updated Terms of Reference, and to evaluate the costs and future resourcing of community planning.

Boyd Robertson / Paul Hawkins

8 Board 28/1/20

9 Finance M9 Agreed to bring a future integrated performance report to the Board on quality-related issues.

Paul Hawkins

7 Board 28/1/20

9 Finance M9 Agreed to produce a one-page simple summary of the financial situation for the Board on 31 March 2020.

Dave Garden

6 Board 28/1/20

8. Attraction, Recruitment and Retention Strategy Update

Discuss outwith the meeting concerns expressed by medical colleagues about the unfair distribution of trainee-grade doctors, especially in secondary care, and that this could result in knock-on unfair recruitment issues.

Boyd Peters / Sharon Hammell to discuss

4 Board 26/11/19

8. Highland Partnership Agreement

Agreed, that once the financial situation had been resolved, the Board would take a strategic look at the outcomes for integration, for North Highland and Argyll & Bute

David Park / Joanna MacDonald / Paul Hawkins

Requested Board Development Topics Date and item of request

Topic Date session to be held

Board 28/1/20 Item 6 CEO report

Highland Quality Approach and Vision and Values – Board discussion requested. Could be tied in with action 8 above

15

Board 28/1/20 Item 11 Performance

Whole system flow, escalation and areas of pressure.

Board 28/1/20 Item 21 AMG

Replacing equipment

16

NHS Highland

Meeting: NHS Highland Board

Meeting date: 31st March 2020

Title: Culture Programme Update

Responsible Executive/Non-Executive: Paul Hawkins, Chief Executive

Report Author: Fiona Hogg, Director of HR and OD

1 Purpose This is presented to the Board for: • Discussion

This report relates to a: • NHS Board Strategy or Direction

This aligns to the following NHSScotland quality ambition(s): • Person Centred

2 Report summary

2.1 Situation The Culture Programme has been established to deliver the required Culture change to address the issues raised in the Sturrock report.

2.2 Background A progress report on the Culture Programme is presented at each NHS Highland Board meeting. This is the update for March’s meeting.

2.3 Assessment Good progress has been made since the last report. The Healing Process will be presented at the Board meeting for approval, but is still being worked on. The EDG will be given sight of this in advance.

2.3.1 Quality/ Patient Care Our Culture Programme is critical in delivering excellent quality services and patient care

NHSH Board 31 March 20, Item 6a17

2.3.2 Workforce Our Culture Programme will ensure our workforce are engaged, motivated, clear on their roles and priorities and working to our values.

2.3.3 Financial

Additional funding has been secured to deliver the Culture Programme, long term changes to our Culture will contribute to reductions in sickness absence, disciplinary and grievance case timelines and improving our recruitment and retention.

2.3.4 Risk Assessment/Management

No specific risks have been identified in this update. 2.3.5 Equality and Diversity, including health inequalities

Fairness along with Dignity and Respect are core principles of our Culture Fit for the Future where our values are embedded is all we do as an organisation. This will also apply to Programme and how we deliver it.

2.3.6 Other impacts None .

2.3.7 Communication, involvement, engagement and consultation The Culture Programme Board is the main engagement and communication on our progress with Culture and draws a wide range of representatives. A full plan for engagement and communication will be developed through a range of tools and mediums and regular updates provided internally and externally. All colleague updates are now issued following the Culture Programme Board.

2.3.8 Route to the Meeting

This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report.

• Culture Programme Board, 9 March 2020 • Culture Programme Board, 17 February 2020

2.4 Recommendation

• Discussion – Examine and consider the implications of the update 3 List of appendices

18

NHS Highland Board 31 March 2020

Item 7a Culture Programme Update Report by Fiona Hogg, Director of Human Resources and Organisational Development

The Board is asked to note the updates in this report

1. Summary This paper updates on progress with our Culture Programme plans and delivery. The Board is asked to note the updates and progress set out in this report.

2. Background Culture Fit for the Future is now a standing item on the Board agenda to ensure updates on our progress are noted, questions can be asked and that key strategic decisions can be made as required.

3. Assessment/options/issues for consideration

Cabinet Secretary Visit Jeane Freeman, the Cabinet Secretary for Health and Sport visited NHS Highland on Monday 10th February (rescheduled from 28th January) to discuss progress with our Culture Programme and in addressing the issues which were raised in the Sturrock report. The Cabinet Secretary met with the Chair, Chief Executive and Senior Leadership Team, as well as with representatives from our Partnership Forum and the Whistleblowers. A key focus for the meetings was on the need for pace and progress with the development and launch of our Healing Process. Agreement was made that we will work with key stakeholders including the Whistleblowers to co-produce the details, to ensure that what we build is fit for purpose and will be trusted by those who will want to use it. Culture Programme Board The Culture Programme Board continues to meet every 4 weeks and the External Culture Advisor will take over chairing this meeting once onboard. They will be reporting directly to the NHS Highland Board Chair. The Board is settling into a good operating rhythm with a wide ranging attendance and we continue to refine and shape our attendance and focus. Further thought is being given to the governance reporting line for the Programme Board. Appointment of External Culture Advisor We had 2 candidates interview for this position, who went through a rigorous assessment process involving the Board, senior leaders and members of the Culture Programme Board, including representatives from the Whistleblowers. We have offered the role to one candidate, who is a highly experienced HR and Transformation professional with a track record both in the public sector and also working as a consultant and we hope they will start in mid March.

19

The second candidate was also strong with different experience which was also of interest to us and we hope to work with them in a consultancy capacity supporting work around the Healing Process and / or our Whistleblowing processes. Culture Commitments and Culture Plan Final updates on these documents were presented to attendees of the 9th March Culture Programme Board and request for feedback by COB Thursday 12th March. We have slightly delayed the plans to launch to join this together with our work on Vision, Values and Objectives and to develop a similar visual approach to these. Timing of the launch and ability to cascade this information in different formats is critical to ensure that the messages are understood. Argyll & Bute Review The Argyll & Bute Culture review questionnaire went live on Wednesday 19th February, and will be available until Friday 27th March. This is available via a secure online portal hosted by our providers, and so is accessible from any device for any current or former colleagues of NHS Highland, in Argyll & Bute. http://survey.progressivepartnership.co.uk/snapwebhost/s.asp?k=158167399010 Paper copies are available on request from Progressive Partnership request one by phoning Progressive on 0131 316 1900 or emailing [email protected]. We expect to have the report by the end of April. In the interim, we have shared the 5 key themes which came up in the initial data gathering exercise with colleagues on the 23rd January and an update on the progress being made against them was circulated on 26th February. Some of these are reflected in our wider Culture plan already, but also include some specific to Argyll & Bute, particularly relating to awareness and understanding of recent management and structural changes within the HSCP and how Argyll & Bute and their needs fit within the wider NHS Highland communication and engagement approach. Establishment of our Healing Process As a result of the additional investment provided by Scottish Government, we have been able to make substantial progress with the design of our Healing Process. This includes securing the support of a professional transformation lead and consultancy support from an experienced former NHS Director of HR to drive the work forward. It also has allowed us to commission independent legal advice from Shepherd and Wedderburn and identify and commission support across a range of other services including Communications, Psychological Therapies and Mediation, with administrative support also in progress. We are in a period of co-production with key stakeholders including Staff-side and the Whistleblowers and will be launching the process in early April. Due to the pace of progress and the timing of written reports, the proposed process will be presented to the Board for approval at the March meeting via a separate paper. Additional Support for Colleagues Progress has been made with our plans for establishing a Guardian Service and Employee Assistance Programme (EAP) to enhance the support for our colleagues.

20

http://survey.progressivepartnership.co.uk/snapwebhost/s.asp?k=158167399010

mailto:[email protected]

As a result of the emerging Covid-19 situation, we have decided to secure the services of Validium, on a 1 year basis initially, via a tender waiver process, so we can rapidly implement additional support for colleagues over this challenging period. We hope to have the service up and running in April, if not before. The Guardian Service is the only provider in the marketplace that we have identified so we have now received a detailed proposal and will be looking to progress with this, subject to a Voluntary Ex-Ante Transparency Notice" (VEAT) which expires on 6th April, to validate this is the case. The commissioning and set up process for Guardian will take longer than for the EAP, but can start within the next few weeks and go live in the summer. Resources Following discussion with Scottish Government, additional funding has been secured to ensure the Culture Programme, including the Healing Process has the resource and capacity to deliver.

3 Update on Milestones and Progress Theme Action Due date RAG Comments

Governance Terms of Reference agreed 28/10/19 Complete Review on 10th February Governance Culture Programme Board in place 11/11/19 Complete Governance External Advisor - advertised 28/10/19 Complete 5 applications received

Governance External Advisor – interviews 29/02/2020 Complete Informal discussions on 17th Jan to make shortlist

Governance External Advisor - appointed 01/03/2020 Green Offer made and accepted, hope to start mid March

Governance Culture Plan and Commitments updated and shared for review

31/12/2019 Complete Plan and commitments shared in Dec

Governance Culture Commitments and Plan published

14/03/2020 Red Re-planning to deliver with Vision, Values and objectives by April 2020

Our Voices Phase 1 engagement complete

02/10/19 Complete Feedback drafted for sharing with the Culture Plan

Our Healing A&B Review – proposal 28/10/19 Complete Our Healing A&B Review – agree provider 26/11/19 Complete Our Healing A&B Review –starts 01/01/20 Complete Initial meetings held 5/6 Dec Our Healing A&B Review – Questionnaire live 16/02/20 Complete Open till 27 March Our Healing A&B Review - reports out 30/04/2020 Green Our Healing Healing Process- key providers

onboarded 13/03/2020 Complete

Our Healing Healing Process – design and documentation finalised through coproduction process

27/03/2020 Green 3rd meeting took place 12 March

Our Healing Healing Process launched for applications

6/04/2020 Green

Our Healing Healing Process – 1:1’s and Panels start

30/4/2020 Green

Our Healing Monthly review panel put in place for ongoing cases and learning

31/03/2020 Green

Our Health Commence commissioning and set up process for Guardian Service

31/03/2020 Green VEAT notice out till 6 April

Our Health Commence tendering process for Employee Assistance Programme

31/03/2020 Green Tender waiver to be completed w/c 16 March

Our Health Employee Assistance Programme live for colleagues

30/04/2020 Green Will go live in next few weeks

Our Health Guardian Service live for colleagues

01/08/2020 Green

21

4 Contribution to Board Objectives

The Culture programme is a critical part of the transformation of NHS Highland and in achieving our objectives to deliver Better Health, Better Care and Better Value, through an engaged and motivated workforce delivering excellent quality services in an organisation where our values are embedded in all that we do.

5 Governance Implications Staff: The Culture Programme Board has the key accountability for the governance of the Programme as per the Terms of Reference which are currently being reviewed. Financial: Additional resource has been secured to ensure the Culture Programme can deliver on its key objectives. Close tracking of costs will be maintained.

6 Risk Assessment No specific risks have been identified associated with this update.

7 General Data Protection Principles Compliance There are no risks to compliance with Data Protection Legislation

8 Planning for Fairness Fairness along with Dignity and Respect are core principles of our Culture Fit for the Future where our values are embedded is all we do as an organisation. This will also apply to Programme and how we deliver it.

9 Engagement and Communication

With the establishment of the Culture Programme Board, the main engagement and communication on our progress with Culture will be driven via this forum. A full plan for engagement and communication will be developed through a range of tools and mediums and regular updates provided internally and externally. All colleague updates are now issued following the Culture Programme Board. Fiona Hogg Director of Human Resources and Organisational Development 13 March 2020

22

NHS Highland


Meeting date: 31 March 2020

Title: Corporate Objectives - NHS Highland Vision, Values and Objectives 2020-21


Report Author: Ruth Daly, Board Secretary

1 Purpose

This report is presented to the Board for: • Approval

This report relates to: • Setting out NHS Highland Board Vision, Values and Objectives for 2020-21.

This aligns to the following NHSScotland quality ambition(s): • Safe• Effective• Person Centred

2 Report summary

2.1 Situation This report outlines a proposed resetting of NHS Highland Board’s Values, Vision and Objectives. These key elements establish the overarching strategic context for the Board and outline the high level aims for the organisation in the coming year.

2.2 Background The Board has embarked on reaffirming and resetting its Values, Vision and Objectives and discussion has been held at a recent Board Development workshop session. The outputs from this session are appended to this report.

Corporate Objectives have been developed by the Executive Directors’ Group and reflect the AOP targets as well as local commitments and priorities. The Corporate Objectives in turn support the proposed organisational Vision and Values statement.

NHSH Board 31 March 20, Item 723

2.3 Assessment

The appended documents set out proposed NHS Highland Values, Vision and Corporate Objectives for 2020-21. These statements were considered and co-produced at a Board Development session in February 2020. Since this time, the Board’s Executive Directors Group has developed the draft Corporate Objectives further. The Corporate Objectives underpin the setting of personal performance objectives for all staff across NHS Highland. They identify the critical areas of business that must be delivered on time and to standard during the forthcoming year which will be underpinned by programmed activities and work plans. The Corporate Objectives provide the high level description of each area, with more specific detail being set out in the cascade down through team and personal objectives. All managers who set objectives and appraise staff will cascade this process through the organisation to ensure NHS Highland’s vision is realised.

2.3.1 Quality/ Patient Care The safety of patient care and experience are core to NHS Highland Objectives.

2.3.2 Workforce The objectives under the ‘Better Workplace Ambition’ detail the workforce focus.

2.3.3 Financial Corporate objectives require to link to the achievement of financial targets.

2.3.4 Risk Assessment/Management A risk assessment has not been carried out for this paper.

2.3.5 Equality and Diversity, including health inequalities There are no equality or diversity implications arising from this paper.

2.3.6 Other impacts No other impacts

2.3.7 Communication, involvement, engagement and consultation The Board will engage with staff on the Values, Vision and Corporate Objectives for 2020-21.

2.3.8 Route to the Meeting The subject of this report has been considered at the Board Development Session of 24 February and the Executive Directors Group of 26 February 2020. The Executive Directors Group has developed the Corporate Objectives further and their feedback has informed the development of the content presented in this report.

2.4 Recommendation

• Decision The Board is asked to approve the draft Values, Vision and Objectives as appended to this report.

3 List of appendices

The following appendices are included with this report:

• Appendix No. 1 NHS Highland Draft Values and Vision and Draft Objectives 2020-21

24

Appendix 1 Our Vision To improve the health of our communities in a way that makes them proud of NHS Highland

Our Values

• CARE AND COMPASSION

• DIGNITY AND RESPECT

• QUALITY AND TEAM WORK

• OPENNESS, HONESTY AND RESPONSIBILITY

Our Aspirations

Person Centred

Employer of Choice

Clinically Excellent

Sustainable

Our Objectives (per board session)

These need to fit to the above aspirations, currently there is duplication between the headings. I’ve tried to take the 11 we started with and put into a series of statements, clustered under the aspirations.

They need refinement and maybe not all are required, some are missing, but we need statements of intent not repeating what our targets are.

This then all flows into a infographic, with all the other elements, including Vision and Values, visually like the Culture Plans and Commitments

Person Centred

Listening and Learning We will improve our ability to listen to what our patients tell us and act on complaints and feedback openly and promptly and to make change as a result

Communication We will develop a strategy and plan to make our communications more accessible, informative and straightforward for everyone

Engagement We will develop robust plans to engage with communities and foster partnership working, so we can design and review our services with people at the heart

Accessibility We will provide care where and how it is needed and ensure appropriate person centre choices in our care

25

Employer of Choice

Culture We will ensure colleagues feel valued and are treated with dignity and respect and any problems or concerns that arise are quickly addressed and resolved and the necessary support provided.

Healing We will address the hurt caused to colleagues who experienced inappropriate behaviour by launching our Healing Process focussed on listening, resolution and learning from the past to inform our future

Absence We will address high levels of absence through delivery of our health and wellbeing strategy and improvements to processes for managing people

Mgt Development We will deliver a tactical training intervention to all managers, supervisors and professional leads to ensure capability and confidence in dealing with colleague concerns

Clinically Excellent

Population Health – We will work to maintain and improve the health of the population of NHS Highland and to reduce inequalities in health outcomes Safety and Quality – We will improve the standard and safety of care through the implementation of an agreed quality improvement programme Service Delivery - We will effectively manage service delivery to ensure the requirements of the Annual Operating Plan are met in full

Technology enabled / Innovation - We will transform our service delivery enabled by digital innovation and real time information to have safe, smarter and more efficient care built around earlier interventions.

Sustainable

Managing Performance - We will continue to develop and utilise high quality data and insights to inform planning, monitoring and decision making across the organisation Infrastructure – We will continually review footprint and facilities to ensure resources are maximised and aligned to the strategy and the needs of our communities, and the environment we provide care in is safe and promotes healing and wellbeing

Finance – We will develop and deliver the plan to achieve the financial targets as agreed with government as part of our return to sustainability in 2022

Governance and Leadership – We will build confidence of our communities and colleagues by demonstrating sound and effective strategic leadership and efficient board governance and oversight

Workforce - We will build a sustainable workforce for the future by nurturing and growing our own talent and ensure our colleagues are supported to work for as long as they wish to.

26

NHS Highland



Title: Annual Operating Plan Performance Report

Responsible Executive/Non-Executive: Deborah Jones, Director of Strategic Commissioning, Planning & Performance

Report Author: George McCaig, Performance Manager

1 Purpose

This is presented to the Board for: • Discussion

This report relates to a: • Annual Operation Plan

This aligns to the following NHS Scotland quality ambition(s): • Safe• Effective• Person Centred

2 Report summary

2.1 Situation This report is an interim performance report produced whilst the performance reporting and governance model is reviewed and implemented. The scorecard at Appendix 1 details performance against National Standards and the Key Performance Indicators agreed with the Board, together with the performance trend and a comparison with the national trend where that is available.

The Board is being asked to review and discuss the performance outcomes highlighting areas of concern and where further information regarding actions and outcomes may be required.


27

2.2 Background The performance reporting and governance model is being reviewed and a new Integrated Performance & Quality report will be produced in April This will be a monthly report and will incorporate Clinical Governance, Operational Outcomes, Finance and Staff Governance.

2.3 Assessment

These section summarises the key changes and updates from the last performance scorecard presented to the Board in November 2019. Cancer Waiting Times (31 days). This continues to be an improving trend though was slightly below the national target in January 2020 (PI 92%, target 95%).

Suspicion of Cancer Referrals (62 days). A declining trend has been reversed in January, though too early to tell if this will be a continuing trend (PI 91.8%, target 95%).

18 Weeks referral to Treatment. Performance has continued to decline throughout this financial year (PI 78.1%, target 90%). New Outpatients Waiting Times. Performance has continued to decline throughout this financial year (PI 82.3%, target 95%). Performance is better than the national average. Treatment Time Guarantee. Performance level is fairly consistent throughout the year, albeit at levels considerably below the national target and below the national average (PI 56%, target 100%). CAMHS Waiting Times. Performance levels are improving and moving towards national target (PI 82.8%, target 90%). Data recording and data quality within mental health services are currently under review. Psychological Therapies Waiting Times. Performance levels are static and below national target (PI 74.7%, target 90%). Data recording and data quality within mental health services are currently under review. Accident and Emergency Waiting. Performance in A&E waiting has been declining, dropping down below the national standard from October 2019 onwards (PI 90.9%, target 95%). Diagnostic Waiting Times. Performance in Diagnostic waiting has been declining and is below national target and average (PI 66.5%, target 100%). SAB (MRSA/MSSA). The year-end target for this indicator (approx. 60 cases annually for NHS Highland) will not be met in this financial year (PI 63 cases at 3 Feb 2020).

2.3.1 Quality/ Patient Care

Shorter waits can lead to earlier diagnosis and better outcomes for many patients as well as reducing unnecessary worry and uncertainty for patients and their relatives. It also reduces inequalities by addressing variations in waiting times between NHS Boards or

28

individual hospitals. Shorter waiting times will have a positive impact on the health of the patient, but in the long-term may result in some positive impact on all businesses, as key workers who are absent from the work due to illness may be treated earlier and will therefore be able to return to the workplace earlier.

2.3.2 Workforce

Extended waiting times may be due to areas where there are vacancies and specialisms where the vacancies are difficult to fill and this will inevitably have a negative on staff.

2.3.3 Financial

This detail is provided within the separate Finance report to this Board. That will change with the implementation of the Integrated Performance and Quality Report which will incorporate the Finance Report.

2.3.4 Risk Assessment/Management Potential risk areas are highlighted in the scorecard using the RAG approach - Red, Amber, Green - with additional information on national comparisons where available.

2.3.5 Equality and Diversity, including health inequalities Accurate and timely performance information is key in assuring a planned approach to services and their provision.

2.3.6 Other impacts None.

2.3.7 Communication, involvement, engagement and consultation This report is presented for governance purposes to the Board and becomes a public document once published on the NHS Highland Board website.


This first report has been completed using information gained through discussions between Planning & Performance and Service Operational Managers and from the North Highland Access Meeting.

2.4 Recommendation

Discussion – review and discuss the performance outcomes highlighting areas of concern and where further information regarding actions and outcomes may be required.


The following appendices are included with this report: • Appendix No 1, AOP Scorecard

29

KEY performance at or above target

Ref. No. IndicatorsGovt or local

Target Local Baseline Benchmark Performance against target

Performance at previous reporting

period Current performance Trendline

Updated since last reported?

Update Frequency Comment

1Detect Cancer Early To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer.

25% (Govt) 24.3%

Scottish average is 25.5%

Peer Group average is 24.1%

24.3% for 2016/2017 25% for 2017/2018 No

Annually, next update

expected August 2020

Breast, colorectal and lung cancers were chosen as indicators by Scot Govt to be included as they are the most common in Scotland accounting for 45% of all cancers in 2011. This OP standard is used as a proxy indicator of survival outcome. Trend Period 2013/8. See 3.1/3.2 for peer group.

2

Smoking Cessation Annual successful quits at 12 weeks post quit in the 40% most deprived board SIMD areas (the bottom two local SIMD quintiles).

336 quits (Govt - Board specific

targets)

281 quits or 87.8% of

2018/19 target (320)

Scottish average 96.3% of national

target

Year-end performance was 281

quits or 87.8% of 2018/19 target (320)

77.4 % of target at Qtr 1 2019/20

No

Quarterly in arrears, next

update expected in March 2020

Smoking remains a major influence on Scotland's health. Trend period is 2014 to Mar 2019. Calculation of the indicator changed in 2018/19 and therfore pre 18/19 trend should be taken as a guide only.

3Alcohol Brief Interventions Annual brief interventions in the 3 priority areas of primary care, A&E and antenatal.

3,688 interventions equivalent to 80%

of delivery in priority areas (Govt

- Board specfic target)

4,940 interventions equivalent to

135.3%

Scottish average for priority areas in 2017/18 is 132.9%

135.3% for 2017/185,831 interventions

equivalent to 158.1% for 2018/19

No


expected June 2020

This standard helps tackle hazardous and harmful drinking, which contributes significantly to Scotland's morbidity, mortality and social harm. The Govt expects high levels of ABI delivery to be maintained. Trend period is 2014 to 2019.

4GP Access - 48 hour GPs to provide 48 hour access to an appriopriate menber of the GP team.

90% of patients (Govt)

96.3% in 2015/16

Scottish average is 93% for 2017/18 96.3% in 2015/16 95% for 2017/18 Trend data

added

Biennial, next update

expected 2020

Every member of the public should have fast and convenient access to their local primary medical services to ensure better outcomes and experiences for patients. Allows practices to monitor/assess any changes over time.

5GP Access - Advance booking People should be able to book an appointment with a GP more than 48 hours in advance


91.3% in 2015/16

Scottish average is 68% for 2017/18 91.3% in 2015/16 82% for 2017/18 Trend data

added

Biennial, next update

expected 2020

Every member of the public should have fast and convenient access to their local primary medical services to ensure better outcomes and experiences for patients. Allows practices to monitor/assess any changes over time.

6Cancer Waiting Times (31 days) For patients diagnosed with cancer, the maximum wait from first decision to treat will be 31 days.

95 % of all patients diagnosed with cancer (Govt)

93.2% for Jan to Mar 2019

Scottish average is 95.8%.

Peer Group average is 95.9% for Jul-Sep 2019

95.1% for Jul to Sep 2019

92% for Jan 20 YesChanged to

monthly from quarterly

7Suspicion of cancer referrals (62 days) For patients referred urgently with a suspicion of cancer, maximum wait from referral to treatment will be 62 days.

95% of those referred urgently

with a suspicion of cancer (Govt)

74.8% for Jan to Mar 2019

Scottish average is 83.3%.

Peer Group average is 83.4% for Jul-Sep 2019

78.4% for Jul to Sep 2019

91.8% for Jan 20 YesChanged to


NHS Highland Annual Operational Plan Standardsperformance below target

The time from when a suspicion of cancer is raised is a distressing and anxious time for both the patient and their family. Within NHSScotland two standards are in place to support diagnostics and ensure treatments are delivered efficiently. The 31-day standard is from decision to treat to start of treatment for newly diagnosed primary cancers (whatever their route of referral). The 62-day standard from receipt of referral to start of treatment for newly diagnosed primary cancers. NCA is NHS Grampian, Highland, Orkney, Shetland, Tayside, Western Isles. Trend period covered is April 2019 to Jan 2020.

Highland Scotland

Highland Quit Rate

Scotland Quit Rate

Highland Scotland

Highland NCA

Scotland

Highland NCA

Scotland

Highland Scotland

Highland Scotland

Appendix 1

30


IndicatorsGovt or local



period Current performance TrendlineUpdated?


8

Early Access to Antenatal Services Pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation. This details the Board deprivation quintile with the lowest antenatal booking rate at 12 weeks.

80% (Govt) 88.6%Scottish average is

87.6% 88.6% for 2017/2018 82.3% for 2018/2019 No


expected November 2020

There is evidence that those women at highest risk of poor pregnancy outcomes are less likely to access antenatal care early and/or have a poorer experience of that care. Trend period is 2016/17 to 2018/19.

918 Weeks Referral to Treatment Elective/planned patients to commence treatment within 18 weeks of referral.

90% of planned / elective patients

(Govt)

80.3% @ 31 March 2019

Scottish average is 76.9% at Sep 2019 77.8% @ Sep 2019 78.1% @ Jan 20 Yes

Changed to monthly from

quarterly

Shorter waits can lead to earlier diagnosis and better outcomes. It also reduces inequalities by addressing variations in waiting times between NHS Boards or individual hospitals. Trend period covered is April 19 to Jan 20.

10New Outpatient Waiting Times Patients to wait no longer than 12 weeks for a first outpatient appointment.

95 % of patients. Boards to work towards 100%

(Govt)

85.5% @ 31 March 2019

Scottish average is 72.9% at Sep 2019

82.9% waiting no longer than 12 weeks

at Nov 2019

82.3% waiting no longer than 12 weeks

at Jan 20 Yes

Changed to monthly from

quarterly

Shorter waits can lead to earlier diagnosis and better outcomes. It also reduces inequalities by addressing variations in waiting times between NHS Boards or individual hospitals. Trend period covered for NHS Highland is April 19 to Jan 20 (National figure to Sep 19)

11 Treatment Time Guarantee

100% of patients to wait no longer than 12 weeks from the

patient agreeing treatment (Govt).

54.5% @ 31 March 2019

Scottish average is 71.3% at Sep 2019

53.6% commenced inpatient/day case

treatment within 12 weeks at Nov 2019

56% commenced inpatient/day case

treatment within 12 weeks at Jan 20

YesChanged to


A legislative requirement. It places a legal requirement on health boards that once planned inpatient and day case treatment has been agreed with the patient the patient must receive that treatment within 12 weeks. Trend period covered for NHS Highland is April 18 to Nov 19 (National figure to Sep 19)

12

Drug and Alcohol Treatment Waiting Times Clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery.

90% of clients (Govt)

90.9% at quarter ending March

2019

Scottish average is 94% at quarter

ending Sep 2019 90.3% at quarter

ending June 201986.1% at quarter ending Sep 2019

No Quarterly

To support sustained performance across all areas in Scotland, in both community and prison settings, we expect that 90% of individuals will be able to access appropriate treatment to support their recovery within 3 weeks of referral. Trend period is Apr 18 to Jun 19.

13

CAMHS Waiting Times Young people to commence treatment for specialist Child and Adolescent Mental Health services within 18 weeks of referral.

90% of young people (Govt)


2019

Scottish average is 64.5% at quarter

ending September 2019

73% commenced their

treatment within 18 weeks in Nov 2019

82.8% commenced their treatment within

18 weeks in Jan 20 Yes Monthly

Timely access to is a key measure of quality. Early action is more likely to result in full recovery and in the case of children and young people will also minimise the impact on other aspects of their development such as their education.Trend period is Apr 19 to Jan 20.

14Psychological Therapies Waiting Times Patients to commence Psychological Therapy based treatment within 18 weeks of referral.



2019

Scottish average is 78.4% at quarter

ending September 2019

85% commenced their

treatment within 18 weeks in Nov 2019

74.7% commenced their treatment within

18 weeks in Jan 20 Yes Monthly

Timely access to healthcare is a key measure of quality and that applies equally in respect of access to mental health services. Data quality issues mean the the national trend should only be taken as an approximate guide. Trend period is Apr 19 to Jan 20.

15IVF Waiting Times Eligible patients to commence IVF treatment within 12 months of referral.

90% of all eligible patients (Govt)

100.0%Scottish average is

100% 100% for quarter ending Sep 2019

100% for quarter ending Dec 2019

100% compliance for all Scottish Boards

Yes Quarterly

Eligible patients should be able to access IVF treatment equitably. Longer waiting times for patients leads to poorer outcomes, as the effectiveness of IVF reduces with age.NHS Highland commissions service for its residents from NHS Grampian and NHS Greater Glasgow and Clyde.

performance below target

Highland - - - - - Scotland_____

Highland - - - - - Scotland_____

Highland Scotland

Scotland Highland

Scotland Highland

Scotland Highland

Highland Scotland

31


IndicatorsGovt or local



period Current performance TrendlineUpdated?


16Accident and Emergency Waiting Patients to wait no longer than 4 hours from arrival to admission, discharge or transfer for A&E treatment.

95% of patients. Boards to work towards 98%

(Govt)

96.4% at 31 March 2019

Scottish average is 83.8% at Dec 19

94.6% waited less than 4 hours in Oct

2019

90.9% waited less than 4 hours in Jan 20

Yes Monthly

This standard is seen as a milestone towards returning to the 98% standard. This is to ensure that all patients receive the appropriate treatment and support at the right time, in the right place by the right person. Trend period covered for NHS Highland is April 18 to Sep 19 (National figure to Dec 19)

17Diagnostic Waiting Times Patients should be waiting no more than six weeks for one of eight key diagnostic tests and investigations

100% (Govt) 86.3% @ March 2019

Scottish average is 82.3% in Sep 20

71.7% waited less than 6 weeks in Aug

2019

66.5% waited less than 6 weeks in Jan 20

Yes Monthly

Diagnostic waiting times are an important component in the delivery of the 18 Weeks RTT commitment as the test or procedure is used to identify a person's condition, disease or injury to enable a medical diagnosis to be made. Trend period covered for NHS Highland is April 19 to Jan 20. (National figure to Sep 20)

18Return Patient Appointments This indicator details the percentage of return patients who a not recalled withinin the timescale set for their return appoutment.

No govt target. 36.8% at March 2019

No national data available

No target set35.7% were not recalled within

timescale @ Sep 2019

33.9% were not recalled within

timescale @ Nov 2019To be updated Monthly

There is no national data available for comparison purposes. Trend period is April 2019 to November 2019.

19 Sickness Absence NHS Boards to achieve a sickness rate of 4% or less.

4.0% or less (Govt)5.23% @ March

2019 (annual figure)

Scottish average is 5.39% @ Mar 2019

(annual figure) 5.35% @ Jun 2019

(annual figure)5.45% @ Nov 2019

(annual figure)Awaiting HR Monthly

OP Standard and Committee requested indicator. Sickness absence can result in cancelled appointments. It can also lead to increased pressure on staff and patients, increased costs of employing bank and agency staff, and reduced efficiency. Trend covers finacial years 2015 to 2019 2018.

20

SAB (MRSA/MSSA) NHS Boards' rate of SAB (staphylococcus aureus bacteraemia (including MRSA)) cases are 0.24 or less per 1,000 acute occupied bed days.

0.24 per 1,000 acute hospital bed days (approx. 60 cases annually)

N.A. (PI calculated

differently in 2018/19)

Performance indicator under

review by SG 52 cases (cumulative)

@ 15 December 201963 cases (cumulative) @ 23 February 2020

Yes Weekly

21

Clostridium Difficile Infections NHS Boards' rate of CDI (clostridium difficile infections) in patients aged 15 and over is 0.32 cases or less per 1,000 total occupied bed days.

0.32 cases or less per 1,000 ocupied bed days (approx. 78 cases annually)

N.A. (PI calculated

differently in 2018/19)

Performance indicator under

review by SG 42 cases (cumulative)

@ 15 December 201955 cases (cumulative) @ 23 February 2020

Yes Weekly

22 Delayed Discharges

No Govt target. Boards expected to

minimise the number of delayed

discharges.

4,011 delayed discharge

beddays @ 31 March 2019.

No benchmark available

N.A.4,183 delayed

discharge beddays at Nov 2019

3,903 delayed discharge beddays at

Jan 2020

Indicator new to this report

Monthly

Timely discharge is a marker for personcentred, integrated and harm free care. A delayed discharge occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the date they are ready for discharge. Trend period covers Apr 2019 to Jan 2020.

These OP standards provide professional and clinical guidance in reducing Healthcare Associated Infection (HAI) in hospitals and other settings ensuring safe and effective care. Trend period covered for NHS Highland is 1 April 18 to 23 February 20. Target assumes an even distribution of cases throughout the year. Figures are cumulative.

performance below target

Scotland Highland

NHS Highland Scotland

NHS Highland

Scotland Highland

Target Highland Trend

Target Highland Trend

Highland Scotland

32

NHS Highland

Meeting: Board Meeting


Title: Infection Prevention and Control

Responsible Executive/Non-Executive: Ms Heidi May, Board Nurse Director/HAI Executive Lead

Report Author: Mrs Catherine Stokoe, Infection Control Manager

1 Purpose To inform members of the position of the board against the national standards on healthcare associated infections and indicators for antibiotic use

This is presented to the Board for: • AwarenessThis report relates to a:• Annual Operation Plan• Emerging issue• Government policy/directive• Local policy• NHS Board/Integration Joint Board Strategy or Direction


2 Report summary

2.1 Situation The current position against the national standards on healthcare associated infections and indicators on antibiotic use, as well as the other key performance indicators ( MRSA screening, mandatory training, and surgical site infection).


2.2 Background There is a requirement to provide pertinent information relating to the national standards and indicators.

2.3 Assessment

The position against the local NHS Highland Board target for Staphylococcus aureus bacteraemia (SAB) reduction will not be met at the end of March 2020. However we remain within expected limits. All staff continue to ensure preparedness is in place for suspected and confirmed cases of Coronavirus COVID19.

2.3.1 Quality/ Patient Care The impact on services and quality of cares remains unchanged.

2.3.2 Workforce

In light of the preparedness occurring for potential COVID19 cases the Infection Prevention and Control staff are prioritising work and providing additional support across the Operational Units. It is a very challenging time.

2.3.3 Financial

In relation to COVID19 the board does face additional funding pressures due to the need to allocate extra staffing and equipment resources to meet clinical demand.


The Infection Prevention and Control team following national guidance at all times. 2.3.5 Equality and Diversity, including health inequalities

An impact assessment has not been completed for this report

2.3.6 Communication, involvement, engagement and consultation The Board has carried out its duties to involve and engage external stakeholders where appropriate: State how his has been carried out and note any meetings that have taken place. • Stakeholder/Group Name, date written as 1 January 2019 • Stakeholder/Group Name, date written as 1 January 2019

2.4 Recommendation

Members are asked to note the report.

34

The Infection Prevention and Control team will focus on the management of invasive vascular devices and blood culture contamination to reduce the incidence of healthcare associated infections. • Awareness – For Members’ information only.



• Infection, Prevention and Control Board report

35

Highland NHS Board 31 March 2020

Item 12 INFECTION PREVENTION & CONTROL REPORT Report by Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control The Board is asked to: • Note the position for the Board. • Note the update on the current status of Healthcare Associated Infections (HCAI)

and Infection Control measures in NHS Highland. 1. Background The Board remains committed to reducing to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean. This report presents an overview of infection prevention and control data and activities. 2. Summary The table below shows NHS Highland Infection Prevention and Control targets and performance data.

Local Target NHS Highland rate

Clostridium difficile

HEAT rate of 32.0 cases per 100,000 OBDs to be achieved by year ending 03/20

Annual performance April – Dec 2019/2020 19.9

Green (NHSH data)

Staphylococcus aureus bacteraemia

HEAT rate of 24.0 cases per 100,000 AOBDs to be achieved by year ending 03/20

Annual performance April – Dec 2019/2020 26.6

Red ( NHSH data)

Clinical Risk assessment Compliance

90% screening target Oct-Dec 2019 (last data received from HPS) Meticillin resistant Staph. Aureus (MRSA) 93% Carbapenemase-producing Enterbacteriaceae (CPE) 93%

Green (validated data)

C-Section Surgical site infection

Target rate of 2% or below Jan-Dec2019 combined rate of 1.8%

Green (NHSH data)

Orthopaedic Surgical site infection

Target rate of 2% or below Jan-Dec 2019 combined rate of 0.9%

Green (NHSH data)

Colorectal Surgical site infection


Jan-Dec 2019 rate of 6.9% Green (NHSH data)

Hand Hygiene 95% Annual performance Jan-Dec 2019 rate of 97%

Green (NHSH data)

Cleaning 92% Annual performance Jan-Dec 2019 rate of 96%

Green (NHSH data)

Estates 95% Annual performance Jan-Dec 2019 rate of 96%

Green (NHSH data)

Source: - Health Protection Scotland/ISD/Local data

Outbreaks/Clusters and multidrug resistant isolates associated with NHS Highland

36

At the time of writing (28/02/20202) Ward 5C Raigmore was closed on 19/02/2020; Ward 6C Raigmore was closed on 20/02/2020 and Ward 7A Raigmore was closed on 25/02/2020 due to confirmed cases of Norovirus. Outbreak control measures remain in place, and it is envisaged that the wards will reopen first week of March following cleaning; if symptoms remain resolved as they currently are. The Board has to date (28/02/2020) tested 35 persons for suspected Coronavirus (COVID19); so far, all people have tested negative. Mask face fit testing continues to occur as part of preparedness. It should be noted that whilst stock of masks and powered hoods is not a concern at the moment, along with other Boards national capacity may become an issue and Health Protection Scotland are aware of this and working to resolve. Pandemic flu plans are being updated as part of the Boards preparedness. Healthcare Environment Inspections (HEI) There have been no HEI inspections carried out within NHS Highland since the last report. General Data Protection Principles Compliance There are no risks to compliance with Data Protection Legislation.

3. Issues for Consideration • As discussed at the last Board meeting, the local NHS Highland Board target for

Staphylococcus aureus bacteraemia (SAB) reduction will not be met at the end of March 2020. However we remain within expected limits (see 6.2).

• We will continue to report on the position against the local NHS Highland Board targets for Staphylococcus aureus bacteraemia and Clostridium difficile infection until April 2020. Following this, we will then report against the NHS Scotland standards, as detailed in the last report to the Board.

• The Infection Prevention and Control team are dealing with an exceptionally high level of work at present, which is resulting in the prioritisation of existing workloads.

4. Contribution to Board Objectives • The Infection Prevention and Control team along with colleagues across the organisation

continue to promote best infection control practice to reduce the potential for norovirus and influenza outbreaks.

• The Infection Prevention and Control team along with colleagues from Health Protection are working together with other members of NHS Highland to ensure resilience and preparedness for suspected and confirmed COVID19 cases.

• We are still aiming to run the Infection Prevention and Control Annual Conference on the 23rd April 2020.

5. New Standards on Healthcare Associated Infections and Indicators on Antibiotic Use

On 10th October 2019 the Chief Nursing Officer published new standards and indicators for healthcare associated infections and antibiotic use. The antibiotics indicators must be achieved by 2022 and the first local data was released to boards on the NSS Discovery platform in January 2020. NHS Highlands position against the new indicators is reassuring and outlined in the table below. Whilst the current position of antibiotic use against the new indicators is reassuring we acknowledge that this position needs to be maintained and continually improved over the next two years. The Antimicrobial Management Team will continue to work with frontline clinical teams to promote optimal antibiotic use and welcomes the support of Control of

37

Infection Committee members to achieve these aims. An update will be provided every year or sooner if any concerns are raised. The antibiotic use indicators are: 1. A 10% reduction of antibiotic use in Primary Care (excluding dental) by 2022, using 2015/16 data as the baseline (items/1000/day). The target for NHS Highland is 1.71 items/1000/day. 2. Use of intravenous antibiotics in secondary care defined as DDD / 1000 population / day will be no higher in 2022 than it was in 2018. The target for NHS Highland is a rate of 0.66 DDDs/1000pts/day. 3. Use of WHO Access antibiotics (NHSE list) ≥60% of total antibiotic use in acute hospitals by 2022. WHO Access antibiotics (NHSE list) are commonly used first line antibiotics, mainly narrow spectrum and include flucloxacillin, doxycycline, trimethoprim and phenoxymethylpenicillin. Current NHS Highland position in relation to new antibiotic indicators Data on NSS Discovery platform to the end of quarter 2, 2019 shows the following position.

Indicator Target Current position at Q2 2019 and comment RAG rating

Primary care (excluding dental) 10% reduction from 2015/16

1.71 or lower items per 1000 patients per day

1.74 items/1000patients/day. Current position equates to 8.4% reduction with downward trajectory

AMBER

Secondary Care – use of IV antibiotics Use no more in 2022 than in 2018 (rate of 0.66)

Maximum of 0.66 DDDs per 1000 population per day

0.655. Awaiting publication of national resources focussing on 3 day review of IV antibiotics

GREEN

Acute hospital use of WHO Access antibiotics At least 60% of all antibiotic use is from Access list

60% or more of all antibiotic use is from Access list

65% Last 6 data points all above 60% target GREEN

Prescribers are to be commended for implementing the best practice guidance and advice on infection management. Strategies for maintaining and improving these positions are in place and include a focus on timely intravenous to oral switch, changing the default duration in primary care for many indications to 5 or 3 days in line with guidance and continuing to promote first line antibiotics in all guidance as much as possible. 6. Healthcare Associated Infection Standards 6.1 Clostridioides difficile infection (CDI)

Scientific literature and Health Protection Scotland now refer to Clostridioides difficile infection. This brings the terminology in line with European Centre for Disease Prevention and Control. For the purpose of board reporting CDI will be used. Figure 1: NHS Highland Clostridioides difficile Infection age 15 and over, case numbers year on year since 2014, based on NHS Highland case number data

38

NHS Highlands position showing actual case numbers as of 31st January 2020 (data not yet validated by HPS) is tabled below 1st April 2019 to 31st January 2020

Total CDI Cases aged 15 and over = 49 Re-occurrence (within 8 weeks of previous episode) =1

Previous CDI (out with 8weeks of previous episode = 5

Aged 15-64 = 17 Aged 65+ = 32

Healthcare Associated = 30 Community Acquired = 17 Unknown = 2 Under Investigation = 0 For definitions of above classifications please see section 2

The position against the new standards on Healthcare Associated Infections for CDI will be tabled in the next Board Paper. The new standard is tabled below.

CDI 2018/19 NHS baseline rate is 16.6 (approximately 78 cases)

NHS Highland new standard rate to achieve by 2022. Is a rate of 14.9 (approximately 44 cases) by 2022

6.2 Staphylococcus aureus (including MRSA) Figure 2: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2014, based on NHS Highland case number data.

0

20

40

60

80

100

April May June July Aug Sept Oct Nov Dec Jan Feb March

Cum

ulat

ive

Case

Num

bers

NHS Highland Cumulative Toxin Positive Cdifficile age 15 and over

2017-18 2018-19 2019-20 Heat Target to 31-3-20

0

10

20

30

40

50

60

70

80

April May June July Aug Sept Oct Nov Dec Jan Feb March

Cum

ulat

ive

Case

Num

bers

NHS Highland Cumulative staph aureus Bacteraemia

2017-18 2018-19 2019-20 Heat Target to 31-3-20

39

The Board need to note that the local NHS Highland Staphylococcus aureus bacteraemia target will not be met. We are at 60 cases against an estimated target of 60 cases by 31st March 2020, however we remain with our predicted limit of 78 cases by 31st March 2020. NHS Highlands position showing actual verified case numbers as of 31st January 2020 is tabled below. 1st April 2019 – 31st January 2020

MSSA = 57 MRSA = 3 Total SABs = 60 Cases

Preventable = 10 Not preventable = 39 Unknown = 8 Under Investigation = 3 Hospital Acquired Cases = 15 Community Acquired Cases = 30 Healthcare Associated Cases = 15 Undergoing Investigation = 0 For definitions of above classifications please see section 2

The position against the new standards on Healthcare Associated Infections for SAB will be tabled in the next Board Paper. The new standard is tabled below.

SAB 2018/19 NHS baseline rate 17.0 (approximately 60 cases)

NHS Highland new standard rate to achieve by 2022 is 15.3 (approximately 44 cases).

6.3 Escherichia coli (E.Coli) Bacteraemia surveillance NHS Highlands position showing actual case numbers as of 31st January 2020 (data not yet validated by HPS) is tabled below. 1st April 2018 to 31st January 2020

Total Cases = 176 Hospital Acquired = 25 Healthcare Associated = 35 Community Associated = 110 Not Known = 6 Under Investigation = 0 For definitions of above classifications please see section 2

The position against the new standards on Healthcare Associated Infections for SAB will be tabled in the next Board Paper. The new standard is tabled below.

EColi 2018/19 NHS baseline rate is 22.8 (approximately 67 cases)

NHS Highland new standard rate to achieve by 2022 is 17.1 (approximately 50 cases)

NHS Highland new standard rate to achieve by 2024 is 11.4 (approximately 34 cases)

7 SURGICAL SITE SURVEILLANCE (SSI)

NHS Highland continues to monitor SSI rates through mandatory surveillance. The clinical teams alongside the Infection Prevention & Control Surveillance team and the Scottish Patient Safety Programme team (Acute adult workstream: SSI) are working jointly to review incidents of infection, and ensure that care practices are evidence based and maintained.

40

RAIGMORE 30 DAYS READMISSION ELECTIVE COLORECTAL SSI January to December 2019, 160 procedures performed, 11 infections reported, an annual rate of 6.9%. In 2018 160 procedures were undertaken and 7 SSIs recorded, giving a rate of 4.4%. 2017 Colorectal SSI rate was 9.4% achieved with 159 procedures with 15 infections. Figure 3: Monthly SSI rate in elective colorectal surgery, Jan 2016 to December 2019

RAIGMORE 30 DAYS READMISSION ORTHOPAEDIC SSI Total Hip replacement (THR) surgery continues to have a low rate of SSI. January to December 2019, 395 procedures performed, 4 infections reported; an annual rate of 1%. 2017 the rate was 0%, 0 infections, and in 2018 there was 1 THR infection in August giving an SSI rate of 0.3%.

Figure 4: Monthly SSI rate for Total Hip Replacement January 2016 – December 2019

Whilst the previous orthopaedic surgical site surveillance graph denotes points above the upper control level, it should be acknowledged that this has been triggered as the actual case numbers are very low and following case review no learning was identified. This applies to the graph below in relation to Hemi-arthroplasty. Hemi-arthroplasty surgery continues to have a low rate of SSI. January to December 2019, 166 procedures performed, 1 infection reported; an annual rate of 0.6%. In 2017 a rate of 0.5% 1 infection reported. In 2018 0.6% with one hemi-arthroplasty infection reported.

41

Figure 5: Monthly SSI rate for Hemi arthroplasty surgery Jan 2016 to December 2019

NHSH 10 DAYS POST DISCHARGE CAESAREAN SECTION SSI Elective C-Section January to December 2019, 368 procedures performed, 6 infections reported, an annual rate of 1.6%. The SSI rate for 2017 was 1.1%, which was a reduction from 2.7% in 2016. For 2018 the SSI rate was 1.7%, 347 procedures with 6 infections identified.

Figure 6: Monthly SSI rate for Elective C-Sections, Jan 2016 to December 2019

Emergency C-Section January to December 2019, 368 procedures performed, 7 infections reported; an annual rate of 1.9%. The SSI rate for 2018 is 3.0% (this is the same rate as 2017), 334 procedures carried out with 10 infections identified.

42

Figure 7: Monthly SSI rate for Emergency C-Section, January 2016 to December 2019

RAIGMORE 30 DAYS READMISSION ELECTIVE VASCULAR SSI January to December 2019, 137 procedures performed, 4 infections reported; an annual rate of 3%. The SSI rate for 2018 was 4%, 124 procedures performed and 5 infections identified. Figure 8: Monthly SSI rate following Vascular Surgery April 2017 –December 2019

It should be noted that the increase at the end of 2019 in relation to the upper control limit reflects the increase in actual operations performed.

43

Section 2 – Healthcare Associated Infection Report Cards - Healthcare Associated Infection Reporting Template (HAIRT)

The following section is a series of ‘Report Cards’ that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections 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. Understanding the Report Cards – Infection Case Numbers Clostridium 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). For each hospital the total number of cases for each month, been reported as positive from a laboratory report, on samples taken more than 48 hours after admission. Understanding the Report Cards – Hand Hygiene Compliance Hospitals 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 broken down by staff group. Understanding the Report Cards – Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. Understanding the Report Cards – ‘Out of Hospital Infections’ CDI and SAB (including MRSA) bacteraemia cases are presented as ‘‘Out of Hospital Infections’ and are not attributable to a hospital. This section identifies those infections from community sources such as GP surgeries and care homes, and those from positive samples taken from patients within 48 hours. Abbreviations

SAB Definitions Definitions: Hospital acquired infection (HAI): Positive blood culture obtained from a patient who has been hospitalised for ≥48 hours. OR patient was transferred from another hospital, the duration of in-patient stay is calculated from the date of the first hospital admission. OR If the patient was a neonate/baby who has never left hospital since being born. OR The patient was discharged from hospital in the 48hr prior to the positive blood culture being taken. OR A patient who receives regular haemodialysis as an out-patient. OR Contaminant if the blood aspirated in hospital Healthcare associated infection (HCAI): Positive blood culture obtained from a patient within 48 hours of admission to hospital and fulfils one or more of the following criteria: 1. Was hospitalised overnight in the 30 days prior to the positive blood culture being taken. 2. Resides in a nursing, long term care facility or residential home. 3. IV, or intra-articular medication in the 30 days prior to the positive blood culture being taken, but excluding IV illicit drug use. 4. Regular user of a registered medical device e.g. intermittent self-catheterisation, home CPD or PEG tube with or without the direct involvement of a healthcare worker (excludes haemodialysis lines see HAI). 5. Underwent any medical procedure which broke mucous or skin barrier i.e. biopsies or dental extraction in the 30 days prior to the positive blood culture being taken. 6. Underwent care for a medical condition by a healthcare worker in the community which involved contact with non-intact skin, mucous membranes or the use of an invasive device in the 30 days prior to the positive blood culture being taken e.g. podiatry or dressing of chronic ulcers, catheter change or insertion. Community infection: Positive blood culture obtained from a patient within 48 hours of admission to hospital who does not fulfil any of the criteria for healthcare associated bloodstream infection. Not known: Only to be used if the SAB is not an HAI, and unable to determine if Community or HCAI. CDI definitions Definitions: Healthcare-associated CDI: a case with onset of symptoms on day three or later, following admission to a healthcare facility on day one, OR in the community within four weeks of discharge from any healthcare facility. This may apply to the current hospital or a previous stay in another healthcare facility, e.g. in another hospital, a long-term care facility or other healthcare facilities (e.g. outpatient departments etc.) Community-associated CDI: a case with [onset outside of healthcare facilities, AND without discharge from a healthcare facility within the previous 12 weeks] OR [onset on the day of admission to a healthcare facility or on the following day AND not resident in a healthcare facility within the previous 12 weeks]

44

Unknown association: a case who was discharged from a healthcare facility 4–12 weeks before symptom onset

ADTC Area Drugs & Therapeutics Committee AMT Antimicrobial ManagementTeam

AMAU Acute Medical Admissions Unit CHP Community Health Partnership

CDI Clostridioides difficile Infection CMO Chief Medical Officer

CNO Chief Nursing Officer CVC Central Venous Catheter

HEAT Health Improvement, Efficiency, Access, Treatment ECDC European Centre for Disease Prevention & Control

GDP General Dental Practitioner HAI Healthcare Associated Infection

HAI QIF Healthcare Associated Infection

Quality Improvement Facilitator

HAIRT Healthcare Associated Infection

Reporting Template

HPS Health Protection Scotland HSE Health and Safety Executive

JAG Joint Advisory Group HFS Health Facilities Scotland

CPE Carbapenemase-producing Enterobacteriaceae MRSA Meticillin Resistant Staphylococcus Aureus

PICC Peripherally Inserted Central Catheter MSSA Meticillin Sensitive Staphylococcus Aureus

PVC Peripheral Venous Catheter SAB Staphylococcus aureus Bacteraemia

PPI Proton Pump Inhibitor SPC Statistical Process Chart

RIDDOR Reporting of Injuries, Diseases & Dangerous Occurrences

Regulations 1995

Hemiarthroplasty: Operation to treat fractured hip (only involves half

of hip)

SHPN Scottish Health Planning Note SHTM Scottish Health Technical Memoranda

SICPs Standard Infection Control Precautions SAPG Scottish Antimicrobial Prescribing Group

IPCT Infection prevention & control team SPSP Scottish Patient Safety Programme

NHS HIGHLAND REPORT CARD

NHS Highland Staphylococcus aureus bacteraemia (SABs) monthly case numbers

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

MRSA 1 0 0 0 1 0 0 2 0 0 0 0 MSSA 7 4 4 8 3 9 6 3 10 4 6 4 Total SABS

8 4 4 8 4 9 6 5 10 4 6 4

-4

1

6

11

16SAB's NHS Highland

MRSA MSSA Total SABS

45

NHS Highland Clostridium difficile infection monthly case numbers

Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 1 2 2 0 2 4 2 2 2 1 2

Ages 65 plus

4 3 5 0 4 4 4 4 2 2 2 3

Ages 15 plus

4 4 7 2 4 6 8 6 4 4 3 5

Hand Hygiene Monitoring Compliance (%) Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Board Total

99

97

97

96

97

97

98

96

99

99

97

98

AHP 100 97 95 93 97 97 96 97 100 98 100 99 Ancillary 100 98 96 98 100 98 99 92 99 99 92 100 Medical 95 93 98 96 95 95 97 96 98 98 98 95 Nurse 99 99 99 97 97 99 98 97 99 99 98 99 Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Board Total

96

96

95

96

96

96

96

96

97

96

96

97

Estates Monitoring Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Board Total

96

96

96

97

96

96

97

93

98

97

96

96

-4

1

6

11

16

C.difficile NHS Highland

Ages 15-64 Ages 65 plus Ages 15 plus

46

NHS HIGHLAND RAIGMORE HOSPITAL REPORT CARD

Staphylococcus aureus bacteraemia (SABs) monthly case numbers

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2019


2 0 1 0 2 0 1 0 2 1 0 0

Clostridium difficile infection monthly case numbers

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2019

Ages 15-64

0 0 0 0 0 1 0 1 0 0 0 1

Ages 65 plus

2 0 0 0 2 2 1 0 2 2 0 2

Ages 15 plus

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

Hand Hygiene Monitoring Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 97 99 95 99 95 95 93 94 98 100 85 / AHP 100 100 100 100 100 100 80 100 100 100 100 / Ancillary 97 100 90 100 100 93 100 90 95 100 60 / Medical 95 96 93 97 85 89 92 93 97 100 86 / Nurse 97 100 97 98 94 98 100 93 98 100 93 /

Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August

2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 93 95 95 96 95 95 94 94 93 96 95 96 Estates Monitoring Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 92 91 95 100 95 95 95 96 96 96 97 98

47

NHS HIGHLAND CAITHNESS GENERAL HOSPITAL REPORT CARD


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


0 1 0 0 0 0 0 0 0 0 1 0


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 1 0 0 0 1 0 0 0 0 0

Ages 15 plus

0 0 1 0 0 0 1 0 0 0 0 0


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 98 100 100 96 97 97 97 99 99 99 100 97

AHP 100 100 100 100 100 100 100 100 100 100 100 100 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 91 100 100 84 86 86 89 96 96 95 100 86 Nurse 100 100 100 100 100 100 98 98 99 100 100 100


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 93 93 95 93 89 92 92 95 95 94 92 93

NHS HIGHLAND BELFORD HOSPITAL REPORT CARD


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

MRSA 0 0 0 0 0 0 0 0 0 0 0 0

48

MSSA 0 0 0 0 0 0 0 1 0 1 0 0 Total SABS

0 0 0 0 0 0 0 1 0 1 0 0


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 0 0 0 1 0 0 0 0 0 0

Ages 15 plus

0 0 0 0 0 1 0 0 0 0 0 0


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 98 92 92 98 92 86 98 98 99 98 100 100 AHP 100 90 75 100 80 100 100 100 100 100 100 100 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 95 79 92 100 100 100 100 91 100 100 100 100 Nurse 97 97 100 93 88 97 93 100 97 93 100 98


Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 99 100 99 100 100 99 97 98 96 96 98 99 NHS HIGHLAND LORN & ISLANDS HOSPITAL REPORT CARD


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


0 0 0 0 0 0 0 0 0 0 0 0

49


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 0 0 0 0 0 1 0 0 0 0

Ages 15 plus

0 0 0 0 0 0 0 1 0 0 0 0


Feb

2019 March 2019

April 2019

May 2019

June 2019

June 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 97 99 100 98 99 97 100 98 99 100 100 95 AHP 100 100 100 100 100 96 / 96 100 100 100 96 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 88 95 100 94 95 92 100 95 96 100 100 85 Nurse 100 100 100 98 100 99 100 100 99 100 98 100


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

99 99 100 100 100 99 99 99 98 99 98 98 Estates Monitoring Compliance (%)

Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 96 94 93 100 92 94 93 95 93 93 92 93 NHS HIGHLAND NORTH & WEST DIVISION COMMUNITY HOSPITALS REPORT CARD

The community hospitals covered in this report card include:

• Dunbar Hospital, Thurso • Town & County Hospital, Wick • Lawson Memorial Hospital Golspie • Migdale Hospital, Bonar Bridge • MacKinnon Memorial Hospital, Broadford • Portree Hospital, Isle of Skye

50

Staphylococcus aureus bacteraemia monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


0 0 0 0 0 0 0 0 0 0 0 0

0 Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 0 0 0 0 0 0 0 0 0 0

Ages 15 plus

0 0 0 0 0 0 0 0 0 0 0 0


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 100 96 97 100 100 100 100 100 100 100 100 100 AHP 100 100 88 100 100 100 100 100 100 100 100 100 Ancillary 100 100 100 100 100 100 100 100 100 100 100 100 Medical 100 80 100 100 100 100 100 100 100 100 100 100 Nurse 100 96 98 100 100 99 98 98 100 99 98 98


Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 98 98 97 97 97 97 98 98 97 97 98 97 NHS HIGHLAND SOUTH & MID DIVISION COMMUNITY HOSPITALS REPORT CARD


• Ross Memorial Hospital, Dingwall • County Community Hospital, Invergordon • Royal Northern Infirmary Community Hospital, Inverness • Town & County Hospital, Nairn • Ian Charles Hospital, Grantown on Spey • St Vincent’s Hospital, Kingussie • For the purposes of monitoring New Craigs Psychiatric Hospital is included in this

report card.

