DUMFRIES AND GALLOWAY NHS BOARD

Transcription

EMBARGOED UNTIL 10 am Monday 6 February, 2012
Agenda and notice for meeting on Monday 6 February 2012 at
10 am
VENUE:
Duncan Rooms, Easterbrook Hall, The Crichton
Jeff Ace
Chief Executive
AGENDA
234
Apologies for absence
235
Declarations of Interest
This item gives members the opportunity to declare an interest in any of the
items appearing on today’s agenda.
236
Minute of the Meeting held on 5 December 2011
The Board is asked to approve the minute of the meeting held on 5
December 2011.
Page 5
237
Matters Arising
INVOLVING PEOPLE, IMPROVING QUALITY, REDUCING INEQUALITIES
238
Improving Safety, Reducing Harm
This
paper provides an overview of the goals and progress with our safety
and improvement programme within community and cottage hospitals,
including Clinical Quality Indicators, Active Patient Care and Patient Safety.
Page 16
239
Patient Experience Report
The paper gives the Board an overview of work currently underway in
Dumfries and Galloway to support the delivery of excellent spiritual care to
our patients. Detail is also provided on compliments received by the Board,
feedback from Releasing Time to Care and complaint response data.
240
Prevention and Control of Infection
Page 25
The Board is asked to consider the healthcare associated infection report.
Page 42
241
Sustaining the Vision – Making a Difference:
Dumfries and Galloway
Allied Health Professionals in
This paper presents to Board the current strategic drivers, service
developments and future priorities for the Allied Health Professionals in NHS
Dumfries and Galloway.
Page 59
242
Workforce Plan 2011 - 2013
This paper presents the 2011 – 2013 Workforce Plan for approval following
an eight week period of consultation.
Page 66
243
Employability
This paper provides an overview of a number of NHS interventions and
services that contribute to supporting people to stay in employment or take
steps towards being work ready.
Page 84
ITEMS OF GOVERNANCE
244
Minute of Scrutiny Committee held on 2 November 2011
The minute of the Scrutiny Committee held on 2 November 2011 is presented
to Board.
Page 91
245
Draft Minute of Staff Governance Committee held on 15 December 2011
The draft minute of the Staff Governance Committee held on 15 December
2011 is presented to Board.
Page 98
246
Draft Note of Spiritual Care Committee held on 22 December 2011
The draft note of the Spiritual Care Committee held on 22 December 2011 is
presented to Board.
Page 105
247
Minute of the Area Clinical Forum held on 16 November 2011
The minute of the Area Clinical Forum held on 16 November 2011 is
presented to Board.
Page 110
248
Minute of the Community Health and Social Care Partnership Board held on
30 September 2011
The minute of the Community Health and Social Care Partnership Board held
on 30 September 2011 is presented to Board.
Page 114
ITEMS OF STRATEGY
249
Draft Dumfries and Galloway Single Outcome Agreement 2012 - 2015
This paper presents to Board the Draft Single Outcome Agreement for 2012 /
2015. The Single Outcome Agreement sets out the vision and principles for
partnership working in Dumfries and Galloway and defines the priorities and
ambitions that partners seek to achieve.
Page 118
250
Scotland’s National Dementia Strategy
This paper provides Board with an overview of Scotland’s Dementia Strategy
and the associated activity being taken forward across NHS Dumfries and
Galloway.
Page 181
ITEMS OF PERFORMANCE / DELIVERY
251
Financial Performance: 9 Months to 31 December 2011
This report summarises the Board’s expenditure for the nine months to 31
December 2011.
Page 187
252
2011 / 2012 Capital Plan
This paper presents to Board an updated Capital Plan to 31 December 2011.
Page 203
253
Performance Report
This report provides information on the level of clinical activity and access
times achieved within services to 31 December 2011. It also highlights data
on efficiency of clinical services as measured against current Health,
Efficiency, Access and Treatment (HEAT) targets.
Page 209
ITEMS FOR APPROVAL / DISCUSSION
254
NHS Lothian Outline Business Case for Royal Hospital for Sick Children and
Department of Clinical Neurosciences: Request for NHS Dumfries and
Galloway Agreement in Principle
This paper presents to Board the NHS Lothian Outline Business Case for the
Royal Hospital for Sick Children and the Department of Clinical
Neurosciences at Little France, Edinburgh.
Page 218
255
Register of Members’ Interests
The updated Register of Members’ Interests is presented to Board for
confirmation of accuracy and note.
Page 226
256
Board Briefing
This paper provides Members with a briefing on a range of health and
partnership related issues.
Page 235
257
Any Other Competent Business
Members should notify the Corporate Business Manager of any items of
business not on the agenda that they wish to raise prior to the
commencement of Board Business at 10 am.
258
Date of Next Meeting
The next formal meeting of the NHS Board will be held on Monday 5 March
2012.
ITEMS FOR NOTING
259
Dumfries and Galloway Alcohol and Drugs Strategy 2011-2014
The Dumfries and Galloway Alcohol and Drugs Strategy 2011-14 has been
developed as required by Scottish Government and sets out key local and
national priorities against which annual progress reports on outcomes can be
prepared.
Page 257
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Agenda Item 236
Minute of the meeting of Dumfries and Galloway NHS Board held on 5
December 2011.
Minute Nos: 207 - 229
Present
Mr M Keggans
Mr J Burns
Mr J Beattie
Mrs H Borland
Dr A Cameron
Mr A Campbell
Dr D Cox
Mrs H Dykes
Mrs L Garbutt
Mr A Hannay
Professor D Hannay
Mr I Hyslop
Mr A Johnston
Mrs A Kelly
Mr C Marriott
Dr J Moore
Mr A Walls
Mr G Willacy
Chairman
Chief Executive
Employee Director
Nurse Director
Medical Director
Non Executive Member
Director of Public Health
Chair of Area Clinical Forum
Director of Finance
Apologies
Mr R Allan
Mrs P Halliday
Mr T Sloan
Attending
Mr J Ace
Mr J Glover
Mr P McCulloch
Mr K Paul
Mrs J Proctor
Ms C Sharp
Ms E Stewart
Mrs J Wilson
Chief Operating Officer
Head of Communications
Capital Services Manager (for Item 222)
Lead Mental Health Nurse (for item 217)
Director of Planning
Workforce Director
Researcher
Board Administrator
NOT PROTECTIVELY MARKED
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Chairman’s Opening Remarks
The Chairman welcomed everyone to the December Board meeting and also
welcomed Ellen Stewart who was in attendance to observe the meeting as part of
the evaluation of the elected Board.
Members had the opportunity to visit Midpark Hospital on 9 November and those
who were able to attend enjoyed a tour of a fantastic facility which will provide a
much improved physical environment for patients and staff.
The Chairman attended the Scottish Health Awards Dinner in Edinburgh on 10
November; this event was well supported by all Boards across Scotland and was
attended by the Cabinet Secretary.
The Chairman had been out and about in the East of the region during November
and met with a range of colleagues in Lochmaben, Langholm, Canonbie, Moffat,
Ecclefechan, Annan and Gretna.
There were useful discussions with general
practitioners around ‘Putting You First’ and other developments.
The Chairman chaired a consultant interview panel on 29 November and an offer of
appointment has been made to two ENT consultants; subject to the usual preemployment checks the consultants will join NHS Dumfries and Galloway early in the
New Year.
Finally, on 1 December the Chairman accompanied the Nurse Director on a
Releasing Time to Care visit at Dumfries and Galloway Royal Infirmary and
commented that this had been a useful experience.
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207 Apologies
Apologies as noted above.
208 Declarations of Interest
There were no declarations of interest.
209 Minute of the Meeting held on 7 November 2011
The minute of the meeting held on 7 November 2011 was approved as an
accurate record.
210 Matters Arising
There were no matters arising.
211 Improving Safety, Reducing Harm
The Nurse Director presented the monthly report which focused on progress in
achieving the Scottish Patient Safety Programme, mainly in Dumfries and
Galloway Royal Infirmary (DGRI).
There had been good progress to
achieving the high level goals of the programme including a reduction in the
Hospital Standardised Mortality Ratio (HSMR) by over 15% and good progress
in general wards, surgical care and critical care.
The mental health
programme has been delayed nationally.
Members commented on the positive report with targets being met and
exceeded, commending staff for achieving that improvement.
In response to comments Members were advised:• every ward in DGRI is undertaking some element of medicines
reconciliation against one source with a move to doing that against two
sources; and
• the HSMR figures updated last week show a further decrease
demonstrating a reduction of over 20% since reporting started.
The Nurse Director confirmed that colleagues would consider how this good
news story may be shared with staff and the general public.
The Board
• following discussion, noted the report.
212 Patient Experience Report
The Nurse Director presented the regular report which focused on the ‘Better
Together’ inpatient survey and cottage hospitals. The report also included
feedback on Releasing Time to Care and the improving picture with regard to
responding to complainants and their families.
8
In responding to comments from Members the Nurse Director advised:• information regarding the source of complaints would be reinstated in
future papers;
• work would be done to understand why patients did not feel confident to
look after themselves when discharged home; and
• a meeting is scheduled with Senior Charge Nurses this week to discuss
progress in identification of who is in charge of a ward at any given time.
The Board
213 Prevention and Control of Infection
The Nurse Director presented the regular report which covered progress
against targets and activity around Clostridium difficile infection (CDI),
staphylococcus aureus bacteraemias (SABs), hygiene and cleanliness.
In responding to comments Members were advised:• there was confidence that the Board would achieve the very challenging
HEAT target and reassurance that there was a huge amount of activity
across hospitals and primary care;
• one of the most potent antibiotics in terms of producing CDI is a group
called cephalosporins and these are now substituted with antibiotics that
are less likely to cause CDI, although there was still a risk;
• it was important to prescribe antibiotics when it was appropriate and
necessary to do so;
• Health Protection Scotland visited to discuss further actions in terms of
CDI and after a high degree of scrutiny there were no particular areas
not already being addressed; and
• work is ongoing across the four localities at a local and practice level in
terms of one drug highlighted.
The Board
214 Pharmacy Control of Entry Arrangements:
The NHS (Pharmaceutical
Services) (Scotland) Amendment Regulations 2011
The Medical Director presented this item for endorsement and which
addressed changes in national regulations in the provision of pharmaceutical
services outside hospital. The Board has an obligation to ensure adequate
pharmacy access for patients in Dumfries and Galloway and is urged to ensure
the market is stable for the companies and individuals investing in pharmacies.
The Medical Director confirmed that a Non Executive Member of the Board
chaired the Pharmacy Practices Committee.
The Board
• following discussion, endorsed and adopted the amended regulations.
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215 Minute of the Area Clinical Forum held on 19 October 2011
Mrs Dykes presented the minute of the Area Clinical Forum held on 19
October 2011.
The Director of Planning advised Members that Putting You First (PYF)
roadshows were currently being held offering staff and partner agencies an
opportunity to learn about the programme and these will continue in to the new
year. The website is now open and continues to be developed and the first
newsletter has been published.
In responding to a concern raised the Director of Planning advised Members
that PYF is a standing item on the GP Sub-Committee and members attend to
debate and discuss how best to involve general practitioners (GPs). Two GP
leads are on the Programme Board and are very involved in discussion around
the Change Fund and the direction of travel. GP colleagues are also invited to
attend roadshows and other events.
Mrs Dykes also advised that GPs are involved in many aspects of
communication, not just in PYF, and highlighted the importance of appropriate
membership on committees.
The Chief Executive recognised the fundamental point on communication.
PYF is now at a point where the level of communication can be increased.
Clinical leaders from the GP community have very good input and there is also
good attendance from primary and community care clinical leads.
It is
important to recognise and continue to enforce the responsibility of individuals
who sit on committees to share information; there is also a responsibility on
individuals to look at the communications published.
The Board
• noted the draft note of the Spiritual Care Committee held on 27 October
2011.
216 Draft Note of the Spiritual Care Committee held on 27 October 2011
The Nurse Director presented the draft note of the Spiritual Care Committee
and highlighted the Carol Service being held on 20 December.
The Board
• noted the draft note of the Spiritual Care Committee held on 27 October
2011.
217 Delivering Improvement in Mental Health Nursing
The Nurse Director presented this item and advised Members this was the
second professional paper being brought to Board, the first having been
maternity services. The detail in the paper sets the strategic context, the
policy, the drivers and the significant amount of activity locally to improve
practice and ensure patients in mental health services receive the best levels
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of care and treatment.
The Chief Executive commended the paper in terms of the assurance it gives
to Board on the work in mental health and mental health nursing. The recent
visit to Midpark Hospital provided the opportunity to question in terms of
redesign and improvement work embraced and taken forward. The Board has
heard in recent months of the Releasing Time to Care work and of the very
real determination amongst the nursing teams to embrace improvement in the
way services are delivered.
This is a comprehensive paper that
demonstrates that range of activity.
In response to comments Members were advised:
• suicide prevention was no longer a HEAT (health improvement,
efficiency, access, treatment) target but a standard and 50% of frontline
staff are required to be trained in suicide prevention; and
• the wealth of services is provided across the region, including within the
prison.
The Chief Operating Officer advised Members that mental health services are
formally assessed by Scottish Government twice a year when a wide range of
performance indicators are used. The mid-year review was held two weeks
ago and the formal response will be taken to Scrutiny Committee.
The Board
• following discussion, noted the paper.
218 Financial Performance: 7 Months to 31 October 2011
The Director of Finance presented the month 7 report and took Members
through the highlights including key variances, risks and pressures, and
additional expenditure approvals, commenting that this remained a positive
position.
The Chief Executive advised that Members should not underestimate how
much work is going in to deliver this financial position. There has been a lot of
service change and service improvement with some difficult changes and staff
are working incredibly hard to maintain that good position. Efficiency savings
are not easy and as the Board moves in to next year that will become harder
as we try to maintain the range and quality of services. The positive position
is down to a lot of very hard work.
In response to comment Members were advised:• Scrutiny Committee will consider a paper on externals and any
opportunity for repatriation. The Board has Service Level Agreements
(SLAs) with tertiary Boards to provide services not provided in Dumfries
and Galloway. These are set up in terms of cost and volume and there
is flexibility to change a patient pathway;
• there is a differentiation between elective cases of simple case mix and
simple complexity and more specialist procedures that are only
undertaken elsewhere. In terms of the more specialist procedures any
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•
•
•
requests for out of area treatment are considered by the Medical
Director, Director of Public Health and others. The Golden Jubilee
National Hospital provides significant capacity for a planned flow of
patients;
prescribing is a zero based budget and the Board has a good history in
forecasting spend;
work is ongoing in terms of carry forward against the Change Fund;
and
some MRI investigations are undertaken elsewhere due to their
specialised nature and a small number of patients who are
claustrophobic and unable to enter a closed magnet travel to an open
magnet.
The Board
• following discussion, noted the financial performance report; and
• approved the additional £1,112k accelerated IM&T (information
management and technology) investment.
219 2011 / 12 Capital Plan Mid Year Review
The Director of Finance presented the paper. Against month 6 spend there
was a £9m expenditure with plans in place to spend just over £10.25m against
the acute mental health project, Lochfield Road development and the estates
investment prioritisation schemes previously approved.
Schemes are
monitored on a monthly basis and any slippage identified early. In terms of
phasing winter and bad soil conditions are taken into account.
Special
dispensation was given to some Boards last year due to the severe weather
conditions and the team would look at our own projects if that proves to be the
case this winter.
The Board
• following discussion, noted the capital plan mid-year review.
220 Performance Report
The Chief Operating Officer presented the monthly performance report and
advised that in terms of activity there was a cumulative increase of 4-5% which
is anticipated will continue for the remainder of the year. The last two years
have seen record levels of activity and this links to the financial performance
and should be viewed in a context of doing more work. The redesign work in
Accident and Emergency (A&E) is now having an impact and is very
encouraging. In terms of activity achievement of the 18 week RTT (referral to
treatment) target is where expected and cancer targets are very satisfactory
being significantly above 95%. There has been some disruption to elective
work due to the day of action and a small number of inpatient cases, day cases
and new outpatient activity, particularly orthopaedics where imaging could not
be guaranteed, have been deferred. This may cause some challenges with
targets in January. The paper included data on theatre cancellations and
theatre utilisation, an important aspect in terms of theatre efficiency.
12
In response to Members’ comments the Chief Operating Officer advised:• the detailed information on sleepers would be taken to Scrutiny
Committee and a summary would be brought to Board;
• work in Bedfordshire in relation to DNAs (did not attend) will be
reviewed, however local rate is very low;
• patients who DNA repeatedly effectively suspend themselves from
targets;
• breaches will continue to be reported to Board although this is no longer
a HEAT target;
• redesign work in audiology is producing results and will be sustainable;
• return ratio is a key efficiency target as CRES savings become more
challenging and will be part of the next job planning; and
• overbooking of clinics has not been considered as it is not personcentred.
The Board
• following discussion, noted the performance report.
221 Acute Services Redevelopment Project – Formal Consultation
The Chief Operating Officer presented this paper which set out the
engagement process through December and the formal consultation from
January to March. The process of engagement to date has raised some
interesting points in terms of people’s understanding of how good the facility is,
how popular it is with the public and an understanding of the next generation of
healthcare. The team will move to public consultation pending Board approval
and a letter of comfort on engagement from the Scottish Health Council (SHC).
In response to Members’ comments the Chief Operating Officer advised:• service provision would be part of the Outline Business Case (OBC)
being prepared;
• services on two sites does have some implications;
• there would be no bed services provided at the Cresswell Unit which
would be operating as an ambulatory care centre during office hours;
and
• it remains the position that headquarters will remain on the Crichton
site.
As the Board’s lead for PFPI (patient focus, public involvement) the Nurse
Director commended the approach set out.
The Board
• following discussion, noted the engagement process to date including
the results of the Option Appraisal event and what is planned for the
remainder of December;
• agreed that, on receipt of the letter of comfort from the Scottish Health
Council, following this engagement process, that formal consultation
begins; and
• agreed the period of formal consultation from 5 January 2012 to 31
March 2012, consulting on five possible sites.
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222 Estate Investment Business Case Crichton Hall, Dumfries
The Chief Operating Officer presented this paper which set out the request for
additional capital for the Crichton Hall business case. In previous discussion
when this investment was approved Members raised the potential use of grant
funding, charitable funds etc.
An approach has been made to Historic
Scotland, the Heritage Lottery, the Big Lottery Fund and Solway Heritage and
unfortunately this has drawn a blank. The terms of reference excluded the
Board and there are no funds available with each of those sources already
under pressure. The paper sets out very clearly why costs have increased
above tender and there is a consistency in the tender submissions, all showing
a significantly increased cost particularly around temporary roof structure and
scaffolding. The paper sets out two options; hold the figure but have a less
than complete job which leaves many of the main risks or increase the figure to
address the complete job.
The Chief Operating Officer recommended to
Board that the higher tender cost be accepted.
In response to comment the Chief Operating Officer advised that there was no
opportunity to avoid this significant work in terms of a future scenario with a
new build off-site.
Mr McCulloch, Capital Services Manager, advised Members of the process in
terms of the pre-tender estimate and the tender costs received for the
individual components of the work. This is the last part of the Crichton roof to
be replaced on an 1880 build. If the work is not undertaken an associated risk
is that dry or wet rot gets in to the building and there will be substantial
problems with the fabric of the building. Four firms were invited to tender.
The Director of Finance advised there was an opportunity in terms of nonrecurring resources available and commented that he supported this project.
The Chief Executive commented that the Estates Team could not have gone to
tender without Board approval in the first instance. The Board is now being
asked to approve the final tender price.
In compliance with the Board’s
governance arrangements the value of this scheme required Board approval to
tender and having done that the final tender price is presented.
The Capital Services Manager confirmed that steps have been taken to reduce
the risk of slippage. The work is lead and slate work and temperature does
not have a significant impact on that; it is not wet work as such.
The Chief Executive advised that in terms of delivering this project to the value
of the tender without any further slippage of cost the tenders had been
scrutinised to the finest of detail and the team now has to work with the
contractor to bring it in on price. There is nothing to suggest that additional
costs will come to bear because of the work done in the pre-tender phase.
However, there is never an absolute guarantee but the Chief Executive
confirmed that in the conversations he had had he was confident from the work
done that this project would not slip.
If additional elements of work or
additional risks were identified they would require to be worked through. The
additional work in the pre-tender stage looks to mitigate those risks.
14
The Capital Services Manager highlighted the two major risks; defective
timber work when the roof coverings are lifted, a contingency has been allowed
for that, and the timeframe. The Capital Services Manager confirmed that he
would not ask Board for approval if he was not comfortable that this project
could be delivered.
The Board
• following discussion, approved Option 2 - the increased capital spend to
include all works necessary to repair the Criffel Wing roof.
223 Board Briefing
The Chief Executive presented the briefing for Board Members’ information.
The Board
• noted the Briefing.
224 Any Other Competent Business
There was no other competent business.
225 Date of Next Meeting
The next formal meeting of the NHS Board will be held on Monday 6 February
2012.
Members were reminded that there was a meeting on 9 January where other
matters would be taken forward.
226 Minute of the Older People’s Consultant Group held on 23 August 2011
The Board
• noted the minute of the Older People’s Consultant Group held on 23
August 2011.
227 Minute of the Older People’s Consultant Group held on 14 October 2011
The Board
• noted the minute of the Older People’s Consultant Group held on 14
October 2011.
228 Minute of the Older People’s Consultant Group Annual General Meeting held
on 2 November 2011
The Board
• noted the minute of the Older People’s Consultant Group Annual
General Meeting held on 2 November 2011.
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229 Older People’s Consultative Group Annual Report 2010 / 2011
The Board
• noted the Older People’s Consultative Group Annual Report 2010 /
2011.
230 Chief Executive
The Chairman commented that this was the Chief Executive’s last public Board
meeting and formally thanked him for his work over the last eleven years. The
Chairman also expressed his personal thanks to the Chief Executive for his
support over the last eight years and, in particular, during his period as
Chairman.
The Chairman thanked the Chief Executive for all he had done for the Board,
for his energy and leadership and wished him well for the future.
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Agenda Item 238
DUMFRIES and GALLOWAY NHS BOARD
6 February 2012
INVOLVING PEOPLE, IMPROVING QUALITY
Improving Safety, Reducing Harm
Author:
Maureen Stevenson, Patient Safety and
Improvement Manager
Sponsoring Director:
Hazel Borland, Nurse Director
Date: 23 January 2012
RECOMMENDATION
The Board is asked to:


note that there have been no ‘Never Events’ reported since the previous report
in June 2011;
consider the progress with our patient safety and improvement programme in
Galloway Community Hospital (GCH) and cottage hospitals.
SUMMARY
The Scottish Patient Safety Programme (SPSP) to date has focused on
improvements in acute care. NHS Dumfries and Galloway chose to extend its
patient safety and improvement programme to include community and cottage
hospitals during 2008/2009.
This paper provides an overview of the goals and progress with our safety and
improvement programme within community and cottage hospitals. This includes
Clinical Quality Indicators, Active Patient Care and Patient Safety.
Patient safety is a standing item on the Healthcare Governance Committee agenda.
Key Messages

All our community and cottage hospitals are actively engaged in improving the
quality and safety of patient care.

A spread plan has been agreed for Active Patient Care in all community/cottage
hospitals.

