LOTHIAN NHS BOARD East Lothian Community Health ... · September 2013 instruction was endorsedto write a paper . Noted this is a ... assessments will be done. MA reportedthat RPP

LOTHIAN NHS BOARD East Lothian Community Health Partnership Sub-Committee DATE: 5th MARCH 2015 Esk Room 1, Local Area Office, Brunton Hall, Musselburgh 14.00 – 16.00

AGENDA 1.0 Apologies:

Welcome:

1.1

Update on Health & Social Care Partnership Mike Ash V

2.0

Minutes of Previous Meeting Held on 30.10.14

Mike Ash

2.0

3.0

Action Note Previous Meeting

Mike Ash

3.0

4.0

Matters Arising

4.1 East Lothian Community Hospital

David Small V

4.2 LUCS Review David Small V

5.0

Items for Discussion

6.0

Performance Reports

6.1 Joint Director’s Report David Small 6.1

6.2 Head of Health Update Alison MacDonald 6.2

6.3 Staff Governance Report

Alison MacDonald 6.3

6.4 Prison Healthcare Report Alison MacDonald 6.4

6.5 Clinical Director’s Report Jon Turvill 6.5

6.6 Finance Report/Financial Plan 2015/16 David King 6.6

6.7 Delayed Discharges

David Small 6.7

7.0

Public Partnership Forum Report

Gill Colston

7.0

8.0

Carer’s Forum Report

Andrew Tweedy

V

9.0

AOCB (please advise Chair in advance)

10.0 Date of Next Meeting: 30 April 2015

14.00 – 16.00 Council Chamber, Town House, Haddington

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NHS LOTHIAN EAST LOTHIAN COMMUNITY HEALTH PARTNERSHIP Minute of the meeting of the East Lothian Community Health Partnership Sub-Committee held on Thursday, 30th October 2014, in Council Chamber, Town House, Haddington Present: Michael Ash in the chair (MA)

Gill Colston, PPF Representative (GC) Councillor Donald Grant, East Lothian Council (DG)

David Heaney, Interim Head of Adult Wellbeing (DH) Alison MacDonald, Head of Health for East Lothian (AXM) Ann McCarthy, PPF Representative (AMcC)

Fiona Mitchell, Director of Operations, NHS Lothian (FM) Sue Muir, Senior Health Promotion Specialist (SM) David Small, Director of Health & Social Care (DAS)

Sian Tucker, Acting Clinical Director, LUCS (ST) Andrew Tweedy, Carers of East Lothian (AT)

Apologies: Moyra Burns, Health Promotion (MB)

Judith Gaskell, Head of Human Resources (JG) David King, Head of Finance (DK) Angela Leitch, Chief Executive, East Lothian Council (AL) Murray Leys, Head of Adult Wellbeing Carol Lumsden, Integration and Transformation Manager (CL) Alison McNeillage, Primary Care Contracts Manager (AMcN) Thomas Miller, Lead Site Staff Rep. (TM) Sharon Saunders, Head of Children’s Wellbeing (SS) Dr Amy Small, EL GP Representative (AS) Jon Turvill, Clinical Director (JT)

In Attendance: Barbara Gilbert, PA (minutes)

1.0 Welcome 1.1 Update on Health & Social Care Partnership

Perennial item. Please refer to Director’s report. MA stated looking at date in May 2015 to go live therefore there will be a role for continuing this group. Children’s Health Service being looked at regarding integration.

2.0 Minutes of Previous Meeting held on 28.08.14 Agreed as an accurate record.

3.0 Action Note Previous Meeting Shadow Strategic Planning Group met on 27.11.14 when Carol Lumsden done a presentation on the Draft Strategic Plan. Progress is being made however noted there are vacancies in this group and MA requested carers be informed of the next meeting on 19.01.15. CHP would like engagement with this forum (this item to be noted as an action) and DG intimated he will talk to Carol Lumsden regarding this. Joint People’s Older Planning Group – discussion has taken place at

Management Team, CL will process daft and DH will convene a meeting of representatives to discuss this paper. In turn this should be fedback to SSPG. AT will bring this item up when he attends later. DH reported the legislative position has changed and we have to make sure new arrangements are met. AM stated this has been lengthy process therefore members are a bit disillusioned. MA promised to implement improved communication. Prestonpans Initial Agreement – this is in the hands of Finance Resources Committee at the present time.

4.0 Matters Arising 4.1 East Lothian Community Hospital

DAS reported papers will come back here depending on outline case, which will probably take place in the spring of 2015. Initial agreement has been agreed by the Cabinet Secretary and we are now involved with more detailed discussions. Detailing thinking has commenced on phasing of Roodlands site, if this is preferred option. Phasing is quite complicated looking like two phases, 1st phase around south site which may be demolished first and then temporary accommodation sited. Ambulance Service is interested and work is being finalised with GP Practices. DAS to enquire as to the date of the next Stakeholder’s meeting for GC and AMcC. MA would like to offer Partnership Forum for more detailed briefing and Partnership Forum advised to get back to MA. GC enquired if architects appointed to which reply was made Keppie are involved. MA requested he be consulted with regards to groups who have a particular interest in this item. ACTION: DAS

5.0 Items for Decision 5.1 East Lothian Health Improvement Alliance

Purpose of report is to update the ELCHP Sub Committee on the East Lothian Inequalities Strategy and Action Plan and the work of the East Lothian Health Improvement Alliance. Following stakeholders event in September 2013 instruction was endorsed to write a paper. Noted this is a joint framework tackling good quality housing, availability of jobs, education and learning opportunities, access to services and social status. To date two sessions have been delivered; a successful workshop with councillors. Action plan is set over next two years therefore East Lothian Health Improvement Alliance are asking for support to drive this forward. DH noted that life expectancy is quite striking depending on which area you live in. Very reassuring that partnership approach agencies. SM stated she has worked with groups in these areas and any action plans that come out assessments will be done. MA reported that RPP will be receiving a report on this item and this will be put on agenda for their next meeting. Margaret Douglas has been invited to this group. AT commented at here is a lot of discussion regarding health and equalities however the issue is around caring role and paid employment and made a plea that this could be looked at in slightly broader remit taking into account . MA stated social economic circumstances is a characteristic and is one of many features and we are looking towards strategic objectives to reduce inequality. MA welcomes this intervention and AT stated he would be happy to be

involved. SM asked how we are supporting carers so there is some small work going on and AT was invited to attend Health Alliance. Discussion took place how IJB include this and it may well be that situation arises where RPP does not exist. Emphasised that it is important that CL puts forward correct outlines in Strategic Plan. Noted that some projects have been lost however there are still projects still funded by Health Alliance and papers will be brought to this group showing what has been developed and it should be noted there are structures. MA thanked SM for her informative report.

6.0 Items for Discussion 6.1 LUCS Review

MA commented on lengthy report and requested ST to point out one or two key features. DAS reported that the CHP for East Lothian is required to log any East Lothian issues and they key issues are change of hours and lone working. Currently there are five bases for LUCS, WGH, RIE, St John’s, Roodlands and Midlothian Community Hospital however challenges have been experienced over the past eighteen months therefore an external review has taken place. ST reported LUCS are experiencing significant difficulties in recruiting and training GPs to fill OOH shifts. Medical and nursing staff sickness is having a significant impact on rota management and attracting other doctors to cover shift. Nearly 20% of staff have sickness higher than 4% which must be addressed in the Service Improvement Plan. IT system called Rotamaster is not used elsewhere in NHS Lothian but is used nationally by the majority of OOHs therefore recommendation has been made for a review of this system. Recommendations have been made for Roodlands and MCH to close at 2200 instead of 2400 i.e. with Monday to Friday opening from 1800 to 2200 hours. Both Roodlands and MCH should close at 2200 on Saturday, Sunday and Public Holidays i.e. open from 0800 to 2200 hours. One car, driver and doctor should cover these two geographical areas with support from car based at RIE when necessary and each base should have a receptionist and doctor as core staffing. Consideration should be made for substituting a Band 5 registered nurse for the receptionist at each site to support, record, manage and assess patient prior to doctor consultation. Home visits are a key and core component of OOH services delivered by GPs and this should continue until alternatives are demonstrated safe and effective and efficient. ST reported this has been approved by the Management Team, Clinical Directors Group and GP Forums however concerns have been raised by Midlothian. MA queried in terms of the change of hours is there any suggestion that this would cost less. ST replied this is not necessarily taking skills from doctors however they may be reluctant to work alone at the base which would boost nursing central bases. DG queried if the reduction of hours is due to lack of use but ST commented on figures i.e. average attendance between 11am to midnight drops to 0.5% however service is busier at weekends. DG enquired if figures are in public domain however ST explained there is one year’s data which has to be circulated with minutes. And it was agreed that ST would forward this to BG. MA reported that as hosting service we need to comment on East Lothian and final report will be delivered to CHP and CMT. Reported that change of hours most sensitive. Sub Committee is

supporting this process however change in hours are noted and noted the point ST made about general logistics. ST will talk to logistics and reassure people regarding impact. The next report will come back to Sub Committee in either January or next meeting and MA explained this needs to fit in with board schedule. MA requested Partnership Forum and carers to get feedback for this item. MA reported this as a useful discussion and appreciates ST coming to meetings and the correct approach is evidence led. ACTION: DAS / ST

7.0 Performance Reports 7.1 Joint Director’s Report

DAS reported slight delay on papers around the Initial Engagement on the Strategic Plan for IJB which are commencing in November however CL is starting engagement process. Planning is still underway for the Scheme of Integration to be submitted to the Council and NHS Board in December 2014 for agreement to consult. Consultation processing the Strategic Plan will take place over January and February 2015. The intention is that IJB cannot deliver functions until Strategic Plan is formally consulted on. NHSL and ELC will then delegate budgets possibly in May 2015 and IJB will direct NHSL and ELC to provide services based on the Strategic Plan again possibly in May 2015. MA suggested carers need to be geared up immediately after Xmas regarding the consultation on Draft Strategic Commissioning Plan and we may have to have a debate which is very important. DAS spoke to a diagram of the East Lothian model of Joint Management Arrangements. We will put in place some joint management arrangements but not part of IJB responsibilities. MA reported a clear distinction between board of IJB and the organisations that deliver service. There are two separate roles, one of influencing board and they are as individuals and drawn from stakeholders and in addition there will be specific issues i.e. bidding out of national pot. Same people will be working in a more directive way, DAS is looking at bringing together management structures and related services and manage as one service keeping the same terms and conditions. DG hopefully consultation will bring this out and noted this is a huge job. AMacD reported Unison in Lothian met with managers in Dublin recently and they are creating one body and Unison appeared to be quite impressed. MA stated he has a slightly different view and only a limited amount to try and achieve things and we are some way from looking at single contract. DH reported Crookston is a good example of bringing two organisations together and encouraged by bringing staff together.