51

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


0 0 0 0 0 0 0 0 0 0 0 0

0 Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 0 0 0 0 1 0 0 0 1 0

Ages 15 plus

0 0 0 0 0 0 1 0 0 0 1 0


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 99 99 97 98 100 99 97 98 99 98 100 100 AHP 100 97 100 98 100 100 98 100 98 98 100 100 Ancillary 100 100 88 96 100 96 95 95 96 96 100 100 Medical 96 100 100 100 100 100

96 100 100 96 100 100

Nurse 99 98 100 99 100 100 100 98 100 100 98 100 Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 99 97 97 98 99 98 99 98 98 98 99 97 NHS HIGHLAND ARGYLL & BUTE IJB COMMUNITY HOSPITALS REPORT CARD


• Argyll & Bute Hospital Lochgilphead • Campbeltown Hospital • Cowal Community Hospital, Dunoon, • Dunaros Community Hospital, Isle of Mull • Islay Hospital • Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead • Victoria Hospital, Rothesay

52

Staphylococcus aureus bacteraemia (SABs) monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

June 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


0 0 0 0 0 0 0 0 0 0 0 0

Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 0 0 0 0 0 0 0 0 0 0 0

Ages 65 plus

0 0 0 0 0 0 0 1 0 0 0 0

Ages 15 plus

0 0 0 0 0 0 0 1 0 0 0 0


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 100 95 98 83 99 94 100 85 99 96 96 97 AHP 100 90 100 50 96 83 100 83 100 90 100 95 Ancillary 100 88 93 91 100 94 100 62 100 100 82 100 Medical 100 100 100 100 100 100 100 100 96 95 100 95 Nurse 100 100 100 89 99 100 100 95 99 100 100 98 Cleaning Compliance (%)

Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


Feb 2019

March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Total 96 95 98 94 95 97 95 95 98 97 97 96

NHS HIGHLAND OUT OF HOSPITAL REPORT CARD Staphylococcus aureus bacteraemia monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020


6 3 3 8 2 9 5 4 8 2 5 4

53

Clostridium difficile infection monthly case numbers Feb

2019 March 2019

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Ages 15-64

0 1 2 2 0 1 4 1 2 0 1 1

Ages 65 plus

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

Ages 15 plus

2 4 6 2 2 2 5 3 2 2 2 2

54

NHS Highland



Title: Review of Health And Social Care Integration Scheme – Argyll And Bute

Responsible Executive/Non-Executive:

Paul Hawkins, Chief Executive


1 Purpose This is presented to the Board for: • DecisionThis report relates to a:• NHS Board/Integration Joint Board Strategy or DirectionThis aligns to the following NHSScotland quality ambition(s):• Safe, Effective and Person Centred

2 Report summary

2.1 Situation This report outlines revisions to the proposed Health and Social Care Integration Scheme for Argyll and Bute following a period of public consultation which the Board is invited to approve.

2.2 Background In November 2019 the Board agreed revisions to an updated Integration Scheme for Argyll and Bute and that a joint consultation exercise be undertaken. It was also agreed that in the event there were no further changes proposed through the consultation process that the revised draft scheme should be submitted to Scottish Government.

2.3 Assessment Resulting from the consultation process there have been additional revisions to the Integration Scheme. These are set out in the appendix to this report.

2.3.1 Quality/ Patient Care The Clinical and Care Governance and Professional Governance framework encompasses the following: • Measure the quality of integrated service delivery by measuring delivery of personal

outcomes and seeking feedback from service users and/or carers.• Professional regulation and workforce development.• Information governance.


• Safety of integrated service delivery and personal outcomes and quality of registered services

Each of these four elements is underpinned by mechanisms to measure quality, clinical and service effectiveness and sustainability.

2.3.2 Workforce Staff are integral to the success of the Health and Social Care Partnership and significant effort will be made to ensure staff are fully involved and engaged in the process to review the Integration Scheme

2.3.3 Financial The revenue and capital budgets of the specified Council and NHS services form part of an integrated budget for the Health and Social Care Partnership to manage.

2.3.4 Risk Assessment/Management A shared risk management strategy which identifies, assesses and prioritises risks related to the delivery of services delegated to the IJB are documented within an integrated risk register.

2.3.5 Equality and Diversity, including health inequalities An EqIA scoping exercise was undertaken in respect of the Argyll & Bute Strategic Plan

2.3.6 Other impacts The review of the Integration Scheme is required by law to be completed by 27 June 2020.

2.3.7 Communication, involvement, engagement and consultation The Board has carried out its duties to involve and engage external stakeholders through a comprehensive public consultation exercise which is described in the appendix to this report.

2.3.8 Route to the Meeting This has been previously considered by the Board in November 2019.

2.4 Recommendation

The Board is invited to: • Note the detail of the 45 responses received during the 6 week consultation period, set

out in Appendices 1 and 2; • Agree the revised Integration Scheme (Appendix 3), which has been further updated to

take account of feedback received as part of the consultation process; • Note that additional revisions to the integration Scheme may be required in respect of

the power to delegate functions in terms of the Children and Young People (Scotland) Act 2014, once in receipt of advice from the Scottish Government; and

• Note that a report will also be tabled at the NHS Highland Board on 31 March 2020 inviting approval of the revised Integration Scheme.

• Agree that the Chief Executives of the two parent bodies jointly submit the revised Scheme to the Scottish Government by end April 2020 for their consideration.

3 List of appendices The following appendices are included with this report: • Appendix No. 1 – Report to Argyll and Bute Council on the Review of the Health and Social

Care Integration Scheme consultation outcome plus appendices. • Appendix No. 2 - Argyll TSI Consultation Response • Appendix No. 3 - Revised Integration Scheme.

56

ARGYLL AND BUTE COUNCIL COUNCIL

LEGAL AND REGULATORY SUPPORT 16 APRIL 2020

REVIEW OF THE HEALTH AND SOCIAL CARE INTEGRATION SCHEME

CONSULTATION OUTCOME REPORT

1. EXECUTIVE SUMMARY

1.1 The full Council and NHS Highland Board, at their meetings held on 28th and 26th November 2019 respectively, approved revisions made to the Health and Social Care Integration Scheme following a review process and agreed that Officers should proceed with arrangements for a 6 week joint consultation exercise, running from 9th December 2019 to 17 January 2020. During this period a total of 45 responses were received and details of these are attached at appendices 1 and 2.

1.2 A review of all the consultation responses has been undertaken by the Working Group that was set up to up to initiate the 5 year review process, at their meeting held on 28 January 2020. Having taken account of all feedback received, a number of further revisions are proposed to the Scheme. The detail of these can be found in the last column of the table within Appendix 1, which outlines the Working Group’s response to the consultation feedback. The Scheme has been updated to reflect the proposed changes arising from the consultation process (highlighted in yellow) and a copy is attached at Appendix 3 for consideration and approval.

2. RECOMMENDATIONS

Members are asked to:-

2.1 Note the detail of the 45 responses received during the 6 week consultation period, set out in Appendices 1 and 2;

2.2 Agree the revised Integration Scheme (Appendix 3), which has been further

updated to take account of feedback received as part of the consultation process;

2.3 Note that additional revisions to the integration Scheme may be required in

respect of the power to delegate functions in terms of the Children and Young People (Scotland) Act 2014, once in receipt of advice from the Scottish Government; and

57

2.4 Note that a report will also be tabled at the NHS Highland Board on 31 March 2020 inviting approval of the revised Integration Scheme.

2.5 Agree that the Chief Executives of the two parent bodies jointly submit the

revised Scheme to the Scottish Government by end April 2020 for their consideration.

3. DETAIL

3.1 The legal requirement to complete a review of an Integration Scheme is set out

in Section 44 of the Public Bodies (Joint Working) (Scotland) Act 2014 (the Act). The Scheme must be reviewed each subsequent period of 5 years beginning with the day on which the Scheme was approved, in the case of Argyll and Bute, 27 June 2015. On this basis the review of the Scheme in Argyll and Bute is required by law to be completed by 27 June 2020. The statutory responsibility to review the Scheme sits with the Board of NHS Highland and Argyll and Bute Council.

3.2 Following a joint review process, the Council and NHS Highland approved the revised Integration Scheme at their respective meetings held at end November 2019 and agreed that, in accordance with Section 46(4) of the Public Bodies (Joint Working) (Scotland) Act 2014, the Council and the Health Board should undertake a joint consultation on the revised Scheme.

3.3 Arrangements for the joint consultation, which ran from 9th December 2019 until 17th January 2020, were put in place, including:-

• Email/postal correspondence issued to all prescribed stakeholders and any others deemed appropriate (870+ targeted)

• Use of Council ‘Keep in the Loop’ service to promote the consultation to customers who have advised they would like to be engaged in consultation activity (3890+ targeted)

• Details of the consultation uploaded to Council and NHS Highland Websites

• Posts on social media • Press release issued • Hard copies placed in Council Customer Service Points and issued upon

request

3.4 A total of 45 responses were received, details of which are attached in appendices 1 and 2. Of these 19 can be evaluated as positive, with respondents expressing agreement with the revisions/content of the Integration Scheme or that they are happy with integrated services in general. Conversely, 18 responses are negative in nature, however the vast majority of these do not comment directly on the content of Integration Scheme. Most of the respondents leaving negative comments have used the consultation process as an opportunity to criticise local services/raise other matters. The remainder of the comments can be classed as neutral, with respondents either providing

58

narrative on suggested changes or leaving feedback such as “no comment” or “don’t have any yet”.

3.5 Respondents leaving feedback via the website (84%) were asked to provide their contact details in order that we could contact them at a later date, if required, in respect of the consultation. They were also asked to advise of their locality. A summary of the responses broken down by area is provided below, taking account of the details provided via the website and as part of email responses (16%) to the dedicated inbox set up for the consultation:- MAKI 14 OLI 10 B&C 10 H&L 8 A&B wide 1 Unknown 2 Total 45

3.6 Following closure of the consultation period on 17 January 2020 the Working

Group, which was established to initiate the 5 year review process, was re-convened on 28 January 2020 to undertake a review of all the consultation responses. The Working Group comprises a range of Senior Officers from both parent bodies, as well as the HSCP. Having considered all feedback received as part of the consultation, the Working Group are recommending a number of revisions to the content of the Scheme, in addition to those previously agreed by the Council and NHS Highland Board in November 2019. These are summarised below, and are also highlighted in yellow within the revised Scheme attached at Appendix 3:-

• Inclusion of a contents table • Paragraph 8.7.7 (page 31) - Change “health owned property” to “NHS

Highland owned property” to provide clarification • Change “Argyll and Bute Integration Joint Board” to “IJB” throughout the

document (with exception of first occurrence) and include within the Definitions and Interpretation section of the scheme (p6)

• Change “and” to “&” throughout document in respect of Children and Families

• Re-ordering of sentences and minor grammatical corrections at paragraphs 4.4.5, 5.3, 8.2.19, 8.2.21, 8.4.2, 8.7.2, and 13.6.

• Paragraph 9.1 - removal of Argyll and Bute Public Partnerships (currently suspended) and the addition of Locality Planning Groups, and Health and Wellbeing Networks

3.7 In addition to the above recommended revisions, it has become apparent that

there are possible issues in terms of the power of the local authority to delegate functions in terms of the Children and Young People (Scotland) Act (2014), affecting the functions that can be delegated to Integrated Joint Boards (IJBs). The Scottish Government are currently in the process of looking at this with a view to identifying a parliamentary Bill suitable to provide a legal solution to the

59

matter, and to advise on what should be included in Integration Schemes. Once the relevant detail has been received there will be a requirement to update the Integration Scheme accordingly.

3.8 Members are asked to consider the outcome of the consultation exercise, and approve the Integration Scheme detailed at Appendix 3. A report will also be submitted to the NHS Highland Board scheduled for 31 March 2020 to invite approval of the revised Integration Scheme. If agreeable, both parent bodies will then arrange for the revised Scheme to be jointly submitted to Scottish Ministers for approval. The Scottish Government have advised that they will require a copy of the draft revised Scheme 4 to 6 weeks prior to the date the new Scheme requires to be in place (27 June 2020). On this basis, it is proposed that the revised Scheme be submitted to the Scottish Ministers by end April 2020, which provides them with an 8 week period to review the Scheme and suggest any potential amendments.

3.9 Thereafter, the Council and NHS Highland will arrange for the final Integration

Scheme to be published as soon as practicable after it takes effect.

3.10 Arrangements will also be put in place to provide the IJB with an update following the Council meeting in April.

4. CONCLUSION

4.1 The 6 week consultation on the revised Integration Scheme has now closed and a total of 45 responses were received. A review of all the feedback was undertaken by the Working Group at their meeting held on 28 January 2020. Members are asked to consider the proposed revisions to the Scheme as a result of the feedback received as part of the consultation exercise and approve the Integration Scheme set out at Appendix 3.

5. IMPLICATIONS

5.1 Policy - In line with Scottish Government Legislation to improve health and social care outcomes for customers

5.2 Financial – none arising from this report 5.3 Legal - Meets the requirements of the Public Bodies (Joint Working) (Scotland)

Act 2014 5.4 HR – none arising from this report 5.5 Equalities/Fairer Scotland Duty – none arising from this report 5.6 Risk – non compliance with statutory measures under the Public Bodies (Joint

Working) (Scotland) Act 2014 5.7 Customer Services – improved outcomes for customers at core of legislation

6. APPENDICES

6.1 Appendix 1 – Consultation responses and proposed action 6.2 Appendix 2 – Consultation Response Argyll TSI

60

6.3 Appendix 3 – Revised Integration Scheme as at February 2020

Policy Lead – Councillor Kieron Green - Health and Social Care Douglas Hendry Executive Director with responsibility for Legal and Regulatory Support 3 March 2020 For further information, please contact: Laura Blackwood Directorate Support Officer Customer Services 01546 604325

61

Review of Argyll and Bute Scheme of Integration – Consultation Responses and Suggested Action/Response

Ref Date Consultation Response

Area Proposed Action/Response

1. 09/12/19 All seems sensible to me OLI No action required 2. 09/12/19 Being part of NHS Highland is something only a colonial

administrator could have dreamed up B&C No action required – outwith the scope of the review

3. 10/12/19 Ok with it MAKI No action required 4. 10/12/19 Disability B&C No action required 5. 11/12/19 Great having such detailed documents to refer to

however they are to lengthy, could you not condense these document and just give a briefer overview (maybe in video or audio format), then have the lengthy documents to back it up.

B&C Note for consideration as part of next review/consultation. The review has been undertaken in line with relevant legislation.

6. 11/12/19 Integration makes sense and if managed properly will save money

B&C No action required

7. 11/12/19 I have reviewed the "summary of revisions". In general, the revisions seem sensible and consistent with the rationale given for the changes. However, in the case of 10.6 (p35), the revision reads, to me, as gobbledegook! in part, because of an inappropriate use of, or lack of, appropriate punctuation and, in part, because of the use of jargon (e.g. "public task"). So, for instance, "any of the other legal basis contained..." is probably more correct (and less confusing) if it were to read: "any of the other legal bases contained...".

OLI Noted – there was an error in the summary of revisions document issued alongside the Scheme. The proposed revised scheme uses the term “bases” not “basis”.

8. 11/12/19 Rubbish, no services available locally B&C No action required – outwith the scope of the review 9. 11/12/19 Having never had use , yet, of the service I cannot

comment on what opportunities may have been missed here to improve the scheme of integration. The changes shown seem to sensibly improve wording, meet changes in legislation and typical usage of names/titles therefore very reasonable to do. The lengthiest points reflect the


62



financial decision taking without sadly ringfencing what goes into the scheme on a year to year basis.

10. 11/12/19 Seems to be changing names for change sake will lead to extra costs unnecessarily as new stationary etc will be required.

H&L No action required

11. 11/12/19 Commented before and things got WORSE..... Decided that Dunoon no longer offers my family the health care it needs so have decided that enough is enough and we are moving from Argyll & Bute. No one listens to the voting public. You all have your own agendas and that does not include the health and wellbeing of us the poor sods who have to travel all the way to Glasgow for health care. Thank you and goodbye.

B&C No action required – outwith the scope of the review

12. 11/12/19 No comment as it's not worth it, no one ever listens to the poor sods who live here and only want a better health care within the area (Dunoon). Big hospital in town slowly being closed before our eyes!!!! "Go to Glasgow! Only a ferry crossing, train, buses, wonderful" Aye right!

B&C No action required – outwith the scope of the review

13. 11/12/19 Don’t have any yet H&L No action required 14. 11/12/19 I use the local Medical Centre in Tarbert, the service is

excellent! MAKI No action required

15. 11/12/19 Although I am not a professional in any related profession - it appears to be a very detailed and comprehensive scheme.

MAKI No action required

16. 11/12/19 I have some concerns about the removal of devolved financial responsibility but I accept that the proposed amendments reflect changes already made to adopted practices. Otherwise, the revisions in text seem to be reasonable.

OLI No action required

17. 11/12/19 Having just read the best part of 60 pages of look how good we are” and ‘cover your back’ legislation compiled


63



by some overpaid, unelected staffers I could not care less about the waste of time and effort that went into all this guff. Who needs all this ? It’s like big businesses “Mission Statements” .... all show and no punch. A and B just trying to look clever.

18. 11/12/19 Why are council services being cut to fund the integrated services - when will their debts to the council be paid back?


19. 11/12/19 A lot of it is change of wording which makes the various conditions understandable. The data protection seems to have been made very brief for such an important (to the service users) point.

OLI Response considered and agreed that all relevant protocols are in place, in line with legislation. No further action required.

20. 11/12/19 It seems that the only revision is in terminology/updating wording. Frankly, the scheme has been pretty useless in terms of managing the crisis in GP supply for Mull and Iona with clueless council members interfering in medical matters. Other things going completely against the aspiration to keep folk at home or 'in a homely setting' are the proposed closure of dementia facilities at Lochgilphead and a recent statement from Lorn Medical Centre (allegedly taking over the Mull & Iona GP service next year) that progressive care will move off-island - another slap in the face for all those who raised funds for the Progressive Care Centre to replace Dunaros but ended up with a hospital with too few inpatient beds (so folk have to be removed to Oban and beyond, away from their families and friends) and the poor compromise that is Bowman Court. We need Progressive Care on Mull.

OLI No action required – majority of the comments are outwith the scope of the review.

64



21. 11/12/19 The October 2019 revisions to the Integration Scheme between Argyll and Bute Council and NHS Highland appear to me to be straightforward and uncontroversial. I note that in the last line of 10.6 the word "basis" has correctly been changed to "bases". In the summary of revisions, however, the revised wording quoted includes the word "basis" unaltered.

OLI Noted – as per 7 above, there was an error in the summary of revisions document issued alongside the Scheme. Revised scheme uses “bases” not “basis”.

22. 11/12/19 As far as I know,I have absolutely no first hand experience of the Argyll and Bute Scheme of Integration. I do have enough experience of the public and third sector to recognise that the document you showed us is too high level for an individual to actually be able to relate it to their day to day experience. Second hand I am aware that whatever the grand plan; underfunding and staff shortages in social work at the very least are making implementation difficult and eroding the quality of experience for service users. More focus is needed on the end user experience than sorting out the management layers.

OLI No action required – outwith the scope of the review.

23. 11/12/19 I don’t think it was a good idea, as the care in the community has been a lot worse, as I’m a health care professional i can see it’s not good, also I had to take months off my work to nurse my sick mother in 2017.

MAKI No action required – outwith the scope of the review.

24. 12/12/19 The integration team works it supports vulnerable people in the community who require joint working partnership to live safely and securely knowing with the knowledge they have support

MAKI No action required – outwith the scope of the review.

25. 12/12/19 It is clear that the entire integration scheme has been a failure. NHS and Social Work should be separated completely and the integration scheme should be discontinued.

Unknown

No action required – outwith the scope of the review.

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26. 12/12/19 No index so one has to wade through 60 pages. I am a male so why bother asking my opinion as 90% of all staff involved in this are women

H&L Agreed to include a contents page.

27. 12/12/19 Steps in the right direction, albeit a very complex text on a complex issue, with lots of lengthy repetitions. I will soon email a few queries regarding some of the content, and will make some hopefully helpful suggestions to render the text a bit easier to read.

OLI Please see comments at 28 below – same respondent.

28. 12/12/19 Dear Madam, dear Sir Thank you for giving residents in Argyll & Bute the opportunity of reading this paper, and of responding to it. As already noted in my on-line response submitted on 12 December 2019, at about 14:50, the document suggests steps in the right direction (comment 27 above) As a local resident, I would, however, like to ask a few questions (see “Feedback – Part One” detailed below) and – with my “linguist hat” on – suggest several edits (see “Feedback – Part Two” detailed below) in order to render the text easier to read. It will be an honour and a pleasure to receive your answers to my queries, and to find that my edits have been approved and integrated. Feedback Part One 1. Substantive issues

OLI

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a) page 27, paragraph 8.4.1 – why was “on a monthly basis” deleted?

i. In paragraph 8.4.2 (page 28), “the parties” are

obliged to provide “comprehensive reports” to “the Chief Financial Officer” – “on a monthly basis”.

ii. The same obligation ought to apply the other way round; in paragraph 8.4.1, “on a monthly basis” should remain.

b) Page 30, paragraph 8.7.7: “Depreciation of health

owned property and other non-current assets used in the services within the scope of Argyll and Bute Integration Joint Board will…”

i. Health owned is unclear. Does it mean,

“Health and Social Care Partnership”? Suggested revision:- “Depreciation of property and other non-current assets, owned by the Health and Social Care Partnership, which are used by Argyll and Bute Integration Joint Board, or its services, will…”

c) Pages 36/37, paragraph 12.3:

i. “Liabilities arising from decisions taken by the Argyll and Bute Integration Board

1a) The Scheme reflects the actual position. The IJB does not meet on a monthly basis and this revision ensures that a report can be provided to every IJB meeting.

i. This provision requires the parent bodies to provide

monthly reports to the HSCP Chief Financial Officer. These reports inform those that are tabled at each IJB meeting (as per 1a above). No change required.

b) The HSCP do not own property. Assets are owned

by the two parent bodies - NHS Highland and Argyll and Bute Council depreciate assets in different ways. Agreed to change “health owned” to “NHS Highland owned” for clarification.

c) “Equally” was deleted to allow flexibility/to share on a different basis, should liability affect one party more than the other.

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will be equally shared between the parties.” Why was “equally” deleted? The clarification is required to prevent future conflict. Suggested revision:- “Liabilities arising from decisions taken by the Argyll and Bute Integration Board will be shared equally between the parties.”

Feedback Part Two 2. Repetitive Issues

168 occurences of the lengthy denomination, “Argyll and Bute Integration Joint Board”! This makes readers want to lose the will to live. My perhaps not very conventional suggestion: Use “Argyll and Bute Integration Joint Board (ABIJB) only once per page; use “ABIJB” whenever the term recurs on the same page.

3. Consistency issue

a) On page 4, the use of “&” in “Children & Families” clarifies the relationship.

Therefore, likewise:

Liabilities will not be occurred equally, and the change provides a fairer process to reflect that one body may incur a greater liability than the other. One of the reasons for removing equally is due to the conflict with the provisions detailed at section 8.2 of the Scheme in respect of Management of the Revenue Budget.

2. Agreed to change Argyll and Bute Integration Joint Board to IJB throughout the document (with the exception of the first occurrence) and include reference in the Definitions and Interpretation section of the Scheme (p5).

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i. Page 3, paragraph 2. Aims and Outcomes:

“Children and Families Social Care Services and Justice Services” Suggested revision: “Social Care services for Children & Families and Justice services”.

ii. Same page, and page 8, item 2.3 (3 further identical occurrences): “for Children and Families and Justice”. Suggested revision: “for Children & Families, and Justice”.

4. Sentence logic issues

a) Page 12, paragraph 4.4.5:

“The Parties will continue to provide support to Argyll and Bute Integration Joint Board for the Performance Targets, Improvement Measures and Reporting arrangements, including the effective monitoring and reporting of targets and measures for adjoining NHS Boards and Integration Joint Boards.” Is the required? The following wording may be easier to understand:

3ai) – agreed to change 3aii) – agreed to change Agreed to change “and” to “&” throughout document in this respect. 4a) Agreed to make suggested change

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“…Board for arrangements regarding Performance Targets, Improvement Measures and Reporting, including…”

b) Page 13, paragraph 5.3: “…delivered by employees of the Council, NHS Highland and of the third and independent sectors, as well as the informal carers.” Suggested revision: “…delivered by employees of the Council, NHS Highland, the third and independent sectors, and by informal carers.”

c) Page 26, paragraph 8.2.21: “Argyll and Bute Integration Joint Board may, subject to there being no outstanding payments due to the partner bodies, …” Suggested revision: “Subject to there being no outstanding payments due to the partner bodies, Argyll and Bute Integration Joint Board may…”

d) Page 28, paragraph 8.4.2: “…will provide to the Argyll and Bute Integration Joint Board Chief Financial Officer comprehensive financial monitoring reports.”

4b) Agreed to make suggested change 4c) Agreed to make suggested change 4d) Agreed to make suggested change

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Suggested revision: “…will provide comprehensive financial monitoring reports to the Argyll and Bute Joint Board Chief Financial Officer.”

5. Other issues

a) Page 23, paragraph 8.2.11, bullet point list:

“NHS Highland for information within such timescales as may be agreed.” Suggested revision: “NHS Highland for information within such a timescales as may be agreed.”

b) Page 25, paragraph 8.2.19: “Where an in year recovery…” Suggested revision: “Where an in-year recovery…” or “Where recovery within the same tax year…”

c) Page 29, paragraph 8.7.2: “The Chief Financial Officer of Argyll and Bute Integration Joint Board will require to work…”

5a) Remain as is – no change 5b) Agreed to change “in year” to “in-year” 5c) Agreed to make suggested change

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Suggested revision: “The Chief Financial Officer of Argyll and Bute Integration Joint Board will be required to work…”

d) Page 37, paragraph 13.6: “…by Argyll and Bute Integration Joint Board but this will not be less than once per year.” Suggested revision: “…by Argyll and Bute Integration Joint Board, but this will not be less than once per year.”

5d) Agreed to make suggested change – inclusion of a comma

29. 12/12/19 a) Remove the word "longer" from the first sentence. There are many bad ways to live longer and living longer is implied by the following healthier.

b) The core values are waffle. For example, I do not know any health service that does not value 'excellence'. Thus it is meaningless. If you can find me a health service that aspires to not be excellent then I am wrong. They can neither be proved nor disproved and undermines their use. Change them or add numbers.

c) This is not needed ", particularly those whose needs

are complex and involve support from health and social care at the same time. "

d) Take out " plan for and "

MAKI a) Agreed no change – the word “longer” forms part of the agreed vision.

b) Comments noted. No change is proposed. The Scheme states the core values that have been agreed by the parent bodies.

c) Comments noted. No change is proposed. d) Comments noted. No change is proposed. e) Comments noted. No change is proposed. f) No action required.

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e) Tale out "high quality". We know that you are not planning low quality.

f) The first 3 Scottish gov outcomes bullet points are

good start out well. Just looked at how long this document is. I am about to give up. I am on a bus and this needs focus. Can you cut out all the waffle and nothingness phrases and I will look at it again.

30. 12/12/19 Fully support the proposed changes set out in the document set.

Unknown

No action required

31. 13/12/19 It's been a complete and utter disaster with a runaway budget, poorly managed, little accountability and little chance of a turnaround. It has also destroyed the morale of council staff given they are being made redundant while nhs staff are protected many of them not even in the jobs they were hired for. There is a need for an urgent review to get a grip of this situation.

MAKI No action required – outwith the scope of the review

32. 13/12/19 The document is poorly worded. It has multiple statements that simply vacuous truths. Similar to “we aspire to provide top quality service”. No one is aspiring to give a sub-optimal service. It make reading the document cringe-worthy and I can’t get beyond this to the substance. If you could tidy this up I could give it another read.

MAKI Comments noted. The Scheme has been prepared in line with Scottish Government model template. No action required.

33. 14/12/19 Due to the geographical constitution of Argyll and Bute, it makes sense to integrate services with a similar area like the Highlands and Islands, with a lot of experiences and efficiencies to be gained. Present arrangements with NHS GG and Clyde are less than desirable. A&E

H&L In principle it would be possible for the current review of the Scheme to consider the inclusion, or otherwise, of discretionary elements of service which are not a statutory requirement to be included. There are no

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services are an hour away (Paisley) plus patients from Helensburgh and Lomond are often referred to Inverclyde Hospital. It doesn’t make much sense.

recommendations being made here to do this. No action required.

34. 15/12/19 Revisions seem appropriate and well thought out. MAKI No action required 35. 16/12/19 No comment OLI No action required 36. 17/12/19 Thought the named person legislation had been changed

and the named person idea had been scrapped? MAKI Following a check by the Council’s Legal Service, it can

be advised that the provision of named persons sits within Part 4 of the Children and Young People (Scotland) Act 2014. Not all of Part 4 is currently in force, but some provisions are. Therefore these legislative functions are delegated by the Health Board to the IJB insofar as they are currently in force.

37. 21/12/19 From review it looks like this is bringing the scheme into line with current rulings and law changes. Interesting that the surplus at year end can be held locally rather than other budgets that have to be handed back to the Scottish Government.


38. 30/12/19 Yet more wordy BS on how to keep the jobs for the bureaucrats. Nothing at all addressing how you will maintain the local community doctors, nurses and surgeries, which is what the remote rural local communities (your voters) actually want. We don’t want more pages and pages of fluff, we want to see proper action to keep the surgeries open.


39. 04/01/20 The revision of the scheme of integration appear to be appropriate to where we are.


40. 05/01/20 I was not able to identify any material changes of note. H&L No action required 41. 07/01/20 I have been asked as a stakeholder to comment on the

above, overall it reads well. Under Justice Services there is no mention of Community justice, this may, however, be intentional.

MAKI Advice from the Chief Social work Officer is that “Justice” is now the appropriate term to cover both Community and Criminal Justice.

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The most relevant legislation for Justice Services is:

a) Social Work (Scotland) Act 1968 Section 27 b) Criminal Justice and Licensing (Scotland) Act

2010 c) Management of Offenders (Scotland) Act 2005 d) Community Justice (Scotland) Act 2016

Legal Services have undertaken a check of the legislation for Justice Services and advise as follows:- a) Included at page 53 of the Scheme. This is a local

authority function that has been delegated by virtue of the Schedule to the Public Bodies (Joint Working) (Scotland) Act 2014.

b) The functions under this statute do not appear in the “must delegate” or “may delegate” lists and therefore it is not possible for either of the parent bodies to delegate any functions under this Act to the IJB.

c) Sections 10 and 11 are included at page 56 of the Scheme. These are functions that the local authority may delegate.

d) As per (b) above.

42. 14/01/20 Hello, I wondered why person centred and co production have been removed as a core value of the council and NHS Highland? The Scottish Government have said Integration is about delivering services in an outcome focused way around the person. There is a lot in the Integration Scheme about the organisation of the IJB and finances. It would be good to keep at least a mention of the reason for integration and the people who should be the main focus of the activity.

B&C The Scheme has been updated to reflect the current Vision/Values of both parent bodies.

43. 15/01/20 Response from Argyll and Bute TSI – please see attached at appendix 2

A&B wide

Heading:- Our understanding of the background to this proposal by Argyll and Bute Council and NHS Highland • Points 1 to 6 – do not raise any issues in respect of

the content of the Scheme. No action required.

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• NB point 4 – Integration Scheme requires to be submitted by June 2020, not 2021.

Heading:- Our understanding of the process which has been followed to arrive at the current proposal • Points 1 to 4 – do not raise any issues in respect of

the content of the Scheme. No action required • NB point 3 – The consultation process followed for

the quinquennial review of the Integration Scheme has been conducted in accordance with the provisions of the Public Bodies (Joint Working) (Scotland) Act 2014, which sets out the legislative requirements with which partners must comply with in undertaking this exercise. As part of this, regard was had to the integration planning principles and the national health and wellbeing outcomes. The joint process also ensured that all relevant stakeholders were consulted by complying with the Public Bodies (Joint Working) (Prescribed Consultees) (Scotland) Regulations 2014. Additional stakeholders, that the partner bodies and the HSCP considered appropriate, were also included, exceeding our legislative requirements. It should be stressed that the planning/review/revision of the Integration Scheme is a task to be undertaken jointly by the parent bodies. It is not carried out by the IJB/HSCP, therefore the application of the Engagement Framework is a tool for use by the IJB, and

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therefore outwith the scope of the joint review of the Scheme being carried out by the parent bodies.

• NB point 4 – Officers involved in the review Working Group were nominated by NHS Highland, Argyll and Bute Council and the HSCP. The statutory consultation process that has been followed in respect of this review allows for all interested parties, including the third sector, to have their say.

Heading:- HSCP budget challenges and the Integration Scheme • Points 1 to 8 – factual points that do not raise any

issues in respect of the content of the Scheme Heading:- Deciding which services should be delegated to the HSCP • Points 1 to 9 do not raise any issues in respect of

the content of the Scheme. • NB - In principle it would be possible for the current

review of the Scheme to consider the inclusion, or otherwise, of discretionary elements of service which are not a statutory requirement to be included. There are no recommendations being made here to do this. No action required.

Heading:- Specific comments in respect of funding arrangements between the partners

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• Points 1 / 2 – The Schemes provisions in terms of the use of recovery plans is in line with the professional guidance provided to local authorities and health boards within the ‘Integrated Resources Advisory Group Finance Guidance’ document. Section 4.3.1 of the document deals specifically with budget variances and at 4.3.1.2 “it is recommended that if an overspend is forecast on either arm of the operational Integrated Budget, the Chief Officer and the relevant finance officer should agree a recovery plan to balance the overspending budget.”

• The comments provided relate to performance, ie how the provisions have been implemented, rather than the provision itself. No alternative to the current arrangements is being recommended, therefore no action is proposed.

Heading:- Participation and Engagement • Point 1 - The view of the parent bodies, as part of

their review of the Scheme, was that no change to the services currently delegated to HSCP was required. This was considered prior to going out to consultation and on balance it was felt that the current scale of delegation best supports effective delivery of services.

• Point 2 – The financial provisions within the Scheme have been detailed in line with the Scottish Government model scheme and, as per the previous comments above in respect of funding, follow the professional guidance provided to local authorities

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and health boards within the ‘Integrated Resources Advisory Group Finance Guidance’ document, which ensures that the provisions of the Public Bodies (Joint Working) (Scotland) Act 2014 are carried out. Sections 4.2.7 to 4.2.10 of the financial guidance clearly sets out the process to be used by the two parent bodies in determining allocations to the Integrated Budget in subsequent years, therefore this detail does not require to be set out in the Scheme itself.

Heading:- Our feedback on what should happen next • Point 1 - As per the points previously made above in

respect of the consultation process, it should be reiterated that this was conducted in accordance with the provisions of the Public Bodies (Joint Working) (Scotland) Act 2014, which sets out the legislative requirements with which partners must comply with in undertaking this exercise. As part of this, regard was had to the integration planning principles and the national health and wellbeing outcomes. The joint process also ensured that all relevant stakeholders were consulted by complying with the Public Bodies (Joint Working) (Prescribed Consultees) (Scotland) Regulations 2014. Additional stakeholders, that the partner bodies and the HSCP considered appropriate, were also included, exceeding our legislative requirements. It should be stressed that the planning/review/revision of the Integration Scheme is a task to be undertaken jointly

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by the parent bodies. It is not carried out by the IJB/HSCP, therefore the application of the Engagement Framework is a tool for use by the IJB, and therefore outwith the scope of the joint review of the Scheme being carried out by the parent bodies.

A report detailing the proposed arrangements for the 6 week consultation was submitted to meetings of the Council (28/11/19), NHS Highland Board (26/11/19) and the IJB (29/11/19). The report was agreed at each of these meetings, and have detailed below an extract of the minute of the IJB held on 29/11/19:-

10. REVIEW OF HEALTH AND SOCIAL CARE INTEGRATION SCHEME The Integration Joint Board gave consideration to a report that set out proposed revisions to the Health and Social Care Integration Scheme following a joint review. The report detailed the next steps including the requirement for the Council and the Health Board to undertake a joint consultation with prescribed stakeholders. Decision The Integration Joint Board – 1. Noted the revisions detailed within the updated Integration Scheme, attached at Appendix 1 to the submitted report. 2. Noted the proposed arrangements for a joint consultation exercise set out at sections 3.6 to 3.12 of the submitted report. 3. Agreed to engage with and participate in the consultation exercise to be carried out. (Reference: Report by IJB Standards Officer, submitted)

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The proposed consultee list was also circulated to relevant Officers within the HSCP who, as part of their duties, undertake engagement related activity. As a result of this further consultee groups were added to the stakeholder list. The initial consultation process, which was carried out in December 2014 when the Scheme of Integration was being introduced, followed a very similar process to the one undertaken in December 2019. The earlier consultation provided a focus on what integration was /what it meant as at this time the Health and Social care partnership was a new body/entity. The Scheme of Integration is now well established. • Point 2 - The view of the parent bodies, as part of

their review of the Scheme, was that no change to the services currently delegated to HSCP was required. This was considered prior to going out to consultation and on balance it was felt that the current scale of delegation best supports effective delivery of services.

• Point 3 – As per previous comments in respect of

fudning, the financial provisions within the Scheme have been detailed in line with the Scottish Government model scheme and follow the professional guidance provided to local authorities and health boards within the ‘Integrated Resources Advisory Group Finance Guidance’ document, which

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ensures that the provisions of the Public Bodies (Joint Working) (Scotland) Act 2014 are carried out. Sections 4.2.7 to 4.2.10 of the financial guidance clearly sets out the process to be used by the two parent bodies in determining allocations to the Integrated Budget in subsequent years. The comments provided relate to performance, ie how the provisions have been implemented, rather than the provision itself. No alternative to the current arrangements is being recommended, therefore no action is proposed.

44. 16/01/20 The document reads more as a management ‘have to

produce’ document rather than a public information readable document. The summary of revisions is helpful but again complicated for the general public. Interesting that the core values at start are not aligned to the HSCP strategic objective for ‘people’ (what a cold word for your staff, service users and their carers) safety and protection from harm, so relevant today. Reference is made elsewhere in the document. This document is severe in its wording, very business led and does not appear to show the wording or willingness to involve community partnership more for the health and wellbeing of the ‘people’ you serve.

H&L The Scheme has been prepared in accordance with the Scottish Government model template. Comments noted. No changes proposed. Comments noted. No changes proposed.

45. 16/01/20 Strachur Community Council is grateful for being included in the consultation on the revised Argyll & Bute Integration Scheme. Members of the Community Council discussed the proposed changes to the document at a meeting on


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15th January 2020 and agreed there were no issues relating to these changes that they wished to comment on.

46. N/A Other minor revisions recommended to the Scheme following the consultation process:- 9.1 – List of consultees

• Remove Argyll and Bute Public Partnership Forums (not consulted with as been suspended) and replace with Locality Planning Groups

• Add Health and Wellbeing Networks – additional consultees

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REPONSE TO THE CONSULTATION ON THE REVISED ARGYLL AND BUTE HSCP INTEGRATION SCHEME.

Our understanding of the background to this proposal by Argyll and Bute Council and NHS Highland

1. The Integration Scheme sets out the “rules” by which Argyll and Bute Council (broadly responsible for social care services in Argyll and Bute) and NHS Highland (broadly responsible for health service provision in Argyll and Bute) delegate their responsibilities for service provision to a separate body - the Argyll and Bute Health and Social Care Partnership (HSCP).

2. Integration schemes exist across Scotland, but vary from area to area in terms of their content (we return to this issue of local variation later in this response).

3. Integration schemes must be reviewed by local partners every 5 years, with submissions to Scottish Government.

4. The Integration Scheme for Argyll and Bute must be revised and submitted to government by 2021 (we return to this issue of timing later in this response).

5. Some “rules” around integration are set by Scottish Government and cannot be changed by the partners, for example, all health and social care partnerships must have delegated responsibility for a core group of services and submit a balanced budget to Scottish Ministers each year.

6. Some “rules” about how the partners work together can be set by the partners themselves. This includes which additional services will be delegated to the partnership to design, manage and make investments in, how partners will decide how much money they are investing in the partnership, and how they will act if they cannot achieve a balanced budget in the partnership. The Integration scheme is therefore not simply a technical document as some may infer from the way in which it is being presented in this consultation; it has far reaching consequences for service provision in Argyll and Bute for the next 5 years.

Our understanding of the process which has been followed to arrive at the current proposal

1. A working group was set up in 2019 to revise the current integration scheme. The advisor to this group was the Standards Officer for the Council and the HSCP.

2. In response to a question by a non-voting Board Member at the Integration Scheme being session of Integration Joint Board (IJB) of 27th November 2019, the Standards Officer confirmed that the issue of which services should be delegated to HSCP was not a matter within the scope of the working group as “senior people” had made that decision at the start (we return to this issue later in this response).

3. In response to a written question by the same IJB non-voting member, the Standards Officer confirmed that the processes set out within the HSCP’s revised Engagement Framework (an excellent document which follows international best practice to set out how HSCP should engage with stakeholders) had not been used for this piece of work since it is an agreement between partners (we return to this issue later in this response).

4. The Standards Officer did not respond to a written request by an IJB Board Member as to the composition of the working group and how the community and third sectors were represented on that group (we return to this later in this response).

HSCP budget challenges and the Integration Scheme

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1. The HSCP in Argyll and Bute has been unable in 2018/19 and so far in 2019/20 to operate within the financial contributions afforded it by the partners to the current agreement – Argyll and Bute Council and NHS Highland.

2. A significant cost-cutting programme has been in place throughout 2018/19 and 2019/20 in an attempt to eliminate the deficit of HSCP, but it is still forecast that at year end in March 2020, the HSCP will still be unable to operate within the budget afforded it by partners.

3. The HSCP is also facing a demand for payment for 2018/19 and 2019/20 which was not budgeted. This arises because currently acute (hospital) services are not only delegated from NHS Highland to the HSCP within the Integration Scheme, but are then further delegated in terms of delivery to NHS Greater Glasgow and Clyde which has increased the price of service provision.

4. The HSCP is also in debt because it is expected to pay back loans from Argyll and Bute Council for sums of money lent to it to cover prior year deficits.

5. The recurring deficit position, the debt to NHS Greater Glasgow and Clyde and the debt to Argyll and Bute Council are documented in successive IJB papers which are public documents.

6. A paper presented by the outgoing Chief Executive of Argyll and Bute Council to the IJB meeting of 27th November 2019 pointed to the very serious impact that the continued excess demand on revenue from the council to support the HSCP budget would have on other council services; again this is a public paper.

7. The scale of the cost-cutting exercise that HSCP is expected to have to implement in 2020/21 and beyond, to balance its books is massive and the HSCP under current legislation cannot fail to submit a balanced budget to Scottish Ministers. In other words, unless there is a greatly increased financial contribution from the partners who delegate services to HSCP, the HSCP will have to plan for and then deliver very substantial cuts in expenditure in order to be able to make its budget submission to Scottish Government for 2020/21 and beyond.

8. Since the Scheme of Integration document is the legally binding agreement that sets out how both partners will financially contribute to the HSCP budget and manage shortfalls, it is not merely a technical document as may be inferred from the way in which it is being presented in this consultation, it is at the very heart of how partners will manage their contributions to the HSCP budget for the 5-year period following its agreement.

Deciding which services should be delegated to the HSCP

1. In the current scheme of delegation specific decisions were made to include Children and Families Social Work and Criminal Justice Social Work.

2. The most unusual aspect of the current Argyll and Bute Scheme of Integration is that the HSCP in Argyll has delegated responsibility for acute (hospital) services. These services are normally the responsibility of the relevant NHS health board.

3. A further anomaly of the current arrangements in Argyll and Bute is that although the HSCP has delegated responsibility for these services, they are mainly provided by NHS Greater Glasgow and Clyde; in other words, their delivery is actually delegated back to a health board, albeit a different Board to that which receives NHS funding from Scottish Government.

4. The choice of which services to delegate to an HSCP by way of agreement in the scheme of delegation is very important in several respects, as illustrated in points 5-8 below – services delegated to an HSCP have different people making decisions about service provision and budgets than those services which sit with parent bodies.

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5. There is an issue of which organisation directly holds financial risk when legislation changes and is expected to find funding to meet the changes: for example, in the case of Criminal Justice Social Work, currently delegated to HSCP, new guidance to courts in Scotland is in respect of a presumption against short sentences, which in turn is expected to greatly increase the work of criminal justice social work teams across the country. At present this function is delegated to HSCP, so any additional burden of work that requires additional resourcing will fall to the HSCP and its already over-stretched budget unless it is exactly matched by an additional contribution from the relevant parent organisation. If this additional burden is not funded the HSCP must find savings from elsewhere in its budget.

6. A further choice is over who controls service design and the future costs of service delivery: for example, the trend in acute service provision is away from multiple general hospitals providing a wide range of acute services and towards fewer more specialist units covering a wider geographical area. In the case of services provided by Greater Glasgow and Clyde a very likely scenario as this trend develops is people from Argyll and Bute having to travel greater distances for treatment with increased costs for transport, accompaniment to appointments and overnight stays, creating significant budget pressures for HSCP to whom these services are currently delegated unless the parent body meets these extra costs in full.

7. There is a question of whose organisational policies and procedures govern consultation with the public about service provision is carried out: the HSCP has different consultation mechanisms from either the council or the health board.

8. Finally, there is the issue of who ultimately makes strategic decisions about service provision and how much should be spent on individual services. For example, in the case of acute (mainly hospital) services, the normal model operating in Scotland means that a health board makes these decisions with the Board of decision-makers comprising a mix of executive and non-executive directors. When acute services are delegated to an HSCP decisions are made not by the whole Integration Joint Board but by a subset of members of IJB called “voting members”, comprising 4 members of the health board (in this case NHS Highland) and 4 politicians, whose appointment to the Integration Joint Board is determined purely by the council.

9. The Scheme of Integration is critically important to communities in Argyll and Bute because it sets out very specifically which of their services will be delegated to the HSCP, and therefore by implication, how people will be consulted about service provision, which organisation will be responsible for the design of these services, how money will be allocated to fund services, and how partners will support the HSCP in financial terms if the delegated budgets are insufficient to fund the specific mix of services that has been delegated.

Specific comments in respect of funding arrangements between the partners

The Integration Scheme being proposed by Argyll and Bute Council and NHS Highland Health Board proposes the following arrangements for funding services delegated to HSCP. We have highlighted what we believe to be particularly relevant sections in italics.

8.2.1 Argyll and Bute Integration Joint Board's Strategic Plan will incorporate a medium term financial plan for its resources. On an annual basis, the annual financial statement will be prepared setting out the amount Argyll and Bute Integration Joint Board intends to spend to implement its Strategic Plan. This will be known as the annual budget. The medium term financial strategy will be prepared for Argyll and Bute Integration Joint Board following discussions with the Council and NHS

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Highland who will provide a proposed budget based on payment for year 1, indicative payments for year 2 and 3 and outline projections for later years. The medium term financial strategy will be used in conjunction with the Strategic Plan to ensure the commissioned services by Argyll and Bute Integration Joint Board are delivered within the financial resources available.

8.2.2 ….There is an expectation that it will deliver the objectives of the Strategic Plan within agreed resources. Argyll and Bute Integration Joint Board cannot approve a budget which exceeds resources available.

8.2.5 The budgets will be based on recurring baseline budgets plus anticipated non-recurring funding for which there is a degree of certainty for each of the functions delegated to Argyll and Bute Integration Joint Board and will take account of any applicable inflationary uplift, planned efficiency savings and any financial strategy assumptions. These budgets will form the basis of the payments to Argyll and Bute Integration Joint Board.

8.2.18 Where it is forecast that an overspend will arise, then the Chief Officer and Chief Financial Officer of Argyll and Bute Integration Joint Board will identify the cause of the forecast overspend and prepare a recovery plan setting out how they propose to address the forecast overspend and return to a breakeven position.

8.2.20 Where recovery plans are unsuccessful and an overspend occurs at the financial year end, and there are insufficient reserves to meet the overspend, then the Parties will consider making interim funds available………………………………Any interim funds provided by the Council or NHS Highland will be repaid in future years based on a revised recovery plan agreed by both parent bodies.

Our comments on the proposed funding arrangements of HSCP and therefore of the services provided are as follows:

1. The proposed reliance on “recovery plans” seems to be somewhat naïve. The HSCP has had recovery plans in place for each of the past 2 years, rigorously enforced in 2019/20 through the so-called “Grip and Control” programme. This has not resulted in the HSCP being able to deliver the services delegated to it within the financial parameters set by the parent organisations.

2. Despite the fact that HSCP has a recurrent deficit and growing levels of indebtedness to parent organisations, the funding mechanism proposed by partners in the new Integration Scheme is to broadly maintain the current baseline budget, to lend money to HSCP to cover deficits, and then to ask the HSCP, which cannot balance its budget, to additionally pay back loans.

Participation and Engagement

The legislation governing revision of integration schemes states:

…. the local authority and the Health Board must jointly consult—

(a)such persons or groups of persons appearing to the Scottish Ministers to have an interest as may be

prescribed, and

(b)such other persons as the local authority and the Health Board think fit.

Argyll and Bute Council and NHS Highland state within this revised Integration Scheme, which they intend submitting to Scottish Government Ministers, that:

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9.1 A joint consultation took place on the revised Integration Scheme took place during December/January 2019/20. The stakeholders who were consulted in this joint consultation were: • Local communities / general public • Health professionals; GPs, management teams, clinical groups including Nursing Staff and Allied Health Professionals • Social work and social care professionals • Users of health services • Carers of users of health care • Commercial providers of health care • Non-commercial providers of health care • Argyll and Bute Council employees • Staff side / Trades Unions • Users of social care • Carers of users of social care • Commercial providers of social care • Non-commercial providers of social care • Non-commercial providers of social housing • The Highland Council • Argyll and Bute Public Partnership Forums • Community / voluntary / Third Sector organisations • Community Councils • Argyll and Bute Council - local Councillors • Scottish Ambulance Service • NHS 24 • Scottish Health Council • Local MPs / MSPs • Dentists • Pharmacists • NHS Greater Glasgow & Clyde • Police Scotland • Scottish Fire & Rescue • Argyll and Bute Advice Network (ABAN) • Lomond & Argyll Advocacy Service • Citizens Advice Bureau / Patient Advice & Support Service (PASS) • Argyll and Bute Community Planning Partnership

The partners state that:

9.2 The range of methodologies used to contact these stakeholders included both Parties’ websites and intranets, third sector external website, e- mail and postal correspondence.

In the same review of the Integration Scheme document, the partners refer to the arrangements for consultation and engagement about health and social care services in Argyll and Bute, stating:

9.3 The Communication and Engagement Strategy, along with the supporting Engagement Framework and Quality standards provides a platform for stakeholders to have their voices heard, their views considered and acknowledged, as well as strengthening relationships and building capacity.

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The aforementioned Engagement Framework was introduced in Argyll and Bute in 2019 after a long period in which members of the community and community organisations/3rd sector organisations had become extremely disillusioned with their lack of access to influence local health and social care provision. The framework was developed with the involvement of a range of stakeholders and is based on international best practice. This framework, into which there was a very high standard of input, was unanimously adopted by IJB and with the support of many partners has been widely promoted within Argyll and Bute communities as addressing previous concerns and introducing a new level of transparency in how decisions are made about health and social care services.

Despite being quoted within the revised Integration Scheme, as outlined above, this framework has not been used for this critical piece of work. The reason given by HSCP, in a written response to an IJB non-voting member being:“The IJB continue to be informed but the work takes place with the parent bodies, the council being nominated to lead on the engagement by the partners as such not an HSCP piece of work.”

The Engagement Framework in general terms ensures input from communities and other interested stakeholders at a sufficiently early stage to inform the formulation of policy and plans, not at an end stage under the guise of consultation, when decisions have to all intents and purposes already been made. It is our belief that the failure to adopt the best practice laid out in the Engagement Framework agreed for Argyll and Bute’s health and social care provision has directly led to the glaring weaknesses within the proposed Revised Integration, specifically:

1. The partners have failed to put forward for consideration by communities in Argyll and Bute options for services that are to be delegated to the HSCP with clear information about the advantages, disadvantages and risks associated with these services being delegate to the HSCP. There was clearly never any intention to do so since the answer by the Standards Officer at the 27th November 2019 confirmed that these decisions had been made by “senior people” at the start of the process and had not formed part of the brief of the working group.

2. The partners have failed to properly and fully explain within the Revised Scheme of Delegation how they intend to make arrangements to adequately fund the services they delegate to HSCP in the future.

The guidance from Scottish Government that governs the revision of the Integration Scheme clearly sets out the following requirement, with subsection 4 being the engagement with all relevant stakeholders:

In finalising the revised integration scheme, the local authority and the Health Board must take account of any views expressed by virtue of subsection (4).

It is our contention that in depriving communities in Argyll and Bute of the opportunity for informed and meaningful engagement on which services should be delegated to HSCP, and, to a lesser extent, full information on how funding arrangements should work between partners, these partners are not in a position to satisfy the requirement of Scottish Ministers to take into account the views of stakeholders.

Our feedback on what should happen next

Subsection (6) of the guidance on revised integration schemes refers to the stage of the process which is the submission of the Revised Integration Scheme to Scottish Government for its consideration.

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Taking into account the requirement of Scottish Government that:

Before complying with subsection (6), the local authority and the Health Board must jointly consult—

(a)such persons or groups of persons appearing to the Scottish Ministers to have an interest as may be

prescribed, and

(b)such other persons as the local authority and the Health Board think fit.

(5) In finalising the revised integration scheme, the local authority and the Health Board must take account

of any views expressed by virtue of subsection (4).

It is our contention that the partners cannot submit the current proposed revised scheme of delegation and that the “consultation” exercise needs to be undertaken again. We would propose that this engagement process includes:

1. Extensive communication with stakeholders about what the Integration Scheme is and what it means for people in terms of their health and social care services, with a particular emphasis on encouraging participation so that the widest possible range of views can be reflected in the partners’ submission to Scottish Ministers. To increase the credibility of this exercise, we propose the partners adopting the principles of the Engagement Framework as quoted within the Integration Scheme document itself, and as promised to the citizens of Argyll and Bute in 2019 as being the new standard for engagement on health and social care matters.

2. The production of a clear and unambiguous options appraisal that clearly sets out all of the options for delegation of services from partners to HSCP, with the implications and risks attached to each option and the subsequent presentation of this information to both communities of geography and communities of interest so that they can make the decision about what additional services they wish NHS Highland in particular, but also Argyll and Bute Council, to delegate to HSCP. They should be fully informed about the implications in respect of who are the decision-makers that will take decisions as to these services in each scenario. In keeping with the principles of the Engagement Framework, a significant number of stakeholders should be involved in shaping the options appraisal and engagement messages.

3. A much clearer explanations of the mechanisms by which the two partners– Argyll and Bute Council and NHS Highland- will ensure sufficiency of funding for the services which they delegate to HSCP, the avoidance of deficits being created within the partnership organisation, and the elimination of the need for repayable loans to be put in place which simply serve to put extraordinary levels of financial pressure upon the HSCP in future years.

Third Sector Interface in Argyll and Bute

15th January 2020

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INTEGRATION SCHEME

BETWEEN

ARGYLL AND BUTE COUNCIL

AND

NHS HIGHLAND

Revised February 2020

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Contents Introduction ................................................................................................................................... 3 1. Vision and Values:……………………………………………………………………………………3 2. Aims and Outcomes: ............................................................................................................. 3

3. Scope of Integration: .............................................................................................................. 5

4. Finance arrangements: .......................................................................................................... 5

1. Definitions and Interpretation ................................................................................................. 6

2. Local Governance Arrangements .......................................................................................... 7

3. Delegation of Functions ......................................................................................................... 9

4. Local Operational Delivery Arrangements .............................................................................. 9

5. Clinical and Care Governance ............................................................................................. 14

6. Chief Officer ......................................................................................................................... 18

7. Workforce ............................................................................................................................ 20

8. Finance ................................................................................................................................ 21

9. Participation and Engagement ............................................................................................. 33

10. Information Sharing and Data Handling ............................................................................... 35

11. Complaints .......................................................................................................................... 36

12. Claims Handling, Liability & Indemnity ................................................................................. 37

13. Risk Management ................................................................................................................ 38

14. Dispute Resolution Mechanism ............................................................................................ 39

Annex 1 ...................................................................................................................................... 41 Part 1 - Functions delegated by NHS Highland to the Integration Joint Board…………………….41 Part 2 - Services currently provided to by NHS Highland which are to be integrated ................... 45

Annex 2 ...................................................................................................................................... 46 Part 1 - Functions delegated by the Council to Argyll and Bute Integration Joint Board………….46 Part 2 - Services currently provided by the Council which are to be integrated ........................... 59

Annex 3 Systems Governance. ................................................................................................... 61

Annex 4 Clinical and Care Governance Structure. ....................................................................... 62

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Introduction 1. Vision and Values:

The vision of Argyll and Bute Council and NHS Highland is that the people in Argyll and Bute will live longer, healthier, happier, independent lives.