There have been no ‘Never Events’ since previously reported to Board in June
2011 and this will continue to be monitored and reported to Healthcare
Governance Committee.
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GLOSSARY OF TERMS
APC
CQI
DGRI
GCH
HAI
LBC
MEWS
MRSA
PCCD
POD
PVC
QI
RTC
SBAR
SPSP
SSKIN
Active Patient Care
Clinical Quality Indicators
Dumfries and Galloway Royal Infirmary
Galloway Community Hospital
Healthcare Associated Infection
Leading Better Care
Modified Early Warning Score
Methicllin Resistant Staphylococcus Aureus
Primary and Community Care Directorate
Patients Own Drugs
Peripheral Venous Catheter
Quality Improvement
Releasing Time to Care
Situation, Background, Assessment, Recommendation
Scottish Patient Safety Programme
Surface, Skin, Keep moving, Incontinence, Nutrition
1.
Introduction
In 2008 NHS Dumfries and Galloway extended its acute safety programme to
community/cottage hospitals. No national programme currently exists for this sector
but a number of Boards have now spread relevant interventions to
community/cottage hospitals.
Goals for our patient safety programme within the Galloway Community Hospital
(GCH) and the cottage hospitals closely mirror those of acute care:




Improve healthcare safety by reducing:
- Non Palliative Care Mortality by 15%
- Adverse Events by 30%
- Healthcare Associated Infection by 50%
Improve patient experience
Create a culture and leadership system attuned to improvement
To develop improvement capability
The Community/Cottage Hospital Driver Diagram (attached as Appendix 1) outlines
the goals, improvement interventions and changes designed to support delivery of
these goals. The areas within Galloway Community Hospital delivering acute care,
such as Accident and Emergency, Theatres and Garrick ward have implemented the
DGRI (Acute Hospital) Patient Safety Programme.
It is worth noting that whilst improvement goals were defined for community/cottage
hospitals, there was no overarching measurement framework. Progress until
recently has been monitored within each hospital by local management teams. A
community/cottage hospital reporting tool has now been developed and recently
implemented which will enable central review and reporting of data.
2.
Progress with the Patient Safety Programme
Core interventions implemented across all hospitals include:
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18




Prevention of Infection – hand hygiene compliance in all hospitals is excellent
with compliance reliable at 95-100%;
Modified Early Warning Score (MEWS) – an adapted MEWS is in use and
supports the early identification and escalation of patients who deteriorate;
SBAR (Situation Background Assessment Recommendation) is a
communication tool designed to enable clinical teams to pass over critical
information swiftly and succinctly. This is being used in all our hospitals at
handover on transfer and to summon help when a patient deteriorates; and
Safety Briefings – are used daily to brief staff on any issues that may affect the
safety of staff or patients, which could include patients at risk, building or
maintenance work, workload issues or infection prevention measures.
The reporting tool which is now available for all cottage hospitals will provide
compliance data for all of the above interventions in future reports.
Other improvement interventions include:

Medication
An active programme of implementing the use of patient’s own drugs has been
underway across the five hospitals in the East of the region, with 85% of all
registered staff now trained. Staff have all undergone theoretical training in the use
of a patient’s own drugs and are implementing the protocols with each admission
allowing drugs brought in from home to be used. This has the benefit of cutting
down on waste and of improving the staff knowledge of the drugs in use.
Castle Douglas Hospital is moving to use the Patient’s Own Drugs (POD) system,
which means all registered nurses will undergo theoretical refresher training on
medication administration, as well as being introduced to the protocols for ensuring
patients own drugs are safe to be used in hospital - leading to introduction of
Medicines Reconciliation. Kirkcudbright Hospital will commence this within the next
12 months.

Thomas Hope Hospital – Patient Care Needs at a Glance
‘Symbol’ boards have been introduced into every patient bedroom area which have
clear symbols showing a range of needs e.g. two staff to assist with walking,
assistance to eat meals, requires a walking stick. These in effect are personalised
Quality Boards individualised to that patient, although they maintain confidentiality.
For example, the use of a ‘forget me not flower’ symbol would indicate a patient with
dementia. Staff can see at a glance what additional needs/support that patient has.

Newton Stewart Hospital – Reducing risk of wandering patients
Newton Stewart Hospital is located upon a fast stretch of the A75. There is an
increase in the number of patients with either dementia or cognitive impairment
being admitted. A number of these patients presented a clear risk of wandering out
of the building towards the main road. Despite attempts of staff to reduce this risk,
ie electronic systems including door alarms, none had a significant impact. A
temporary fence was erected which has eradicated wandering out into the car park
and beyond. It has now been replaced with a drystone dyke allowing safe access
to the patients’ garden.
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3.
Active Patient Care (APC)
Amid national concerns around fundamental elements of patient care, such as
nutrition and hygiene, NHS Dumfries and Galloway has tested a new approach to
ensure high standards of care, which we have called ‘Active Patient Care’ (driver
diagram attached as Appendix 2)
Active Patient Care is a structured process based on the assessment of patient need
which delivers key interventions to every patient at individually prescribed time
intervals. It can reduce adverse incidents such as falls, patients wandering and
pressure ulcers; nurses are with their patients more administering a package of
anticipatory care which helps orientate them and help them to feel safe and confident
in the care they receive.
A spread plan has been agreed for all cottage hospitals and acute wards with full
implementation by August 2012.
3.1
Successes within our test sites
Testing began in Newton Stewart Hospital in February 2011.

There have been no preventable acquired Grade 1 pressure ulcers at Newton
Stewart Hospital for over one year. This is being replicated in Dalrymple
Ward at the Galloway Community Hospital which was the second test site.

There has been a reduction in falls in both sites since the introduction of APC.

There has been a reduction in both areas of the number of times patients are
having to use alert systems (buzzers) to request care, demonstrating that care
is organised, planned and implemented timeously on an individual patient
basis.

There has been a reduction in paperwork through utilising the APC record
sheet.
3.2
Next steps
A team is working on spreading APC across all in-patient areas of NHS Dumfries
and Galloway. From November 2011 to May 2012 all ward areas will participate in
learning events to test and implement APC in their ward. All inpatient areas will
have implemented the process by August 2012.
4.
Clinical Quality Indicators (CQIs)
CQIs are evidence based, nurse sensitive indicators that support measurement of
the quality, safety and reliability of care. CQIs are a tool to enable understanding,
measurement, monitoring and improvement in quality of care in the clinical setting.
There are currently three national CQIs being implemented across NHSScotland:

Falls

Food, Fluid and Nutrition

Pressure Area Care
CQIs are now embedded across acute hospitals settings and the East and West
Primary and Community Care Directorates (PCCDs) with all staff actively involved in
the scoring of patients against these for pressure care, falls and food, fluid and
nutrition. Whilst the majority of hospitals score 95% or more, there are pockets
where further work is required to fully embed the CQIs.
4
20
5.
Releasing Time to Care (RTC)
The majority of cottage hospitals started their work on RTC in March 2011, with
Castle Douglas Hospital acting as a pilot in the first instance starting this work in July
2010. The hospitals have completed the foundation modules which are:

Knowing How We Are Doing – enables staff to track the ward’s performance
and the impact of change over time;

Well Organised Ward – simplifies the workplace and ensures that everything is
in the right place at the time it is needed, prepared correctly and ready to use;
and

Patient Status at a Glance – seeks to make information on patients clear and
available to those who need it. It is a visible plan of the patient’s journey which
can reduce interruptions to ward staff.
They have now moved to implement process measures which include:

Meals;

Medicine;

Patient Observations;

Shift Handovers;

Admissions and Discharges;

Patient Hygiene;

Ward Rounds; and

Nursing Procedures.
This has rolled out to all hospitals with quality improvement boards displayed in a
prominent place where patients, staff and visitors have access. Staff are actively
utilising and maintaining these boards, capturing the data at the end of each month
in order to evidence trends.
6.
Visible leadership
For cottage hospitals in the East an active programme of visible leadership has been
underway in each hospital over the last year, its main objective being to ensure that
the Senior Charge Nurse (SCN) is visible and available to patients and relatives
when required. This has included ensuring that all patients and next of kin are
contacted on admission and that an ongoing dialogue is put in place to update next
of kin on their relative’s condition. This has proved invaluable in ensuring issues
which may previously have ended up as a complaint are addressed at the time and a
regular face to face, or in some cases telephone, dialogue takes place.
Although there is no such dedicated 'programme' for cottage hospitals in the West
relating to visible leadership, there is an agreement with SCNs that being visible and
accessible is an absolute must do. The SCN work on this has been taken quite
literally, they make themselves visible by way of giving direct patient care and also
walk around the inpatient areas to speak to patients and relatives as much as
possible. APC described in section 3 enables patients, relatives and carers to
access and agree care delivery, supporting improved communication with patients
and families.
5
21
7.
Learning from Incident Management
All significant incidents are discussed at the local senior charge nurse meetings and
learning is shared across the other hospitals. An example is described below:
Following a patient fall which resulted in a fracture, a comprehensive review of the
system of care was undertaken. Improvements made include:






all patients at risk of falls are highlighted in the SBAR handover;
staff safety briefs held on each shift, highlighting to each staff member any
patient who requires special observation;
staff desk installed in main day room and a nurse allocated to observe those
patients therein;
telecare equipment in use e.g. chair/bed alarms etc;
dementia training undertaken by one registered nurse in Annan Hospital and
cascaded to auxiliaries. Plans to roll out this to other hospitals in the East of
the region are underway; and
these measures have proven so successful in reducing falls in one hospital
that they have been rolled out to the other hospitals in that PCCD. Falls
across PCCD East have shown a reduction in December 2011.
8.
Conclusion
Improving Safety Reducing Harm strategies are being deployed across our
community and cottage hospitals. We have taken good practice from our work in
acute care and spread where applicable to our community/cottage hospitals and vice
versa. With the introduction of Active Patient Care and falls reduction work, good
practice in our small hospitals is spreading and being tested in Dumfries and
Galloway Royal Infirmary.
Early work to develop improvement capability within our workforce is now paying
dividends with a very committed group of staff actively engaged in improving patient
care within our community/cottage hospitals.
The outcomes of this work can now be monitored through the measurement systems
we have put in place; reductions in infection, falls and pressure ulcers have been
demonstrated.
6
22
MONITORING FORM
Policy / Strategy Implications
Delivering SGHD SPSP.
Staffing Implications
Encouraging staff across NHS Dumfries and
Galloway to take forward learning from adverse
events
Financial Implications
None at this time.
Consultation
No consultation required at this time as this is a
nationally agreed programme.
Consultation with Professional Patient safety discussed at Area Clinical Forum
Committees
Risk Assessment
Patient safety and risk management are connected
activities. Improving patient safety reduces the risk
to patients, staff and the organisation.
Best Value
Vision and Leadership:
 Commitment and leadership
 Sound governance at strategic and
operational level
Sustainability
 A contribution to sustainable development
Sustainability
Embedding continuous improvement enables us to
ensure sustainability and reliability of processes
and outcomes for patients
Compliance with Corporate Corporate Objective 2
Objectives
Single Outcome Agreement Improving patient safety within acute services
(SOA)
impacts on keeping our population safe.
Impact Assessment
No Equality Impact Assessment required as this is a programme that impacts on all
patients receiving care and treatment.
7
23
Community Hospital Driver Diagram and Change Package
Improve healthcare
safety by reducing:
Leadership (GMs)
System for Safety
1. Non Palliative Care
Mortality by 15%
2. Adverse events by
30%
Care of Inpatients
3. Reduce hospital
associated infection by
50%
Improve patient
experience
Medicines
Management
Create a culture of
improvement
** Existing national
priorities, programmes,
strategies
Infection
Prevention**
Appendix 1
Develop Sustainable Infrastructure with
Engaged and Committed Leadership
Promote the Strategic Position of Quality
and Safety
Prevent Pressure Ulcers
Optimise Communication
Early Response to the Deteriorating
Patient (failure to rescue, unplanned
transfers to higher level of care
Prevent Harm from Falls
(addition June 2009)
Prevent Malnutrition
Medicines Reconciliation
High Alert Medicines
(anticoagulants**,narcotics, insulin)
Handovers and Transitions
Key
Process
Measures
Reliable
At 95% or
better
Prevent Healthcare Associated Infection:
MRSA , MSSA, C-Difficile
Hand Hygiene
General Infection preventionPeripheral and central line infections
8
24
NHS DUMFRIES AND GALLOWAY DRIVER DIAGRAM FOR ACTIVE PATIENT CARE (APC)
OUTCOME
To reduce preventable
adverse events in
PRIMARY DRIVERS
Provide patient and family
Implement
driven care
reliably all
elements of
inpatient areas of NHS
by 30% by 30th April
2013
SECONDARY DRIVERS
Active Patient
Create a culture whereby
care
nurses use their
professional knowledge,
evidence and skill, to
assess, plan, implement
and evaluate care which is
Appendix 2
CHANGE CONCEPTS
Using the model for improvement and
appropriate risk assessments for each patient,
implement The Nursing Process.
Identify a willing APC champion to lead in
individual roll out areas
Develop internal support mechanisms (don’t
work in silos)
Involve Executive Board members leading on
APC
Communicate openly with patients and family
Involve the patient and family in their care
Involve and expert patients
Teach the model for improvement
Share knowledge through experience
person centred.
Communicate through existing structures
Engage all MDT members
Ensure a consistent approach to achieve
reliability
Start small and use the safety cross 9
25
Agenda Item 239
6 February 2012
INVOLVING PEOPLE IMPROVING QUALITY
Patient Experience Report
Author:
Sally Talbot-Smith, Patient Services Manager
RECOMMENDATION
The Board is asked to consider this Patient Experience report.
SUMMARY
The paper gives the Board an overview of work currently underway in Dumfries and
Galloway to support the delivery of excellent spiritual care to our patients.
Detail is also provided on compliments received by the Board, feedback from
Releasing Time to Care and complaint response data.
Key Messages:
 The community chaplaincy listening project has been underway for 12 months
in Dalbeattie with positive results.
 Information has been developed to support people with dementia to cope with
bereavement.
 The improvements made to the percentage of complaints responded to within
20 days continue to be sustained.
GLOSSARY OF TERMS
CCL (Community Chaplaincy Listeneing)
DGRI (Dumfries and Galloway Royal Infirmary)
GP (General Practitioner)
NES (NHS Education for Scotland)
PCCD (Primary and Community Care Directorate)
SPSO (Scottish Public Services Ombudsman).
26
1. Spiritual Care – Patient Experience
When considering spiritual care it is helpful to distinguish between religion and
spirituality.
Spiritual needs may not always be expressed within a religious
framework. It is important to be aware that all human beings are spiritual beings
who have spiritual needs at different times of their lives. Although spiritual care is
not necessarily religious care, religious care, at its best, should always be spiritual
(Association of Hospice and Palliative Care Chaplains 2003).
Everyone, whether religious or not, needs support systems, especially in times of
crisis. Effective spiritual support can have a significant impact on a patient, or their
family’s experience of our services. Many patients, carers and staff, especially
those confronting serious or life threatening illness or injury, have spiritual needs and
welcome spiritual care. They look for help to cope with their illness and when
coping with loss, fear, loneliness, anxiety, uncertainty, impairment, despair, anger
and guilt. Those actively associated with a faith community, now statistically in a
minority, expect to derive help and comfort from their religious faith. On the other
hand, the majority who have no such religious association but recognise their need
for spiritual care, look for a skilled and sensitive listener who has time to be with
them. This needs to be a person who can help them to find within themselves the
resources to cope with their difficulties and the capacity to make positive use of their
experience of illness and injury.
In order to provide the best possible patient
experience the NHS needs to aim to offer both spiritual and religious care with equal
skill and enthusiasm.
In Scotland, healthcare chaplaincy has transformed in the last ten years. Each
health board is now charged with providing spiritual care as part of the holistic
package of care and treatment. Chaplains have had opportunities to expand their
horizons and their capacities and are responsible for facilitating spiritual care both for
those of all faiths and those of none.
Detailed below are a selection of on-going approaches in NHS Dumfries and
Galloway designed to improve the patient experience through strong spiritual care,
delivered by any member of staff who has patient/family contact.
1.1 Community Chaplaincy Listening Project
Patients discuss a large number of emotional issues with their GPs. Difficult news is
given or on-going support with long term conditions is provided in primary care.
Patients may also contact their GP, not knowing where else to turn, when their life
has hit a difficult patch. A ten minute GP consultation is not sufficient, or indeed the
most appropriate solution, for this group of vulnerable people.
The need for
spiritual care and support was identified for patients in primary care and from this
need the idea of the ‘community chaplaincy listening’ project was born. Community
Chaplaincy Listening (CCL) is an action research programme set up by NHS
Education for Scotland (NES).
The aim of the project, which started 12 months ago in NHS Dumfries and Galloway,
is to provide patients with someone who will listen to them but who has the skills to
also offer some constructive reflection.
27
“When people are faced with problems which don’t need medical intervention,
sometimes they don’t know where to turn. CCL gives people the opportunity to tell
their story in a safe and uncritical environment. Talking to someone helps them to
relieve the pain or burden they have in their chest but always enables them to
discover the strengths they have to cope with difficult circumstances and situation”.
(Community Chaplain)
The current chaplaincy listener is providing the service, on a voluntary basis, for two
sessions per week (six patients per week) and this is currently available via referral
from GPs and practice nurses only to patients in Dalbeattie. It is hoped that it will
also be possible to open this to referrals from district nurses in the area.
Patients meet with the chaplaincy listener who introduces them to the service and
what to expect. They then meet with the listener for as many sessions as are
needed to tell their story, consider the existential issues they are facing and feel
some sense of resolution or peace with what is currently happening in their life. The
patients decide on the number of sessions they need and, when they feel it is the
right time, they discharge themselves from the listening service. Sessions last one
hour and patients are free to discharge themselves from the listening service at any
time without explanation.
It is hoped that this service will enable some patients presenting with what could be
moderate depression to find a path through their difficulties without the need to be
prescribed anti-depressants or to access specialist services. The chaplaincy
listening project is also providing active support to some patients who appropriately
need to be referred to specialist services, for example psychology during the 18
week waiting time.
The chaplaincy listener support to patients is freeing up GP
time to see other patients that only a GP is suitable to see.
The first cycle of the Community Chaplaincy Listening (CCL) project, March 2010 –
March 2011, was evaluated by NHS Education for Scotland. NHS Dumfries and
Galloway had not had the project running for long by March 2011 but eight patients
had been seen at that point and were included in the evaluation along with those
from Glasgow, Tayside and the Western Isles. A summary of the key findings from
that report are as follows:



Patients overwhelmingly reported having a positive experience with the CCL
service; many gave examples of positive changes they had made in their
daily lives as a consequence of using the CCL and would use it again if
needed in future.
GPs found the CCL service helpful; they welcomed an additional place to
refer patients when patients expressed disease rather than ill health, they
found patients reported favourably on their experiences of the service, they
predicted that their prescription patterns could change once more patients use
the service and they liked the confidential nature of the service but also
requested more information about which patients had attended.
Setting up the CCL service carefully, building good relationships and providing
clear information/marketing materials was very important in allowing the
service to be well understood and accepted by GP referrers. Chaplains
28




found that negotiating access and maintaining relationships with GP practices
was a key part of the work at each site.
Clearly articulating the concept of spiritual listening and how it is distinct from
other types of listening was essential. This has been (and is) a complex
process, which can take time to explain. Once referrers understood the
distinct qualities of the CCL service, they referred patients. The time this took
varied from site to site.
Listeners reported largely positive experiences of providing the CCL; they
saw the benefits and heard positive patient feedback about what they had
gained from the service, they felt clear about the benefits to patients and
easing the burden of spiritual issues on doctors.
NHS Managers would like to see the CCL as part of a suite of talking
therapies. They felt CCL ‘filled a gap’ between seeing the GP and being
referred to psychology or other talking therapies. Issues of governance,
confidentiality and competence can be addressed.
The use of chaplaincy volunteers as listeners in the CCL requires careful
consideration. In particular, GPs were keen that all listeners should be well
trained and show expertise, experience and competence in listening skills.
Patient questionnaire feedback responses on the Community Chaplaincy Listening
Service (across all Scottish sites detailed above) included:










Good to talk to someone that wasn’t closely involved.
It was good to talk to someone who doesn’t know you.
I’ve been on a listening course before so I knew what to expect.
That someone would listen to my problems and give me a clear idea of what I
needed to do or react to given situations.
I didn’t expect to find such compassion and positivity. This experience was
invaluable to my mental and emotional well-being. I can’t praise it highly
enough.
Didn’t know what to expect but glad to go as the person I spoke to identified
with me in one of my problems.
I was treated with respect and a very caring attitude, which was very calming.
That I would be able to let out all my feelings about what I was going through
to someone who was not emotionally involved with me/my situation.
Yes, it’s an excellent and very helpful service. Particularly good that there
was no waiting list
I think it is a very innovative support structure which gives recognition to
emotional and spiritual needs requiring to be met in a genuine listening
situation.
An idea for expansion of the project in Dumfries and Galloway is to open it up to
patients of Kirkcudbright and Castle Douglas though a further chaplaincy listener
volunteer will need to be sourced in order for this to be possible.
1.2. Loss and bereavement in people with dementia
Alzheimer Scotland, supported by the University of the West of Scotland, undertook
a piece of work to address the paucity of help and information available for formal
and informal carers of people with dementia who are bereaved. It is recognised that
carers experience anticipatory losses when caring for someone with dementia and
29
advice is available to help them. However the experience of Alzheimer Scotland’s
Helpline and carer support services has highlighted the challenges that bereavement
poses for people with dementia in coming to terms with their losses both past and
present.
People with dementia may not have the cognitive skills to resolve or make sense of
their grief; however loss of cognition should not be confused with an absence of
emotion. We know that however severe the dementia it is possible that the person
may experience emotions and that this may be expressed by a variety of behaviours
including fear, agitation, restlessness, distress and suspicion. Impaired short term
memory adds to the distress of bereavement as difficulties in retaining information
mean that the loss of the person is relived each time there is discussion about the
person who has died.
In the absence of research, and with little information available regarding the support
of this group of patients at a painful and confusing time in their life, an information
sheet has been developed based upon best dementia practice and this includes
person centred care, validation therapy and reminiscence work. The information
sheet provides practical tips and advice on telling the person, planning and attending
the funeral and after the funeral. It also provides strategies for coping with awkward
questions. The information sheet is attached at appendix 2.
1.3 Sage and Thyme Training
It is recognised that health and social care professionals offering day to day care
provide much general psychological support to patients and carers and play a key
role in psychological assessment and prevention and amelioration of distress.
Sage and Thyme is a model for training health and social care professionals in
patient-focussed support.
It was developed by members of staff at University
Hospital of South Manchester NHS Foundation Trust (UHSM) and a patient in 2006.
Its aim is to teach the core skills of dealing with people in distress. It was originally
developed to meet the level 1 skills requirement described in the 2004 NICE
guidance on ‘Improving Supportive and Palliative Care for Adults with Cancer’. The
training is based upon the evidence relating to communication skills and
psychological assessment and support.
Sage and Thyme is a model to enable health and social care professionals to listen
to concerned or distressed people, and to respond in a way that empowers the
distressed person. The model is taught in a three hour level 1 course and is offered
through the NHS Dumfries and Galloway learning directory. In its most basic form,
it is described as follows:
Setting: If you notice concern - create some privacy – sit down.
Ask: “Can I ask what you are concerned about?”
Gather: Gather all of the concerns – not just the first few.
Empathy: Respond sensitively – “You have a lot on your mind”.
&
Talk: “Who do you have to talk to or to help you?”
Help: “How do they help?”
You: “What do YOU think would help?”
30
Me: “Is there something you would like ME to do?”
End: Summarise and close – “Can we leave it there?”
The training reminds staff how to listen and how to respond in a way which
empowers the patient. It discourages staff from ‘fixing’ and demonstrates how to
work with the patient’s own ideas first. Effective communication and support are
widely regarded as being key factors in determining a patient’s satisfaction,
compliance with treatment and recovery.
2. Patient Feedback
2.1 Compliments received by Patient Services in October and November 2011
•
•
•
•
Community Nursing PCCD West received nine compliments for October
2011.
Kirkcudbright Hospital received three compliments for October 2011 and four
for November 2011.
Thomas Hope received four thank you cards during the month of October
2011 and three for the month of November 2011.
Castle Douglas Hospital received seven compliments for October 2011 and
five for November 2011.
The Patient Services Team received six compliments in October 2011 and five for
November 2011. Specific patient feedback about departments includes:
“I have always been most impressed with the quick and efficient way I and my wife
have been seen at D & G Infirmary but my last visit surpassed all previous excellent
efficiencies” – Orthopaedic Out Patients.
“…. The hospital delivers first class patient care at every level of its operation. The
management/administrative planning and practices were evident in every
department throughout my visits….. the Day Surgery Unit almost (but not quite)
made me feel as though it was a pleasure to be there … My overall conclusions
were being looked after by dedicated and caring professional, excellent teamwork
and clearly happy in their work.
“I feel compelled to write to show my appreciation of the excellent treatment I
received during my recent stay in hospital. The staff in ward 4 were very kind, skilful,
knowledgeable and professional and I send my grateful thanks to all.”
“To all in the Birthing Suite – thanks for all your help. You are about people and it
shows. You are generous with your time giving of your energy, lavish with your
unselfish deeds and we will remember your kindness to us”.
A compliment was sent directly to Nicola Sturgeon, Cabinet Secretary for Health, in
respect of Miss Amanda Hawkins, Orthopaedic Consultant from a fire-fighter who
had broken his arm in a biking accident. It had been thought that this gentleman
would not work again however due to the efforts of Miss Hawkins and referral to a
specialist in Glasgow the gentleman was able to return to work as a fully operational
fire-fighter. He commented that “she is everything the NHS strives to be and its
31
people like her that make the staff in NHS in Scotland stand out from the rest of the
country.”
In respect of the Day Surgery Unit – “I could observe the excellent balance between
the need of providing care and the need to be sensitive toward my own sense of
dignity … what I experienced was a window of compassion and kindness expressed
by very caring unselfish people”.
“I felt it necessary to inform you of the excellent care that is being provided within the
hospital because only too often we hear the negatives … I can only say again from
the moment my mother arrived at DGRI the care and attention that she received was
of the highest standard”.
2.2 Feedback from Releasing Time to Care Questionnaires
Outpatients –
 Exceptional – no complaints
 Reassured regarding treatment
 Everyone very courteous
 Staff were very helpful and kind all the time
 The experience was one that left me happy. I feel the doctor made the right
decision and I could get help if I needed it
Day Surgery Suite –
 It would be good to give the day surgery number to patients prior to admission
so they can contact the unit to discuss any queries or information needed
 Organised, efficient and everything explained
 Very professional and knowledgeable staff
 Staff very caring, friendly and understanding
Castle Douglas Hospital –
 I received very good attention
 Helpful and friendly staff
3. REPORTS TO PROCURATOR FISCAL
There have been no complaints reported to the Procurator Fiscal in November 2011.
4. SCOTTISH PUBLIC SERVICES OMBUDSMAN
There have been no new complaints raised with the Scottish Public Services
Ombudsman in November 2011.
5. CONCLUSION
Maintaining health and well being is an important element of delivering personcentred healthcare services. Providing spiritual care is recognised as one of the
ways of supporting patients and their carers to cope with their healthcare experience,
which can often be under distressing circumstances.
This paper describes a number of activities taking place within Dumfries and
Galloway that are helping us to achieve this method of support for patients and their
carers.
32
Formal Complaints Data
1.1
Appendix 1
October Complaints
Complaints received
Complaints acknowledged in 3 working days
Complaints completed in 20 working days
Complaints not completed in 20 working days
Complaints still ongoing
Complaints withdrawn
Upheld
Upheld in Part
Not Upheld
October 2011
11
11 (100%)
9 (82%)
2 (18%)
0
0
2 (18%)
6 (55%)
2 (18%)
One complaint from October is currently being investigated by the Significant
Incident Review Group and the outcome of the complaint will be decided on
completion of the review.
1.2
November Complaints
Complaints received
Complaints acknowledged in 3 working days
Complaints completed in 20 working days
Complaints not completed in 20 working days
Complaints still ongoing
Complaints withdrawn
Upheld
Upheld in Part
Not Upheld
November 2011
19
19 (100%)
19 (100%)
0
0
0
4 (21%)
3 (16%)
5 (26%)
Five complainants in November have been offered meetings to discuss the issues of
concern. The outcome of these complaints will be decided following the meetings.
1.3 Compliance with National Timescales
Acknow ledged in 3 w orking days
100%
95%
90%
85%
D
N
ov
20
ec 09
20
J a 09
n
2
Fe 010
b
2
M 010
ar
2
Ap 010
r2
M 01
ay 0
2
J u 010
n
20
J u 10
l2
Au 01
g 0
2
Se 010
p
2
O 010
ct
20
1
N
ov 0
20
D
ec 10
2
J a 010
n
2
Fe 011
b
2
M 011
ar
2
Ap 01
ri l 1
2
M 01
ay 1
2
J u 011
n
20
J u 11
l2
Au 01
g 1
2
Se 01
pt 1
20
1
O
ct 1
20
1
N
ov 1
20
11
80%
5
0
30+
Days to Respond
Nov-11
10
Oct-11
No of Complaints
25
Sep-11
Aug-11
Jul-11
Jun-11
25-30
May-11
Apr-11
Mar-11
Feb-11
Jan-11
20-25
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
0-20
Jul-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
No. of complaints
D
ov
ec
20
09
20
J a 09
n
20
Fe 10
b
2
M 010
ar
2
Ap 010
r2
M 01 0
ay
2
J u 010
n
20
J u 10
l2
Au 01
g 0
20
Se 10
p
2
O 010
ct
20
1
N
ov 0
20
1
D
ec 0
20
J a 10
n
20
Fe 11
b
2
M 011
ar
2
Ap 01
ri l 1
2
M 01
ay 1
20
J u 11
n
20
J u 11
l2
Au 01
g 1
2
Se 011
pt
20
1
O
ct 1
20
1
N
ov 1
20
11
N
33
Responded in 20 w orking days
100%
80%
60%
40%
20%
0%
1.4 Complaint Response Times
Complaint Response times
Jan 2011
20
Feb 2011
15
Apr 2011
Mar 2011
May 2011
Jun 2011
Jul 2011
Aug 2011
Sep 2011
Oct 2011
Nov 2011
1.5 Number of complaints per month November 2009 – November 2011
Number of Complaints per month, August 2009 to August 2011
40
35
30
25
20
15
10
5
0
34
1.6 Issues within complaints
Complaint Issues (Top 3) December 2010 - November 2011
20
18
16
No of Issues
14
12
Clinical Treatment
10
8
Staff attitude and
behaviour
6
4
Staff
communication
(oral)
2
0
Dec
1.7
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Upheld issues within complaints
Upheld Issues - (Top3) Dec 2010 - Nov 2011
14
12
No of Issues
10
Clinical Treatment
8
6
Staff attitude and
behaviour
4
Staff
communication
(oral)
2
0
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
35
1.8
Number of Complaints by Directorate
Issues of Complaint by Directorate - Sep 2011 - Nov 2011
18
16
No of Issues
14
12
10
Sep
8
Oct
Nov
6
4
Scottish Prison
Service
Patient
Services
Pharmacy
Service
Dental
Services
Womens and
Childrens
PCCD West
(Stewartry and
Radiology/ Xray
Operations
Mental Health
PCCD East
(Nithsdale
AHPs
Addiction
Services
Acute
Services
0
Financial
Services
2
NB: Work is currently being undertaken within DATIX to update the new Organisation
Structure.
36
MONITORING FORM
Complaints Policy.
Ensuring staff learn from complaints in relation to
issues raised.
Consultation
Consultation with Professional
Committees
Risk Assessment
Not required
Not required
Not required
Best Value
Sustainability
Compliance with
Objectives
Actions from complaints followed through and
reported to General Manages and Clinical Nurse
Managers who have a responsibility to take
account of any associated risk.
Commitment and leadership
Accountability
Responsiveness and consultation
Joint Working
Not required
Corporate To promote and embed continuous improvement by
connecting a range of quality and safety activities to
deliver the highest quality of service across NHS
Single Outcome Agreement Health inequalities
(SOA)
Impact Assessment
Not undertaken as learning from patient feedback applies to all users.
37
IS 42 December 2011
Information sheet
Loss & bereavement in
people with dementia
Introduction ........................................... 1
What is grief? ......................................... 1
Breaking the news .................................. 2
Planning the funeral – rituals ................. 2
The funeral - a rite of passage ................ 3
After the funeral ..................................... 3
Handling awkward questions ................. 3
Be consistent .......................................... 4
Finally….. ............................................... 4
Useful links ............................................ 5
people with dementia and their families.
There is information and research about grief
and bereavement available for family carers of
someone who has dementia but there is very
little information on how to support a person
with dementia come to terms with the loss
he/she may face on the death of someone
close to them.
We all have losses in our lives but, for people
with dementia, these losses are more
profound - loss of a life, a relationship, a
sense of self and memories. As memory
fades, other losses follow – work, driving,
hobbies, skills, abilities and finally
independence. The way people deal with
these losses or little deaths will affect the way
they deal with the ultimate one of their own
death or the death of someone close to them.
Introduction
This information sheet looks at how loss and
bereavement affects people with dementia and
how best we can help them through this
difficult process. It focuses on the best
possible techniques available, including: •
•
•
Person centred care – seeing the
person first
Validation therapy – responding to the
underlying emotion
Reminiscence work – sharing the past
experiences of the person through
pictures and music.
Grief is a normal response to loss but,
depending on the relationship and past
experiences, it may be expressed differently.
Mourning is the outward expression of grief
and it manifests itself in many ways - physical,
mental, emotional and spiritual - and is
usually associated with unhappiness, anger,
guilt, pain and longing for the lost person or
thing.
Each person’s experience of bereavement will
be unique to them and will depend on their
individual relationship and how much contact
the deceased person may have had with the
person with dementia.
The purpose of the grieving process is to
adapt over time to the loss of someone
important to you. The aim is to accept the
reality of the loss, work through the pain and
adjust to life without the deceased. As
Christina Rossetti wrote in her poem
Remember “Better by far you should forget
and smile than that you should remember and
be sad”. This may be extremely difficult for
people with dementia.
It is hoped that the information provided in
this information sheet will provide support at
some level, regardless of the relationship or
context of the bereavement
What is grief?
Grief has been described as ‘the constant yet
hidden companion of dementia’ both for
Page 1
38
Loss & bereavement in people with dementia
someone else who is not so emotionally
involved, such as another member of the
family or a care worker, nurse or doctor.
The mourning process may be experienced by
people with advanced dementia but they may
not have the cognitive skills to resolve or
make sense of their grief.
Find a time of day when the person is at their
best and rested. It is best if one person is
delegated to break the news as a family group
might be overwhelming. Find a quiet
comfortable space and stay calm. Use body
language to express your sadness, cuddle
them or hold their hand. Keep the sentences
short and do not give too much information at
once. Avoid using euphemisms such as
‘passed away’ or ‘at peace now.’ Allow plenty
of time, and be prepared to frequently repeat
the information. If this becomes too difficult,
invite other members of the family or carers to
share the load.
It is widely believed that protecting a person
with dementia from the truth can cause
confusion because the story will not match the
reality. For example, telling someone who is
agitated and asking where her late husband is
to “Go on up to bed because Bob will be up
later” might solve the immediate problem
(getting the person to go to bed) but she
might still be waiting for Bob to arrive and get
anxious and upset when he doesn’t. Loss of
cognition should not be confused with the
absence of emotion. We know that, however
severe the dementia is, the person is still able
to feel emotions.
Case study
Mary and Bob have just heard the news that
their 45 year old son Keith has died whilst
playing a game of squash. Mary has to tell
Bob but knows he will not really understand as
he has advanced dementia. They have always
shared everything and she feels very much
alone. She sits quietly next to Bob and shares
the news with him. Bob senses her distress
and they spend a long time holding each other
and then they look at photos. Mary knows
Bob will not remember and she will have to
have this conversation with him many times
over the weeks to come, but the sense of love
and comfort they gave each other remains
with Mary and strengthens her.
Grief may be expressed by a person with
dementia as agitation and restlessness. They
may have a sense that something is not right,
or a generalised feeling of ‘wrong being’ or
perhaps that someone who is close to them is
missing. The person may confuse the present
loss with an earlier one. It is also possible
that the person may not be able to retain the
information that the person has died.
Expression of grief will be affected by a variety
of factors: the extent of the dementia and loss
of awareness, how close a relationship the
person had with the deceased and how well
the person can express their loss.
Planning the funeral – rituals
Breaking the news
If at all possible, tell the person that someone
close to them has died. This is especially
important if the person with dementia has
regular contact with the person who has died
either as a carer, friend, spouse or sibling.
This may not be easy, especially if you are
also upset, but it is much better to tell the
person than try to pretend everything is all
right as they may pick up on your sadness and
not understand why. If you can’t bring
yourself to break the news, try to identify
Where possible, involve the person with
dementia as much as possible in discussions
about the funeral and in making the practical
arrangements. This will be dependant on the
religion and wishes of the deceased person
and on how close the person with dementia
was to the deceased person. If appropriate,
involving the person with dementia in the
funeral planning can help to embed awareness
of the death and create more references for
gentle ‘reminders’ such as sharing messages,
Page 2
39
After the funeral
letters and cards of sympathy. Avoiding such
information and involvement tends to cause
more problems in the long run and denies the
person the opportunity to grieve.
This may be a sad and difficult time for you if
you now have to sort out the deceased
person’s clothes and possessions but do
consider involving the person with dementia in
some small way. You may want to give them
some item of clothing which had a particular
smell or feel, or perhaps a familiar object.
This can help embed the information that the
person has died and gives many opportunities
for reminiscing.
Reminiscing is something that gives us all
comfort after bereavement. Try using photos
and telling shared stories about the person.
Taking the person with dementia to visit the
grave or memorial site can also help and
keeping up faith rituals can give solace. It is
also important to allow the person with
dementia to talk about how they feel.
The funeral - a rite of passage
Support the person with dementia to attend
the funeral, especially if it is a close family
member or friend who has died. If you are
concerned you will be unable to cope because
of dealing with your own grief, try to identify
someone else to take care of the person with
dementia. People tend to behave appropriately
at such events as often they recall the rituals
and conduct required of such an occasion and
can take many cues from the setting and from
others.
An ‘order of service’ with the person’s photo
on the front is a good visual reminder.
Family members shouldn’t hide their own grief
for the person’s sake as this can be more
confusing.
Handling awkward questions
If you haven’t been able to do any of the
above, or even if you have, there is a strong
possibility that the person with dementia will
continue to ask for the person who has died
wanting to know where they are and when
they will be back.
Case study
Ada and Jim had been married for 65 years.
Ada had vascular dementia and Jim had
lovingly cared for her for many years. For the
last two years they had lived together in a
care home. Sadly, Jim died and their
daughters thought it would be too upsetting
for Ada to attend the funeral and did not
involve her in the planning of it. The care
staff encouraged the daughters to reconsider
and allow them to take Ada to the funeral and
sit at the back. Reluctantly. the daughters
agreed.
A gentle reminder may work for some people;
for others being reminded that the person has
died is greatly upsetting. It can be as if they
are hearing the news for the first time, with
each reminder having the same upsetting
effect. This is also very hard to cope with,
especially if you have to contend with your
own grief and you may feel frustrated, angry
and lonely. If this is the case, try to give
yourself some space, then try a different
approach.
When Ada entered the church, she had no
intention of sitting at the back and took her
seat with the family. Her behaviour was
appropriate throughout the service and she
was able to join in with the hymn singing,
although she did not approve of the choice of
hymns! It was felt that this helped Ada to
come to terms with her loss of Jim. Her
daughters were pleased she was there and
able to take part.
Imagine a man asking for his deceased wife,
Mary. The response to his question “Where’s
Mary?” could be the blunt truth (“She died last
November, Dad”) or avoidance (“She’s not
here just now”).
Instead, try tuning into the emotion the
person is expressing beneath the words and
respond to that emotion. If you are giving the
Page 3
40
message that you understand how they feel,
this can override the need to have the
question answered. The emotion(s) may be: •
•
•
•
•
•
•
unexplained change in behaviour, provide
support for these emotions. Be prepared to
revisit the experience or to never again
address it, depending on the response of the
person with dementia.
genuine longing for the person
bewilderment as to why the person
isn’t nearby
fear
distress
suspicion
anger
concern.
Accept that the person may want to talk about
the deceased person frequently or infrequently
and that they may have far more
understanding of the situation than you think.
Consider using reminiscence, talking about the
deceased person. Having a favourite piece of
music or photographs can help the person
work through their grief.
If you can latch on to the emotion, then
knowing what to say comes easier. For
example:
If regularly responding to the emotion and
reminiscence really isn’t working then, as a
last resort, try distraction, bearing in mind
that this will not help the grief process but
may alleviate the stress of the moment.
“You sound as though you are really missing
her. Tell me what she was like/what you miss
about her.”
OR
Look for any patterns as to when the person is
asking about the person who has died. Is it
always early evening or always in the
morning? Is it related to a particular routine
that he and Mary always had? If you can spot
a pattern then having the distraction in place
or fulfilling a routine before the questions start
may help.
“You sound really frightened/lost/angry, let
me help you with that.”
There may also be something practical you
could do. If the person is saying, “Mary would
help me!” then ask “What would Mary do for
you if she was here?” This could involve, for
example, giving the person a hug or finding
something they are looking for. This may
meet their immediate need and reduce the
distress.
Be consistent
A consistent approach is essential when
supporting someone with dementia so there
must be good communication between all
family members and professionals about what
techniques are being used to manage the
bereavement and awkward questions.
Everyone involved must use the same
techniques to avoid further confusion and
upset to the person. This should be clearly
written in support plans.
Sharing your own loss can also help. (“I miss
her too.”)
Use the past tense when speaking as this will
help orientate the person. (“We used to love
Mum’s chocolate cake, didn’t we Dad? Do you
think we could make one as good?”)
Finally…..
Be responsive to the moment, paying
attention to the mood of the person and
responding appropriately. If the person seems
unaware of change and is not distressed, don’t
try to force reality on him/her. If the person
seems sad or angry or there is any other
The key to helping a person with dementia
cope with the loss is to be patient and
responsive and that it will take time.
Remaining present in the situation will help
responses to be authentic and supportive.
Page 4
41
Take time to address your own feelings. Be
honest with yourself and with the person with
dementia. Do not hesitate to ask for help
from others in dealing with either your own
grief or the person with dementia’s grief.
Useful links
www.alzheimers.org.uk
www.scie.org.uk/publications/elearning/deme
ntia/dementia06/resource/flash/index.html
This information sheet has been funded by the
Patient Support and Participation Division of
the Chief Nursing Officer Directorate of the
Scottish Government and is an activity to aid
the roll out of Shaping Bereavement Care.
Developed in partnership with the University
of the West of Scotland.
Alzheimer Scotland
22 Drumsheugh Gardens, Edinburgh EH3 7RN
Telephone: 0131 243 1453
Email: alzheimer@alzscot.org
Alzheimer Scotland - Action on Dementia is a company limited by guarantee,
registered in Scotland 149069. Registered Office: 22 Drumsheugh Gardens,
Edinburgh EH3 7RN. It is recognised as a charity by the Office of the
Scottish Charity Regulator, no. SC022315.
Find us on the internet at
www.alzscot.org
Page 5
42
Agenda Item 240
6 February 2012
Prevention and Control of Infection
Author:
Elaine Ross, Infection Control Manager
Sponsoring Director
RECOMMENDATION
The Board is asked to consider this healthcare associated infection report.
SUMMARY
This report provides information to the NHS board and general public in a format that facilitates
comparison with other NHS boards in Scotland. This paper is placed on the public website
following discussion at Board.
This important topic is also discussed in detail at every Healthcare Governance Committee
meeting.
Key messages are:
• There were two small unrelated outbreaks of Norovirus in NHS facilities in December 2011.
These were swiftly contained and had minimal impact on service delivery. A full report has
been presented to the Infection Control Committee
• There were two cases of SAB in December
• There were 6 cases of Clostridium difficile in December
GLOSSARY
Antimicrobial Management Team (AMT)
Clostridium difficile Infection (CDI)
Staphylococcus aureus bacteraemia (SAB)
Meticillin Sensitive Staphylococcus Aureus (MSSA)
Meticillin Resistant Staphylococcus Aureus (MRSA)
Root Cause Analysis (RCA)
Health improvement Efficiency Access Target (HEAT)
1
43
Healthcare Associated Infection Report
Date: 16th January 2012
Section 1 – Board Wide Issues
This section of the HAIRT covers Board wide infection prevention and control activity and
actions. For reports on individual hospitals, please refer to the ‘Healthcare Associated
Infection Report Cards’ in Section 2.
A report card summarising Board wide statistics can be found at the end of Section 1.
Key Healthcare Associated Infection Headlines for December 2011
There were two small unrelated outbreaks of Norovirus in NHS facilities. These were swiftly