7.2 Head of Health Update AMacD highlighted note that Crookston intermediate care beds are up and running and there are 20 people waiting on care homes or packages of care. There has been good joint working with regular updates and patients receiving high level of rehabilitation. AMaCD stated any members of Sub Committee are welcome to visit Crookston and please get in touch with Barbara and this will be organised. DG enquired if anybody had declined to which AMacD replied a couple of people have declined who have been used to existing staff and they do not want to move and other issue is how

we portray unit in proficient manner. MA stated he looks forward to receiving further reports in the future. Hospital to Home has service in East Lothian which has been extended increasing to 6 care assistants and a Band 6 and then looking to extend further. Discussion took place on Capital Projects updating on various initial agreements. Mental Health Service event was held on 1st September 2014 to start disaggregating the service between East Lothian and Midlothian. Children’s Service work is ongoing to identify where best this service will sit and event being held tomorrow (31.10.14). Difficult to recruit trained health visitors however this is a national concern and work is ongoing in East Lothian to move staff to different areas. GC enquired what does Hospital to Home offer. AMacD replied a very small number of staff are involved and bridge gap therefore we are doubling staff to look at more people with complex difficulties. ACTION: AMacD / BG

7.3 Staff Governance Report AMacD reported an issue with long term sickness absence however concentrated work is being undertaken with JG, relevant Nurse Manager and increased sessions with Occupational Nurse. It is a concern we have an ageing workforce and there is a significant illness over some staff. TM is very supportive in working with managers.

7.4 Prison Healthcare Report AMacD produced quarterly update. Psychology service to be increased with variety of funding and this has been identified as deficit over number of years. At present there are nine applicants for this post. Mental Health Services have recruitment in process for Senior Charge Nurse at HMP Addiewell. Mental Health Team at HMP Saughton has been shortlisted for a Mental Health Award at the Daily Record Scottish Health Awards which is being held on 6th November 2014. New structure at National Meetings is being introduced and the first meeting was held this morning. Plans are well underway for new woman’s unit at HMP Edinburgh including a mother and baby unit which is due to open in December 2016. AMacD reported SM does some good work around this. MA reported the enclosed two appendixes are for information. DG suggested worthwhile to have visits. DAS stated this will not be a delegated function to IJB and probably will be included in the Healthcare Governance Committee and report direct to Health Board.

7.5 Clinical Director’s Report AMacD reported in the absence of JT that Tranent Practice started last week covering Crookston which is going well. Eskbridge Practice continues to cover six of the seven care homes in the Musselburgh area. We continue to be concerned about the shortage of Care of the Elderly in Roodlands and two vacant posts will be advertised imminently. DAS reported these will be joint appointments with Royal Infirmary and will have extended rota.

7.6 Finance Report/Financial Plan 2014/15

AMacD updated on the financial position in the absence of David King. At the end of month 6 there is an overspend of £697,000 and noted that prescribing is still a significant issue. There has been some LRP auctioned since month 5 however there remains a significantly large element of LRP to be auctioned before the end of the financial year. Managers to be involved at end of each month to show up LRP position. Operational pressures – significant financial pressures from Roodlands regarding the use of a locum consultant to support the geriatric services and some staff within the prison service are in the process of being moved from this budget to other budges which has created additional staffing pressures with a concomitant cost. MA stated it would be interesting to see when IJB comes into effect how LRP is dealt with. MA reported there is a report being issued today by the Auditor General Scotland, Caroline Gardener, which is an update of NHS and instructed everybody to look at Page 1 which demonstrates the first time that money within health is going down, which is a 1.1% decrease and this is full of statistics which will result in a direct effect which we are interested in.

7.7 Delayed Discharges We said we would have a separate report on this. DAS gave a quick update on number side which tracks two years therefore helpful to see trends. In September the number of delayed discharges was 43 which has been the highest figure for a number of years. In October the figure came down to 30 and we are expecting November will show a further improvement again. Considering increasing capacity of Crookston again. DH reported recruitment fair is taking place at Queen Margaret University on 31.10.14 and 14 expressions of interest have been received. This event is being held at Bleachingfield again next week which is an area that has been hard to recruit historically. DH stated that Tyneholm Stables had a number of adult protection concerns lately so working closely with them and a recent review showed phased admission i.e. one a fortnight however we need to see improvements are maintained. Lammermuir have a voluntary suspension introduced by provider and again we are working closely with them and hopeful by next month improvement measures can be sustained. DAS reported as we are coming into winter January may be a high point for delayed discharges so we need to our best to keep this under control. MA stated we will identify in a one page item the concerns and this to be kept on agenda as a separate item. ACTION: DAS / BG

8.0 Public Partnership Forum Report GC reported one paper is in draft however there may be some amendments. Meeting planned for 10 February 2014 and MA stated he would happy to attend any meeting as conscious that we are going through changing times. Keith can link into this meeting.

9.0 Carer’s Forum Report AT welcomed the fact that they are involved in discussions regarding the content of the Strategic Plan which relates to carers. Agreed carer support to be added to the Strategic Plan. Today’s event was very positive however the need for evidence to be included which is critically important i.e. issue of multi morbidity and how does this get

pulled into process. MA stated he is aware of the fact and everybody will have a view however we need to be clear we are seeking everybody’s input.

10.0 AOCB None

Dates of Future Meetings 8th January 2015 1400 – 1600 Esk Room 1, Brunton Hall, Musselburgh 5th March 2015 1400 – 1600 Esk Room 1, Brunton Hall, Musselburgh

East LothianSub Committee

05.09.13 3.0

No DOM REF ACTION Decision Progress/Update Manager Due Completed Filter78 30.10.14 3 Action Note Previous

MeetingCHP would like engagement with Shadow Strategic Planning Group. Vacancies in group of Shadow Strategic Planning Group.

DG will talk to CL DG / CL

79 30.10.14 4.1 East Lothian Community Hospital

Parternship forum to receive more detailed briefing.

DAS to enquire as to the date of the next Stakeholder's meeting.

DAS

80 30.10.14 6 LUCS Review Next report of LUCS to discussed again at future meeting

ST to come to meeting on 08.01.15 or 05.03.15 to discuss LUCS review

ST / DAS

81 30.10.14 7.2 Head of Health Update Crookston - members invited to visit

Ann McCarthy and Gill Colston would like to visit Crookston. AMacD notified by email 03.11.14

AMacD

82 30.10.14 7.7 Delayed Discharges Concerns intimated around increase in winter months.

On agenda for 08.01.15

LOTHIAN NHS BOARD East Lothian Community Health Partnership Sub-Committee 5th March 2015 Joint Director

JOINT DIRECTOR’S REPORT

1 Purpose of the Report 1.1 The purpose of this report is to update and brief members on integration of health

and social care. 2 Recommendations

The Sub-Committee is invited to: 2.1 Note the content of the report. 2.2 Discuss the implications for the sub committee.

3 Summary of the Issues

SUMMARY Consultation on the scheme of integration is now complete Initial consultation on the draft strategic plan is now complete The Scheme of Integration will be presented to the NHS Board and Council for approval on 4th and 10th March respectively. The CHP sub committee will continue in its role for NHS services until the IJB is established

3.1 The main issues are.

3.2 Timescales. The scheme of integration has been consulted upon and will be

presented to the NHS Board and Council for approval to submit to the Scottish Government on 4th and 10th March respectively.

3.3 The initial consultation on the strategic plan has been completed and work has

now begun on the second draft. There will be further consultation on the second draft.

3.4 A meeting has been held with representatives from each Joint Planning Group to

discuss the role of the groups in relation to the new planning structure. 3.5 The table below contains an updated timetable.

6.1

Page 1 of 3

ACTION DATE COMMENTS FINAL DRAFT SOI TO NHSL

03/12/14 complete

FINAL DRAFT SOI TO ELC

Council 16/12/14 complete

CONSULTATION ON SOI 17/12/14 to 17/02/15 complete FINAL SOI FOR AGREEMENT TO NHSL

04/03/15

FINAL SOI FOR AGREEMENT TO ELC

10/03/15

SUBMIT SOI TO SCOTTISH GOVERNMENT

1ST April 2015 latest

CABINET SECRETARY APPROVES AND ORDER LAID BEFORE PARLIAMENT FOR 28 DAYS

April and possibly May 2015

Assumes immediate approval

IJB LEGALLY CONSTITUTED

July 2015

IJB APPROVES STRATEGIC PLAN

July 2015 Exact sequencing to be agreed

NHSL and ELC DELEGATE FUNCTIONS

July 2015 “

NHSL and ELC DELEGATE BUDGETS

July 2015 “

IJB “DIRECTS” NHSL AND ELC TO PROVIDE SERVICES BASED ON STRATEGIC PLAN

July 2015 “

3.6 Joint Management Structures. Work is underway to design joint management

structures to ensure further integration of services and support the responsibilities of the IJB. This will be consulted upon during March 2015.