The core values of Argyll and Bute Council and NHS Highland are: caring; creative;

committed; collaborative; teamwork; excellence; and integrity. compassion; respect;

integrity; team work; equality; fairness; transparency; efficiency; improvement;

involvement ,co-production and a person centered approach.

The core values of the Health and Social Care Partnership are: compassion; integrity;

respect; continuous learning; leadership; and excellence.

2. Aims and Outcomes: The main purpose of integration is to improve the wellbeing of people who use health

and social care services, particularly those whose needs are complex and involve

support from health and social care at the same time. The Integration Scheme is

intended to achieve the National Health and Wellbeing Outcomes.

Argyll and Bute Integration Joint Board (IJB) will plan for and deliver high quality health

and social care services to, and in partnership with, the communities of Argyll and

Bute.

The IJBArgyll and Bute Integration Joint Board will set out within its Strategic Plan

how it will effectively use allocated resources to deliver the National Health and

Wellbeing Outcomes prescribed by the Scottish Ministers in regulations under section

5(1) of the Public Bodies (Joint Working) (Scotland) Act 2014, namely that:

• People are able to look after, and improve, their own health and wellbeing and live in good health for longer.

• People, including those with disabilities or long term conditions or who are frail are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

• People who use health and social care services have positive experiences of those services, and have their dignity respected.

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• Health and social care services are centered on helping to maintain or improve the quality of life of people who use those services.

• Health and social care services contribute to reducing health inequalities.

• People who provide unpaid care are supported to look after their own health and wellbeing, including reducing any negative impact of their caring role on their own health and wellbeing.

• People using health and social care services are safe from harm.

• People who work in health and social care services feel engaged with the work

they do and are supported to continuously improve the information, support, care and treatment they provide.

• Resources are used effectively and efficiently in the provision of health and

social care services.

• Any other National Health and Well Being outcome prescribed in the future will

also be adopted.

Argyll and Bute Council and NHS Highland have agreed that Social Care services for

Children &and Families social worksocial care services and Criminal Justice Services

should be included within the functions and services to be delegated to the IJB Argyll

and Bute Integration Joint Board, therefore the specific national outcomes as detailed

below for Children &and Families and Criminal JusticeJustice are also included:

The national outcomes for Children &and Families are:-

• Our children have the best start in life and are ready to succeed.

• Our young people are successful learners, confident individuals, effective contributors and responsible citizens; and

• We have improved the life chances of children, young people and families at risk.

• Any national outcomes prescribed in the future will also be adopted.

National outcomes and standards for Social WorkSocial Care Services in the Criminal

JusticeJustice System are:-

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• Community safety and public protection.

• The reduction of re-offending.

• Social inclusion to support desistance from offending.

• Any national outcomes prescribed in the future will also be adopted

3. Scope of Integration: Argyll and Bute Council and NHS Highland have agreed to delegate to the IJB Argyll and Bute Integration Joint Board the following functions:

• All NHS services that the legislation permits for delegation.

• All Adult social worksocial care services.

• All Children & Families social worksocial care services.

• All Criminal JusticeJustice social worksocial care services.

4. Finance arrangements: The general principles are agreed as:

• The Council and NHS Highland recognise that they each have continuing financial governance responsibilities, and have agreed to establish the IJB Argyll and Bute Integration Joint Board as a “joint operation” as defined by IFRS 11.

• The Council and NHS Highland will work together in the spirit of partnership, openness and transparency.

• The Council and NHS Highland payments to the IJB Argyll and Bute Integration

Joint Board derive from a process that recognises that both organisations have

expenditure commitments that cannot be avoided in the short to medium term. The Council and NHS Highland will prepare and maintain a record of what

those commitments are and provide this to the IJB Argyll and Bute Integration

Joint Board.

• The IJB Argyll and Bute Integration Joint Board will monitor its financial position and make arrangements for the provision of regular, timely, reliable and

relevant financial information on its financial position which will be shared with the Council and NHS Highland. The IJBArgyll and Bute Integration Joint Board,

the Council and NHS Highland will share financial information to ensure all

parties have a full understanding of their current financial information and future financial challenges and funding streams.

• The existing financial regulations of the Council and NHS Highland will apply to resources transferred to the IJBArgyll and Bute Integration Joint Board.

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Integration Scheme

The Parties:

The Argyll and Bute Council, established under the Local Government (Scotland)

Act 1994 and having its principal offices at, Kilmory, Lochgilphead, Argyll, PA31 8RT

(herein after referred to as “the Council”);

And

NHS Highland Health Board, established under section 2(1) of the National Health

Service (Scotland) Act 1978 (operating as “Argyll and Bute CHP“) and having its

principal offices at Assynt House, Beechwood Park, Inverness, IV2 3BW Aros,

Lochgilphead, Argyll PA31 8LB] (hereinafter referred to as “NHS Highland”) (together

referred to as “the Parties”).

1. Definitions and Interpretation

1.1 “The Act” means the Public Bodies (Joint Working) (Scotland) Act 2014.

1.2 “Argyll and Bute Integration Joint Board” means the Integration Joint Board to be established by Order under section 9 of the Act.

1.3 “IJB” means Argyll and Bute Integration Joint Board.

1.31.4 “Outcomes” means the Health and Wellbeing Outcomes prescribed by

the Scottish Ministers in Regulations under section 5(1) of the Act.

1.41.5 “The Integration Scheme Regulations” means The Public Bodies (Joint Working) (Integration Scheme) (Scotland) Regulations 2014.

1.51.6 “Integration Joint Board Order” means The Public Bodies (Joint Working)

(Integration Joint Boards) (Scotland) Order 2014.

1.61.7 “Scheme” means this Integration Scheme.

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1.71.8 “Strategic Plan” means the plan which the IJBArgyll and Bute Integration

Joint Board is required to prepare and implement in relation to the delegated provision

of health and social care services to adults and children in accordance with section

29 of the Act.

1.81.9 ‘’Acute Services’’ means medical and surgical treatment provided mainly

in hospitals and minor injury units.

1.91.10 “Locality Planning Groups” means local management groups who are

accountable for local services and have a level of devolved financial and operational

responsibility to make decisions on the use of resources and service delivery for their

communities. “Locality Planning Groups” mean local planning groups comprising

representatives of local partners and stakeholders who are accountable to the

Strategic Planning Group for the planning and partnership delivery of agreed local

health and care service priorities. Their specific purpose is to develop a locality plan,

influence priorities for their local area, agree mechanisms for the delivery of actions

at a local level and review and report on the locality plan annually.

In implementation of their obligations under the Act, the Parties hereby agree as

follows:

In accordance with section 1(2) of the Act, the Parties have agreed that the integration

model set out in sections 1(4)(a) of the Act will be put in place for the IJBArgyll and

Bute Health Integration Joint Board, namely the delegation of functions by the Parties

to a body corporate that is to be established by Order under section 9 of the Act. This

revised Scheme comes into effect on the date the Parliamentary Order to establish

Argyll and Bute Integration Joint Board comes into force.

2. Local Governance Arrangements

2.1 The role and constitution of the IJBArgyll and Bute Integration Joint Board is

established through legislation, with the Parties having agreed that the voting

membership will be:

2.1.1 NHS Highland: 4 members of the NHS Highland Health Board.

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2.1.2 Council: 4 Elected Members of the Council nominated by the Council.

2.1.3 The Parties have agreed that the first Chair of the IJBArgyll and Bute

Integration Joint Board will be the nominee of the Council. The term of office of

the Chair and the Vice Chair will be a period of two years.

2.2 The IJBArgyll and Bute Integration Joint Board will sets out within its Strategic

Plan how it will effectively use allocated resources to deliver the National Health and

Wellbeing Outcomes prescribed by the Scottish Ministers in regulations under section

5(1) of the Act, namely that:

• People are able to look after and improve their own health and wellbeing and live in good health for longer.

• People, including those with disabilities or long term conditions or who are frail are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

• People who use health and social care services have positive experiences of those services, and have their dignity respected.

• Health and social care services are centered on helping to maintain or improve the quality of life of people who use those services.

• Health and social care services contribute to reducing health inequalities.

• People who provide unpaid care are supported to look after their own health

and wellbeing, including reducing any negative impact of their caring role on their own health and wellbeing.

• People using health and social care services are safe from harm.

• People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide.

• Resources are used effectively and efficiently in the provision of health and

social care services.

• Any other National Health and Well Being outcomes prescribed by the Scottish Ministers.

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2.3 The Parties have agreed that Social Care services for Children &and Families

social worksocial care and Criminal JusticeJustice social worksocial care should be

included within the functions and services to be delegated to the IJB Argyll and Bute

Integration Joint Board,. t Therefore, the specific national outcomes as detailed below

for Children &and Families and Criminal JusticeJustice are also included:

The national outcomes for Children &and Families are:-

• Our children have the best start in life and are ready to succeed.

• Our young people are successful learners, confident individuals, effective contributors and responsible citizens; and

• We have improved the life chances of children, young people and families at risk.

• Any national outcomes prescribed in the future will also be adopted.

National outcomes and standards for Social WorkSocial Care Services in the Criminal JusticeJustice System are:-

• Community safety and public protection.

• The reduction of re-offending.

• Social inclusion to support desistance from offending.

• Any national outcomes prescribed in the future will also be adopted

3. Delegation of Functions

3.1 The Parties agree to delegate a comprehensive range of health and social care

functions for adults and children to the IJBArgyll and Bute Integration Joint Board.

3.2 The functions that are to be delegated by NHS Highland to the IJBArgyll and Bute

Integration Joint Board are set out in Annex 1.

3.3 The functions that are to be delegated by the Council to the IJB Argyll and Bute

Integration Joint Board are set out in Annex 2

4. Local Operational Delivery Arrangements

4.1 The local operational arrangements agreed by the Parties are:

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4.1.2 The IJBArgyll and Bute Integration Joint Board has responsibility for the

planning and delivery of services. This will be achieved through the Strategic

Plan.

4.1.3 The IJB Argyll and Bute Integration Joint Board is responsible for the

operational oversight of Integrated Services, and, through the Chief Officer, will

be responsible for the operational management of Integrated Services.

4.1.4 The IJB Argyll and Bute Integration Joint Board will be responsible for the

operational oversight of the planning, commissioning and contracting of

delegated Acute Services and, through the Chief Officer, will be responsible for

the operational management, and budget of Acute Services.

4.1.5 As the majority of Acute services are contracted from a neighbouring Health

Board (NHS Greater Glasgow andor Clyde), the IJBArgyll and Bute Integration

Joint Board will be responsible for the operational oversight of Acute Services.

A lead Director for Acute Services in NHS Greater Glasgow and Clyde (GG&C)

has been identified as the contract liaison officer who is responsible for the

operational management of Acute Services in NHS GG&C.

4.1.6 NHS Greater Glasgow and Clyde will provide information as part of the contract

monitoring arrangements on a regular basis to the Chief Officer and the IJB

Argyll and Bute Integration Joint Board on the operational delivery and

performance of these services.

4.2 Support for Strategic Plan

4.2.1 The IJBArgyll and Bute Integration Joint Board is required under section

29 of the Act to prepare a strategic plan. All Health and Social Care

Partnerships’ primary responsibility is the achievement of the national health

and wellbeing outcomes through the delivery of the principles of integration. A

critical element in discharging this responsibility is the production and delivery

of a Strategic Plan.

4.2.2 The NHS Board will share with the IJBArgyll and Bute Integration Joint

Board necessary activity and financial data for sServices, facilities and

resources that relate to the planned use of services by service users within

Argyll and Bute for its service and for those provided by other Health Boards.

4.2.3 The Council will share with the IJBArgyll and Bute Integration Joint

Board necessary activity and financial data for services, facilities and

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resources that relate to the planned use of services by service users within

Argyll and Bute for its services and for those provided by other councils.

4.2.4 The Parties agree to use all reasonable endeavours to ensure that other

Integration Joint Boards and any other relevant Integration Authority will share

the necessary activity and financial data for Services, facilities and resources

that relate to the planned use by service users within the area of their

Integration Authority.

4.2.5 The Parties shall ensure that their Officers acting jointly will consider

the Strategic Plans of the other Integration Joint Boards or Authorities to

ensure that they do not prevent the Parties and the IJBArgyll and Bute

Integration Joint Board from carrying out their functions appropriately and in

accordance with the Integration Planning and Delivery Principles, and to

ensure they contribute to achieving the National Health and Wellbeing

Outcomes. The Integration Authorities that are most likely to be affected by the

Strategic Plan are:

• West Dumbarton Integration Joint Board

• Inverclyde and Renfrew and East Renfrew Integration Joint Boards share a common acute provider of services (NHS Great Glasgow and Clyde)

4.2.6 The Parties shall advise the IJBArgyll and Bute Integration Joint Board

where they intend to change service provision of non- Integrated Services that

will have a resultant impact on the Strategic Plan.

4.2.7 The NHS Highland Board will consult with the IJB Argyll and Bute

Integration Joint Board to ensure that any overarching Strategic Plan for Acute

Services and any plan setting out the capacity and resource levels required for non- delegated budgets for such Acute Services is appropriately co-ordinated

with the delivery of Services across the NHS Highland area. The parties shall

ensure that a group including the Chief Operating Officer, NHS Highland and

Chief Officer of the IJBArgyll and Bute Integration Joint Board will meet regularly to discuss such issues.

4.3 Corporate Support Services

4.3.1 The Parties will continue to provide identify and put in place the corporate

support required to fulfil the duties of the IJBArgyll and Bute Integration Joint

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Board. The Parties will, by 1.04.2016:

• Identify the corporate resources currently utilised to deliver the delegated functions.

• Identify and aAgree on an ongoing basis, the corporate support services

required to fully discharge the IJB’s Argyll and Bute Integration Joint Board's duties under the Act.

• The Parties will continue to provide the IJB Argyll and Bute Integration

Joint Board with the corporate support services it requires to fully

discharge its duties under the Act .

The provision will be reviewed within the first year to ensure that it is adequate.

4.4 Performance Targets, Improvement Measures and Reporting

Arrangements 4.4.1 The Parties will identify a core set of indicators that relate to services,

from publicly accountable and national indicators and targets against which

the Parties currently report. A list of indicators and measures which relate to

integration functions will be collated in a Performance Management

Framework and will provide information on the data gathering and reporting

requirements for performance targets and improvement measures. The

Parties will share all performance information, targets and indicators from the

Performance Management Framework with the IJB Argyll and Bute

Integration Joint Board. The improvement measures will be a combination of

existing and new measures that will allow assessment at local level. The

performance targets and improvement measures will be linked to the national

and local outcomes to assess the timeframe and the scope of change.

4.4.2 The Performance Management Framework will also indicate where the

responsibility for each measure lies, whether in full or in part. Where there is

an ongoing requirement in respect of organisational accountability for a

performance target for the NHS Board or the Council, this will be taken into

account by the IJBArgyll and Bute Integration Joint Board when preparing the

Strategic Plan.

4.4.3 The Performance Management Framework will also be used to prepare

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a list of any targets, measures and arrangements which relate to functions of

the Parties, which are not delegated to the IJB Argyll and Bute Integration

Joint Board, but which are affected by the performance and funding of

integration functions and which are to be taken account of by the IJBArgyll and

Bute Integration Joint Board when preparing the Strategic Plan.

4.4.4 The Performance Management Framework will be reviewed regularly to

ensure the improvement measures it contains continue to be relevant and

reflective of the national and local outcomes to which they are aligned.

4.4.5 The work on the core indicators, including HEAT Targets, National

Health and Wellbeing Outcomes and locally agreed indicators and

establishment of a Performance Management Framework will be completed

by the 31st March 2016.

4.4.64.4.5 The Parties will continue to provide support to the IJBArgyll and

Bute Integration Joint Board for arrangements regarding the Performance

Targets, Improvement Measures and Reporting arrangements, including the

effective monitoring and reporting of targets and measures for adjoining NHS

Boards and Integration Joint Boards.

4.4.74.4.6 The IJBArgyll and Bute Integration Joint Board will receive

performance management information for consideration, approval and

agreement, and will act appropriately as necessary, in response to all relevant

performance management information, including:-.

4.4.6.1 Public Health and Wellbeing Status reports including analysis of Argyll

and Bute population, at macro, demographic specific and locality level.

4.4.6.2 Clinical and Care Governance reports to be assured of the quality,

safety, risk and effectiveness of services.

4.4.6.3 Staff Governance reports to be assured of compliance and best practice

in workforce relations, workforce planning and organisational development.

4.4.6.4 Patients and Users of Care Services; Involvement and Community

Engagement reports ensuring their involvement in the shaping, delivery and

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evaluation of service performance.

4.4.6.5 Financial Governance reports including financial management, budget

setting recommendation, expenditure reporting, financial recovery plan and cost

improvement plans for consideration and approval.

4.4.6.6 Performance Management Framework information, to be assured of the

performance of services against targets, indicators and outcomes.

5. Clinical and Care Governance

5.1 The Parties and the IJBArgyll and Bute Integration joint Board are accountable

for ensuring appropriate clinical and care governance arrangements in respect of their

duties under the Act. The Parties will have regard to the principles of the Scottish

Government’s draft Clinical and Care Governance Framework, including the focus on

localities and service user and carer feedback.

5.2 The Parties recognise that the establishment and continuous review of the

arrangements for Clinical and Care Governance and Professional Governance are

essential in delivering their obligations and quality ambitions. The arrangements

described in this section are designed to assure the IJBArgyll and Bute Integration

Joint Board of the quality and safety of services delivered in Argyll and Bute.

5.3 Explicit lines of professional and operational accountability are essential to

assure the IJBArgyll and Bute Integration Joint Board and the Parties of the

robustness of governance arrangements for their duties under the Act. They underpin

delivery of safe, effective and person-centered care in all care settings delivered by

employees of the Council, NHS Highland, and of the third and independent sectors,

and by as well as the informal carers.

5.4 In relation to existing health and social care services, NHS Highland is

accountable for health functions and services, whilst Argyll and Bute Council is

responsible for social care services. Professional governance responsibilities are

carried out by the professional leads through to the health and social care professional

regulatory bodies.

5.5 The Chief Social Work Officer holds professional accountability for social work

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and social care services. The Chief Social Work Officer reports directly to the Chief

Executive and Elected Members of the Council in respect of professional social

worksocial care matters. He/she is responsible for ensuring that social work and social

care services are delivered in accordance with relevant legislation and that staff

delivering such services do so in accordance with the requirements of the Scottish

Social Services Council.

5.6 Principles of Clinical and Care Governance will be embedded at service

user/clinical care/professional interface using the framework outlined below. The

IJBArgyll and Bute Integration Joint Board will ensure that explicit arrangements are

made for professional supervision, learning, support and continuous improvement for

all staff.

5.7 The IJBArgyll and Bute Integration Joint Board will fulfil its devolved responsibility

in terms of overseeing delivery of delegated functions by ensuring that there is

evidence of effective performance management systems. Professional and service

user networks or groups will inform the agreed Clinical and Care Governance

framework directing the focus towards a quality approach and continuous

improvement.

5.8 The Clinical and Care Governance and Professional Governance framework will

encompass the following:

• Measure the quality of integrated service delivery by measuring delivery of

personal outcomes and seeking feedback from service users and/or carers.

• Professional regulation and workforce development.

• Information governance.

• Safety of integrated service delivery and personal outcomes and quality of registered services

5.9 Each of the four elements, listed at 5.8, will be underpinned by mechanisms to

measure quality, clinical and service effectiveness and sustainability. They will be

compliant with statutory, legal and policy obligations strongly underpinned by human

rights values and social justice. Service delivery will be evidence-based, underpinned

by robust mechanisms to integrate professional education, research and

development.

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5.10 The IJBArgyll and Bute Integration Joint Board is responsible for embedding

mechanisms for continuous improvement of all services through application of a

Clinical and Care Governance and Professional Governance Framework. The

IJBArgyll and Bute Integration Joint Board will be responsible for ensuring effective

mechanisms for service user and carer feedback and for complaints handling.

5.11 NHS Highland Executive Medical Director and Board Nurse Director share

accountability for Clinical and Professional Governance across NHS Highland as a

duty delegated by NHS Highland. This will include ensuring:

• Quality monitoring and governance arrangements that include compliance with professional codes, legislation, standards, guidance and that these are

regularly open to scrutiny.

• Systems and processes to ensure a workforce with the appropriate knowledge and skills to meet the needs of the local population.

• Effective internal systems that provide and publish clear, robust, accurate and timely information on the quality of service performance.

• Systems to support the structured, systematic monitoring, assessment and

management of risk.

• Co-ordinated risk management, complaints, feedback and adverse

events/incident system, ensuring that this focuses on learning, assurance and improvement.

• Improvement and learning in areas of challenge or risk that are identified

through local governance mechanisms and external scrutiny.

• Mechanisms that encourage effective and open engagement with staff on the design, delivery, monitoring and improvement of the quality of care and

services.

• Planned and strategic approaches to learning, improvement, innovation and development, supporting an effective organisational learning culture.

5.12 The Chief Medical DirectorOfficer, or his/her depute, will be a member of the

Clinical and Care Governance Committee and will provide professional advice in

respect of the overview and consistency of the Clinical and Care Governance and

Professional Governance Framework.

5.13 The Board Nurse Director, or his/her depute, will be a member of the Clinical

and Care Governance Committee and will provide professional advice in respect of

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the overview and consistency of the Clinical and Care Governance and Professional

Governance Framework.

5.14 The Chief Social Work Officer, through delegated authority holds professional

and operational accountability for the delivery of safe and high quality social work and

social care services within the Council. An annual report on these matters will be

provided to the Council, NHS Highland and the IJB Argyll and Bute Integration Joint

Board.

5.15 The Chief Social Work Officer will be a member of the Clinical and Care

Governance Committee and will provide professional advice in respect of the delivery

of social work and social care services by Council staff and commissioned care

providers in Argyll and Bute.

5.16 The Parties, in support of the IJBArgyll and Bute Integration Joint Board will put

in place structures and processes to support clinical and care governance, thus

providing assurance on the quality of health and social care in Argyll and Bute. A

Clinical and Care Governance Committee, bringing together senior professional

leaders across Argyll and Bute, including the Medical Director, Board Nurse Director,

Chief Social Work Officer, and the Director of Public Health, will be established. This

committee, chaired by one of its members, will ensure that quality monitoring and

governance arrangements are in place for safe and effective health and social care

service delivery in Argyll and Bute. This will include the following:

• compliance with professional codes, legislation, standards, guidance

• systems and processes to ensure a workforce with the appropriate knowledge and skills to meet the needs of the local population.

• effective internal systems that provide and publish clear, robust, accurate

and timely information on the quality of service performance.

• systems to support the structured, systematic monitoring, assessment and management of risk.

• co-ordinated risk management, complaints, feedback and adverse

events/incident system, ensuring that this focuses on learning, assurance

and improvement.

• improvement and learning in areas of challenge or risk that are identified through local governance mechanisms and external scrutiny.

• mechanisms that encourage effective and open engagement with staff on

the design, delivery, monitoring and improvement of the quality of care and

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services.

• planned and strategic approaches to learning, improvement, innovation and development, supporting an effective organisational learning culture.

5.17 The Clinical and Care Governance Committee will provide advice to the IJB

Argyll and Bute Integration Joint Board, the Strategic Planning Group and to locality

planning groups, all of whom may seek relevant advice directly from the Clinical and

Care Governance Committee, as required.

5.18 Arrangements will be put in place so that the Area Clinical Forums, Managed

Care networks, other appropriate professional groups, and the Adult and Child

Protection Committees are able to directly provide advice to the Clinical and Care

Governance Committee.

5.19 The Clinical and Care Governance Committee will report directly to the IJB

Argyll and Bute Integration Joint Board and will provide clear robust, accurate and

timely information on the quality of service performance.

5.20 Information will be used to provide oversight and guidance to the Strategic

Planning Group in respect of Clinical and Care Governance and Professional

Governance, for the delivery of Health and Social Care Services across localities

identified in the Strategic Plan.

5.21 Annex 3 provides a schematic to show the systems governance arrangements.

5.22 Annex 4 provides a schematic to show the clinical and care governance

arrangements.

6. Chief Officer

6.1 The Chief Officer has both strategic and operational responsibility for the delivery

of services. The Chief Officer will be directly responsible to and line-managed by the

Chief Executive Officers of both Parties, and via the Chief Executive Officers is

responsible to NHS Highland and the Council. The Chief Officer is also accountable

to the IJBArgyll and Bute Integration Joint Board.

6.2 The Chief Officer will be accountable directly to the IJBArgyll and Bute Integration

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Joint Board for the preparation, implementation of, and reporting on, the Strategic

Plan. The Chief Officer will also be responsible for operational delivery of services and

the appropriate management of staff and resources.

6.3 The Chief Officer will establish a senior management team, equipped to direct

and oversee the structures and procedures necessary to carry out all functions in

accordance with the Strategic Plan.

6.4 In the event that there is a prolonged period when the Chief Officer is unable or

unavailable to fulfil his/her functions, interim arrangements will be required to

temporarily replace the Chief Officer. The Parties will nominate suitably qualified and

experienced senior officers to carry out the functions of the Chief Officer for the

duration of the interim period, and submit the said nominations for approval by the

IJBArgyll and Bute Integration Joint Board.

6.5 The Chief Officer’s objectives will be set annually and performance appraised by

the Chief Executive Officers of both Parties, in consultation with the Chair and Vice

Chair of the IJBArgyll and Bute Integration Joint Board.

6.6 The Chief Officer will be a full member of both the Council and NHS Highland’s

corporate management teams, as well as a non-voting member of the IJBArgyll and

Bute Integration Joint Board.

6.7 The Chief Officer will ensure the maintenance of an up to date integrated risk

register in respect of all functions delegated to the IJBArgyll and Bute Integration Joint

Board.

6.8 The Chief Officer will routinely liaise with appropriate officers of NHS Highland in

respect of the IJB’s Argyll and Bute Integration Joint Board’s role in contributing to the

strategic planning of acute NHS healthcare services and provision (in accordance with

the Act) and delivery of agreed targets that have mutual responsibility. Operational

management of Integrated Services and acute services will be the responsibility of

the Chief Officer, as detailed in sections4.1.3, 4.1.4 and 4.1.5.

6.9 The Chief Officer will routinely liaise with the relevant Executive

Directorappropriate Officer(s) of the Council in respect of the IJB’sArgyll and Bute

Integration Joint Board’s role in informing strategic planning for local housing and the

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delivery of housing support services. Housing functions, apart from equipment,

adaptations and aspects that relate to personal support, are outside the scope of the

IJB Argyll and Bute Integration Joint Board; however, close liaison between the Chief

Officer and the appropriate Officerexecutive Director(s) will assist in the strategic

planning process.

6.10 The Chief Officer will develop close working relationships with Elected Members

of the Council and Executive and Non-Executive members of NHS Highland.

6.11 The Chief Officer will establish and maintain effective relationships with a range

of key stakeholders across the Scottish Government, NHS Highland, the Council,

Independent and Third sectors, service users, Trades Unions, and professional

organisations and informal carers.

6.12 The Chief Officer will ensure appropriate arrangements are in place in respect

of information governance and the requirements of the Information Commissioner’s

Office.

7. Workforce 7.1 The Parties are committed to expand upon the existing transitional plans, to

produce producing and maintaining a fully integrated Workforce and Organisational

Development Plan, relating to the delegated functions, as prescribed in the Act. This

will include engagement and learning and development for all staff, to promote the

development of a robust organisational structure and healthy organisational culture.

The plan will be complete by 01.04.2016 but will remain under annual review. Chief

Officer, the IJBArgyll and Bute Integration Joint Board, Chief Officer will be

responsible for implementation and review of the plan, in conjunction with the

implementation of the Strategic Plan.

7.2 The development of the plan will be remitted to the Human Resources and

Workforce Development and Organisational Development work streams already in

place, for completion. These workstreams are led by Human Resources and

organisational Development Leads from both Parties and include NHS staff side

(Trade Unions representing NHS Highland staff) and Trades Unions representatives

(representing Council staff), as well as other key stakeholders.

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8. Finance

8.1 Roles and Responsibilities

8.1.1 The IJBArgyll and Bute Integration Joint Board will make arrangements

for the proper administration of its financial affairs by appointing a Chief

Financial Officer to discharge the responsibilities that fall within Section 95 of

the Local Government (Scotland) Act 1973.

8.1.2 The Chief Financial Officer is accountable for financial management of

delegated budgets and overall financial resources of the IJBArgyll and Bute

Integration Joint Board.

8.1.3 The Chief Financial Officer of the IJBArgyll and Bute Integration Joint

Board will be responsible for managing preparation of the annual budget of the

IJB Argyll and Bute Integration Joint Board, managing the medium term

financial planning process to support the strategic plan, and providing financial

advice and information to support the planning and delivery of services by the

IJB Argyll and Bute Integration Joint Board.


Board will be responsible for producing regular finance reports to the IJB Argyll

and Bute Integration Joint Board and managers, ensuring that those reports

are timely, relevant and reliable.


Board will be responsible for preparing the IJB’sArgyll and Bute Integration

Joint Board’s accounts and ensuring compliance with statutory reporting

requirements as a body under the relevant legislation.


Board will work with the Council Section 95 Officer and NHS Highland Director

of Finance to ensure the Council and NHS Highland are kept informed on the

financial position, performance and plans of the IJBArgyll and Bute Integration

Joint Board.

8.1.7 The Council Section 95 Officer and NHS Highland Accountable

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Officertwo Chief Executive Officers of Argyll and Bute Council and NHS

Highland are responsible for the resources that are allocated by the IJBArgyll

and Bute Integration Joint Board to their respective organisations for

operational delivery.

8.1.8 The Chief Financial Officer will work with the Council Section 95 Officer

and NHS Highland Director of Finance to ensure both organisations work

together to develop systems which will allow the recording and reporting of

the IJBArgyll and Bute Integration Joint Board financial transactions.

8.2 Management of Revenue Budget

8.2.1 The IJB’sArgyll and Bute Integration Joint Board's Strategic Plan will

incorporate a medium term financial plan for its resources. On an annual basis

the annual financial statement will be prepared setting out the amount the IJB

Argyll and Bute Integration Joint Board intends to spend to implement its

Strategic Plan. This will be known as the annual budget. The medium term

financial strategy will be prepared for the IJBArgyll and Bute Integration Joint

Board following discussions with the Council and NHS Highland who will

provide a proposed budget based on payment for year 1, indicative payments

for year 2 and 3 and outline projections for later years. The medium term

financial strategy will be used in conjunction with the Strategic Plan to ensure

the commissioned services by the IJBArgyll and Bute Integration Joint Board

are delivered within the financial resources available.

8.2.2 The IJBArgyll and Bute Integration Joint Board is able to hold reserves.

There is an expectation that it will deliver the objectives of the Strategic Plan

within agreed resources. The IJBArgyll and Bute Integration Joint Board cannot

approve a budget which exceeds resources available would result in the

reserves moving into a deficit.

8.2.3 The term payment is used to maintain consistency with legislation and

does not represent physical cash transfer. As the IJBArgyll and Bute Integration

Joint Board does not operate a bank account, the net difference between

payments into and out of the IJBArgyll and Bute Integrated Joint Board will

result in a balancing cash payment between the Council and NHS Highland.

An initial schedule of payments will be agreed within the first 40 working days

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of each new financial year and may be updated taking into account any

additional payments in-year.

8.2.4 The Council and NHS Highland will establish a core baseline budget for

each function and service that is delegated to the IJB Argyll and Bute Integration

Joint Board to form an integrated budget.

8.2.5 The budgets will be based on recurring baseline budgets plus

anticipated non-recurring funding for which there is a degree of certainty for

each of the functions delegated to the IJBArgyll and Bute Integration Joint

Board and will take account of any applicable inflationary uplift, planned

efficiency savings and any financial strategy assumptions. These budgets will

form the basis of the payments to the IJBArgyll and Bute Integration Joint

Board. These budgets will be reviewed against actual levels of expenditure for

the previous 3 financial years. For NHS funding, the starting point will normally

be the Argyll & Bute NRAC share of baseline funding.

8.2.6 For each financial year iInformation will be provided by the Parties on the

financial performance of the delegated services against budget in their

respective areas for the last 3 years to enable all parties to undertake due

diligence to gain assurance that the delegated resources are sufficient to

deliver the delegated functions.

8.2.7 The Parties will each prepare a schedule outlining the detail and total

value of the proposed initial payment in each financial year, the underlying

assumptions behind that initial payment and the financial performance against

budget for the delegated services in the preceding year for their respective

areas. These schedules should be prepared and concluded at least one month

before the start of the financial year they relate to. The payment will include

funding relating to service level agreements for hospital services provided by

other Health Boards to Argyll and Bute residents. The schedules will also

identify any amounts included in the payments that are subject to separate

legislation or subject to restrictions stipulated by third party funders. These

documents must be approved by the Director of Finance for NHS Highland

and the Section 95 Officer for the Council prior to submission to the IJB Argyll

and Bute Integration Joint Board.

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8.2.8 The IJBArgyll and Bute Integration Joint Board Chief Financial Officer will

review these documents and reach agreement with both parties on the value

of the initial payment. The Chief Financial Officer will then prepare a schedule

that describes the agreed value of the payments. The Council’s Section 95

Officer, NHS Highland Director of Finance and the IJBArgyll and Bute

Integration Joint Board Chief Officer must sign this schedule to confirm their

agreement.

8.2.9 The process for agreeing the subsequent payments to the IJBArgyll and

Bute Integration Joint Board will be contingent on the corporate planning and

financial planning processes of the Council and NHS Highland. The funding

available to the IJBArgyll and Bute Integration Joint Board will be dependent

on the funding available to the Council and NHS Highland and the corporate

priorities of both. Both parties will provide indicative three year allocations to

the IJBArgyll and Bute Integration Joint Board subject to annual approval

through the respective budget setting processes. These indicative allocations

will take account of changes in NHS funding and changes in Council funding.

8.2.10 Each year the Chief Financial Officer and Chief Officer of the IJBArgyll

and Bute Integration Board should prepare a draft budget for the IJBArgyll and

Bute Integration Joint Board, based on the Strategic Planagreed funding and

present this to the Council and NHS Highland for information within such

timescale as may be agreed.

8.2.11 The draft annual budget should be prepared to take account of the

matters set out above and uses the previous year payment as a baseline that

will be adjusted to take account of:

• Activity Changes arising from the impact on resources in respect of

increased demand (e.g. demographic pressures and increased

prevalence of long term conditions) and for other planned activity changes.

• Cost inflation on pay and other costs.

• Efficiency savings that can be applied to budgets.

• Performance on outcomes. The potential impact of efficiencies on

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agreed outcomes must be clearly stated and open to challenge by the Council and NHS Highland.

• Legal requirements that result in additional and unavoidable expenditure commitments.

• Transfers to/from the set aside budget for hospital services set out in the Strategic Plan.

• Budget savings required to ensure budgeted expenditure is in line with funding available including an assessment of the impact and risks associated with these savings.

8.2.12 The Director of Finance of NHS Highland, the Section 95 Officer of the

Council and the Chief Financial Officer of the IJBArgyll and Bute Integration

Joint Board will ensure a consistency of approach and application of

processes in considering budget assumptions and proposals.

8.2.13 Due diligence of the Council and NHS Highland contributions will be

undertaken annually and the Chief Financial Officer of the IJBArgyll and Bute

Integration Joint Board will prepare a schedule outlining the agreed value of

the payments. The schedule must be approved by the IJBArgyll and Bute

Integration Joint Board Chief Officer,; the Council Section 95 Officer and the

NHS Highland Director of Finance.

8.2.14 The allocations made from the IJBArgyll and Bute Integration Joint

Board to the Council and NHS Highland for operational delivery of services will

be approved by the IJBArgyll and Bute Integration Joint Board. The value of

the payments will be as set out in the Strategic Plan and supporting financial

plan.

8.2.15 The annual direction from the IJBArgyll and Bute Integration Joint

Board to the Council and NHS Highland will take the form of a letter from the

Chief Officer referring to the arrangements for delivery set out in the Strategic

Plan and will include information on:

• The delegated function/(s) that are being directed.

• The outcomes and activity levels to be delivered for those delegated functions.

• The amount of and method of determining the payment to carry out the delegated functions.

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8.2.16 Once issued, these can be amended or varied by a subsequent

direction by the IJBArgyll and Bute Integration Joint Board.

8.2.17 Any potential deviation from the planned outturn should be reported to

the IJBArgyll and Bute Integration Joint Board, the Council and NHS Highland

at the earliest opportunity.

8.2.18 Where it is forecast that an overspend will arise, then the Chief Officer

and Chief Financial Officer of the IJBArgyll and Bute Integration Joint Board

will identify the cause of the forecast overspend and prepare a recovery plan

setting out how they propose to address the forecast overspend and return to

a breakeven position. The Chief Officer and Chief Financial Officer of the

IJBArgyll and Bute Integration Joint Board should consult the Section 95

Officer of the Council and the Director of Finance of NHS Highland in

preparing the recovery plan. The recovery plan should be approved by the

IJBArgyll and Bute Integration Joint Board. The report setting out the

explanation of the forecast overspend and the recovery plan should also be

submitted to the Council and NHS Highland.

8.2.19 A recovery plan should aim to bring the forecast expenditure of the

IJBArgyll and Bute Integration Joint Board back in line with the budget within

the current financial year. Where an in- year recovery cannot be achieved and

then any recovery plan that extends into later years should ensure that over

the period of the Strategic Plan forecast expenditure does not exceed the

resources made available. Where a recovery plan extends beyond the current

year the amount of any shortfall or deficit carried forward cannot exceed the

reserves held by the IJBArgyll and Bute Integration Joint Board unless there

is. Any recovery plan extending beyond in year will require prior approval of

the Council and NHS Highland. in addition to Argyll and Bute Integration Joint

Board.

8.2.20 Where recovery plans are unsuccessful and an overspend occurs at

the financial year end, and there are insufficient reserves to meet the

overspend, then the Parties will consider making interim funds available. An

analysis will be undertaken to determine the extent to which the overspends

relate to either budgets delegated back to or activities managed by the Council

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or NHS Highland with the allocation of the interim funds being based on the

outcome of this analysis. Any interim funds provided by the Council or NHS

Highland will be repaid in future years based on a revised recovery plan

agreed by both parent bodies, as required by either of the Parties. The NHS

and Council will require to be satisfied that the recovery plan provides

reasonable assurance that financial balance will be achieved. If the revised

recovery plan cannot be agreed by the Parties or is not approved by the

IJBIntegration Joint Board, the dispute resolution mechanism in clause 14

hereof, will be followed.the Parties will be required to make additional

payments to Argyll and Bute Integrated Joint Board. Where there is a

requirement for additional payments an analysis of the requirement for

additional payments will be carried out to determine the extent to which they

relate to either budgets delegated back to or activities managed by the Council

or NHS Highland with the allocation of the additional payments being based

on the outcome of this analysis. Any additional payments by the Council and

NHS Highland will then be deducted from future years funding/payments.

8.2.21 Subject to there being no outstanding payments due to the partner

bodies, the IJBArgyll and Bute Integration Joint Board may, subject to there

being no outstanding payments due to the partner bodies, retain any

underspend to build up its own reserves and the Chief Financial Officer will

maintain a reserves policy for the IJBArgyll and Bute Integration Joint Board.

8.2.22 There will be arrangements in place to allow budget managers to vire

budgets between different budget heads set out in the financial regulations.

8.2.23 Redeterminations to payments made by the Council and NHS Highland

to the IJBArgyll and Bute Integration Joint Board would apply under the

following circumstances:

• Additional one off funding is provided to Partner bodies by the Scottish

Government, or some other body, for expenditure within a service area

delegated to the IJBArgyll and Bute Integration Joint Board. This would

include in year allocations for NHS and redeterminations as part of the

local government finance settlement. The payments to the IJBArgyll

and Bute Integration Joint Board should be adjusted to reflect the full

amount of these as they relate to the delegated services. The Parties

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agree that an adjustment to the payment is required to reflect changes

to demand and activity levels.

• Where either Party requires to reduce the payment to the IJBArgyll and

Bute Integration Joint Board, any proposal requires a justification to be

set out and then agreed by both Parties and the IJBArgyll and Bute


8.2.24 Where payments by the Council and NHS Highland are agreed under

paragraphs 8.2.3 to 8.2.23 above, they should only be varied as a result of the

circumstances set out in paragraphs 8.2.16, 8.2.22 and 8.2.23. Any proposal

to amend the payments out with the above, including any proposal to reduce

payments as a result of changes in the financial circumstances of either the

Council or NHS Highland requires a justification to be set out and the

agreement of both Parties.

8.3 Financial Systems

8.3.1 The Chief Financial Officer will work with the Section 95 Officer of the

Council and Director of Finance of NHS Highland to ensure appropriate systems

and processes are in place to:

• Allow execution of financial transactions.

• Ensure an effective internal control environment over such

• Maintain a record of the income, expenditure, assets and liabilities

of the IJBArgyll and Bute Integration Joint Board.

• Enable reporting of the financial performance and position of the IJBArgyll and Bute Integration Joint Board.

• Maintain records of budgets, budget savings, forecast outturns, variances, variance explanations, proposed remedial actions and financial risks.

8.4 Financial reporting to the IJBArgyll and Bute Integration Joint Board:

8.4.1 The Chief Financial Officer will provide comprehensive financial

monitoring reports to the IJBArgyll and Bute Integration Joint Board on a

monthly basis. These reports will set out information on actual expenditure and

budget for the year to date and forecast outturn against annual budget together

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with explanations of significant variances and details of any action required.

These reports will also set out progress with achievement of any budgetary

savings required. The Chief Financial Officer will also report to the IJBArgyll

and Bute Integration Joint Board as appropriate in relation to:

• Developing a medium and longer term financial strategy to

support delivery of the Strategic Plan.

• Preparation and review of the annual budget.

• Collating and reviewing budget savings proposals.

• Identifying and analysing financial risks.

• Considering the proposals in relation to reserves.

8.4.2 On a monthly basis the Parties will provide comprehensive financial

monitoring reports to the Argyll and Bute Integration Joint BoardChief Financial

Officer comprehensive financial monitoring reports. The reports will set out

information on actual expenditure and budget for the year to date and forecast

outturn against annual budget together with explanations of significant

variances and details of any action required. These reports will also set out

progress with achievement of any budgetary savings required.

8.5 Financial reporting to management:

8.5.1 The Chief Financial Officer will work with the Section 95 Officer of the

Council and Director of Finance of NHS Highland to ensure:

• Managers are consulted in preparing the budget of the IJBArgyll and

Bute Integration Joint Board.

• Managers are supported in identifying budgetary savings.

• Managers are made aware of the budget they have available.

• Managers are provided with information on actual income and

expenditure.

• Managers are provided with information on previous forecast outturns.

• Managers are supported to provide up to date information on forecast

outturns.

• Managers are supported to provide explanations of significant variances.

• Managers are supported to identify action required.

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• Managers are supported to identify and assess financial risks.

• Managers are supported to identify and assess future medium to longer

term budget implications.

8.6 Financial Statements:


Board will supply any information required to support the development of the

year-end financial statements and annual report for both the Council and NHS

Highland.

8.6.2 The Section 95 Officer of the Council and the Director of Finance of NHS

Highland will supply the Chief Financial Officer of the IJBArgyll and Bute

Integration Joint Board with any information required to support the

development of the year-end financial statements and annual report of the


8.6.3 Prior to 31 January each year, the Chief Financial Officer of the IJBArgyll

and Bute Integration Joint Board will agree with the Section 95 Officer of the

Council and the Director of Finance of NHS Highland a procedure and timetable

for the coming financial year end for reconciling payments and agreeing any

balances.

8.7 Capital Expenditure and Non-Current Assets

8.7.1 The IJBArgyll and Bute Integration Joint Board will not receive any

capital allocations, grants or have the power to invest in capital expenditure nor

will it own any property or other non-current assets. The Council and NHS

Highland will:

• Continue to own any property or non-current assets used by Argyll and Bute Integration Joint Board.

• Have access to sources of funding for capital expenditure.

• Manage and deliver any capital expenditure on behalf of the IJBArgyll and Bute Integration Joint Board.


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Board will be required to work with the relevant officers in the Council and

NHS Highland to extract details of the prepare and maintain an asset registers

of property and noncurrent assets used by the IJBArgyll and Bute Integration

Joint Board.

8.7.3 The Chief Officer of the IJBArgyll and Bute Integration Joint Board will

work with the relevant officers in the Council and NHS Highland to prepare an

asset management plan for the IJBArgyll and Bute Integration Joint Board to

be approved by the IJBArgyll and Bute Integration Joint Board within a

timescale to be agreed annually by the Council and NHS Highland (it is

expected this would normally be 30 September). The asset management plan

will set out suitability, condition, risks, performance and investment needs

related to existing property and other non-current assets identifying any new

or significant changes to the asset base.

8.7.4 Alongside the asset management plan, the Chief Officer of the IJBArgyll

and Bute Integration Joint Board will work with the relevant officers in the

Council and NHS Highland to prepare a bid for capital funding for property

and other non-current assets used by the IJBArgyll and Bute Integration Joint

Board. This should be approved by the IJBArgyll and Bute Integration Joint

Board within a timescale to be agreed annually with the Council and NHS

Highland (it is expected this would normally be 30 September). A business

case approach should be adopted to set out the need and assess the options

for any proposed capital investment. Any business case will set out how the

investment will meet the strategic objectives of the IJBArgyll and Bute

Integrated Joint Board and set out the associated revenue costs.

8.7.5 Whilst responsibility for managing and delivery of capital expenditure

remains the responsibility of the Council or NHS Highland, the relevant officers

in the Council and NHS Highland will work with the Chief Officer of the

IJBArgyll and Bute Integration Joint Board to report quarterly on progress with

capital expenditure related to property or other non-current assets used by the

IJB Argyll and Bute Integration Joint Board.

8.7.6 The IJBArgyll and Bute Integration Joint Board, the Council and NHS

Highland will work together to ensure capital expenditure and property or

other non- current assets are used as effectively as possible and in

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compliance with the relevant legislation on use of public assets.

Legacy projects will be managed by the relevant partner – either the Council

or NHS Highland with reporting of progress as set out above.

8.7.7 Depreciation of NHS Highland health owned property and other non-

current assets used in the services within the scope of the IJBArgyll and Bute

Integration Joint Board will be charged to the accounts of the IJBArgyll and

Bute Integration Joint Board and incorporated in the budgets and payments

to the IJBArgyll and Bute Integration Joint Board.

8.7.8 Revenue costs from property and other non-current assets used in the

services within the scope of the IJBArgyll and Bute Integration Joint Board will

be charged to the accounts of the IJBArgyll and Bute Integration Joint Board

and incorporated in the budgets and payments to the IJBArgyll and Bute


8.7.9 Any gains or losses on disposal of property and other non-current

assets used in the services within scope of the IJBArgyll and Bute Integration

Joint Board will be retained within the accounts of the Council or NHS

Highland and not charged to the IJBArgyll and Bute Integration Joint Board.

8.7.10 Capital receipts will be retained by the Council or NHS Highland.

8.8 VAT

8.8.1 The IJBArgyll and Bute Integration Joint Board will not be required to

be registered for VAT, on the basis it is not delivering any supplies that fall

within the scope of VAT. The actual delivery of functions delegated to the

IJBArgyll and Bute Integration Joint Board will continue to be the responsibility

of the Council and NHS Highland.

8.8.2 Both the Council and NHS Highland will continue to adhere to their

respective VAT arrangements which will be accounted for through respective

financial ledgers and statements. The IJBArgyll and Bute Integration Joint

Board will consult HMRC regarding any VAT issues arising from proposed

transfer of services between the Parties (e.g. VAT leakage) taking specialist

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external VAT advice beforehand if necessary.

9 Participation and Engagement

9.1 A joint consultation took place on the revised iIntegration sScheme took place

during December/January 2019/20. The stakeholders who were consulted in this joint

consultation were:

• Local communities / general public

• Health professionals; GPs, management teams, clinical groups including Nursing Staff and Allied Health Professionals

• Social work and social care professionals

• Users of health services

• Carers of users of health care

• Commercial providers of health care

• Non-commercial providers of health care

• Argyll and Bute Council employees

• Staff side / Trades Unions

• Users of social care

• Carers of users of social care

• Commercial providers of social care

• Non-commercial providers of social care

• Non-commercial providers of social housing

• The Highland Council

• Locality Planning Groups Argyll and Bute Public Partnership Forums

• Community / voluntary / Third Sector organisations

• Community Councils

• Argyll and Bute Council - local Councillors

• Scottish Ambulance Service

• NHS 24

• Scottish Health Council

• Local MPs / MSPs

• Dentists

• Pharmacists

• NHS Greater Glasgow & Clyde

• Police Scotland

• ScottishScotland Fire & Rescue

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• Argyll and Bute Advice Network (ABAN)

• Lomond & Argyll Advocacy Service

• Citizens Advice Bureau / Patient Advice & Support Service (PASS)

• Argyll and Bute Community Planning Partnership

• Health and Wellbeing Networks

9.2 The range of methodologies used to contact these stakeholders included both

Parties’ websites and intranets, e- mail and postal correspondence.

9.3 The Parties will support Argyll and Bute Integration Joint Board to

develop a Participation and Engagement strategy by providing appropriate

resources and support. The existing Communication and Engagement Plan

will inform the development of the Participation and Engagement Strategy

ensuring significant engagement with, and participation by, members of the

public, representative groups and other organisations in relation to decisions

about the carrying out of integration functions. This strategy shall be

developed alongside the Strategic Plan and will be approved by Argyll and

Bute Integration Joint Board prior to consultation on the Strategic Plan.

9.49.3 Key principles of the Communications and Engagement Plan

demonstrate the value of feedback and the way it influences improvement -

“You Said, We Did” philosophy. A range of methodologies will be employed to

capture this including social media and web based technology e.g. Patient

Opinion. The Communication and Engagement Strategy, along with the

supporting Engagement Framework and Quality standards provides a

platform for stakeholders to have their voices heard, their views considered

and acknowledged, as well as strengthening relationships and building

capacity. The IJBArgyll and Bute Integration Joint Board has adopted the

“You Said, We Did” philosophy. A wide range of engagement methods have

been adopted.

9.59.4 The Parties will carry out Equality and Socio-Economic Impact

Assessments (EQSEIAs) / Planning for Fairness Assessments (PFFs), to

ensure that services and policies do not disadvantage communities and staff.

9.69.5 The Parties will continue to allocate responsibility to senior

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managers and their teams to support local public and staff involvement and

communication.

10 Information Sharing and Data Handling

The Parties agree to be bound by the Data Sharing Protocol and to continuance of the existing agreement to use the Scottish Accord on the Sharing of Personal Information (SASPI), in respect of information sharing.

10.1

10.210.1 The Parties agree to be bound by the Information Sharing Protocol and to

continuance of the existing agreement to use the Scottish Information Sharing

Toolkit and guidance from the Information Commissioners Office, in respect of

information sharing.

10.310.2 The Parties have developed an Information Sharing Protocol which covers

guidance and procedures for staff for sharing of information.

10.410.3 All staff managed within the delegated functions will be contractually required

to comply and adhere to respective local information security policies and

procedures including data confidentiality policies of their employing organisations

and the requirements of the IJB’sArgyll and Bute Integration Joint Board’s agreed

Information Sharing Protocol.

10.510.4 The Parties have established a group to agree the Information Sharing

Protocol and procedures before 1st April 2016. Agreements and procedures will be

reviewed annually by the group, or more frequently if required. The NHS Highland

Information Assurance Group and Argyll and Bute Council Information Security

Forum, acting on behalf of the Parties will meet annually to review the Protocol and

will provide a report detailing recommendations for amendments, for the

consideration of Argyll and Bute Integration Joint Board. In the event of amendment

being required outside of that timescale the NHS Highland Information Assurance

Group and Argyll and Bute Council Information Security Forum acting on behalf of

the Parties will meet, agree the recommended amendment(s) and provide this

information to the Chief Officer, who will then appropriately inform Argyll and Bute

Integration Joint Board. The Data Protection Officers of NHS Highland and Argyll

and Bute Council, acting on behalf of the Parties, will meet annually, or more

frequently, if required, to review the Information Sharing Protocol and will provide a

report detailing recommendations for amendments, for the consideration of the

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10.610.5 With regard to individually identifiable material, data will be held in both

electronic and paper formats and only be accessed by authorised staff, in order to

provide the patient or service user with the appropriate service. In order to provide

fully integrated services it may be necessary to share information within the

delegated functions and with external agencies. Where this is the case Argyll and

Bute Integration Joint Board will seek the consent of the service user for the sharing

of data, unless a statutory requirement exists. In order to comply with the Data

Protection Act 1998, Argyll and Bute Integration Joint Board will always ensure that

personal data it processes will be handled fairly, lawfully and within justification.

In order to comply with the Data Protection Act 1998 Argyll and Bute Integration Joint

Board will ensure that any personal data that it holds will be processed in line with the

Data Protection Principles contained within Schedule 1 of the Act.

10.710.6 In order to provide fully integrated services it will be necessary to share

personal information between the parties and with external agencies. Where this is

the case, the IJBArgyll and Bute Integration Joint Board will apply a legal basis

contained in Article 6 of the General Data Protection Regulations (‘the GDPR’).,

Ggenerally, this will be either public task or legal obligation but, where appropriate,

any of the other legal baseis contained in Article 6 will be used.

10.810.7 Where the sharing consists of ‘special category’ information the legal

basis for sharing will be consistent with the requirements of Article 9 of the GDPR

and schedule 1 of the Data Protection Act 2018 (‘the DPA’).

10.8 In order to comply with the requirements of the DPA and the GDPR, the

IJBArgyll and Bute Integration Joint Board will always ensure that personal data it

holds will be processed in line with the Data Protection Principles contained within

Article 5 of the GDPR and section 35- 40 of the DPA.

11 Complaints

The Parties agree the following arrangements in respect of complaints on behalf of,

or by, service users.

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11.1 Both Parties will retain separate complaints policies reflecting the distinct

statutory requirements.

11.1.1 There will be a single point of contact for complainants. This will be

agreed between the Parties to co-ordinate complaints specific to the delegated

functions to ensure that the requirements of existing legal/prescribed elements

of health and social worksocial care complaints processes are met.

11.1.2 Staff within the delegated functions will apply the complaints policy of

the relevant Party, depending on the nature of the complaint made. Where a

complaint could be dealt with by the policies of both Parties, the appropriate

manager will determine whether both need to be applied separately or a single

joint response is appropriate. Where a joint response to such a complaint is not

possible or appropriate, the material issues will be separated and progressed

through the respective Party’s procedures.

11.2 In the first instance all complaints will be handled by front line staff. If they are

unresolved, they will then be passed to a relevant senior manager and thereafter to

the Chief Officer.

11.3 If the complaint remains unresolved, the complainant may refer the matter to the

Scottish Public Services Ombudsman for health or the complaints review committee

and/or the Scottish Public Services Ombudsman for social care, as appropriate.

11.4 All complaints procedures will be clearly explained, well publicised, accessible,

will allow for timely recourse and will sign-post independent advocacy services.

11.5 The person making the complaint will always be informed which policies are

being applied to their complaint.

11.6 The Parties will produce a quarterly joint report, outlining the learning from

upheld complaints. This will be provided for consideration by the IJBArgyll and Bute

Integration Joint Board and the Clinical and Care Governance Committee.

12 Claims Handling, Liability & Indemnity

The Parties agree the following arrangements in respect of claims handling, liability

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and indemnity:

12.1 The IJBArgyll and Bute Integration Joint Board, whilst having a legal personality

in its own right has neither assumed nor replaced the rights or responsibilities of either

NHS Highland or the Council as the employers of staff who are managed within the

delegated functions, or for the operation of buildings or services under the operational

remit of those staff.

12.2 The Parties will continue to indemnify, insure and accept responsibility for the

staff that they employ; their particular capital assets that the IJBArgyll and Bute

Integration Joint Board uses to deliver services with or from; and the respective

services themselves, which each Party has delegated to the IJBArgyll and Bute


12.3 Liabilities arising from decisions taken by the IJBArgyll and Bute Integration Joint

Board will be equally shared between the Parties.

13 Risk Management

13.1 The Parties will develop a shared risk management strategy that will identify,

assess and prioritise risks related to the delivery of services under integration

functions, particularly any which are likely to affect the IJB’sArgyll and Bute Integration

Joint Board’s delivery of the Strategic Plan.

13.2 The risk management strategy will identify and describe processes for mitigating

those risks and set out and agree the reporting standard, which will include:

• Risk Management Process

• Escalation of Risks

• Risk Register and Action Plans

• Risk Tolerance

• Training

13.3 The risk management strategy will be approved by both Parties. The risk

management strategy will allow for any subsequent changes to the strategy to be

approved by the IJBArgyll and Bute Integration Joint Board.

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13.4 The risk management strategy will include an agreed risk monitoring framework

and arrangements for reporting risks and risk information to the relevant parties from

the date of inception of the IJBArgyll and Bute Integration Joint Board.

13.5 The Parties will develop an integrated risk register that will set out the key risks

for the IJBArgyll and Bute Integration Joint Board. Risk officers from each of the

Parties will review respective procedures and formulate revised procedures which will

allow associated risks, scoring and mitigations to be identified for inclusion in the

integrated risk register. by 01.04.2016.

13.6 The Integrated Risk Register will be reported to the IJBArgyll and Bute Integration

Joint Board on a timescale and format agreed by the IJB,Argyll and Bute Integration

Joint Board but this will not be less that once per year.

13.7 The risk integrated management strategy will set out the process for amending

the integrated risk register.

13.8 The Parties will make appropriate resources available to support the IJBArgyll

and Bute Integration Joint Board in its risk management.

14 Dispute Resolution Mechanism

14.1 Where either of the Parties fails to agree with the other on any issue related to

this Scheme, they will follow a process which comprises:

14.1.1 A representative of NHS Highland and the Council will meet to resolve

the issue, supported by appropriate Officers.

14.1.2 In the event that the issue remains unresolved, the Chief Executive

Officers of NHS Highland and the Council, and the Chief Officer, will meet to

resolve the issue, supported by appropriate Officers.

14.1.3 In the event that the issue remains unresolved, the Chair of NHS

Highland and the Leader nominated representatives of the Council will meet to

resolve the issue, supported by appropriate Officers.

14.1.4 In the event that the issue remains unresolved, NHS Highland and the

Council will proceed to mediation with a view to resolving the issue.