contained and had minimal impact on service delivery. A full report has been presented to the
Infection Control Committee.
Staphylococcus aureus (including MRSA)
Staphylococcus aureus is an organism which is responsible for a large number of healthcare
associated infections, although it can also cause infections in people who have not had any recent
contact with the healthcare system. The most common form of this is Meticillin Sensitive
Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant
Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain
antibiotics and is therefore more difficult to treat. More information on these organisms can be found
at:
Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346
MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252
NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections. Known as
bacteraemias, these are a serious form of infection and there is a national target to reduce them. The
number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of
section 1 and for each hospital in section 2. Information on the national surveillance programme for
Staphylococcus aureus bacteraemias can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248
Figure 1
2
44
NHS Dumfries and Galloway Staphylococcus aureus Bacteraemia (SAB) Performance Chart
SAB Monthly performance against 2013 HEAT target
0.7
0.6
Rate/ 1000 AOBDS
0.5
0.4
HEAT
Actual performance
0.3
0.2
0.1
0
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Figure 2
This graph maps cases of SAB year on year.
There were two cases of SAB in December. The result of root cause analysis concludes that neither
of these were preventable. However, a focus on Sepsis through a Scottish Patient Safety
Programme Collaborative may assist in the future will early identification and treatment of potential
Sepsis.
3
45
Clostridium difficile
Clostridium difficile is an organism which is responsible for a large number of healthcare
associated infections, although it can also cause infections in people who have not had any
recent contact with the healthcare system. More information can be found at:
http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx
NHS Boards carry out surveillance of Clostridium difficile infections (CDI), with a national
reduction target. The number of patients with CDI for the Board can be found at the end of
section 1 and for each hospital in section 2. Information on the national surveillance
programme for Clostridium difficile infections can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277
Figure 3
NHS Dumfries and Galloway Clostridium difficile Infection (CDI) Performance Chart
CDI Monthly performance against 2013 HEAT target
cases over 65 years per 1000 TOBDs
1.2
1
0.8
HEAT
0.6
Actual
performance
0.4
0.2
0
Apr-11 May- Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
11
Whilst it is disappointing to see the number of case of CDI rise slightly during December it should be
recognised that overall these numbers are far lower than those seen in previous years. As has been
described to Board before, some variation is to be expected.
The quarterly rolling average presented on page 9 of this paper has taken a downward turn and is
approaching the HEAT target to be met by 2013.
A recent teleconference with Health Protection Scotland confirmed that they endorsed the
approaches that are being taken to address this important issue.
4
46
Origin of CDI cases December 2011
HAI-occurring during hospital admission or within 3
4 weeks of discharge from hospital
CAI-occurring within 48 hours of admission or 3
more than 12 weeks after discharge from hospital
Unknown- occurring between 4 and 12 weeks
post hospital discharge
Figure 4
Year on year comparison
Hand Hygiene
Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of
infections. More information on the importance of good hand hygiene can be found at:
http://www.washyourhandsofthem.com/
NHS Boards monitor hand hygiene and take a zero tolerance approach to non compliance.
The hand hygiene compliance score for the Board can be found at the end of section 1 and
for each hospital in section 2. Information on national hand hygiene monitoring can be
found at:
http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx
5
As
repo
47
Area
Opportunities
taken
Total number of
opportunities in
sample
Percentage
compliance
Staff wearing
Jewellery
Total number in
sample
Percentage Total
compliance
rted previously to Board, all wards audit hand hygiene monthly as part of the Scottish Patient Safety
Programme. Results are presented below.
Critical Care
General ward
Peri-operative
GCH
137
174
363
263
138
100
378
318
99%
57%
96%
82.7%
82
144
105
146
83
145
105
146
99%
99%
100%
100%
From January the requirement has been broadened to include assessment of hand hygiene
technique as well as the number of opportunities taken and the combine percentage will be reported
locally and nationally. Ward staff have been informed of this change over a number of months
during the regular bi monthly audits performed by the Boards hand hygiene and at departmental and
management meetings. An additional awareness campaign is due to commence shortly.
Whilst feedback on technique has always been a part of the feedback following audit, the use of a
correct technique has not previously formed a part of the overall score.
Outbreaks
During December there were two outbreaks, one proven and one suspected norovirus
gastroenteritis. Both were managed as per the Outbreak Plan, the first time it has been applied
since an extensive review last year. Learning points include the availability of outbreak management
materials on line and availability of replacement curtains, suitability of furnishings and training. There
were examples of good practice with prompt reporting and action taken together with excellent
cooperation from Estates and Domestic Staff during a busy holiday period.
The first out break occurred in Netherlea, a 7 bedded respite care facility for children with profound
needs. The unit was closed for a total of 3 days and t a total of 4 children and 2 members of staff
were symptomatic.
The second outbreak was in Dalrymple Ward, Galloway Community Hospital. In total 12 patients
and eight staff were affected. Affected patients were widely spread throughout the ward which was
closed from 24th December to admissions and transfers until Monday 4th January 2012.
Cleaning and the Healthcare Environment
6
48
Keeping the healthcare environment clean is essential to prevent the spread of infections.
NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain
compliance with standards above 90%. The cleaning compliance score for the Board can
be found at the end of section 1 and for each hospital in section 2. Information on national
cleanliness compliance monitoring can be found at:
http://www.hfs.scot.nhs.uk/online-services/publications/hai/
Healthcare environment standards are also independently inspected by the Healthcare
Environment Inspectorate. More details can be found at:
http://www.nhshealthquality.org/nhsqis/6710.140.1366.html
Figure 8
Domestic Monitoring Results Oct - Dec 2011
99.0
98.0
97.0
96.0
October
95.0
December
November
94.0
93.0
92.0
West
East
Crichton
DGRI
All clinical and non clinical areas are audited at least monthly as part of the routine domestic
monitoring.
7
49
NHS DUMFRIES AND GALLOWAY HEALTH BOARD REPORT CARD
NHS Dumfries and Galloway
Total Staphylococcus aureus Bacteraemia Cases (all ages)
The data presented on this and the following page is the collated HAI data
for all NHS Dumfries and Galloway.
A further breakdown is presented on subsequent pages and covers acute
hospitals, community hospitals and out of hospital infections.
Figures presented for Clostridium difficile Infection (CDI) on this page
include all cases over 15 years of age.
Figures presented for CDI on the following pages exclude cases less than
65 years of age as required for the HEAT target measurement.
May-11
96
Jun-11
Jul-11
96
Aug-11
Sep-11
95
Oct-11
Nov-11
96
Dec-11
Jan-12
Feb-12
5
4
3
2
1
0
Apr-11
Apr-11
3
Bi Monthly National Hand Hygiene Monitoring Compliance (%)
Apr-11
6
May-11
May-11
3
Jun-11
Jun-11
2
Mar-12
Jul-11
Aug-11
Jul-11
1
Aug-11
5
Sep-11
Oct-11
Sep-11
4
Nov-11
Oct-11
3
Dec-11
Nov-11
1
Jan-12
Dec-11
2
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
MRSA Bacteraemia Cases (all ages)
1.2
1
Cleaning Compliance (%)
Apr-11
96
May-11
995
Jun-11
95.8
Jul-11
96.5
Aug-11
96.2
Sep-11
96.2
Oct-11
95.9
Nov-11
96.9
0.8
Dec-11
96.1
Jan-12
Feb-12
Mar-12
0.6
0.4
0.2
Estates Monitoring Compliance (%)
Apr-11
97.6
May-11
96.1
Jun-11
96.4
Jul-11
96.6
Aug-11
95.4
Sep-11
97.1
Oct-11
97.1
Nov-11
97.9
Dec-11
97.9
0
Jan-12
Feb-12
Mar-12
Apr-11
Apr-11
0
Clostridium difficile Cases (ages 15 and over)
May-11
May-11
1
Jun-11
Jun-11
0
Jul-11
Aug-11
Jul-11
0
Aug-11
0
Sep-11
Oct-11
Sep-11
0
Nov-11
Oct-11
1
Dec-11
Nov-11
0
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
MSSA Bacteraemia Cases (all ages)
14
12
6
100
10
5
80
8
6
4
60
4
3
40
2
2
20
1
0
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
00
Apr-11
Apr-11 May-11
May-11 Jun-11
Jun-11
Apr-11
12
May-11
5
Jun-11
13
Jul-11
5
Aug-11
11
Sep-11
3
Oct-11
6
Nov-11
2
Dec-11
6
8
Jan-12
Feb-12
Mar-12
Apr-11
3
May-11
2
Jun-11
2
Jul-11
Jul-11
Jul-11
1
Aug-11
Aug-11 Sep-11
Sep-11
Aug-11
5
Sep-11
4
Oct-11
Oct-11
Oct-11
2
Nov-11
Nov-11
Nov-11
1
Dec-11
Jan-12
Jan-12
Dec-11
2
Feb-12
Feb-12
Jan-12
Mar-12
Mar-12
Feb-12
Mar-12
50
NHS DUMFRIES AND GALLOWAY HEAT TARGET PROGRESS
Quarterly rolling year Staphylococcus aureus Bacteraemia Rates per 1000 Acute Occupied Bed Days for HEAT Target Measurement
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
Apr 10 Mar 11
Jul 10 Jun 11
Oct 10 Sept 11
Actual Performance
Target
Jan 11 Dec 11
Apr 11 Mar 12
Jul 11 Jun 12
Oct 11 Sept 12
Apr 10 Mar 11
Jul 10 Jun 11
Oct 10 Sept 11
Jan 11 Dec 11
Apr 11 Mar 12
Jul 11 Jun 12
Oct 11 Sept 12
Jan 12 Dec 12
Apr 12 Mar 13
0.32
0.26
0.28
0.26
0.32
0.26
0.26
0.26
0.26
0.26
0.26
0.26
0.26
Jan 12 Dec 12
Apr 12 Mar 13
Quarterly rolling year Clostridium difficile Infection Cases per 1000 total occupied bed days for HEAT Target Measurement
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Apr 10 Mar 11
Jul 10 Jun 11
Oct 10 Sept 11
Actual Performance
Target
9
Jan 11 Dec 11
Apr 11 Mar 12
Jul 11 Jun 12
Oct 11 Sept 12
Apr 10 Mar 11
Jul 10 Jun 11
Oct 10 Sept 11
Jan 11 Dec 11
Apr 11 Mar 12
Jul 11 Jun 12
Oct 11 Sept 12
Jan 12 Dec 12
Apr 12 Mar 13
0.67
0.39
0.72
0.39
0.58
0.39
0.51
0.39
0.39
0.39
0.39
0.39
0.39
Jan 12 Dec 12
Apr 12 Mar 13
51
Healthcare Associated Infection Reporting Template (HAIRT)
Section 2 – Healthcare Associated Infection Report Cards
The following section is a series of ‘Report Cards’ that provide information, for each acute hospital in the Board, on the
number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and
Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card
which covers all community hospitals [which do not have individual cards], and a report which covers infections identified
as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may
differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The
national reports are official statistics which undergo rigorous validation, which means final national figures may differ from
those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at
local level than is possible to provide through the national statistics.
Understanding the Report Cards – Infection Case Numbers
Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital,
broken down by month. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive
Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data are presented as both a
graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website:
Clostridium difficile : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139&sectionID=1
Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346
MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1
For each hospital the total number of cases for each month are those which have been reported as positive from a
laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive
samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was
contracted prior to hospital admission and will be shown in the “out of hospital” report card.
Understanding the Report Cards – Hand Hygiene Compliance
Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health
Protection Scotland’s national hand hygiene campaign website:
http://www.washyourhandsofthem.com/
Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital
report card presents the percentage of hand hygiene compliance for all staff in both graph and table form.
Understanding the Report Cards – Cleaning Compliance Hospitals strive to keep the care environment as clean as
possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits
can be found on the Health Facilities Scotland website:
http://www.hfs.scot.nhs.uk/online-services/publications/hai/
The first page of each hospital Report Card gives the hospitals cleaning compliance percentage in both graph and table
form.
Understanding the Report Cards – ‘Out of Hospital Infections’ Clostridium difficile infections and Staphylococcus
aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the
only place a patient may contract an infection. This total will also include infection from community sources such as GP
surgeries and care homes and. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports
on SAB and CDI cases reported to a Health Board which are not attributable to a hospital. Given the complex variety of
sources for these infections it is not possible to break this data down in any more detail
10
52
INDIVIDUAL REPORT CARDS
Dumfries and Galloway Royal Infirmary
Total Staphylococcus aureus Bacteraemia Cases (all ages)
4.5
4
Dumfries and Galloway Royal Infirmary is the District General Hospital serving the
region of Dumfries and Galloway.
It contains 392 staffed beds, and has a full range of specialties.
3.5
3
2.5
2
1.5
1
0.5
0
Apr-11
Apr-11
3
Bi Monthly National Hand Hygiene Monitoring Compliance (%)
Apr-11
May-11
96
Jun-11
Jul-11
96
Aug-11
Sep-11
95
Oct-11
Nov-11
96
Dec-11
Jan-12
Feb-12
May-11
May-11
3
Jun-11
Jun-11
2
Mar-12
Jul-11
Jul-11
0
Aug-11
Aug-11
4
Sep-11
Sep-11
2
Oct-11
Oct-11
1
Nov-11
Nov-11
1
Dec-11
Jan-12
Dec-11
1
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
MRSA Bacteraemia Cases (all ages)
1.2
1
Cleaning Compliance (%)
Apr-11
95.2
May-11
94.2
Jun-11
95.2
Jul-11
95.8
Aug-11
94.3
Sep-11
95
Oct-11
96.4
Nov-11
96.7
Dec-11
96.3
Jan-12
Feb-12
Mar-12
0.8
0.6
0.4
0.2
Estates Monitoring Compliance (%)
Apr-11
97.8
May-11
95.6
Jun-11
96.3
Jul-11
96.1
Aug-11
92.3
Sep-11
95.3
Oct-11
94.5
Nov-11
96.2
Dec-11
95.7
Jan-12
Feb-12
Mar-12
0
Apr-11
Apr-11
0
May-11
May-11
1
Jun-11
Jun-11
0
Clostridium difficile Cases over 65 years of age
Jul-11
0
Aug-11
Aug-11
0
Sep-11
Sep-11
0
Oct-11
Oct-11
0
Nov-11
Nov-11
0
Dec-11
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
MSSA Bacteraemia Cases (all ages)
4.5
100
9
8
4
7
80
3.5
6
3
60
5
2.5
4
2
40
3
1.5
2
1
20
1
0.5
00
0
Apr-11
Apr-11
8
Jul-11
May-11
4
May-11
Jun-11
Jun-11
7
Jul-11
Jul-11
1
Aug-11
Aug-11
2
Sep-11
Sep-11
1
Oct-11
Oct-11
1
Nov-11
Nov-11
0
Dec-11
Dec-11
3
11
Jan-12
Feb-12
Jan-12
Mar-12
Feb-12
Apr-11
Apr-11 May-11
May-11 Jun-11
Jun-11
Mar-12
Apr-11
Apr-11
3
May-11
May-11
2
Jun-11
Jun-11
2
Jul-11
Jul-11 Aug-11
Aug-11 Sep-11
Sep-11 Oct-11
Oct-11 Nov-11
Nov-11 Dec-11
Dec-11 Jan-12
Jan-12 Feb-12
Feb-12 Mar-12
Mar-12
Jul-11
Jul-11
0
Aug-11
Aug-11
4
Sep-11
Sep-11
2
Oct-11
Oct-11
1
Nov-11
Nov-11
1
Dec-11
Dec-11
1
Jan-12
Jan-12
Feb-12
Feb-12
Mar-12
Mar-12
53
Galloway Community Hospital
Clostridium difficile Infection Cases over 65 years of age
1.2
1
The Galloway Community Hospital opened in September 2006,
The following services are provided in the Hospital:
• Day Surgery - 12-trolley area.
• Assessment and Rehabilitation -Dalrymple Ward -24 beds.
• Palliative care -Dalrymple Ward, St Johns Unit -2 beds.
• Acute Medicine Services - Garrick Ward- 20 beds.
• Maternity services are provided from Clenoch Birthing Centre which 2 beds for
low risk pregnancy.
• Renal services are provided from a 4 station haemodialysis unit 0.8
0.6
0.4
0.2
0
Apr-11
Apr-11
0
May-11
May-11
0
Jun-11
Jun-11
0
Jul-11
Jul-11
0
MSSA Bacteraemia Cases
Aug-11
Aug-11
1
Sep-11
Sep-11
0
Oct-11
Oct-11
0
Nov-11
Dec-11
Nov-11
0
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
MRSA Bacteraemia Cases
1
1.2
0.9
1
0.8
0.7
0.8
0.6
0.6
0.5
0.4
0.4
0.3
0.2
0.2
0.1
0
0
Apr-11
Apr-11
0
May-11
May-11
0
Jun-11
Jun-11
0
Jul-11
Jul-11
0
Aug-11
Aug-11
0
Sep-11
Sep-11
0
Oct-11
Oct-11
0
Nov-11
Dec-11
Nov-11
0
12
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Apr-11
Mar-12
Apr-11
0
May-11
May-11
0
Jun-11
Jun-11
0
Jul-11
Jul-11
0
Aug-11
Aug-11
0
Sep-11
Sep-11
0
Oct-11
Oct-11
1
Nov-11
Nov-11
0
Dec-11
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
54
Community Hospitals
2.5
There are eight Community hospitals across Dumfries and Galloway. These
provide assessment of adults, rehabilitation and palliative care.
There are 134 beds in total. This also includes Allanbank, The Craigs unit.
Hospital
Beds
Annan
24
Castle Douglas
21
Kirkcudbright
14
Lochmaben
16
Moffat
12
Newton Stewart 22
Thomas Hope
12
Thornhill
13
2
1.5
1
0.5
0
Apr-11
Apr-11
0
May-11
May-11
0
Jun-11
Jun-11
1
Jul-11
Jul-11
1
Aug-11
2
Sep-11
Sep-11
0
Oct-11
Oct-11
0
Nov-11
Dec-11
Nov-11
0
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
1
1
0.9
0.9
0.8
0.8
0.7
0.7
0.6
0.6
0.5
0.5
0.4
0.4
0.3
0.3
0.2
0.2
0.1
0.1
0
0
Apr-11
Apr-11
0
Aug-11
May-11
May-11
0
Jun-11
Jun-11
0
Jul-11
Jul-11
0
Aug-11
Aug-11
0
Sep-11
Sep-11
0
Oct-11
Oct-11
0
Nov-11
Dec-11
Nov-11
0
Jan-12
Dec-11
0
13
Feb-12
Jan-12
Mar-12
Feb-12
Apr-11
Mar-12
Apr-11
0
May-11
May-11
0
Jun-11
Jun-11
0
Jul-11
Jul-11
0
Aug-11
Aug-11
0
Sep-11
Sep-11
0
Oct-11
Oct-11
0
Nov-11
Nov-11
0
Dec-11
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
55
Out of Hospital Infections
4.5
4
The population of Dumfries and Galloway is in the region of 150,000.
There are 35 GP practices located across the region.
Where a patient presents to accident and emergency or develops a SAB or CDI
within 48hours of admission to hospital they are classified as being an 'out of
hospital' acquired infection. This is being addressed by root cause analysis of
each case and work with GP’s and community pharmacists to ensure findings are
acted upon. More accurate recording of origin of these cases is reflected in the
apparent increase in MSSA Bacteraemia cases illustrated in the graph below.
3.5
3
2.5
2
1.5
1
0.5
0
Apr-11
Apr-11
3
May-11
May-11
0
Jun-11
Jun-11
4
Jul-11
Jul-11
3
Aug-11
Aug-11
4
Sep-11
Sep-11
2
Oct-11
Oct-11
4
Nov-11
Dec-11
Nov-11
1
Jan-12
Dec-11
3
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
2.5
1
0.9
2
0.8
0.7
1.5
0.6
0.5
1
0.4
0.3
0.5
0.2
0.1
0
0
Apr-11
Apr-11
0
May-11
May-11
0
Jun-11
Jun-11
0
Jul-11
Jul-11
1
Aug-11
Aug-11
1
Sep-11
Sep-11
2
Oct-11
Oct-11
1
Nov-11
Dec-11
Nov-11
0
Jan-12
Dec-11
1
14
Feb-12
Jan-12
Mar-12
Feb-12
Apr-11
Mar-12
Apr-11
0
May-11
May-11
0
Jun-11
Jun-11
0
Jul-11
Jul-11
0
Aug-11
Aug-11
0
Sep-11
Sep-11
0
Oct-11
Oct-11
0
Nov-11
Nov-11
0
Dec-11
Jan-12
Dec-11
0
Feb-12
Jan-12
Mar-12
Feb-12
Mar-12
56
ANNEX
C
Monthly Healthcare Associated Infection Case Numbers for NHS Dumfries and Galloway – December 2011
Monthly Number of Clostridium difficile Infection (CDI) cases in patients aged 65 and over.
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
DGRI
1
2
2
7
3
6
Jul-11
1
Aug-11
2
Sep-11
1
Oct-11
1
Nov-11
0
Dec-11
3
Community Hospitals*
0
0
0
0
0
1
1
2
0
0
0
0
Out of Hospital Infections**
5
4
5
3
0
4
3
4
2
3
1
3
Board Total
6
6
7
10
3
11
5
8
3
3
1
6
Jul-11
0
Aug-11
0
Sep-11
0
Oct-11
0
Nov-11
1
Dec-11
0
Monthly Number of Clostridium difficile Infection (CDI) cases in patients aged under 65 years.
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
DGRI
1
0
0
1
1
1
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
1
1
1
0
2
0
3
0
0
Board Total
2
0
0
2
2
2
0
2
1
3
1
0
15
57
Monthly Number of MRSA Bacteraemia cases
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
DGRI
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Board Total
0
0
0
0
1
0
0
0
0
1
0
0
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Monthly Number of MSSA Bacteraemia cases
Jan-11
Feb-11
DGRI
0
2
1
3
2
2
0
4
2
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
2
1
0
1
Board Total
0
2
1
3
2
2
1
5
4
2
1
2
* Community hospitals should be reported as a single total
** For the purposes of this report, patients identified within 48 hours of admission with a SAB or Clostridium difficile infection (CDI) will be included as part of the
'Out of Hospital Infections' total. This total will also include infections from community sources, such as GPs and Care Homes.
16
58
MONITORING FORM
Consultation
Committees
Risk Assessment
Best Value
Sustainability
Compliance
Objectives
with
Achievement of HAI HEAT targets
Nil
Nil
Update paper only consultation not required
Update paper only. Contents are agenda items for
discussion at PCCD and HMG and SCN meetings
Addressed through the corporate risk register
Governance and Accountability
• sound governance at a strategic and
operational level
Fewer infections will reduce bed occupancy and
use of resources
Corporate 7. To meet and where possible, exceed goals and
targets set by the Scottish Government Health
Directorate for NHSScotland, whilst delivering the
measurable targets in the Single Outcome
Agreement.
Single Outcome Agreement Nil
(SOA)
Impact Assessment
Not required. Update paper only
17
59
Agenda Item 241
6 February 2012
Sustaining the Vision – Making a Difference
Allied Health Professions in Dumfries and Galloway
Author:
Hazel Dykes, Associate Director AHPs
RECOMMENDATION
The Board is asked to consider and discuss the current strategic drivers, service
developments and future priorities for the Allied Health Professions in NHS Dumfries
and Galloway.
SUMMARY
The Allied Health Professions (AHPs) collectively provide a unique contribution to
rehabilitation, diagnostics and health improvement.
This group of professions is made up of:
Art Therapy*
Drama Therapy*
Dietetics
Music Therapy*
Occupational Therapy
Orthoptics
Orthotics** and Prosthetics*
Physiotherapy
Podiatry
Radiography (Diagnostic and Therapeutic*)
Speech and Language Therapy
*not directly employed in D and G
** Joint post with Ayrshire and Arran
Key Messages:
• AHPs play a key role in enabling individuals to continue living at home and
help facilitate early discharge from care settings.
• AHPs work in partnership with patients and families, social care and the
voluntary and independent sectors to support and assist people to optimise
60
•
•
•
their independence and wellbeing.
AHPs have a strong focus on safe, effective, person-centred care and can
assist boards and local authorities to effectively meet the challenges of
providing equitable and sustainable high quality services.
Integrating AHP services into primary and community care multi-agency
teams is essential to obtain optimum benefit from their specialist skills and
approaches to care.
Effective leadership is critical for effective change.
GLOSSARY OF TERMS
AHP
Allied Health Professions
GM
General Manager
MH
Mental Health
MSK
Musculoskeletal
NMAHP Nurses, Midwives. Allied Health Professionals
OT
Occupational Therapy
PYF
Putting You First
SLT
Speech and Language Therapy
1. The strategic contexts
“Allied Health Professionals (AHPs) are critical to people’s ongoing assessment,
treatment and rehabilitation throughout their illness episodes. They support people
of all ages in their recovery, helping them to return to work and to participate in sport
or education. They enable children and adults to make the most of their skills and
abilities and to develop and maintain healthy lifestyles. They provide specialist
diagnostic assessment and treatment services”. Building on Success - Future Directions for
the Allied Health Professions in Scotland June 2002
AHPs make a significant contribution to improving the health and wellbeing of people
and have established a reputation for being health professionals firmly committed to
building and maintaining therapeutic partnerships with patients and their families.
Interventions by AHPs include supporting faster access to diagnostics and providing
early assessment and offering advice and treatment to help individuals realise their
full potential and be able to function effectively in the communities in which they live.
Paediatric therapists support children to get the best possible start developmentally
and enable the majority to participate in education; people with learning difficulties
are helped to live fulfilling lives and those with mental health problems are able to
work with AHPs to focus on their strengths, their recovery and their ability to remain
in or return to work.
Patients in hospital have the required treatment to recover
from surgery and illness, manage their symptoms and return home as early as
possible as a result of AHP input. People can also now self refer to AHP services
for a variety of conditions e.g. communication difficulties, musculoskeletal problems
and foot care.
Patients and carers frequently state that AHP services make a significant difference
through supporting individuals to improve their quality of life. AHPs play a central
61
role in helping individuals to live self-determined, independent lives wherever
possible avoiding unnecessary admission to hospital or care settings. This is
particularly relevant to older people and those with dementia or complex needs
where a change of environment can be very disruptive and unsettling for the
individual and their family.
AHP services across Scotland have a common purpose that can be summed up in
the following delivery statements. AHPs can:
•
•
•
•
•
•
Play a central role in reshaping older people services by leading the delivery of
community-based rehabilitation and reablement approaches working through
effective partnerships across health and social care.
Release health and social care resources within the community by using AHP
expertise to underpin supported self management, enablement and independent
living approaches within the communities they serve.
Work as first point of contact practitioners to support early diagnosis and
intervention in primary care and provide an alternative to outpatient referral.
Actively support reductions in the number of unplanned admissions to hospital
and/or care settings through targeted early and anticipatory interventions as part
of multi-professional teams.
Reduce length of stay and improve patient flow through enhanced recovery and
early supported discharge.
Release capacity in AHP services to deliver these improvements through
productive and modern working practices such as effective triage and
telerehabilitation.
2.
The local context
2.1
AHP Professional Leadership
The AHP Associate Director is the professional lead for AHP staff and this post sits
within the NMAHP Directorate led by the Nurse Director.
2.2
The role of AHPs
Profession
Main function
Patient/client groups
Arts Therapists
Provide psychotherapeutic
interventions which enable clients All age groups - mental health,
learning disability, palliative care,
to gain insight and promote the
and other community groups.
resolution of difficulties through
the use of art materials.
Dietitians
Translate the science of nutrition
into practical information about
food. They work with people to
promote nutritional wellbeing,
prevent food-related problems
and treat disease.
Drama Therapists
Encourage clients to experience
their physicality, to develop an
All age groups - especially
ability to express the whole range
mental health and other
of their emotions, and to increase
community groups.
their insight and knowledge of
themselves and others.
All age groups with special
dietary requirements or those
needing advice and education on
nutrition.
62
Music Therapists
Facilitate interaction and
All age groups - mental health,
development of insight into clients'
learning disability, physical
behaviour and emotional
disability.
difficulties through music.
Occupational Therapists
Assess, rehabilitate and treat
people using purposeful activity
and occupation to prevent
disability and promote health and
independent function.
All age groups where physical or
mental functioning impact on
everyday life, especially children,
older adults and those with
chronic disease.
Orthoptists
Diagnose and treat eye
movement disorders and defects
of binocular vision.
Mainly children and older adults.
Orthotists
Design and fit orthoses (such as
callipers and braces) which
provide support to parts of
patients' bodies and compensate
for paralysed muscles, provide
relief from pain, or prevent
physical deformities.
All age groups with injury or
physical disability.
Physiotherapists
Assess and treat people with
physical problems caused by
accident, ageing, disease or
disability, using physical
approaches to maximise the
patient's recovery and alleviate
pain.
All age groups - especially those
with neuromuscular,
musculoskeletal, cardiovascular
or respiratory problems.
Prosthetists
Provide care and advice on
rehabilitation for patients who
have lost or were born without a
limb, fitting the best possible
artificial replacement.
All age groups of those missing
limbs or amputees.
Podiatrists
Diagnose and treat abnormalities
of the foot. They give professional All age groups - mainly older
advice on prevention of foot
adults and those with chronic
problems and on proper care of
disease - e.g. vascular, diabetes.
the foot.
Diagnostic Radiographers
Produce high quality images on
film and other recording media,
using all kinds of radiation.
Therapeutic Radiographers