3.7 Future of CHP Subcommittee. CHPs cease to exist under national legislation in

April 2015. However, NHS Lothian has decided to exercise its ability to establish committees and will maintain CHP sub committees until IJBs are legally constituted. This ensures that governance for NHS services is maintained.

3.8 East Lothian Community Hospital. Work is continuing on the outline business

case. Capita have been asked to review the bed number assumptions and to extend that work into review of beds for the whole of the strategic plan.

3.9 Work is also underway on options for decant capacity to allow site development.

3.10 Over the last few months there has been a focus on working with the clinical services to determine clinical adjacencies. Up to 100 staff have attended these meetings. In March 2015 there will be new rounds of community engagement and involvement. There is a Stakeholder Event planned for 20th March and invites have

Page 2 of 3

been sent to all previously involved members from our partner agencies including the third sector and also community councillors. Plans are being made for 3 public engagement/involvement sessions in April 2015 in three separate ward areas across East Lothian. At these attendees will see draft models and service information and will be able to make comment/feedback in advance of final design proposals. A group will be established including members of the public that will meet regularly to help cascade and share ongoing plans and updates.

4 Key Risks 4.1 There is a risk to the CHP of lack of focus on existing services and priorities as

work on integration progresses. This is addressed in the CHP risk register. 5 Risk Register 5.1 A risk has been added to the CHP risk register.

6 Impact on Health Inequalities 6.1 There are no immediate implications for health inequalities of any of the issues

covered. 7 Impact on Inequalities 7.1 There are no immediate implications for inequalities of any of the issues covered.

8 Involving People 8.1 Each issue covered will have an involvement plan where appropriate.

9 Resource Implications 9.1 There are no new resource implications from the issues raised in this paper.

David Small Joint Director of Health and Social Care 26th February 2015 List of Appendices: none

Page 3 of 3

Paper 6.2 NHS LOTHIAN East Lothian Community Health Partnership Sub Committee 5th March 2015 Head of Health

Head of Health Report

1 Purpose of the Report 1.1 The purpose of this report is to update and brief members on CHP Performance and

developments. 2 Recommendations

The Sub Committee is invited to: -

2.1 Note the content of the report. 3. Summary of the Issues

3.1 The main issues are: 3.1.1 ELSIE

Hospital at Home: ELSIE commenced operations on Monday, 2nd February, and the first cohort of patients have been supported back into their homes from an acute hospital by the ELSIE medical, nursing and AHP clinicians, earlier than would otherwise have happened. There is in place an ELSIE Clinical Operations Group which will manage all operational aspects of service management and clinical as well as information governance for ELSIE. This group links with the pan Lothian Hospital At Home services to share learning and experiences as well as attempt to standardise approaches, documentation etc. Health data will be collected in Trak and live screens are anticipated this week for population, eventually being available for interrogation, data analysis etc via the Business Objects reporting system. Integrated working is a key aspect of ELSIE and already much good multi-agency work is either planned or in progress between health and social care as well as multi-disciplinary work between health professionals.

Step Down Care Beds: These beds within the Crookston Care Facility, Tranent, are fully functional and already working to Discharge To Assess principles for early pull down of patients from acute hospitals, maximising rehabilitation potential, and discharging directly to

SUMMARY Start of the ELSIE service on 02/02/15 Update on Step Down beds and Hospital to Home Childrens Services Governance

Paper 6.2

home where possible or care home placement, earlier than would otherwise have been the case. The intention is to also move towards prevention of admission by using some of these beds for Step Up directly from a patient’s home for intensive short term management to prevent admission to an acute hospital setting. In terms of communication, the first ELSIE Newsletter has been issued to all staff with a second to follow at the end of this month. Personal communication amongst and between professionals has also spread the message. An official launch of ELSIE will be planned for April, engaging with both Council and NHS Lothian communications departments. Hospital to Home: The Hospital to Home Team has now been up and running for one year. It initially started in Dunbar/North Berwick area and progressed to Musselburgh with a second team from the 19th January 2015. Our current capacity is between 5 to 7 patients, for each area, depending on what care package has been requested. in addition to basic care packages the carers assist the domiciliary physiotherapy service. A carer will go to see patients for ongoing mobility sessions so they can build the patients confidence. They do this after they have completed their care rounds. We are supplementing the Hospital at Home team by going to patients to obtain bloods, urine samples, clinical observations, and weights etc. The CCSW’s are getting trained in community equipment and a Physiotherapist has provided some training with regards to walking aids. We work closely with our community colleagues, i.e. District Nurses and the Social Work department. The Coordinator and I review all the patients on a weekly basis and update the social work IT system weekly. This enables us to pick up problems early and hopefully prevent hospital readmissions. Examples are any deterioration in a patient’s mobility or for Community OT issues with equipment. When a long term care provider has been obtained for any patient we provide a handover sheet that we send onto the care brokers. They attach this to the contract for the company. We do try and have a face to face handover on the day of the handover but this is not always possible as the carers have a busy morning schedule. All patients are given a questionnaire to complete when being discharged from us and it is currently sitting at 95%. Potential Work closer with district nursing teams; expand the training for the CCWS to enable them to carry out simple dressings so this support the District Nursing team; improve further joint working so that health and social work can share the care of a patient and work together and work towards an on call system whereby Hospital to Home, Emergency Care Service (ECS) and Domicilary Care can rotate being on call.

3.1.2 Capital Projects

Blindwells Meeting with practices in the immediate area of this development arranged (18/02/15) to generate options in addressing the provision of primary care services to the ensuing population.

Paper 6.2

This will need to consider both the needs of the early stage population, prior to any practice being located within the development, and the longer term needs of the population of the whole development.

3.1.3 Children’s Services

The CHP sub committee will continue till July 2015 (tbc) that will be the governance route for NHS Children’s services till then and they will remain part of the management responsibility of the Director of Health and Social Care. We will shortly consult on an organisational structures proposal that brings the Councils Children’s Wellbeing service into the Joint Director’s remit. The detail of the proposal will be that a Head of Childrens Services will report to the Joint Director and will be responsible for the current ELC Children’s Wellbeing and the NHS East Lothian Health Visiting and School Nursing services. Therefore the operational management of NHS children’s services will be secured through that route. In terms of governance the IJB will not have the delegated function till 16/17 so we have to be clear where the governance reporting for NHS Children’s services will be for the remainder of 15/16 after July 2015. The thinking at the moment is not to establish something separate but to have a direct line from the Director to the appropriate NHS Lothian committee. It should be noted that we are experiencing, in line with the wider Lothian position, increasing difficulty in recruiting Band 6 Health Visitors. Discussions are on-going on a pan Lothian basis to find solutions.

4. Risk Register Nil added. 5. Impact on Health Inequalities 5.1 There are no immediate implications for health inequalities of any of the issues

covered. 6. Impact on Inequalities 6.1 There are no immediate implications for health inequalities of any of the issues

covered. 7. Involving People 7.1 Each issue covered will have an improvement plan where appropriate. 8. Resource Implications 8.1 There are no new resource implications from the issues raised in this paper. Alison Macdonald Head of Health 17th February 2015

6.3 NHS LOTHIAN East Lothian Community Health Partnership Sub Committee 5th March 2015 Head of Health

STAFF GOVERNANCE REPORT 1 Purpose of the Report 1.1 The purpose of this report is to update the East Lothian Sub Committee re key

employment performance indicators for the year to date in East Lothian CHP.

Any member wishing additional information should contact the Executive Lead in advance of the meeting.

2 Recommendations

The East Lothian Sub Committee is recommended to:

Note and comment on the data provided to date 3 Key Performance Indicators 3.1 Sickness Absence Statistics

Please see East Lothian summary data.

Absence %

2014/2015 April May June July Aug Sept Oct Nov Dec Total Absence

4.72 4.26 4.97 5.10 5.58 5.46 6.24 6.53 7.18

Long Term 2.79 2.64 3.13 3.33 3.20 3.46 3.73 3.88 4.52 Short Term 1.93 1.62 1.83 1.77 2.38 1.99 2.51 2.64 2.65

Actions identified to address increase in absence:

• Work with Head of Employee Relations, relevant CNM/CSDM and Partnership Lead to identify specific barriers to return to work.

• OH Senior Nurse to be involved with specific cases. • Employee placement scheme to be explored more fully to facilitate return to

work on an individual basis, if appropriate. • Thorough review at manager’s 1:1 meetings and Health Management Team.

3.2 Establishment Data

Please see summary data below and as follows: - WTE / Headcount in post (2014/2015)

Core Services

Mar April May June July Aug Sept Oct Nov Dec

Wte in Post 444.6 444.55 449.3 440.5 450.3 442.8 449.2 457 472 466 Headcount 627 618 597 620 598 595 611 606 620 613 LUCS Mar April May June July Aug Sept Oct Nov Dec Wte in Post 107.5 110.51 109.2 106.7 107.5 105.1 107.8 105 102.1 102 Headcount 261 259 254 256 260 260 260 256 251 254 Prison Mar April May June July Aug Sept Oct Nov Dec Wte in Post 79.1 77.37 76.5 78.8 80.62 80.39 79.9 76 76.1 76 Headcount 95 92 91 90 95 95 93 90 93 86 3.3 NHS Lothian Recruitment Freeze

NHS Lothian have employed a significant number of nursing staff to supports wards open for Winter. In order that posts are available for these staff some vacancies are being held. Any nursing vacancies which are not able to be filled by this route are escalated via Chief Nurse to Nurse Director and advertised.