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14.2 With regard to the process of appointing a mediator, a representative of NHS

Highland and a representative of the Council will meet with a view to appointing a

suitable independent mediator. If agreement cannot be reached, a referral will be

made to the President of The Law Society of Scotland inviting the President to appoint

a mediator. The Parties agree to share the cost of appointing a mediator.

14.3 Where an issue remains unresolved following the process of mediation, the

Chief Executive Officers of NHS Highland and the Council will communicate in writing

with Scottish Ministers, on behalf of the Parties, informing them of the issue under

dispute and that agreement cannot be reached

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Annex 1 Part 1 Functions delegated by NHS Highland to the IJBIntegration Joint Board

Functions prescribed for the purposes of section 1 (6) of the act

Column A Column B The National Health Service (Scotland) Act 1978

All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978

Except functions conferred by or by virtue of—

section 2(7) (Health Boards);

section 2CB (ref footnote 1) (Functions of Health Boards outside Scotland);

section 9 (local consultative committees);

section 17A (NHS Contracts);

section 17C (personal medical or dental services);

section 17I(1) (use of accommodation);

section 17J (Health Boards’ power to enter into general medical services contracts);

section 28A (remuneration for Part II services);

section 48 (provision of residential and practice accommodation);

section 55(2) (hospital accommodation on part payment); section 57 (accommodation and services for private patients);

section 64 (permission for use of facilities in private practice);

section 75A(3) (remission and repayment of charges and payment of travelling expenses);

section 75B(4)(reimbursement of the cost of services provided in another EEA state);

(1) Section 17I was inserted by the National Health Service (Primary Care) Act 1997 (c.46),Schedule 2 and amended by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 4.The functions of the Scottish Ministers under section 17I are conferred on Health Boards by virtue ofS.I. 1991/570, as amended by S.S.I. 2006/132.(2) Section 55 was amended by the Health and Medicines Act 1988 (c.49), section 7(9) andSchedule 3 and the National Health Service and Community Care Act 1990 (c.19), Schedule 9. Thefunctions of the Secretary of State under section 55 are conferred on Health Boards by virtue of S.I.1991/570.(3) Section 75A was inserted by the Social Security Act 1988 (c.7), section 14, and relevantlyamended by S.S.I. 2010/283. The functions of the Scottish Ministers in respect of the payment ofexpenses under section 75A are conferred on Health Boards by S.S.I. 1991/570.

131

section 75BA (5)(reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013); section 79 (purchase of land and moveable property);

section 82(6) use and administration of certain endowments and other property held by Health Boards); section 86 (accounts of health Boards and the Agency) section 88 (payment of allowances and remuneration to members of certain bodies connected with the health services); section 98 (7) (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 (8);

(4) Section 75B was inserted by S.S.I. 2010/283, regulation 3(3) and amended by S.S.I.2013/177.(5) Section 75BA was inserted by S.S.I. 2013/292, regulation 8(4).(6) Section 82 was amended by the Public Appointments and Public Bodies etc. (Scotland) Act2003 (asp 7) section 1(2) and the National Health Service Reform (Scotland) Act 2004 (asp 7),schedule 2.(7) Section 98 was amended by the Health and Medicines Act 1988 (c.49), section 7. Thefunctions of the Secretary of State under section 98 in respect of the making, recovering, determination and calculation of charges in accordance with regulations made under that section is conferred onHealth Boards by virtue of S.S.I. 1991/570.(8) S.I. 1989/364, as amended by S.I. 1992/411; S.I. 1994/1770; S.S.I. 2004/369; S.S.I. 2005/455;S.S.I. 2005/572 S.S.I. 2006/141; S.S.I. 2008/290; S.S.I. 2011/25 and S.S.I. 2013/177

132

The Health Boards (Membership and Procedure) (Scotland) Regulations 2001/302; The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000/54;

The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004/114;

The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004;

The National Health Service (Discipline Committees) Regulations 2006/330;

The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006/135;

The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009/183;

The National Health Service (General Dental Services) (Scotland) Regulations 2010/205; and

The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011/55(9).

Disabled Persons (Services, Consultation and Representation) Act 1986

Section 7 (Persons discharged from hospital)

Community Care and Health (Scotland) Act 2002

All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002.

Mental Health (Care and Treatment) (Scotland) Act 2003

All functions of Health Boards conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003.

Except functions conferred by—

section 22 (Approved medical practitioners);

section 264 (Detention in conditions of excessive security: state hospitals);

(9) S.S.I. 2011/55, to which there are amendments not relevant to the exercise of a HealthBoard’s functions.

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Education (Additional Support for Learning) (Scotland) Act 2004

Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010

All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010

Patient Rights (Scotland) Act 2011

All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011

Children and Young People (Scotland) Act 2014

All functions of Health Boards conferred by, or by virtue of, Part 4 (provision of named persons) and Part 5 (child's plan) of the Children and Young People (Scotland) Act 2014.

Carers (Scotland) Act 2016

Section 12 (duty to prepare young carer statement)”

Section 31 (duty to prepare local carer strategy)

Except functions conferred by—

section 31(Public functions: duties to provide information on certain expenditure etc.); and

section 32 (Public functions: duty to provide information on exercise of functions).

Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012/36(10).

(10) S.S.I. 2012/36. Section 5(2) of the Patient Rights (Scotland) Act 2011 (asp 5) provides adefinition of “relevant NHS body” relevant to the exercise of a Health Board’s functions.

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Part 2 Services currently provided by NHS Highland which are to be integrated

• Hospital inpatient (scheduled and unscheduled)

• Rural General Hospitals

• Mental Health

• Pediatrics

• Community Hospitals

• Hospital Outpatient Services

• NHS Community Services (Nursing, Allied Health Professionals, Mental HealthTeams, Specialist End of Life Care, Homeless Service, Older Adult Community

Psychiatric Nursing, Re-ablement, Geriatricians Community/Acute, Learning

Disability Specialist, Community Midwifery, Speech and Language Therapy,Occupational Therapy, Physiotherapy, Audiology

• Community Children's Services - Child and Adolescent Mental Health Service,Primary Mental Health workers, Public Health Nursing, Health visiting, School

Nursing, Learning Disability Nursing, Child Protection Advisors, Speech and

Language Therapy, Occupational Therapy, Physiotherapy and Audiology,

Specialist Child Health Doctors and Service Community Pediatricians

• Public Health

• GP Services

• GP Prescribing

• General Dental, Opticians and Community Pharmacy

• Support Services

• Contracts and Service Level agreements with other NHS boards coveringadults and children

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Annex 2

Part 1 Functions delegated by the Council to the IJBArgyll and Bute Integration Joint Board

Functions prescribed for the purposes of section 1(7) of the Public Bodies (Joint Working) (Scotland) Act 2014

Column A Enactment conferring function

National Assistance Act 1948(11)

Column B Limitation

Section 48 (Duty of councils to provide temporary protection for property of persons admitted to hospitals etc.)

The Disabled Persons (Employment) Act 1958(12)

Section 3 (Provision of sheltered employment by local authorities)

(11) 1948 c.29; section 48 was amended by the Local Government etc. (Scotland) Act 1994 (c.39), Schedule 39, paragraph 31(4) and the Adult Support and Protection (Scotland) Act 2007 (asp 10) schedule 2 paragraph 1. (12) 1958 c.33; section 3 was amended by the Local Government Act 1972 (c.70), section 195(6); the Local Government (Scotland) Act 1973 (c.65), Schedule 27; the National Health Service (Scotland) Act 1978 (c.70), schedule 23; the Local Government Act 1985 (c.51), Schedule 17; the Local Government (Wales) Act 1994 (c.19), Schedules 10 and 18; the Local Government etc. (Scotland) Act 1994 (c.49), Schedule 13; and the National Health Service (Consequential Provisions) Act 2006 (c.43), Schedule 1

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The Social Work (Scotland) Act 1968(13)

Section 1 (Local authorities for the administration of the Act.)

Column B Limitation

So far as it is exercisable in relation to another integration function.

Section 4 (Provisions relating to performance of functions by local authorities.)


Section 8 (Research.)


Section 10 (Financial and other assistance to voluntary organisations etc. for social work.)


Section 12 (General social welfare services of local authorities.)

Except in so far as it is exercisable in relation to the provision of housing support services.

Section 12A (Duty of local authorities to assess needs.)


(13) 1968 c.49; section 1 was relevantly amended by the National Health Service (Scotland) Act 1972 (c.58), schedule 7; the Children Act 1989 (c.41), Schedule 15; the National Health Service and Community Care Act 1990 (c.19) (“the 1990 Act”), schedule 10; S.S.I. 2005/486 and S.S.I. 2013/211. Section 4 was amended by the 1990 Act, Schedule 9, the Children (Scotland) Act 1995 (c.36) (“the 1995 Act”), schedule 4; the Mental Health (Care and Treatment) (Scotland) Act 2003 (asp 13) (“the 2003 Act”), schedule 4; and S.S.I. 2013/211. Section 10 was relevantly amended by the Children Act 1975 (c.72), Schedule 2; the Local Government etc. (Scotland) Act 1994 (c.39), Schedule 13; the Regulation of Care (Scotland) Act 2001 (asp 8) (“the 2001 Act”) schedule 3; S.S.I. 2010/21 and S.S.I. 2011/211. Section 12 was relevantly amended by the 1990 Act, section 66 and Schedule 9; the 1995 Act, Schedule 4; and the Immigration and Asylum Act 1999 (c.33), section 120(2). Section 12A was inserted by the 1990 Act, section 55, and amended by the Carers (Recognition and Services) Act 1995 (c.12), section 2(3) and the Community Care and Health (Scotland) Act 2002 (asp 5) (“the 2002 Act”), sections 8 and 9(1). Section 12AZA was inserted by the Social Care (Self Directed Support) (Scotland) Act 2013 (asp 1), section 17. Section 12AA and 12AB were inserted by the 2002 Act, section 9(2). Section 13 was amended by the Community Care (Direct Payments) Act 1996 (c.30), section 5. Section 13ZA was inserted by the Adult Support and Protection (Scotland) Act 2007 (asp 10), section 64. Section 13A was inserted by the 1990 Act, section 56 and amended by the Immigration and Asylum Act 1999 (c.33), section 102(2); the 2001 Act, section 72 and schedule 3; the 2002 Act, schedule 2 and by S.S.I. 2011/211. Section 13B was inserted by the 1990 Act sections 56 and 67(2) and amended by the Immigration and Asylum Act 1999 (c.33), section 120(3). Section 14 was amended by the Health Services and Public Health Act 1968 (c.46), sections 13, 44 and 45; the National Health Service (Scotland) Act 1972 (c.58), schedule 7; the Guardianship Act 1973 (c.29), section 11(5); the Health and Social Service and Social Security Adjudications Act 1983 (c.41), schedule 10 and the 1990 Act, schedule 9. Section 28 was amended by the Social Security Act 1986 (c.50), Schedule 11 and the 1995 Act, schedule 4. Section 29 was amended by the 1995 Act, schedule 4. Section 59 was amended by the 1990 Act, schedule 9; the 2001 Act, section 72(c); the 2003 Act, section 25(4) and schedule 4 and by S.S.I. 2013/211.

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Section 12AZA (Assessments under section 12A - assistance)

Column B Limitation


Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.)

Section 13ZA (Provision of services to incapable adults.)

Section 13A (Residential accommodation with nursing.)

Section 13B (Provision of care or aftercare.)

Section 14 (Home help and laundry facilities.)

Section 28 (Burial or cremation of the dead.)

Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.)

Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.)


So far as it is exercisable in relation to persons cared for or assisted under another integration function.


The Local Government and Planning (Scotland) Act 1982(14) Section 24(1) (The provision of gardening assistance for the disabled and the elderly.)

Disabled Persons (Services, Consultation and Representation) Act 1986(15)

(14) 1982 c.43; section 24(1) was amended by the Local Government etc. (Scotland) Act 1994 (c.39), schedule 13.

138


Section 2 (Rights of authorised representatives of disabled persons.)

Section 3 (Assessment by local authorities of needs of disabled persons.)

Section 7 (Persons discharged from hospital.)

Section 8 (Duty of local authority to take into account abilities of carer.)

Column B Limitation

In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of section 16 and which have been delegated.

In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in section 16 of that Act) which are integration functions.

The Adults with Incapacity (Scotland) Act 2000(16)

Section 10 (Functions of local authorities.)

Section 12 (Investigations.)

Section 37 (Residents whose affairs may be managed.)

Section 39 (Matters which may be managed.)

Only in relation to residents of establishments which are managed under integration functions.

Only in relation to residents of establishments which are managed under integration functions.

Section 41 (Duties and functions of managers of authorised establishment.)

Section 42 (Authorisation of named manager to withdraw from resident’s account.)

Section 43 (Statement of resident’s affairs.)

Section 44 (Resident ceasing to be resident of authorised establishment.)

Only in relation to residents of establishments which are managed under integration functions




(15) 1986 c.33. There are amendments to sections 2 and 7 which are not relevant to the exercise of a local authority’s functions under those sections. (16) 2000 asp 4; section 12 was amended by the Mental Health (Care and Treatment) (Scotland) Act 2003 (asp 13), schedule 5(1). Section 37 was amended by S.S.I. 2005/465. Section 39 was amended by the Adult Support and Protection (Scotland) Act 2007 (asp 10), schedule 1 and by S.S.I. 2013/137. Section 41 was amended by S.S.I. 2005/465; the Adult Support and Protection (Scotland) Act 2007 (asp 10), schedule 1 and S.S.I. 2013/137. Section 45 was amended by the Regulation of Care (Scotland) Act 2001 (asp 8), Schedule 3.

139


Section 45 (Appeal, revocation etc.)

The Housing (Scotland) Act 2001(17)

Section 92 (Assistance to a registered for housing purposes.)

Column B Limitation


Only in so far as it relates to an aid or adaptation.

The Community Care and Health (Scotland) Act 2002(18)

Section 5 (Local authority arrangements for residential accommodation outwith Scotland.)

Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.)

The Mental Health (Care and Treatment) (Scotland) Act 2003(19)

Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.)

Section 25 (Care and support services etc.)


Section 26 (Services designed to promote well-being and social development.)


Section 27 (Assistance with travel.)

Section 33 (Duty to inquire.)

Section 34 (Inquiries under section 33: Co-operation.)

Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.)


(17) 2001 asp 10; section 92 was amended by the Housing (Scotland) Act 2006 (asp 1), schedule 7. (18) 2002 asp 5. (19) 2003 asp 13; section 17 was amended by the Public Services Reform (Scotland) Act 2010 (asp 8), section 111(4), and schedules 14 and 17, and by the Police and Fire Reform (Scotland) Act 2012 (asp 8), schedule 7. Section 25 was amended by S.S.I. 2011/211. Section 34 was amended by the Public Services Reform (Scotland) Act 2010 (asp 8), schedules 14 and 17.

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Section 259 (Advocacy.)

The Housing (Scotland) Act 2006(20)

Section 71(1)(b) (Assistance for housing purposes.)

Column B Limitation

Only in so far as it relates to an aid or adaptation.

The Adult Support and Protection (Scotland) Act 2007(21)

Section 4 (Council’s duty to make inquiries.)

Section 5 (Co-operation.)

Section 6 (Duty to consider importance of providing advocacy and other.)

Section 11 (Assessment Orders.)

Section 14 (Removal orders.)

Section 18 (Protection of moved persons property.)

Section 22 (Right to apply for a banning order.)

Section 40 (Urgent cases.)

Section 42 (Adult Protection Committees.)

Section 43 (Membership.)

Social Care (Self-directed Support) (Scotland) Act 2013 )

(20) 2006 asp 1; section 71 was amended by the Housing (Scotland) Act 2010 (asp 17) section 151. (21) 2007 asp 10; section 5 and section 42 were amended by the Public Services Reform (Scotland) Act 2010 (asp 8), schedules 14 and 17 and by the Police and Fire Reform (Scotland) Act 2012 (asp 8), schedule 7. Section 43 was amended by the Public Services Reform (Scotland) Act 2010 (asp 8), schedule 14. (22) 2013 asp 1.

(22

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Column B Limitation

Section 5 (Choice of options: adults.)

Section 6 (Choice of options under section 5: assistances.)

Section 7 (Choice of options: adult carers.)

Section 9 (Provision of information about self-directed support.)

Section 11 (Local authority functions.)

Section 12 (Eligibility for direct payment: review.)

Section 13 (Further choice of options on material change of circumstances.)

Section 16 (Misuse of direct payment: recovery.)

Section 19 (Promotion of options for self-directed support.)

Carers (Scotland) Act 2016 2324

Only in relation to a choice under section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013.

Section 6

(Duty to prepare of adult carer support plan)

Section 21 (duty to set local eligibility criteria)

Section 24 (Duty to provide support)

(23) section 21 was inserted into the Schedule of the Public Bodies (Joint Working) (Scotland) Act 2014 by paragraph 6 of the schedule of the Carers (Scotland) Act 2016 (asp 9)

(24) inserted by Public Bodies (Joint Working) (Prescribed Local Authority Functions etc.) (Scotland) Amendment Regulations 2017/190

142


Section 25

(Provision of support to carers: breaks from caring)

Section 31 (Duty to prepare local carer strategy)

Section 34 (Information and advice service for carers)

Column B Limitation

Section 35

(Short breaks services statements)

Functions, conferred by virtue of enactments, prescribed for the purposes of section 1(7) of the Public Bodies (Joint Working) (Scotland) Act 2014


Column B Limitation

(25 ) Section 4 was amended by the Mental Health (Care and Treatment )(Scotland)Act 2003 (asp13)schedule 4 and the Adult Support and Protection (Scotland)Act 2007 (asp 10)section 62(3) (26) S.S.I. 2002/265, as amended by S.S.I. 2005/445.

(27 ) Section 4 was amended by the Mental Health (Care and Treatment )(Scotland)Act 2003 (asp13)schedule 4 and the Adult Support and Protection (Scotland)Act 2007 (asp 10)section 62(3) (28) S.S.I. 2002/265, as amended by S.S.I. 2005/445.

Section 4(27)

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Additional Functions delegated by the Council to Argyll and Bute Integration Joint Board Column A Column B

Enactment conferring function Limitation

___________________________________________________________________________________________

National Assistance Act 1948

Section 45

(Recovery in cases of misrepresentation or non-disclosure.)

Matrimonial Proceedings (Children) Act 1958

Section 11 (Reports as to arrangements for future care and upbringing of children.)

The Social Work (Scotland) Act 1968

Section 5 (Powers of Secretary of State.)

Section 6B (Local authority inquiries into matters affecting children.)

Section 27 (Supervision and care of persons put on probation or released from prisons etc.)

Section 27ZA (Advice, guidance and assistance to persons arrested or on whom sentence deferred.)

Section 78A (Recovery of contributions)

Section 80 (Enforcement of duty to make contributions.)

Section 81 (Provisions as to decrees for ailment.)

Section 83

(Variation of trusts.)

Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.)

The Children Act 1975

Section 34 (Access and maintenance.)

Section 39 (Reports by local authorities and probation officers.)

144

Section 40 (Notice of application to be given to local authority.)

Section 50 (Payments towards maintenance of children.)

Health and Social Services and Social Security Adjudications Act 1983

Section 21 recovery of sums due to local authority where persons in residential accommodation have disposed of assets.)

Section 22 (Arrears of contributions charged on interest in land in England and Wales)

Section 23 (Arrears of contributions secured over interest in land in Scotland) Foster Children (Scotland) Act 1984

Section 3 (local authorities to ensure well-being of and to visit foster children.)

Section 5 (Notification by persons maintaining or proposing to maintain foster children.)

Section 6 Notification by persons ceasing to maintain foster children.)

Section 8 (Power to inspect premises.)

Section 9 (Power to impose requirements as to the keeping of foster children.)

Section 10 (Power to prohibit the keeping of foster children.)

The Children (Scotland) Act 1995

Section 17 (Duty of local authority to child looked after by them.)

Section19 (Local authority plans for services for children)

Section 20 (Publication of information about services for children)

Section 21 (Co-operation between authorities)

Section 22 (Promotion of welfare of children in need)

Section 23 (Children affected by disability)

145

Section 24 (Assessment of ability of carers to provide care for disabled children)

Section 24A (Duty of local authority to provide information to carer of disabled child)

Section 25 (Provision of accommodation for children etc.)

Section 26 (Manner of provision of accommodation to child looked after by local authority)

Section 26A (Provision of continuing care: looked after children)

Section 27 (Daycare for pre-school and other children)

Section 29 (Aftercare)

Section 30 (Financial assistance towards expenses of education or training and removal of power to guarantee indentures etc.)

Section 31 Review of case of child looked after by local authority)

Section 32 (Removal of child from residential establishment)

Section 36 (Welfare of certain children in hospitals and nursing homes etc.)

Section 38 (Short term refuges for children at risk of harm.)

Section 76 (Exclusion orders.)

Criminal Procedure (Scotland) Act 1995

Section 51 (Remand and committal of children and young persons.)

Section 203 Reports.)

Section 234B (Drug treatment and testing order.)

Section 245A (Restriction of liberty orders.)

The Adults with Incapacity (Scotland) Act 2000

Section 40 (Supervisory bodies.)

The Community Care and Health (Scotland) Act 2002

Section 4

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(Accommodation more expensive than usually provided.).)

Section 6 Deferred payment of accommodation costs.)

Management of Offenders etc (Scotland) Act 2005

Sections 10 (Arrangements for assessing and managing risks posed by certain offenders) Section 11 (Review of arrangements) ( Adoption and Children (Scotland) Act 2007

Section 1 (Duty of local authority to provide adoption service.)

Section 4 (Local authority plan)

Section 5 (Guidance)

Section 6 (Assistance in carrying out functions under sections 1 and 4)

Section 9 (Assessment of needs for adoption support services)

Section 10 (Provision of services)

Section 11 (Urgent provision)

Section 12 (Power to provide payment to person entitled to adoption support service)

Section 19 (Notice under Section 18 local authorities duties)

Section 26 (Looked after children - adoption is not proceeding.)

Section 45 (Adoption support plans.)

Section 47 (Family member’s right to require review of plan)

Section 48 (Other cases where authority under duty to review plan)

Section 49 (Re-assessment of needs for adoption support services)

Section 51 (Guidance)

Section 71 (Adoption allowance schemes.)

147

Section 80 (Permanence Orders.)

Section 90 (Precedence of certain other orders)

Section 99 (Duty of local authority to apply for variation or revocation.)

Section 101 (Local authority to give notice of certain matters.)

Section 105 (Notification of proposed application for order)

The Adult Support and Protection (Scotland) Act 2007

Section 7 (Visits)

Section 8 (Interviews)

Section 9 (Medical examinations)

Section 10 (Examination of records etc.)

Section 16 (Right to remove adult at risk)

Children’s Hearings (Scotland) Act 2011

Section 35 (Child assessment orders.)

Section 37

(Child protection orders.)

Section 42 (Parental responsibilities and rights directions.)

Section 44 (Obligations of local authority.)

Section 48 (Application for variation or termination

Section 49 (Notice of an application for variation or termination.)

Section 60 (Local authorities duty to provide information to Principal Reporter.)

Section 131 (Duty of implementation authority to require review.)

Section 144 (Implementation of a compulsory supervision order; general duties of implementation authority.)

148

Section 145 (Duty where order requires child to reside in a certain place.)

Section 153 (Secure accommodation: regulations.)

Section 166

(Review of requirement imposed on local authority)

Section167 (Appeal to Sheriff Principal: section 166)

Section 180 (Sharing of information: panel members.)

Section 183- (Mutual Assistance)

Section 184 (Enforcement of obligations of health board under section 183)

Social Care (Self-directed Support) (Scotland) Act 2013

Section 8 (Choice of options; children and family members.)

Section 10 (Provision of information; children under 16.)

Carers (Scotland) Act 2016

Section12 (Duty to prepare a Young Carer Statement)

Part 2 Services currently provided by the Council which are to be integrated: All permitted Council functions apart from housing and housing support services,

other than aids and adaptations aspects of housing support.

• Social WorkSocial care Services for Adults and Older People

• Services and Support for Adults with Physical Disabilities and Learning Disabilities

• Mental Health Services

• Drug and Alcohol Services

• Adult Protection and Domestic Abuse

• Carers Support Services

• Community Care Assessment Teams

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• Support Services

• Care Home Services

• Adult Placement Services

• Health Improvement Services

• Housing support including Aids and Adaptions

• Day Services

• Local Area Co-ordination

• Self-Directed support

• Respite Provision for adults and young people

• Occupational Therapy Services

• Re-ablement Services, Equipment and Telecare

• Social workSocial care services for children and young people

• Child Care Assessment and Care Management

• Looked After and accommodated Children

• Child Protection

• Adoption and Fostering

• Special Needs/Additional Support

• Early Intervention

• Through-care Services

• Youth Justice Services

• Social WorkSocial care Criminal JusticeCommunity JusticeJustice Services

• Services to Courts and Parole Board

• Assessment of offenders

• Diversions from Prosecution and Fiscal Work Orders

• Supervision of offenders subject to a community based order

• Through care and supervision of released prisoners

• Multi Agency Public Protection Arrangements

150

Annex 3: Systems Governance.

System Governance Schematic

Adult Protection Committee

151

Clinical Services Groups/Networks

Clinical and Care Governance Committee

Annex 4: Clinical and Care Governance structure.

Argyll and Bute Integration Joint Board

Mandatory Training

Professional Regulation

Infection Control Care Assurance

Service User Feedback

Registered Services

Blood Transfusion

Resuscitation

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NHS Highland



Title: Short-Life Working Group - Governance Review



1 Purpose


This report relates to: • Establishing a Short Life Working Group to review NHS Highland corporate governance

and the agreement of the Terms of Reference for this Group.

This aligns to the following NHSScotland quality ambition(s): • Effective

2 Report summary

2.1 Situation This report outlines a proposed review of NHS Highland Board’s governance arrangements and the means by which this will be carried out.

2.2 Background A Short Life Working Group to consider Board governance has been established to review the existing status of NHS Highland governance committees and make recommendations to the Board to improve governance of all Board matters.

2.3 Assessment The appended document sets out a proposed Terms of Reference for the Short Life Working Group for the Board’s approval.

The Group’s aim is to ensure a streamlined and more effective governance structure which can provide clear assurance to the Board. It is recognised that improvements to the current governance arrangements will permit a more effective relationship between the Board and its Committees.


A Short Life Working Group has met once on 27 February 2020 and has developed draft Terms of Reference which are appended to this report for Board approval.

2.3.1 Quality/ Patient Care 2.3.2 Workforce 2.3.3 Financial

The provision of robust governance arrangements is key to NHS Highland delivering on its key objectives and to improving workforce, clinical and financial governance.




2.3.7 Communication, involvement, engagement and consultation The outcome of the Governance Review will be communicated to the wider organisation as appropriate on completion.

2.3.8 Route to the Meeting The subject of this report has been considered at a meeting of the Short Life Working Group established informally to consider improvements to the Board’s governance.

2.4 Recommendation

• Decision The Board is asked to approve: • the undertaking of a governance review for the Board’s governance committees • the establishment of a Short Life Working Group to take forward the review • the terms of reference for the Short Life Working Group.



• Appendix No. 1 Governance Review Working Group Draft Terms of Reference

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APPENDIX 1

GOVERNANCE REVIEW GROUP

ROLE AND REMIT 1. Governance Review Group Role The role of the Group is to review the existing status of NHS Highland governance committees and make recommendations to NHS Highland Board to improve its governance of all Board matters. 2. Governance Review Group Remit The Group shall review and make recommendations to the Board on the operation and best practice of NHS Highland governance committees in relation to the following: • Review of current areas of focus • Review of membership • Regularise governance committees operation to ensure sound assurance to NHS

Highland Board. • Ensure Committee time and Non-Executive resources are deployed effectively to

improve Board governance with a clear separation between governance and managerial roles

The Group will focus its work on the following governance committees: Audit Committee Staff Governance Committee Clinical Governance Committee Highland Health and Social Care Committee Finance Committee Asset Management Group Remuneration Committee Health and Safety Committee Joint Monitoring Committee

3. Boundaries and Accountabilities

The Group will make its recommendations to NHS Highland Board.

DRAFT

GOVERNANCE REVIEW GROUP

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4. Group Membership Board Vice Chair 2 x Non Executive Directors Chief Executive Chief Officer North Highland 1 x other Executive Director Ex Officio Board Chair The Group will be chaired by the Chief Executive 5. Quorum No business shall be transacted at a meeting of the Group unless at least 3 members are present. 6. Meetings The Committee will meet as necessary to fulfil its remit.

February 2020 Board Secretary

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NHS Highland Board 31 March 2020

Item ?

CLINICAL GOVERNANCE COMMITTEE

Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk/

DRAFT MINUTE 12 February 2020 – 9am

Present Mr Alasdair Christie, Non-Executive (substitute for Ann Clark) Ms Elspeth Caithness, Staff-side representative Ms Heidi May, Nurse Director Ms Margaret Moss, Chair of Area Clinical Forum Mr Adam Palmer, Board Non-Executive Mr Graham Peach, Public Representative Dr Boyd Peters, Medical Director Dr Gaener Rodger, Non Executive and Chair

In attendance Ms Mary Burnside, Interim Head of Midwifery Ms Fiona Campbell, Clinical Governance Manager, A&B – VC Dr Jim Docherty, Clinical Lead for eHealth Dr Rebecca Helliwell, Associate Medical Director, A&B - VC Ms Fiona MacBain, Committee Administrator, Highland Council Ms Iona McGauran, Lead Nurse, Raigmore Ms Louise MacInnes, Risk Manager Dr Stewart MacPherson, Associate Medical Director Ms Mirian Morrison, Clinical Governance Development Manager Mr Andrew Nealis, Information Assurance & IT Security Manager Ms Kate Patience-Quate, Depute Nurse Director Dr Ian Rudd, Director of Pharmacy Ms Claire Wood, Associate Director, AHPs

1 Apologies

Committee Members: Ms Deirdre Mackay, Non-Executive Director Ms Ann Clark, Non-Executive Director Dr Louise Wilson, Interim Director of Public Health

Attendees: Ms Donellen Mackenzie, Depute Director, Adult Social Care Dr Ken MacDonald, Associate Medical Director, Raigmore Ms Susan Russel, Principal Officer (Nursing), Highland Council Ms Sara Sears, Lead Nurse, North and West Dr Stephanie Govenden, Lead Doctor for Child Protection

Preliminaries

The Chair thanked Ms Fiona MacLean for her valuable contribution as a public representative on the Committee. Recruitment for replacement public representatives was being undertaken for the Clinical Governance Committee and for the Highland Health and Social Care Committee.

NHSH Board 31 March 20, Item 15a157


1.1 Declarations of Conflict of Interest – Mr Alasdair Christie wished to record that he had considered making a declaration of interest as a member of the Highland Council but felt his status was too remote or insignificant to the agenda items under discussion to reasonably be taken to fall within the Objective Test, and on that basis he felt it did not preclude his participation at the meeting. He declared a potential financial interest in Item 8, Complaints, as General Manager of Inverness, Nairn, Badenoch and Strathspey Citizens Advice Bureau, who provided assistance to people in formulating complaints to the NHS. However, he did not feel this interest was significant enough to preclude his participation in discussion of that item. 2 Minute of meeting on 3 December 2019 and Action Plans Actions were considered as follows: • RD&I Group: It was clarified the RD&I Director had, in January 2020, indicated his intention to

step down in summer 2020 and the post would be filled following due process. • AAA Screening: The title of this action was inaccurate as the report had included wider issues,

including colposcopy. Assurance was provided that the concerns raised had been addressed through meetings and written submissions and that a further update was due to the Committee in approximately nine months.

• Medical Education Governance Group annual report: the issues raised were being considered by the various QPS Groups but the planned meeting between Emma Watson and Gaener Rodger was awaited, having been cancelled twice.

• Antenatal Scanning Internal Audit Report: the Audit Committee was monitoring uncompleted actions and clinical concerns had been addressed.

• Maternity Transfers: This would be further considered by the Committee in April when a suite of maternity-related annual reports were due.

• N&W Exception report: The East Lothian triage system discussed was being implemented due to the needs of recruitment and demand. It would be considered as a potential case study for a future meeting.

• Raigmore Exception report / eHealth Order Comms project: This had been escalated to the Board and assurance received that the project would re-commence in 2020-21.

• Raigmore Exception report / lack of tracking of junior doctor errors: This had been raised by the outgoing Director of Public Health and consideration was required on how to pass his actions to his successor, Dr Louise Wilson on an interim basis. This remained outstanding.

• Point of Care Testing / Medical Devices etc: a meeting was planned in March 2020 between Gaener Rodger and Paul Davidson.

• Emergency Blood stocks at Mackinnon Memorial: New procedures had been put in place, all except one staff (on maternity leave) had been trained, and assurance in relation to management was provided.

• Scottish Patient Safety Programme: the lack of regular reporting had been highlighted to the Board, along with concerns about staffing levels for Quality Improvement, and the Medical Director summarised the situation in relation to SPSP which required review to rationalise various strands of quality work including SPSP, Excellence in Care, Value Management and the Highland Quality Approach. Data was being gathered ahead of a workshop in April 2020, being organised by Cameron Stark on behalf of Boyd Peters. Reference was also made to the national situation where rationalisation was also being investigated to avoid duplication or gaps. Gaener Rodger would also discuss the matter with the new Chief Executive, Paul Hawkins.

• Gosport Report Actions: These were now considered to be complete, but discussion took place around the recruitment of a Controlled Drug Inspector (CDI) for only 16 hours when 24 was recommended. It was likely that a full cycle of inspections could take around two years, therefore it was not practical to keep an action open for that length of time. There was a full-time CDI in A&B and it was suggested the resources might be shared. Following discussion, it

158

was agreed Ian Rudd and Heidi May would discuss this outwith the meeting, with Ian Rudd to bring any issues to the Committee by exception and to also present the action plan in due course.

• Forensic Medical Examiner Service: It was clarified that the existing police premises would be available for use until the new facility was completed.

The Committee: • Approved the minute. • Noted and/or agreed the actions, as detailed. 2.1 Matters Arising a. CGC Terms of Reference

Gaener Rodger Proposed revisions to the Membership and attendance lists were in red and the Committee was invited to consider any other amendments that might be required ahead of a formal review in August 2020, once the outcome of the Partnership Agreement renewal with the Highland Council was known. • It was clarified the Clinical Lead for eHealth should be listed as a regular attendee but that

the Head of eHealth did not require to be listed but would attend as a substitute if asked by the Clinical Lead.

• The list of reporting Committees and Groups required updating. • The attendance listings for Associate Medical Directors and Clinical Leads required

amending to reflect the restructure. • The complex situation in relation to governance of Adult Social Care in North Highland and

A&B was summarised. New partnership agreements would soon be in place. It was suggested the Director of Adult Social Care be asked to present a report to the Committee on the management of governance of ASC including synergy with A&B, which had different governance arrangements.

• The importance of having a single clinical governance framework across the whole of NHS Highland was highlighted and a draft framework would be brought to the meeting in June 2020, along with a revised Terms of Reference. In relation to Children’s Services, there was a framework in place, with the Council’s clinical governance group feeding into the newly established Infants, Children & Young People’s Clinical Governance Group, which covered all of NHS Highland.

• The structure and section titles of the agenda had changed. • It was pointed out that the move from five to six Committee meetings per year had a knock

on effect on Operational Division QPS meetings which were usually timed to fit with the Committee’s reporting schedule. The Chair clarified there was no expectation of QPS minutes at every CGC meeting, and that emerging issues could be brought up by exception if required at any meeting. However, an Exception and Emerging Issues report was expected from each area at each meeting.

The Committee noted the suggestions and agreed the actions as detailed.

b. Lorn & Islands In-patient Action Plan 2018

Fiona Campbell The Committee noted the action plan which had been missing from the report to the Committee in December 2019 and agreed Fiona Campbell would check if the outstanding actions had been completed.

c. Information Assurance Group Terms of Reference

Donald Peterkin / Andrew Nealis

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A brief summary was provided of the reasons for the changes, mainly GDPR and other digital legislation, and the aim to align meeting frequency with those of the Clinical Governance Committee. There would be a core membership with rotating satellite attenders. Clinical representation would be undertaken by the Caldicott Guardian (a senior person responsible for protecting the confidentiality of people's health and care information and making sure it was used properly). However, if the current Caldicot Guardian was not a practising clinician, this might require consideration and would be discussed at the first meeting of the IAG in April 2020, the outcome to be reported to the Committee via the minutes. The Committee approved the Terms of Reference.

3 Case Study: Whole System Flow Katherine Sutton, Head of Acute Services The presentation focused on Day of Care Surveys on 31 October 2019 in Raigmore and in Highland Community Hospitals, comparing issues including occupancy, boarding, top reasons for not being discharged, age profiles and length of stay of patients. Various key statistics were highlighted including Raigmore having a 98% occupancy rate and community hospitals only 71%. Raigmore had 33% of patients boarded out of area, 29% of patients surveyed did not meet the criteria for an acute hospital stay, and 1% of patients had used 30% of overall occupied bed days. The Winter Plan 2019-20 was summarised, with the aim of having rapid access to care at home capacity, a coordination facility / hub, additional community hospital capacity and the block purchase of care home beds. However the latter aim had not been achieved due to the unexpected closure of a 28-bed care home in Inverness, and the impact of this on unscheduled care performance was detailed. Reflections were as follows: • 1% of patients occupy 30% of bed days Raigmore • 168 patients in the survey were in beds inappropriately • Demography Population and Patients • Elderly patients in hospital beds lose muscle mass and function • Insufficient capacity to accommodate current clinical practice models How do we redesign our whole system Acute / Community and Social care to better meet current needs? • PMO Flow workstream • Clinical leadership • MDT approach • Multiple marginal gains • Clinical strategy During discussion, the following issues were considered: • The presentation was praised as being extremely helpful in demonstrating the complexity of the

situation in an understandable manner, as well as the opportunity to change ways of working. It would be circulated to all.

• It was noted the delayed patients at Raigmore were on average older than in community hospitals and it was thought this was in part due to nervousness of moving frail elderly people over the age of 90, and a tendency to therefore leave them in an acute setting for a few extra days while waiting for them to be ready to return home or to a care—based situation. Ideally systems were required to try to reduce the numbers of admissions.

160

• There were considerably higher occupation rates in Raigmore than in community hospitals and this was in part due to geographical considerations, either avoiding patients being in a community hospital far from their homes and families, or in a community hospital which was more difficult for required health professionals to access.

• Discharges increased over the festive period, perhaps a desire for people to have family at home, and it would be ideal to be able to replicate this pattern at other times, and also to spread the view that hospital stays should be as short as possible, with prevention of admission being a key factor.

• Shifting the balance of care had been discussed for a long time and information was sought on progress other Boards were making on this. A holistic approach was urged, with Adult Social Care and community factors being vital to the flow within the system. Realistic conversations with patients and families were encouraged, especially to dispel the notion that hospital was the best place for an elderly relative to be cared for other than for specific reasons. It was occasionally challenging to obtain the patient’s own wishes if they differed from those of their family.

• It was confirmed that unscheduled care included mental health. • Information was sought and provided on what the future situation was likely to be without the

necessary change to clinical pathways. • Attention was also drawn to the recruitment problems being faced in Highland, and to a Flow

Management Group, being run by Katherine Sutton, which was considering the issues presented. There was no shortage of ideas, but increased pace of change was required.

• Boyd Peters pointed out that flow and pressure in the system were regularly cited as the greatest concern by clinicians across the Board.

The Committee noted the presentation. 4 Executive and Professional Reports by Exception The Committee was asked to consider the issues identified and receive assurance that appropriate action was being taken/planned. a. Belford Hospital verbal update – Boyd Peters Regular support was being provided by Emma Watson and ongoing engagement and monitoring with Belford colleagues was being undertaken along with a recruitment drive to increase the numbers of substantive or long-term staff and reduce locum usage. NHS Highland was supportive of the Belford as a key element of overall service delivery. b. Internal Audit report – Maternity Redesign – Mary Burnside

• Maternity & Neonatal Services was a workstream in the Clinical and Care Strategy which was

being developed. • Clinical governance reporting arrangements were being mapped with the Best Start Steering

Group. • There was a Project Manager and an Executive Senior Responsible Office (Heidi May) in

place, the latter to chair the Steering Group. • Progress would be reported to the Committee in April and October 2020 and, to date, this was

positive in A&B, with North Highland not far behind. • The report had been to the Audit Committee in December 2019, at which it had been agreed to

move the timescales to 31 March 2020 instead of 31 January 2020. It was important Internal Audit was informed of this change to avoid actions being noted as late.

c. Internal Audit report – Controlled Drugs – Jackie Agnew Areas of good practice and for improvement, with actions, were detailed, some of which had been completed, some were in hand, due in April 2020, and some were awaiting follow-up, with details

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provided. Discussion had taken place with the auditors on the possibility of slippage on actions due to unforeseen service requirements. It was recommended that any action dates that were unlikely to be met were followed up as a matter of importance, with reference to the Section 22 Hearing that took place in November 2019 at which NHS Highland had been strongly criticised for the number of Internal Audit actions that were outstanding. It was confirmed that the first annual governance report was due to be presented to the Committee in April 2020. 5 Operational Unit Reports by Exception and Emerging Issues with Minutes of Meetings of Patient Quality & Safety Committees / A&B Clinical and Care Governance Group The Committee was asked to consider the issues identified and receive assurance that appropriate action was being taken/planned. 5.1 Argyll & Bute IJB and minutes of Clinical & Care Governance Group of 14 November 2019 Heidi May drew attention to the significant rise in Datix entries relating to staff shortages, which was being considered by the Senior Leadership Team. Performance in A&B was good and there were concerns about possible under-reporting, and this required to be reviewed on a regular basis. Attention was drawn to the staff availability section on the quality dashboard, which was updated on a daily basis. Several reports had referenced vacancies and shortages and Heidi May also drew attention to the importance of considering service redesign for any areas where there had been vacancies for over 3-6 months, and the importance of being proactive in managing vacancies. Stewart MacPherson asked that staff shortages be added to the exception report template and Mirian Morrison explained that it was being updated to tie in more closely with the dashboard. It was requested that congratulations be passed on to staff in Campbelltown for their recent award. 5.2 North and West, and minutes of QPS group • The complaints response rate was 36%, not 18% as stated in the report. • Stewart MacPherson had taken over clinical leadership of N&W in addition to S&M. In relation

to management of the Rural General Hospitals, this role was being shared with Emma Watson. Boyd Peters thanked both for their help during the transitional period of structure review.

5.3 South and Mid, and minutes of QPS group of 16 January 2020 • Attention was drawn to Health & Safety incidents which resulted in clinical recommendations

but without clinical representation, therefore in future a parallel system had been developed with the QPS group to avoid this, and this was recommended for other Operational Divisions across the organisation.

• Attention was drawn to challenges around mental health escorts. • Discussion took place on licence issues for dashboard access for some committee members,

which was being negotiated with eHealth. Consideration was given to the type of dashboard report required and attention was drawn to a leaflet produced by NHS Fife which provided key information in a simple manner. This would be investigated and a draft brought to the meeting in April 2020.

5.4 Raigmore, and minutes of QPS group of 19 November and 17 December 2019 • Attention was drawn to an SAER which had highlighted the need for improved awareness of a

training for dealing with patients on the autistic spectrum. • The practice of inviting clinicians to the weekly Duty of Candour meetings was having positive

results. • An update was provided on preparations for possible corona virus cases, of which there had

been no positive results to date in Scotland.

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5.5 Infants, Children & Young People’s Clinical Governance Group • The group was working well with processes being put in place to tackle the issues being

brought to the group. • The minutes of the group meetings were requested for future. 6 Scottish Patient Safety Programme a. Mental Health b. Primary Care c. Adult This had been covered at Item 2, Minutes and Actions from previous meeting. 7 Corporate Risk Register Update Louise McInnes, Risk Manager Risk Management was being reviewed as a result of an Internal Audit report, including revised strategy and policies, taking best practice from other Boards, and ensuring alignment with appropriate governance groups. Chairs and clinical leads would be discussing guidance and scrutiny in March 2020. • A typo in the report was highlighted – ‘extremely likely risks’ should be 20 not 200. • Attention was drawn to Risk 576, Highland’s Vascular Surgery, for which performance was

improving. This was being reviewed and clarification was still required around de-escalation processes.

• Concern was expressed that the Clinical and Care Strategy that was being developed had not yet been considered by the Committee and Boyd Peters would present on this in April 2020. With reference to the clinical governance risk register, it was important the committee had appropriate ownership and oversight of the strategy.

• Attention was drawn to the importance of balancing risk appetites across different governance committees.

• Previous Chief Executive, Iain Stewart, was praised for having the vision to get the changes in motion.

• Discussion took place on risk reporting processes, and the importance of alignment of risks with the Annual Operational Plan was highlighted. It was hoped there would be a Board development session on this in March 2020. The corporate risk register was considered by the Senior Leadership Team on a monthly basis and by the Board every 6 months, with specific risks going to the relevant committees.

• Attention was drawn to the importance of completing Internal Audit actions on time, to avoid them being placed on the risk register.

• Information was sought and provided on how issues were escalated to the risk register. The Committee noted the update. 8 Complaints Mirian Morrison, Clinical Governance Development Manager • Complaints would be presented to every second Committee meeting, with a bi-annual Scottish

Public Services Ombudsman report. • Information was sought and provided on what was included in the ‘other’ category. New coding

would be used from April 2020 which would be more informative. • The significant improvement in Stage 2 response times was welcomed. • The merits of including compliments as well as complaints was considered. Compliments were

usually entered onto Datix, and shown to the Chief Executive and to the relevant staff. An overview could be added to the complaints report.

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• Other issues discussed included increasing focus on Stage 1 as well as Stage 2 complaints, identifying themes, proactive contact with MP / MSPs, and the need to consider Care Opinion reporting.

The Committee: • Reviewed the complaints performance by operational unit • Noted the emerging themes by operational unit • Noted action taken to improve performance 9 Older People in Acute Hospitals (OPAH) Heidi May, Nurse Director a. Falls NHS Highland had overachieved against target, which was welcomed, although there was local variance in performance. It was likely the targets would be re-based and internal targets were another option to ensure continued improvement. b. Food, Fluids and Nutritional Care Longstanding gaps in metrics and outcomes had resulted in new priorities which would be reported on in 6 months. It was encouraging to be part of national work developing outcomes for FFNC for hospitals and communities. c. Tissue Viability The key priority across NHS Highland was targeting care at home and care home education, noting the range of patients coming into hospital with pressure damage. There had been some well-attended education events the previous year, also planned for the coming year, and there had been good engagement with Care at Home and Care Home representatives on the Tissue Viability Leadership Group. During discussion, reference was made to good practice in early diagnosis undertaken in N&W which was being shared through the TVLG. d. Dementia – This would be presented in April 2020. e. Documentation - This would be presented in April 2020. The Committee noted the updates. 10 Assurance Map Ruth Daly, Board Secretary The Map detailed the assurance needs and pathways within the organisation, with each governance committee being invited to consider their own areas of assurance. The Map was a live document that would be regularly updated and amendments were invited. During discussion, attention was drawn to the list of clinical governance issues that had mainly been derived from the committee’s terms of reference, of which a significant re-write was planned. Key issues to be considered included the balance between acute and community services, the clinical and care strategy, the North Highland partnership review and adult social care. Heidi May suggested using the term ‘clinical workforce’ rather than ‘doctors and nurses’ and this would be discussed with Ruth Day outwith the meeting. Heidi May offered to take the Map to the Children’s Services Clinical Governance Group and to the Control of Infection Committee.

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It was clarified that the usefulness of the Map was to identify gaps and avoid duplication and waste, and to ensure governance of issues was being undertaken in the most appropriate ways. The Committee noted the assurance map, which highlighted the assurance routes of the organisation and had been recently agreed by the Audit Committee. 11 Health and Care (Staffing) (Scotland) Act update Stephen Loch, title, on behalf of Heidi May, Nurse Director A presentation covered the following: • Staffing statistics – the increased odds of death, longer stays, nurse burnout, and poor quality

of care when the number of staff per patients was reduced • Journey so far – legislation was passed in May 2019, and the NHS Highland Nursing and

Midwifery Implementation Group was in place since October 2019, with the Group’s scope now widened

• Detail of the Act – the legal duty to provide appropriate staffing levels • Clinical leadership roles • Provision of professional advice • High costs of agency use • Duty to have real time staffing assessments and risk escalation processes in place. • Evolving Common Staffing Method • Excellence in Care • NHS Boards were required to publish and submit an annual report to the Scottish Government • Responsibilities of Healthcare Improvement Scotland • Care Services and the Care Inspectorate • Actions Currently Underway: engagement with Board Senior Management Teams and Chief

Operating Officers; testing elements of the Act to inform guidance; national working groups developing guidance with NHS Highland input; government advisors supporting Boards; workload tools and establishment reviews; Board Lead appointed, Director of HR Fiona Hogg

• Next Steps: develop an NHS Highland Programme Board; continue with NMAHP implementation group which is developing an action plan, issues log, risk register & communications plan; sub groups to be set up for each group of clinical and care staff; develop FAQ information & team updates; develop support systems for all groups implementing the Act

During discussion, the following issues were considered: • In relation to the requirement that ‘NHS Boards should not use agency that costs more than

150% of NHS Staff cost’, NHS Highland were currently not meeting this, and would therefore be required to submit a report to the Scottish Government.

• It was clarified that commissioned care staff were included but contracted services were not. However, there was a responsibility when contracting care home services to consider their compliance. A test case on this was anticipated.

• Information was sought and provided on the objectivity of the staffing model, and this included the triangulation process which comprised thousands of observations, professional judgement and patient outcomes.

• With reference to the delays that had been experienced, it was important to progress with implementation of the next steps.

The Committee: • Noted the progress made in preparing for Health & Care Staffing Act 2019 • Agreed the recommended reporting structure • Agreed the recommendations contained in this update

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REPORTING GROUP ANNUAL REPORTS 12 Area Drugs and Therapeutics Committee – Ian Rudd, Director of Pharmacy • Subgroups were functioning well with support, however it was proving challenging to attract

adequate medical representation and it was thought this was due to capacity pressure. • An emerging issue was the increased levels of regional working without a regional clinical

governance structure. This was hampering efficiency and examples of this were provided. Boyd Peters explained that a process had been started and a meeting had been held in January 2020 with key stakeholders, with a focus on cancer, which increasingly required a regional approach. Heidi May referenced the individual accountability held by each Board for its finances, and the complexity of regional governance and decision making as a result. Working together in the future was vital and required further consideration.

13 Pregnancy, Newborn and Vision Screening Programmes – Sally Amor It was noted a haemoglobinopathies screening incident would be presented to a future committee. 14 Cancer Quality and Improvement Group – Derick Macrae This was deferred to April 2020. 15 Any Other Competent Business There was none. 16 Reporting to the Board The Committee agreed to delegate to the Chair to decide which items should be reported to the Board. 17 Close of meeting: 1pm 18 Information Items The latest Hospital Standardised Mortality Ratio publication had been emailed to the Committee that morning, having been embargoed until 11 Feb 2020.

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STAFF GOVERNANCE COMMITTEE Report by Alasdair Lawton, Committee Chair

The Board is asked to:

• Note that the Staff Governance Committee met on Tuesday 11 February 2020 withattendance as noted below.

• Note the Assurance Report and agreed actions resulting from the review of thespecific topics detailed below.

Present:

Alasdair Lawton, Board Non-Executive Director (Chair) Jean Boardman, Board Non-Executive Director (Video Conference) Gaye Boyd, Deputy Director of Human Resources James Brander, Board Non-Executive Director Kevin Colclough, ? Sarah Compton-Bishop, Board Non-Executive Director (Video Conference) Paul Hawkins, Chief Executive Fiona Hogg, Director of Human Resources Stephen Loch, Lead Nurse for Workforce Planning and Development Etta Mackay, Staff Side Representative Adam Palmer, Employee Director David Park, Chief Officer (Highland Partnership) Stephen Loch, Lead Nurse for Workforce Planning and Development Ann Pascoe, Board Non-Executive Director (Video Conference)

In Attendance:

Ruth Daly, Board Secretary Leah Girdwood, Board Committee Administrator Sharon Hammell, Head of Strategic Change and Engagement Louise McInnes, Risk Manager (Item 4.4) Caroline Morrison, Education, Learning and Development Manager Lorna Munro, Internal Audit (Observer)

Apologies:

Alexander Anderson, Board Non-Executive Director Ann Clark, Board Non-Executive Director David Garden, Director of Finance Joanna MacDonald, Chief Officer (Argyll & Bute) Philip MacRae, Non-Executive Director Boyd Robertson, Chairman Gaener Rodger, Board Non-Executive Director Paul Simmons, Learning & Development Facilitator


AGENDA ITEMS

• NHS Highland Draft Assurance Map/Revised Staff Governance Committee Terms of Reference and Membership

• Assurance Report from Meeting held on 5 November 2019 • Culture Fit for the Future • Development of Dignity at Work Project • Progress on Apprenticeship Activity/Recruitment and Attraction Strategy

• Staff Appraisal and Pay Progression Considerations • Workforce Report

• Scottish Government Workforce Planning Requirements • Brexit Update • Corporate Risks Report • Staff Experience Report

• Statutory and Mandatory Training Update – Safe Information Handling • NHS Highland Whistle Blowing - Update on Standards

• Improving Grievances Processes Proposal • Draft Assurance Report from Health and Safety Committee held on 24 October

2019 • Draft Minute from Meeting of the Highland Partnership Forum held on 27

September 2019 • Dates of Future Meetings

DATE OF NEXT MEETING The next meeting will be held on Tuesday 21 April 2020.

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1 WELCOME AND DECLARATIONS OF INTEREST There were no Declarations of Interest. 1.2 NHS Highland Draft Assurance Map/Revised Staff Governance Committee

Terms of Reference and Membership Considerations R Daly presented the draft assurance map and confirmed assurance for Committee was placed within the HR and Organisational Development section. The requirement and guidance for the assurance map came from the Scottish Government handbook. The map would be a working document, presented to the Audit Committee in 6 monthly intervals. It was recognised the document was high level and did not name individual teams or staff members. R Daly welcomed further input or feedback on the document. A Palmer suggested it would be beneficial for Staff Governance Committee if the section relevant to Staff Governance assurance could be extracted for presentation at future Committee meetings. With regards to the draft Terms of Reference, F Hogg advised there had been a short-life working group set up for discussing and producing the draft. It was expected that a document with the Terms of Reference and revised approach would be ready to present to the Committee at the next meeting in April. The Committee agreed to wait until April for an update. ACTION: Agreed to provide an extract of the Staff Governance assurances for future meetings – R Daly ACTION: Noted an update on the Terms of Reference would be provided at the next meeting – F Hogg The Committee

• Considered the NHS Highland Draft Assurance Map. • Noted the progress with the revised Staff Governance Terms of Reference and

Membership Considerations.

2 ASSURANCE REPORT FROM MEETING HELD ON 5 NOVEMBER 2019 There had been circulated draft Assurance Report from the meeting on 5 November 2019. The Committee Approved the circulated draft Assurance Report.

3 MATTERS ARISING 3.1 Culture Fit for the Future F Hogg advised an update on Culture Fit for the Future had been presented at the last Board and Board Development meetings. She noted that during the most recent visit of the Cabinet Secretary, emphasis had been placed on the importance of progressing with the healing process. Areas where additional support could be provided from Government were identified. It was hoped the process would be up and running by May 2020.

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The Culture Programme Board was confirmed to be up and running. Interviews had taken place for the position of Chair of the Board. P Hawkins confirmed he would attend the next meeting. The Terms of Reference for the Board had been approved, and discussions were to follow regarding the purpose and focus of members. A Palmer highlighted the need to move quickly to resolve older cases, advising the Cabinet Secretary believed the cases provided quick win opportunities for NHS Highland. He noted a visit was to follow from Gregor Smith on 18 February 2020 to check progress. F Hogg advised of ongoing discussions around outstanding cases and what could be done to continue to make progress. It was acknowledged that the ‘Once for Scotland’ policy could provide help with improving the process and this would be discussed at the next meeting of the Highland Partnership Forum. After discussion, the Committee Noted the current position.

3.2 Development of Dignity at Work Project NHS Highland was noted as one of the pilot Boards for the new Dignity at Work project for NHS Scotland. It was recognised that the current approach in place had not made any impact in Highland. F Hogg advised that a number of colleagues had attended the initial workshop for the project. E Caithness highlighted the benefit of attending the workshop. A Palmer advised the project was still in the first stages and further updates would be available in due course. The Committee otherwise Noted the position.

3.3 Progress on Apprenticeship Activity/Recruitment and Attraction Strategy S Hammell introduced the circulated report on the current position of the attraction, recruitment and retention strategy. NHS Highland’s online recruitment was being assessed for areas of improvement. It was suggested there could be quick wins gained through enhancement of current online activity. Work was also underway with Highlands and Islands Enterprise, who had successful recruitment campaigns on LinkedIn, to improve NHS Highlands LinkedIn presence. The NHS Highland exit questionnaire was to be relaunched. The importance of the completion was highlighted; it was believed it could provide more comprehensive data around staff retention and allow improved responses to feedback. The importance of stakeholder engagement in the strategy was highlighted, identifying common challenges and opportunities in the Highland area and promoting the area as a great place to live and work. With regards to apprenticeships, the apprenticeship programme was to be optimised. A draft of the attraction, recruitment and retention strategy would be produced by the end of March 2020. During discussion, J Brander highlighted the benefit of engaging with schools to encourage children to pursue careers with NHS Highland. He noted the success of a recent visit by pupils from Raigmore Primary to meet with NHS nurses to find out about nursing careers. He also noted the presence of NHS Highland at a Nairn Academy careers evening. S Loch had attended the event and agreed it was a success and should be built upon in the strategy going forward. K Colclough advised a team would be developed to work at careers events in Highland. In relation to apprenticeships, C Morrison confirmed there was work required to identify gaps with relevant education providers. E Caithness suggested there should be greater focus on staff retention. She also suggested people were willing to come to the Highlands but required more information on the benefits of living and working here. S Hammell agreed to discuss the matter further out with Committee. A Palmer stated there was improvement needed in gathering data from exit questionnaires.

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He also advised a survey had been completed on what contributed to enabling staff to work longer, which could provide further data on retention, noting the information gathered from both surveys should be linked together to aid formalisation of plans. D Park recognised improvements could be made on movement of staff between departments and roles. He recognised there was competition for recruitment within NHS Highland. He also noted there was a gap in available data which could pinpoint skillsets or geographical areas which have particular risks related to recruitment. Following discussion, the Committee Noted the update.