Treat mainly cancer patients using
ionising radiation and,
All age groups - mainly
occasionally, drugs. They provide individuals with cancer and
care across the entire spectrum of tissue defects.
cancer services.
Speech and Language
Therapists
All age groups - especially
Assess, diagnose and treat
children and those with
people with communication and/or
neurological or cancer-related
swallowing difficulties.
problems
All age groups.
2.3
The structure of AHP services in Dumfries and Galloway
The AHP Services in NHS Dumfries and Galloway sit within a number of the
Directorates – East and West Primary Care, Diagnostics, Mental Health, Women and
63
Children and Acute – depending on either, the most appropriate clinical links to
services also operationally managed within the same directorate, or the division of
workload for the general managers. For example, Radiography is operationally
managed by the Diagnostics general manager who also operationally manages
Radiology Services; Dietetics is operationally managed by the West Primary Care
Directorate general manager, but the department is area wide and provides acute
and primary care dietetic services.
Each of the services has a professional lead who is accountable to their respective
general manager for operational activity and the Associate Director for professional
matters.
AHP staff are based in a variety of locations including hospitals, health centres and
specialist departments. They provide assessment and treatment wherever it is most
appropriate, for example, patients own home, outpatient clinic, school, specialist
department etc.
3.
Current priorities, service developments and planned actions
It is essential that the expertise of the Allied Health Professions is utilised effectively
to obtain maximum benefit from their unique skills.
This is now increasingly
important as we move towards better integration with the social care and the third
and independent sectors. The values of AHPs’ absolutely complement those of
NHSScotland.
“Collaboration, co-operation, partnership working,
service provision and effective communication”.
increased
flexibility,
local
AHPs fully understand the need for their talents to be used as appropriately, flexibly
and timeously as possible and skill mix review, role development and working hours
are continuously reviewed within each service.
There have been a significant number of changes in recent years to the way AHPs
contribute to care pathways that are too numerous to mention in one paper.
However the following examples give an indication of the type of developments that
have been introduced:
•
Lead Physiotherapist for Stroke – to provide specialist advice to all groups of
staff on stroke rehabilitation.
•
Advanced Practitioner Radiographers – to undertake plain film reporting
previously undertaken by Consultant Radiologists.
•
Extended Scope Physiotherapist in Orthopaedics – to triage, assess and treat
patient referred with back problems avoiding the need for an orthopaedic OP
appointment.
•
Redesign of Mental Health Occupational Therapy Services – to ensure best
use of specialist expertise.
•
OT Triage for Hand Conditions prior to surgery – to ensure best post
operative recovery and functional outcome.
•
Specialist Falls Prevention Physiotherapists – to provide advice across all
care sectors in the best approach to falls prevention.
64
•
•
Occupational Health Specialist Physiotherapist – to reduce the length of time
that staff are off work due to MSK problems.
Radiography Assistant Practitioner posts – to undertake some of the more
straightforward duties within the radiography department.
There is still much work to do to review and redesign AHP services in line with the
changing healthcare environment. Locally this is particularly in relation to Putting
You First and the integration agenda recently advocated by the Cabinet Secretary.
In addition there is the need to further develop the use of technology to support
patients and staff, for example, greater use of Telehealth equipment to help people
stay in their own homes, central booking systems for outpatient services to optimise
usage of staff time, the use of the Telepresence suite to reduce travelling time for
staff to peripheral clinics and expedient introduction of the MiDIS database for
effective information sharing.
4.
Conclusion
AHP expertise is already recognised and valued. However, it could be more
effectively utilised as we continue to move towards improved joint working.
AHPs continually demonstrate their commitment to service improvement and high
quality patient care. The important role that they have in supporting the delivery of
safe, effective, person-centred care should be fully utilised as we develop the clinical
service changes of PYF and other national policy.
65
MONITORING FORM
Delivery Framework for Adult Rehabilitation 2007
Healthcare Quality Strategy for NHSScotland 2010
Realising Potential 2010
Joint Declaration on NMAHP Leadership 2010
From Strength to Strength 2011
Achieving Sustainable Quality in Scotland’s
Healthcare – A ’20:20’ Vision 2011
Any workforce elements of work described in this
paper are in line with HR and staff side
requirements.
Not applicable as this is an update paper for Board
Consultation
Not applicable as this is an update paper for Board
Consultation with Professional Not applicable as this is an update paper for Board
Committees
Not required for this paper.
Risk Assessment
Best Value
Vision and Leadership
Effective Partnerships
Sustainability
Effective AHP services contribute significantly to
the health and wellbeing of a defined population.
Compliance with Corporate Objectives 1 - 7
Objectives
Single Outcome Agreement Effective partnership working.
Health inequalities.
(SOA)
Impact Assessment
The provision of high quality, effective AHP services is relevant to all. Specific
provision needs are addressed as required of joint service change and development.
66
Agenda Item 242
20 January 2012
Workforce Plan 2011-2013
Author:
Tracy Davidson, Workforce Development
Manager
Caroline Sharp, Workforce Director
RECOMMENDATION
The NHS Board is asked to endorse the 2011-2013 Workforce Plan which was
approved by the Staff Governance Committee on behalf of the Board at its meeting
on Thursday 15 December 2011.
SUMMARY
The draft Workforce Plan was released for an 8 week consultation on 4 July 2011.
The following groups or committees were provided with the document:
• NHS Board
• Area Partnership Forum
• Staff Governance Committee
• Hospital Management Group
• Primary and Community Care Management Group
• Area Clinical Forum
• All NHSD&G Staff
• All General Managers
• All Executive Directors
It was also published on the intranet for staff to access and comment on.
In addition, facilitated workshops were held with the NHS Board and Area
Partnership Forum which provided an opportunity to provide more information on the
consultation and debate the plan.
The feedback received during the consultation period provided a useful insight into
the wider organisation’s perception of what the Workforce Plan should include (or not
include). This feedback was reflected back to the Staff Governance Committee in
67
September 2011 and agreement was reached to review the plan taking into
consideration the range of feedback received.
There was specific feedback on whether the plan contained the right balance of
strategic versus operational content. This has been taken into account in the redraft of the plan which is now a more strategic and future-focussed document.
A key positive outcome of the consultation process was an increased level of
engagement with our professional structures and committees which was reflected in
the feedback received from the Area Partnership Forum and the Area Clinical
Forum. It was generally acknowledged that the facilitated feedback sessions had
worked well and could be developed as part of the consultation process on an
ongoing basis.
The revised plan was presented to the Staff Governance Committee in 15 December
2011 and the committee approved the plan on behalf of the Board, as per the
requirements of the extant HDL.
Following this approval, the Workforce Plan is now presented to the full Board for
endorsement of the Staff Governance Committee’s decision.
GLOSSARY OF TERMS
HDL – Health Department Letter.
68
MONITORING FORM
Workforce Strategy Development in general, plus
impact on local service plans.
Two-year staff projections are included in the Plan,
however these may be subject to change and
revision as service needs dictate; any changes
would be agreed in conjunction with staff side
colleagues.
Any workforce planning activity must meet the
Affordability, Availability & Adaptability tests as
highlighted in HDL 52.
Consultation
Consultation took place as described within this
paper
Consultation with Professional As above.
Committees
Risk Assessment
Workforce risks are noted on the corporate risk
register and the Workforce Directorate risk register.
Best Value
Most of the principles of Best Value have been
demonstrated in the development of the draft
Workforce Plan (e.g. Use of Resources, Effective
Partnerships, Governance and Accountability)
Sustainability
The sustainability of our healthcare services, and
the impact they have on the community and
environment, have been taken in account.
Compliance
Objectives
Single
(SOA)
with
Outcome
Corporate All have relevance, but in particular Corporate
Objectives 2, 4, 5 and 6.
Agreement Areas of partnership and combined/joint services
delivery with the Council have been considered in
the Plan.
Impact Assessment
An Equality Impact Assessment (EQIA) has been carried out.
69
WORKFORCE PLAN
2011-13
70
NHS Dumfries & Galloway
Workforce Plan 2011- 2013
Contents
1. Context
2. Drivers For Change
3. Defining The Future Workforce
4. Current Workforce
5. Workforce Action Plan
6. Plan Implementation, Monitoring and Review
NHS Dumfries & Galloway Workforce Plan 2011-13
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71
SECTION 1.0
CONTEXT
Introduction and Purpose of the Plan
This Workforce Plan covers 2011-2013 and has been developed using the Six Steps Methodology to
Integrated Workforce Planning1. The plan supports our workforce projections which are submitted to
the Scottish Government on an annual basis.
The Workforce Plan describes the challenges that we face nationally and locally and identifies strategic
actions needed to deliver the ambitions within our strategic change programme ‘Putting You First’.
SECTION 2.0
DRIVERS FOR CHANGE
There are four key factors that will influence the development of services within NHS Dumfries and
Galloway over the next few years; our strategic change programme, the Quality Strategy, the local
population demographics and our own workforce profile and finally the financial context within which we
operate.
2.1
Strategic Change
The key service strategy currently being implemented within Dumfries and Galloway that will have a
major impact on workforce is the local change programme ‘Putting You First’.
Putting You First sets out to test change that is:
•
•
•
•
Person centred
Safe
Delivered in partnership
Delivered as close to home as appropriate
The aim is that “People will be at the heart of the services we have in place. We will work with them as
partners to be as fit and able as possible and provide services and care as close to home as clinically
and professional possible with services built around people and communities. Our staff and partners will
have the skills and resources necessary to provide this”.
It is anticipated that the changes put in place will lead to sustainable, transformational change in the
way that public sector services are provided and in the balance of care where those services are
provided. The programme is being delivered in partnership between NHS Dumfries and Galloway,
Dumfries and Galloway Council, and the 3rd and independent sectors and is overseen by a Change
Programme Board.
Our ambition for services is:
•
•
•
1
To place people firmly at the centre of services that are agile and flexible; able to be
responsive to people’s lives and changing needs;
To place the primary focus of services on maintaining or re-establishing well-being and
independence;
To take a prevention/early intervention approach, anticipating potential or expected outcomes
wherever possible and planning for these with patients and their families and carers as
partners.
Six Steps Methodology to Integrated Workforce Planning, Skills For Health – Workforce Projects Team, 2008
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The overall approach of the Change Programme is one of well-being and independence, underpinned
by;
• Partnership working with Dumfries and Galloway Council, 3rd and Independent Sector and the
communities we work within
• Self management and support for carers, (development of Carers Strategy)
• Prevention, early intervention and re-ablement
• Rapid response
• Information and support
• Anticipatory Care
• Telehealthcare/E-health (including development of skills/training)
2.2
The Quality Strategy
The Healthcare Quality Strategy2 for NHSScotland published in May 2010 puts people at the heart of
the NHS by delivering measurable improvement and delivering the highest quality healthcare. NHS
Dumfries and Galloway will use every opportunity to embed the quality ambitions of this strategy into its
business, specifically through;
•
•
•
•
•
Engaging effectively with staff, patients and the public regarding service change and
development
Including quality in all our strategic and operational planning meetings and discussions
Developing local service measures that move towards qualitative measures as well as
quantitative and that are more meaningful to staff and users
Promoting leadership that encourages staff at all levels to challenge current thinking and ways
of working and that welcomes ideas and innovation
Learning from our mistakes and not being afraid to admit that we do not always get things right
In addition, we will liaise with NHS Education for Scotland to ensure that any education required to
support patient safety and the Quality Strategy is incorporated within the service.
NHS Dumfries and Galloway has signed a memorandum of understanding with University of the West of
Scotland which we will use to maximise opportunities for developing a quality education and career
development framework for our workforce.
2.3
Population and Workforce Demographics
Changes to the local population and labour market require us to plan our future workforce now. The
current population of Dumfries and Galloway is substantially different from the Scottish population
profile. There is a larger proportion of older people, and a markedly smaller proportion of young people.
The average age in Scotland is 40.1 years whereas in Dumfries and Galloway it is 43.6 years.
Figure 1: Population Projections for Dumfries and Galloway
2
The Healthcare Quality Strategy, The Scottish Government, May 2010
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73
Population Projections for Dumfries & Galloway by Age Group
Percentage Change
0-15
16-64
65+
60%
50%
40%
30%
20%
55.8%
10%
0%
-10%
-20%
-30%
-8.1%
-18.7%
2008
2013
2018
2023
2028
2033
Year
Source: GROS 2008-based
The working age population of Dumfries and Galloway is predicted to decline by 10.8% by 2033. This
will see a decrease in the size of the available workforce from 86,000 in 2008 to approximately 77,000
in 2033. The male workforce is predicted to decline by 9.7%, a reduction of 7,000 people. The
estimates take into account the change in women's state pension age between 2010 and 2020 and the
subsequent change of both male and female state pension age to 66 by 2026. These changes to state
pension age counteract some of the natural loss of the workforce through ageing. Further proposals to
increase the state pension age are not yet reflected in these figures.
The recession appears to be affecting the local labour market in Dumfries & Galloway; in 2008 the
Employment Rate (those of working age 16-64) was 73.5% and at 2010 is 72.4% (although still higher
than the average for Scotland which is 71%). This increase in supply within the local labour market is
evidenced by increasing numbers of applicants for posts in the organisation, although this is coupled
with a few specialised posts which remain hard to fill.
The age profile of our current workforce means we need take this into account when planning our future
workforce, some key statistics are:
18% of Nursing & Midwifery Staff are 55+
32% of Nurses in Band 5-8 are 55+
30% of Support Staff are 55+
75% of Estates staff are in the age band 50-60+
The Reshaping the Medical Workforce Project, a national strategic policy of moving to a health service
predominantly delivered by trained doctors and to reduce the reliance of trainees for front-line service
delivery. This will be translated into 25% reduction in trainee numbers and 40% reduction in middle
grade numbers, again another driver for planning for our future workforce now.
2.4
Financial Context
The draft Scottish Government budget has now been confirmed following the three year spending
review which concluded in September. In line with previous years the Board’s allocation letter will be
issued during February 2012 following approval of the Scottish Budget. There has been no significant
change in financial planning assumptions for 2012/13, with a 1% general uplift position confirmed,
against a headline uplift of 2.19%.
A pay freeze for the public sector in Scotland has been confirmed for 2012/13, although the latter years
of the budget have not been agreed. The Scottish Government have also proposed that the national
changes to Public Sector Pensions be implemented from next financial year.
SECTION 3.0
DEFINING THE FUTURE WORKFORCE
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74
We measure our success in delivering our purpose and outcomes as an organisation against the four
dimensions of success pictured above. Each of these dimensions is integral to our achievement of
excellent care that is person-centred, safe, effective, efficient and reliable. Achieving balance across
the four dimensions in strategic planning, service and workforce redesign and operational delivery
means that the patients and public of Dumfries & Galloway, and our staff, are confident that our decision
making at all levels within the organisation is informed by the quality ambitions, patient experience and
patient safety, appropriate service pathway and design and delivery, an engaged and motivated
workforce and effective, best value use of all the resources available to us.
Future workforce demand is reviewed on an ongoing basis and the workforce changes made are all part
of a wide variety of service redesign schemes which are agreed and taken forward in partnership with
Staff Side colleagues and, where appropriate, in consultation with users and carers. In addition
Dumfries and Galloway are also committed to meeting the national target to reduce the number of
senior managers by 25% between 31st March 2010 and 1st April 2015.
For 2012/13, Whole Time Equivalent changes within the workforce will be delivered through service
redesign and include skill mix reviews and the implementation of more effective rostering and job
planning. In conjunction with this, a number of other management activities are being actively pursued
to further increase workforce efficiency where it is safe and appropriate to do so, including;
•
•
•
All services are proactively reviewing any vacancies as they arise and carefully managing
recruitment on a case by case basis.
All services use robust management of the redeployment register to ensure that all vacancies
are tested against the redeployment register prior to wider advertising.
The organisation has undertaken an assessment of fixed term contracts and the contracts for
those individuals identified as being beyond retirement age.
Workforce Projections 2012/13 to be inserted
SECTION 4.0
CURRENT WORKFORCE OVERVIEW
NHS Dumfries & Galloway employs 4,4493 staff (3,490 Whole Time Equivalent). Our workforce is
predominantly female (5:1), a higher ratio than the Scottish average which is almost 4:1 female to male.
Figure 2 represents the workforce by pay band (based on data at 30th September 2011, and includes
Medical and Dental staff who are not aligned to Agenda for Change pay bands but have been
assimilated to those for this purpose).
3
Source – SWISS (Scottish Workforce Information Standard System) Standard Report @ 30 September 2011
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75
This pyramid-type chart be used to represent the whole workforce, service areas or the workforce in
particular locations. It can be a helpful tool to visualise where there are gaps in particular areas or an
imbalance in staff numbers at any one level. For example, relatively small numbers in one band might
reveal limited opportunities for staff in terms of career progression which could potentially impact on our
ability to retain staff.
Figure 2: Pay Band Distribution of NHS Dumfries & Galloway at 30th September 2011
Agenda For Change Band
9
Administrative Services
8d
Allied Health Professions
8c
Out of Hours Drivers
8b
8a
Health Science Services
Medical & Dental
Medical & Dental Support
7
Nursing & Midwifery
6
Other Therapeutic
5
4
Personal & Social Care
Support Services
3
2
1
Figure 3: Age Profile of NHS Dumfries & Galloway at 30th September 2011
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76
Employees aged 55 or over, who are coming up to retirement age in the next ten years, account for 891
members of staff in NHS Dumfries & Galloway. This is equivalent to 20% of the current workforce. It is
also important to remember that many NHS jobs have a physical element that may become less
attractive to older employees.
Figure 4: Breakdown of Workforce aged 55+ by Job Family at 30th September 2011
0%
6%
0%
Medical
20%
Dental
Medical/Dental support
Nursing & midw ifery
AHPs
45%
19%
Other therapy
Personal & social care
Healthcare science
1%
3%0%
2%
Emergency Services (Out of Hours)
4%
Administrative services
Support services
Figure 5: Current Workforce by Staff Group and Gender at 30th September 2011
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77
Figure 6: Current Workforce by Gender and Contract Type at 30th September 2011
The number of staff vacancies is an important indicator of the current workforce. Nursing and Midwifery
vacancies were 0.9% of the staffing establishment as at 30th June 2011, of which 0.1% had been vacant
for over three months. The vacancy rate for Consultant staff was considerably higher at 9.2%, with the
majority of consultant posts remaining vacant for over six months. The vacancy rate for Allied Health
Profession staff groups was 2.0%. All vacancy rates are consistent with levels in previous timeframes.
Table 1: Vacancies in Medical, Nursing and Allied Health Professions at 30th June 2011
Staff in Post
Total Vacancies
- Less than 3 months
- 3 months or more
- less than 6 months
- over 6 months
Total Vacancy Rate %
Over 3 months Vacancy Rate
Over 6 months Vacancy Rate
Nursing &
Midwifery
1,731.1
15.8
13.8
2.0
0.9%
0.1%
-
Allied Health
Professions
240.9
5.0
5.0
2.0%
0.0%
-
Medical
Consultant
109.0
11.0
4.0
7.0
9.2%
5.8%
Source: ISD – NHSScotland Workforce Statistics
SECTION 5.0
OUR FUTURE WORKFORCE ACTION PLAN
Our ambition:
As an organisation, we will enable the delivery of excellent, safe health and healthcare through our
workforce by creating a culture and an infrastructure which fosters a person centred, healthy and
productive workforce which is designed, recruited, supported and developed efficiently and effectively to
deliver the organisations purpose and outcomes.
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78
We will achieve this by:
Embedding the five Staff Governance Standards, equality and diversity principles and our Code of
Positive Behaviour as core organisational values, and deliver against these values in every interaction
our workforce undertakes.
Our outcomes will be:
1. The right people to succeed within and for our organisation will have been identified, attracted
and recruited to our organisation to deliver quality, person centred services.
2. The future design of our workforce and the processes that support it will deliver safe, efficient,
effective and reliable services which align employee responsibilities, behaviours and actions to
the organisations purpose and outcomes.
3. An organisational culture will have been created through working with staff and partners that
nurtures and enables talent to flourish and fosters a culture of empowered leadership that
delivers transformational change through highly engaged and motivated staff.
4. Staff will actively participate in learning and development to deliver high performance teams that
learn for improvement at all levels in the organisation.
5. The workforce will be ambassadors for equity, health improvement and workforce wellbeing and
will seek through all interactions to promote these principles of equity, health and wellbeing
across the organisation.
Workforce Dimensions of Success
5.1
Recruitment and Selection
We recognise that to achieve our planned outcomes, we need to be an employer of choice which
attracts and retains staff, supported by first class recruitment, selection, induction, performance
management and staff development processes.
To achieve this we will:
•
•
Maximise the opportunities for staff within NHS Dumfries and Galloway and the general
population of this area by continuing to develop employability and volunteering initiatives, and
where appropriate, to undertake this in collaboration with our partners, including further and
higher education providers.
Develop a Young People’s Employment Framework in conjunction with the Local Authority which
confirms our commitment to working with young people, with a focus on further development of
the range of opportunities provided under our Modern Apprenticeship programme, the
development of other access and training initiatives that enable young people at or leaving
school or further education in our region to make informed choices about the diversity of careers
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79
•
•
•
5.2
and opportunities within the NHS and promotes equity of access to careers to the public sector
for young people, in line with the ambitions of ‘More Choices, More Chances’.
Explore potential synergies with the Local Authority with respect to the planning of our services,
sharing our resources and promoting our region as a positive work / life destination.
Use local and national workforce information to identify and target recruitment and retention ‘hot
spots’ within our workforce at directorate level, via directorate workforce plans, and design
appropriate tailored interventions to address them.
Build career frameworks for the development and progression of talent within our organisation
through the development of new and extended roles such as Maternity Care Assistant,
Healthcare Support Worker, Assistant Practitioner roles in for example Radiography,
Physiotherapy and Occupational Therapy, we will extend the use of the Advanced Nurse
Practitioner role, and we will continue to develop the Extended Scope Practitioner role.
Workforce Design and Productivity
The future shape and design of our workforce will significantly change over the next ten years as we
realise the impact and benefits of our workforce demographics, ‘Putting You First’, new, and developing
services and patient pathways at local, regional and national levels, as well as the fiscal challenges that
the NHS and wider public sector faces.
To achieve this we will;
•
•
•
•
•
•
Fully integrate workforce planning into our service and financial planning at all levels within the
organisation, to identify future workforce design requirements and benefits, and put plans in
place to achieve the changes required in partnership. In particular, develop a workforce design
and development plan as part of the “Putting You First” programme plan, to ensure that
workforce planning is an integral part of the overall service planning undertaken throughout the
programme’s development.
Develop annual Directorate level workforce action plans that identify the changes required within
the directorate workforce for future service delivery that reflect professional considerations with
regard to workforce change and describe how these changes will be achieved.
Utilising workforce planning tools and methodologies where they are available to inform decision
making in relation to workforce design and skill mix.
Utilise national and local quality and productivity programmes, such as ‘the Productive Series’
and ‘Releasing Time to Care’, and e-health programmes and technologies to support individuals
and teams to maximise their contribution in their role, working with partners in areas of joint
interest and opportunity.
Increase efficiency and productivity of the core workforce through;
Reducing bank, agency and overtime spends
Maximising change and improvement opportunities through natural labour turnover
without creating a static organisation
Improving processes for and long term effectiveness of redeployment
Reducing sickness absence levels to 3.5% and increasing our focus on employee
wellbeing and attendance
Creating skills mix shifts where these are safe and appropriate to service delivery
Improvements in rostering efficiency organisation wide, including assessment of future
opportunities for the implementation of e rostering
Improvements in job planning for doctors, realising benefits from increased efficiency and
focus of medical resources across the organisation