4 Key Risks 4.1 There are no immediate risks for any of the issues covered. 5 Risk Register 5.1 There are no immediate implications for any of the issues covered. 6 Impact on Health Inequalities None 7 Impact on Inequalities None 8 Involving People

None 9 Resource Implications

None Alison Macdonald Head of Health 17TH February 2015

Paper 6.4

NHS LOTHIAN East Lothian CHP Subcommittee 5th March 2015 Alison MacDonald, Head of Health East Lothian HSCP Chief Nurse for East and Midlothian

HM PRISONS UPDATE 1 Purpose of the Report 1.1 The purpose of this report is to update and brief members on Prison Healthcare

performance and developments. 2 Recommendations

The Sub Committee is invited to: - 2.2 Note the content of the report. 3. Summary of the Issues

4. Quarterly update of Prison Healthcare issues as affecting HMP Addiewell and HMP

Edinburgh both hosted services within East Lothian CHP. Psychology Service Two part-time Psychologists have been recruited on a job share basis. Mental Health Services Senior Charge Nurse at HMP Addiewell due to start early March 2015. Development of new psychiatrist support model to prison to be presented to SMT on 12th March 2015. Regional Women’s Unit Please note Appendix 1

5. Emerging Themes from Inspection

Feedback from recent inspections including HMP Edinburgh (Appendix 2). Notice has been given of the Inspection to take place at HMP Addiewell in June 2015.

SUMMARY Psychology Service Mental Health Service Emerging Themes from Inspections Regional Women’s Unit Update

Paper 6.4

5 Impact on Health Inequalities 5.1 No impact assessment on Health Inequalities have yet been covered yet. 6 Resource Implications 6.1 None identified as all new posts have external funding streams and nursing restructure

was within current budget. Alison MacDonald Head of Health East Lothian CHP; Chief Nurse, East and Midlothian 18th February 2015 [email protected] Appendices Appendix 1: Regional Women’s Unit Update Appendix 2: Emerging Themes from Inspection Paper

2

Paper 6.4 Appendix 2

Emerging Themes and Priorities for Improvement : Healthcare elements within HMCIP Inspection 2013- 2014

1. Introduction

This is the second annual report on the emerging themes and priorities for improvement identified in the HMCIP inspection of Scottish Prison. The report this year is based on the inspections that were conducted by HMCIP over the period April 2013 – March 2014. The criteria used to appraise and inspect prisons is contained within a document entitled Standards Used in the Inspection of Prisons in Scotland and was developed in 2006. The existing standards are based upon sources such as Human Rights Treaties, Prison Rules and the European Convention for the Prevention of Torture. These are being reviewed by HMCIP with the aim to introduce new standards by 2015. The paper will be helpful to a number of agencies including, NHS Boards, Healthcare Improvement Scotland, the National Prisoner Healthcare Network, the SPS and other key stakeholders including the third sector. Information has again been included within this report on the inspection process, the role of the inspectorate and how this is supported by the NHS. The methodology used to determine the emerging themes is described in supporting information attached in appendix 1 to the paper showing the recommendations made in respect of healthcare in each of the inspections conducted in the year 2013 - 2014. It is hoped that the analysis of the emerging themes will be useful information that can inform the overarching driving improvement agenda for prisoner healthcare of the National Prisoner Healthcare Network and local NHS Boards.

2. Background Information

Her Majesty's Chief Inspector of Prisons for Scotland (HMCIP) is required to inspect the prison establishments throughout Scotland in order to examine the treatment of, and the conditions for, prisoners.

The Chief Inspector produces an Annual Report which is presented to the Scottish Ministers and laid before Parliament. David Strang, was appointed as the Chief Inspector in the course of 2013 with the inspections for 2013-2014 and the annual report for the year being his first. In his report he refers to the consultation process that is currently being conducted into the new standards.

In addition to changes within the Inspectorate the National Prisoner Healthcare Network has also changed in the last year and is no longer hosted by Healthcare Improvement Scotland although HIS do continue to provide healthcare input into the inspection process which is defined in a Memorandum of Understanding (MOU) between Healthcare Improvement Scotland and HMCIP. The purpose in HIS having this role is to provide public assurance about the quality and safety of healthcare. The Network is now chaired by Andreana Adamson, the NHS Director, Health and Justice and is constructed as an Advisory Board supported by a number of standing operating groups and associated workstreams.

1


3. Methodology

The following describes the methodology applied by HMCIP in their inspection of establishments and then the methodology applied to construct this report reflecting common and emerging themes in respect of healthcare drawn from the Inspectorate reports.

a. HMCIP Inspection process

The inspection process involves a rolling programme of visits to prison establishments, either to undertake full inspections or follow up visits under its remit to examine the treatment of and conditions for prisoners.

According to the 2013 - 2014 annual report and guidance from the Chief Inspector to the Network Advisory Board the Standards for Inspecting Prisons in Scotland (2006) have been re-written and are now going through an extensive consultation with the aim of being introduced in 2015. These Standards are the baseline against which all inspections and prison monitoring takes place.

In addition the underlying principles, that all inspections are managed under, are described in the HMIP Guidance for Conduct document that sets out the principles and processes for the inspection of prison establishments. The guidance also outlines the responsibilities of the Scottish Executive and the Scottish Prison Service in facilitating the inspection process and in responding to reports produced by HMCIP.

b. Emerging themes paper

The reports and recommendations made by HMCIP from each of the three full and two follow up inspections conducted in the year 1 April 2013 - 31 March 2014 were analysed and emerging themes were drawn from the reports. The detail of all of the recommendations is provided in Appendix 1 attached. The prisons inspected in the time period above were;

· HMP Inverness

· HMP Low Moss

· HMYOI Polmont (follow up)

· HMP Edinburgh

· HMP Barlinnie (follow up)

Appendix 1 includes detail of the dates of the visit by HMCIP, the name and type of prison and its function, whether the inspection was full or a follow up and a full list of the recommendations made by the Inspectorate in respect of healthcare matters. In addition, the standards against which each recommendation has been made is included to provide the reader with context and ensure that all matters identified can be easily assimilated and understood. The recommendations were then assessed to determine emerging themes and priorities for driving improvement and these are shared in this paper to support joint learning.

2


4. Emerging Themes

The emerging themes that were identified fell into three main categories;

1. Healthcare Records,

2. Staffing and in particular mental health staffing, and

3. Facilities for those with disabilities

1. Healthcare Records The table that has been appended to this paper shows a number of references in each of the establishments to medical and health records. Going forward it has been intimated that the terminology healthcare records is adopted as standard. Reference is made to the need for greater confidentiality in the management of healthcare records both within establishments and when the prisoner is transferred to another. 2. Staffing, particularly mental health staffing The reports highlights the need for a full complement of staff and makes particular reference in more than one establishment to the need to have mental health staff in place. The reports also mention that suitable health resources are required to ensure appropriate interventions can be supported. 3. Facilities for those with disabilities The need for adequate resources to accommodate disabled prisoners was identified in more than one establishment. These recommendations included the need for there to be sufficient cells able to cater for the needs of disabled prisoners and that they are clean and suitable for wheelchair access. Showering facilities for disabled prisoners was also raised as a matter of concern. Good practice The Inspectorate reports highlight areas of good practice as well as making recommendations for improvement. Appendix 2 to this paper shows each of the identified good practice comments from the inspections and follow up visits. It is notable that NHS Lothian and HMP Edinburgh have been highly proactive in their approach to healthcare and that they received several commendations from the Inspectorate in their report. Lessons from NHS Lothian could be shared with other Health Boards to enable them to make a similar contribution to developing excellence in prisoner healthcare. Conclusion From the inspection reports that have been published in the year 2013 - 2014, and the commentary provided in respect of healthcare, arrangements appear to be working well with a number of good practice areas recognised.

3


In his statement in the 2013-2014 annual report the Chief Inspector of Prisons for Scotland David Strang made the following observations in respect of healthcare in prisons;

The vast majority of those currently detained in prison will return to the community in which they lived before they were imprisoned. For some, this will be in a short time; for others it may be in several years' time. Many will be described in terms of the challenges and problems they have faced - broken relationships, substance misuse and addictions, mental health problems, unemployment, lack of educational achievement, offending background and harm they have caused to others. There are some good examples of throughcare which supports the transition from the prison to the community. The issue of an ageing prison population is a growing one. This provides particular challenges where prisoners have increasing levels of disability and dementia, and are needing higher levels of medical interventions and high health and social care needs.