3.4 Staff Appraisal and Pay Progression Considerations F Hogg provided an update on staff appraisal and pay progression, advising a Pay Appraisal Programme Board had been developed and the Terms of Reference confirmed. Focus had been on statutory and mandatory training. On the staff appraisal process, she recognised the need to create a process which would be easy for all staff and allow beneficial conversations to take place. She recognised there were similarities between roles across NHS Scotland and national generic objectives could be created to make the appraisal process even easier.

Paul Hawkins left the meeting at 10.50am 4 WORKFORCE 4.1 Workforce Report G Boyd provided the Committee with an update, as at end November 2019. She highlighted a decrease in wte vacancy numbers which had been expected as the recruitment process had slowed down in October 2019. Bank and locum usage had remained consistent, and an increase was reported in agency usage. The number of fixed term contracts had increased slightly, with maternity cover being identified as the main reason for this. There had been no change in NHS Highland’s job families, nursing and midwifery remained the highest percentage of the workforce. Staff turnover had continued to decrease. A summary of Occupation Health activity was provided and it was noted there had been a decrease in the total number of referrals since the August report. There had been an increase in sickness absence levels, with the highest percentage being from the North & West area. Capability and grievance remained the highest proportion of employee relations cases. The number of staff on the redeployment register continued to fluctuate. It was noted an audit was being undertaken into the redeployment process. During discussion, A Pascoe queried supplementary staffing figures and whether there was a target figure. It was noted there was a buffer figure used for bank staff, so there would not be a target of zero. It was further noted supplementary staff were not used solely to cover vacancies. S Compton-Bishop noted poor trends appeared in some of the data sets. She suggested culture improvements should be reducing workforce problems. F Hogg advised this was an ongoing area of concern, and that the main concerns from the report were in relation to long-term sickness levels. She noted the importance of keeping staff in work by managing relationships, especially in situations which have been caused by stress or unhappiness. There would likely be no reduction in sickness until problem areas had been worked through. In relation to vacancy numbers, D Park queried whether there was a recruitment problem, or a lack of capacity to recruit due to problems with the process. G Boyd advised there was not currently a way to report accurately on the issue. The data presented how many people were recruited. K Colclough noted the new Job Train system would give better data for reporting

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on this, but the data available was limited as the system had only recently been rolled out. He suggested a model report for the data expected from the system could be provided to the next meeting. Etta Mackay queried whether there was an age profile available for the sickness absence numbers. She further noted there was no menopausal policy within NHS Highland. G Boyd advised a policy was being set up. ACTION: Agreed a model report on Job Train data would be provided for the next meeting – K Colclough The Committee

• Noted the content of the report • Noted the areas that require further improvement

4.2 Scottish Government Workforce Planning Requirements – Projections and

Annual Operational Plan Element (Incl Update on Health and Care (Staffing)(Scotland) Act

K Colclough provided an update on workforce planning. The NHS Highland plan had been published for 2019/20. The national workforce plan had also been published and would be presented for the next Committee meeting. The annual strategic plan for 2020/21 was still to be published, noted as being in the final stages. He advised a draft would be taken to the Highland Partnership Forum and a formal plan brought back for Staff Governance Committee in April. A new 3 year plan was to be published in 2021. The workforce chapter for the Annual Operating Plan had been drafted, and feedback from Scottish Government on this had been positive. With regard to the Health and Care (Staffing)(Scotland) Act, S Loch advised there had been a lot of activity from a Nursing, Midwifery and Allied Health Professional perspective. There was work ongoing for set up of a Programme Board to ensure compliancy. He noted Scottish Government had since funded 1 wte nursing post. K Colclough highlighted the challenges for professions without a workload tool in place. He recognised the requirement to submit workforce projections to Scottish Government on an annual basis. A fully developed Clinical and Care Strategy was thought to provide a fuller idea of what these projections would be. ACTION: Agreed to provide a fuller update on the matter to the April meeting – K Colclough The Committee Noted the update

4.3 Brexit G Boyd advised the internal group had stood down whilst awaiting further information on the matter. Scottish Government would be providing updates. NHS Highland were continuing to encourage staff to apply for resident status. The Committee Noted the current position

4.4 Corporate Risks Report L McInnes provided an update on the corporate risk register, and the corporate risk report which would be taken to all future meetings of Staff Governance Committee. She advised there was a review of the arrangements for risk management across the NHS Highland. The Risk Management Steering Group were embedding the changes made to the risk

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management process and ensuring the process was aligned with management functions. There would be stronger links to governance groups for better visibility of risks. All corporate risks had been aligned to one of the Governance Committees. She stated training and further guidance would be provided on risk management and on the actions required with regards to risks. During discussion, A Palmer noted that non-completion of PDPs had not been added as a risk. F Hogg advised this would be one to consider in the future but completion of PDPs was not mandatory which would cause a problem. She suggested how conversations were managed could be risk to be added. D Park highlighted the need to ensure an understanding of how risks could be removed from the register, noting clarity on this would be required. The Chair advised the document would be a working document, reviewed regularly. L McInnes added the project was still in phase one and further work was required, including how to remove risks. The Committee Noted the content of the report

5 STAFF EXPERIENCE 5.1 Staff Experience Exception Report C Morrison talked to the previously circulated report. She noted there were 4 primary work streams and an update was provided for each. In relation to performance management, she advised there had been a review of the Mandatory Training and Induction Policies. The Induction Policy provided information on what is expected of new starts on their first day, first week and first 3 months in post. There was a need to address low compliance for the induction programme. A portal for corporate induction had been produced. The Chair highlighted the need for a balance between staff completing training and carrying out their routine workload. D Park added there was a requirement for compliance, and that the South & Mid team had made great progress with their compliance rates for training. On modernising careers, C Morrison advised the number of apprenticeships had increased to 20, but it was recognised the figure needed to be maintained. She advised 10 of the modern apprenticeships contained management elements. Foundation apprenticeships had been piloted; however the apprentices would not be employed by NHS Highland. Graduate apprenticeships were noted to provide an opportunity to grow and develop existing staff. It was stated mandatory funding was given to training providers for more apprenticeships than were currently in employment. A tentative plan was in place to resolve this and maximise on the funding. Leadership and Management development was being reviewed. A portal was in development for new leaders and managers, and had received positive feedback. Sessions on courageous conversations training were ongoing and demand for the sessions had been high. There were concerns with capacity around the training; however, it was thought it should be seen as mandatory for leadership roles. On staff experience it was noted that completion of PDPs had been poor. Communication was required to highlight the importance of PDPs to staff. A set of national behaviours had been identified which tied in with the culture programme and PDPs. With regards to iMatter it was noted managers were required to confirm their own teams to ensure information was recorded accurately on the system. 30% of teams had been confirmed. Continued communication would be sent to managers. A Palmer highlighted to

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the Committee that an iMatter national comparison report was available and contained data that required attention. It was agreed this would be added to agenda for the next meeting. ACTION: Agreed an update on the apprenticeships plan would be provided to the next meeting – C Morrison ACTION: Agreed an update on completion of PDPs be provided to the next meeting – C Morrison 5.2 Statutory and Mandatory Training Update – Safe Information Handling There was no discussion in relation to this Item. After discussion, the Committee:

• Considered the content of the circulated report • Agreed a further update was required for the next meeting

6 LOCAL AND NATIONAL POLICY IMPLEMENTATION (Incl. “Once for Scotland”) 6.1 NHS Highland Whistle Blowing – Update on Standards F Hogg noted the ‘Once for Scotland’ programme looked at the whistleblowing policy and standards. A final version of the policy and standards would be ready and implemented by July 2020. She recognised the NHS Highland process needed to be compliant, and include primary care colleagues and contractors. A short-life working group had been set up to ensure all areas were sighted on the plan. She advised training was due to be issued. It was highlighted to the Committee that the whistleblowing policy was not intended to be a HR owned policy, as it concerns all areas of the organisation. A Palmer advised there was a new Non-Executive Whistleblowing Champion who would be covering both NHS Highland and NHS Grampian, and would report into the Cabinet Secretary. A Palmer and G Boyd also highlighted they had been working on a pre-whistleblowing stage which would potentially be a raising concerns policy. This was to be raised at the HR Sub Group and the Highland Partnership Forum to ensure it’s requirement. The Committee Noted the current position within NHS Highland relating to Whistle Blowing.

6.2 Improving Grievances Processes Proposal A Palmer highlighted the need for an informal procedure which would enable concerns to be resolved before a formal procedure initiated. Part of the work had begun, with a training day for HR & Staffside representatives for the ‘Once for Scotland’ policies which were approved and would be implemented in March. G Boyd noted Highland had taken the opportunity for ‘Once for Scotland’ policies to link with ongoing culture changes. The Committee Noted the updated position.

7 REPORTS FROM OTHER COMMITTEES 7.1 Draft Assurance Report from Health and Safety Committee – 24 October 2019

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7.2 Minute from Meeting of the Highland Partnership Forum – 27 September 2019 (Draft)

The Committee otherwise Noted the circulated draft Minutes.

8 DATES OF FUTURE MEETINGS The Committee Agreed the following meeting schedule for 2020: 21 April 4 August 20 October 9 AOCB There were no matters discussed in relation to this Item. 10 DATE OF NEXT MEETING The next meeting of the Committee will take place on Tuesday 21 April at 9.00am in the Board Room, Assynt House, Inverness.

The Meeting closed at 12.00pm

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HIGHLAND NHS BOARD

Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk

DRAFT MINUTE of MEETING of the NHS Board Audit Committee

Board Room, Assynt House 25 February 2020 2.00pm

Present: Mr Alasdair Christie, NHS Board Non-Executive (In the Chair) Mr Alexander Anderson, NHS Board Non-Executive (VC) Mrs Ann Clark, NHS Board Non-Executive Mrs Ann Pascoe, NHS Board Non-Executive

Also Present: Mr Boyd Robertson, Chair NHS Highland Dr Boyd Peters, Board Medical Director

In Attendance: Mr Iain Addison, Head of Area Accounting Mr John Boyd, Grant Thornton Mr Chris Brown, Scott Moncrieff Ms Charlotte Craig, Business Improvement Manager (VC until 2.30pm) Mrs Ruth Daly, Board Secretary Mr D Eardley, Scott Moncrieff Mr David Garden, Interim Director of Finance Miss Leah Girdwood, Board Committee Administrator Ms Fiona Hogg, Director of Human Resources and Organisational Development Miss Stephanie Hume, Scott-Moncrieff Ms Deborah Jones, Director of Strategic Commissioning, Planning and Performance (Item 3.1) Ms Joanna MacDonald, Chief Officer (Argyll & Bute) (VC from 2.30pm) Mr David Park, Chief Officer (North Highland) Mr Donald Peterkin, Data Protection Officer (Item 3.1) Mrs Christine Thomson, Board Committee Administrator

1 WELCOME, APOLOGIES AND DECLARATION OF INTERESTS

Apologies for absence were submitted from Heidi May, Gaener Rodger and Paul Hawkins.

Members were asked to consider whether they had an interest to declare in relation to any item on the Agenda for this meeting. The following declarations were made:

NHSH Board 31 March 20, Item 15c177

Mr A Christie advised that being an elected member of the Highland Council he had applied the test outlined in paragraphs 5.3 and 5.4 of the Code of conduct and concluded that this interest did not preclude his involvement in the meeting. The Committee Noted that the meeting would be audio recorded for administrative purposes and that the recording would be deleted once the Minutes had been completed. 2 MINUTE OF MEETING HELD ON 20 JANUARY 2020 The minute and action plan of the meeting held on 20 January 2020 were Approved. The Committee: • Approved the Minute of the meeting held on 20 January 2020. • Noted the rolling action plan. 3 MATTERS ARISING 3.1 GDPR Update Donald Peterkin advised that self-assessments had been issued to 13 named individuals in various areas in the Board with a closing date of 28 February. Of the five self-assessments received to date, three were ready to be reissued with action plans to the areas including any learning points. No major issues had been identified to date with emphasis being on smaller learning points which with some commitment from the areas should be easy to resolve. Any common themes would be fed back through the organisation for learning purposes. It was noted that while the current risk for the organisation was high, after the pilot assessment on South and Mid the risk had reduced in the area. The pilot area were still working on their action plan which was due 28 February 2020 and which should further reduce risk. It was agreed that Donald Peterkin keep the Chair advised by e mail whether appropriate progress was being made and identify any issues. It was further noted that this would also be reported through the Executive Directors Group (EDG). The Committee Noted the update. 4 INTERNAL AUDIT 4.1 Internal Audit Progress report There had been circulated a copy of the progress report which summarised Internal Audit work undertaken up to 11 February 2020. It was noted that good progress had been made against the annual audit programme and that internal audit were on track to deliver the Internal Audit plan for 2019/20 by June 2020. The Business Continuity Planning report and the IT Service Redesign report would be presented to the Audit Committee in May 2020.

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The Committee Noted the Internal Audit Progress Report. 4.2 Individual Reports for consideration 4.2.1 Counter Fraud Stephanie Hume spoke to the circulated report which focussed on NHS Highland compliance with best practice and national requirements. It was noted that David Garden and Gaye Boyd were the sponsors for the audit. Areas of good practice were identified including that a Counter fraud policy was in place and training was available. However, a number of areas of improvement had been identified. She highlighted in particular that no formal fraud risk assessment had been undertaken within the organisation. The management response provided noted this is due to be completed by March 2021. Stephanie Hume also highlighted that a formal counter fraud training and awareness programme had not been put in place. Training was available on LearnPro but it was not mandatory and only 3.5% of staff had undertaken the training. This was augmented by staff not having an understanding of the key policies and a lack of clarity regarding roles and responsibilities. Improvements were also identified in relation to the fraud policy, ensuring it is up to date and reflects current practice, and fraud cases are handled in line with agreed procedures. During discussion, Ann Pascoe highlighted that the monetary value of fraud cases in the Highland Board was small compared with the rest of Scotland. She queried if this was an area of concern. Chris Brown confirmed if the number of cases is considered proportionally lower than other Boards this should be an area of concern, particularly in relation to counter fraud training. Iain Addison noted that the number of potential fraud cases investigated by CFS on behalf of NHS Highland was in proportion to the size of other Boards. With regards to training, Alexander Anderson questioned when training action would begin and whether all staff would be trained on counter fraud. Fiona Hogg advised that a phased approach had been suggested together with a short LearnPro module which would be mandatory for all staff but recognised a formal plan would be required to implement this. The Chair acknowledged there were issues around risk assessment, training, policies and communication and stressed that these needed to be addressed. He suggested a list of the common themes highlighted by Internal Audit reports could be compiled and used to help support development throughout the Health Board and requested that counter fraud should be a substantive item going forward to keep the Committee aware of progress. After discussion, the Committee

• Noted the report findings • Agreed counter fraud should become a substantive item for Audit Committee

4.3 Internal Audit Plan Chris Brown spoke to the previously circulated updated draft internal audit plan for 2020/21. He highlighted the need for the internal audit resource to be as useful as possible. He reminded members of the definition of internal audit being to provide an Independent objective assurance and consulting activity. The aim was to provide assurance to the Board through Audit Committee that processes and controls were in place to manage key risks and

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achieve objectives and that these process were working well. In addition internal audit provide assistance to management in improving services.

It was noted that the 450 day plan should provide as much added value as possible. The draft plan previously circulated set out areas which had been previously been suggested and comments were welcomed on areas for focus or priority. It was noted that this would be further discussed with EDG.

The Chair considered that focus should be on supporting aims of getting to the destination in terms of descending the ladder of escalation and preparing processes and plans to meet matters highlighted in the Section 22 Report. He considered that internal audit should be used in a wider way to demonstrate that financial responsibilities were being met and targets and efficiencies being made.

Chris Brown confirmed that reviews had been completed in the past to make recommendations for improvement following a consultancy “critical friend” style and that this could be done again.

Ann Clark queried whether NHSH devoted a smaller proportion of its resource to internal audit than most other Boards. It was noted that 450 days is within a reasonable range but at the lower end of the range. Ann Clark requested a management view on whether there was a need for additional resource. David Garden suggested that when this went to tender, other boards were assessed in comparison and NHSH was not far from the norm and that some other boards with more input days may use less qualified individuals. It was noted that when originally awarded the contact was for 500 days. It was stressed that if any additional days were requested from Internal Audit it was important to look at how the days are used to ensure they are aligned to key risks and priorities. The need to provide evidence of action to PAPLs was provided as an example and it was noted that a section 22 action plan was being developed.

On a query from Alex Anderson as to why the allocation of audit days to financial systems were low it was noted that financial systems already receive a considerable amount of audit scrutiny from External Audit on an annual basis in addition to any Internal Audit work and given the finance teams are aware of this process, strong systems of control are often maintained which lead to less issues being identified.

On a query in respect of the 2022/25 plan, it was noted that a 3 year plan was developed which was refreshed every year, with another 3 year plan being developed at the end of the 3 years.

It was agreed that the views of the EDG should be sought and these be shared with the Committee. Boyd Robertson stressed that spotlight was on Highland and that it would be useful to show that any increase in audit time had been directed towards particular areas. Additional days should be targeted to areas requiring improvement which would provide assurance to Government and select committees reviewing NHSH.

David Park suggested that the total number of outstanding actions should be considered when discussing adding additional audit days as while management were beginning to respond to actions, they still required clearing. The Chair noted again that any additional Internal Audit resource would be targeted and would likely not result in standard audit actions but aid the Board moving forward. It was noted that internal audit could be used to the Board’s benefit by providing an independent view to look at progress made and benchmark. David Garden stressed that an internal follow up system had been agreed and it was noted that if the follow up situation could be improved then the number of audit days allocated to follow up could be used more usefully.

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The Committee Agreed that further discussion on the Audit Plan take place at EDG 4.4 Follow up report David Garden drew attention to the effort which had been put into audit follow ups since the last Committee meeting and the progress that had been made, stating that the number of outstanding actions had been reduced and work was continuing to make further progress. Stephanie Hume spoke to the circulated report providing an updated position on the follow up of internal audit actions. She advised that there were 58 outstanding actions, of which 26 were partially complete, 5 awaiting response, 27 not yet due and 16 which were no longer applicable. She noted that some of the due dates had been changed by management on the 27 actions not yet due, but that 13 had not passed their original due date. David Garden explained that the follow ups would be undertaken internally and recruitment for a member of staff to provide dedicated time to this would be carried out in 2020/21. The Chair noted this would be good evidence to provide at the PAPLs Committee to show work was being done within NHS Highland to prevent the issues in the Section 22 report occurring again. During discussion, Ann Pascoe queried the position in relation to older actions and their relevance. Chris Brown confirmed that everything contained within the report was still relevant as during each exercise management were provided with the opportunity to highlight any which were no longer relevant. David Garden added that older actions were being worked through and due dates were being revised. Alexander Anderson raised concerns around the amendment of due dates, noting no actions on the report appeared as overdue. Stephanie Hume confirmed that only 13 of the 58 actions had not had the due dates revised and as such the remaining had passed their original due dates set by management, and that the responsible officer would set and review the completion date. The Chair proposed transferring the outstanding actions identified as risk level grade 3 or 4 to the corporate risk register in order to incentivise resolution. He stressed that every Executive Director would be required to attend the special meeting of the Audit Committee; otherwise the related action would be escalated to the Board. Ruth Daly agreed to contact Executive Directors to emphasise the requirement for resolution, and to arrange the transfer of the high grade actions to the corporate risk register. The Chair recommended that no amendments to due dates be allowed until after the special meeting of the Audit Committee. Stephanie Hume advised most of the actions which were not yet due, would be due in March 2020. It was agreed that extracts from the original audit reports be circulated to allow the full remit of the actions to be viewed. The Chair queried the actions which were identified as no longer applicable in the report. Stephanie Hume clarified that these were actions which management had been unable to complete and the outcome had been that managers had either chosen to accept the risk, or moved the risk onto a risk register to be managed elsewhere. The Chair proposed this outcome could be used to address some of the actions which had not been clear or not understood by officers. After discussion, The Committee

• Noted the follow up report • Agreed to arrange a special meeting of the Audit Committee before the PAPLS

Committee

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• Agreed Executive Directors should attend the special meeting of the Audit Committee

• Agreed to circulate extracts of the original audit report for overdue actions

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5 EXTERNAL AUDIT 5.1 Draft External Audit Plan John Boyd spoke to the draft external audit plan. It was noted they were still awaiting audit fees to be confirmed by Audit Scotland for audit remunerations. The purpose of the paper was to propose the audit fees for 2019/20 to the Committee. He advised the fees related to audit risks with the financial statements, particularly around the valuation of PPE. The plan also reflected the work on the Section 22 report as external audit were expected by Scottish Government to follow up actions raised in the report. Iain Addison raised concerns over the increased fees for the work on the pension fund, as this work was always required annually. He also noted the PPE assets were revalued annually, and the highest valued assets were revalued more frequently and was unclear as to the requirement for the additional work identified by external audit in relation to this. Ann Clark sought clarification on whether feedback had been passed to External Audit on the matters raised and whether there was any solution available to prevent extra costs in the future. John Boyd confirmed feedback had been received and a response given. In relation to pensions and valuation of PPE he advised there had been an increased focus from the accounting regulator on external audit work in these areas. External Audit would have to use their own valuation specialist for PPE to provide an independent review of the valuations, noting this increased the risks around PPE. He also advised there was a requirement for an independent review of pensions and Grant Thornton would be required to complete this in-house due to timing issues around the central review, which reflected the additional costs. After discussion, the Committee Noted the draft External Audit Plan. 6 COUNTER FRAUD 6.1 Update of Fraud Awareness The previously circulated report on fraud awareness was noted. The Chair advised that the Annual review meeting had taken place where comparisons could be made with other Boards in Scotland. It was noted that Highland was not out of step in terms of reported cases and that a case had been made for webinar training. Ann Clark expressed concern as to whether the approach to the impact assessment tool was sufficient or whether a more defined project management approach should be taken to the rollout. It was noted that the tools helped to highlight areas where higher risks are found. It was noted that resource would be pursued with payroll department to address payroll matching as this required to be completed by the end of the financial year. The Committee Noted the report. 7 RISK MANAGEMENT 7.1 Risk Management and Corporate Risk Update Boyd Peters informed the Committee that the Chief Executive had decided that the Medical Director would be responsible officer for risk management. Talking to the previously

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circulated report, he advised the risk management process and corporate risk register appeared to be in an improved state. The Committee members highlighted a number of amendments which were required to the document such as reference to individuals as risk owners. It was also highlighted that some risks had multiple Committees noted as risk owners in the documentation. Boyd Peters confirmed there would be a meeting with Louise McInnes, Risk Manager, to discuss the particular risks related to each Committee. The Chair stressed the need for clarification on this as there was a potential for difficulty when sharing information relating to risks with Committees. He also suggested that risk owners should be job titles rather than named individuals to prevent confusion and errors when individuals move on or organisation restructures take place. Alex Anderson queried the need for involvement of Committees when decisions on risks are made by the Risk Management Steering Group. Chris Brown confirmed the purpose of the discussion of risks at Committees was to provide assurance and oversight. The Committee Noted the update. 8 FINANCIAL GOVERNANCE 8.1 Draft Accounting Policies Speaking to his previously circulated report, Iain Addison highlighted changes to this year’s report in respect of new International Financial Reporting Standards that apply to NHS Boards, noting the most significant change was IFRS16 which related to leases. He advised this would be formally adopted in April 2020 and work was ongoing for the implementation of this. The Committee Noted the draft accounting policies and Agreed to adopt them. 9 AUDIT SCOTLAND The Committee Noted the following reports highlighted from the Audit Scotland website:

• The 2018/19 audit of NHS Lothian, 18 December 2019 – Delay to the opening of the Royal Hospital for Children and Young People

• Preparing for withdrawal from the European Union, 16 December 2019 • Children and Young Peoples Commissioner Scotland Annual Audit report 2018/19,

1 December 2019 The Committee Noted the highlighted reports. 10 ANY OTHER COMPETENT BUSINESS There was no other competent business.

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11 DATE OF NEXT MEETING The Chair noted a special meeting of the Audit Committee was to be arranged before the PAPLS Committee meeting with the next scheduled meeting of the Audit Committee being held on 19 May 2020 at 2.00pm in the Board Room, Assynt House, Beechwood Business Park, Inverness.

The meeting closed at 4.00pm

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HIGHLAND HEALTH & SOCIAL CARE GOVERNANCE COMMITTEE Report by Committee Chair


• Note that the Highland Health & Social Care Governance Committee met onWednesday 5 February 2020 with attendance as noted below.


Present:

Ann Clark, Board Non-Executive Director - In the Chair James Brander, Board Non-Executive Director Dr Paul Davidson, Medical Lead David Garden, Director of Finance Tracy Ligema, Head of Community Services Deidre MacKay, Non-Executive Director Adam Palmer, Employee Director David Park, Chief Officer Simon Steer, Interim Director of Adult Social Care

In Attendance:

Mary Burnside, Head of Midwifery (from 1.40pm) Leah Girdwood, Board Committee Administrator (Observing) George McCaig, Performance Manager (from 1.45pm) Brian Mitchell, Board Committee Administrator Ann Pascoe, Chair of the Carers Improvement Group (from 1.25pm) Michael Simpson, Public/Patient Representative Katherine Sutton, Head of Acute Services (from 3.00pm) Ian Thomson, Lead Social Work Officer (North and West)(from 1.25pm) Dr Neil Wright, Lead Doctor (Videoconference)

Apologies:

Rhiannon Boydell, Mid Ross District Manager Councillor Biz Campbell, Highland Council Dr Ann Galloway, Area Clinical Forum Representative Dr Ian Kennedy, Lead Doctor Margaret MacRae, Staffside Representative Philip MacRae, Board Non-Executive Director Cllr Linda Munro, Highland Council Sara Sears, Associate Lead Nurse (North) Cllr Nicola Sinclair, Highland Council

NHSH Board In-Committee 31 March 2020, Item 5d187

AGENDA ITEMS

• Financial Position as at end December 2019 • Assurance Report from 7 November 2019

• Update on Flow Activity • Progress Report on Implementation of Carers (Scotland) Act 2016 • Minute of Meeting of Clinical Governance Committee held on 3 December 2019 • Minute of Meeting of North Highland Local Partnership Forum held on 5

December 2019 • Minute of Meeting of North Highland Health and Safety Sub Committee held on

11 September 2019 • North Highland Performance Reporting – Health and Wellbeing Balanced

Scorecard and Annual Operational Plan Performance Report

• NHS Highland Annual Operational Plan – Waiting Times Update • Chief Officer’s Reports • Update on Review of Partnership Agreement • Monitoring the Delivery of Adult Social Care Contracted Services

• Scottish Parliament Adult Social Care Inquiry DATE OF NEXT MEETING The next meeting will be held on Wednesday 15 April, 2020 in the Board Room, Assynt House, Inverness.

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1 WELCOME AND DECLARATIONS OF INTEREST At the commencement of the meeting a short Development Session was held, with a view to ensuring Committee members had a more in depth understanding of the underlying detail of financial reporting being presented to Committee, in relation to which they were required to take appropriate assurance or otherwise. Members were advised D MacKay had agreed to accept the role of Committee Vice-Chair. There were no formal Declarations of Interest made. 2 FINANCE 2.1 Summary Financial Position as at end December 2019/NHSH Recovery Plan

Update D Garden spoke to the circulated report advising as to the overall NHS Highland financial position, reporting a revenue budget overspend of £10.9m and a potential projected out-turn overspend of £14m, with £2.5m of required savings still to be delivered. The attention of members was drawn to Divisional area level performance, with aspects relating to Raigmore Hospital being highlighted, noting cost pressures relating to drug, locum and clinical supplies expenditure. Overall, movement from Months 8 to 9 had shown significant improvement. Members were also shown an indication of the summary subjective spend position, overall savings delivery to date and by Unit area, and locum/supplementary staffing spend comparison with previous years. D Park took the opportunity to advise the financial management and savings programme, through greater engagement levels, had been successful to date and allowed for greater confidence in reporting detail. He paid thanks to all staff who had been involved to date. The Chair advised there would be a focus on locum and supplementary staffing spend at a future Committee Development session. She further welcomed the progress made in relation to securing a high level of recurrent savings. In terms of looking forward at the next meeting, D Park confirmed good progress was already being made in relation to developing both the Annual Operating Plan and Savings Plans required for 2020/2021. After discussion, the Committee:

• Noted the M6 year to date position of an £10.9m overspend on budgets, and a projected overspend of £14m.

• Noted the forecast comprised £2.5m of unidentified savings.

The Committee agreed to consider the following Item at this point in the meeting. 3 PERFORMANCE AND SERVICE DELIVERY 3.1 Progress Report on Implementation of Carers (Scotland) Act 2016 I Thomson spoke to the circulated report, advising as to progress in relation to bringing together a Carers Programme, developing a comprehensive Carers Strategy, understanding available resources and developing a Carers Programme budget, developing a new range of services for Carers in Highland, development of Short Breaks Statement, the waiving of charges for services for Carers, and otherwise supporting practice across Highland. It was noted A Pascoe, NHSH Non-Executive Board member had been appointed Chair of the Carers Improvement Group. A Pascoe stated current focus related to establishing pilots to help gather evidence of Carers actual needs and training requirements, as well as an audit of all Delayed Discharges over 6 months in duration so as to define what it is that Carers

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actually need at this time. She stated there was also a need to consider cultural elements relating to the inclusion of Carers as part of a wider person-centred care approach. She stated oversight of the relevant £1.8m budget was key, recognising support provided to the client also represented a level of benefit to the associated Carer(s) involved. On the points raised during discussion, I Thomson undertook to establish the level of Carers Support Plans currently in place, confirmed activity was underway to bring relevant budgets together and advised the £1.8m resource outlined was provided for new Carer Improvement activity only. The Chair agreed the need for receipt of assurance in relation to available resource and direction of associated spend. M Simpson sought further information on the three pilot areas identified and was advised these had been chosen on the basis they met the criteria of having the necessary facilities to enable a full Carer needs evaluation to take place prior to any eventual rollout, at which point consideration would be given to equity of access to services. D Park welcomed progress to date, and an increased spend profile. He highlighted the need to remain sighted on the total level of resource available and to be able to ensure this was utilised in the most effective and informed manner. A Pascoe confirmed officers were sighted on relevant GDPR legislation as part of any evaluation of direct/indirect benefit to Carers. In terms of Strategy development, I Thomson advised this would take place as learning was received and appropriately evaluated. He added much of the available resource would be consumed through provision of the Information and Advice Service, provision of Local Carers Link Workers and for Self-Directed Carer Support. As the outcome of pilot areas was received a high level Strategy would emerge, with rural areas to be a particular focus. In terms of unmet need, P Davidson sought an update on how individual Carers were to be identified and suggested this as a role for the Carers Practice Development Officer. It was confirmed those involved were working closely with Lorraine Coe, Sutherland District Manager on this point whilst recognising that some individuals would be reluctant to self-identify as a Carer at all. I Thomson confirmed creative approaches were being encouraged, and that officers continued to work with Public Health on relevant aspects. After discussion, the Committee: • Noted the outline for progressing a Carers Programme, the steps proposed to bring

together a comprehensive Carers Strategy, the outline of a development of a Carers Programme Budget, and the work being undertaken to comply with full range of duties contained within the Act.

• Agreed the expenditure necessary to implement three Carers Services pilots. • Agreed the high-level profile to direct a tender for high quality and effective Carers

services in Highland. • Agreed proposals to progress recruitment of a Carers Practice Development Officer.

A Pascoe and I Thomson left the meeting at 2.00pm

3.2 Assurance Report from Meeting held on 7 November 2019 There had been circulated draft Assurance Report and associated Rolling Action Plan from the meeting of the Committee held on 7 November 2019. The Chair advised the Rolling Action Plan would be developed to become a live document. The Chair went on to advise literature relating to recruitment of Lay Representatives had been reviewed prior to a new recruitment exercise planned for late February/early March 2020. Discussion had been held with the Communications Team following the previous recruitment exercise with a view to improving the level of interest generated. The Committee Approved the circulated draft Assurance Report.

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3.3 Matters Arising 3.3.1 Update on Flow Activity (incl Delayed Discharge) D Park gave a presentation to members on delayed discharges which had recently been considered by the NHSH Oversight Group. . Displaying data relating to Delayed Discharge across NHS Highland sites, members were advised this had increased in the previous year, with the predominant rise relating to Raigmore. The closure of a 28 bed Care Home in late 2019 had impacted however underlying Care Home and Care at Home capacity constraints were the major contributors. It was reported these constraints accounted for 83% of delays, with 54% of lost bed days related to Care Home/Adults with Incapacity. Care at Home capacity was reported as being directly related to recruitment issues, with Highland experiencing a relatively low unemployment rate at that time. In Highland over 75% of Care Home capacity was provided by the Independent Sector. D Park went on to advise that two new Care Homes were to open within six months. In terms of an Action Plan moving forward, there would be discussion with the Independent Sector to address issues of risk and to consider block purchase arrangements, continued discussion on developing a Care Academy and Care Staff Bank, pilot of a front end Enhanced Recovery Service to support discharge and ensure best use of available resources, development of an enhanced support service for Care Homes so as to prevent admissions, and provision of additional coordinated assistance in association with Scottish Government. During discussion, reference was made as to night time care levels and S Steer advised this was impacted by relevant Working Time and Living Wage Regulations. As a result, consideration was being given as to the need for continued overnight presence and whether alternative, responsive, mobile solutions could be introduced where applicable. He stated this became more difficult within remote and rural areas. Overall, there was a need to ensure the total available resource was utilised in a coordinated manner for the widest benefit to Highland patients. A care cluster approach may be considered. On working with Care Homes to avoid hospital admissions, it was advised a Flow Programme Board was to be established to consider aspects including pre-hospital care. He emphasised the importance of clinical interface arrangements. Dr Wright confirmed the value of being able to discuss care matters with relevant colleagues, highlighting community resource constraints as a very real issue. The Chair raised the subject of Hospital at Home services, as supported by the Cabinet Secretary, and was advised there was no set framework as to what that should or may involve. This had yet to be considered for Highland. It was confirmed that IV antibiotic delivery at home was provided in some areas of Highland however this was not a universally available service. The Chair, in welcoming the intended Programme Board approach, also heard that the overall Oversight Board structure being implemented by Scottish Government was in place for all NHS Board under Level 4 support arrangements, with the individual topic areas subject to change. The Committee otherwise Noted the presentation content and update provided.

3.4 Sub Committee and External Groups 3.4.1 Clinical Governance There had been circulated Minute of Meeting held on 3 December 2019. On the point raised in relation to Migdale Hospital, D Park advised staffing resource had been identified and the Strathy Ward re-opened. One patient had been transferred to New Craigs during the period of Ward closure. Whilst no changes were envisaged at that time,

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activity was underway to secure an enhanced Mental Health Leadership Team. T Ligema confirmed recent successful recruitment activity in this area. 3.4.2 North Highland Local Partnership Forum There had been circulated Minute of Meeting held on 5 December 2019. 3.4.3 North Highland Health and Safety Sub Committee There had been re-circulated Minute of Meeting held on 11 September 2019. The Committee otherwise Noted the circulated Minutes.

M Burnside left the meeting at 2.55pm.

3.5 North Highland Performance Reporting – Health and Wellbeing Balanced

Scorecard and Annual Operational Plan Performance Report G McCaig spoke to the circulated report, Balanced Scorecard and Performance Report. The attention of members was drawn to the projected outturn on Outpatients and TTG Waiting Times for North Highland, plus declining performance in relation to both Enablement and Psychological Therapies activity. During discussion, S Steer highlighted strong Grading performance within the Highland Care Home sector. He stated NHS Highland was a strong deliverer of Social Care activity and took the opportunity to thank those involved in delivering relevant services. In relation to Enablement, he stated there was a need to evaluate the associated impact of this service and whether this was meeting the needs originally identified. T Ligema expressed the view Enablement activity should not sit as an isolated service and should be considered day to day activity. The Chair reminded members that NHS Highland was commissioned to provide Adult Social Care services on behalf of Highland Council and as such the relevant Indicators being measured may not necessarily directly align to NHS priorities. This point would be raised with Highland Council. D Park stated the circulated reports should be utilised to help identify particular areas of concern requiring greater detailed consideration, and reiterated that NHSH was a strong performer in relation to Adult Social Care activity although Mental Health performance remained a concern. He advised Annual Operational Plans would help inform relevant Performance Indicators moving forward. After discussion, the Committee otherwise Noted the content of the circulated report.

G McCaig left the meeting at 3.10pm.

3.6 NHS Highland Annual Operational Plan – Waiting Times Update K Sutton gave a presentation to members and advised current activity was being led by B Steven, with specific targets having been set in relation to both Outpatients and Treatment Time Guarantee activity. Officers were on track to deliver the agreed improvement trajectory for Outpatients, with additional capacity contracted where appropriate, and efficiency work expected to produce positive results over time. In relation to TTG improvement activity, it was reported this had been impacted by winter pressures and a series of relevant coding issues. The overall position was recovering at this time. Members took the opportunity to recognise the improvement evidenced in relation to Outpatient activity and offered their thanks to all relevant staff involved. During discussion, the Chair sought an update on the key improvement activity for the coming year, significant risk areas and associated mitigating actions being taken. K Sutton

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advised all patients were prioritised on a clinical basis (Emergency, Urgent, Others) and as such those in hospital have a reason to be there. Re-prioritisation was undertaken where appropriate, in consultation with patients and according to clinical need. She went on to advise that, as an example of cross-cutting activity, Theatre capacity across NHS Highland would continue to be released and NHSH continued to lobby the Scottish Government for additional resource. It was stated any move to more strongly apply the NHSH Local Access Policy would require Committee and NHS Board support. On the question as to what support the Committee/NHS Board may be able to offer, it was advised the relevant Access Recovery Board had suggested consideration of adoption of the Glasgow model in relation to which a full report was to be submitted both to this Committee and the NHS Board for support and approval. At the close of discussion, D Park reminded members such improvement activity was being undertaken at a time of ever increasing demand levels. After discussion, the Committee otherwise Noted the updated position.

D Garden and K Sutton left the meeting at 3.35pm.

3.7 Chief Officer’s Reports D Park spoke to the circulated report which provided an overview of Operational activity across North Highland, highlighting areas of focus for improvement as well as areas of further opportunity. Updates were provided in relation to People (Recruitment and Selection, staff Experience and Sickness Absence), Quality and Safety (Improvement Activity, Infection Prevention & Control, and Patient Safety), Care (Adult Social Care, Integrated Health & Social Care Community Services, Mental Health & Learning Disabilities and Drug & Alcohol Recovery, Support for People with Dementia and their Families, Primary Care Services, Midwifery – Community Midwifery Units, Chronic Pain Service, Highland Sexual Health, Technology Enabled Care, Dental and Prison/Custody Services) and Service Redesign. During discussion, it was confirmed the report on the Caithness Maternity Services community engagement exercise was in draft format, and would be subject to further discussion prior to submission to the NHS Board. Once finalised the report would be shared with the Committee. The Chair sought a future update in relation to HQA, wider leadership training, and Value Management activity. On the issue of GP recruitment, the Chair also sought an update in relation to the possible development of innovative approaches in this area such as the use of resource sharing arrangements, joint working and peripatetic recruitment. D Park advised that whilst creative solutions were being considered, he reminded members that GPs were independent contractors for the most part. ACTION: Agreed to receive a full report on Quality Improvement activity at a future meeting – D Park After discussion, the Committee otherwise Noted the detail of the Chief Officer’s report.

4 HEALTH IMPROVEMENT There were no matters discussed in relation to this Item.

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5 COMMITTEE FUNCTION AND ADMINISTRATION 5.1 Highland Health and Social Care Partnership Updates D Park advised discussion continued with Highland Council in relation to agreeing a new Partnership Agreement and Scheme of Integration. Financial resource remained a key discussion point in relation to which an early resolution would be sought. The Committee Noted the position.

5.2 Remaining 2020 Meeting Schedule The Committee Noted the following remaining meeting schedule for 2020: 9 April 11 June 13 August 8 October 10 December 6 FOR INFORMATION 6.1 Monitoring the Delivery of Adult Social Care Contracted Services There had been circulated a report summarising outcomes from 49 contracts monitored during Quarters 2 and 3. A further monitoring visit was undertaken for The Highland Council. It was reported the number of operational meetings with providers had significantly increased in recent months. Monitoring of the payment of the Living Wage for care staff remained a priority. It was noted contract monitoring activity regularly highlighted issues and concerns requiring follow up action and review. Forty main areas had been identified and which were being acted upon, including in relation to management/staffing issues, service delivery concerns; potential or actual Large Scale Investigations; concerns with financial viability, a change of provider/owner and transfer of packages to another provider. Progress had been, and was ongoing, with regard to service delivery concerns previously identified and this had led to discussion under the LSI Protocol and the ongoing review of provider Service Improvement Plans. The Contracts Team continued to implement a new system for escalating and de-escalating of risks to service delivery. It was stated routine contract monitoring continues to identify and resolve issues in relation to Adult Social Care contracted services and the intention remained to focus effort on priority areas. The Committee Noted the outcomes of the second and third quarter reviews and progress made in resolving issues highlighted in previous reviews.

6.2 Scottish Parliament Adult Social Care Inquiry – Call for Views There had been circulated a report advising as to a call for views on a Social Care Inquiry, in relation to exploring the future delivery of Social Care in Scotland and what is required to meet future needs, by the Scottish Parliament Health and Sport Committee. It was advised the key questions in the call for views related to “experiences of Social Care in Scotland” and “the future delivery of Social Care in Scotland”. The Highland response would be developed by the Joint Monitoring Committee following a Workshop to be held in mid-February 2020.

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This would in turn be considered by the Strategic Planning Group prior to submission on behalf of the Highland Health and Social Care Partnership. The Committee so Noted.

7 DATE OF NEXT MEETING The next meeting of the Committee will take place on 15 April 2020 in the Board Room, Assynt House, Inverness.


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MINUTES of MEETING of INTEGRATION JOINT BOARD (IJB) held in the COUNCIL CHAMBER, KILMORY, LOCHGILPHEAD

on WEDNESDAY, 29 JANUARY 2020

Present: Councillor Kieron Green, Argyll and Bute Council (Chair)Sarah Compton-Bishop, NHS Highland Non-Executive Board Member (Vice Chair)

Joanna Macdonald, Chief Officer, Argyll and Bute HSCPProfessor Boyd Robertson, Interim Chair, NHS Highland (VC)Councillor Aileen Morton, Argyll and Bute CouncilCouncillor Gary Mulvaney, Argyll and Bute CouncilCouncillor Sandy Taylor, Argyll and Bute CouncilJean Boardman, NHS Highland Non-Executive Board MemberDr Gaenor Rodger, NHS Highland Non-Executive Board MemberDr Angus McTaggart, GP Representative, Argyll and Bute HSCPAlex Taylor, Chief Social Worker/Head of Children and Families, Argyll and Bute HSCPJudy Orr, Head of Finance and Transformation, Argyll and Bute HSCPLinda Currie, Lead AHP, NHS HighlandElizabeth Higgins, Lead Nurse, NHS HighlandKevin McIntosh, Staffside Lead for Argyll and Bute HSCP (Council)Kirsteen Murray, CEO, Third Sector InterfaceFiona Thomson, Lead Pharmacist, Argyll and Bute HSCPElizabeth Rhodick, Public RepresentativeFiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health)

Attending: Douglas Hendry, IJB Standards Officer/Executive Director, Argyll and Bute CouncilAlison McGrory, Acting Associate Director of Public Health, Argyll and Bute HSCPFiona Hogg, Director of HR and OD, NHS HighlandDavid Forshaw, Principal Accountant, Argyll and Bute CouncilCaroline Cherry, Head of Adult Services, HSCPJulie Lusk, Head of Adult Services, HSCPCharlotte Craig, Business Improvement Manager, Argyll and Bute HSCPFiona McCallum, Committee Services Officer, Argyll and Bute CouncilJennifer Swanson, Organisational and Workforce Development Manager, Argyll and Bute HSCP (representing Jane Fowler)Pauline Jespersen, Advanced General Practice Nurse/Nurse Partner, Oban Frailty Project (for item 4)Dr Eric Jespersen, GP, Oban Frailty Project (for item 4)Dr Ruth McLean, GP, Oban Frailty Project (for item 4)Jaki Lambert, Interim Head of Midwifery for Argyll and Bute (for item 7)Catriona Dreghorn, Lead Midwife for Argyll and Bute (for item 7)Lora White, Dementia Specialist Improvement Lead, Argyll and Bute HSCP (for item 9)

NHSH Board 31 March 20, Item 15e197

Nicola Gillespie, Local Area Manager, Mental Health, Argyll and Bute HSCP (for item 9)Kate MacAulay, Local Area Manager for Mid Argyll, Argyll and Bute HSCP

The Chair intimated that a request for deputations to be heard by the Integration Joint Board had been received from UNISON and it was unanimously agreed to hear from this organisation.

The Integration Joint Board heard deputations from Simon MacFarlane, Kirsty Williamson and Belinda Braithwaite. They all spoke in connection with the proposal relating to the redesign of Dementia Services in Argyll and Bute which is dealt with at item 9 of this Minute. They put their arguments forward and requested that the Board agree to proceed with Option 4 (Development of Knapdale Ward to provide Inpatient Assessment/Respite/Day Care/Outpatients/ Hub & Community Team Base with Development of Enhanced Community Teams) instead of Option 3 as recommended in the report..

The Integration Joint Board were then presented with a Petition with 3010 signatures.

1. APOLOGIES FOR ABSENCE The Chair welcomed everyone present to the meeting and introductions were made.

Apologies for absence were received from Jane Fowler, Rebecca Helliwell, Donald MacFarlane and George Morrison.

2. DECLARATIONS OF INTEREST There were no declarations of interest.

3. MINUTES AND ACTION LOG The Minute of the Integration Joint Board meeting held on 27 November 2019 was approved as a correct record subject to the following amendment:

Under item 11 it was agreed that future reports would include –

a) additional data around training figures, namely % of council training (not just the total number),

b) NHS training data which is available from the NHS HR department as reported to their Staff Governance Committee, and

c) trend lines and narrative on plans for improvement.

The Chair referred to the Action Log and asked for an update on recruitment to the Integration Joint Board. The Business and Improvement Manager confirmed that a further round of recruitment to fill outstanding positions would commence in February 2020.

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4. MINUTES OF COMMITTEES

(a) Finance and Policy Committee held on 29 October 2019 The Minute of the Finance and Policy Committee meeting held on 29 October 2019 was noted.

(b) Finance and Policy Committee held on 21 November 2019 The Minute of the Finance and Policy Committee meeting held on 21 November 2019 was noted.

(c) Finance and Policy Committee held on 12 December 2019 The Minute of the Finance and Policy Committee meeting held on 12 December 2019 was noted.

5. CHIEF OFFICER'S REPORT A report prepared by the Chief Officer which provided an update on various issues since the last meeting was before the Integration Joint Board for consideration. The Chief Officer highlighted the recent appointments of Caroline Cherry as Head of Adult Services (Older Adults and Community Services) and Julie Lusk as Head of Adult Services (Mental Health, Learning Disabilities & Lifelong Conditions) and also advised of two community nurses from Argyll and Bute, Maggie Wilkinson and Joanna Taylor who had recently been awarded the prestigious title of Queen’s Nurse.

Decision

The Integration Joint Board noted the contents of the report.

(Reference: Report by Chief Officer, submitted)

6. PRESENTATION ON OBAN FRAILTY PROJECT The Advanced General Practice Nurse, Pauline Jespersen gave a presentation on the Oban Frailty Project which took a prevention and early intervention approach to addressing frailty in older people. She was joined by Dr Eric Jespersen and Dr Ruth McLean from the Lorn Medical Centre where the project is run from. They explained the process involved and how this has brought about positive outcomes for patients. The long term plan was to take a more anticipatory approach and it was hoped to role the project out to other areas and practices. They then responded to a number of questions asked.

Decision

The Integration Joint Board recorded their thanks for a very informative presentation.

7. BEST START FORWARD PLAN FOR MATERNITY AND NEONATAL SERVICES The Integration Joint Board considered a presentation and report by Jaki Lambert, Interim Head of Midwifery and Catriona Dreghorn, Lead Midwife for Argyll and Bute, advising on progress with the Best Start forward plan for Maternity and Neonatal Services (2017). The plan focuses on care being centred on the needs of mothers and babies. As one of the five early adopter boards in Scotland, Argyll and Bute was tasked with introducing continuity of care for all women, developing community hubs in a way that brought care

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closer to home and innovated for cross board working and finding remote and rural solutions. They then responded to a number of questions asked.

Decision

The Integration Joint Board noted progress on the Best Start forward plan for Maternity and Neonatal Services in Argyll and Bute.

(Reference: Report by Interim Head of Midwifery (Argyll and Bute), submitted)

8. CULTURE FIT FOR THE FUTURE The Integration Joint Board considered a presentation and report which had previously been presented to the NHS Highland Board and provided an update on progress with the set up and delivery of the Culture Programme.

Decision

The Integration Joint Board noted the update and progress set out in this report.

(Reference: Report by Director of Human Resources and Organisational Development and Programme Senior Responsible Officer, dated 17 January 2020, submitted)

The Chair ruled, and the Board agreed to adjourn the meeting for a short break and to thereafter vary the order of business and consider the report on Dementia Services Redesign next.

The Board reconvened at 3.05 pm.

9. DEMENTIA SERVICES REDESIGN The Integration Joint Board considered a report which reflected the work of the Dementia Services Review Group and set out a re-distribution of assessment, treatment and care from one in-patient assessment resource for the whole area, to an enhanced specialist community resource within the Health and Social Care Partnership localities.

Decision

The Integration Joint Board:

1. noted the extensive work carried out by the Dementia Redesign Group to focus on future service provision and pathways;

2. approved the recommendation of an Enhanced Community Dementia Team model as the further redesign of dementia services, made by the Transformation Board and Senior Leadership Team; and

3. agreed that the Enhanced Community Dementia Team model be progressed, noting that –

a) full consultation on the proposal would be undertaken; and

b) a further report would be submitted to the Integration Joint Board on the outcome of the consultation exercise in March 2020.

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.(Reference: Report by Head of Service, Older Adults and Community Hospitals, and Head of Service, Mental Health, Learning Disability and Lifelong Conditions, submitted)

Betty Rhodick left the meeting at this point.

10. FINANCE

(a) Budget Monitoring The Integration Joint Board considered a report which provided a summary of the financial position of the Health and Social Care Partnership as at 31 December 2019.

Decision


1. noted the forecast outturn position for 2019-20 was a forecast overspend of £1.310m as at 31 December 2019 and that there was year to date overspend of £0.965m as at the same date;

2. noted the above position excluded any provision for the on-going dispute with NHS Greater Glasgow & Clyde; and

3. agreed to a joint letter being sent from the Chair of NHS Highland Board and the Chair of Argyll and Bute Integration Joint Board to the Chair of NHS Greater Glasgow and Clyde Board seeking a resolution to the ongoing dispute.

(Reference: Report by Head of Finance and Transformation, submitted)

(b) Financial Risk The Integration Joint Board considered a report which provided an updated assessment of the financial risks to face the organisation which had not been reflected in the forecast of the financial outturn.

Decision

The Integration Joint board:

1. noted the updated financial risks identified for the Health and Social Care Partnership; and

2. noted that financial risks would continue to be reviewed and monitored on a two monthly basis and reported to the Board.


(c) Budget Outlook The Integration Joint Board considered a report which summarised the budget outlook covering the period 2020-21 to 2022-23.

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Decision

The Integration Joint Board noted the current estimated budget outlook report for the period 2020-21 to 2022-23.


(d) Budget Consultation 2020/21 The Integration Joint Board considered a report which presented a draft public consultation on the budget for 2020/21.

Decision


1. agreed to accept the Management and Operational savings contained in Appendix 2 of the report;

2. requested Officers to revise the draft consultation document taking into account feedback from Integration Joint Board Members and conduct public engagement on the budget over a 4 week period prior to the March Integration Board meeting;

3. requested that additional savings options of at least £2.521m be presented to the Integration Joint Board in March 2020 in order that a balanced budget can be approved for 2020/21.


(e) Proposed Fees and Charges The Integration Joint Board considered a report which provided details of the proposed annual Social Work fees and charges uplifts for 2020/21.

Decision

The Integration Joint Board reviewed and endorsed the appended 2020/21 Social Work Fees and Charges proposals so that they could be submitted to Argyll and Bute Council for ratification at its 2020/21 budget meeting.

(Reference: Report by Principal Accountant (Social Work), submitted)

11. HSCP PERFORMANCE EXCEPTION REPORT - FINANCIAL QUARTER 2 2019/20 The Integration Joint Board considered the Health and Social Care Partnership Performance Exception Report for Financial Quarter 2 (2019/20).

Decision


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1. noted the new scorecard performance for the FQ2 (19/20) reporting period;

2. considered and noted the HSCP performance against National Health and Wellbeing Outcome Indicators and the Ministerial Steering Group measures of integration for the HSCP;

3. noted the performance commentary with regard to actions to address exceptions against all indicators; and

4. agreed that the Clinical and Care Governance Committee should review and discuss further concerns raised about National Indicators 12, 16 and 17 and review the overall ownership of future scrutiny of performance.

(Reference: Report by Head of Strategic Planning & Performance, submitted)

Sarah Compton-Bishop, Boyd Robertson, Fiona Broderick and Jennifer Swanson left the meeting at this point.

12. TRANSFORMATION PROGRAMME BOARD REPORT The Integration Joint Board put in place a “Transforming Together” programme with 8 work streams to strengthen and build on achievements today and continue the changes required to meet the HSCP’s vision, priorities and objectives. A report providing an overview on the progress made in the last 3 months was before the Board for consideration.

Decision


1. noted the contents of the report; and

2. requested that a formal review paper on progress be brought to the Finance and Policy Committee in April 2020.

(Reference: Report by Head of Strategic Planning & Performance, submitted)

13. DATE OF NEXT MEETING Wednesday 25 March 2020, 1.00 pm, Council Chamber, Kilmory, Lochgilphead.

14. VALIDICTORY The Chair advised that Denis McGlennon had resigned from the Board. On behalf of the Integration Joint Board he thanked Denis for his contribution to the Integration Joint Board over the years.

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DRAFT

Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk/

DRAFT MINUTE of MEETING of the AREA CLINICAL FORUM

Board Room, Assynt House, Inverness 23 January 2020 – 1.30pm

Present Margaret Moss Area Nursing, Midwifery and Allied Health Professionals Committee (Chair) Eileen Anderson, Area Medical Committee Linda Currie, Area Nursing, Midwifery and Allied Health Professionals Committee (video conference) Ann Galloway, Psychological Services Advisory Committee Jim Law, Psychological Services Advisory Committee Stephen McNally, Raigmore Laura Menzies, Area Nursing, Midwifery and Allied Health Professionals Committee Al Miles, Area Medical Committee Calum Murray, Area Pharmaceutical Committee Wil Nel, Clinical Director West Adam Palmer, Employee Director Manar Elkazindar, Area Dental Committee Catriona Sinclair, Area Pharmaceutical Committee Iain Thomson, Adult Social Work and Social Care Advisory Committee

Colin Farman, Area Health Care Science Advisory Committee Alex Javed, Area Health Care Science Advisory Committee

In Attendance

Deborah Jones Director of Strategic Commissioning, Planning and Performance Fiona Hogg, Director of Human Resources and Organisational Development Heidi May, Nurse Director Chris Morgan, Programme Manager, Clinical and Care Strategy Boyd Robertson, Chair NHS Highland (item 2 only) Paul Shercliff, Service Planning Manager Christine Thomson, Committee Administrator Boyd Peters, Medical Director (from item 3.3)

1 WELCOME AND APOLOGIES

Margaret Moss took the Chair and welcomed those present to the meeting.

Apologies were submitted from Lorien Cameron-Ross, Paul Davidson, Frances Jamieson and Clare Watt

1.1 DECLARATIONS OF INTEREST

NHSH Board 31 March 20, Item 15g205


There were no declarations of interest. 2 INTRODUCTION OF BOYD ROBERTSON, CHAIR OF NHS HIGHLAND Boyd Robertson advised that his interim appointment as Chair of NHS Highland had now been made substantive and confirmed that non – executive Board members had agreed to attend the ACF on a rotational basis. He stressed the need for the ACF to represent the views of clinicians and advised that the Board recognised the time constraints of clinicians attending meetings of the ACF. It was generally considered that it would be a positive move to strengthen 2 way dialogue between members of the Board and the ACF. 3 DISCUSSION ITEMS 3.1 UPDATE ON CLINICAL STRATEGY – REVISED PROPOSALS Deborah Jones gave a presentation on the revised proposals for the clinical strategy. Key feedback had indicated that there was a need to fully integrate health and social care and to knit together primary care and community care services. The concept of one hospital delivered across 4 sites was seen as an acceptable concept. In addition there was a need to seek integrated mental health provision. It was stressed that services required to be delivered consistently and in the most cost effective way possible. There was a need to create a strategy to transform services while potentially saving money and to create standard pathways using consistent systems and processes and applying the principles of realistic medicine in order to provide sustainable and resilient 7 day services that meet the needs of the population and the diversity of Highland remote and rural communities. The focus of the revised approach rested on 5 key areas: planned care; unplanned care; mental health; maternity, obstetrics and first 1000 days; and complexity, frailty and end of life care. Cross cutting themes were noted as adult social care, eHealth and digital, estates and facilities, and clinical and care role redesign. The importance of communication and engagement was stressed with actions including the identification of resource to support the development of messaging and facilitation of engagement sessions; engagement in the process of development; communication with staff, stakeholders and public; use of internet as a single point of truth for all parties regarding the development of strategy; communicating a channel for questions and answers; sharing monthly reports with all parties. Facilitated sessions with patient groups, staff forums, and consultation meetings with external stakeholders would be arranged. Some concerns were raised around flow and it was suggested that more clinical engagement was required. The need for engagement between strategic and operational level was stressed and it was noted that in order to manage the work adequate resource would be required. Priority areas would require to be identified with a rolling programme looking at strategy as an ongoing process. It was generally considered that more clinical representation was required. Ann Galloway stressed that mental health should be inclusive of mental wellbeing and that physical and emotional well being runs through everything. She stressed that psychology had not been represented at any meetings to date. Workstream Leadership Teams would identify the membership of the groups. It was agreed that a member of Deborah Jones team provide an update to a future meeting. The Forum

• Noted the update

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• Agreed that a further update be provided to the next meeting of the Forum 3.2 CULTURE PROGRAMME Fiona Hogg gave an update on the Culture Programme to date. She advised that a Culture Programme Board had been set up which had met 3 times, initial engagement sessions had taken place, external support was in place for investigations and mediation, courageous conversations training had been launched, a CEO bulletin and team brief set up, a health and wellbeing strategy group had been set up and the culture commitment plan had been drafted. It was stressed that all options had different functions and there was a need to identify why a particular route would be chosen. Work was also underway to agree a pathway for priorities and concerns. The Once for Scotland implementation was being used to deal with the outstanding grievances. Some concern was expressed as to how to deal with individuals who no longer were employed in the organisation and it was noted that for current cases the correct route to follow would be to use the bullying and harassment policy by talking to the manager, HR and trade union, but for historical cases the route to follow would be the healing process. In cases of doubt Fiona Hogg should be contacted. It was agreed that a further update be provided to the next meeting of the Forum. The Forum Agreed that Fiona Hogg be invited to the next meeting of the Committee to provide an update. 3.3 HEALTH & CARE (STAFFING) (SCOTLAND) BILL Heidi May advised that the evidence was growing of the impact of insufficient staff in the NHS, particularly in nursing. She advised that each additional patient a nurse has to look after, over and above their current workload was associated with a higher rate of death, a longer length of stay, a higher risk of nurse burnout and higher risk of poor quality care. Conversely, if the workload was reduced by one patient then this lowers the risk of the patient dying, lowers the risk of readmission, reduces the length of stay and reduces nurse burn out. A similar situation existed regarding medical staff, with over half of the doctors in training advising that they worked beyond rostered hours regularly, felt tired and suffered from lack of sleep. She advised that data quality was an issue which required attention. It was noted that the Bill became an Act in May 2019 and preparations could now be made with key actions to be implemented and Boards considering the staffing levels required in each Board. The scope was noted as covering all clinical professions and care staff employed in health and social care. Work force tools had been developed with nursing and midwifery which were nationally validated and required to be used. Heidi May stressed that the Act gave everyone the ability to influence staffing levels. Additional funding had been given to put staff in place to support the enactment of the Act and the lead on this was Fiona Hogg supported by Heidi May. A nursing and midwifery implementation group existed to ensure that nurses, midwives and AHPs would be fully ready for enactment of the Act.