Create an environment that encourages innovation and change for quality, service and financial
improvement through programmes such as;
Efficiency & Productivity Framework for SR10 2011-2015
The Little Red Book Initiative
What If? Innovation Fund
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5.3
“Putting You First” and the Strategic Change Fund
Organisational Culture and Leadership
We recognise that to achieve an organisational culture that enables talent to flourish and fosters a
culture of empowered leadership that delivers transformational change and highly engaged and
motivated staff we need to deliver an employee experience that reflects these core values, beliefs and
attitudes over time.
To achieve this we will;
•
•
•
•
•
•
5.4
Shape our organisational environment and culture through working with employees, staff side
and other partners using the principles of Strengths Based Leadership and Adaptive Leadership
theory.
Guide the definition of a talent management and succession planning strategy over the next
twelve months through our new ‘Building for Success’ Leadership Development Framework.
Develop the use of a competency based approach for development of workforce plans at team
and directorate levels to enhance understanding of the roles and capabilities required for the
future, and the changes required to achieve this.
Develop a thorough understanding of the nature of the ‘staff experience’ through the national
project led by NHS Dumfries and Galloway in partnership with NHS Forth Valley and NHS
Tayside, linking this to patient experience and making explicit connections to the quality of
patient outcomes and embed this learning within the organisation at individual, team and
organisational levels.
Deliver the actions set out in our annual Staff Governance Action Plan at team, directorate and
organisation levels and embed the standards within the organisation’s culture to achieve
continuous improvement in performance against the five Staff Governance Standards.
Demonstrate leadership and management of transition and change in a respectful and dignified
manner that reflects the Board’s Code of Positive Behaviour and the National Dignity at Work
Toolkit.
Learning and Development for Improvement
The organisation will only achieve its objectives and the Quality Strategy ambitions through developing
a cohort of staff who actively participate in continuous learning and development and who strive to
deliver in high performance teams that learn for quality improvement and embed that learning at all
levels in the organisation.
To achieve this outcome we will;
•
•
•
•
Undertake a learning, development and improvement skills and competencies audit, in
conjunction with our key partners, and use this information to maximise the benefits that they
can bring to improvement work undertaken within our organisation going forward.
Review our organisational, team and individual learning needs to update our Learning and
Development Strategy aligned to NHS Dumfries and Galloway purpose and outcomes with a
clear focus on corporate, directorate and operational needs to deliver education that will develop
a quality and improvement focused workforce now who are adaptable and resilient in the future.
Improve educational governance to ensure best value for all training opportunities by maximising
the contribution of the Strategic Education Development Group.
Make explicit links between existing frameworks such as Knowledge and Skills Framework,
Career Framework, Scottish Credit and Qualifications Framework, NHS Education Scotland
Professional Frameworks and embed the use of these frameworks in career planning and role
development.
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•
•
•
•
5.5
Maximise the use of technology as a delivery method for staff learning and development, to
improve access and flexibility.
Build on key partnerships e.g. Higher Education Institutions, Further Education Institutions,
Community Planning Partners, NHS Education for Scotland, Skills for Health, Scottish
Qualifications Authority, other Boards to share best practice expertise and resources.
Follow an Organisational Development/Organisational Effectiveness approach to support
strategic change programmes (e.g. Putting You First) and other Directorate/Team-level
interventions. This includes assessing the workforce impact of the introduction of for example
telehealth models of service provision as a key element of our strategic direction, to ensure our
workforce will have the necessary training and skills to deliver services in this way
Ensure that all education and development interventions developed have an evaluation
framework with Return on Investment built in and where appropriate, increase the use of Patient
Reported Outcome Measures within these frameworks in order to provide quantitative evaluation
and metrics of the benefits of learning and development interventions to patient outcomes and
experience.
Equity, Health and Wellbeing
To address the challenges nationally within ‘A Force For Improvement’ and the national OHSFoR
strategy ‘Safe and Well at Work’ published earlier this year, and the parallel equity, health and wellbeing
challenges within our local environment, it is recognised that all staff within Dumfries & Galloway need
to be ambassadors for equality, health improvement and workforce wellbeing and should seek through
all their interactions with each other, and with patients and the wider community to promote these
values across the organisation and within the communities we serve and live within. Coupled with this
is the recognition that affording the workforce the opportunity to maintain an appropriate work-life
balance, promotes positive staff morale and motivation which significantly contributes to more effective
service delivery.
To achieve this ambition we will:
•
•
•
•
Develop and deliver all health, safety and staff wellbeing actions and interventions in accordance
with the aims of the ‘Safe and Well at Work’ strategic framework with particular focus on:
o respect and dignity within the workplace
o promoting and enabling attendance at work, and developing and reviewing policies to
enable this
o provision and delivery of staff support services which are person centered and
demonstrate a clear commitment to the overall health, safety and wellbeing of staff
Working in partnership via the Area Partnership Forum develop and embed a ‘safe and aware’
culture that proactively enables and supports safety and health at work throughout the
organisation, and minimises adverse incidents in the workplace
Deliver the actions and interventions set out in the organisations Single Equality Scheme, and
assess the impact of those interventions on staff and patient experience to identify areas for
further improvement
Review our Code of Positive Behaviour for staff and our Healthy Understanding between NHS
Dumfries and Galloway and the People of Dumfries and Galloway together within the context of
our core purpose and values, and ensure they are embedded within the organisation going
forward
SECTION 6.0
PLAN IMPLEMENTATION, MONITORING AND REVEW
The delivery of this Workforce Plan and the specific actions held within local workforce plans will be
monitored by the Workforce Steering Group and through regular workforce data reports to the Board’s
Staff Governance Committee and Area Partnership Forum.
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82
SUMMARY OF CONSULTATION FEEDBACK
The draft Workforce Plan was released for an 8 week consultation on 4th July 2011. The following
groups or committees were asked to comment on the plan and it was also published on the intranet for
staff to access and comment on:
•
NHS Board, Area Partnership Forum, Staff Governance Committee, Hospital Management
Group, Primary and Community Care Management Group, Area Clinical Forum, All NHSD&G
Staff, All General Managers, All Executive Directors.
In addition, there were facilitated workshops with the NHS Board and Area Partnership Forum which
provided an opportunity to provide more information on the consultation and debate the plan. The
feedback received during the consultation period provided a useful insight into the wider organisation’s
perception of what the Workforce Plan should include (or not include).
In the main, the feedback received was around the balance in the plan of strategic versus operational
content. This has been taken into account in this re-draft of the plan which is now a more strategic and
future-focussed document. It is important though that we do not lose sight of our ambition to develop
bottom up workforce planning, and this will continue to be driven through workforce plans at Directorate
Level.
Acronyms used in this plan
AHP
ISD
SWISS
Allied Health Profession
Information Services Division
Scottish Workforce Information Standard System
Page 14 of 15
83
If you know of someone that may be interested in this information and for any reason is unable to read
it, please tell them about it. We are happy to provide this document in other formats.
For any further information on the Workforce Plan or to access it in other formats please contact:
Tracy Davidson
Workforce Development Manager
Workforce Directorate
Crichton Hall
Dumfries
DG1 4TG
Email: tracy.davidson@nhs.net
Tel: 01387 244322
The Workforce Plan is available on the NHS Dumfries and Galloway intranet and by visiting our website
at: www.nhsdg.scot.nhs.uk
Page 15 of 15
84
Agenda Item 243
6 February 2012
Employability
Author:
Philip Myers, Health and Wellbeing
Specialist, Joint Health and Wellbeing Unit
Dr Derek Cox, Director of Public Health
RECOMMENDATION
1. discuss the NHS D&G contribution to the employability agenda;
2. note the range of employability and health improvement activities being
undertaken across the Board; and
3. note the NHS contribution through community planning mechanisms in order
to support individuals to remain in or enter employment and/or volunteer.
SUMMARY
This paper provides an overview of a number of NHS interventions and services that
contribute to supporting people to stay in employment or take steps towards being
work ready.
Key Messages:
To acknowledge the important NHS contribution in supporting people to enter work
and stay in work.
To acknowledge the excellent partnership working that exists in supporting patients
to enter work and stay in work.
To be aware of the important and developing function of NHS D&G as an exemplar
public sector employer.
Glossary of Terms
BHC:
Building Healthy Communities
EP:
Employability Partnership
GP:
General Practitioner
LTC:
Long term conditions
85
MSK:
NHS D&G:
OH:
SALSUS:
OHSxtra:
Musculoskeletal
Occupational Health
Scottish provider of Occupational Health and safety services
Occupational Health Extra
1. Introduction
In Scotland it is frequently health conditions that are cited as the main barriers to an
individual’s progress into sustained and rewarding work. Evidence shows that those
out of work suffer poorer health and greater health inequalities while those in ‘good’
work are healthier. Furthermore, worklessness is associated with poorer physical
and mental health and wellbeing. Being in employment can be therapeutic and can
reverse the adverse health effects of unemployment.
From an NHS perspective these health improvement activities are aligned to high
level policies such as the NHS Quality Strategy, the ‘Putting You First’ strategy and
the Single Outcome Agreement. There are also opportunities to link work in this
area with the developing ‘asset based approach’ to health improvement.
The NHS contributes to the local Employability Partnership (EP) through
representation from the Joint Health and Wellbeing Unit. The EP is made up of
partners from the Council, Jobcentre Plus, Dumfries and Galloway College, Skills
Development Scotland and the Third Sector.
The EP has completed an
employability service mapping exercise and has developed a local Employability
Pipeline. Through its action plan the EP raises the profile of groups who find it
extremely difficult to enter the labour market, for example, the 16-34 age group and
people with disabilities.
Reporting is to the Community Planning Strategic
Partnership.
2. NHS Dumfries and Galloway Health and Work Group
In order to respond to and co-ordinate actions detailed within a number of national
strategies a local NHS Dumfries and Galloway Health and Work Group has been
established. The Group, currently jointly led by the Associate Director of Allied
Health Professions and a Health and Wellbeing Specialist, brings together health
staff from a range of disciplines. An Action Plan will be formally launched in early
2012. The Group plan to develop a communication strategy to ensure that there are
appropriate links with other NHS groups who have a role in the health and work
agenda.
3. Scottish Health Offer
The Scottish Health Offer sets out a number of principles and standards for the
health service to meet in terms of supporting individuals with a health barrier back
into work. The Offer is not about the NHS providing employability services; it is
86
about supporting and signposting individuals to appropriate services (both internal
and external).
To support local Health Professionals in delivering the concept of the ‘’Scottish
Offer’’ a Single Point of Contact (referral point) has been established. Hosted by
Dumfries and Galloway Council’s Employability and Skills Service the Single Point of
Contact will enable Health Professionals to make a rapid referral to an adviser who
will determine the employability needs of the individual.
A two and a half hour training programme called Health and Work Awareness
Raising for Health Professionals has been developed by the Scottish Government
and is delivered in partnership with Jobcentre Plus. It sets out to introduce some of
the main health and work relationship concepts and offers practical solutions as to
how health staff can support patients in their return to work. Sessions delivered to
groups of Allied Health Professional Leads and other partners have been well
received.
The training is being rolled out to Allied Health Professional and other
staff groups during the spring of 2012.
4. Long Term Conditions (LTC) and Vocational Rehabilitation
An important element of the health and work agenda is the requirement for the NHS
to build capacity to support self management for individuals with LTC. Dumfries and
Galloway has many examples of good practice where programmes/groups provide
information, advice and support on managing and living with a specific conditions
e.g. Living with Muscular Sclerosis, Challenging Pain, Hale and Hearty.
The developing work being taken forward by the Occupational Therapy Mental
Health Team and the Support in Mind project provides an excellent example of joint
working with the Third Sector.
5. Building Healthy Communities (BHC)
BHC is a community development programme operating throughout the region. It
provides one to one support for people living in vulnerable circumstances and uses
volunteers to deliver a variety of local initiatives which are designed to improve
health, increase community participation and for some people enter into work.
BHC’s Long Term Conditions Programme supports and assists individuals who have
been diagnosed with an LTC.
Since the onset of the programme in 2009 the
programme has supported 7 people back into employment and 29 people into
volunteering. BHC is seeking funds from the Putting You First programme in order
to continue this work.
6. Working Health Services (Fit for Work Service) Pilot
The Department of Work and Pensions funded Fit for Work Service pilot was
launched in Dumfries and Galloway in April 2010. The service offers free and
confidential support to individuals who are employed in small or medium sized
87
enterprises with no existing access to an occupational health service. The service
has been designed to support employees who are off work or who are at risk of
sickness absence.
Locally the service is hosted within the Occupational Health (OH) Department and is
delivered via a case management approach.
Referrals can be made to
Physiotherapy, Counselling, OH Physician, OH Nurse and Occupational Therapy.
The service can also refer onto other services such as employment advice, housing
and money management etc. An individual can self refer to the service plus health
professionals can refer their patients.
7. Musculoskeletal (MSK) Low Back Pain Service
The Musculoskeletal Low Back Service was launched in April 2010.
The service
has been set up to provide an enhanced low back pain service and is delivered by a
physiotherapist based within the Orthopaedic Department. The main focus of the
service is around improving the triaging of patients and developing the treatment
pathway for back pain referrals.
The service accepts referrals from GP’s,
Physiotherapists and Consultants.
The MSK Pathway for low back pain now comprises a number of treatment options
including onward referral to the Pain Association Scotland, DG One leisure facility,
SALSUS, local podiatry services, appliance department and surgery.
8. Occupational Health and Safety Extra (OHSxtra)
OHSxtra is an NHS service designed to help NHS employees who are experiencing
ongoing health problems. The aim of the project is to provide support to staff with
their return to work following sickness absence or support employees who may be at
risk of sickness absence through offering access to services which are most
commonly associated with pathways to recovery. In NHS Dumfries and Galloway
this includes access to Cognitive Behavioural Therapy and physiotherapy
interventions. The service is intended to complement existing NHS OH Services.
9. Fit Note
This came into effect on 6 April 2010 replacing the existing so called sick note. In
short the new fit note allows general practitioners to advise on one of two options;
‘not fit for work’ or ‘may be fit for work taking into account the following advice’. This
enables patients a more speedy return to work benefitting both the individual and the
employer.
10. Keep Well
Keep Well is part of a health programme aiming to improve mental health and
wellbeing and reduce the risk of cardiovascular disease. One of the programme’s
outcomes is health checks for the HEAT 8 target. Individuals aged 40-64 years old
are offered the opportunity for a free health check. Following the health check if
results are found to be out with the normal range the client is asked to make an
appointment with their GP. The programme also offers opportunities for participants
88
to receive lifestyle advice through supported sessions with a Health Coach – this
advice could extend to support with employment issues.
In order to reach
vulnerable individuals the Keep Well Team have engaged with a number of partners
across the region including public, private and third sector organisations. Keep Well
clinics continue to be delivered across NHS Dumfries and Galloway sites.
11. Support for carers
The Carers Strategy for Scotland 2010 - 2015 recognises and promotes the
importance of carers as equal partners in the planning and delivery of care and
support.
This extends to supporting carers with employment issues. There is a
key role for the NHS in supporting carers in relation to employment issues including;
identifying carers, being an exemplar employer in terms of developing and
implementing carer friendly policies and effective practices which enable carers to
remain in or return to work and recognising health and wellbeing issues associated
with being a carer.
89
MONITORING FORM
Policy / Strategy
Implications
This paper links to and supports action in a number of
policy areas including:
Health Works
Equally Well
Towards a Mentally Flourishing Scotland
Realising Potential – An Action Plan for Allied Health
Professionals in Mental Health
Single Outcome Agreement for Dumfries and Galloway
As a result of welfare reform benefit changes frontline
staff may be requested to support individuals with
appeals as part of the benefit re-assessment process.
There may be an increase in referrals to various
services.
No financial implications identified at this stage
Consultation
The various services identified in the paper have
ongoing consultation mechanisms in place.
Consultation with
The following Professional Committees have been
Professional Committees
consulted with:
Area Clinical Forum
Allied Health Professional Advisory Committee
Nursing and Midwifery Professional Advisory
Committee
GP Sub Committee
Primary and Community Care Management Group
Risk Assessment
Each service mentioned will be responsible for own
risk assessment.
Best Value
The following Best Value themes are addressed in this
paper:• Effective Partnerships
• Equality
• Sustainability
Sustainability
Each service is responsible for its own sustainability
strategy. There are workforce planning implications for
the NHS given the local demographic profile. The
NHS as an exemplar employer is one way of attracting
a future workforce.
Compliance with Corporate The following Corporate Objectives are addressed in
Objectives
this paper:1, 2, 3, 6 and 7
Single Outcome Agreement The following Single Outcome Agreement priorities are
(SOA)
addressed in this paper:• Priority 2 – We will prepare our young people for
adulthood and employment
• Priority 4 – We will support and stimulate our
local economy
• Priority 5 – We will maintain the safety and
security of our region
90
Impact Assessment
Various elements of the programme have been impact
assessed as they have been developed. For example
the Scottish Offer was impact assessed nationally and
Keep Well was impact assessed locally.
91
Agenda Item 244
Scrutiny Committee
Minutes of the Scrutiny Committee meeting held on 2nd November 2011 at
12noon in the New Boardroom, Crichton Hall, Dumfries.
Present:
Mike Keggans (Chair)
John Moore
David Hannay
Andrew Walls
In Attendance:
Craig Marriott
John Burns
Jeff Ace
Katy Lewis
James Gray
Angus Cameron
Ian Bryden
Stewart Cully
Laura Wilson (Minutes)
Mike Keggans welcomed members to the meeting and introduced James Gray from
PricewaterhouseCooper, the Board’s new External Auditors.
1.
Apologies for Absence
1.1
Apologies were received from Tommy Sloan and Andrew Johnstone
2.
Minutes of meeting held on 30th August 2011
2.1
The Scrutiny Committee agreed the minute taken at the previous meeting on
30th August 2011, with two amendments.
2.2
Andrew Walls asked that paragraph 5.2 be amended to show Angus Cameron’s
title as Dr Cameron not Mr Cameron. Also Mr Walls asked that reference to the
impact assessment in paragraph 8.6 be changed to Quality Impact Assessment.
3.
Matters Arising
3.1
David Hannay asked for confirmation that the updated minor injuries report would
be brought to the next Scrutiny Committee in December 2011. John Burns
confirmed that this would be the case.
Page 1 of 7
92
i.
3.2
State of the Estate
Ian Bryden confirmed that the State of the Estate report was due to be
issued in September 2011, however, Scottish Governement had come
back to Boards requesting additional information on the disposal of
property and equipment, which had significantly delayed the release of the
report.
4.
Energy and Carbon Performance Update
4.1
Ian Bryden presented the Energy and Carbon Performance Update paper to the
Scrutiny Committee, confirming that the figures for the first half of 2011/12
financial year are positive, putting the Board in a good starting position for the
remainder of the year.
4.2
It was noted that in light of the Acute Services Redevelopment, the Energy
Strategy would need to be reviewed to incorporate the new statistics for the
redevelopment over the coming years.
4.3
Mr Bryden took committee members through the details within the paper
explaining how the figures compared against the HEAT target, which was on
course to be delivered by the end of the financial year.
4.4
The report highlighted that there was more electricity used within the Board’s
health facilities in the summer, compared to the winter months, due to the
extensive use of the air conditioning units.
4.5
The Estates team are in the process of delivering monthly performance updates
to each of the Board’s Energy Champions, charting the progress their area had
made against the annual targets.
4.6
Craig Marriott mentioned that due to the carbon reduction legislation, the Board
would in future receive an estimated charge of £138k, the impact of which would
be noted in the draft Financial Plan for 2012/13.
4.7
Mr Bryden and his team were thanked for the work undertaken to put processes
in place to achieve the challenging targets set for the year ahead.
4.8
The Scrutiny Committee noted the report.
4.9
Ian Bryden left the meeting.
4.10
Stewart Cully joined the meeting.
Page 2 of 7
93
5.
Business Report
5.1
Jeff Ace and Stewart Cully gave an update on the Data Dashboard information to
Scrutiny Committee, which was first highlighted to members in June 2011.
5.2
Stewart Cully gave an overview of the information that Board staff would be able
to view from both the iDasboard and Qlikview software, available on the intranet
homepage. The new software allows users to drill down through the information
presented within the reports to activities over 30 minute intervals and also down
to the individual patient activity information.
5.3
Mr Cully mentioned that the system would be rolled out to individual clinician
teams over the next year and may be available at a later date for roll out to GP
Practices across the region.
5.4
Jeff Ace explained that the information within the iDashboard system would be
filtered to give a higher level Business Report, which would be presented to
Scrutiny Committee on a 6 monthly basis. The first of the structured Business
Reports would be presented to members at the next meeting on
9th December 2011.
Action: J Ace
5.5
The Scrutiny Committee noted the presentation.
5.6
Stewart Cully left the meeting.
6.
Review of Family Health Services (FHS) Expenditure
6.1
Angus Cameron presented a paper to Scrutiny Committee on the Review of
Family Health Service Expenditure, explaining that approximately £70m is spent
in primary care each year. Dr Cameron explained that the report investigated the
opportunity to deliver efficiencies. It was recognised this was a difficult task as
Primary Care is closely linked to national contracts, therefore, there are limited
efficiency opportunities.
6.2
It was noted that a substantial proportion of the budget was allocated to
supporting the information technology required within GP practices.
6.3
Dr Cameron mentioned that there were potential savings to be made in relation
to the supply of oxygen cylinders to patients. If the Board moved to using
concentrators it would generate a possible saving of over £100k per annum.
6.4
It was noted that the Board had an increased financial cost over the past 4-5
years on the rent for Third Party Development (3PD) Primary Care premises. A
significant number of premises used for medical services are still 3PD owned.
Page 3 of 7
94
6.5
Katy Lewis mentioned that she was undertaking an exercise with Linda Bunney
to manage this service as robustly as possible. The rental costs charges to the
Primary Care budget were based on the revaluation reports for each of the
premises.
6.6
7.
Transfer of Healthcare Responsibility in HMP Dumfries
7.1
Angus Cameron presented the Transfer of Healthcare Responsibilty in
HMP Dumfries paper to Scrutiny Committee, explaining that the Board took
control of the healthcare budget for HMP Dumfries on 1st November 2011.
7.2
It was noted that the General Medical Services tender was significantly above the
Prison budget line, however, the Board were looking at ways to reduce this cost.
One possiblity was to reduce the involvement from doctors, by increasing the
duties undertaken by the nursing staff.
7.3
John Burns mentioned that he had received a letter from the Director General
stipulating the requirements of the Board for the transfer. It was noted that a
National Steering Group had been established to deal with the transfer, however,
the group has agreed to continue looking at various aspects of the transfer and to
ensure the smooth running of the service.
7.4
Mr Burns confirmed that the letter mentions that the Health Board was legally
accountable to provide a quality service to prisoners in the Dumfries and
Galloway area.
7.5
Jeff Ace highlighted that the Prison could be included in the list of sites visited by
HEI. Mr Ace stated that he was working with Board and Prison colleagues to try
to bring the prison in line with Legionella procedures. Angela Brown from
Domestic Services has also visited the site to ensure areas are brought up to
speed with the NHS Board procedures and legislation.
7.6
It was noted that the Board’s process for handling complaints would not fit with
the Prison guidelines, therefore, agreement had been given for the Senior Nurse
at the Prison to deal with complaints in the initial stages, with additional support
sought from more senior members of staff, as required.
7.7
Dr Cameron highlighted to committee members that there were approximately
100 long term prisoners within HMP Dumfries, explaining that any prisoner who
dies whilst in the custody of the prison would instigate the Fatal Accident Enquiry
process.
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95
7.8
David Hannay congratulated the team on the smooth transition of the service and
asked why the psychology service is provided by NHS Cumbria, rather than
being provided within the region. It was confirmed that Psychology was not
included within the prison healthcare budget and would need to be costed