The National Prisoner Healthcare Network is committed to supporting Boards in their pursuit of the delivery of high quality care equivalent to that of the wider population of Scotland. The Network will continue to produce annual reports that show common themes and to work with NHS Boards through its various workstreams to develop plans. The Network has a number of workstreams and standing operating that will aim to support NHS Boards to consider the common themes that have arisen through the inspection of the establishments visited this year by the Inspectorate. The outcomes from the inspectorate visits are extremely beneficial to NHS Boards and to the Network in its aim to support the aims of the Justice and Health Ministries to reduce offending and eliminate health inequalities. It is also important for health and the SPS to have a mutual understanding of the function of the inspection process. There is a need for joint working to ensure services are delivered effectively and to assist future improvement to be implemented. The inspection process with the assistance of health is an important means of facilitating this necessary joint working. John Porter

Nursing Advisor for the National Prisoner Healthcare Network

16 December 2014

4


Suggested Reading HMCIP : Standards Used in the Inspection of Prisons in Scotland http://www.scotland.gov.uk/Resource/Doc/254430/0100121.pdf HMIP Guidance for Conduct http://www.scotland.gov.uk/Resource/Doc/254432/0100123.pdf HMCIP Annual Report 2013 -2014 http://www.scotland.gov.uk/Publications/2014/06/9777/0 Strategy for Justice in Scotland www.scotland.gov.uk/Publications/2012/09/5924/0

Scottish Prison Service Organisational Review http://www.sps.gov.uk/MediaCentre/Organisational_Review_Published.aspx

5

http://www.scotland.gov.uk/Resource/Doc/254430/0100121.pdf

http://www.scotland.gov.uk/Resource/Doc/254432/0100123.pdf

http://www.scotland.gov.uk/Publications/2014/06/9777/0

http://www.scotland.gov.uk/Publications/2012/09/5924/0

http://www.sps.gov.uk/MediaCentre/Organisational_Review_Published.aspx


Appendix 1

HMP Establishment

Nature of Prison Date and Type of

Inspection

NHS Board Emerging Health Themes from Inspection

No Recommendation Context HMP Inverness

HMP Inverness serves courts in the Highlands, Islands and Moray – a large and diverse catchment area embracing rural and urban communities. The emphasis on safe and secure custody has not changed in over one hundred years, even if the approach has markedly evolved. Inverness prison is currently the smallest penal establishment in Scotland, but it has an expansive history which constantly unfolds to a new and challenging future.

10-18 Feb 14 Full

NHS highland 48 NHS Highland and HMP Inverness should ensure that all prisoners have confidential access to medical personnel

This recommendation is covered under Standard 32 - Health services of a high quality are available to all who need them. 32.3 Some of the blank referral forms seen during the inspection were printed in a size six font which makes them very difficult to read and accurately complete. This may impede prisoners' access to appropriate healthcare. In addition to the self-referral process described above, where concern is noted, health referrals can be made orally by others, most commonly Officers, Chaplains and prisoners' families.

32.4 Medical services are provided from within a group of six Doctors from a local medical practice. They are scheduled to deliver medical services between 08:00 and 18:00 Monday to Friday. Clinics are facilitated every weekday between 09:00 and 11:00 with additional attendance every Saturday morning to provide medical assessments for those prisoners admitted on the previous evening.

32.5 Provision of out-of-hours medical cover

1


both throughout the night and on Sundays is delivered by an on-call Doctors' service managed by Raigmore Hospital (Professional line access). Emergency medical services are accessed through a '999' request.

32.6 Waiting time for a routine, non-emergency Doctor's appointment is on average one week.

32.7 The small complement of Nurses results in delays in prisoners being able to access nursing services. The level of service available is further reduced in the event of any medical crisis. This also impedes delivery of other daily planned activities such as dispensing medication. On such occasions, healthcare provision and the general day-to-day prison regime are adversely affected.

32.8 Furthermore, as a result of the absence of any Healthcare or Pharmacy Assistants, Nurses are required to carry out administrative functions including checking and organising 'in-possession' medication prior to dispensing. This detracts from their clinical activity and is a contributory factor in delays in providing prisoner care and treatment.

32.9 Some prisoners may also experience delays in accessing Mental Health Services

2


due to the limited provision available. There is only one whole-time equivalent (WTE) Mental Health Nurse on the nursing complement and as the service is person-specific there is no cover for time off, annual leave, sickness or any other absence. The Mental Health Service is supported by a Consultant Psychiatrist who conducts a weekly clinic and, in the event of urgent referrals, can be contacted for advice.

32.10 Addictions Nurse duties are supported by the Mental Health Nurse. This places additional pressures on delivering a wide range of therapies and often results in the delivery of assessment and crisis management interventions at the cost of prevention and maintenance interventions and health promoting activities.

49 NHS Highland should

undertake a review of the workforce and skill mix, using national workforce tools, in order to ensure they have the capacity to deliver the relevant care to meet the needs of the prisoner population

32.11 For prisoners transferring in to HMP Inverness from other prisons, their health records usually, but not always, accompany them. For those admitted directly from Court, their health information is verified through contact with Doctors' services and other care providers as soon as is practicable. A formal request for healthcare records is made to the prisoner's community Doctor for all those sentenced to over six

3


months imprisonment.

32.12 The electronic health records system 'VISION' is in place within HMP Inverness. This allows healthcare staff to access the health information of those prisoners who have an already established electronic record in the community. A VISION terminal is situated at a secure desk unit in the interview room in Reception, however due to the cramped nature of the room, nursing staff, in order to access the terminal, need to turn their back on the prisoner to read or enter any data. As a result the terminal is seldom used during admission interviews and medical information is therefore not always accessed at the point of assessment.

. 50 NHS Highland should

ensure that the VISION terminal in reception is accessible to nursing staff and situated in such a way as to user safety of the user.

32.13 There is access to the Primary Care based Emergency Care Summary on admission, however healthcare staff report that this information is often out-of-date and has limited use.

32.14 There are good processes in place in relation to communicating health-related information at the point of the prisoner's release. On liberation, prisoners are provided with a health-related discharge letter and information is also sent directly to the prisoner's community healthcare provider. Where appropriate,

4


community-based providers visit the prisoner to establish contact prior to release. This pre-release contact can also be accommodated through the use of video conferencing, for example with a Community Practice Nurse or Community Addictions Worker.

32.15 Often, those health records that accompany a prisoner on transfer into HMP Inverness are found to be sent in a brown envelope instead of the approved sealed transfer bag. This presents a risk to the level of confidentiality afforded to the prisoners' medical data.

51 The NHS should ensure

that all medical notes are securely transferred,

32.16 All parts of the Health Centre are cleaned by prisoners and while healthcare staff report that these prisoners are never left unsupervised, it is possible for them to read health-related information from documents that are left unattended and within view including for example, Kardex, prescription sheets, etc.

52 NHS Highland should ensure confidential information is appropriately managed

32.17 There are no records of unacceptable or unnecessary delay in transferring mentally ill prisoners to more appropriate settings. For those prisoners being transferred to the local facility at New Craigs, arrangements are made easier as the prison's Consultant Psychiatrist also practices at the hospital. This has resulted in greater consistency of approach and improved communications and decision making. 32.18 Clinics dealing with Sexual Health and Blood Borne Virus (BBV) are provided once

5


per week. Ophthalmology and Podiatry services are available on an as required basis with an on-site provision taking place approximately once every three weeks and priority given to those prisoners with diabetes. 32.19 Dental clinics operate twice weekly with a maximum waiting time for routine appointments currently sitting at approximately two weeks. There is no dental hygienist service available.

32.20 Chronic disease management is provided from a combination of on-site healthcare staff and specialist services at the local general hospital.

32.21 There is a specially adapted cell in F Wing which can hold two prisoners with physical disabilities, which is fit for purpose. This room is accessible by a wheelchair, is large enough for two prisoners to move around in and live comfortably and has a fully accessible integral wet room. However the area requires a degree of cleaning and repair, for example the shower curtain is stained and frayed and the wet room flooring would benefit from deep cleaning or replacement. Whenever possible prisoners with a physical disability will be held in this cell.

32.22 In addition A and B Hall and E Wing

6


each have a cell that would be used to house a prisoner with physical disabilities if required, however these cells are not fit for purpose. The doors on the cells in A and B Hall have been widened to allow wheelchair access, however there have been no modifications to the toilet. The toilet in the cell in E Wing has been adapted to allow wheelchair access, however a wheelchair user would have difficulty entering or moving around the cell.

32.23 The communal showering facilities in A and B Hall and E Wing are not adapted for wheelchair use.

32.24 When a female prisoner is temporally lodged in HMP Inverness to attend Court, she will be located in the adapted cell in F Wing. Should a male prisoner be located in this cell he will be temporarily relocated to one of the other designated disabled cells in A or B Hall or E Wing.

53 NHS Highland should ensure there is adequately and appropriately adapted cells in place to accommodate prisoners with a disability

33.1 Prisoners can self-refer or be referred to Addiction Services. There is one whole time equivalent Addictions Nurse with a second, vacant Addictions Nurse post being advertised at the time of inspection. There is additional addictions support from an Addiction Support worker, formerly Phoenix Futures, and the attending Doctor service

7


for prescribing support.

33.2 Harm Reduction sessions are facilitated once per week by The Harm Reduction Service, part of the wider NHS Substance Misuse Service. There is evidence of health promotion activities in relation to substance misuse taking place within the prison. 33.3 Prisoners identified as having an addictions problem but who are refusing to take up the offer of active treatment are reviewed by the addictions worker every two to four weeks and more frequently when approaching their release date.

33.4 Interventions are closely linked to those available in the community. These include one-to-one interventions and counselling, group work and structured programmes. The Addictions Team are involved in the induction process promoting involvement with BBV, harm reduction and overdose management. Many of the interventions take place in the Links Centre in small interview rooms with open ceilings which is not conducive to maintaining confidentiality.

HMYOI Polmont

Polmont is Scotland's national holding facility for Young Offenders aged between 16 - 21 years of age. Sentences range

42-28 Mar 14 Follow up

NHS Forth Valley

The healthcare recommendations made in the visit in October 2012 had been implemented

8


from 6 months to Life. The average sentence length is between 2 - 4 years.