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It was agreed that the presentation be circulated to members of the Forum. The Act therefore placed a duty on Boards to provide professional advice on staffing levels and ensure appropriate staffing at all times, with an escalation process in place should this advice be ignored or it be established that the Board was unable to meet the requirement of the calculated workforce. It was stressed that clinical leadership roles should have adequate time to undertake this leadership role. It was further noted that the government were indicating that Boards only worked with agreed agencies. It was noted that a common staffing method was required to reach a conclusion as to the number of staff required. Validated tools and quality indicators were required and the need to engage with staff, managers and unions was stressed. Excellence in Care aimed to ensure standard outcome measures in every Board in Scotland. An annual report would also be published by Scottish Government. Health Care Improvement Scotland would have a responsibility to ensure monitoring was in place and also have the power to demand compliance with reporting responsibilities. This related also to care services. It was noted that guidance was currently being developed and the Programme Board was in the process of being set up with issues, logs of risks and communication plans being established. The need to consider service redesign and ensure training is in place was noted with Heidi May stressing that when staff were trained locally there was more chance of them staying with the organisation. Fiona Hogg stressed the need to think long term and identify how to ensure a sustainable trained workforce. She considered that the Programme Board should report through clinical governance as opposed to staff governance. It was further noted that this Act did not pertain to independent contractors but that the Boards would be held accountable indirectly. Guidance was being built which would cover Board staff visiting practices. Adam Palmer queried whether there was acknowledgement that the Board may have to staff appropriately or do less than at present. The demographics of both patients and staff was noted together with the effects of Brexit in terms of attracting and retaining staff were noted. It was further noted that the pool of those of workforce age was diminishing and considered that if the service could not be delivered it would require to be redesigned. No discussion had taken place on penalties for breaking the Act but it was noted that HIS have authority to ensure Boards engage. The Forum thereafter:

• Noted the presentation • Agreed that members will share this widely with their respective Advisory

Committees for cascade and discussion with clinical staff 3.4 DRAFT ANNUAL OPERATING PLAN 2020-2023 Paul Shercliff gave an update on the annual operating plan. It was noted that some initial

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feedback had been received and that ongoing clinical and managerial engagement would be welcome. Three main areas of the plan were highlighted, these being: strategic, such as clinical and care strategy, culture fit for the future and workforce plan; tactical such as Caithness redesign , Badenoch and Strathspey redesign , Skye Lochaber and Wester Ross redesign and elective care centre; and operational such as reduction of TTG., reduction in waiting times. The first draft had been submitted in December 2019 with the second draft due to be submitted to Scottish Government on 14 February and the final draft by early March 2020. Any further comments should be passed to Paul Shercliff. Ann Galloway highlighted the fact that learning disability was missing from the document and that some of the data regarding the amount of sessions for CBT given in the section on mental health services was incorrect and needed amending. Catriona Sinclair advised that there were several challenges for pharmacy which had not been included in the document. Margaret Moss expressed concern over the impact of the PMO on the long-term sustainability of services where service redesign and modernisation would require reinvestment of some funding to create and staff new models of care. In these situations savings could be made but quality, safety and sustainability required to be considered with the same rigour. It was noted that where significant re-investment may be required for service redesign this required consideration through joint clinical financial discussions. It was suggested that more engagement was required on quality and safety and noted that all quality improvement leads had been transferred from operational areas to the PMO. It was noted that the Board ensures quality is delivered through the balanced score card which is presented to the Clinical Governance Committee. In addition each operational unit has a patient quality and safety group chaired by clinicians. Further there is a clinical governance and care agenda and exception report which is presented to each meeting of the Clinical Governance Committee. It was considered that a presentation on the balanced score card and Discovery at a future meeting would be helpful for better understanding of clinical data that reflects quality and safety. The Forum Noted the update. At this stage Margaret Moss advised that this was Christine Thomson’s last meeting of the ACF and thanked her for her assistance to the Forum over the years and wished her well in her retirement. 4 DRAFT MINUTE OF ACF MEETING HELD ON 21 NOVEMBER 2019 The previously circulated minute of meeting held on 21 November 2019 was agreed. The Forum thereafter Agreed the minute. 4.1 Updated Attendance record The previously circulated updated attendance record was noted. The Forum Noted the updated attendance record. 5 MATTERS ARISNG 5.1 Area Dental Committee – Director of Dentistry

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Margaret Moss had written to the Medical Director and Chief Executive and received confirmation that progress was taking place on this matter, working with the interim Director of Dentistry. 6 FEEDBACK FROM HIGHLAND HEALTH & SOCIAL CARE COMMITTEE 6.1 Minute of Meeting of 7 November 2019 There had been no ACF representation at the meeting. 7 ASSET MANAGEMENT GROUP 7.1 Minute of Meeting of 19 November 2019 7.2 Draft Minute of Meeting of 17 December 2019 There had been circulated minutes of the meetings of the Asset Management Group of 19 November 2019 and 17 December 2019 which were noted. Peter Cook had undertaken to update the medical equipment list. The Forum Noted the update. 8 REPORTS/MINUTES FROM PROFESSIONAL ADVISORY COMMITTEES 8.1 Area Nursing, Midwifery and AHP Advisory Committee, Minute of Meeting held

on 19 November 2019 The previously circulated minute of the meeting held on 19 November 2019 was noted. It was reported that discussions were taking place on how to reinvigorate the Committee. 8.1.1 Area Nursing, Midwifery and AHP Leadership Committee, Note of Meeting held

on 3 December 2019 The previously circulated note of the meeting held on 3 December 2019 was noted. 8.1.2 Area Nursing, Midwifery, and AHP Leadership Committee, Meeting held on 7

January 2020 8.2 Area Dental Committee, Minute of Meeting of 13 November 2019 The previously circulated minute of the meeting held on 13 November 2019 was noted. 8.3 Area Medical Committee 8.3.1 Minute of meeting held on 17 September 2019 The previously circulated minute of the meeting held on 17 September 2019 was noted. 8.3.2 Draft Minute of Meeting held on 19 November 2019

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The previously circulated minute of the meeting held on 19 November 2019 was noted and it was highlighted that the membership from the hospital side of the Committee were experiencing difficulty in attending meetings on Tuesday afternoons. 8.4 Area Optometric Committee There had been no meeting since the last meeting of the Area Clinical Forum. 8.5 Area Pharmaceutical Committee 8.5.1 Minute of Meeting held on 18 November 2019 The previously circulated minute of the meeting held on 18 November 2019 was noted with the challenges of recruitment and retention being highlighted. 8.6 Psychological Services Advisory Committee 8.6.1 Draft Note of Meeting held on 7 November 2019 The previously circulated draft note of the meeting held on 7 November 2019 was noted. The SBAR on neuropsychological services within NHS Highland which had previously been circulated to members of the Forum would be considered as a substantive item at the next meeting of the Forum. 8.7 Adult Social Work and Social Care Advisory Committee There had been no meeting since the last meeting of the Area Clinical Forum. 8.8 Health Care Science Forum It was noted that the first meeting of the revised Area Health Care Science Forum had taken place and that approval had been given to Colin Farman, Alex Javed and Peter Cook to attend on the ACF on a rotational basis. A constitution was currently being developed. Discussion had taken place on the new Health Care Science Strategy being developed by the Scottish Government. Meetings would be held monthly in the first instance. Heidi May stressed the importance of ensuring that the Health Care Science Strategy feeds into the Board’s Clinical and Care strategy. Margaret Moss welcomed the fact that Health Care Sciences would now be full members of the Forum. The Forum Noted the updates from the Professional Advisory Committees.. 9 NHS HIGHLAND BOARD MEETING 9.1 Highland Financial Position It was noted that this paper was not yet available but would be published on the website with the Board meeting papers. Boyd Peters advised that progress had been made and that there was confidence that further improvements would be made. 9.2 Infection Prevention and Control Report and Annual Workplan The infection prevention and control report was noted 9.3 Chief Executive’s and Directors’ Report

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The Chief Executive’s and Directors’ Report was noted. 9.4 Attraction Recruitment and Retention Strategy Update The previously circulated report by Sharon Hammell was noted and it was agreed that she be invited to the next meeting of the ACF. 9.5 Community Planning – Early draft The early draft report was noted and it was agreed that Cathy Steer be invited to a future meeting of the Forum. The Forum Noted the Board papers 10 FOR INFORMATION 10.1 Dates of Future Meetings 5 March 2020 30 April 2020 2 July 2020 3 September 2020 29 October 2020 17 December 2020 The Forum Noted the items for information. 11 ITEMS FOR FUTURE ACF MEETINGS Items for future meetings were noted as follows: 11.1 Overview of UHI activity from a research/education and innovation perspective

Presentation by Sandra McRury 11.2 Personalising Realistic Medicine – summary of PRM event – Rebecca Helliwell 11.3 Health Promoting Health Service – Bev Green 11.4 Performance Framework – Donna Smith 11.5 NHSH Assurance Framework - Ruth Daly 11.6 CAG – discuss at advisory committee meetings in the first instance 11.7 Service Level Agreements 11.8 Whole System flow- Katherine Sutton 12 ANY OTHER COMPETENT BUSINESS There was no other competent business 13 DATE OF NEXT MEETING The next meeting will be held on 5 March 2020 at 1.30pm in the Board Room, Assynt House Inverness.


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HIGHLAND NHS BOARD

Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 www.nhshighland.scot.nhs.uk

MINUTE of MEETING of the FINANCE SUB-COMMITTEE

Chief Executive’s Office, Assynt House, Inverness

21 January 2020 – 2.30pm

Present Alasdair Lawton (in the Chair) Ann Clark, Chair of Highland Health and Social Care Committee Alasdair Christie, Chair of Audit Committee David Garden, Interim Director of Finance Prof Boyd Robertson, NHS Board Chair

In Attendance Adrian Ennis, Improvement Director Fiona Hogg, Director of HR and Organisational Development Brian Mitchell, Board Committee Administrator George Morrison, Head of Finance Argyll and Bute (VC) David Park, Chief Officer, Highland Health and Social Care Partnership Mark Wilde, Scottish Government Transformation Support (3.10pm)


Apologies for absence were received from Committee member Iain Stewart, Chief Executive and Attendees Joanna MacDonald, Chief Officer A&B and Heidi May, Board Nurse Director.

There were no formal Declarations of Interest.

2 MINUTE OF MEETING ON 19 DECEMBER 2019

The Sub-Committee Approved the Minute of Meeting held of 19 December 2019.

3 UPDATE ON FINANCIAL RECOVERY PROGRAMME

AE presented an overview of the financial recovery programme. At month 9, the forecast outturn against the £28m savings target was £27m which consisted of the risk adjusted delivery tracker valued at £26.1m and the Pipeline Tracker with a risk adjusted value of £0.9m. The year to date delivery of the delivery tracker was £17.8m, which was £1.3m ahead of the year to date trajectory as outlined in the Annual Operational Plan. The in-month delivery was £5.46m, with £8.3m left to be delivered across Months 10-12. A total of nine schemes had been added to the pipeline in month 9.

AE presented additional detailed analysis in relation to actual delivery in Month 9, profile of savings against target, unidentified Cost Improvement Programme against target, an overview of key risk areas, a breakdown of the full year effect by workstream and list of non-

NHSH Board 31 March 2020, Item 15h213



recurrent schemes, analysis of the pipeline and delivery tracker, and a Divisional split of the target vs. delivery across North Highland and Argyll and Bute to date. It was confirmed planning for 2020/2021 activity had started, with an indicative savings target set and new pipeline established, in relation to which a degree of progress had been made.

A Clark sought advice on the key learning points to be taken forward, with AE advising the level of support and resource provided by Human Resources and Finance would be critical. FH confirmed a plan to provide HR support had been put in place and DG advised consideration was being actively given to relevant Finance support. AE further advised Project Management resource needed to be assessed/reviewed and Acute Leadership elements maintained and supported. There was also a need to ensure enhanced front line staff buy-in, as there was evidence of individuals continuing historic practice despite cost improvement activity. DG confirmed this included individual budget holders continuing historic spend profiles despite high level instruction to address the same. The removal of Budget Holder responsibility from individuals could form part of future review activity under relevant Grip and Control considerations.

The Sub-Committee Noted the update.

4 NHS HIGHLAND OVERSIGHT GROUP ACTIVITY

DG advised the Oversight Group, meeting the previous week had received quantification of the remaining financial gap in 2019/2020, insofar as this outlined that with outstanding savings requirements and ongoing cost pressures this amounted to a total sum of £8.7m. The relevant cost pressures had been outlined, including aspects relating to the SLA with NHS Greater Glasgow and Clyde and an update had been provided on current and planned mitigation activity with a view to bridging the relevant gap. The Oversight Group had also received an indication of the outline financial plan for 2020/2021, the key milestones associated with preparation of the 2020/2021 savings programme and the further actions yet to be scheduled.

Members were advised that ongoing SLA discussion with NHS Greater Glasgow and Clyde was not expected to derive any positive financial benefit to NHS Highland. Noting a lack of engagement from GG&C, including response to relevant correspondence there was general agreement that following the next meeting of the Argyll and Bute IJB, the NHSH Chair and Chair of the IJB jointly write to the Chair of GG&C to express their concern.

ACTION: Agreed to write to Chair of NHS GG&C to express concern at lack of engagement to date – NHS Board Chair/Argyll and Bute IJB Chair

MW went on to reference the indicative outline financial plan for 2020/2021, this showing a savings programme of £24.1m and inclusive of £8.8m brokerage agreed with Scottish Government. These figures were predicated on various assumptions relating to financial uplift, including from Highland Council for Adult Social Care. With the PMO focussing on delivery of the £24.1m savings programme, members requested that ASC elements relating to Non-Pay cost pressures (£31.1m), bridging the ASC funding gap (£9.5m) and ASC quantum uplift (£5.5m) be separated out for reporting purposes. This was agreed.

AE referenced the overview of the key milestones for 2020/2021 savings programme and advised workstream Charters had been issued and appropriate returns sought. The Financial Recovery Programme Board was now meeting on a weekly basis. MW emphasised the importance of ensuring and delivering sustainable financial recovery, with the existing level of Scottish Government support set to be reduced over time. He advised the PMO Team had become permanently funded, with members to be subject to year-end

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review. Consideration was being given to agreeing a six month extension of the contract for the Cost Improvement (PMO) Director, funding for which would require to be identified. He stated the appointment of a permanent PMO Director should also be considered. In terms of ensuring NHSH continued to make good progress on financial recovery he stated the FRPB should continue to meet on at least a fortnightly basis, a permanent Finance Director should be appointed prior to 2019/2020 financial year end, and there should be a restructuring of Divisions so as to empower clinicians and devolve budgetary responsibilities. In terms of Clinical and Care Strategy development progress, MW confirmed the relevant Workstream activity listening exercise had now been concluded. The Steering Group would meet later that week to approve any required changes with a view to ensuring development activity commenced from 1 February 2020 and was concluded by September 2020. The role of SROs would be crucial. AE confirmed the Cost Improvement Programme was appropriately aligned to relevant Strategy elements in a process similar to that for 2019/2020 activity with a number of key savings opportunities already identified. In terms of the wider picture he stated achievement of financial balance over the next two financial years was readily achievable, taking in to account anticipated NRAC uplifts over the same period. DP cautioned as to the potential for Major Service Change process requirements to impact on savings delivery and on this point A Clark stated engagement of stakeholders should be factored in at the earliest possible stage. FH suggested development of framework to assist in this area. MW confirmed Major Service Change requirements had been acknowledged as a risk, with existing focus on the delivery of tangible change. A Christie stated, in recognising the need for change in the way that NHSH services are structured and delivered, the NHS Board needed to provide a consistent and informed message, and be more open around the level of risk involved when discussing the matter with local MSPs etc. The Sub-Committee otherwise Noted the updates provided. 5 RENEWAL OF INTEGRATION SCHEMES UPDATE Those present were advised Highland Council had sought a two week hiatus in funding negotiations with a view to ensuring appropriate levels of political engagement. It was stated whilst the NHS Board had agreed to await the outcome of this process prior to any escalation activity, the option remained live to progress this with both Highland Council and Scottish Government as and when required. The Sub-Committee so Noted. 6 AOCB There were no matters discussed. 7 DATE OF NEXT MEETING The next scheduled meeting of the Committee will be held on 20 February 2020 at 11am in the Board Room, Assynt House. The meeting closed at 4.00pm.

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HIGHLAND NHS BOARD


DRAFT MINUTE of MEETING of the FINANCE SUB-COMMITTEE

Board Room Assynt House, Inverness

22 February 2020 – 11am

Present Alasdair Lawton (in the Chair) Ann Clark, Chair of Highland Health and Social Care Committee Sarah Compton Bishop, Chair of A&B IJB Heidi May, Board Nurse Director David Garden, Director of Finance Prof Boyd Robertson, NHS Board Chair

In Attendance Adrian Ennis, Improvement Director Paul Hawkins, Chief Executive Anna McInally, Freedom of Information Administrator Joanna MacDonald, Chief Officer A&B George Morrison, Head of Finance Argyll and Bute (VC) David Park, Chief Officer, Highland Health and Social Care Partnership Chris Morgan, Clinical and Care Strategy Project Manager Katherine Sutton, Head of Acute Services


Apologies for absence were received from Committee member Alasdair Christie, Chair of Audit Committee, Fiona Hogg, Director of HR and Organisational Development and Attendees.

There were no formal Declarations of Interest.

2 MINUTE OF MEETING ON 22 JANUARY 2020

The Sub-Committee Approved the Minute of Meeting held of 22 January 2020.

3 UPDATE ON FINANCIAL RECOVERY PROGRAMME

Mr Ennis provided an overview of the financial recovery programme at month 10. At month 10, the forecast outturn against the £28m savings target was £27m which consisted of the risk adjusted delivery tracker valued at £26.9m and the Pipeline Tracker with a risk adjusted value of £0.1m. The in-month delivery was £3.5m. The year to date delivery of the delivery tracker was £21.3m which was £1.3m above the year to date trajectory as outlined in the Annual Operational Plan. It was confirmed £17m of the £26.9 of the savings delivered were recurrent.

NHSH Board 31 March 20, Item 15h217



The remaining gap of £1m would be closed through continuous management of the risk associated with the schemes on both the delivery and pipeline tracker. In relation to savings programme for 2020/21, the savings target was £24m. To date, £15.5m of unadjusted savings have been identified, once risk adjusted this figure reduces to £2.2m. The workstreams will be refreshed as there were a number of changes in 2019/20. In the next year, there will be a focus on service redesign to provide a better patient care. It was confirmed, the £17m of recurrent savings delivered in 2019/20 has reduced the underlying deficit of £39.5m by £17m on an annual basis. The recurrent savings have not reduced the savings target for 2020/21, it has prevented the savings target increasing. The Sub-Committee Noted the update. 4 MONTH 10 FINANCIAL POSITION The Director of Finance provided an overview of the financial position at month 10 along with the reconciliation of the cost improvement programme to financial ledger. The year to date position at month 10 indicated an overspend of £10.1m against a forecasted overspend of £11.4m, this means an adverse variance of £0.6m in the forecasted year to date position. The financial ledger indicated a potential overspend of £13m by year end resulting in a gap of £1.6m to deliver the Annual Operating Plan target. In Month 9, the forecasted overspend was £13.9m therefore there has been a positive movement in month due cost improvement savings. With regards to the cost pressures at Raigmore, the pressures have stabilised and they have been managed as part of the overall budget. A risk within Raigmore was the end of year stock count, particularly within theatres as there is no electronic stock control system and there was a potential the stock take could result in an overall additional cost when adjusted on the balance sheet. There was a discussion regarding reviewing the terms of reference for the Committee to include performance data to enable to the financial date to be include alongside the Board’s performance. A short life working group has been established to review all of the Committees and outcomes will be implemented. The Sub-Committee Noted the update. 5 CLINICAL AND CARE STRATEGY UPDATE Mr Morgan provided an update on the progress of the Clinical and Care Strategy. A listening exercise was undertaken in December and time has been spent analysing the outcomes. Three workstreams, Mental Health, Frailty and Maternity were on target to meet the set milestones in terms of identify the scope of the project and establishing project teams. Both Unscheduled Care and Planned Care have progressed as anticipated due to business as usual pressures and annual leave but the slippage would be recovered. By April the operating models for the workstreams will be developed and testing will commence. In June, the recommendations for the care and clinical strategy would be circulated. The strategy is forecasted to deliver £10m of savings in 2020/21 and £15m recurrently thereafter. It was confirmed Cathy Steer was leading engagement with external stakeholders

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The Sub-Committee Noted the update. 7 RENEWAL OF INTEGRATION SCHEMES UPDATE Mr Garden advised there has been no progress to date regarding the renewal of Highland Health and Social Care Partnership Agreement. It was confirmed solicitors have been engaged on an advisory capacity and the Scottish Government was aware. The Sub-Committee Noted the update. 8 AOCB There were no matters discussed. 9 DATE OF NEXT MEETING The next scheduled meeting of the Committee will be held on 19 March 2020 at 11am in the Board Room, Assynt House. The meeting closed at 12:30pm.

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HIGHLAND NHS BOARD

Assynt HouseBeechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 www.nhshighland.scot.nhs.uk

MINUTE of MEETING of the ASSET MANAGEMENT GROUP

Ante Room, Assynt House, Inverness 22 January 2020 – 2pm

Present Alasdair Lawton, Non-Executive Director (Chair) Eric Green, Head of Estates James Brander, Non-Executive Director Carol Marlin, Monitoring Accountant Alister McNicoll, Deputy Head of eHealth David Whyte, Medical Equipment Manager John Grieve, Public Representative George Morrison, Head of Finance Argyll and Bute Eileen Anderson, ACF Representative Michelle Fraser, Capital Accountant

In Attendance Peter Cooke, Head of Medical Physics Steve Brown, EES Section Head David Ashburn, Microbiology Department Manager

1. WELCOME, APOLOGIES AND DECLARATION OF INTERESTS

Apologies for absence were received from Committee members, David Garden, Director of Finance, David Park, Chief Officer HHSC Partnership, Bob Summer, Head of Health and Safety.

2. MINUTES OF 15 OCTOBER 2019

The Group Approved the Minutes of the meeting of 19 December 2019 pending amendments to the following items.

Item 4 – The item will now read “The Radiology capital allocation remained unspent; it was unlikely Radiology would spend all of the allocation because of the challenge of identifying revenue budget for turnkey works. The committee discussed possible solutions.”

Item 6 – The item will now read “The lease of a property in William Smith House in Thurso would cost £21,000 per annum”

Item 7.1 – Every mention of Riverbank Medical Practice will now read “Riverview Medical Practice.”

3 MATTERS ARISING

There were no matter arising.

4 CAPITAL MONITORING REPORT

Miss Fraser provided an overview of the Capital Monitoring Report. Two allocations had been received in the December 2019 allocation for Hospital Eye Service equipment for North Highland and A&B.

NHSH Board 31 March 20, Item 15i221

2

Miss Fraser asked the group to continue to push with orders and to receipt and pay as many invoices as possible in the upcoming months to try and alleviate the pressures of the last weeks in March. Mr Lawton echoed this statement and ask the group to ensure that all funding was spent as quickly as possible.

At month 9, the contingency fund was £41,000 however at the meeting it was confirmed that the funding for the Gairloch/Aultbea extension, £130,000, would not be utilised in this financial year and this would now be required in 20/21. The contingency fund was now £171,000.

The Group noted the Report.

5 MICROBIOLOGY AUTOCLAVE REPLACEMENT

Mr Ashburn provided an overview of the paper circulated to the Committee. The current autoclaves are 13 and 14 years old and now regularly breakdown and both require to be replaced like for like. Mr Ashburn was asked if procurement had been involved in obtaining the quotes, if there was Estates work required and if both machines need replaced this financial year. The cost for both machines is £99,700 plus VAT.

Mr Grieve asked if the Autoclave replacement was included in the Capital Plan, which it is not, and made the suggestion that this item should be used as an example to the Board in how Capital Planning is not working and how AMG are working more reactive with equipment replacement.

The Group approved the replacement of one machine this financial year once the questions had been answered and the second machine would be added to the 20-21 Capital Plan.

6 BLADDER SCANNER REPLACEMENT

The Committee discussed the paper requesting funding of £6,000 for the replacement of a 20 year old bladder scanner that is used by the District Nurses Team across Inverness, Beauly and the RNI Inpatients Unit.

The Group approved the purchase of the Bladder Scanner.

7 RENAL UNIT SCI STORE INTERFACE (RAIGMORE)

A paper was submitted for approval of £26,000 for SCI store interface for the Renal Unit. Due to annual leave there was no one in attendance to speak to the paper and the Committee had questions. As the questions could not be answered the paper was not approved and will need to be represented at the next meeting.

The Group requested for the paper to be resubmitted to the next meeting.

8 AOCB

8.1 RADIOLOGY 19-20 CAPITAL FUNDING ALLOCATION

Mr Cooke provided an overview on the paper explaining the difficultly in spending the Radiology 19-20 Funding Capital Allocation due to the lack of revenue funding relating to work required to allow the capital purchases. However there were 4 items that could be purchased without revenue funding. Miss Fraser reported to the Committee that from the comments made at the December meeting, with the Radiology allocation having difficulties

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3

in spent, she had made moves to ensure that the funding was fully utilised and that of the £660,000 allocation all that remained was £220,000.

The Committee was informed that the first 2 items in the paper, Haemodynamic Monitoring systems were now being funded via the Radiotherapy allocation slippage, which is required to be reprovided in 20-21, therefore the group was asked to fund the two remaining items totalling £245,000. With the remaining Radiology allocation of £220,000 and the balance of £25,000 from contingency the group approved the purchases.

The Group approved the purchase of the 2 items from the remaining Radiology allocation and the balance from Contingency.

8.2 LONE WORKER ALARM SYSTEM – LORN & ISLANDS HOSPITAL

A paper was submitted to the Committee for approval of a Lone Worker Alarm System in Lorn & Islands Hospital. There was no one in attendance to answer any questions relating to the paper that Committee asked. Mr Morrison was aware of the paper but could not answer of what was used in other areas and what was Health & Safety and Staff Governance thoughts on this system.

The Group asked Mr Morrison to find out answers to the questions and to ask someone to attend the next meeting to present the paper.

8 DATE OF NEXT MEETING

The next scheduled meeting of the Committee will be held on 19 February 2020 at 2pm in the Ante Room.

The meeting closed at 2.55pm.

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HIGHLAND NHS BOARD


DRAFT MINUTE of MEETING of the ASSET MANAGEMENT GROUP

Ante Room, Assynt House, Inverness 19 February 2020 – 2.00pm

Present James Brander, Non-Executive Director (Chair) Eric Green, Head of Estates Michelle Fraser, Capital Accountant John Grieve, Public Representative Alister McNicoll, Deputy Head of eHealth George Morrison, Head of Finance Argyll and Bute David Whyte, Medical Equipment Manager Colin Farman, ACF Representative

In Attendance Anne Allan, Senior Nurse, Renal Service Steve Brown, EES Section Head Peter Cooke, Head of Medical Physics Anna McInally, Freedom of Information Officer Neil Stewart, Head of Procurement and Logistics


Apologies for absence were received from Committee members, Alasdair Lawton, Non-Executive Director, David Garden, Director of Finance, Carol Marlin, Monitoring Accountant, and Bob Summers, Head of Occupational Health & Safety.

2 MINUTES OF 22 JANUARY 2020

The Group Approved the Minutes of the meeting of 22 January 2020

3 MATTERS ARISING

There were no matter arising.

4 CAPITAL MONITORING REPORT

Ms Fraser provided an overview of the Capital Monitoring Report at Month 10. It was confirmed no allocations have been received since Month 9 but further allocations were expected. With regards to spend, progress has been made and budget holders have been reminded of March 31 deadline for capital spending. Mr Stewart advised there were a backlog of over five hundred purchase orders on PECOS and urged staff to contact him directly if orders required prioritisation.

At Month 10, the contingency fund was £105,000.

The Group noted the Report.

5 RENAL UNIT SCI STORE INTERFACE (RAIGMORE)

NHSH Board 31 March 2020, Item 15i225



Ms Allan provided an overview of the circulated report. The IT system within the Renal department at Raigmore Hospital, HERMES, does not have an interface with Sci-Store and, as such, renal staff were unaware when renal patients have been admitted or discharged from other departments in Raigmore Hospital. Renal staff were reliant on discharge letters, phone calls or the Scottish Ambulance Service. The lack of an interface has meant renal patients have not been recorded and inaccurate data has been sent to the Scottish Renal Registry. Thereafter, there was discussion regarding the most appropriate funding source for the software. It was agreed the funding should be taken from eHealth and Mr McNicoll agreed to raise the matter as a priority within eHealth due to the associated risks. It was noted, if the supplier could not install the software before 31 March, the funding would be taken from 2020/21 budget. The Group would be kept appraised of the progress. The Group Agreed the purchase and funding should be taken from the eHealth budget. 6 FORT WILLIAM RESIDENTIAL ACCOMMODATION Mr Green sought approval to lease a residential property in Fort William for locums providing out of hours care in the area. The previous lease concluded in January and an AirBnB has been used as a temporary solution. Accommodation in the area remains challenging due to tourism and locums have advised accommodation is imperative. The lease will commence in March 2020 for one year at a cost of £870 per month for a fully furnished property. The Group Agreed to the lease of residential accommodation in Fort William. 7 LORN AND ISLES HOSPITAL LONE WORKING ALARM SYSTEM Mr Morrison provided an overview of the circulated paper. It was confirmed Health and Safety have been consulted. The preferred supplier was PinPoint who were used across NHS Highland. The total cost was £17,671.38 and the supplier has confirmed the system would be installed by 31 March 2020. Mr Morrison agreed to forward the relevant emails regarding the installation to Ms Fraser. The Group Agreed to fund the lone working alarm system in Lorn and Isles Hospital. 8 MEDICAL EQUIPMENT PURCHASE ADVISORY GROUP Mr Cooke provided an overview of the circulated report regarding the establishment of a NHS Highland Medical Devices Governance Group with various sub groups, including, Medical Equipment Purchase Advisory Group which would oversee the planning and replacing of medical equipment across NHS Highland and would report into the Asset Management Group. Thereafter, there was a detailed discussion regarding the inventory of medical equipment. It was confirmed medical devices have been added to NHS Highland’s Risk Register on the basis a large portion of the inventory will require replacement in the near future. The Group endorsed the principle of the creation of the NHS Highland Medical Devices Governance Group with sub structure suggested.

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9 AOCB 9.1 Torridon House Lease Mr Green advised the Committee of the proposal to lease Torridon House to accommodate staff from Larch House and Scotia Court. Furthermore, it was proposed staff from Laxford House would be moved to office space at New Craigs but this is yet to be confirmed. Torridon House be configured similar to Assynt House and flexible working would be adopted. The close proximity of Torridon House to Assynt House was a benefit but it was noted the lack of car parking would be problematic but there were no parking alternatives available. The paper would be tabled at the next meeting of SLT for discussion and approval. The Group supported the lease of Torridon House but SLT will decide whether the lease should be progressed due to the implications on staff.

10 DATE OF NEXT MEETING The next scheduled meeting of the Committee will be held on 18 March 2020 at 2.00pm in the Ante Room.


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Page 1 of 3

NHS Highland


Meeting date: 31st March 2020

Title: Month 11 update

Responsible Executive/Non-Executive: David Garden

Report Author: Carol Marlin

1 Purpose

This is presented to the Board for:

Discussion

This report relates to a:

Annual Operation Plan

This aligns to the following NHS Scotland quality ambition(s):

Effective

2 Report summary

2.1 Situation This report ensures Finance Committee members are informed of the financial position at month 11, including year to date actual savings delivered and future forecast delivery.

2.2 Background To achieve financial balance in 2019-20 NHS Highland are required to deliver £28M of savings as informed by the Annual Operating Plan and mitigate cost pressures of potentially £7.7m.

2.3 Assessment Detailed analysis of the situation and considerations are provided in the attached report.


Page 2 of 3

2.3.1 Quality/ Patient Care

For savings schemes. the impact on quality of care is assessed at an individual scheme level using a Quality Impact Assessment tool. All savings are assessed using a QIA which can be accessed from the Programme Management Office.

2.3.2 Workforce

The impact on staff including resources, staff health and wellbeing is assessed at an individual scheme level within the Quality Impact Assessment tool. All savings are assessed using a QIA which can be accessed from the Programme Management Office. 80% of the cost improvement savings are non-pay. In terms of mitigation schemes, some slow down of non-critical posts have been expected to contribute to the financial targets.

2.3.3 Financial

Reporting delivery of £11.4m recognising that there remains a gap of £1.8m to deliver this.


Risk assessment of delivery is undertaken at an individual scheme and workstream level. Additionally, risk is assessed at an overall programme level and is summarised in the report.

2.3.5 Equality and Diversity, including health inequalities

n/a 2.3.6 Other impacts

N/A

2.3.7 Communication, involvement, engagement and consultation The Board has carried out its duties to involve and engage external stakeholders where appropriate through the following meetings: Workstream meetings held fortnightly Financial Recovery Board held weekly Scottish Government Oversight Board for NHS Highland


This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report. Financial Recovery Board 19 February 2020

2.4 Recommendation

Discussion and noting

230

Page 3 of 3


The following appendices are included with this report: Report plus two appendices

231

NHS Highland Board meeting 31st March 2020

Financial Positon Report at 29th February 2020 (Month 11) By David Garden, Director of Finance


1. Consider the financial position of the Board at Month 11 noting the overspend of £10.9m against year to date budgets

2. Note the continued expectation of the need for £11.4m of financial brokerage

3. Acknowledge the financial position as set out in this report and appendices.

1. Highlights Current Financial Ledger Position at Month 11

For the eleven months to February 2020, NHS Highland has overspent against budget by £10.9m.

Approximately £10.5m of this deficit is part of the approved brokerage for the year while the remainder relates to the shortfall in savings delivery.

Forecast – Financial Ledger Forecast Position at Month 12

The year-end forecast position is a deficit of £12.1m of which £11.4m is planned and approved brokerage.

This results in a £0.7m gap from the target deficit for the year (£12.1m - £11.4m).

There is also a potential additional cost pressure which is not reflected in the ledger of £1.5m related to a proposed uplift in Argyll & Bute’s Service Level Agreement with NHS Greater Glasgow and Clyde. This remains subject to discussion between the parties.

Our approach to bridging the remaining gap is described later in this report. The Board should note that in order for the reported ledger position to be as accurate as possible, some adjustments are not yet made to our formal ledger position but which will be actioned as we progress the final month of the year. These are described, along with the adjusted forecast, later in this report. 2. Movement from Month 10 There has been a further improvement in the projected out-turn reported in Month 10 (£13m) when compared to the projected out-turn reported in Month 11. The movement totals £0.9m and reflects the transfer of a range of recurrent and non-recurrent savings and cost pressure mitigation measures from plans to delivered savings in our ledger. In addition a number of cost mitigations have come to fruition.

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3. Savings Programme PMO led savings programme The savings programme is a key component of NHS Highland’s recovery plans and has a target of £28m for 2019/20. Delivery against this target is as follows:

£m Savings delivered/in delivery (risk adjusted) 27.1 Pipeline to be converted to delivery (risk adjusted) 0.0 Total Savings Programme 2019/20 27.1

Target 28.0

Gap (0.9) Approximately 64% of the savings programme is recurrent in nature which provides a strong financial platform from which to build for 2020/21. This forecast deficit is a component of the reported net deficit to target at year end. 4. Impact of cost pressures While the PMO led savings programme is performing well, a number of cost pressures have been reported during the year which have to be mitigated with additional savings over and above those planned to be delivered via the PMO. Current estimates suggest allowance must be made for cost pressures totalling £6.2m at year-end reflecting locum, agency and prescribing cost pressures amongst others. As noted above, a possible additional pressure of £1.5m from our SLA with NHS GG&C is also creating concern and has informed our additional savings target although we remain hopeful of resolving this matter separately. Action to mitigate cost pressures To mitigate these savings, a series of measures have been identified, most of which are non-recurring but which will substantially mitigate the emergent pressures and allow our financial targets to be met. The following table summarises these savings:

Savings Area Plan (£m) Actioned (£m)

To be actioned

(£m) Procurement 0.3 0.3 Professional Fees 1.0 1.0 Year-end financial flexibility 1.4 1.4 0.0 Divisional budgets – further housekeeping

2.0 2.0 0.0

Recruitment slippage (non-critical posts) 0.3 0.3 Funded programmes – slippage to 1.7 1.7 0.0

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5. Adjusted Forecast

As noted previously, a number of adjustments should be made to the forecast out-turn position in our ledger to reflect adjustments not yet recorded but which will occur in the remaining two months of this year. The table below summarises these:

6. Bridging the remaining gap Efforts continue to identify additional savings to bridge the potential £1.6m residual gap by year-end. The Committee should note that if the potential reduction from NHS GG&C does not materialise then the need for additional savings would be reduced significantly and efforts in this regard continue. The Committee should also note that there is, of course, a requirement to continue to manage and mitigate risk in the ongoing delivery of this year’s savings programme. Risk exists in the ongoing delivery of the savings programme, in the conversion of the savings pipeline and in our ability to manage any further emerging cost pressures not anticipated in our forecasts to date. Appendix 1 attached provides finance reporting in more detail and shows tables and supporting points for the period to month 11 Appendix 2 attached shows the position of Adult Social Care at month 11. 7. Governance Implications Accurate and timely financial reporting is essential to maintain financial stability and facilitate the achievement of Financial Targets which underpin the delivery and development of patient care services. In turn, this supports the deliverance of the Governance Standards around Clinical, Staff and wider Public awareness and involvement. The financial position is scrutinised in a wide variety of governance settings in NHS Highland.

8. Risk Assessment

2020/21 NOSPG Income 0.1 0.1 0.0 Totals 6.8 6.2 0.6

234

Risks to the financial position are monitored monthly. There is an over-arching entry in the Strategic Risk Register. 9. General Data Protection Principles Compliance There are no risks to compliance with Data Protection Legislation 10. Planning for Fairness A robust system of financial control is crucial to ensuring a planned approach to savings targets – this allows time for impact assessments of key proposals impacting on services. 11. Engagement and Communication The majority of the Board’s revenue budgets are devolved to operational units, which report into two governance committees that include staff-side, patient and public forum members in addition to local authority members, voluntary sector representatives and non-executive directors. These meetings are open to the public. The overall financial position is considered at the full Board meeting on a regular basis. All these meetings are also open to the public and are webcast. David Garden Director of Finance 17th March 2020

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NHS HIGHLAND FINANCE REPORT

MONTH 11- FEBRUARY APPENDIX I

NHS Highland Board

31st March 2020

236

Director of Finance narrative – Feb 2020

• Headlines: • The month eleven position shows an adverse YTD position of £10.9m >£10.4m YTD of planned deficit (£11.4m) >£1m savings >Offset by £0.5m in operational cost reductions • As summary YTD position highlights, our continuing major pressure operationally is

Raigmore with a £3.1m adverse YTD position. This is partly linked to both the premium cost locum and agency, increased prescribing issues along with clinical supplies, short stay ward and medical rota gaps. Detail in slide 7

• Premium pay costs are still a major pressure with locums spending £16.4m to month 11

and other staff groups £22.2m - see slides 12 to 14 for more detail. • Projected position remains at £11.4m although no resolution to the Glasgow/A&B SLA

position

• Month 11 position is showing £12.1m potential overspend at year end leaving a challenge of £0.7m to deliver the AOP target (Excluding GG&C)

237

Director of Finance narrative – Feb 2020 (cont)

• The £12.1m projection is a further improvement of £0.9m on the previous reported projection at month 10 (see slide 8 for more info).

• Following month 8 a mitigation plan to reduce cost pressures was implemented, with

targets of £4.9m and £1.9m identified (£6.8m). To month 11 £5.5m has been identified and brought into the projected position for current and future months forecast.

• Challenge remaining of £0.7m to reach £11.4m target – not including discussions around the GG&C contract.

• Capital spend to Month 11 £20.2m and is on track to deliver a balanced position

238

Funding 2019-20

• SG funding for 2019/20 assumes £820m

• This includes baseline funding uplifted by 2.56% for 2019/20 and superannuation uplift

• Allocations received to date • FHS allocation • Anticipated funding for non

Discretionary, FHS, and other expected allocations

• Funding to and from The Highland Council for Adult and Children’s

services bring total expected funding to £909.8m

Current

Summary Funding & Expenditure 2019/20 Plan

£m

SGHSCD -Baseline Funding 644.8

- Recurring Supplemental Allocations 22.8

- Non Recurring Supplemental Allocations 4.7

- FHS GMS Allocation 67.7

Sub total - SGHSCD Core RRL 740.0

- Non Core Funding 46

SGHSCD Funding at month 9 786.1

Anticipated funding

- FHS Non Discretionary 34.3

- Recurring Pending allocations 0.5

- Non Recurring Pending allocations (0.7)

- Non Core Pending allocations 0.0

TOTAL SGHSCD Funding 820.2

Add- Adult Social Care Quantum Funding 100.6

Less - THC Childrens services Transfer (11.0)

Funding 909.8

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Summary YTD position by unit-February 2020

• Month 11 overspend of £10.9m made up of; • £10.5m of planned ‘gap’ (11 months of the

AOP £11.4m) • Saving delivery phasing of £1m • Operational pressures of (£0.5m) Broken down as follows; Operational units Raigmore £3.1m operational overspend (see

slide 7 for more info)

North & West small deficit of £0.1m

Support Services Facilities £1m overspend (national waste

contract)

Tertiary – out of area £1m overspend

Offset with underspends in South & Mid, ASC

central and income, Corporate and Argyll & Bute

Plan Actual Var

Expenditure to Month

11 - Feb 2019 to Date to Date to Date

Planned

Deficit

Savings

delivery

Operational

Variance

£m £m £m £m £m £m

South & Mid Division 205.4 205.7 (0.3) 0.0 (0.6) 0.4

Raigmore Division 175.9 181.3 (5.4) 0.0 (2.3) (3.1)

North & West Division 139.9 141.6 (1.7) 0.0 (1.6) (0.1)

Sub Total NH Op Units 521.3 528.6 (7.4) 0.0 (4.5) (2.8)

ASC - Central 4.2 3.0 1.2 0.0 0.6 0.6

Facilities 22.0 23.3 (1.3) 0.0 (0.3) (1.0)

e health 7.9 7.9 0.1 0.0 0.0 0.1

Tertiary 19.6 21.1 (1.4) 0.0 (0.5) (1.0)

Central services (775.1) 29.1 8.1 0.0 4.3 3.8

ASC Income (12.3) (12.6) 0.3 0.0 0.0 0.3

HSCP Corp Support 1.1 1.1 0.1 0.0 0.0 0.1

TOTAL H&SCP (211.3) 601.5 (0.4) 0.0 (0.4) (0.0)

Corporate Services 21.6 21.2 0.4 0.0 (0.0) 0.4

Argyll & Bute 189.7 189.7 0.0 0.0 (0.5) 0.6

Planned Defcit 801.4 (10.9) (10.5) (0.4)

Total Expenditure 801.4 812.3 (10.9) (10.5) (1.0) 0.5

Components of Variance

240

Monthly Outturn Comparison

YTD position at month 11 is £10.9m overspend

0

2

4

6

8

10

12

14

16

18

20

May June July Aug Sept Oct Nov Dec Jan Feb March

£m

's

YTD position comparison

17-18 YTD 18-19 YTD 19-20 YTD

241

Raigmore Cost pressures

Raigmore cost pressures YTD Full year£m's £m's

Medical pay pressures including locuma (1.3) (1.4)

Nursing pressures including worforce tool (1.1) (1.1)

Short stay ward - medical & nursing (0.3) (0.4)

Non Pay Theatres & endoscopy (0.6) (0.6)

Drugs - Ophthalmolgy (0.7) (0.7)

Cancer 0.6 0.6

Medical & Surgical (0.6) (0.2)

Radiology (0.4) (0.4)

Other (0.0) (0.4)

(4.4) (4.5)

Offsetting underspends 1.3 2.1

Operational pressures (3.1) (2.4)

242

Forecast position as at month 11

• Operational forecast at month 11 is £12.1m overspend.- positive movement in month of £0.9m

• Planned deficit as per AOP of £11.4m • £1.5m of savings yet to be actioned • Operational variance Underspend of £0.8m

as follows; • S&M unit forecast a small underspend

excluding savings

• Raigmore have a forecasted overspend of £2.4m (excluding workstream savings) due to drugs locums and clinical supplies (see slide 7)

• N&W have an underspend after savings of £0.5m

• Facilities have £1.1m pressure made up of the new national waste contract and energy costs

• Out of are costs are currently overspending by £1.1m

• Offset by underspends in Central, social care and corporate

• Argyll & Bute showing breakeven

Annual

Summary Funding &

Expenditure Forecast

Plan Outturn Variance Planned

Deficit

Savings to

achieve

Operational

Variance

£m £m £m £m £m £m

South & Mid Division 226.0 226.8 (0.9) (1.0) 0.1

Raigmore Division 192.2 197.4 (5.2) (2.8) (2.4)

North & West Division 153.7 155.2 (1.6) (2.1) 0.5

Sub Total NH Op Units 571.9 579.5 (7.6) 0.0 (5.9) (1.7)

Adult Social Care - Central 4.7 3.4 1.3 0.6 0.7

Facilities 23.8 25.2 (1.4) (0.3) (1.1)

e health 8.8 8.7 0.1 0.0 0.1

Tertiary 21.3 22.9 (1.6) (0.5) (1.1)

Central services 69.9 61.9 8.0 4.7 3.3

ASC Income (13.5) (13.7) 0.2 0.0 0.2

HSCP Corporate Support 1.6 1.6 0.0 0.0 0.0

TOTAL H&SCP 688.4 689.5 (1.1) 0.0 (1.5) 0.4

Corporate Services 24.0 23.6 0.4 0.0 0.4

0.0

Argyll & Bute 208.7 208.7 0.0 0.0 0.0

Unplanned Savings (11.4) 0.0 (11.4) (11.4) 0.0

Total Expenditure 909.8 921.8 (12.1) (11.4) (1.5) 0.8

Forecast Components of Variance

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Summary position by subjective spend

• Medical pay has an overspend of £5m YTD overspend including locum costs , other staff group underspends are bringing the total to £1.8m YTD. Year end projection £1m overall pay overspend

• In non pay - clinical costs are the main driver in projections (£1.7m supplies and equipment) with drugs (£0.7m) and out of area (£1.4m) also showing significant overspends for year end

• Savings show £12.9m projection being the £11.4m planned deficit and £1.5m not yet achieved

• Commitments have a £2.2m benefit showing where costs have been held to aid the recovery plan

• Over recovery of operational income of £1.9m forecast

YTD YTD YTD Annual Forecast Year End

Subjective Spend Budget Actuals Variance Plan Out-Turn Variance£m £m's £m's £m £m £m

PAYMedical & Dental 76.7 81.9 (5.2) 84.0 89.0 (5.0)

Medical & Dental Support 5.3 5.0 0.3 5.8 5.4 0.4

Nursing & Midwifery 136.4 136.3 0.0 149.5 148.8 0.6

Allied Health Professionals 25.7 24.3 1.4 28.0 26.6 1.4

Healthcare Sciences 11.9 11.6 0.3 13.0 12.7 0.3

Other Therapeutic 12.0 10.9 1.0 13.4 12.0 1.4

Support Services 26.8 26.8 (0.0) 29.1 29.3 (0.1)

Admin & Clerical 50.1 49.2 0.9 54.7 53.9 0.9

Senior Managers 2.7 2.6 0.1 3.0 2.9 0.1

Social Care 34.6 33.8 0.8 37.7 36.9 0.8

Commtments/Pay Savings (1.9) (0.4) (1.5) (2.3) (0.5) (1.8)

Pay - Total 380.3 382.1 (1.8) 415.9 417.0 (1.0)

Drugs 90.7 91.6 (0.9) 99.1 99.8 (0.7)

Property 39.9 40.7 (0.8) 43.4 44.4 (0.9)

Non Pay 35.1 33.9 1.2 40.2 37.5 2.7

Clinical non pay 35.6 37.6 (2.0) 39.3 40.9 (1.7)

Health care OOA 52.9 53.8 (0.9) 56.6 58.1 (1.4)

GG&C SLA 60.0 60.1 (0.1) 65.5 65.6 (0.1)

Social Care ISC 92.2 92.3 (0.1) 101.0 101.5 (0.5)

FHS 87.0 86.3 0.7 96.5 96.2 0.3

Commitments 2.5 0.0 2.5 34.7 32.4 2.2

Savings (11.4) 0.0 (11.4) (13.2) (0.3) (12.9)

Operational Income (63.3) (66.0) 2.7 (69.3) (71.2) 1.9

Total 801.4 812.3 (10.9) 909.7 921.8 (12.1)

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Savings Delivery Month 11

Savings forecast to PMO delivery £000's

Ledger savings

Recurrent savings delivered and forecast 16,045

Non Rec savings delivered and forecast 10,448

Savings delivery at month 11 26,493

Target 28,000

Balance to achieve 1,507

Savings delivered as above 26,493

Savings delivered and forecast as per PMO 27,126

Difference -633

Pipeline savings not in ledger 48Cost reduction not yet shown in forecast 585

633

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Locum spend

Spend of £16.5m to month 11 19-20 compared to £13.9m in 18-19 to month 1

2019-20 break down

Raigmore £5.7m S&M £1.4m N&W £5.4m A&B £3.9m

Month 11 costs decreased by £99k

800

900

1,000

1,100

1,200

1,300

1,400

1,500

1,600

1,700

1,800

Mth 1 Mth 2 Mth 3 Mth 4 Mth 5 Mth 6 Mth 7 Mth 8 Mth 9 Mth 10 Mth 11 Mth 12

£0

00

's

Locums 2016-17 to 2019-20

2019/20 2018/19 2017/18 2016/17

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Locum movement

M9 – M10

• Area M10 M11 Diff £000 £000 £000

• Raigmore 559 487 72

• N&W 483 405 76

• S&M 158 179 21

• A&B 362 378 12

Movements

• 2nd urology locum, ENT & Paeds

Haematology rota gaps- pressure in

Oral and Maxillofacial

• Belford moving to fixed posts

• Caithness locums covering annual

leave in mth 10

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Supplementary staffing spend

2019/20 M11 costs of £2.05m - cumulative £22.23m

2018/19 M11 costs of £1.80m -cumulative £20.33m

Small increase in month of £37k

1.600

1.700

1.800

1.900

2.000

2.100

2.200

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12

Supplementary staffing

SS Spend 2017/18 SS Spend 2018/19 SS Spend 2019/20

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Capital Income and Expenditure report Month 11

Original

Plan

Current

Plan Summary Funding & Expenditure

Plan to

Date

Actual to

Date

Variance

to Date

£000's £000's £000 £000 £000

FUNDING

6,616 6,616 NHS Highland Capital Allocation (Formula) 4,580 4,580 03,250 3,250 Raigmore Critical Care & Theatres 2,979 2,979 0

527 527 Oban CT Scanner 527 527 0110 110 Fortrose Medical Practice-slipped from 1819 0 0 0

18,709 18,709 Skye and B&S bundle 11,214 11,214 014,500 1,000 Elective Care Centre 646 646 0

750 750 Radiotherapy replacement 0 0 0769 Others 318 318 0

44,462 31,731 SG Allocation Letter February 2020 20,264 20,264 0Anticipated Allocations

(47) SAS Trauma funding reprovision 0 0 01,000 500 Raigmore Fire Compartmentation upgrade 458 458 0

47,812 32,184 Total Capital Funding 20,264 20,264 0

Expenditure/Commitments

687 687 PFI Lifecycle Costs 630 633 (3)3,750 3,750 Raigmore Critical Care & Theatres 3,271 3,338 (68)

750 750 Radiotherapy 0 18 (18)18,709 18,709 Skye,B&S Hospital bundle 11,214 11,214 (0)14,500 1,000 Elective Care Centre 646 646 (0)

527 527 Oban CT Scanner 527 558 (31)1,000 500 Raigmore Fire Compartmentation upgrade 458 812 (353)

42,273 25,923 16,746 17,218 (473)

Rolling Programmes

1,150 1,249 Estates Backlog Main. 758 757 01,555 1,555 Medical Equipment 1,425 1,186 240

1,100 eHealth Replacement 280 280 0660 224 Radiology 205 (2) 207

3,365 4,128 2,669 2,221 448

2,174 2,133 Other including Contingency 849 771 78

47,812 32,184 Capital Expenditure 20,264 20,210 53

0 (0) SURPLUS/DEFICIT MONTH 11 0 53 53

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NHS Highland APPENDIX II

Adult Social Care Financial Statement at Month 11 2019-20

Annual YTD YTD YTD Forecast Forecast

Services Category Budget Budget Actual Variance Outturn Variance

£000's £000's £000's £000's £000's £000's

Older People - Residential/Non Residential Care

Older People - Care Homes (In House) 10,883 9,972 10,324 (351) 11,347 (464)Older People - Care Homes - (ISC/SDS) 28,537 26,220 27,803 (1,583) 30,352 (1,814)Older People - Other non-residential Care (in House) 962 891 930 (38) 1,032 (70)Older People - Other non-residential Care (ISC) 1,326 1,208 1,241 (33) 1,362 (36)

Total Older People - Residential/Non Residential Care 41,709 38,292 40,298 (2,006) 44,093 (2,384)

Older People - Care at Home

Older People - Care at Home (in House) 14,155 12,613 11,965 647 13,308 847Older People - Care at home (ISC/SDS) 13,810 13,462 11,635 1,827 12,773 1,037

Total Older People - Care at Home 27,965 26,075 23,600 2,475 26,081 1,884

People with a Learning Disability

People with a Learning Disability (In House) 3,953 3,622 3,343 279 3,662 291People with a Learning Disability (ISC/SDS) 27,128 24,867 26,009 (1,142) 28,648 (1,520)

Total People with a Learning Disability 31,082 28,489 29,352 (863) 32,310 (1,229)

People with a Mental Illness

People with a Mental Illness (In House) 357 328 222 106 244 113People with a Mental Illness (ISC/SDS) 6,446 5,905 6,175 (270) 6,779 (333)

Total People with a Mental Illness 6,803 6,233 6,397 (164) 7,023 (220)

People with a Physical Disability

People with a Physical Disability (In House) 1,083 995 770 226 852 231People with a Physical Disability (ISC/SDS) 6,355 5,836 5,700 136 6,247 109

Total People with a Physical Disability 7,439 6,831 6,470 362 7,099 340

Other Community Care

Community Care Teams 6,478 5,949 5,587 362 6,094 384People Misusing Drugs and Alcohol (ISC) 44 40 20 20 22 22Housing Support 5,610 5,087 5,255 (168) 5,752 (142)Telecare 848 761 609 152 688 160

Total Other Community Care 12,980 11,837 11,472 365 12,556 423

Support Services

Business Support 1,390 1,244 1,139 105 1,258 132Management and Planning 2,809 1,798 405 1,394 632 2,176

Total Support Services 4,198 3,043 1,544 1,499 1,890 2,308

Total Adult Social Care Services 132,175 120,799 119,132 1,667 131,052 1,123

ASC services now integrated within health codes 3,565 2,971 2,971 0 3,565 0

Total Integrated AdultSocial Care Services 135,740 123,770 122,103 1,667 0 134,617 1,123

Three Care categories account for 77% of total spend on ASC

Older People accounts for the largest proportion of the Forecast Overspend.