separately as it was a specialist councilling service for prisoners.
7.9
7.10
Angus Cameron left the meeting.
8.
Acute Services Redesign Project Management
8.1
Jeff Ace presented a paper to the Scrutiny Committee on the Acute Services
Redesign Project Management’s proposed revised management structure.
8.2
Mr Ace mentioned that it was critical that the committee recommend approval of
the Acute Services formal structure to the Health Board to ensure the success of
the project.
8.3
It was proposed that the Scrutiny Committee play a key role in making the
decisions on the financial targets set at the start of the project. It was also
recommended that the Board appoint a Project Director who had relevant and
recent experience on a similar technical project. The Project Director would
provide advice to the Scrutiny Committee to assist in making appropriate
decisions relating to the project.
8.4
Scottish Futures Trust have offered their services to provide a member of staff to
be seconded as the Acting Project Director until the substantive post can be
filled.
8.5
John Moore stated that he was looking for assurance that the project structure
that had been agreed was based on other projects of similar size and that it was
realistic and would come in on time and within budget.
8.6
A discussion took place with committee members on the way the project could be
taken forward and the concerns that they had with the future decisions to be
taken by the committee.
8.7
Jeff Ace mentioned that Non-Executive members may want to speak with
George Willacy, who was a member of the Project Board in the Cresswell build,
therefore, would be able to give an opinion on the processes and decisions to be
made with a large project.
8.8
Jeff Ace was asked to explore the data within paragraph 24 of the paper and
present a revised report to Board on 7th November 2011.
Action: J Ace
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96
8.9
The Scrutiny Committee endorsed the Project Structure and agreed that an
interim Project Director be appointed on a secondment basis.
9.
Financial Performance - Month 6 to 30th September 2011
9.1
Craig Marriott presented the Financial Performance Month 6 paper to Scrutiny
Committee, which detailed the Board’s expenditure for the first 6 months of the
current financial year.
9.2
It was noted that the Board was reporting an underspend against budget of
£1,715k at the end of September 2011, compared with an underspend of
£2,152k at the end of August 2011. The decrease in the underspend was as a
result of the transfer of £1.047m from the revenue to capital budgets, to cover the
extensive maintenance work to be undertaken by the Estates department.
9.3
The Scrutiny Committee discussed and considered the report.
10.
2011/12 Capital Plan Mid Year Review
10.1
Craig Marriott presented the 2011/12 Capital Plan Mid Year Review paper to the
Scrutiny Committee, explaining that the main focus was to review key projects
detailed within the plan, for example Mid Park Hospital and Lochfield Road
scheme, to ensure they were due to be concluded within the timeframe, as
agreed at the start of the project and within budget.
10.2
It was noted that the capital to revenue transfer had been completed, however,
there was still pressures on Estates to deliver all of the aspects of maintenance
that need to be undertaken before the end of the year.
10.3
A review of the Dumfries Property Strategy was underway to take into account
the Acute Services Redevelopment, withdrawal from Nithbank and possible
alternative uses for the Cresswell site and hospice block.
10.4
The Scrutiny Committee noted the report and agreed that the revised Dumfries
Property Strategy be brought back to committee in 2012.
Action: J Ace
11.
Draft Scottish Budget
11.1
Craig Marriott asked that a copy of the presentation intended to be given to
Scrutiny Committee on the Draft Scottish Budget be circulated to committee
members for information. Any queries to be raised directly with Mr Marriott.
11.2
The Scrutiny Committee noted the update.
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97
12.
Draft Revenue Plan 2012/13
12.1
Craig Marriott presented the Draft Revenue Plan 2012/13 report to
Scrutiny Committee, which detailed the timescales and actions that needed to be
undertaken in preparation of the Financial Plan for 2012/13.
12.2
Mr Marriott confirmed that the overall Cash Releasing Efficiency Savings (CRES)
target would remain the same in 2012/13, with the overall CRES target of £22.5m
over the next 3 years.
12.3
It was noted that further discussion needed to take place with the Operations
Team to look at the energy price increase, which was estimated at 27% for
2012/13.
12.4
In relation to Prescribing, it was highlighted that the cost of precribing the new
Dabigatron and HepC drugs would be approximately £1.4m in 2012/13.
However, it was noted that another new HepC drug had been submitted to the
SMC earlier in the week and if approved would reduce the cost to the Board next
year.
12.5
John Burns asked if an analysis of the external contracts could be brought back
to committee, which identified how much of the cost was associated with tertiary
and how much could be repatriated to NHS Dumfries and Galloway.
Action: C Marriott
12.6
The Scrutiny Committee agreed the timetable.
13.
Any Other Business
13.1
Agreement was given to change the start time of the next Scrutiny Committee
meeting from 9am - 1pm to 9.30am - 1pm. Laura Wilson was asked to make the
necessary amendment and notify members in advance of the next meeting.
Action: Laura Wilson
14.
Date and time of next meeting
The next meeting of the Scrutiny Committee will be held on 9th December 2011
at 9.30am - 1.00pm in the New Boardroom, Crichton Hall, Dumfries.
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98
Agenda Item 245
Staff Governance Committee
Meeting Room 4, Crichton Hall
Minutes of the Meeting held 15 December 2011 at 10.30am
Present
Andrew Campbell
Jim Beattie
Lesley Garbutt
Alf Hannay
Katrina Hepburn
Michael Keggans
Anna Kelly
Alastair McKay
George Willacy
Non Executive Board Member (Chair)
Employee Director
Non Executive Board member
Staff Side Representative
Chairman
Non Executive Board Member
Non Executive Board Member
In Attendance
John Burns
Linda Davidson
Ros Kelly
Arlene Melbourne
Caroline Sharp
Sandy Wilkie
Chief Executive
Deputy Director of HR and Staff Governance
Occupational Health Manager
Executive Assistant to Workforce Director
Workforce Director
Head of Organisational Development
ACTION
1
Welcome, Introduction and Apologies
Apologies were received from Jeff Ace, Hazel Borland and Tommy Sloan.
2
Minutes of the Previous Meeting
The minutes of the meeting held on 19 September 2011 were agreed as a
true and accurate record.
3
Matters Arising
Mr Willacy stated that on page 3 of the minutes it reported that he said
‘staff had been de-skilled’ but what he meant was that all their skills were
not being kept up to date rather than the suggestion that they are deskilled. His clarification was noted.
4
Workforce Report
Mrs Davidson introduced the paper and stated that the report had been
extended with additions such as special leave as requested.
Mr Campbell noted that turnover was slowing slightly. Mr Beattie
expressed disappointment that some staff had been on fixed term
contracts for a number of years. Mrs Davidson agreed she would take this
conversation outside the meeting to discuss in more detail.
Mr Keggans asked if it was possible to analyse fixed term contracts further
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by length of contract and Miss Sharp confirmed that the team would see
what could be done to provide further analysis. She noted that a key job
of the Workforce Business Partners working with the General Managers
was to monitor staff on fixed term contracts in their Directorates and to
have appropriate plans in place to manage them. Mrs Hepburn noted a
particular issue in Cresswell in relation to staff moving from Fixed Term
contracts to the Bank and Mr Willacy reported of a recent helpful
discussion with Miss Sharp around Fixed Term contracts.
Mr Hannay entered the meeting
Mr Beattie noted that he was pleased to see that there have been no new
bullying and harassment cases in the quarter and provided some further
detail to the Committee of a group set up by Margo Christie to develop
effective approaches and processes around bullying and harassment.
Mr Beattie then highlighted that we only talk about the sickness absence
rates and do not seem to highlight that the attendance is 95-96%. Miss
Sharp suggested that we might carry that forward to Mrs Kelly’s paper in
respect of health & safety. Mr Beattie confirmed to the Committee the
continuing close partnership working being undertaken in this area.
Staff Governance Committee noted the report.
Staff Governance Risk Register
Miss Sharp presented an update paper on Corporate Staff Governance
risks and invited questions from Committee members so the Committee
can continue to provide assurance into Board that staff governance risks
are being appropriately managed.
Mrs A Kelly asked in regard to SG7 would there be enough middle grade
doctors if there was something like a flu epidemic and Miss Sharp
confirmed that the risk as detailed covered the whole junior medical
workforce and issues such as a flu pandemic are planned for by
emergency and contingency plans which are in place.
Mr Burns reported that we continue to see a reduction in training places
because of the way the system is set nationally. He reported that we find
that more remote District General Hospitals are not always first choice or
high priority so Junior Grade rotas are an ongoing challenge. Nationally
Boards are trying to put forward a proposition to SGHD which will see a
slow down in reduction as there is no alternative model in place. SGHD
want to move to a trained doctor service which means a need for a
different Consultant Contract or a different grade of doctor. The Specialty
Doctor grade which was negotiated has been an unattractive grade for
medical staff. He confirmed that locally we need to look at the way we
deliver services, work with Consultant teams differently and try to manage
gaps in service. With regard to the risk to the Board, this is recorded as a
risk every 6 months but until there is a change then this risk will continue
to be flagged.
Mr McKay queried a risk in the Pathology service and Miss Sharp replied
that this risk would be captured at a level below the Corporate Risk
Register and would be managed at General Manager and Chief Operating
Officer level.
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Staff Governance Standard A – Well Informed
Mrs Davidson highlighted areas of recent activity undertaken relevant to
this standard. She reported that work continues locally with Staff
Governance Action Plans and it is supported with staff involvement. The
staff survey results are included in the local Staff Governance Action Plans
and they will be looked at at the Annual Reviews. Putting You First events
have been held and the first two newsletters have been issued. There is
also information on the work being undertaken by the communications
team and staffing information at Midpark.
Mr Campbell stated the paper demonstrates that staff are well informed
but there is a question about the communications which is a wider issue.
Mr Beattie noted the recent SGSAAT letter received and stated that the
Self Assessment Audit paper overall was positive but John Davidson from
Scottish Government has offered a meeting with one of his team to
discuss. He noted that the most recent staff survey in 2010 did not have
as many staff completing it as in previous years, and thishad been flagged
in the feedback letter.
Miss Sharp confirmed that the letter had arrived that week from the
Scottish Government about the SAAT and advised members that hard
copies were available for members at the end of the meeting. The
Workforce Directorate and Mr Beattie will pull together an assessment and
will bring it back to the next Staff Governance Committee.
Mr Beattie noted that there had not been an invitation to staff side to
attend the Putting You First event. Mr Burns replied that he did not know
what the guest list was but reported that the event was well attended by
the Third Sector, PPF, Council and Members of Senior Teams and was
facilitated by an external group. The conclusions were that there are 6 or
7 themes that will emerge and there were some interesting conversations
led by GPs. Judith Proctor and the team are now working to take forward
actions from the report.
Mr McKay advised that he attends the Area Clinical Forum and there had
been some discussion there and Hazel Dykes had put forward some
comments from ACF. Mr Burns confirmed that they had engaged and
agreed with Hazel Dykes a communication from ACF.
Mr Hannay stated that there was still some anxiety in the organisation
around the Third Sector. Mr Burns replied that there is need for Social
Care, Health and the Third Sector to have closer partnership working with
these groups and there is a need for staff side to be closely involved.
Staff Governance Committee noted the update of this Standard.
6
Staff Governance Standard B – Appropriately Trained
Mr Wilkie outlined the range of activities under this standard. He
confirmed that his team had started sampling and looking at the quality of
ADR conversations ie. the level and quality as per HOT Target W7 and he
would bring a report to the next Staff Governance Committee. He noted
that there has been an increase in the new mandatory training topics at
W9 and also the dip in compliance in relation to moving and handling.
Finally he noted good progress is being made with Healthcare Support
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Workers since the introduction of CEL 23 and confirmed that the Learning
& Development team will continue to monitor on an ongoing basis.
Mr Beattie advised that there had been a presentation from NES at the
Employee Directors meeting around learning resource and asked if we are
tapping into that. Miss Sharp replied that we were and that Alison
McConnachie from the Learning & Development Team had been heavily
involved in that work with NES.
Mr Beattie reported that there had been a successful pilot at NHS
Grampian around careers and transition which had been funded by the
Scottish Government which could be looked at for Dumfries & Galloway.
Mr Wilkie would look into this.
SW
Mrs A Kelly advised that she had recently been on a walkround at
Lochmaben Hospital and most of the staff were due to do their mandatory
moving and handling training updates and asked if it would be more
sensible to take the training out to the place rather than the staff having to
come in for training in ‘dribs and drabs’. Miss Sharp confirmed that we
have completed a review of the model of delivery of moving and handling
training and the team are now moving to a different model of delivery
which will be more anchored in workplaces.
Mr McKay stated that there was a drive for Modern Apprentices in the
Scientific and Technical side and he would like to speak to Mr Wilkie
outside the meeting about this.
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Staff Governance Standard C – Involved in Decisions
Mrs Davidson introduced this paper and highlighted that APF continues to
meet and she outlined what had been discussed at the last meeting. JNC
meets monthly and informal trade union meetings take place with herself,
Mr Beattie and Mr Ace and she outlined other items in the paper. She
gave information on the Audiology redesign and reported that there was
good partnership working in that particular area. Mrs A Kelly stated that
there should be much praise for the Audiology Department and their
waiting time achievements.
Workforce Plan
Miss Sharp presented the final draft of the Workforce Plan and invited
comments and approval from Staff Governance Committee. She noted
that iIt is key for Staff Governance Committee members to deal with any
issues in the Plan and for Staff Governance to approve the Plan on behalf
of the Board so it can be endorsed at the February Board meeting.
Mr Campbell confirmed that there has been an 8-week consultation on the
Plan and a lot of work done on it and the Plan is now before Staff
Governance to comment on or otherwise.
Mr McKay stated that his biggest comment was that there was a
description of the workforce and it was not fully inclusive of the
professional groups. He queried some of the statistics in the Plan and
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Miss Sharp advised that the information is drawn down from national
systems but she would take them away and do a final check of the
arithmetic before publishing.
Mr Keggans reflected that this was a much better document and was more
useful and meaningful than earlier iterations. He asked if it was being
submitted to the Scottish Government before the formal sign off by the
Board. Miss Sharp confirmed that Staff Governance Committee is the
decision making place for sign off following which it is appropriate to take it
to Board for full public endorsement. In the meantime, Mrs A Kelly asked
about reducing Senior Manager posts by 25% which seemed a lot and Mr
Burns replied that this has already been achieved. Miss Sharp stated that
it was a national target which had been set by the Scottish Government.
The time line of that target commencing 31 March 2010 enabled us to
capture the significant changes we had made when we changed our whole
management Directorate structure. She confirmed that the Board carries
such a small number of Managers who are covered within the Senior and
Executive Manager Cohort and only have 16 members in that cohort. Mr
Burns stated that we would have made this change anyway to get a better
Directorate structure.
Mr Willacy queried the numbers of people retiring and wondered if there
would be enough nurses in future and Miss Sharp responded that this was
an important issue which needed to be delivered through the 5 dimensions
of workforce success as described in the Plan.
Mrs A Kelly said she had been reading about nurses not being able to get
jobs and noted that there are some jobs which are not being recruited to
for more than 3 months and sought clarity on the disconnect. Mr Burns
replied that it could be specialist posts or Senior/Charge Nurse posts,
which are more senior posts to recruit to.
Staff Governance Committee were happy to endorse the Workforce Plan
for 2011-13 to go to Scottish Government then to Board in February.
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Staff Governance Standard D – Treated Fairly and Consistently
Mrs Davidson introduced this paper and gave an overview of this particular
standard. She reported that Liesje Turner, Equality & Diversity Lead for
the Board was doing work on targets against Respect standards for the
standard to be rolled out. She also reported that there were 6 PIN Policies
which are to be released nationally and a CEL has now been received
giving full details about the PINs and the roll outs. The Workforce
Directorate are to be presented with the LGBT Chartermark in January
which is the 4th in the Board and she outline some of the work undertaken
to gain the award. She also gave a briefing about the ‘What If’ bids.
Mr Campbell congratulated the Workforce Directorate on achieving the
LGBT Chartermark. Miss Sharp reported that Liesje Turner is now
providing some resource to Scottish Government to do some national
work to assess the Give Respect, Get Respect programme nationally and
to inform the Workforce Directorate in the Scottish Government about the
impending duties coming in from the Equality Scheme.
Evaluation of Partnership Conference
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Miss Sharp reported that the paper describes feedback from the
Partnership Conference held on 1 November. Mrs A Kelly noticed the lack
of medical staff attending and asked if they had been invited. Miss Sharp
replied that they had been and she has continuing dialogue with the
Medical Director about the lack of attendance and issues around clinical
commitments. She noted that it is a challenge and we cannot pull senior
clinical staff away from crucial patient work which is planned but she
confirmed that there needs to be continuing dialogue to see if medical
staff can engage some way in this process. Mr Beattie reported that the
format used for the last 2 Partnership Conferences had been excellent but
need better teambuilding with medical staff.
Mr Beattie left the meeting
Staff Governance Committee noted the paper.
9
Staff Governance Standard E – Improved & Safe Working
Environment
Mrs R Kelly presented this paper and outlined some of the latest statistics
compiled by SWISS and the work being done to continue the good work
around sickness absence and the process around case conferences. She
reported that the Sickness Absence policy is under review and is being
renamed ‘Attendance Management Policy’. The revised policy is out for
consultation at the moment.
She briefed on figures of health & safety incidents and also topics such as
flu campaign and SHARPS and safety campaign.
Mr Hannay advised the Committee that the case conferences bring staff
back into the workplace and these are working.
Mr Willacy asked if there was new legislation about long term sickness
and Miss Sharp replied that there had been a change last year where the
sick note was replaced by the fit note which provides information about
what an individual could do to return to work, rather than stay off. Mr
Burns then noted that there was a piece on the news the previous week
where the Government were considering removing this responsibility from
the GP and putting to a panel but this is still a matter for debate.
Mr McKay stated it was important to look at patterns of sickness and be
responsive to individuals circumstances and previous attendance patterns.
Mrs R Kelly replied that the new policy does address that and it makes it
clear for Managers that there is some discretion that can be used at
Return to Work interviews and mitigating circumstances should be taken
into account. She advised that there would be training taking place
following the introduction of the new policy.
Miss Sharp briefed the Staff Governance Committee that Internal Audit
have recently completed 2 audits within the organisation, one of which is in
relation to the Sickness Absence Policy and Compliance and the other
with Working Time Directive Compliance which is a health & safety issue.
Those reports have been submitted to Internal Audit and will flow to Audit
Committee and she would bring a detailed report on each of those audits
being put in place to the next Staff Governance Committee.
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10
Meeting Dates in 2012
The meeting dates for 2012 were agreed.
11
APF Minutes – August 2011
The APF minutes from the August meeting were noted.
12
Any Other Business
There was no other business.
13
Date of Next Meeting
The next meeting will be held on Wednesday 14 March 2012 at 10.30am
in the New Board Room, Crichton Hall.
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Agenda Item 246
NHS DUMFRIES AND GALLOWAY
SPIRITUAL CARE COMMITTEE
Notes of Meeting held on Thursday 22 December 2011
Present:
Mrs. Penny Halliday, Non-Executive Director (Chair)
Mrs. Hazel Borland, Nurse Director
Dr. James Clark-Maxwell, G.P., Dalbeattie
Miss Carolyn Hornblow, Volunteer Member
Rev. Douglas Irving, Kirkcudbright
Mrs. Jan Lethbridge, Inter Faith Council Member
Mr. Paul Lyttle, University of West of Scotland
Rev. Canon Robin Paisley, Dumfries
Mrs. Morag Thornhill, Volunteer Member
Mr. George Willacy, Non-Executive Director
Ms. Mandy Spence, Midwife
Rev. Sandy Strachan, Hospital Chaplain, Dumfries
Dr. Liz Wilkinson, Clinical Psychologist
In Attendance:
Mrs. Sally Talbot-Smith, Patient Services Manager
Apologies:
Fr. David Borland, Dumfries
Rev. Adam Dillon, Annandale and Eskdale
Mr. John Glover, Communications Manager
Ms. Lesley Grainge, Midwife
Mrs. Liesje Turner, Equality and Diversity Lead
ACTION
1.
Apologies
As above.
2.
Notes of meeting held on 27 October 2011
Approved.
3.
Matters Arising
3.1
Chaplain Sessions
Mrs. Borland explained that she had met with Mr. Paisley and Mr.
Strachan and agreed a plan to move towards advertising. Mrs.
Borland to contact Ewen Kelly for advice around the advert which
will be very different from previous adverts, and to seek clarification
around the name “chaplain” to ascertain whether to advertise for a
qualified chaplain or not.
Mr. Willacy requested that the results of this conversation be fed
back to the next Committee meeting. Mrs. Borland explained that
the next meeting was not until March and she had hoped to
advertise in January. Mr. Paisley commented that it may be difficult
to appoint to this part-time post. Previously these posts had been
sub-contracted to the Church of Scotland but now the view is that
people should be generic chaplains giving spiritual care, and
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qualifications are now available for people who do not wish to be
ordained ministers. Mr. Paisley explained that it may be we appoint
someone who is willing to study for such a qualification and their skill
set will be holistic. Mrs. Lethbridge supported Mr. Willacy’s view that
feedback should come to the Committee before advertising. Mr.
Irving suggested that all the chaplains in Dumfries and Galloway
should meet and have an input.
Agreed that Mrs. Borland would contact Mr. Kelly and feedback to
Mrs. Halliday as Chair before progressing this issue.
3.2
Bequest
Mrs. Borland had raised this issue with David Bryson, General
Manager, in relation to the companies who have been working on
the new mental health facility with a view to making better use of the
external space at the Alexandra Unit. To be followed up in the new
year.
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Reflections of Life
Mrs. Borland had met with Mr. Paisley, Mr. Strachan and Mr. Glover
and the plan is to move this forward in January to ensure staff are
aware of this resource.
Copies will be issued to all
wards/departments and to all GP practices. Planned sessions with SS/JAG
viewing tables will take place in DGRI and Galloway Community
Hospital. Mr. Glover to contact Education for Scotland (NES) for
display materials. A joint letter from Mrs. Halliday, Mrs. Borland and
Mr. Strachan will be issued to all staff. A “flashy” advert will be
placed on the intranet.
3.4
DGRI New Build
At the last meeting it was agreed that Mrs. Borland contact Mr. Ace
around consideration to spiritual space in the new build. Mr. Willacy
had raised this issue very clearly, on behalf of the Committee, at the
December Board meeting.
3.5
Congratulations
Mrs. Halliday offered congratulations, on behalf of the Committee, to
James Clark-Maxwell on his ordination on 26 November.
3.6
Membership of Committee
Mrs. Halliday highlighted a suggestion made at the last meeting to
invite Dr. Ken Donaldson to join the Committee and Mrs. Borland
explained that she had spoken with him and in his role as Clinical
Director he is happy to champion spiritual care, and has been
involved with some work with Ewan Kelly, but felt that he could not
commit to the Committee due to his clinical workload.
Mrs. Halliday commented on the involvement of public health on the
Committee and the link between public health and the Community
Chaplaincy Listening Project (CCLP). Mrs. Halliday explained that
as a non-executive director she had been asked to form a
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partnership with the Director who had the remit for public health and
she has met with Dr. Dr. Derek Cox a couple of times.
From these meetings Mrs. Halliday has asked for a member of the
public health team to join the Committee. Dr. Cox is very interested
in the CCLP and agrees this is something the Health and Well-being
Unit could take on board. Mrs. Halliday will be presenting at the
January Board meeting and her presentation will include spiritual
care and dovetailing this in with public health to move forward.
During this presentation, Mrs. Halliday will request a
workshop/presentation type meeting with the Board. Dates will be
requested/circulated.
Mrs. Borland explained that she would
support Mrs. Halliday’s comments about how committed Dr. Cox is
to this project. Mrs. Halliday explained that she had discussed the
Sage and Thyme training with Dr. Cox and suggested that this
would be good training for volunteers coming into the project. Dr.
Wilkinson explained that NHS Dumfries and Galloway was the first
Board in Scotland to undertake this Level 1 communication training
aimed at dealing with distress. We currently have eight trainers and
150 members of staff have been trained so far.
Mr. Paisley highlighted the sentence on page 3 of the notes in
relation to the need to invite staff who are currently still in service to
be new members. He pointed out that Geoff Lachlan was a retired
surgeon. Mrs. Borland noted that at the last meeting Mr. Andrew
Ratnam and Mr. Ewan Flint had been mentioned, and Mr. Strachan
suggested Mr. Brian Power as well, and agreed to invite them to join
if that was what the Committee wanted, although she commented on
being thoughtful about the size of the Committee. Agreed that Mrs.
Borland would send invite letters to ascertain any interest.
3.7
Carol Service
Mr. Willacy commented that the Carol Service had been excellent
and thanked Mr. Paisley and Mr. Strachan. He suggested that the
Committee send a letter of thanks to Mr. Brand, the Musical
Director, and this was agreed.