HMP Barlinnie Barlinnie Prison is situated on the outskirts of Glasgow but still close to the busiest courts in Scotland and close to population centres and public transport routes that allow ease of access for family visits. Barlinnie is Scotland's largest, most complex penal establishment and holds all categories of prisoners. However, its main purpose is to hold remand and short term prisoners sent by the West of Scotland courts. We also hold a significant number of long term prisoners who have just been sentenced, are awaiting transfer to another establishment or are here for a specific management reason. Barlinnie also has a

8-12 July 2013 Follow Up

NHS Greater Glasgow and Clyde

2.41 Consideration should be given to increasing the size of the Mental Health Team

The complement of mental health nurses has not increased since the time of the full inspection. Mental health services in HMP Barlinnie primarily provide an assessment function leaving them with limited capacity to conduct any substantial therapeutic interventions. The facilities provided for conducting mental health related interviews are non-therapeutic and confidentiality may be compromised. The Mental Health Team (MHT) receive on average 20-30 new referrals each week with a rolling caseload of approximately 80 prisoners at any one time. The service is supported by a Psychiatrist offering four two-hourly sessions per week.

9


facility that holds protection prisoners and sex offenders who are separate from the main population. The segregation unit is available for both local prisoners and national prisoners from other establishments for a variety of management reasons.

13 NHS Greater Glasgow and Clyde should ensure that the mental health team in place in HMP Barlinnie has the necessary resources to deliver the level of mental health interventions identified.

Healthcare staff and operational staff when spoken with did not share the same understanding of the location, content and purpose of care plans for those prisoners with poor mental health.

HMP Edinburgh

HMP Edinburgh is a large community facing establishment receiving prisoners predominantly from courts in Edinburgh and the Lothians and Borders, but including prisoners from the Kirkcaldy courts and Fife area.

Adult male prisoners of all categories (remand

9-18 September 2013

NHS Lothian 63 NHS Lothian should conduct a further review of health care provision taking specific cognisance of mental health and addictions requirements as a matter of urgency.

Standard 32 Health services of a high quality are available to all who need them. 32.17 Meeting the healthcare needs of HMP Edinburgh's population is challenging and efforts are being made to recruit new staff as well as build a reliable and consistent body of staff through an established nursing bank. Given the requirements for bank staff to have completed mandatory training such as Personal Protection Training and the time frame for this to take place, it is a welcomed

10


and convicted) from these areas are held and as a result the establishment has close links with the Lothian and Borders Community Justice Authority.

HMP Edinburgh also holds specific national populations including women, sex offenders and non-offence protection prisoners.

Edinburgh is the first prison to introduce Prison Watch Scotland. This initiative was launched on 22 February 2011. Prison Watch is a scheme similar to Neighbourhood Watch, but deals with the area around HMP Edinburgh. Created in Partnership with the Scottish Prison Service, Lothian & Borders Police and City of Edinburgh Council. The most important person

approach to have bank staff trained and accessible at short notice.

11


involved is members of the public - those who live and work locally or visit the prison regularly and want to play a part in maintaining the area.

64 NHS Lothian should

ensure that all health records are stored in accordance with national and local policy guidelines.

32.28 Medical records are held within the Health Centre. There is a suitable secure unit for safe and confidential storage of records situated within the clinical office, however this is not large enough to store the volume of records held in HMP Edinburgh. As a result, a great number of health records are being stored on the floors and on desks within secured offices in the wider health centre. These records are not "live" and require to be archived in an appropriate, secure storage facility as a matter of urgency.

65 NHS Lothian should ensure that a record of transfers to more appropriate settings is maintained

32.30 We are advised that no statistical record of numbers of prisoners transferred to more appropriate settings for the purpose of mental health needs is kept by health care staff detailing time scales; referral from assessment to transfer, length of stay and total numbers of transfers. It would also be useful to use this approach to identify trends of both efficient practice and causes of delay in order to inform on-going improvements.

12


66 HMP Edinburgh should

review the provision of cells designed for wheelchair access and suitable for those with physical disabilities

32.44 There are five cells in HMP Edinburgh designed for wheelchair access and suitable for those with physical disabilities, however at the time of the inspection, there were nine prisoners who required the use of a wheelchair.

67 HMP Edinburgh should ensure that disabled cells are clean and properly maintained

The disabled cell in Glenesk House is very basic and the standard of cleanliness is poor.

68 HMP Edinburgh should review the provision of showers suitable for disabled prisoners

In Ingliston and Hermiston Houses, access to showers for disabled prisoners not located in a disabled cell is poor with a large step leading into the shower area and with only one hand rail on the wall.

69 NHS Lothian, NHS Forth Valley and SPS should review the process for dispensing Methadone to prisoners temporarily transferring between HMP Edinburgh and HMP & YOI Cornton Vale

Standard 33 Addictions are dealt with the way most likely to be effective and when they conflict, treatment takes priority over security measures as far as possible. Women prisoners who are required to attend a Northern Court may be temporarily transferred from HMP Edinburgh to HMP & YOI Cornton Vale on the day prior to their Court appearance. For those prisoners who are prescribed Methadone, this process can prove problematic due to the differing dispensing regimes in place in each prison. In essence, the prisoner going to Court from HMP & YOI Cornton Vale will not be given her Methadone in the morning before leaving the prison but will have to wait until she returns before it is dispensed to her. However, should she be returned from

13


Court direct to HMP Edinburgh, she cannot be issued with her Methadone as her prescription and medical notes will still be held inHMP & YOI Cornton Vale. When this situation occurs, Healthcare staff in HMP Edinburgh are required to waste valuable time pursuing prescription details from equally busy healthcare staff in HMP & YOI Cornton Vale causing further delay to dispensing of the prisoner's prescribed Methadone.

HMP Low Moss

HMP Low Moss, opened in March 2012, is one of the newer parts of the prison estate.

The establishment replaced the dated prison accommodation that had previously occupied most of the site and had started out as a barrage balloon station at the beginning of the Second World War.

HM Prison Low Moss provides 700 cells as well as facilities to help prisoners address their re-offending and re-integrate back into the community on their

13 -21 May 2013 Full

NHS Greater Glasgow and Clyde

37 NHS Greater Glasgow and Clyde should ensure that they have a full complement of staff within HMP Low Moss.

STANDARD 32 Health services of a high quality are available to all who need them. 32.9 The full complement of healthcare staff is not in place. Seven clinical positions were vacant at the time of inspection. These include Primary Care and Mental Health nursing positions and Nursing Assistants.

14


release from prison. It holds adult male convicted and remand prisoners primarily from the North Strathclyde Community Justice Authority area.

The facilities include a link centre where prisoners are able to deal with matters relating to employment, housing, social work, throughcare addiction service, etc.

38 NHS Greater Glasgow and Clyde should ensure that prisoners' relevant health care information is transferred to the appropriate health care provider on his release

32.14 As healthcare records are held both electronically and in paper-based format, ensuring that all relevant information is transferred to the appropriate healthcare provider on release can prove time-consuming. This also creates unnecessary risks should information be missed or reported out of context.

39 The NHS should ensure that all medical notes are securely transferred

32.17 During the inspection medical records received from outwith the establishment were seen to have been delivered, wrapped in a brown envelope and partially opened.

15


40 HM Low Moss should increase the number of non-clinical drugs tests carried out

Standard 33 33.7 There is a process in place for compulsory drug testing, however the number of prisoners tested in HMP Low Moss is low in comparison to other establishments. From staff spoken with it appears that this is in some way due to the protracted nature of the process (up to five hours), during which time the two Residential Officers who are administering the test cannot perform their core duties.

16


17


Appendix 2

Good Practice Identified by the inspection visits in 2013 - 14 The following is a list of good practice identified in healthcare in the HMCIP inspections in the 2013-14 period. NHS Lothian - HMP Edinburgh Good Practice 7: There is a Clinical Lead identified for the Doctors who attend HMP Edinburgh. (Paragraph 32.4) Good Practice 8: There is a supportive and positive attitude from senior healthcare managers in NHS Lothian. This includes a willingness to review services on an on-going basis. (Paragraph 32.9) Good Practice 9: It is noted that the Health Care Manager has instructed clinical staff to record cancellation of clinics via the Datix system (NHS incident and adverse event reporting system) for the purpose of audit and risk assessment. (Paragraph 32.14) Good Practice 10: With the support of NHS Lothian, the Healthcare Manager has reviewed referral pathways which have improved the process. These have been mapped and improvement methodology is being applied to improve the efficiency of referral management and support needs analysis. Additional mapping has been conducted regarding reception, the admission process and condition- specific pathways. (Paragraph 32.18) Good Practice 11: NHS Lothian have introduced a prison nursing course to support the development of nurses, specifically focusing on enhanced assessment skills of minor injuries and illness. (Paragraph 32.19) Good Practice 12: In order to ensure newly admitted prisoners have legitimate access to medications they are currently prescribed, a facsimile prescription providing information given by the prisoner, medications brought into the establishment by the prisoner and any other available health-related documentation, is sent to the prisoner's registered Doctor in the community. The community Doctor then verifies the accuracy of the proposed prescription, signs it and returns it to prison healthcare staff. This is then passed to the Prison Doctor which informs the decision to prescribe locally. A Kardex is then generated and medications are administered accordingly. Although this is a lengthy process, in the absence of access to real time health records, this is an area of good practice. (Paragraph 32.24) Good Practice 13: Although complaints regarding dental services are minimal, the Healthcare Manager has engaged with the Dental Director in NHS Lothian to ensure the efficient handling of complaints and to pursue continuous improvements. (Paragraph 32.34) Good Practice 14: There is evidence of health promotion activity and preventative interventions such as general health screening. There is a concerted effort in providing female specific health support such as well woman activities and cancer screening activity. (Paragraph 32.40) Good Practice 15: There is a weekly Blood Borne Virus (BBV) clinic delivered by a BBV Nurse Specialist and supported by a BBV Consultant. Improvement to this service during the previous year has resulted in waiting times being halved. BBV testing now takes place within four weeks from referral and a vaccination programme is in place. Responsibility for the maintenance of vaccinations is now the responsibility of House block nurses. (Paragraph 32.41)