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DRAFT

Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk/

DRAFT MINUTE of MEETING of the AREA CLINICAL FORUM

Board Room, Assynt House, Inverness 5 March 2020 – 1.35pm

Present Margaret Moss Area Nursing, Midwifery and Allied Health Professionals Committee (Chair) Eileen Anderson, Area Medical Committee Eddie Bateman, Area Dental Committee Lorien Cameron-Ross, Area Medical Committee Peter Cook, Area Healthcare Science Forum Linda Currie, Area Nursing, Midwifery and Allied Health Professionals Committee (Videoconference) Ann Galloway, Psychological Services Advisory Committee Frances Jamieson, Area Optometric Committee (from 1.45pm) Jim Law, Psychological Services Advisory Committee Stephen McNally, Raigmore Kitty Millar, Clinical Representative (Argyll and Bute) Wil Nel, Clinical Director West (Videoconference) Adam Palmer, Employee Director Manar Elkhazindar, Area Dental Committee Catriona Sinclair, Area Pharmaceutical Committee Iain Thomson, Adult Social Work and Social Care Advisory Committee

In Attendance Paul Davidson, Deputy Medical Director (Community Services) Sharon Hammell, Head of Strategic Change and Engagement (from 2.00pm) Fiona Hogg, Director of Human Resources and Organisational Development Brian Mitchell, Board Committee Administrator Chris Morgan, Strategy Development Programme Manager (Item 3.1) Katherine Sutton, Head of Acute Services (Item 2.1)

1 WELCOME AND APOLOGIES

Margaret Moss took the Chair and welcomed those present to the meeting.

Apologies were submitted from Colin Farman, Paul Hawkins, Alex Javed, Boyd Peters and Clare Watt.

1.1 DECLARATIONS OF INTEREST

There were no declarations of interest.

NHSH Board 31 March 2020, Item 5g251


2 DISCUSSION ITEMS 2.1 Whole System Flow K Sutton gave a presentation to members in relation to whole system flow and unscheduled care. Referencing the six Essential Actions relating to improving unscheduled care, she outlined the results of the last Raigmore Hospital Day of Care Survey (October 2019). This Survey had highlighted issues relating to bed occupancy and delayed discharge numbers, patient age profile, length of stay and number of boarders. It was noted this data had previously led to the establishment of a Post-Acute Ward, with Social Care the key element when seeking to reduce the number of patients with very long hospital stay. It was reported 1% of patients had a stay of over 100 days, this consuming 30% of the overall occupied bed days for the period. The key findings relating to Community Hospitals were also highlighted, with 71% occupancy on the day and similar discharge issues being faced in relation to alternative care and guardianship. K Sutton went on to advise the Winter Plans for 2019/2020 had been based on these Day of Care survey results and had prioritised rapid access to Care at Home capacity in the Inverness areas; block purchase of Care Home beds; development of a coordination facility/hub; and provision of additional community hospital capacity. Care at Home and care home capacity issues were having a direct impact on Hospital flow. During discussion, it was advised the recently opened care home in Inverness had initially indicated it did not wish to provide for NHS patients and as such discussion was being held as to providing alternative models of care such as delivery within patient homes. L Cameron-Ross urged consideration of the Nairn community model as a positive example of what could be achieved. Reflecting on survey results, it was noted 1% of patients were occupying 30% of Raigmore Hospital bed days and 168 patients were considered to be in the wrong place of care on the day. Other matters to be further considered related to the demography of patients and the wider population being served given elderly patients in hospital lose both muscle mass and function. There was insufficient capacity to accommodate current clinical practice models. Alongside Dr E Watson, Clinical Director consideration was being given as to how best to redesign acute, community and social care services to meet existing need. Work would be coordinated through the relevant PMO Flow workstream, involving appropriate Clinical leadership and based on a multi-disciplinary team approach that would seek to achieve multiple marginal gains and inform the NHSH Clinical Strategy. K Sutton advised she welcomed the generation of ideas for consideration for inclusion within the relevant pipeline. There followed discussion, during which members heard as to the impact on clinicians of a hospital operating at 98% capacity. There was agreement as to the need to address issues relating to emergency flow and ensure appropriate resource across all hospital functions. It was suggested additional Radiology capacity would be of real benefit and in response. K Sutton suggested consideration of relevant testing activity outwith hospital or at alternative points in the treatment cycle. The adoption of the Clinical and Care Strategy approach was welcomed, with issues relating to recruitment in to the care sector being highlighted as a concern. It was suggested streamlined assessment activity would help with patient flow. It was noted matters relating to Adults with Incapacity legislation and guardianship were not considered to be major contributory factors in Highland. It was suggested the impact of health and social care integration on social worker resource should be further considered. In terms of moving forward, K Sutton stated there were a number of suggested areas where a redesign of services may have a beneficial impact on hospital flow such as the adoption of both community pre-habilitation and rehabilitation services with a view to reducing existing lengths of stay. Consideration would also require to be given as to whether the provision of community services should continue to be privately led or provided in-house. A Palmer welcomed potential consideration of in-house Care at Home provision. A discharge lounge approach had also been suggested. L Currie stated consideration of re-ablement activity etc had to include Allied Health Professions as part of the wider conversation around potentially

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disinvesting in one area to invest in another and in response K Sutton encouraged her to get involved in seeking to redesign what was considered to be an outdated service model. She emphasised funding could be made available for relevant service redesign activity, subject to appropriate bids. The Forum: • Noted the presentation content. • Agreed further service redesign ideas be relayed to K Sutton. • Agreed the presentation provided be disseminated to Professional Advisory Committees. 2.2 Attraction, Recruitment and Retention S Hammell gave a short presentation to members in relation to improving NHSH staff attraction, recruitment and retention activity, outlining relevant initiatives and advising as to relevant quick wins, as well as anticipated medium and long term impacts. She highlighted aspects relating to ensuring best value; development of an Attraction, Recruitment and Retention (ARR) Strategy; long term planning; “Grow Your Own” activity and working with strategic partners in relation to matters such as housing provision. She advised discussion was ongoing with Scottish Government in relation to developing national recruitment campaigns. The importance of aligning any ARR Strategy to the Culture Programme Action Plan was also emphasised. An outline of relevant component enablers was also provided. During discussion, specific recruitment challenges were referenced, such as in relation to Radiology and in response S Hammell advised there was a need to take advantage of existing staff members and their individual stories to highlight and emphasise the positive NHS Highland working environment and supportive innovation culture. Recent improvements in relation to culture and behaviour were recognised, and it was agreed the sharing of positive staff experiences and the highlighting of high levels of staff retention, could only be beneficial in recruitment terms. It was confirmed opportunities for developing international recruitment activity were being considered. The view was expressed that the issues highlighted in this and previous discussion had shown the need to better understand the wider labour market, and variation between areas including across diverse Highland locations and communities. There was need to consider if there was sufficient supply available to meet current demand, with improved workforce planning activity required. C Sinclair highlighted the need to increase current Pharmacist training numbers at this time and took the opportunity to highlight an overall ageing NHS workforce. She emphasised the importance of being able to attract greater numbers of young staff and suggested positive stories be taken from the current younger staff cohort to help in that area. It was stated the University of the Highlands and Islands (UHI) had a key role to play. M Elkhazindar suggested the low level of private practice work available in Highland could be impacting on senior clinician recruitment and suggested consideration of proactive ‘head hunting’ activity. The need to be more proactive overall in relation to recruitment was accepted although it was stated the methods involved would require further detailed consideration. Reference was also made to recent incentivisation activity in England, relating to Nursing Students; and the success of “golden hellos” for new Vocational Dental Trainees. Welcoming the ideas generated in discussion, S Hammell indicated a desire to strengthen current clinical engagement with this topic and undertook to seek to develop this aspect further. After discussion, the Forum otherwise: • Noted the presentation content. • Agreed a short working session with Sharon at the next ACF meeting be allocated to

further generation of clinical ideas and discussion to support this work.

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3 STANDING ITEMS 3.1 Development of the NHSH Clinical and Care Strategy C Morgan gave a presentation to members, providing an update on relevant Strategy development structure; and advising as to the overall programme approach, completion of key February 2020 milestones, agreement of relevant individual workstream leadership and associated roles, outline of workstream focus areas and the plan for relevant March 2020 activity. He advised March 2020 would see acceleration of Workstream development, including finalising plans to deliver strategic recommendations, finalising focus areas, gathering focus area teams, and production of SBARs for communicating on the areas of focus. The Strategy Development Team would focus on finalising materials for staff, stakeholder and public engagement then planning and commencing the same. C Morgan went on to emphasise there were a number of strategic changes being implemented across NHS Highland at that time and as such relevant activity planners would be brought together to ensure appropriate synergy and help inform future discussion/plans. During discussion, C Morgan re-emphasised current improvement activity should continue, with the caveat that silo working should be avoided where possible and in recognition of the need to link to relevant workstream activity where appropriate. It was important to recognise such existing work may be changed by or subsumed into relevant wider workstream activity. The Chair raised previous references to development of a clinically led, managerially enabled approach, questioning how this would be achieved and suggested use of the phrase ‘triumvirate’ be dropped in favour of one that reflected more of a multi-disciplinary approach. P Davidson confirmed the need for wider clinical inputs had been recognised. In concluding discussion, C Morgan thanked members for their respective input and requested the detail of his presentation be utilised for wider groups and discussion. He confirmed he would look to further engage with both Governance and Professional Advisory Committees, while attending meetings of this Forum as and when appropriate. After discussion, the Forum: • Noted the presentation content. • Agreed the presentation be passed to Professional Advisory Committees for discussion.

C Morgan left the meeting at 3.20pm.

3.2 Update on Culture Activity F Hogg advised the Culture Programme Board was now operational, meeting on a four weekly basis. The Board was providing relevant oversight, taking appropriate learning and ensuring a flexible approach is taken when designing underlying support structures. As the work of the Board matured, progress was expected to accelerate significantly. Representatives on the Programme Board were expected to provide feedback where appropriate. She went on to advise that the Argyll and Bute Culture Review had been launched and would run to 27 March 2020, promotion in relation to which was also underway. The aim is to gain a better understanding of staff experience and it was confirmed any emergent actions would be applied across all NHS Highland. Members were asked to encourage staff members to participate in the relevant Survey process. An external Culture Advisor had been appointed to oversee progress, provide challenge and drive actions forward. Additional external expertise would be drawn upon as required. It was reported the preparation of plans for the developing Healing Process were now well advanced and it was hoped the inclusion of an external process and representative would help to alleviate any trust issues that may remain. It was hoped the relevant process would be launched by end April 2020. The Area Clinical Forum would continue to be updated on

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relevant progress through feedback from Forum members who share ACF representation on the Culture Programme Board. During discussion, members welcomed the encouraging progress being made and heard the proposed bespoke Healing Process which would be accessible to individual staff members concerned. It would also seek to outline relevant roles, responsibilities and requirements placed on managers and leaders. Hearing that frontline staff had yet to witness a change in behaviour at that level, F Hogg stated senior staff would be encouraged, rather than instructed, with clarification given as to the relevant expectations in this area. She stated it was important to promote Courageous Conversations and help all staff to build on those skills. M Moss emphasised the need for effective communication and cascading of information around all aspects of this activity, including the NHS Board commitment to improve internal culture and behaviour, and suggested managers may require assistance to develop their respective skills in this area. M Elkhazindar sought an update on the membership of the Culture Programme Board, querying whether this included new and junior staff members. In acknowledging the progress being made in relation to an effective Healing Process, she asked how the wider NHS Board would seek to ensure past behaviours were not being continued. She further asked whether there were associated consequences for those who did continue with such unacceptable behaviour. F Hogg emphasised the importance of organisations having formal processes in place, for when informal/early intervention processes were unsuccessful in resolving matters, and stressed the complex balance requiring to be struck. While cultural elements were acknowledged as complex to address, everyone was seeking to achieve the same goal. Further updates would be presented to future meetings of the Forum. The Forum otherwise Noted the updated position and welcomed progress to date.

The meeting adjourned at 3.50pm, at which point F Hogg left the meeting, and reconvened at 3.55pm.

4 DISCUSSION ITEMS 4.1 SBAR on Neuropsychological Services Dr Galloway spoke to a circulated SBAR document and gave presentation to members in relation to NHSH Neuropsychological Services. Outlining national recommendations relating to appropriate staffing levels for Acute, Specialist Community, and Stroke Neuropsychological Services she advised, in NHS Highland this would be 5.1wte, with the current staffing level at 1.25wte, only including 0.65wte of a Consultant Neuropsychologist. Dr Galloway went on to provide the context for raising this matter at Area Clinical Forum level, advising as to relevant Local Development Plan (LDP) Standards and stating these were not being met, with in some cases extremely long patient waits to be seen. It was stated this position was not one that had recently emerged, with historic data showing performance against target had been 0% in June of 2016. The situation had not improved and J Law advised he had been providing service cover for some period of time, with wider staff morale at a very low ebb and stress levels extremely high. Existing service resource levels were inadequate. In outlining associated consequences of the existing position, it was stated clinicians were of the belief that patients were being harmed by the inability of the Service to offer any meaningful neuropsychological input, with under-resourcing a high risk position for both patients and the wider service. Without resource NHSH would never meet government requirements, achieve clinical/professional standards and continue to provide sub-optimal care for a complex client group. The absence of comprehensive services could mean patients did not receive full and effective treatment, would continue to present for ongoing

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treatment and would increase the overall cost of care to that individual. Such additional strain on NHS services increased relevant expenditure. The more cost effective solution would be to increase neuropsychological resource to an appropriate level. In conclusion, Dr Galloway advised Area Clinical Forum support was being sought in relation to raising the matter to NHS Board level as an urgent and priority need requiring action, and to support a bid for securing adequate funding and resource. During discussion, A Galloway stated there was need to not only consider issues relating to financial resource, but also those around the associated managerial and wider service structure, referral pathway criteria and existing ways of working. Noting the absence of a service within the Argyll and Bute area, members stated any future bid for resource would be required to articulate such a service gap in the context of an SLA agreement with NHS Greater Glasgow and Clyde. With current service performance levels acknowledged as unacceptable, members sought more context as to the current position. It was advised there had been long-term concerns that Neuropsychological services did not sit within the broader psychological service framework and as a result had been the subject of numerous previous bids for increased resource without success. A Palmer sought advice as to whether there would be a readily available supply of relevant, appropriately skilled individuals and was advised this was the case. As to whether additional staff resource was the only option for achieving service improvements, Dr Galloway stated whilst this would resolve service delivery issues around low level cases, the same did not apply for the more complex cases hence the need to ensure referral criteria was a major part of any future discussion. M Moss advised any escalation of this matter would require further articulation of the current position, providing detail of what the Neuropsychological Service is and does. The historic position should be outlined and this should include any and all previous service change considerations and actions. It would be important to provide an update on any referral pathway considerations to date and on the point previously raised regarding possible financial resource redistribution, identify where this could be taken from and outline the associated anticipated impact. This would enable further consideration as to how the matter could be most appropriately taken forward by the Chair in association with Dr P Davidson, as Executive Lead and raised at NHS Board level, recognising the newly introduced process for Executive Directors Group (EDG) advance consideration of matters. After discussion, the Forum: • Noted the reported position in relation to Neuropsychological services. • Agreed the Chair should raise the matter as a concern at the next NHSH Board meeting

and seek to discuss further with Dr P Davidson and Dr A Galloway how the matter may be appropriately escalated.

5 MATTERS ARISING There were no matters discussed in relation to this Item. 6 FEEDBACK FROM HIGHLAND HEALTH AND SOCIAL CARE COMMITTEE There were no matters discussed in relation to this Item. 7 ASSET MANAGEMENT GROUP There had been circulated draft Minute of Meeting held on 22 January 2020.

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The Forum Noted the circulated draft Minute. 8 REPORTS/MINUTES AND PROGRESS ON WORKPLANS FROM

PROFESSIONAL ADVISORY COMMITTEES ETC 8.1 Area Nursing, Midwifery and AHP Advisory Committee - Minute of Meeting held

on 14 January 2020 The Forum Noted the circulated Minute of the Meeting held on 14 January 2020. 8.1.1 Area Nursing, Midwifery and AHP Leadership Committee - Notes of Meetings

held on 7 January and 4 February 2020 The Forum Noted the circulated Notes of Meetings held on 7 January and 4 February 2020. 8.2 Area Dental Committee - Minute of Meeting of 13 November 2019 The Forum Noted the circulated Minute of the Meeting held on 13 November 2020. 8.3 Area Medical Committee - Minute of Meeting held on 19 November 2019 The Forum Noted the circulated Minute of the Meeting held on 19 November 2020. 8.4 Area Optometric Committee The Forum Noted there had been a meeting held on 3 February 2020, the Minute from which was not yet available. It was reported there had been discussion in relation to Care Portal access, with the matter scheduled for discussion at the next Area Clinical Forum meeting. 8.5 Area Pharmaceutical Committee – Draft Minute of Meeting on 20 January 2020 The Forum Noted the circulated draft Minute of the Meeting held on 20 January 2020. It was reported there had been similar discussion in relation to Care Portal access and requirements for both SCI Store letter access and feedback on referrals. P Davidson advised there were associated network issues involved at that time. The Forum Agreed to invite J Docherty to address the next meeting in relation to Care Portal access. 8.6 Psychological Services Advisory Committee - Draft Minute of Meeting held on 6

February 2020 The Forum Noted the circulated draft Minute of the Meeting held on 6 February 2020. 8.7 Adult Social Work and Social Care Advisory Committee – Minute of Meeting

held on 10 February 2020 The Forum Noted the circulated Minute of the Meeting held on 10 February 2020. It was reported there had been discussion in relation to Personal Outcome Plan Review activity. The matter was considered to relate to Health and Social Care issues and would be raised with Mr C Morgan, Project Manager out with the meeting.

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8.8 Health Care Science Forum – Note of Meeting held on 23 January 2020 The Forum Noted the circulated Note of Meeting held on 23 January 2020. P Cook advised members the meeting had been well attended, with relevant Terms of Reference for the Forum having now been agreed. The Forum otherwise: • Noted the updates from the Professional Advisory Committees. • Agreed the Committee Administrator circulate Professional Advisory Committee Terms

of Reference documents to P Cook to help inform any future discussion in this area. 9 NHS HIGHLAND BOARD MEETING – 31 March, 2020 There was no discussion held in relation to this Item. 9.1 Feedback from Board Development Session held on 24 February 2020 There was no discussion held in relation to this Item. 10 FOR INFORMATION 10.1 Dates of Future Meetings 30 April 2020 2 July 2020 3 September 2020 29 October 2020 17 December 2020 The Forum Noted the remaining meeting dates in 2020. 11 ITEMS FOR FUTURE ACF MEETINGS Items for future meetings were noted as follows: • Consider topics for discussion from each Advisory Committee • Update on Culture Programme – Fiona Hogg (September) • Update on the School of Health Social Care and Life Science, University of

Highlands and Islands - Sandra McRury (September/October) • Personalising Realistic Medicine – Rebecca Helliwell (July) • Community Planning and clinical engagement – Cathy Steer • Presentation on Discovery and Balanced Score Card – George McCaig • Medical Device Management Group – Peter Cook • NHS Highland Draft Assurance Map – Ruth Daly (July) • Attraction, recruitment and Retention – follow up 1 hour workshop with Sharon

Hammell (July)

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12 ANY OTHER COMPETENT BUSINESS 12.1 Coronavirus Readiness Arrangements P Davidson took the opportunity to seek feedback from members as to the level of information currently being provided to Clinical Specialties and overall position in relation to development of relevant preparedness plans. A Palmer advised he was also in the process considering this insofar as it applied to all staff members. In response, members stated that in addition to improved communications processes more generally, and specifically in relation to this matter, there was also a need for an increase in the level of face mask fit testing being undertaken. Members reported using the Health Protection Scotland (HPS) website for up to date advice and this was agreed to be the most useful source of information.. P Davidson encouraged continued use of the HPS website, advising the Health Protection Team were currently handling hundreds of telephone calls daily. He emphasised the importance of staff awareness and the development of appropriate contingency plans should matters escalate quickly. Highlighting the importance of ensuring heightened public awareness, M Elkhazindar sought an update in relation to Patient Focussed Booking (PFB) arrangements and was advised no changes were being implemented at that time. NHS Scotland remained in Containment mode and would continue to be guided by Scottish Government. In terms of any potential effect on GP practices, P Davidson advised relevant Pandemic Flu/Resilience Plans were in place and should individual Practices have to close then processes existed for ensuring appropriate “buddying” arrangements. Plans for funding any associated locum expenditure had yet to be clarified. The issue of supply contingencies was also referenced. Members acknowledged a number of issues had yet to be clarified. It was stated Public Health Consultants had overall responsibility in relation to Outbreak Management arrangements and as such any concerns should be relayed to Drs K Oates and J Wares. The need for clear, concise staff messaging was reiterated by members and it was suggested an FAQ approach be adopted to address the relevant ‘what if’ questions. If the advice was to be that staff members should access the latest information from Public Health, BBC, and HPS then that message should be relayed to all staff at the earliest opportunity. The Forum otherwise Noted the current position. 12.2 Establishment of an NHS Highland Executive Director Group Having heard as to arrangements being introduced by the new Chief Executive, for the early scrutiny of NHS Board and Committee reports, serious concern was expressed that such a process appeared to be at odds with previous discussion with the Cabinet Secretary regarding the ability of staff members to raise matters directly to NHS Board level. M Elkhazindar emphasised the Area Clinical Forum had only just reviewed their Constitution, subsequently approved by the NHS Board, and this had included an element relating to the ability of the Forum “to escalate any issues to the NHS Highland Board if serious concerns are identified about the quality and safety of provision of care in the services delivered across NHS Highland”. The Chair emphasised Executive membership and attendance at all Area Clinical Forum meetings had been sought via the Chief Executive and was already to be enhanced, with a Non-Executive NHS Board member expected to attend each meeting moving forward. This would heighten awareness of any relevant issues at NHS Board level. The concern expressed by members would be discussed with the Chief Executive who was to be invited to attend the next meeting.

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The Forum: • Noted the position. • Sought to invite the new Chief Executive, Paul Hawkins to attend the next meeting. 13 DATE OF NEXT MEETING The next meeting will be held on 30 April 2020 at 1.30pm in the Board Room, Assynt House Inverness.


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NHS Highland

Meeting: NHS Highland


Title: Healing Process Plan

Responsible Executive/Non-Executive: Paul Hawkins, CEO

Report Author: Mark Wilde, Strategic Advisor; Fiona Hogg, HRDirector

1 PurposePlease select one item in each section and delete the others.This is presented to the Board for:• Decision

This report relates to a:• Local Policy

This aligns to the following NHS Scotland quality ambition(s):• Person Centred

2 Report summary

2.1 SituationNHS Highland is seeking to address the recommendations of the Sturrock Report (“the

Report”) and specifically the need for a Healing Process to be established for impacted

individuals.This paper sets out a proposed Healing Process for approval of the Board.

2.2 BackgroundThe Sturrock Report was published in May 2019 and made a series of recommendationsfor NHS Highland to consider and implement to address the cultural issues related tobullying and harassment identified in the Report.Recommendations contained in section 34 of the Report identified a need for a process tobe established to provide individualised support for affected individuals (paras 34.1 to34.5) using an independent process (34.10 to 34.11) and with consideration of financialclaims where appropriate (34.18).

NHSH Board 31 March 2020, Item 6b261

Page 2 of 7

Subsequent consultation with stakeholders including the Board, whistle-blowers, staff-side and also the Cabinet Secretary for Health and Sport identified the concept of a “Healing

Process” to address these recommendations. In recent weeks the way in which the Healing Process will work has been discussed and co-produced with staff-side and whistle-blowers in a series of workshops and meetings. This paper and its attachments sets out the results of this co-production effort and seeks the Board’s approval for the Healing Process. A formal launch date for the Healing Process will be subject to Board approval once the impact of the Covid-19 pandemic on our colleagues, our communities and our services has subsided.

2.3 Assessment

The following diagram provides an overview of the key components of the Healing Process with a brief narrative explanation of the key components also provided. The Healing Process will be open to current employees and ex-employees. Further consideration will be given prior to the launch date as to whether the scope should be widened further. Current employees who wish to access the process will be able to do so in relation to bullying and harassment which occurred up to 31 December 2019. It is important that colleagues who have not felt able to speak up in the past can be supported and those who are in formal processes about past concerns can explore whether the healing process could resolve their situation. However, this is a process about past concerns, hence the need for an end date.

Initial Meeting (Appendix 1)

The first stage of the Healing Process has been designed to provide initial support and advice for individuals who may have been affected by bullying and harassment, through an independent organisation.

Initial Meeting

Apologise, Learn, Make Changes

Psychological Therapies

Independent Panel

Apologise, Learn, Make Changes

No further action recommended

Action recommendedCase referred to another process

Could proceed to Mediation, Tribunal,

Civil Action

Consideration of settlement, re-

engagement, or other resolution

Independent Members• HR Law Specialist• NHS HR Director

• NHS Clinical Director• Union Official • NHS Non Exec

Director• Lived experience

representative

Case referred to another process

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The 1:1 meeting serves a number of purposes: • To allow for discussion about the Healing Process overall, how it works, and the

different outcomes/pathways that can be used; • An opportunity to ask questions and explore possible outcomes with a trained,

independent professional; • To provide an opportunity for individuals to talk in confidence about their

experiences and to have those documented if desired; • Support to individuals to prepare a statement that can be used throughout the

Process; ensuring that individuals do not have to continually repeat their experiences;

• Allow individuals to register their intention to pursue any one or more pathways whilst protecting their anonymity during the discussions at this early stage.

This first part of the process will allow individuals to bring a companion to any meeting. This can be a colleague, family member or a trade union representative. It should not, however, be a legal advisor. This service will be provided by CMP Resolutions (CMP) who are a specialist mediation and dispute resolution consultancy. CMP will also administer this stage of the process. Psychological Therapies (Appendix 2)

This service will also be provided by an independent provider called Validium. Validium is a provider of psychological support and counselling services with a significant number of clients in the NHS and UK public services. Validium will receive referrals from CMP personnel following the Initial Meeting. One of Validium’s counsellors or other psychological specialists, as appropriate for each

individual, will call the individual to have a telephone discussion about the impact of the perceived bullying and harassment and to assess their support needs. Validium will then confirm the most appropriate support or treatment for the individual and obtain authorisation to proceed. To streamline the process, certain levels of support will be pre-authorised on referral and these will only be exceeded with the direct approval of the Chief Executive of NHS Highland. The treatment interventions that can be provided for referred individuals are described in Appendix 2 and include: • Online or Supported Online cCBT package (self-administered) hosted on our own

secure portal; • Counselling brief therapy via the client’s preferred method – e.g. face to face,

telephone, video or e-counselling sessions - with fully qualified, accredited and experienced counsellors (BACP or equivalent level);

• Extended counselling for those individuals needing more support/sessions to enable them to reach their counselling objectives;

• General psychological assessments – from psychologists or fully accredited CBT therapists, including a meaningful report to the referrer outlining e.g. prognosis, recovery timescales, treatment options and recommendations;

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• Psychological/trauma treatments e.g. CBT or EMDR, usually with the assessing clinician, or occasionally, with a more appropriate psychologist or CBT therapist – as authorised by the referrer following the report;

Independent Panel (Appendix 3):

One outcome from the 1:1 meeting can be for the matter to be considered by an Independent Review Panel (IRP). The IRP will include an employment law specialist, a non-executive director from the NHS in Scotland, a union official with strong NHS experience, a lived experience representative, an NHS HR Director and an NHS Clinical (Medical or Nursing) Director. Participants may be active in the NHS or retired. The IRP has the power to make a recommendation for one or more of the following in each case: i) an apology and/or recommendation for organisational learning; ii) assessment for provision of psychological therapies; iii) financial payment or consideration for: Re-engagement or Re-employment or Re-

deployment; iv) referral to an internal process for consideration; or v) no further action by NHS Highland (NHSH). The IRP will focus on listening and understanding the experience and circumstances from the applicant’s perspective. The IRP is tasked with finding the resolution that is most likely to aid healing for the individual and organisation. The IRP has power to make recommendations but it will be the responsibility of the Chief Executive as Accountable Officer (and in exceptional cases the Remuneration Committee in respect of payments) to approve these. The Chief Executive will have delegated authority from the Remuneration Committee on how to resolve individual cases The current guidance in respect of payments or settlements is DL(2019)15: NHS Scotland: Guidance on Settlement and Severance Arrangements. This guidance will be applied, but will also take cognisance of any amendments or alternative arrangements reached in respect of this Healing Process only, following discussion and agreement between the Chief Executive, on behalf of the Board and Scottish Government. Implementation

The Healing Process will run for a period of nine months from the date of its formal launch. A formal launch will not take place until the impact of Covid-19 on colleagues, communities and services has reduced. The Board will formally review the launch date again in its meeting at the end of May. Additional, detailed planning will re-commence at the point at which launch is approved by the Board, in particular in further developing appropriate, GDPR compliant record keeping protocols at each stage in the process. Contact has been made with prospective members of the Independent Review Panel and mobilisation of the Panel can occur as soon as the Healing Process is ready to launch.

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In addition, prior to launch it is proposed that the recently appointed External Culture Advisor is tasked to provide assurance over the implementation of the Healing Process to the Board and our stakeholders.

2.3.1 Quality/ Patient Care The Healing Process is one component of NHS Highland’s strategy to address many of

the cultural issues that were reported in the Sturrock Report. It is designed to help both current and former colleagues move on from a difficult period in our organisation’s history. By taking these steps, we can proceed with improving the culture of our organisation and rebuilding our reputation in the local community. The focus will move away from the past which can only further enhance the excellent care provided across the organisation.

2.3.2 Workforce

As noted in 2.3.1, it is anticipated that the Healing Process will positively benefit existing colleagues as part of our wider Culture Fit for the Future strategy. Addressing the issues of the past will also contribute to improved recruitment and retention as NHS Highland strives to be an excellent employer.

2.3.3 Financial

The Scottish Government has contributed £1.03m to support NHS Highland to deliver the Healing Process. These funds are being used to procure the services of the lawyers, mediators, panel members, communications specialists and administrative personnel who will help deliver this independent Healing Process. The following specialists have been procured to date:

• CMP Resolutions: Initial Meeting Facilitators and Administrators • Validium: Psychological Therapies Provider. • Shepperd and Wedderburn: Legal Adviser • Barbara-Anne Nelson: Independent HR Adviser • Muckle Media: Communications and Engagement Adviser

Funds will be accounted for with Scottish Government as they are drawn down and it is not anticipated that there will be any additional financial burden to NHS Highland as a result of the Healing Process planning and delivery phase. The costs (if any) of any payments made to participants in the Healing Process will be borne by Scottish Government at the appropriate time and again, no impact on NHS Highland finances is anticipated.

2.3.4 Risk Assessment/Management Refer to Appendix 4 for a summary of the key risks associated with the Healing Process.

2.3.5 Equality and Diversity, including health inequalities

Not required for this matter.

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2.3.6 Other impacts Not applicable

2.3.7 Communication, involvement, engagement and consultation The Healing Process has been coproduced with the direct involvement of current and former colleagues from the whistle-blowers group and from staff-side. These stakeholders have met or spoken with us on a twice weekly basis to review and develop the Guidance Frameworks in Appendices 1 to 3 and the same groups have also been engaged in developing the communications plan with our specialist advisors. This Board paper and its appendices paper are issued with the support of these groups. A communications plan is being developed by Muckle Media which will include use of multiple media channels and a roadshow to promote the Healing Process. The Board will be briefed on the proposed communications plan when the Healing Process is close to being launched. In the interim, a holding website will go-live following the 31 March Board meeting at www.healing-process.co.uk which will allow individuals to express interest in participating in the process on an anonymous basis and allow NHS Highland to begin to quantify the likely interest in the process.


This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report.

• Executive Director Group 23 March 2020.

The Board should note that the normal route to the meeting has been curtailed due to the urgency of coproducing the Healing Process combined with the impact of the Covid19 pandemic on our colleagues and our organisation. This has not, in anyway, curtailed the detailed preparation for the Healing Process and nor has it impacted on the extent of coproduction with whistle-blower and staff-side colleagues.

2.4 Recommendation

• Decision – The Board is invited to approve the Healing Process as described in this Board paper and to agree to set a date for launching the Healing Process once the impact of the current Covid19 pandemic on our colleagues, communities and services has reduced.



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• Appendix No 1: Initial Meeting – Guidance Framework • Appendix No 2: Psychological Therapies – Guidance Framework • Appendix No 3: Independent Panel Review – Guidance Framework

• Appendix No 4: High level risk summary – Shepherd and Wedderburn

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Initial Meeting

Guidance Framework

March 2020

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1

Table of Contents

1 Introduction .................................................................................................................................... 2

1.1 Purpose of this document ....................................................................................................... 2

1.2 Disclaimer ................................................................................................................................ 2

2 Delivery Partner .............................................................................................................................. 2

2.1 CMP Resolutions ..................................................................................................................... 2

3 Process overview ............................................................................................................................ 2

3.1 Scope ....................................................................................................................................... 2

3.2 Role of the practitioner ........................................................................................................... 3

3.3 Practitioner team .................................................................................................................... 3

3.4 Accessing the service .............................................................................................................. 3

3.5 Eligibility check ........................................................................................................................ 3

3.6 Streamlined process ................................................................................................................ 4

3.7 Response times ....................................................................................................................... 4

3.8 Meeting locations ................................................................................................................... 4

3.9 Meeting times ......................................................................................................................... 4

3.10 Locations outside Highland and Argyll and Bute .................................................................... 4

3.11 The interview process ............................................................................................................. 4

3.12 Complaints .............................................................................................................................. 5

3.13 Additional meetings ................................................................................................................ 5

4 Record Keeping ............................................................................................................................... 5

4.1 Information security ............................................................................................................... 5

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1 Introduction

1.1 Purpose of this document

This document is designed to act as a guidance note for the preparation of the first stage of the Healing

Process at NHS Highland. The document will be of use to members of the co-production groups, to

NHS Highland Board members and to other stakeholders who are participating in or supporting the

Healing Process.

1.2 Disclaimer

This document might evolve and change as the Healing Process planning and implementation phase

matures. This document is, therefore, subject to further change and should be read with this context

in mind.

2 Delivery Partner

2.1 CMP Resolutions

CMP Resolutions was established (originally as Conflict Management Plus Ltd) in 1989 and since then

has played a pivotal role in establishing high quality dispute resolutions processes in the UK. CMP’s

mission is to create workplaces where people can really be authentic, bringing their ‘whole self’ to

work, without the fear of conflict. CMP is a pioneer of approaches to conflict management and works

to improve workplace relationships by preventing and managing workplace conflict; building skills;

and rebuilding relationships.

3 Process overview

3.1 Scope

The first stage of the Healing Process has been designed to allow for an independent organisation to

provide support and advice for individuals who may have been affected by bullying and harassment.

This first part of the process is being called a 1:1 Session. It is open to individuals to bring a companion.

This can be a colleague, family member or a trade union representative. It should not be a legal

advisor. The 1:1 meeting serves a number of purposes:

• To allow for discussion about the Healing Process overall, how it works, and the different

outcomes/pathways that can be used;

• An opportunity to ask questions and explore possible outcomes with a trained, independent

professional;

• To provide an opportunity for individuals to talk in confidence about their experiences and to

have those documented if desired;

• Support to individuals to prepare a statement that can be used throughout the Process;

ensuring that individuals do not have to continually repeat their experiences;

• Allow individuals to register their intention to pursue any one or more pathways whilst

protecting their anonymity during the discussions at this early stage.

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3.2 Role of the practitioner

The 1-1 Session provides independent information about the options available to individuals who are

uncertain about what action they wish to take over a given situation. A trained practitioner will, in

confidence, listen to individual’s concerns and support them in identifying what they would like to do,

and the pros and cons of different options available.

The practitioner will help individuals to decide what they want from the Healing Process and how to

get to that outcome and will do some reality checking to help make sure what is sought is appropriate

and achievable within the Healing Process.

3.3 Practitioner team

CMP have drawn together a team of experienced practitioners who have been selected for their

extensive interpersonal skills and are dedicated to this project. They will not be working with NHS

Highland in any other way other than this Process.

Practitioners have gone through a rigorous interviewing process before being accepted onto the

interviewer panel and have at least five years documented practice experience, and most hold

between 10 and 20 years’ experience. CMP’s practitioners are trained in the following:

• Mediation;

• Counselling skills;

• Employment law relating to harassment, discrimination and victimisation; and

• Investigating bullying and harassment allegations.

None of the practitioner team has a connection to NHS Highland and all are based outside of the

region. The team has been trained on the Healing Process and their expertise lies in being able to have

deep supportive conversations. There is a range of different types of practitioners, so if individuals feel

more comfortable with a particular type of person e.g. gender, this will be accommodated wherever

possible.

3.4 Accessing the service

Individuals will access the 1:1 session by calling a dedicated number, sending an email to the

confidential mailbox or completing a web-contact form. The phone line will be available from 8.30-

17.30 Monday to Friday (not bank holidays). Outside of normal hours individuals will be able to leave

a message which will be picked up by the administrator the next working day.

Initial contact will be managed independently by CMP, with a dedicated, trained administrator. The

administrator will take some basic details, including preference for a face to face, telephone or online

meeting. The administrator will also ask the individual to confirm that they are an ex-employee of NHS

Highland or a current employee of NHS Highland this is in order to carry out a basic eligibility check.

3.5 Eligibility check

As described above in paragraph 3.4 the Healing Process is designed for current and ex-employees of

NHS Highland. . CMP administration will be confirming on behalf of NHSH that the individuals

accessing the process have answered yes to the question regarding their eligibility to do so. . Should

the person accessing the system be a relative of a previous employee then they will also be asked to

confirm eligibility in the manner described and this will also be recorded in the same manner.

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3.6 Streamlined process

Anyone accessing the Healing Process must participate in the 1:1 stage. Whilst individuals may have

a view that they know which option they feel is correct for them it is important that they are able to

discuss this with the support of a CMP practitioner. In these cases, at the point of initial contact, the

administrator will gather some additional information to ensure that referral to the next stage of the

process is expedited smoothly (to minimise the risk of inappropriate referral), and arrange for a

shorter 1:1 session with CMP of up-to [1] hour.

3.7 Response times

CMP are committed to providing a 1:1 session within two weeks of initial contact. Once the

administrator has taken basic details individual cases will be assigned to an appropriate practitioner

who will make contact to confirm where and when the session will take place.

3.8 Meeting locations

It is important for meetings to take place somewhere neutral, comfortable and confidential such as a

serviced office, or hotel. No sessions will take place at any NHS Highland building or site. Telephone

and online sessions will also be offered.

3.9 Meeting times

For some people meeting during the day will not be possible. CMP will offer some early morning and

evening sessions and also sessions over the weekend.

3.10 Locations outside Highland and Argyll and Bute

The CMP team is based in different locations in the UK and may therefore be able to offer face to face

meetings for individuals who live further afield.

3.11 The interview process

A practitioner will meet with each individual, usually for about two hours, but if more time is needed

that will be accommodated wherever possible.

Through demonstrating empathy and understanding and without losing impartiality, the practitioner

will work with individuals to help facilitate self-expression about each individual’s situation. Each

option available will be explored and the practitioner will guide each individual through each of the

pathways, so that all options are clearly understood.

Concerns about each approach will be explored and individuals will be helped to see the benefits and

drawbacks of each where relevant. Practitioners will also undertake reality checking with participants

to ensure that what they desire is appropriate and obtainable within the Healing Process.

Throughout the meeting the practitioner will:

• Ensure they listen actively and give an opportunity to get across the information needed;

• Clarify they have arrived at an accurate, appropriate summary of issues;

• Discuss in detail the available options, without losing their impartiality; and

• Support individuals to come to an informed and clear decision.

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Importantly, individuals will not be asked to make a decision during the meeting unless they arrive

naturally at that point. Everyone will be encouraged to take a few days to digest and mull over the

information from the meeting before making a final decision, which gives an opportunity for further

personal research. Decisions remain for each individual participant to make.

The practitioner will make contact within a few days after the session to establish what decision may

have been reached and provide further information on the next steps.

3.12 Complaints

Practitioners allocated to the Healing Process are completely independent and are not attached to any

one pathway. Their sole focus is on ensuring that participants have the right information to make an

informed decision about what to do next and understand what those next steps might look and feel

like.

Anyone who is unhappy with the way they feel after a session has been concluded has the right to

make a complaint using the CMP complaints process www.cmpsolutions.com/complaints.

3.13 Additional meetings

It is expected that most people will only need one 1:1 session and a follow up call/contact. If individuals

do feel that they do need more time this will be facilitated in appropriate cases wherever possible.

4 Record Keeping

4.1 Information security

CMP will need to keep some basic information about each case to ensure that they have the right

information to pass on as part of each referral. The data will be kept on a secure database only

accessed by the administrator and contract manager for this part of the process. No data is accessible

by anyone from NHS Highland. CMP has achieved Cyber Essentials Plus certification, which is a high

level internet and data security accreditation. CMP’s full privacy policy is available here:

www.cmpsolutions.com/privacy.

The only people who will know details about the 1:1 session will be the CMP administrator and the

practitioner. However, depending on what decisions are made about which pathways are

subsequently accessed, some personal information will need to be passed onto NHS Highland to

ensure that the next steps can be organised. Access to this information will be to a limited number of

individuals and only those who would have a need to have this information to progress the next stages

for them

CMP will be sharing some high level anonymous data to help monitor the quality of their work and

delivery of the contract. For example the number of sessions held and the average length of time in

session. CMP will also be collecting some feedback from participants after the session about how it

went to help ensure they are delivering a quality service.

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Healing Process

Psychological Therapies

Guidance Framework

March 2020

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1

Table of Contents 1 Introduction .................................................................................................................................... 2


1.2 Disclaimer ................................................................................................................................ 2

2 Delivery Partner .............................................................................................................................. 2

2.1 Validium .................................................................................................................................. 2

3 Process overview ............................................................................................................................ 2

3.1 Initial Referrals and Triage ...................................................................................................... 2

3.2 Treatment Interventions ......................................................................................................... 2

3.3 Record Keeping ....................................................................................................................... 3

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1 Introduction


This document provides an overview of the Psychological Therapies support model which forms a key

component of the Healing Process. The document will be of use to members of the whistle-blowers

and staff-side co-production groups, to NHS Highland Board members and to other stakeholders who

are participating in or supporting the Healing Process design effort.

1.2 Disclaimer

This document might evolve and change as the Healing Process planning and implementation phase

matures. This document is, therefore, subject to further change and should be read with this context

in mind.

2 Delivery Partner

2.1 Validium

Validium has provided effective information, support, counselling and psychological interventions

since 1998. Validium currently has approximately 300 customers for these services, with about a third

of these being in the public or third sectors. NHS and healthcare experience includes working in

hospitals (e.g. general, specialist and community); community-based healthcare providers, local and

regional NHS Trusts (many with multiple organisations); health professional organisations/royal

colleges; Occupational Health providers, CCG groups and GP/specialist medical groups.

Other public sector organisations include emergency services, councils, education and governmental

bodies.

3 Process overview

3.1 Initial Referrals and Triage

Validium will supply a tailored referral and consent form for use by CMP Resolutions (who will facilitate

the Initial Meetings) who will be the referrers of individual cases by email for an initial Validium triage

of each individual’s needs.

One of Validium’s counsellors or other psychological specialists, as appropriate for each individual,

will call the client to have a telephone discussion about the impact of the perceived bullying or

harrasment and to assess their support needs.

Validium will then feedback to NHS Highland the most appropriate support or treatment for the

individual and obtain authorisation to proceed. To streamline the process, certain levels of support

could be pre-authorised on referral.

3.2 Treatment Interventions

The treatment interventions that can be provided for referred individuals are as follows:

• Help-sheet or podcast resources;

• Onward referrals from Validium counsellors/case managers for more specific/appropriate

external (or, if preferred by individual, NHS Highland) internal support;

• Online cCBT package (self-administered) hosted on our own secure portal;

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• Supported Online cCBT package;

• Counselling brief therapy via the client’s preferred method – e.g. face to face, telephone,

video or e-counselling sessions - with fully qualified, accredited and experienced counsellors

(BACP or equivalent level);

• Resilience/wellbeing coaching sessions delivered by specialist clinicians;

• Extended counselling for those individuals needing more support/sessions to enable them to

reach their counselling objectives;

• General psychological assessments – from psychologists or fully accredited CBT therapists,

including a meaningful report to the referrer outlining e.g. prognosis, recovery timescales,

treatment options and recommendations;

• Psychological/trauma treatments e.g. CBT or EMDR, usually with the assessing clinician, or

occasionally, with a more appropriate psychologist or CBT therapist – as authorised by the

referrer following the report;

3.3 Record Keeping

Validium’s case management system1 and reporting methods will enable regular reports on the

numbers of cases being handled, services used and results achieved. These reports will not contain

individually identifiable data.

1 Further work is needed to establish how secure record keeping occurs between providers of the wider Healing Process and to ensure touch points between providers are managed seamlessly and securely.

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Independent Review Panel

Guidance Framework

March 2020

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2

Table of Contents 1 Introduction .................................................................................................................................... 3


1.2 Disclaimer ................................................................................................................................ 3

2 IRP Scope ......................................................................................................................................... 3

3 Healing Principles ............................................................................................................................ 3

4 Exclusions from IRP scope ............................................................................................................... 4

5 Membership of the IRP ................................................................................................................... 5

6 Who can access the IRP .................................................................................................................. 5

7 Companion ...................................................................................................................................... 5

8 Logistics ........................................................................................................................................... 6

9 Testimony and supporting information .......................................................................................... 6

10 Recommended outcomes available to IRP ................................................................................. 7

10.1 Outcome 1: Apology and/or Recommendation for Organisational Learning ......................... 7

10.1.1 Apology ........................................................................................................................... 7

10.1.2 Recommendation for Organisational Learnings ............................................................. 7

10.2 Outcome 2: Provision of Psychological Therapies – Validium ................................................ 8

10.3 Outcome 3: Financial payment; Re-engagement or Re-employment or Re-deployment ...... 8

10.3.1 Financial payment ........................................................................................................... 8

10.3.2 Re-engagement, Re-employment or Re-deployment ................................................... 12

10.4 Outcome 4: Referral to other process .................................................................................. 13

10.4.1 Mediation ...................................................................................................................... 14

10.4.2 Concerns about individuals who have left NHSH .......................................................... 14

10.4.3 Timescales ..................................................................................................................... 14

10.5 Outcome 5: No further action from NHS Highland ............................................................... 14

10.6 Status of IRP Recommendations ........................................................................................... 15

10.7 Legal claims and use of Settlement Agreements/COT3 ........................................................ 15

10.8 Proactive steps by IRP ........................................................................................................... 16

10.9 Themes .................................................................................................................................. 16

10.10 Final Report of IRP Learnings ............................................................................................ 16

10.11 Record Keeping ................................................................................................................. 16

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1 Introduction


This document is designed to act as a guidance note for the Independent Review Panel stage

of the Healing Process at NHS Highland. The document will be of use to members of the co-

production groups, to NHS Highland Board members and to other stakeholders who are

participating in or supporting the Healing Process design effort.

1.2 Disclaimer

This document might evolve and change as the Healing Process planning and implementation

phase matures. This document is, therefore, subject to further change with consultation as

appropriate and should be read with this context in mind.

2 IRP Scope

One outcome from the 1:1 meeting can be for the matter to be considered by an Independent Review Panel (IRP) who will make recommendations to the Chief Executive as the Accountable Officer for NHS Highland Board with delegated authority from the Remuneration Committee, and within the internal governance framework agreed by the NHS Highland Board on [date tbc], on how to resolve individual cases. The IRP has power to make recommendations only. Cases will be presented to the board on a no-names basis save as otherwise agreed. As explained in 10.3.2 recommendations for re-engagement/re-employment/re-deployment will be considered by the Director of Human Resources and Organisational Development who will ensure that the recommendation is explored delegating responsibility for action as appropriate. The NHSH board will only be informed of the outcome of such recommendation as appropriate and after the outcome has been finalised by the Director of Human Resources and Organisational Development. The IRP has the power to make a recommendation for one or more of the following in each case:

i) an apology and/or recommendation for organisational learning; ii) assessment for provision of psychological therapies; iii) financial payment (which are capped in accordance with the Levels set out in 10.3)

or consideration for: Re-engagement or Re-employment or Re-deployment; iv) referral to an internal process; or v) no further action by NHS Highland (NHSH).

The IRP will focus on listening and understanding the experience and circumstances from the applicant’s perspective. The IRP is tasked with finding the resolution that is most likely to aid healing for the individual and organisation.

3 Healing Principles

The “Healing Principles” for the IRP to have regard to in all of its actions are: to deal with each case with kindness, compassion, empathy, equity, fairness and accountability, taking into account the interests of the applicant, and all those who could be affected (but who the IRP

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may not hear from) including those who may be or be perceived to be witnesses, bystanders, other affected employees/ex-employees, victims, individuals accused of wrongdoing or other failures, the community as a whole and NHSH.

4 Exclusions from IRP scope

The IRP is not a judge and jury of the facts. This is a key difference between the Healing

Process and the internal Dignity at Work/Disciplinary processes, and external court and

tribunal processes.

The IRP deals with “harm” and “healing” taking into account the view point of the individual

accessing the Healing Process only. It does not deal directly with “fault” and “loss”. The

Healing Process is being made available as an additional avenue separate from the traditional

investigative or adversarial processes which are normally available to support individuals in

healing. This has many benefits, including ease of access for individuals, an open and helpful

forum, and an aim of finding healing rather than apportioning blame.

This is an innovative process brought about by an extraordinary set of events including the

independent Sturrock Report. A unique feature of this process is that it will hear only one

version of events, from the individual’s perspective. This is to ensure the individual’s account

is listened and responded to without judgement.

Given this different approach which it is hoped will benefit individuals in healing, there is a

need to recognise that it would not be fair for the IRP to make a determination of fault in

circumstances where it has not heard opposing points of view. It would also not be

appropriate for the IRP to recommend a financial payment directly based on financial loss. In

all other forums, compensation for loss can only be awarded after a determination of fault

and strict rules for compensating financial loss would normally apply. The circumstances in

which financial payment may be available are set out in respect of outcome 3 below.

In striking the right balance between ease of access, and not wanting to re-open past trauma

more than necessary, while still being an authentic, meaningful and accountable process, the

IRP will not be hearing both sides and apportioning blame.

As such, while the IRP can make recommendations based on its understanding of the

applicant’s personal story, it is beyond the IRP’s scope to find, for example, that another

individual or NHSH itself is to blame. However, it is understood that for many individuals, an

analysis of the facts and addressing “blameworthy” conduct is essential from their

perspective to be heard. For this, the IRP will not itself make a determination of blame, but

may refer out to the appropriate process where available and appropriate.

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5 Membership of the IRP

This panel will be made up of members who are independent from NHS Highland. The

composition of the panel will be made up of 5 individuals including the following experience

(noting that an individual may satisfy more than one of the listed experiences) as follows:

• Employment Law Specialist (Shepherd & Wedderburn)

• Retired NHS HR Director

• Retired NHS Clinical Director

• Retired Union Official

• NHS Non-Exec Director (Chair)

• A Lived Experience representative

Individuals will only be appointed to the IRP after a conflict check. In the event that a panel

member has a conflict of interest or a connection to any particular individual case, an

alternate panel member will be appointed for that case.

The default position is that there will be one panel which hears all cases, save where the use

of alternates is required to account for conflicts of interest, incapacity, or other unresolvable

unavailability. The panel composition may need to be reviewed if the volume of cases means

that this approach is unsustainable

6 Who can access the IRP

All those entering the Healing Process can make a request at the 1:1 that their case progress

to an IRP. It is understood that engaging in the IRP process itself will have a healing value for

some. For others, the IRP is relevant as a means to an end in that some outcomes are only

available if recommended by the IRP (and could not be accessed directly from the 1:1

meeting). For some individuals, they will not wish or require to access the IRP stage, as they

will be able to access the outcome sought directly from the 1:1 stage. As with the 1:1 stage it

is recognised that some individuals may be unable to access this process themselves (due to

death or incapacity) and in those circumstances they can be represented by another party.

7 Companion

Individuals who access the Healing Process will be entitled to bring a trade union representative or

one companion of their choosing to each stage, including the IRP. The only limitation is that the

companion should not be a legal representative, as this process is focussed on healing and is intended

to be a move away from legal processes which can be formal and adversarial. The role of the

companion is to act as support. They may ask questions and call for breaks. They can respond on behalf

of the applicant, however, the IRP will be entitled to place greater weight on responses from the

applicant.

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8 Logistics

The IRP will be held by way of face-to-face meeting whenever possible. Other options can be agreed

where appropriate including: video conference; telephone; by way of written representation; pre-

recorded video statement; or (in limited circumstances) via participation by a representative only.

It is anticipated that the IRP meeting will last up to 2 hours but with flexibility to extend meetings in

exceptional circumstances. There will then be a period of confidential consideration by the IRP. It is

hoped that in most cases the IRP will be in a position to make a recommendation based on the

information available to them at this time. However, in some cases, the IRP may request further

information from the individual either during the meeting or after, in order to aid its deliberations. It

is anticipated that a request for further information is most likely to occur where an individual is

seeking financial payment or Re-engagement, Re-employment or Re-deployment. The IRP will not

contact anyone else for information on an individual’s case save with express consent of the individual.

There will be a second IRP meeting only in exceptional cases. The IRP will aim to provide their

recommended outcome within one month of the final IRP meeting with the individual.

9 Testimony and supporting information

The primary information that the IRP will be taking into account is the testimony of the individual

entering into the Healing Process. As such, it is crucial that individuals tell the truth. Individuals

entering into the Healing Process, and the IRP stage will be required to confirm their commitment to

honesty at the outset.

There are no prescriptive rules about what other materials (if anything) an individual should bring to

the IRP in support of their testimony. This is a matter of choice for the individual. For those who are

submitting papers in advance, the process for doing so will be explained in the invitation to the IRP. It

is also understood that there will be circumstances where an individual may have wished to bring

further information, but is unable to do so (for example because they have never been able to access

such information or have decided not to retain materials). Each case is unique and the IRP will take

into account all information before it. It is not envisaged that other witnesses will provide statements

to the IRP. Exceptions can be made at the request of the individual or IRP where witness testimony is

considered appropriate in all the circumstances, including the nature of the outcome sought.

Where individuals are seeking financial payment, the IRP will need to consider the appropriateness of a financial payment (and if so the value) in all the circumstances and in line with the guidance Levels explained at 10.3 below. As noted above, while a financial payment may be available to recognise harm suffered and to support healing, it is not intended to nor will it directly compensate for financial loss. Supporting information will be required for the IRP to make an informed evaluation. Such information could include, for example:

• The written, spoken or pre-recorded video account of the applicant

• A harm impact statement from the applicant explaining the harm suffered and how the harm affects/has affected them

• Supporting documentary information of harm suffered and/or the impact it has had

• Written medical information from a GP or other specialist (whether accessed privately or on the NHS) on the harm suffered and/or the impact that harm has had on the individual

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• A statement from another individual on the impact the harm has had on the individual (but not the events that led to the harm itself)

As explained above, the IRP will not hear statements from other witnesses in most cases. While it is

understood that for some applicants, they will consider statements from witnesses as relevant to

supporting their account of what happened to them, the function of the IRP is not to apportion fault,

blame or loss. Rather, the IRP’s function is to understand harm that the individual feels and to identify,

what, if any, outcome may best facilitate healing. Witness statements will not normally be relevant to

that determination. The exception to this is that witnesses may have a greater role where the

applicant is incapacitated.

10 Recommended outcomes available to IRP

The available outcomes are set out below. These are not mutually exclusive. It is possible for an

individual to access more than one outcome. Each individual’s experiences and needs are unique and

as such we understand that their journey through the Healing Process must also be unique.

An individual should identify which outcome(s) listed below it is seeking from the IRP. This should be

done in advance in writing and will be confirmed by the IRP at the outset of the meeting. It is ultimately

a matter for the IRP to determine which outcome(s) to recommend in a particular case to best aid an

individual’s healing. They will at all times be guided by the Healing Principles. As set out above, the

IRP makes recommendation(s) only. Once the IRP has made its recommendation(s), there is no right

of appeal by the individual against the decision of the IRP.

10.1 Outcome 1: Apology and/or Recommendation for Organisational Learning

10.1.1 Apology For many, a key step towards healing will be having the harm they have experienced listened to

without judgment, acknowledged, and a sincere apology given. The IRP having heard from the

individual during the IRP Meeting, may make a recommendation for the Chief Executive to issue a

letter of apology on behalf of NHSH.

The IRP recommendation will include details about the suggested content of the apology. The final

wording of any apology issued will be a matter for the Chief Executive. All apologies will be bespoke

to the individual and reflect their circumstances while addressing any common themes consistently.

The apology will address harm and the impact it has had on the individual. It will also include an

acknowledgement of any failures of NHSH where appropriate.

The IRP will not recommend that apologies name or blame other individuals, or are given by named

individuals other than the Chief Executive. However, a recommendation of mediation may be a

possibility in some cases and should be explored where an apology or dialogue with a named person

would be beneficial to healing. Mediation is a voluntary process and will only be taken forward with

the consent of all relevant participants.

10.1.2 Recommendation for Organisational Learnings Some individuals entering the Healing Process will identify areas in which they believe NHSH could

improve its practices to the benefit of themselves and/or others, both to reduce the risk of harm and

to create opportunities for positive innovation. It is crucial that these opportunities for learning and

improvement are identified and responded to appropriately.

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The IRP may therefore make a recommendation to NHSH that organisational learning is implemented,

delegating responsibility for this action as appropriate. These recommendations will relate to further

review of matters/processes/procedures. The IRP will at all times remain mindful that in its functions

it will only have access to information from the individual’s perspective. As such, in making any

recommendations to NHSH it will not be prescriptive about the outcomes, but rather, will highlight

the perceived problems and may recommend that steps are taken to investigate further and/or

address findings. The IRP may make such recommendations as a result of one individual seeking this

outcome, or in response to a theme that it becomes aware of during the course of the Healing Process.

It would then be a matter for the Chief Executive or Director of Human Resources and Organisational

Development to ensure that the recommendation is explored and if appropriate implemented,

delegating responsibility for action as appropriate.

NHSH will maintain a record of all IRP recommendations for Organisational Learnings and provide a

public quarterly status update in the [24 months] after the Healing Process closes on actions taken in

response to such recommendations.

10.2 Outcome 2: Provision of Psychological Therapies – Validium

The IRP can recommend that an individual be referred to an initial psychological needs assessment by

Validium to determine what support or therapy is clinically indicated and should be provided. Any

assessment or subsequent treatment plan will be held complying with the normal requirements of the

provider in relation to confidentiality. The process for agreeing the nature and scope of any

psychological therapies are described in the Psychological Therapies Guidance Framework.

It is noted that the individual may request, and the IRP may recommend, multiple outcomes. As such,

the individual may be offered psychological therapies in addition to other outcomes. If, after receiving

their outcomes an individual considers that psychological therapy is no longer desired, the individual

can withdraw from psychological therapies. As explained below there is no right of appeal against a

decision by the IRP. As such, if an individual considers that Psychological Therapies may be of benefit

then they should include this in their request to the IRP.

10.3 Outcome 3: Financial payment; Re-engagement or Re-employment or Re-

deployment

10.3.1 Financial payment It is accepted via the findings of the Sturrock Report that certain cultural issues in NHSH may have led

to some individuals experiencing harm. It is because of these findings that NHSH has made this Healing

Process available. This process is focussed on healing and is in addition to existing rights that

individuals may have. It is therefore not intended to mirror either the process or outcomes of other

available forums and financial payment is being made available under this process in recognition of

the fact that some individuals will be unable to access a financial payment or monetary compensation

in another forum.

Financial payment will be available in cases where the IRP considers that: the individual has incurred

harm as a result of the NHSH culture; and a financial payment would be appropriate in all the

circumstances and in line with the Healing Principles.

In such cases the IRP will also recommend a financial payment sum; include an explanation of what

the sum relates to (this may be relevant for tax purposes) and a justification for arriving at that sum.

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The IRP recommended sum will be the gross amount. All sums shall be paid subject to any applicable

deductions for tax and national insurance.

This recommendation will be sent to the Chief Executive as Accountable Officer on a no-names basis

unless agreed otherwise. The Accountable Officer will have delegated authority from the

Remuneration Committee as a Committee of the Board to decide on the resolution of individual cases.

The arrangements for any financial payment will require to be in accordance with the provisions and

the Corporate and Financial Governance reporting requirements of NHS Highland, in considering each

recommendation for financial payment, the Chief Executive as Accountable Officer will be required to

comply with the provisions of DL(2019)15: NHS Scotland: Guidance on Settlement and Severance

Arrangements as may be amended or replaced as appropriate following discussion and agreement

between NHSH and the Scottish Government.

As noted at the outset, when determining whether any financial payment should be paid, and if so

what level of payment is appropriate, the IRP will be guided by considering harm and healing and the

overriding Healing Principles together with the Levels set out below. The IRP will consider the impact

of harm holistically. The IRP will not focus directly on financial loss or on fault/blame (those issues can

more appropriately be considered in another forum which analyses and tests the full facts from both

sides: such avenues will be available to some via other processes or legal claim routes). It is accepted

that the harm an individual feels may be connected to both financial loss and fault. However, harm

can also exist without a direct financial impact. Assessing harm in monetary sums is imperfect, but

financial payment may be the most appropriate outcome in some cases.

All relevant internal and external governance arrangements must be applied. While the IRP will make

a determination based on the information before it, that determination will not have the benefit of

hearing from others who may have a different perspective on events. As such, a finding by the IRP

does not carry the weight of a finding by an investigative process and as such should not be interpreted

as such or as a finding of fact. Rather, it is a finding that based on the information before it (which is

by its nature only a partial picture), the IRP considers that the individual has, on the face of it,

sufficiently demonstrated their position for the purpose of this Healing Process, albeit it is recognised

that a full investigative process may have reached a different conclusion.

When considering if (and if so how much) financial payment to recommend, the IRP will be guided by

the Healing Principles when applying the following scale and the expectation is that most cases will

fall within Core Levels 1 to 3:

Core Financial Payment Levels 1 to 3

• Level 1: £500 to £5,000: o Harm: To recommend financial payment in Level 1 the IRP must find that the

information available to it sufficiently demonstrates that the individual has suffered harm as a result of the culture in NHSH and that: harm has been incurred over a short or medium term duration; there have been occasional or sporadic instances of harm; and/or there have been systemic failures.

o Impact of harm: To recommend financial payment in Level 1 the IRP must find that the information available to it sufficiently demonstrates that there is or has been a detrimental impact on the individual’s life.

o Supporting information: May be testimony from the individual of the medical and other impact that the harm has had and/or is continuing to have on them but could include further information.

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• Level 2: £5,000 to £15,000: o Harm: To recommend financial payment in Level 2 the IRP must find that the

information available to it sufficiently demonstrates that the individual has suffered harm as a result of the culture in NHSH and that: serious harm has been incurred; harm has occurred over a longer term duration; there have been numerous instances of harm or one particularly serious instance; there have been serious incidents of harm; and/or there have been serious or repeated systemic failures.

o Impact of harm: To recommend financial payment in Level 2 the IRP must find that the information available to it sufficiently demonstrates that there is or has been a significant detrimental impact on the individual’s life.

o Supporting information: Given the financial payment sums available in Level 2, the IRP will make a recommendation for such a payment if it has been provided with sufficient testimony and supporting information of both the harm incurred and the impact it has had on the individual. This may include medical information from a GP or specialist; a harm impact statement from the individual (and/or another party such as a colleague or family member) addressing all of the points set out above; and supporting documentation as applicable.


information available to it sufficiently demonstrates that the individual has suffered very serious harm as a result of the culture in NHSH and in particular that: very serious instances of harm have been incurred; serious harm has been incurred over a significant period; there have been repeated instances of serious harm or one extremely serious instance of harm; and/or there have been serious and repeated systemic failures.

o Impact of harm: To recommend financial payment in Level 3 the IRP must find that the information available to it sufficiently demonstrates that the impact of the harm incurred is serious, there is an ongoing significant detrimental impact on the individual and that the individual is likely to face challenges in making a full recovery.

o Supporting information: Given the financial payment sums available in Level 3, the IRP will make a recommendation for such a payment if it has been provided with sufficient testimony and supporting information of both the harm incurred and the impact it has had on the individual. This may include medical information from a GP or specialist; a harm impact statement from the individual (and/or another party such as a colleague or family member) addressing all of the points set out above; and supporting documentation as applicable.

Additional Financial Payment Levels 4 and 5 As explained above, the majority of cases where a recommendation for financial payment is made, will fall within the Core Levels 1 to 3 above. However, the IRP may make a recommendation for Financial Payment within Additional Levels 4 and 5 where it considers it appropriate in all the circumstances. It is anticipated that recommendations at the Additional Level 4 will be rare and Level 5 will be exceptionally rare:


information available to it sufficiently demonstrates that the individual has suffered exceptionally serious harm as a result of the culture in NHSH and in particular that:

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exceptionally serious instances of harm have been incurred; exceptionally serious harm has been incurred over a significant period; there have been a significant number of repeated instances of exceptionally serious harm or in rare cases one extraordinarily serious instance of harm; and/or there have been exceptionally serious and repeated systemic failures which were not corrected despite concerns being raised at the time by or on behalf of the individual.

o Impact of harm: To recommend financial payment in Level 4 the IRP must find that the information available to it sufficiently demonstrates that the impact of the harm incurred is exceptionally serious, has an extremely detrimental impact on most or all aspects of the individual’s life and that the individual will face significant challenges in making a full recovery.

o Supporting information: Given the financial payment sums available in Level 4, the IRP will make a recommendation for such a payment if it has been provided with sufficient testimony and supporting information of both the harm incurred and the impact it has had on the individual. This may include medical information from a GP or specialist; a harm impact statement from the individual (and/or another party such as a colleague or family member) addressing all of the points set out above; and supporting documentation as applicable including to demonstrate financial impact.

• Level 5: £60,000 to £95,000 (higher sums may be recommended where the IRP considers compensation in excess of Level 5 appropriate in all the circumstances subject to SG and NHSH Board approval):

o Harm: A recommendation at Level 5 will only be appropriate in the most exceptional cases. To recommend financial payment in Level 5 the IRP must find that the information available to it sufficiently demonstrates that the individual has suffered exceptionally serious and sustained harm as a result of the culture in NHSH and that: exceptionally serious and sustained harm has been incurred over a significant period; there have been an extensive number of repeated instances of exceptionally serious harm; and/or there have been exceptionally serious and repeated systemic failures which were intentional and were made worse after concerns were raised at the time by or on behalf of the individual.

o Impact of harm: To recommend financial payment in Level 5 the IRP must find that the information available to it sufficiently demonstrates that the harm incurred has been potentially catastrophic and that the individual has little or no prospects of full recovery.

o Supporting information: Given the financial payment sums available in Level 5, the IRP will make a recommendation for such a payment if it has been provided with sufficient testimony and supporting information of both the harm incurred and the impact it has had on the individual. This may include medical information from a GP or specialist; a harm impact statement from the individual (and/or another party such as a colleague or family member) addressing all of the points set out above; and supporting documentation as applicable including to demonstrate financial impact.

In some cases, financial payment will be subject to the individual entering into a settlement

agreement/COT3 on agreed terms as explained below. As per Scottish Government policy, no

individual will be asked to enter into a Non-Disclosure Agreement.

Payments will normally be made within 30 days of approval by the NHS Highland Board or any

settlement agreement or COT3 being agreed where applicable.

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10.3.2 Re-engagement, Re-employment or Re-deployment The IRP may recommend that the individual be considered for Re-engagement, Re-employment or Re-

deployment as a sole outcome or in addition to any another outcome (including financial payment

under 10.3.1).

• Re-engagement means an ex-employee returning to their original role.

• Re-employment means an ex-employee returning to NHSH in a different role.

• Re-deployment means a current employee moving to a different role. If such recommendation is made it will then be a matter for discussion between the individual and the

Director of Human Resources and Organisational Development who will ensure that the

recommendation is explored delegating responsibility for action as appropriate subject to the

individual’s suitability, skills, retraining requirements or any clinical/registration needs, whether there

is an existing vacancy and if not whether there is sufficient justification to create a role for this purpose

within NHSH. Where the IRP recommends that NHSH consider Re-deployment for an existing

employee, this will be subject to the individual agreeing that they are seeking that outcome. If that

outcome is recommended for consideration, there will be no automatic change to the employee’s

employment position, and nor will they move automatically into the “Re-deployment pool”. The

individual will remain in their current role until such time as Re-deployment may be agreed (if

appropriate) in accordance with the NHSH Re-deployment policy.

Where an individual is re-engaged, re-employed or re-deployed the default position is that no

backdated pay will be paid, and continuity of employment will not be preserved (as continuity is a

statutory construct, legally it is beyond the scope of NHSH to agree to preserve continuity). It will be

open to the IRP to recommend that backdated payments are made and/or that NHSH treat the

individual as having continuity for the purpose of certain contractual rights if it deems it appropriate

in a particular case. Re-engagement, Re-employment or Re-deployment may be subject to

COT3/Settlement Agreement and will be in the event that backdated payments and/or continuity of

employment for contractual purposes are recommended (see below). In the event backdated

payments are recommended and made, these will be subject to applicable deductions for tax and

national insurance.

Where recommendations relate to Re-engagement, Re-employment or Re-deployment, the Director

of Human Resources and Organisational Development (delegating responsibility for action as

appropriate) will take all reasonably practicable steps to deliver the recommended outcome.

However, it is accepted that Re-engagement, Re-employment or Re-deployment can have an impact

on the existing workforce and as such further consultation and consideration may be required. In the

event that Re-engagement/Re-deployment cannot be facilitated, the Director of Human Resources

and Organisational Development (delegating responsibility for action as appropriate) will confirm this

to the Individual without delay.

Where the IRP recommends that the individual be considered for Re-engagement, Re-employment

and Re-deployment the IRP may also make an alternative recommendation which will apply only if Re-

engagement, Re-employment or Re-deployment cannot be facilitated.

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10.4 Outcome 4: Referral to other process

The IRP may recommend that the circumstances described by the individual require to be considered

via another extant NHS Highland policy (Once for Scotland HR Policy) in accordance with the terms of

that process. For example, this could be relevant where the individual considers that a more detailed

consideration of the circumstances causing harm is required and that fault/blame should be

apportioned as a full investigation of the facts is out with the IRP’s scope. While the NHSH Board will

not be provided with the names of individuals where the IRP recommendation is referral to another

process, by their nature these are processes that will be managed by NHSH HR and as such, the

individual’s name will be known to the relevant individuals in the NHSH HR team and otherwise in

accordance with the relevant process and the usual confidentiality provisions contained therein.

The referral could be to a process initiated by and centred around the individual accessing the Healing

Process (and as such, the individual would also have the power to withdraw from that process). These

processes are only available to current employees. For example:

• Bullying and Harassment (this process is one which the individual can choose to progress or not and is entitled to withdraw from)

• Grievance (as above - in line with the scope of the Once for Scotland policy issues related to values and behaviours would not be dealt with via this policy but via the Bullying and Harassment Policy.)

• Ill-health (for example if the individual would benefit from Occupational Health support or other reasonable adjustments)

• Training – this may include training and development for the individual themselves or themed training for organisational learning and development

Alternatively, it could be a process centred around another employee (and as such, the individual will

have less input into how that process progresses and their role within it). Both individuals who are

current and ex-employees can request that such a process is commenced:

• Employee Conduct Policy (this process is used if the individual considers that another person’s

behaviour amounts to misconduct, and NHSH agrees that the matter merits further

consideration. Referral would also have to be made to the Bullying and Harassment Policy,

which covers within its scope current employees, as this is the Policy which pre-empts

application of the Employee Conduct Policy. In such cases the individual has the right to raise

concerns and will be advised if the matter is being progressed under the disciplinary process

in respect of another employee, but the individual will not have a right to know the outcome

of that process as that is confidential to the accused employee. The individual accessing the

healing process may have been the trigger for the disciplinary process commencing but once

a process centred around another employee has commenced, it is then a matter for NHSH of

how to progress. The individual may be asked to be a witness in that process (and if they are

a current employee NHSH may require them to participate). If issues are raised by an ex-

employee it will be for NHSH to determine how best to progress these issues in line with the

provisions of the relevant Once for Scotland Policy.

• Capability process (as above relating to another employee’s perceived capability not conduct

– for example, this could be where it may be considered that training for an alleged bully may

be appropriate. This would be progressed by NHSH with the individual named in the normal

manner.

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Individuals do not have the right to know the outcome of a process centred around another employee.

That information is private and confidential to the affected employee. While some outcomes (such as

dismissal and demotion) will be visible, it is important to note that there are a range of outcomes

which are “invisible”. This can include but is not limited to disciplinary warnings and training.

In cases where concerns are significant enough to merit referral to the police or a regulating body the

IRP may recommend that NHSH carry out further investigation into the matter in order to determine

whether a referral is appropriate. For example, if an individual raises a concern about professional

misconduct, patient care or a potentially criminal matter such as assault.

10.4.1 Mediation The IRP may recommend a mediation between the individual and existing (or past) NHSH employees.

While the IRP can make this recommendation, NHSH recognises that for mediation to be effective it

must be voluntary on both sides. As such, while reasonable steps will be taken to encourage others to

participate in a mediation, it will not require existing employees to participate, and nor would it have

the authority to require participation from an ex-employee.

10.4.2 Concerns about individuals who have left NHSH Where concerns have been raised about ex-employees, the IRP (and NHSH) have limited scope to take

action. They may recommend and facilitate a mediation. In cases where concerns are significant

enough to merit referral to the police or a regulating body the IRP may recommend that NHSH carry

out further investigation into the matter in order to determine whether a referral is appropriate.

10.4.3 Timescales Where the IRP recommends the use of another process, it will also recommend set timescales for such

processes to be progressed within. These timescales can only be departed from with valid justification

in line with those policies. This can be helpful particularly where an individual was deterred from

pursuing Bullying and Harassment or Grievance due to concerns about the process being protracted.

10.5 Outcome 5: No further action from NHS Highland

It is hoped that in some cases the participation in the Healing Process will have been helpful to the

individual and that as such, no further action after the IRP may be required. This outcome would also

be appropriate if the IRP considers that the individual has not been harmed on or before 31 December

2019 by the cultural issues related to allegations of bullying and harassment in NHSH addressed in

the 2019 Sturrock Report or is otherwise not eligible to participate in or receive an outcome via the

Healing Process.

It is also recognised that in some cases, an individual may not agree with the recommended outcome

of the IRP. There is no further stage of appeal within NHSH. It is important that the IRP takes ownership

of decisions and is not seen to be passing that responsibility to others. The only circumstances in which

the IRP will defer to another process is where the outcome sought by the individual relates to matters

outwith the scope of the IRP which can more appropriately be dealt with via an extant NHSH process.

If an individual wishes to take further action after receiving the IRP outcome, it will be for the individual

to determine if they are eligible to and wish to pursue an application to the Employment Tribunal, Civil

Court or other body. Existing employees may also have access to extant NHSH processes (to the extent

these have not previously been exhausted).

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10.6 Status of IRP Recommendations

The IRP’s powers are limited to making recommendations to the Chief Executive (on behalf of the

NHSH Board via delegated authority from the Remuneration Committee). The expectation is that the

Chief Executive will [approve/support] the IRP recommendations in most cases provided these are

made within the IRP’s powers as set out in this guidance and related Healing Process documentation

and will present them to the NHSH Board for final approval.

The individual will always be sent a copy of the Outcome(s) as [approved by the Chief Executive]. The

individual will not automatically be sent a copy of the IRP recommendations. However, at the IRP

meeting, the individual may make a request that they are provided with a copy of the IRP

recommendations along with the Outcome. If an individual does not request the recommendations at

this time, they will still be able to make such a request to see their recommendations up to [DATE].

10.7 Legal claims and use of Settlement Agreements/COT3

In many cases the IRP recommendations will be implemented without the requirement for individuals

to enter into a settlement agreement or COT3.

The exception to this will be where an individual is offered and wishes to accept a recommendation

under outcome 3 and in all the circumstances of the case the IRP, CLO or NHSH considers it appropriate

to make that recommendation conditional upon the individual entering into a binding settlement

agreement or COT3 on mutually agreeable terms whereby the individual waives their right to pursue

a legal claim(s) in respect of the specific matters to which their situation relates, including any

potential employment, personal injury or other claim. This may arise in circumstances where there is

a live or prospective claim which would not be time barred in the Employment Tribunal or the civil

courts. As noted above, in the event that the IRP has recommended Re-engagement or Re-

employment together with backdated pay and/or the preservation of continuity for contractual

purposes, this recommendation must always be made subject to the individual entering into a binding

settlement agreement or COT3 on mutually agreeable terms.

In all cases, in the event the individual receives a financial payment, and also pursues a legal claim

arising out of or connected to the same or similar circumstances, NHSH is entitled to disclose the

financial payment during proceedings and request that it be offset against any compensation that may

be awarded on just and equitable grounds. NHSH may similarly offset such financial payment against

any sums which may be offered in a future settlement agreement, COT3 or otherwise.

In the event that an individual accesses the Healing Process having already received a compensation

payment from NHSH via settlement agreement, COT3, legal claim or otherwise, the IRP will be entitled

to offset any sums previously paid from any financial payment that it may recommend.

The Healing Process is voluntary and confidential. However, it is not carried out on a “without

prejudice” basis. That means that NHSH and the individual are entitled to rely on the content of what

is said, the outcome, and any other relevant information in defence or pursuit or any legal claims.

As has been previously stated, the Healing Process is designed to focus on Healing. While the IRP will

make determinations based on the information presented to them, that information will be taken

from the individual’s perspective only and as such is by its nature limited and incomplete. The usual

standards of evidence do not apply. As such, any recommendations or other statements from the IRP

must be understood in that context. They should not be relied upon as an admission of fault or liability

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in any particular case, as it is recognised that a process which required evidence from all relevant

parties may have made a different determination. Any IRP recommendation or statement is not a

finding of fact or blame and cannot be relied upon as such in any other process.

10.8 Proactive steps by IRP

The IRP’s purpose is to aid healing on an individual level. As such, in its recommendations it will be

guided by the preferred outcomes proposed by the individual and will focus its attention on those

routes. The IRP is not precluded from proactively suggesting alternative outcomes to an individual to

consider. It may be that the individual has indicated that their preferred outcome is financial payment.

In such cases the individual should consider also including an alternative proposal as it may be that

the IRP determines that financial payment is not appropriate/available in their case but another

outcome may be. The IRP will not make a recommendation for an outcome relating to that individual

if the Individual does not confirm that they wish that outcome to be considered. For example, if the

individual is not interested in mediation, the IRP will not recommend mediation even if the IRP

considers that it may assist in healing. This process is led by the individual and the IRP will respect that

individual choice.

However, the IRP may become aware of matters which it considers are significant enough that they

should be addressed by NHSH even if this has not been requested by the individual. The IRP will in

such circumstances be entitled to proactively raise concerns with NHSH. For example, this could occur

if a serious conduct or clinical negligence issue is raised.

10.9 Themes

It is anticipated that the IRP may become aware of common themes arising as the Healing Process

progresses. The IRP will decide each case on its own merits. The focus of the IRP is on harm felt by an

individual and aiding healing for that individual, others affected and NHSH taking into account the

Healing Principles. Underlying themes will be relevant to the Final Report of the IRP explained below.

10.10 Final Report of IRP Learnings

On conclusion of the Healing Process, the IRP will prepare a Final Report of their Learnings and may

also be asked to provide interim reporting. The aim will be to report on the process itself, and any

themes which arose. This report can make further recommendations to NHSH. It may also be useful

to NHSH in informing any future process changes. The details of the required reporting will be

determined by NHSH and/or the Scottish Government.

10.11 Record Keeping

We understand that privacy and security of personal information will be extremely important to

participants in the Healing Process.

Therefore, at the outset of the process, participants will be provided with a GDPR compliant privacy

notice explaining to them how their personal information will be collected during the process, what

will be done with that personal information and who that personal information will be shared with.

This privacy notice will apply to all of those individuals who access the Healing Process and will cover

all stages of the Healing Process from their initial engagement with CMP onwards. However, we

recognise that if personal information is transferred to a third party as part of the Healing Process

then that third party’s privacy notice may govern the participant’s engagement with that party and

further information will require to be given to the participant at that stage. For example, if a

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participant is referred to Validium then Validium will act as a data controller for the purposes of

providing services to the participant and so Validium’s privacy notice will apply to Validium’s

processing of personal data in the treatment of that participant. Our aim is to be as clear as possible

with participants on how their information will be used.

Any personal information collected during the process will be used lawfully and in accordance with

data protection law. Participants will also be provided with information on their rights under data

protection law.

We are in the process of mapping the data flows between the various providers involved in the Healing

Process for each stage of the Healing Process and how this information will be kept secure. This

exercise will inform the final privacy notice.

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NHS Highland Healing Process

High Level Legal Summary

25 March 2020

Introduction and scope This is a high level legal summary prepared by Shepherd and Wedderburn LLP for the use of NHS Highland (NHSH) in relation to the proposal to implement the Healing Process. The Healing Process has been proposed in response to the 2019 Sturrock Review into the culture at NHSH and allegations of bullying and harassment.

This note has been prepared taking into account the information available at the date of writing and in particular, the draft documentation prepared by the co-production groups and shared with the NHSH Board for its board meeting on Tuesday 31 March 2020.

There are of course many benefits to the introduction of the Healing Process: it was a key recommendation of the Sturrock Report; it plays a vital role in organisational and individual learning and healing; and it has the public support of the Scottish Government. However, this note focusses on identifying high level risks (both legal and otherwise where relevant). It should be read in that context. It is therefore not a balanced risk assessment weighing up the pros and cons of implementing the Healing Process.

1. High Level Legal Summary 1.1 The Healing Process proposes giving financial payments (and other outcomes including

outsourced psychological therapies and reengagement of individuals who have left the organisation which have an associated cost) to individuals, many of whom would not be able (and/or willing) to pursue a legal claim via the courts or tribunal. For example, many are time barred; would find a legal process disproportionately expensive or burdensome; and/or while they feel aggrieved, have no valid legal claim to pursue.

1.1.1 This creates a number of potential challenges including:

(i) Given the current climate and pressures on the NHS as a result of Covid 19 and otherwise, there is a risk that using funds to support individuals who do not have a technical legal remedy could be criticised as not being the best use of public funds.

(ii) It could also create discord in other NHS, public sector or other areas where individuals feel similarly harmed but are not provided with a remedy.

1.1.2 However, given that the Healing Process is offering a forum to individuals who would have no other potential remedy available, those accessing the process are less likely to complain about the outcome (and in any case they are unlikely to have a legal basis for doing so) provided the terms of the process are clear from the outset and are followed. It is worth noting that there is no right of appeal against an outcome of the Healing Process (albeit some individuals may still be permitted to pursue matters under other processes).

1.2 The Healing Process will be time intensive to create, coordinate and participate in. As above, this could be criticised on cost and resource grounds. Delaying the commencement of the process given the current unprecedented circumstances of Covid 19 will assist in addressing this concern. However, it must be accepted that in order to address important issues, investment is required.

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1.3 The Healing Process is voluntary. Opt-in processes can lead to a degree of inequality among applicants as by its nature it is only used by those who self-select in. As such, a comprehensive media campaign, engagement from staff-side and mechanisms to support vulnerable individuals in accessing the Healing Process have been put in place to mitigate the risk and widen access.

1.4 The Healing Process differs from existing legal and employment processes as it is “one sided”:

it only takes into consideration the account of the individual accessing the process. This is important to ensure that individuals feel listened to and can focus on healing. The documentation makes it very clear that this limits the scope of the process and the nature of any outcome. For example, the Healing Process cannot determine fault or blame, but it can form a view based on an individual’s account. It is recognised that this also creates challenges including:

1.4.1 Participants will be required to commit to honesty albeit there is a risk of abuse. There is a great degree of responsibility for the Independent Review Panel to exercise sound judgement in determining what if any outcome is appropriate and to recognise the limitations of the information presented to it.

1.4.2 Safeguards have been included to ensure that the outcome of the process does not apportion fault or blame and make it clear that it cannot do so given its limited fact-finding scope. However, there remains a risk that those who are accused of bullying/being a bystander may feel that it is unfair that they were not given the chance to share their viewpoint and may later feel aggrieved if they perceive that an outcome provided to one person implies criticism. To mitigate this risk, the Healing Process is very clear throughout that it must recognise its limitations including in particular the one-sided nature. It is also important to stress that the Healing Process is open to eligible individuals who feel they have been affected by the cultural issues, whether as actual or perceived victim, bystander, bully or otherwise. It is crucial that the messaging around these points is clear. If despite these safeguards any current NHSH employee feels adversely affected by the Healing Process they will be able to access support via the HR processes where it is hoped an explanation and resolution will be found.

1.4.3 Some individuals may feel that a more investigative process is required to aid healing. As such, the Healing Process can refer out to another process to enable this to happen when appropriate.

1.5 The Healing Process will include apologies to individuals where appropriate. This recognises the importance of addressing cultural issues and taking steps to support individuals in healing.

1.6 The Healing Process can make recommendations to give people their jobs back or move people into new posts. That is complex and as such each case will need to be managed individually and in line with existing processes as appropriate.

1.7 The Healing Process is new. It is important to ensure clarity around the scope of the Healing Process in terms of who it is available to, what it is, and the possible outcomes to guard against disappointment or confusion and to manage expectations. It is hoped that the media surrounding the launch and the documentation will assist in this regard.

1.8 GDPR is being considered at the outset and must be complied with throughout. Great care will be taken to ensure that all personal information is handled appropriately and in accordance with legal rules.

1.9 The Healing Process is engaging with individuals on sensitive topics, and many individuals have experienced trauma. It is important to ensure that individuals can make an informed choice about whether this voluntary process will be helpful to them and that they are supported in accessing it if they wish to do so as it is recognised that for many this will be challenging. It is also recognised that for some people, they will decide that the Healing Process would not be helpful for personal reasons.

1.10 In some cases, individuals who receive an outcome will be required to enter into a form of settlement agreement but this will be managed on a case by case basis given the range of circumstances and legal risks. As explained above many of those accessing the Healing Process will not be able to raise a legal claim and it is hoped this process will be of assistance

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to them. For others, the Healing Process may not be their only route to resolution as they may access existing internal HR processes and/or claim instead of or as well as the Healing Process. The fact that the Healing Process is a new additional process could be criticised as creating a risk of actual or perceived double recovery for some. This risk is mitigated as any outcome of the Healing Process is intended to be offset against any other remedy available and the use of settlements where appropriate.

1.11 The Healing Process is not “without prejudice”. This means that either party could rely on what is said in pursuit/defence of court proceedings to the extent relevant and appropriate. In general, it is hoped that by accessing the Healing Process this will make claims less likely and in any case access to the process will be viewed positively.

1.12 The Healing Process is stated in many areas to be “confidential” from the board of NHSH in that while they will be aware of high level and anonymised outcomes, in most cases, they will not have sight of the names of individuals to whom outcomes are being provided. However, it is not intended that individuals entering the process will be bound by confidentiality and as such, they could tell people about their outcome. NHSH does not use non-disclosure agreements as a matter of course in any case.

1.13 This process is new and as such there is a challenge in determining in advance what the demand will be and as such putting in place appropriate resources. Flexibility has been built in where appropriate to try to accommodate varying demand.

1.14 The Healing Process is of fixed duration (it is expected to run for a period of 9 months) and relate only to incidents that occurred in a fixed period (incidents in the period 2019 and before).

1.14.1 Key benefits of this limitation in scope are that:

(i) It demonstrates the uniqueness of this project and reduces the risk of setting a precedent for day-to-day HR functions (albeit there will be learnings which may assist in developing other processes).

(ii) It ensures a set time period for engagement in the process. In the event there is a negative reaction from any individuals/groups the impact of this will hopefully be limited as the process has an end date.

1.14.2 But it also creates certain risks as some who wish to access it may find that given its scope, they are not eligible. It is hoped that by supercharging existing processes this risk will be mitigated.

Shepherd and Wedderburn LLP

25 March 2020

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NHS Highland



Title: Temporary Arrangements for Corporate Governance

Responsible Executive/Non-Executive: Boyd Robertson, Board Chair


1 Purpose


This report relates to: • Local corporate governance.


2 Report summary

2.1 Situation This report outlines a proposal to delegate the responsibility for the governance of NHS Highland for an initial period of three months to the Board Chair and Chief Executive. This is an emergency measure to enable the organisation to respond appropriately to the Covid-19 Pandemic.

2.2 Background The NHS faces unprecedented demand as it responds to the Covid-19 Pandemic. NHS Highland is facing prolonged stress to normal systems of work which requires Board to establish temporary and appropriate governance arrangements that respond to support the organisation in the coming months.

The Board recognises the need for the organisation to continue to operate within an appropriate legal framework, act in the best interests of the population, be efficient in the use of resources and put the safety of staff and patients at the forefront of its efforts.


2.3 Assessment The Board is asked to delegate responsibility for the governance of NHS Highland for an initial period of three months to the Board Chair and Chief Executive, with the Vice Chair and Deputy Chief Executive acting as substitutes. This arrangement is proposed to take effect from 1 April 2020 with reviews taking place monthly following the initial three month period. In the event that actions are taken through the delegated authority, in accordance with Standing Orders, the Board Chair will inform the relevant Governance Committee Chair and the Board. The Chair and Chief Executive will reserve the right to recall a meeting of any Governance Committee. The following meetings will therefore be suspended: April Clinical Governance Committee - 14 April Highland Health and Social Care Committee – 15 April Staff Governance Committee – 21 April Audit Committee – 21 April Asset Management Group – 22 April Health and Safety Committee – 22 April Finance Committee - 23 April May Asset Management Group – 20 May Board Development – 25 May Board Meeting – 26 May June Clinical Governance Committee – 9 June Highland Health and Social Care Committee – 10 June Audit Committee – 17 June, subject to national agreement of the annual accounts process Asset Management Group – 17 June NHS Highland Board – 23 June, subject to national agreement of the annual accounts process In accordance with Standing Orders, and for the avoidance of doubt, the delegated authority does not include items of the business which are reserved exclusively for approval by the Board, due to either Scottish Government directions or a Board decision, in the interests of good governance practice. This includes the approval of the annual accounts and report.

2.3.1 Quality/ Patient Care 2.3.2 Workforce 2.3.3 Financial

All Governance Committees provide assurance and governance on staff, clinical and financial matters on behalf of the Board. Any decisions taken under delegated authority will be communicated to the relevant Committee Chair and the Board.


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2.3.7 Communication, involvement, engagement and consultation Board Members have been notified that this temporary change to corporate governance arrangements has been proposed.

2.3.8 Route to the Meeting This is an emergency situation, responding to the urgent need for front line staff, senior officers and the Executive to deal with the Covid-19 Pandemic with as little distraction as possible.

2.4 Recommendation

• Decision The Board is asked to delegate the responsibility for the governance of NHS Highland for an initial period of three months to the Board Chair and Chief Executive, with the Vice Chair and Deputy Chief Executive acting as substitutes. This arrangement will take effect from 1 April 2020 with reviews taking place monthly following the initial three month period. In the event that actions are taken through the delegated authority, in accordance with Standing Orders, the Board Chair will inform the relevant Governance Committee Chair and the Board. The Chair and Chief Executive will reserve the right to recall a meeting of any of the Governance Committees. They will also agree the necessary arrangements to ensure the annual report and accounts process can be completed with the necessary degree of independence and in accordance with government guidance. The Board Chair and Governance Committee Chairs will meet with the Chief Executive and key members of the Executive Team on a regular basis and provide all Board members with regular updates and in exceptional circumstances an emergency Board meeting will be called.

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HEALTH & SAFETY COMMITTEE Report by Fiona Hogg, Director of Human Resources & Organisational Development


• Note that the Health and Safety Committee met on Thursday 13 February 2020 withattendance as noted below.


Present:

Elspeth Caithness, RCN (Joint Chair) Fiona Hogg, Director of Human Resources & Organisational Development (Joint Chair) Alexander Anderson, Non-Executive Board Director (Videoconference) Sally Bassett, UNISON Karen McNicoll, Divisional General Manager

In Attendance:

Virginia Paul-Ebhohimhen, Consultant Occupational Health Physician Leah Girdwood, Board Committee Administrator (Observing) Eric Green, Head of Estates Louise McInnes, Risk Manager (from 11.25am) Russell McKechnie, Section Head of Clinical Technology Mark Middleton, Argyll and Bute (Videoconference) Brian Mitchell, Board Committee Administrator Linda Rawlinson, Occupational Health Nurse Manager Bob Summers, Head of Occupational Health and Safety

Apologies:

Rosie Brunton, Health and Safety Manager, Raigmore Hospital Fiona Campbell, Clinical Governance Manager, Argyll and Bute Sarah Crawshaw, Moving and Handling Manager Diane Fraser, Violence and Aggression Prevention Manager Tracy Ligema, Head of Community Services (North and West) Joanna MacDonald, Chief Officer, Argyll and Bute Health and Social Care Partnership David Park, Chief Officer, Highland Health and Social Care Partnership Catherine Stokoe, Infection Control Manager Katherine Sutton, Head of Acute Services Karen-Anne Wilson, Health and Safety Manager, North & West

NHSH Board 31 March 2020, Item 15f303

AGENDA ITEMS

• Draft Revised Committee Terms of Reference • Assurance Report from Meeting held on 10 October 2019 • Fire Safety - Training and Update on EFA/Patient Mobile Phone Charging • Radon Monitoring Programme Support Arrangements

• Asbestos Exposure Incident – Aros Building, Lochgilphead • New Craigs – Ligature Management and Removal • Health and Safety Team and Estates Plan Update

• Minute of Meeting of the Estates Health and safety Group held on 7 November 2019

• Operational Units Health and Safety Management Plan Performance Update • Revised Operational Health and Safety Management Plan 2020-2023

• Verbal Report by Health and Safety Representatives • Update on Risk Management • RIDDOR Reporting/HSE Activity • Infection Control

• Occupational Health Service Update and Annual Report 2017/18 • Radiation Protection • Medical Devices Regulation

• Revised Radiation Safety Policy • HBP11 Management of Suicide and Ligatures Procedure • HBP02 Health Surveillance and Health Assessments Procedure • Minute of Meeting of Radiation Safety Committee held on 18 June 2019

• Minute of Meeting of Water Safety Group held on 5 November 2019 • Draft Minute of Meeting of Hand Arm Vibration Short Life Working Group held

on 24 October 2019 • Estates and facilities Alert 2019 005 Door Stops and Buffers

• Remaining 2020 Meeting Schedule • Communications • Issues Requiring Escalation to NHS board

DATE OF NEXT MEETING The next meeting will be held on Thursday 23 April 2020.

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1 WELCOME AND DECLARATIONS OF INTEREST F Hogg opened the meeting, introduced herself and confirmed, as Executive Lead for Health and Safety, she would fulfil the role of Joint Chair. She advised that as new arrangements for Health and Safety governance came in to the effect, the role of this Committee would change so as to give greater emphasis on high level overview activity etc whilst reflecting the wider culture agenda within NHS Highland. There were no Declarations of Interest. Members were advised the meeting was inquorate and therefore any decisions taken

on the day would require ratification at the following meeting.

The Committee agreed to consider Agenda Items in the following order.

2 MATTERS ARISING 2.1 Patient Mobile Phone Charging/Fire Safety Training E Green advised mobile phone charging was a complex area to oversee. He stated whilst any device could be PAT tested there was little that could be done to avoid chargers being brought on to NHSH premises. A LearnPro module had been developed following recent unsafe incidents. He went on to state there was a requirement to raise awareness of the issue among Nursing colleagues, advise as to what can be done and emphasise any action would include a joint check of equipment only. Those present agreed the requirement for provision of a consistent Guidance message. ACTION: Agreed the provision of a Guidance message discussed with Communications Team – E Green On Fire Safety training activity, E Green advised the relevant LearnPro module had been made available for use and that face to face training continued where appropriate. A Fire Safety Training Dashboard was under development and would be submitted to the next meeting for consideration. Concern was expressed that not all Fire Safety training had been available through LearnPro and on this point E Green advised the key was to ensure an appropriate level of managerial awareness of the various training options available for staff. A Anderson highlighted training performance within Raigmore and RNI, Inverness and was advised there were specific compartmentation matters within RNI that required to worked through with the relevant Regulator. Further work would be undertaken following the winter period as this would involve a series of necessary temporary bed closures. In addition, there were current data processing issues relating to training performance. Concern was expressed that the ongoing data processing issues meant the organisation could not adequately assess and seek to appropriately mitigate the relevant risk. It was agreed further detail was required for the next meeting. ACTION: Agreed sample Fire Safety Dashboard be presented to next meeting – E Green ACTION: Agreed detailed update on Fire Safety Training performance be provided to the next meeting – E Green The Committee otherwise Noted the updates provided.

2.2 Radon Monitoring Programme Support Arrangements B Summers outlined the relevant monitoring requirements in this area and advised this had been mostly completed in relation to North Highland although a programme was required for

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the outstanding sites. A technical solution had been identified and implemented for the Fort William site previously identified. A baseline survey was required for the Argyll and Bute Area and discussion was underway in association with Argyll and Bute Council with a view to providing the same through a suitably negotiated contract arrangement. Any cost implication would be discussed with the Chief Officer for Argyll and Bute Health and Social Care Partnership. It was confirmed all relevant Building Standards were met for new build facilities and that all issues relating to historic buildings were addressed as when these arose. The Committee Noted the position.

3 HEALTH AND SAFETY PERFORMANCE 3.1 Estates Plan and Updates E Green advised that the current Estates Risk Register was being updated in association with the Clinical Governance Team. Local Risk Registers were being developed and would be complete by 1 April 2020. High Level risks were recorded on Datix. He confirmed all relevant safety critical activity was being undertaken as required. The NHS Water Safety Policy had recently been published and an Authorising Engineer engaged. It was emphasised all required Authorising Engineers were in place, this being unique among Scottish NHS Boards. Work continued in relation to developing an Asbestos Management Policy and associated Implementation Plan. Set procedures had been established in relation to access and egress for Confined Spaces. In terms of assurance reporting to the Committee, B Summers referenced the establishment of an Estates Health and Safety Group and in response E Green advised he would anticipate the Committee receiving Annual Reports relating to Fire Safety, Water Safety and Electrical Safety, these being the relevant key areas managed by the Estates Service. In terms of Asbestos Management, E Green advised this was a complex subject with relevant Regulations subject to continuous update and change. Where there was any doubt as to the presence of Asbestos then staff members were being instructed to keep away from that area. E Caithness emphasised the importance of taking shared learning from all relevant incidents. Discussion moved on to the matter of Lone Working arrangements, and appropriate liaison with Health and Safety representatives. It was noted Lone Working was currently being managed via a simple to use mobile device Application. E Caithness, referencing the need for Health and Safety representatives to be included in the membership of the Estates Health and Safety Group, advised two new representatives had now been appointed. E Green confirmed representatives were engaged and supported where appropriate and confirmed wider staff awareness issues were discussed on a regular basis. Other matters raised in discussion had included the need for greater follow up in relation to Datix reports, Corporate Risk identification to assist with any relevant resource bidding process, and the potential for developing a Staff Register for Health Surveillance. ACTION: Agreed Estates Health and Safety Plan be brought to the next meeting – E Green ACTION: Agreed discussion be held on possible development of a Staff Register for Health Surveillance – E Green/V Paul-Ebhohimhen After discussion, the Committee otherwise Noted the position.

E Green left the meeting at 10.40am.

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4 DRAFT REVISED COMMITTEE TERMS OF REFERENCE F Hogg introduced the circulated draft revised outline Committee Terms of Reference, these having been amended to reflect changes to the NHS Highland governance framework relating to Health, Safety and Wellbeing. She went on to advise that P Hawkins, Chief Executive had indicated his desire to reconsider the overall NHS Highland governance framework, which may in turn impact on this area. There was reference as to the need to consider changing the title of the Committee to include Wellbeing and on this point E Caithness advised the relevant Sub Committee had not favoured taking that approach. She stated however there was a clear need for the Committee to remain sighted on this activity. There was agreement the matter required appropriate oversight, including for the Wellbeing Group chaired by B Summers. It was suggested the matter be raised for consideration as part of any governance framework discussion by the Chief Executive given the associated behavioural and cultural aspects. A Anderson endorsed the request for inclusion of Wellbeing and emphasised the need to drive activity at an Operational level whilst providing necessary oversight in relation to the same. There was general agreement this Committee should continue to provide focus on strategic matters and the suggestion was made that a specific Working Group could be considered for Wellbeing activity. L Rawlinson stated discussion had highlighted the need to ensure appropriate accountability and assurance in relation to a number of disparate activity areas relating to Health, Safety and Wellbeing activity across NHS Highland. Discussion then moved on to the matter of Committee membership, with members expressing concern in relation to leadership and senior management representation. F Hogg confirmed the Chief Executive was sighted on this issue in terms of Senior Leadership Team representation across all Governance Committees. A Anderson echoed the need for this to be addressed from a NHS Board Non-Executive members’ position. Progress was expected to be made ahead of the next Committee meeting. ACTION: Agreed a proposal for Committee oversight and assurance in relation to Wellbeing activity be brought to the next meeting – F Hogg/B Summers ACTION: Agreed the matter of senior leader representation be raised with the Chief Executive as part of any Governance framework review and an update brought to the next meeting – F Hogg After discussion, the Committee otherwise Noted the position with regard to revising the current Committee Terms of Reference.

5 ASSURANCE REPORT FROM MEETING HELD ON 24 OCTOBER 2020 The Committee Approved the circulated draft Assurance Report from the meeting of the Committee held on 24 October 2019. 6 MEDICAL DEVICES REGULATION PROGRESS REPORT R McKechnie spoke to the circulated report in relation to compliance with the Medical Devices Regulation 2017, advising parallel running of Regulation transposed from the 1993 Medical Devices Directive (MDD) was to cease from May 2020. The Medical Devices Regulation had made a number of specific requirements on Healthcare institutions in relation to devices that they ‘manufacture’. In addition, there were a number of other new requirements including in relation to surveillance by regulatory authorities, clinical follow up and post market monitoring by manufacturers, Healthcare Institution Exemption (HIE), traceability, and research/research sponsor responsibilities.

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It was reported NHS Highland operated a number of services that would qualify as the manufacturing of Medical Devices, with a summary gap analysis relating to the same provided for members. The Regulation required NHS Boards to have appropriate quality management systems relating to manufacture and use/distribution and whilst this was in place for Radiotherapy and Laboratories this would need to be extended for medical devices in other services. This would require enhancing management and documentation systems in those services. The report indicated the level of risk associated with MDR compliance, noting the services concerned had been operating safely for some period of time. In terms of activity being undertaken with a view to achieving compliance with MDR it was noted a Datix alert had been circulated to help highlight any services not yet identified in the gap analysis. Clinical services were working to improve existing documentation and systems for compliance. By May 2020 the NHS Board will be required to publish some detail relating to devices manufactured internally and register with the Medicines and Healthcare Products Regulatory Agency for those services considered to be making devices for individual patients. NHS Highland would not achieve full MDR compliance until after May 2020. On the issue of potentially registering for a Healthcare Institution Exemption, R McKechnie advised he was unaware as to whether the NHS Board would opt to take this approach. For medical Physics, a working group had been established with a view to taking an audit of equipment and develop appropriate quality management systems. Any Quality Management systems that are developed may require accreditation. A Anderson took the opportunity to raise the potential risks to staff and was advised that, as most activity related to assisted technology, the key issue for NHS Highland would be the development of the Quality Management systems and regulating area of operation not previously subject to the same. ACTION: Agreed a six month update report be submitted to the Committee in due course – R McKechnie The Committee otherwise Noted the content of the circulated report.

R McKechnie left the meeting at 11.15am.

7 MATTERS ARISING 7.1 Asbestos Exposure Incident – Aros Building, Lochgilphead M Middleton advised an investigation in to the Asbestos incident previously discussed at Committee had found there were a number of associated causes, with the building itself considered to no longer be fit for purpose. Matters highlighted by the investigation included an asbestos management system that was not comprehensive or effective; an ineffective monitoring system; and issues in relation to both local monitoring and requisite action notification processes. He went on to advise relevant system issues had been recognised, as was the failure to properly communicate with staff, in relation to which a formal apology had been made to those who may been affected. A further meeting would be held with staff and Union representatives to address any outstanding issues or questions. B Summers advised the incident in question had highlighted a number of issues relating to asbestos management in NHS Highland and stated there was a need for the Estates Service to take appropriate learning, especially in relation to provision of clear and early communication. M Middleton emphasised that the Health and safety Executive had been kept appropriately informed at all times and reiterated that an external contractor had previously identified nothing quantifiable in relation to asbestos within the building in question. ACTION: Agreed a six month update report be submitted to the Committee in due course, on improvements made to the Asbestos Management Arrangements in light of his incident – E Green

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7.2 New Craigs – Ligature Management and Removal B Summers advised an inventory had been developed, identifying all relevant ligature points and risk rating these according to the Manchester Tool. There were approximately 1900 points rated as High Risk and requiring action. There were 300 points identified for complete removal. Overall, this was a complex area with a range of activity already having been undertaken to date. There was need to fully scope and understand the extent of the work that will be required as well as the associated plan to address the same. Advising the New Craigs building had not been adapted to meet changing levels of associated risk, B Summers stated another event, that involved a previously identified High Risk ligature point, would not reflect well on NHS Highland. Relevant Clinical and Estates Plans had to be coordinated to ensure all necessary, relevant requirements would be met. He emphasised a large degree of work had already been undertaken, with a large degree more to be done. F Hogg expressed frustration as to the absence of relevant management representation at this meeting, and with the lack of progress in this particular subject area. She stated she would be looking for receipt of a comprehensive update at an early date. E Caithness stated the matter had reached the stage where further escalation should now be considered. It was confirmed a Ligature Steering Group had been established and continued to meet regularly. ACTION: Agreed the Chief Officer (North)/Head of Estates be requested to provide a comprehensive update on all relevant activity - F Hogg The Committee otherwise Noted the update provided.

8 HEALTH AND SAFETY PERFORMANCE 8.1 Health and Safety Team Plan Update B Summers provided a verbal update in relation to circulated Health and Safety Team Plan 2020-2023, as at February 2020, advising as to the development of draft Asbestos and Restraint Policy/Procedure documents. In relation to the latter Policy, consideration was being given as to the training provided as well as arrangements for staff release to attend the same. It was suggested the Committee would benefit from an update in relation to the same for New Craigs, where training performance levels required improvement. E Caithness agreed a report was required for the Committee to be fully appraised around recent service changes as well as associated staff education/training activity. F Hogg advised she would raise this issue as part of the discussion relating to New Craigs ligature points. During the meeting it was further suggested that a gap analysis be undertaken between NHS Highland and the exemplar Carse View Unit within NHS Tayside. ACTION: Agreed an update be provided to the next meeting in relation to - D Fraser The Committee otherwise Noted the updated position.

4.1.2 Minute of Meeting of Estates Health and Safety Group held on 7 November 2019 There had been circulated Minute of meeting of the Estates Health and Safety Group held on 7 November 2019. The Committee otherwise Noted the circulated Minute.

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8.2 Operational Units Health and Safety Management Plan Performance Update 8.2.1 North Highland Health and Safety Performance 8.2.1.1 Draft Minute of Meeting of North Highland Health and Safety Sub Committee

held on 28 January 2020 There had been circulated Minute of meeting of the North Highland Health and Safety Sub Committee held on 28 January 2020. B Summers advised the Group provided assurance to both this Committee and the Highland Health and Social Care Committee. The Committee Noted the circulated Minute.

8.2.1.2 North Highland Plan Performance Updates, Revised Plan and Audit Schedule In addition to the relevant Smartsheet web links to the updated Health and Safety Management Plans for Raigmore Hospital (Medical, Surgical, Clinical Support Services and Quality & Patient Safety), North & West and South and Mid Divisions there had been circulated a performance update report for North Highland Divisional Health and Safety Management Plans. On the matter of conducting relevant Risk Assessments, B Summers advised these were based on a four step process, up to and including the review stage. E Caithness confirmed Operational Managers undertake Risk Assessments and set relevant priorities for the following period. E Caithness stated it was difficult to take assurance in relation to Raigmore activity at this time due to the current Health and Safety management structure. K McNicoll advised relevant managers had been challenged to seek improved Health and Safety performance within Raigmore and confirmed she would also be looking to consider current structures. There was general agreement as to the need for improved assurance reporting systems, recognising structural changes would impact on any associated reporting process. During discussion, A Anderson queried the RAG Rating being used and advised he favoured an approach that only provided for a Green Rating where performance had reached 100%. Accepting this point, B Summers advised a revised Plan was due for April 2020 and this was to include a Rating element that provided 5% incremental performance reporting with a view to providing greater accuracy. The Committee otherwise Noted the North Highland Management Plan Performance Updates.

8.2.2 Argyll and Bute Health, Safety and Fire Group Minutes There had been no documents submitted in relation to this Item. It was reported the last meeting had taken place in November 2019. 8.2.3 Revised Operational Health and Safety Management Plan 2020-2023 There had been circulated as part of the agenda the relevant Web link to the revised Operational Health and Safety Management Plan 2020-2023. B Summers advised the revised Plan would go live from 1 May 2020, with a continuation of previous Plans ongoing where appropriate. The new Plan would provide a clearer reporting profile for members. The Committee so Noted.

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9 ADVISERS’ REPORTS – RISK MANAGEMENT L McInnes spoke to the circulated report and advised Risk Management arrangements within NHS Highland were in process of being reviewed by the Risk Management Steering Group, following the issue of an Internal Audit report and associated recommendations. The Risk Management policy was being reviewed and operational Guides, risk analysis tools and training packages were being developed with a view to ensuring Risk Management was embedded throughout NHS Highland. To this end organisational risks were shared with Governance Committees for scrutiny and assurance purposes. Associated risk relating to staff would be reported through the Staff Governance Committee. The Risk and Clinical Governance Managers were setting up meetings with Chairs and Lead Executives to provide further guidance and support on this process. There were no Corporate Risks assigned to the Health and Safety Committee for assurance purposes at that time. The Health and Safety Committee would receive regular reports on the overall corporate risk profile, as per the circulated report, with committee member feedback encouraged in relation to the same. It was reported, over the coming year, operational risk would also begin to be assigned to operational level governance groups to ensure appropriate assurance and oversight, with the exception that high level operational risks would also be highlighted to this Committee. The circulated report gave an update in relation to progress around corporate risks and compliance with key performance indicators, and provided assurance in relation to each of the corporate risks of interest to the Health and Safety Committee. During discussion, L McInnes emphasised relevant Management Teams, not Quality and Patient Safety Groups, must be sighted on risk areas. The Risk Management Steering Group would eventually be phased out and risk management activity had to be considered day to day business. Relevant Guidance relating to the role of the Audit Committee would be taken forward as required. On the point raised, it was stated there was a need for clear, visible structure for risk assessing relevant Operational Plans. On the matters raised by A Anderson, it was confirmed that a grading system would be developed to enable operational managers to help assess and identify their individual top risk areas. After discussion, the Committee otherwise Noted the content of the circulated report.

L McInnes left the meeting at 12.00pm

10 REPORT BY HEALTH AND SAFETY REPRESENTATIVES E Caithness advised the List of Representatives had been updated and was in the process of being refreshed. Operational Unit Managers would be advised as to their respective Representatives, each of whom would cover a number of areas due to restricted numbers. She further undertook to furnish both the Head of Occupational Health and Safety and Health and Safety Managers with this information. Management at New Craigs had been advised as to their particular Representative. It was further reported that engagement levels across North Highland Operational Units was strong in South and Mid, mixed in North and West, and challenging in relation to Raigmore. E Caithness was to attend the next Argyll and Bute Health and safety meeting to gauge the position in that area. Appropriate help and support would be provided to all Representatives. The need for improved communication processes was a common theme. The Committee Noted the reported position.

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11 ADVISER’S REPORTS 11.1 RIDDOR Reporting/HSE Activity B Summers introduced a circulated, revised report as at 20 January 2020 outlining relevant Adverse Event data (Slips, Trips and Falls; Violence and Aggression; and Moving and Handling) and RIDDOR events for the period. He advised data relating to Sharps/Needle Stick Injuries would be added for future reports. He went on to highlight under-reporting in relation to RIDDOR events and stated improved promotion, monitoring and feedback was required. Comments on the revised format were welcomed. During discussion, it was confirmed the circulated data was available down to ward level. The question as to who had access to this data was raised and in response B Summers advised this required to be further clarified with the Clinical Governance Development Manager. It was understood the matter had been discussed forward with eHealth however there were cost implications involved in widening access to Management Teams and other relevant managers. ACTION: Agreed data access requirements be defined and the matter taken forward accordingly – B Summers/M Morrison The Committee otherwise Noted the circulated report.

11.2 Infection Control There had been circulated a report which indicated performance against relevant Local Delivery Plan Standards relating to Infection Prevention and Control. Further updates were also provided in relation to Healthcare Environment Inspection activity; outbreaks/clusters and multidrug resistant isolates associated with NHSH; Respiratory Protective Equipment (FFP3) activity; provision of assurance relating to Estates compliance with relevant Policy requirements, and updated HCAI standards and antibiotic use indicators for Scotland. On the point raised in relation to Face Fit Testing, at a time when Coronavirus was starting to have an impact, it was stated the compliance level may have been reduced by a range of redesign activity affecting front line staff ability to undertake relevant FFT testing activity. ACTION: Agreed future reports include supporting narrative information – C Stokoe The Committee otherwise Noted the reported position.

11.3 Occupational Health Service Update There had been circulated an update outlining recent activity levels against Key Performance Indicators. There had been no significant health concerns identified through current health surveillance programmes or referrals. The Committee Noted the reported position.

11.4 Radiation Protection There had been circulated a report which gave updates in relation to Radon activity; actions associated with new radiation legislation; Nuclear Medicine; Radiology; The Control of Electromagnetic Fields at Work Regulations (CEMFAW) 2016; Lasers and the work of the

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Radiation Safety Committee. On the point raised, it was advised any update in relation to radioactive waste monitoring would be via the Business Continuity Manager. The Committee otherwise Noted the circulated report.

12 POLICY AND PROCEDURES 12.1 Draft NHS Highland Radiation Safety Policy There had been circulated, for ratification, draft NHS Highland Radiation Safety Policy. It was confirmed this document adequately reflected relevant Regulations relating to both IRMER and Ionised Radiation. The Committee Agreed to Ratify the circulated draft Procedure document.

12.2 HBP11 Management of Suicide and Ligatures There had been circulated, for comment, draft Management of Suicide and Ligatures Procedure. Drawing the attention of members to key elements of the draft document, B Summers advised the final version would be available for ratification at the next meeting. Relevant comments were invited, with particular emphasis on Raigmore. The Committee Noted the circulated draft Procedure document.

12.3 HBP02 Health Surveillance and Health Assessments Procedure There had been circulated, for ratification, draft Health Surveillance and Health Assessments Procedure. B Summers advised this document represented one element of overall COSHH management activity within NHS Highland. The Committee Agreed to Ratify the circulated draft Procedure document.

13 FOR INFORMATION 13.1 Minute of Meeting of Radiation Sub Committee held on 18 June 2019 13.2 Minute of Meeting of Water Safety Group held on 5 November 2019 13.3 Draft Minute of Hand Arm Vibration Short Life Working Group held on 24

October 2019 ACTION: Agreed to discuss membership detail out with the meeting – B Summers/V Paul-Ebhohimhen The Committee Noted the circulated Minutes.

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14 AOCB 14.1 Estates & Facilities Alert 2019 005 Door Stops and Buffers B Summers spoke to the circulated Estates & Facilities Alert (EFA) on door stops and buffers and confirmed relevant requirements would be discussed with the Estates Service. The Committee otherwise Noted the circulated Alert information.

14.2 Remaining 2020 Meeting Schedule The Committee Noted the remaining meeting schedule for 2020 as follows: 23 April 3 September 5 November A Anderson requested consideration be given to moving future meetings to Thursday afternoons. The Committee otherwise Noted the future meeting dates for 2020.

14.3 Restructure of Health and Safety Team B Summers gave a brief update in relation to a restructure of the existing Health and Safety Team, advising as to the proposed revised staffing profile. He went on to advise as to relevant Health and Safety Practitioner requirements and emphasised that relevant staff would be classified as Senior Health and Safety Advisors, and not managers. Discussion would be held with the Head of Estates to define relevant Service requirements. The Committee so Noted.

15 COMMITTEE FUNCTIONAND ADMINISTRATION 15.1 Communications There were no matters identified in relation to communication issues at this time. 15.2 Issues Requiring Escalation to NHS Board There were no matters requiring escalation to the NHS Board from this meeting. 16 DATE OF NEXT MEETING The next meeting of the Committee was provisionally set for Thursday 23 April 2020 in the Board Room, Assynt House, Inverness.


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Documents

HIGHLAND NHS BOARD DRAFT MINUTE of BOARD ......this (‘coffee conversations’) was explained. Evidence from 150200 hospitals over 510 years - - suggested that 37k coffee conversations