1

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Good Practice 16: It is acknowledged that the Prison Healthcare Team have conducted a Long-Term Conditions (LTC) Management Pathway Event in March 2013. The purpose was to scope needs, conduct a service gap analysis and inform progression planning. (Paragraph 32.43) Good Practice 17: A Naloxone 'Take Home' training programme was introduced last year and there are currently eight prisoners awaiting training. Seventy-four prisoners have been trained since October 2012. This has been a success, as have new arrangements for overcoming testing difficulties, re-instating the addiction clinic, promoting attendance at conversation cafes and information days provided for families and prisoners. (Paragraph 33.4) Good Practice 18: Prisoners who engage with addiction services are encouraged to attend a Harm Reduction Group prior to release to support sustained recovery on liberation. Community-based services are also invited into the prison before the prisoners' liberation dates in order to improve engagement with community support systems. (Paragraph 33.7)

NHS Highland - HMP Inverness Good Practice 7: Prisoners have access to healthcare provision through a self-referral process. Referral forms are issued on request by Hall staff. Once completed, referrals are deposited in a locked post box which can then only be accessed by healthcare staff. Referrals are collected several times throughout the day allowing healthcare staff to prioritise need through appropriate triage arrangements. Good Practice 8: There are good processes in place in relation to communicating health- related information at the point of the prisoner's release. On liberation, prisoners are provided with a health- related discharge letter and information is also sent directly to the prisoner's community healthcare provider. Where appropriate, community- based providers visit the prisoner to establish contact prior to release. This pre-release contact can also be accommodated through the use of video conferencing, for example with a Community Practice Nurse or Community Addictions Worker. Good Practice 9: There are no records of unacceptable or unnecessary delay in transferring mentally ill prisoners to more appropriate settings. For those prisoners being transferred to the local facility at New Craigs, arrangements are made easier as the prison's Consultant Psychiatrist also practices at the hospital. This has resulted in greater consistency of approach and improved communications and decision making. Good Practice 10: In addition to NHS addiction services, there is a wide range of further throughcare services and systems in place to provide the continuation of addiction support from prison into the community. These include organisations and programmes such as Apex, TAS, SMART Recovery and Turning Point who deliver referrals, pre-release information and intervention options and who take part in multi- agency discussions as part of case conference arrangements. Staff from support organisations regularly attend the prison in person or make contact through video conferencing facilities to establish a contact with prisoners prior to release.

NHS Forth Valley - YOI Polmont (Follow up visit) Referrals to mental health services are responded to quickly. (Paragraph 1.16)

2




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Mental health services are able to respond quickly to referrals. The majority of young offenders will be seen on the day of referral or the day after. The team can respond to any crisis referrals quickly. There is access to on-call psychiatrists who will see young offenders on the day of referral if required. A well-established referral process for healthcare is in place. (Paragraph 32.3) The established referral process remains in place. Young offenders continue to be able to access initial healthcare appointments quickly.

NHS Greater Glasgow and Clyde - HMP Barlinnie ( follow up visit)

The 'Keepwell and Wellman Clinic' (paragraph 8.14). The nurse-led 'Keepwell and Wellman' clinic continues to offer health promotion advice and activities to prisoners and is valued.

NHS Greater Glasgow and Clyde - HMP Low Moss

Although the report identifies area of good practice none were highlighted in the healthcare area

3

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6.5 NHS LOTHIAN East Lothian Community Health Partnership Sub Committee 5 March 2015 Clinical Director

CLINICAL DIRECTOR’S REPORT 1 Purpose of the Report 1.1 The purpose of this report is to update the East Lothian Community Health

Partnership Sub Committee on medical issues within East Lothian

Any member wishing additional information should contact the author of the report in advance of the meeting.

2 Recommendations The East Lothian Community Health Partnership Sub Committee is recommended to note the contents of the report. 3 Discussion of Key Issues 3.1 GP Practices and GP Forum Meetings

3.1.1 TRANENT practice continues to provide medical cover for 20 Intermediate Care

beds within Crookston Care Home, and this arrangement is helping people transition from hospital to home in larger numbers than originally anticipated.

3.1.2 ESKBRIDGE practice Musselburgh continues in being lead GP support of six of the seven care homes in the Musselburgh area. The practice is being supported in this financially, and with the assistance of a support pharmacist and the Care Home Liaison Nurse, Val Reid

3.1.3 The GP Workforce crisis pressures continue to be of major concern. We have met with GP Practice representatives to take forward ideas which will support hard pressed practices.

3.2 Joint Mental Health Planning Group 3.2.1 The crisis response subgroup has asked for further time to examine this issue, and

is now expected to report to the meeting on 18 March.

3.3 Hospitals and Secondary Care

3.3.1. We continue to be most concerned about our shortage of doctors in Care of the

Elderly Medicine. We continue to discuss all options for future management models with the Clinical Director for Medicine of the Elderly at the Royal Infirmary. Dr Andy

Jamieson is leaving us at the end of March for a post in Inverness. Our associate specialist in Medicine of the Elderly is on long term sick leave and is sadly unlikely to return to work. We continue to require the services of a locum, currently Dr Robert Shepherd.

3.3.2 Recent interviews for the vacant posts held jointly with the Royal Infirmary led to the appointment of three new consultants, one of whom will be part time. All expressed a preference for work based at the Royal rather than Roodlands, but two were willing to have sessions at Roodlands in their job plan. The levels of senior medical cover that Roodlands has had are now very difficult to sustain. Some provision being planned to be sessional outreach from the Royal.

3.3.3 The long awaited ELSIE Hospital at Home service has started operating, and after three weeks successful operation, has started taking direct referrals from one GP Practice in Prestonpans. The service will open to other practices gradually. The day hospital services have been reconfigured to allow patients to be assessed in their home, attending the hospital by appointment for further assessment and investigation according to need. Ward 1c activity is being run down as a prelude to upgrading work which has been postponed in the past.

3.3.4 Dr Barney Coyle has been appointed as a full time Consultant in General Adult Psychiatry, replacing the retiring Dr Bill Riddle, who has been successful in applying for a new part time post. Our consultant complement will thus rise from 3 to 3.5 wte, allowing us to implement improvements in the medical support of the nurse led Intensive Home Treatment Team, and increased consultant presence on Hermitage Ward, Royal Edinburgh Hospital.

4 Risk Register 4.1 The risk on medical staffing at Roodlands is contained within NHS Lothian’s

corporate risk on medical staffing and has been discussed at the NHS Lothian Risk Management Group.

5 Impact on Inequality, Including Health Inequalities

There is no immediate impact.

6 Involving People 6.1 Not applicable. 7 Resource Implications

Not applicable Dr Jon Turvill Clinical Director 23 February 2015 [email protected] List of Appendices

2

6.6 East Lothian Community Health Partnership Sub-Committee – 5th March 2015 Financial Position – 10 Months to 31st January 2015 David Small, Joint Director 1. Purpose of the paper. The paper summarises the financial position for month 10, 2014 for the CHP. It also notes the on-going work towards the 2015/16 financial plan. 2. Recommendations

• To note the reported financial position at 31st January 2015. • To note the update to the financial plan • To support management actions to bring the CHP back into financial balance in

2015/16

3. Discussion of key issues 3.1 The overall financial position at Month 10, 2014 is as follows :-

Annual Budget

YTD Budget

YTD Actual Variance

£000's £000's £000's

£000’s Core 18,682 15,750 16,312 (562) Hosted 29,706 14,410 14,424 (14) Unachieved LRP -269 -207 (207) GMS 12,497 10,842 10,775 67 Prescribing 17,188 14,374 14,937 (563) Resource Transfer 3,163 3,163 3,163 0 80,967 58,332 59,611 (1,279)

3.2 Summary The CHP is overspent by c. £1.3m at the end of month 10, of which c. £563,000 lies within the Prescribing budget. Although – having excluded prescribing – this is roughly the same as the position in month 9, this position is significantly worse that that projected at both the mid-year and quarter three reviews. Its now highly unlikely that the CHP will achieve its projected financial out-turn. 3.2.1 Prescribing The prescribing position has two elements :- 3.2.1.1 A price pressure – the prescribing position is simply volumes (that is number of

scripts) times price (the average cost of a script). Although the number of scripts is in line with the forecast (and the budget), the average price has been higher that forecast all through the financial year and has not reduced in line with earlier, in year, forecasts.

3.2.1.2 Unmet LRP – the pan-Lothian LRP target for Prescribing is c. £4.3m, currently it is estimated that c. £800,000 of this target will not be achieved in year.

The Prescribing position reported above reflects these two pressures as they affect the budgetary position of the CHP. Work is underway to identify additional LRP schemes but it is not expected that these will have any further impact on the current year’s position. 3.2.2 LRP – 2014/15 It can be send from the table above, that of the CHP’s 2014/15 LRP target of £1.4m, £269,000 remains to be achieved. The MYR recovery plan identified a considerable amount of slippage to support the LRP position in year but it has not proved possible to release the slippage as planned. Accordingly the LRP target will not be achieved in year. It should be noted that of the LRP actioned in 2014/15, c. £340,000 has been achieved non-recurrently. Plan are being finalised to address the recurrent shortfall in the 14/15 LRP position along with further plans to address the 2015/16 LRP target. 3.2.3 Operational Pressures There are three key operational financial pressures :-

• Roodlands Hospital – within the hospital there is a significant financial pressures from the use of a locum Consultant to support the Geriatric services.

• Prison Service – further to the reorganisation of the Prison Service since this provision was moved into the NHS, some staff are in the process of being moved from this budget to other budgets. This has created additional staffing pressures with a concomitant cost.

• Ward Staffing – the impact of delayed discharge across the system means that all wards are now working at maximum capacity all of the time and this is generating financial pressures within the nurse staffing budgets.

3.2.4 2015/16 Financial Plan. NHS Lothian is now close to completing its financial plan which reflects the Scottish Government’s recent announcements of additional resources for the Health Service. This plan is broken down into each ‘business unit’, the CHP being considered a business unit for planning purposes. At the time of writing the 15/16 draft financial plan is not yet in balance although work is underway to finalise this. A range of difficult decisions has been worked through by the management teams and the Board and this is reflected in the final position. The plan will set an LRP target for the CHP of £1,048,000 and the CHP will also have to support its share of the overall 15/16 LRP target for Prescribing of £3,840,000. Any unmet recurrent LRP from 2014/15 will be added to these 15/16 targets. The CHP has already prepared plans to manage its LRP target (excluding prescribing) but the LRP plans for prescribing are not yet finalised. The outline 2015/16 LRP plans are attached to this paper. 4. Key Risks The risks are laid out above but the overall risk is that of the failure of the Management Team to achieve its financial target in 2014/15. This will be continuously monitored during the remainder of financial year. 5. Risk register These risks are captured within the overall financial risks examined in the risk register held by both the CHP. 6. Impact on inequality including Health inequality This paper is a discursive financial analysis which should not impact on inequality. 7. Involving People This paper is a discursive financial analysis which should not impact on involving people. 8. Resource Implications The resource Implications are laid out above. David King February 2014.

Local Reinvestment Plans – Outline 2015/16 (excludes prescribing) LRP Review 2015/16 Targets for 15/16 Est b/fwd from 2014/15 -41 2015/16 Target -1,043 CHP Target 2015/16 -1,084 2015/16 Schemes £000's Review of non-qualified graded staffing within wards 0 Independent Prescribing 0 District Nursing 50 Consolidation of wards within Belhaven Hospital 194 Advanced Nurse Practice 50 Hospital at Weekend, Roodlands Hospital, Haddington 20 Consolidation of Physiotherapy Clinics Day Hospital Redesign, Roodlands Hospital, Haddington In 14/15 Redesign of Consultant Rotas 20 Review of Occupational Therapy (including ELC) 35 Prisons Review 280 PCCO 200 Review of EL Mgt Team In 14/15 Public Health 40 LUCS 200 Community Equipment Store Complex Care Review of SLAs (general) Administration 9 Estates - Esk Centre, Musselburgh 125 1,223 (Under)/Over Recovery 139

6.7 LOTHIAN NHS BOARD East Lothian Community Health Partnership Sub-Committee 5th March 2015 Director of Health and Social Care

DELAYED DISCHARGES IN EAST LOTHIAN 1 Purpose of the Report 1.1 The purpose of this report is to update the sub committee on progress with

tackling delayed discharges.

Any member wishing additional information should contact the Executive Lead in advance of the meeting.

2 Recommendations

The Sub-Committee is invited to: 2.1 Note the update on the joint work underway in East Lothian Health and Social Care

Partnership to reduce delayed discharges. 2.2 Note the information on trends in activity and demand.

3 Summary of the Issues 3.1 A long term summary of the information for all Lothian Local Authorities is shown in

the tables below.

2014/15 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15Overall Total 136 173 185 177 210 178 195 164 196 160Edinburgh 97 133 139 133 147 114 151 108 141 101East Lothian 25 19 30 25 30 43 30 37 31 36Midlothian 7 13 11 13 18 10 3 8 8 6West Lothian 5 4 4 5 9 8 9 9 12 15Non-Lothian 2 4 1 1 6 3 2 2 4 2

2013/14 April 2013 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14Overall Total 107 121 109 129 112 133 155 131 155 164 142 156Edinburgh 62 85 71 91 87 102 130 97 113 119 108 118East Lothian 30 28 29 30 21 22 15 24 22 19 16 17Midlothian 12 4 6 7 4 6 5 7 7 12 10 14West Lothian 2 3 1 1 0 2 2 1 9 12 5 4Non-Lothian 1 1 2 0 0 1 3 2 4 2 3 3 3.2 The February 2015 number for East Lothian was 29. 3.3 An analysis of the reasons for delay is attached at Appendix 1. It shows some

changes in the reasons for delay. Over the last few months the biggest reason has been access to care homes, however this has now shifted to patients waiting for or

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completing assessment or waiting for packages of care. This is because access to care homes has recently improved.

3.4 The total numbers waiting in this analysis are larger than those above because this

analysis is based on live data and the monthly figures are validated data. 3.5 The partnership has established a delayed discharge “task group” which will meet

weekly. Its remit is to reduce the total number of delays and achieve the 4 week and 2 week targets.

3.6 The Scottish Government recently announced £100m additional funding for

delayed discharges across Scotland for over three years. East Lothian will receive £1.76m of this (around £0.6m per annum). Work is underway to set priorities for the use of this money.

4 Key Risks 4.1 There are no new risks raised by the issues in this paper that are not addressed

elsewhere. 5 Risk Register 5.1 There are no implications for the risk register from the issues in this paper.

6 Impact on Health Inequalities 6.1 There are no immediate implications for health inequalities of any of the issues

covered. 7 Impact on Inequalities 7.1 There are no immediate implications for inequalities of any of the issues covered.

8 Involving People 8.1 Each issue covered will have an involvement plan where appropriate.

9 Resource Implications 9.1 There may be resource implications from the issues raised in this paper.

David Small Director 26th February 2015 List of Appendices The following Appendices are attached: Appendix 1 – reasons for delay

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REASONS

0

10

20

30

40

50

60

70

80

90

28/11/20

14

05/12/20

14

12/12/20

14

19/12/20

14

26/12/20

14

02/01/20

15

09/01/20

15

16/01/20

15

23/01/20

15

30/01/20

15

06/02/20

15

13/02/20

15

20/02/20

15

DATE

NO

11A - Awaiting commencement of post-hospital social care assessment11B - Awaiting completion of post hospitalsocial care assessment24A - Awaiting place in Local AuthorityResidential Home24C - Awaiting place in Nursing Home(not NHS funded)25D - Awaiting completion of social carearrangements -in order to live in own home25DOT - Health OT assessed POC under14hours25E - Living in own home - awaitingprocurement/delivery of equipment25F - Specialist Housing Provision(including homeless patients)Other

New

TOTAL

Total

Packages Care Homes

Assessment

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6.7 ACTIONS CURRENTLY UNDERWAY

DATE TYPE OF SERVICE

IMPACT LEAD PROGRESS UPDATE

COST SOURCE OF FUNDING

10 step down beds at Crookston

06/10/14 BEDS 10 places for people currently delayed in hospital (but requires capacity in home care and care homes to avoid getting clogged)

AM On schedule See below

See below

10 step down beds at Crookston

13/10/14 BEDS 10 places for people currently delayed in hospital (but requires capacity in home care and care homes to avoid getting clogged)

AM On Schedule Combined £1m per annum

Change Fund and NHS Lothian

Consider increase rate of admission to Tyneholme Stables

ongoing BEDS Reduce numbers waiting in hospital for nursing home places. Additional support from Care Home Liaison and ANP’s on stand-by.

DH Under consideration. Contractual and care inspectorate issues to be clarified.

? In recurrent budgets already

Double Hospital to Home Service

13/10/14 POC Additional 8 to 10 packages of care

AM Approved and recruitment underway – start date tbc

£120k per annum

NHS Lothian from Cabinet Secretary’s £5m

Social Enterprise to Provide Care Packages

Tbc (depends on

POC Additional packages (minimum of 20) DH Final meeting with CI held on 29/09/14. Due Diligence underway.

£200k per annum

Change Fund

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registration) Additional Team for Emergency Care Service

27/10/14 POC/ADMISSION AVOIDANCE

Support ELSIE to avoid hospital admission

DH Recruitment complete, awaiting pre-employment checks and PVGs. Aim to start on 27/10

£100k per annum

Change Fund

ELSIE Mid October ADMISSION AVOIDANCE

Reduce hospital admissions

AM Advanced Nurse Practitioners in place, part time GP recruited. Consultant recruited, but start date awaited.

400k per annum

NHS Lothian

IMMEDIATE FURTHER ACTIONS BEING CONSIDERED

Double Hospital To Home Service again

tbc POC Additional 20 packages AM Currently being costed £200k per annum ?

tbc

Recruit to in house Dom Care Servcice

November (after independent sector recruitment fair in October and after new rotas in place)

POC Tbc DH Planning under way for this.

Posts already funded

Recurrent budgets

FURTHER ACTIONS BEING CONSIDERED

Review the whole systems model

System processes

Whole system is more streamlined and efficient. Community resources

DS/DH/AM

Scope of review being drafted

TBC TBC

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using external facilitation; use of LEAN methodology

are working efficiently; impact of local capacity pressures is more manageable

Additional residential care capacity

Tbc BEDS Xx places for people currently waiting in hospital and in Crookston step down beds for long term care.

DS Being costed C£500k per annum.

tbc

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