Mr. Paisley explained that the choir had doubled from last year and
suggested setting the date as 18 December 2012 and booking Mr.
Brand again for the three Tuesday evenings which was agreed.
The Committee agreed that the collection money would be gifted to
SANDS. Mr. Strachan will liaise with the necessary office at DGRI
with regard to the collection money.
4.
Committee Remit
Mr. Paisley commented on the remit of the Committee being to
promote understanding of spiritual care and these holistic
interactions and suggested that this may be contained in the
Spiritual Care Policy. He feels this is an issue as most people do
not understand what spiritual care is. Comments on the remit
should be submitted to Mrs. Borland by the beginning of February
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and the Remit and the Spiritual Care Policy will be circulated prior to
sign off at the March meeting.
Mrs. Turner explained her interest in reaching people of school age
and asked if there was something the Committee could do to
influence education. Mrs. Halliday agreed this could tie in with the
Health and Well-Being Unit. Mr. Paisley explained that he is the
elected member for All Faith Communities in Dumfries and Galloway
and represents them on the Education Committee which is currently
reviewing the guidelines, and invited Mrs. Turner to join this group
and she accepted.
Mr. Irving commented on the new joint working arrangements
between health and social work. In terms of the Health Board being
a good employer, he explained that his concern is that the goodwill
of staff is being relied upon. Mrs. Borland noted this very important
point, emphasising that this Committee is about spiritual care for
patients, carers and staff and the need to look to staff governance
which is around communication and supporting staff.
5.
Board Paper – Patient Experience
Mrs. Borland explained that at the October meeting we discussed
that the opportunity to have a Board workshop on Spiritual Care was
no longer available and decided to use the February Board Patient
Experience paper to reflect some of the ongoing work. Mrs. TalbotSmith was invited to attend the meeting. Mrs. Borland asked for
suggestions as to what the Committee would like to see included in
the paper.
• Community Chaplaincy Listening Project – Mrs. Talbot-Smith
to meet with Mr. Paisley and Dr. Clark-Maxwell
• Tayside Centre for Organisational Effectiveness and the
UWS Compassionate Care work – Mrs. Talbot-Smith to meet
with Mr. Lyttle
• Suggestion that Dr. Donaldson was planning a paper to
record a patient experience related to spiritual care – Mrs.
Talbot-Smith to contact Dr. Donaldson
Mr. Paisley commented on a patient experience around a patient
who had been able to do something for someone else and the
spiritual resources available to them through the other patient. Mr.
Irving raised the four-bed issue and there was discussion around
how we keep social contact/spiritual care alive when we move to a
single room hospital. Mrs. Halliday commented on striking a
balance between what is required politically and that people have
the opportunity to share and offer support to each other if they want
to. Dr. Wilkinson commented on the research evidence on the
benefits of social contact for ill people that is available. Dr. ClarkMaxwell suggested that we ask how the new build project plans to
replace the positive aspects of communal space. Mrs. Borland
explained that this will be built in to every ward and highlighted the
fact that the single rooms would be very different from the current
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facilities in DGRI and would be safe, effective and person-centred.
Workstream groups are being set up via Jeff Ace’s office. Mr.
Paisley suggested that the workstream groups should have a
spiritual care component, and the Committee agreed that their view
is that spiritual care needs to be taken on board by all the
workstream groups and Mrs. Borland agreed to speak to Mr. Ace
about this. Mrs. Halliday agreed that she would formally raise this
issue at February Board meeting and ask for reassurance regarding
passive care which takes place in hospitals not being lost when we
move to a single room hospital.
Mr. Lyttle explained that he would be visiting Denmark in April and
Finland in May, and would ask what happens in those countries and
bring this back to the Committee June meeting.
6.
ACTION
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Any Other Competent Business
Shaping Bereavement Care
Mrs. Borland explained that the plan had been approved by the
Board and she will get together in the new year with the volunteers
who have said they wanted to be on the work groups to move this
forward.
Alzheimer’s and Dementia
Jenny Henderson’s work in Dumfries and Galloway in relation to
Alzheimer’s and Dementia should be included in the February Board
paper. Mr. Willacy commented that Jenny’s work will become part
of the Putting You First programme. Agreed that Jenny should be
invited to the March meeting.
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Spiritual Care and Health Conference – 13 and 14 March 2012
Noted that Mr. Lyttle and Dr. Clark-Maxwell are speakers at this
Conference. Possibility of funding two places. Information will be
circulated and if you are interested in attending please contact
Margaret.
Chief Executive
Mr. Willacy suggested that the Committee send a formal letter of
thanks to Mr. John Burns and a welcome letter to Mr. Jeff Ace –
agreed.
Date and Time of Next Meeting
Wednesday 7 March 2012, at 1 pm, in the New Board Room,
Crichton Hall.
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Agenda Item 247
Area Clinical Forum
Minute of the Area Clinical Forum meeting held in the
Education Centre, DGRI on Wednesday 16th November 2011
Present
Hazel Dykes (Chair)
Moira Cossar, Jim Graham,
Kim Heathcote, Alastair McKay, Monica McTurk,
In Attendance
Jeff Ace, Jan McCulloch
Apologies
Andrew Cairns, Karen King, Ian Peacock
1.
Apologies
2.
Minute of the Previous Meeting
The Minute of the meeting held on Wednesday 19th October 2011 was approved.
3.
Matters Arising
a) Support for Committees
Hazel Dykes has spoken with John Burns about support for the Advisory committees
including backfill. John has advised that money for establishing and supporting the
advisory committees may have been available initially when the new structures were
formed. This should be included in allocations and advised that Hazel should follow
this up.
4.
Update from Jeff Ace, Chief Operation Officer
a) Winter Planning
Jeff explained that the winter planning of NHS Dumfries and Galloway has
been tested and refined through experience of two particularly challenging
winters in 2009/10 and 2010/11. Enhancements to patient pathways, a
formalisation of escalation protocols and the continuation of excellent joint
working with partner agencies put the Board in a strong position to maintain
safe and effective services throughout the winter of 2011/12.
The redevelopment of Ward 4 into a short stay unit gives the opportunity to
increase the proportion of elective activity undertaken as day surgery or on a
23-hour stay basis. This should further reduce elective inpatient admissions
throughout the winter. The development of a short stay unit also provides the
opportunity to maximise medical bed resource by offering an alternative
admission route.
Eight beds (in two four-bed bays) will be held as reserve capacity for this winter
and will be utilised if demand exceeds normal operating capacity.
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Jeff informed members that a bid has been made to the Change Fund for
money for an additional physician. This follows the success of a rapid
consultant intervention pilot being carried out that resulted in a reduction in
admissions beyond ward 7.
Jeff also spoke of plans for geriatricians, a mixture of consultant and nonconsultant staff to be allocated specific geographical areas, which should allow
earlier discharge from DGRI to cottage hospitals.
The bed reconfiguration at DGRI has meant that there are 22 less beds than
before, although Ward 5 beds could be brought in as a backup service ‘mini
ward’ if necessary.
System change has meant that escalation data now sits on a patient database
that provides up to date data for capacity managers and on call manager.
The joint escalation plans with the Dumfries and Galloway Council are working
well.
Jeff was aware that the relationships between secondary care and GPs need to
be strengthened and the earlier involvement of STARS in the patient discharge
process needs to be addressed.
b)
Bed Reconfiguration at DGRI
It was acknowledged that the timescale for the reconfiguration of the beds at
DGRI had been too ambitious, and although this had started in January to finish
in September, there were still some issues around staff redeployment, which
may have been eased if more time had been taken.
All medical day care is being done on the wards and to date everything is
satisfactory although it still has to be fully tested as there has been no surge in
capacity yet.
Jeff had been pleased with the staff side engagement which had been very
good and has left a good legacy for major change through effective partnership
working.
c)
New Build for Dumfries Hospital
Jeff explained that in 5 years time DGRI would be in severe trouble as the
building needs serious refurbishment that would cost many millions of
pounds. This, compounded by no facilities to decant patients during a
refurbishment programme meant that a completely new £200million build was
a serious alternative suggestion, which the Board agreed to.
Jeff outlined the work that the project team will do once it is established.
Although considerable work has already been done with staff through extensive
consultations on the redesign of DGRI with those who were moving to the
previously planned ‘new wing’, there is a need now to engage with all other
depts. and areas not previously included.
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A Project Director, appointed by the Futures Fund will be starting work soon
and the public consultation will commence in December; a number of possible
sites have been identified and will be assessed for suitability.
An outline business case (OBC) will be submitted to the Board in May/June
2012 and will be followed approximately 18 months later by a full business
case, with a move to the new build in 2016/17.
Consultations with services are currently being set up. ACF members
emphasised to Jeff how important early, meaningful discussions with the
clinicians and professions are, along with good communications to staff about
the build. Jeff said that the communications manager is currently putting
something together for staff.
Jeff stressed that there will be demands on peoples’ time over the coming 6
months when opinions are being sought.
5.
Update from Committees
Area Nursing and Midwifery Committee (ANMAC)
Discussions have taken place with the ANMAC Chair and Chair of the Allied Health
Professions committee about having joint meetings of the committees.
It has been agreed to trial this idea in the New Year with proposals that every
second meeting is joint.
The committee also had discussions about the current structure of ward rounds and
Moira thought further discussions with medical colleagues would be useful. Moira will
arrange to speak with the Chair of AMC to discuss.
Health Care Scientists’ Committee (HCSC)
Kim Heathcote had attended the Healthcare Scientist Leads’ meeting and there has
been a re-launch of the HCS document.
A letter from National Education for Scotland (NES) has indicated that the HCS leads’
posts will become a substantive post for 2.5 days per week and will be funded by NES.
Another national even will take place on the 25th November 2011.
Alastair McKay asked if avenues were available for professions to access funding for
educational purposes. Hazel Dykes responded that there has never been a training
and education policy across the Board for non-medical staff but that this is currently
being developed.
6.
Update from Board
The Chair informed members of the changes to the format of the Health Board
meetings. The board workshops have been discontinued and replaced with a
non executive session in the afternoon; this session allows members to discuss
items from the mornings Board meeting.
This revised format allows ACF Chair to reinforce the role of ACF and Professional
Advisory Committees and also to discuss with Board members the special interest
areas many of them have.
113
7.
Any Other Business
The Chair informed members that she will be meeting with Health Board Chair to
discuss strengthening the roles of the PACs.
Date of Next Meeting: 21st December 2011
114
Minute
Agenda Item 248
COMMUNITY HEALTH AND SOCIAL CARE
PARTNERSHIP BOARD
Meeting of Friday 30 September 2011
at 10.30am in The Duncan Rooms, Easterbrook Hall, The Crichton, Dumfries
In Attendance
Social Work Sub Committee Members
John Dougan (Chairman) - Stranraer & North Rhins
James Dempster - Mid and Upper Nithsdale
Iain W Dick - Stranraer and North Rhins
Sandra McDowall - Mid Galloway
Lorna J McGowan - Lochar
Willie Scobie - Stranraer and North Rhins
Roberta Tuckfield - Wigtown West
Present
NHS Board Sub Committee Members
John Burns - Chief Executive NHS
Craig Marriott - Director of Finance NHS
Andrew Campbell - NHS Non Executive Member
Andrew Johnston - NHS Non Executive Member
Officials
John Alexander - Director of Social Work
Carol Henshall - Service Manager Committee and
Member Services
Judith Proctor - Director of Planning, Head of
Strategic Planning, Commissioning
and Performance
Allan Monteforte - Senior Social Work Manager
Alex Haswell
Director Chief Executive Service
115
Minute
30 September 2011
Minute
0.1
PROCEDURE - John Dougan opened the meeting and welcomed both
Members and the Public who were in attendance at today’s meeting. He
summarised the progress made by the Community Health and Social Care
Partnership Board over the past year and thanked Members for their continuing
commitment to partnership working. He extended the best wishes on behalf of the
Board to Mr Tommy Sloan, NHS Non Executive Board Member for a speedy
recovery.
1.
APPOINTMENT OF CHAIRMAN
Decision
1.1
NOTED that, in accordance with the partnership agreement, the chairmanship
would rotate at this meeting and it now fell to the NHS membership to nominate and
appoint a Chairman; and
1.2
AGREED that Andrew Johnston be appointed as Chairman of the Community
Health and Social Care Partnership Board
PROCEDURE - Andrew Johnston assumed the role of Chairman of the Community
Health and Social Care Partnership Board
2.
SEDERUNT AND APOLOGIES – Community Health and Social Care
Partnership Board NHS Committee
4 Members present.
3.
DECLARATIONS OF INTEREST – SOCIAL WORK SERVICES SUB
COMMITTEE
Iain W Dick declared an interest in Item 9 - Developing a Day Services Framework
by virtue of his membership of the Coronation Day Centre and had
determined that the interest was such that he would leave the meeting when
funding of Voluntary Day Centres was considered
4.
MINUTE OF THE COMMUNITY
PARTENRSHIP BOARD OF 17 JUNE
HEALTH
AND
SOCIAL
CARE
Decision
APPROVED.
4A. ITEM OF BUSINESS DEEMED URGENT BY THE CHAIRMAN DUE TO A
NEED FOR A DECISION
4A.1 MINUTING CONVENTIONS
Decision
116
Minute
30 September 2011
Minute
AGREED that a review of the respective minuting conventions in use by the NHS
and the Council be undertaken to seek to harmonise in so far as the meetings of the
Community Health and Social Care Partnership were concerned.
REPORTS
8.
EQUIPMENT AND ADAPTATIONS TO SUPPORT INDEPENDENT LIVING
Decision
AGREED having reviewed and scrutinised the delivery of the services to assure that
the progress and procedures are in line to ensure the delivery of the services
outlined in the Social Work Services Business Plan as follows:8.1
to receive a report in March 2012 on progress and outcomes;
8.2
to remit to the Director of Social Work, in conjunction with the Chief Executive
NHS, to further review processes to assure further and continuing improvements in
integrated working and discharge planning and joint assessments;
8.3
to remit to the Chief Executive NHS to review the Service Level Agreements
with other Health Boards to address quality issues and discharge protocols;
8.4
to recognise forthcoming legislative changes in respect of special care selfdirected support and the need to understand that the assessment for the provision of
major adaptations must look at needs now and as they will be over the subsequent
10 years; and
8.5
to engage with Registered Social Landlords to assure that adapted housing
stock be maintained and accessible.
MEMBER – Iain W Dick declared an interest in the following item of business and
left the meeting when the debate turned to the particulars of the funding of Day
Centres and the meeting divided for a vote.
9.
DEVELOPING A DAY SERVICES FRAMEWORK
SOCIAL WORK SUB COMMITTEE VOTE
9.1
MOTION by WILLIE SCOBIE seconded by JAMES DEMPSTER to the use of
Social Work Change Fund budget to provide as a minimum the same level of
additional funding for the Voluntary Day Centres as provided in 2011/12 for the
financial year 2012/13 i.e. £81,096 to support them across the procurement process
and to receive a report on options for additional funding for 2011/12 to take account
of inflation and to provide for options for funding in 2012/13 to provide for confidence
and assurance in the provision of voluntary day centres.
9.2
AMENDMENT by SANDRA MCDOWALL seconded by ROBERTA
TUCKFIELD to the use of Social Work Change Fund budget to provide the same
level of additional funding for the Voluntary Day Centres as provided in 2011/12 for
the financial year 2012/13 i.e. £81,096 to support them across the procurement
process
117
30 September 2011
Minute
9.3
Minute
On a vote being taken by roll call Members voted as follows:-
Motion - 3 Votes being:Jim Dempster, Lorna McGowan and Willie Scobie
Amendment - 3 Votes being
John Dougan, Sandra McDowall and Roberta Tuckfield
9.4
There being an equality of votes the Chairman exercised his right to a casting
vote which fell in favour of the amendment
9.5
NHS Committee AGREED with the recommendations as set out in the paper.
Decision
AGREED
9.5
the proposed timetable for the tender process for generic day care;
9.6
the outcomes-based approach being taken for generic day care service
design; and
9.7
to the use of Social Work Change Fund budget to provide the same level of
additional funding for the Voluntary Day Centres as provided in 2011/12 for the
financial year 2012/13 i.e. £81,096 to support them across the procurement process.
10.
DEVELOPMENT OF THE CHSCPB
Decision
AGREED the initiation of a development programme for members of the Community
Health and Social Care Partnership Board.
118
Agenda Item 249
6 February 2012
Draft Dumfries and
Agreement 2012 / 2015
Galloway
Author:
Jennifer Wilson, Corporate Business Manager
Single
Outcome
Jeff Ace, Chief Executive
RECOMMENDATION
The Board is asked to endorse the Draft Dumfries and Galloway Single Outcome
Agreement 2012 / 2015.
SUMMARY
The draft Single Outcome Agreement (SOA) 2012 / 2015 was approved by the
Strategic Partnership on 24 November and subsequently a small number of detailed
amendments were made which have been approved by the Executive Group. The
SOA for 2012 / 2015 replaces the region’s Community Plan.
Key Messages:
The SOA sets out the vision and principles for partnership working in Dumfries and
Galloway.
It defines the priorities and ambitions for what partners seek to achieve for the
population of Dumfries and Galloway.
The actions and performance targets provide detail of the actions and outcomes that
will be achieved.
Individual organisations will use the SOA to direct and inform their work and use of
resources so that the vision is achieved in partnership.
GLOSSARY OF TERMS
SOA
Single Outcome Agreement
119
MONITORING FORM
Complies with community planning responsibilities
and requires individual agencies to integrate
actions and plans into their business plans.
New ways of delivering services and supporting
individuals and communities will be required.
Supports Best Value and seeks to make
operational efficiencies and maximise other funding
opportunities.
Consultation
Single Outcome
partnership.
Agreement
developed
in
Consultation with Professional Not undertaken.
Committees
Risk Assessment
Not undertaken.
Best Value
The Single Outcome agreement seeks to address
all seven of the Best Value themes and provide the
right services in the right place, at the right time and
in the right place.
Sustainability
Ensuring long-term economic,
environmental wellbeing.
Compliance
Objectives
Single
(SOA)
with
Outcome
social
and
Corporate The Single Outcome Agreement seeks to deliver on
all of the Corporate Objectives.
Agreement All priorities and ambitions.
Impact Assessment
The Equality Act 2010 has a public sector equality duty which consists of a general
equality duty and specific equality duties.
120
Together is Better
2012-15
As at 9 December 2011
1
121
Contents
Page
1.
2.
3.
4.
5.
6.
3
4
5
6
8
28
Introduction
Summary Priorities and Ambitions
Performance Framework
Governance, accountability and funding
Area profile
What we will do - actions, performance and key
targets
2
122
1.
Introduction
This Single Outcome Agreement (SOA) sets out the vision and principles for partnership
working in Dumfries and Galloway. It also defines the Priorities and Ambitions for what
we want to achieve for the people of our region. The Actions and Performance Targets
give the detail about what we are going to do and the outcome that we will achieve.
Individual organisations will use this Agreement to direct and inform their work and use
of resources so that we achieve our vision together.
OUR VISION
Working together to create an ambitious, prosperous and confident Dumfries and
Galloway where people achieve their potential.
OUR PRINCIPLES
These principles have been identified as important in guiding partners to achieve the
Vision:
Best value
- providing the right services in the right place, at the right time and at the right price.
Engagement
- listening to, speaking and consulting with individuals and communities, following
National Standards and Compact guidance where involving the public and ensuring
participation are key elements.
Diversity
- treating people equally and respecting others irrespective of social or cultural
differences.
Sustainability
- ensuring long-term economic, social and environmental wellbeing.
Working together
- finding ways of planning and delivering services in a better way that makes a real
difference to people’s lives.
3
123
2.
Summary of the Priorities and Ambitions
Priority 1
We will provide a good start in life for all our children
Ambitions
1.1
Our children will be kept safe.
1.2
We will make effective interventions.
1.3
All children and young people will be supported through transition.
1.4
All children will have a sound basic education in numeracy and literacy.
1.5
Our children will have the best possible health and wellbeing.
Priority 2
We will prepare our young people for adulthood and employment
Ambitions
2.1
Young people will be supported to make the right choices.
2.2
We will ensure our young people have high quality learning
experiences and succeed.
Priority 3
We will care for our older and vulnerable adults
Ambitions
3.1
Older and vulnerable adults will have choice and control in decisions
affecting their lives.
3.2
Older and vulnerable adults will be enabled to optimise their health and
independence reducing the need for crisis management.
3.3
Older and vulnerable adults will be provided with high quality and
reliable support.
3.4
Unpaid carers will be key partners in care delivery.
3.5
Older and vulnerable adults will have good information on their rights.
3.6
We will protect adults at risk.
3.7
Older and vulnerable adults will be supported to improve their health.
Priority 4
We will support and stimulate our local economy
Ambitions
4.1
We will attract and sustain investment to grow our local economy.
4.2
Employment opportunities will be enhanced through innovation and
skills development.
4.3
We will build the capacity of individuals and communities to support the
economy.
4
124
Priority 5
We will maintain the safety and security of our region
Ambitions
5.1
Our people and communities will be safe and secure.
5.2
We will build individual and community resilience.
5.3
We will ensure that individuals and communities are treated fairly and
with respect.
Priority 6
We will protect and sustain our environment
Ambitions
6.1
We will be a carbon neutral region.
6.2
The resources of landscape, natural and built environment of Dumfries
and Galloway will be protected and enhanced.
3.
Performance Framework
3.1
Links to the national performance framework and other strategies
The Ambitions in the SOA contribute to the Scottish Government’s 15 National
Outcomes. It is important to recognise the inter-dependence of the Ambitions and that
each contributes to more than one National Outcome and/or national strategy.
Performance recording arrangements
3.2
It is recognised that there is an ongoing need to improve performance information
and in particular consolidating trend and baseline information and identifying new
strategic indicators and/or new recording mechanisms.
This work has been ongoing throughout the duration of the first two SOAs and so
there is experience and expertise to draw on. By using existing partnership reporting
measures and frameworks we will have strengthened our performance management
approach. Partners will continue to use the computer based Covalent system as the
preferred tool for recording and reporting progress.
3.3
Performance reporting
On a partnership basis:
• Quarterly progress reports on the overall SOA will be assessed by the Strategic
Partnership.
• Progress of projects and services is reported to the Strategic Partnership on an
ongoing basis.
• A publication called 'Broadcast' is delivered to every household in Dumfries and
Galloway once a year to tell local people about progress in achieving performance
targets.
• Local media, e newsletters and the Community Planning website are employed to
ensure information is available to public and all partners.
• The performance reports on the SOA required by the Scottish Government will be
submitted on time.
5
125
On an individual basis:
Partners will report progress on the delivery of their contribution to the SOA through their
own performance and reporting arrangements.
4.
Governance, accountability and funding
Dumfries and Galloway community planning partners evidence openness,
inclusiveness and accountability through the formal decision making processes.
Oversight of the SOA is the responsibility of the Strategic Partnership with the
Executive Group undertaking a problem solving role in relation to any progress not
on schedule.
In accordance with the national Guidance, Dumfries and Galloway community
planning partners have agreed to deliver on the overall set of commitments.
Individual partnerships are identified within the SOA for each of the Indicators and will
be deemed accountable by the Strategic Partnership for delivery. Individual partner
agencies are expected to ensure that they are able to deliver on the SOA by having
the Actions and targets integrated into their respective Business Plans.
It is recognised that delivery of the SOA is dependent on adequate funding and all
local partners are committed to working constructively with the Scottish Government to
secure that, as well as making operational efficiencies and maximising other funding
opportunities.
It is also recognised that new ways of delivering services and supporting individuals
and communities will be required.
A mapping exercise of the region’s assets is being undertaken and during the three year
period of the SOA, the resources invested in each of the Priorities will be identified. This
work will begin with the public sector resources.
Agency
D&G Council
NHS D&G
DG Constabulary
Key Assets
budget
staff
schools
customer service centres
libraries
leisure centres
museums
budget
staff
main hospitals
cottage hospitals
GPs and surgeries
budget
staff
6
126
D&G Fire and Rescue Service
Scottish Enterprise South
Dumfries and Galloway College
Crichton Campus Universities
Third Sector
Private Sector
police stations
budget
staff
fire stations
budget
staff
business parks
budget
staff
campuses
students
budget
staff
students
budget
staff and Board members
Community Councillors
volunteers
turnover
businesses
7
127
5.
Area profile
The Area Profile for Dumfries and Galloway highlights some of the key characteristics of,
and issues facing the region which have determined the Priorities, Ambitions and Actions
outlined in this SOA.
5.1
General issues
Population and geography
•
•
•
•
•
•
third largest region in Scotland covering 6,426 sq km (8% of the total land area of
Scotland)
population of 148,190 (2.8% of the total population of Scotland)
larger proportion of older people and a markedly smaller proportion of young people
persons aged 60+ make up 30.1% of the population (Scotland: 23.1%)
significantly fewer people aged 16 to 29 years - 14.2% (Scotland: 18.7%)
57% of population of working age, the lowest figure of all 32 local authority areas
(Scotland average: 63%)
Rurality
•
•
•
•
•
•
small settlements of 4,000 or less spread across a large area
one third of people living in settlements with less than 500 people
23 persons per sq km (Scotland average: 67)
biggest town is Dumfries (population 31,610), followed by Stranraer (10,380) and
Annan (8,450)
over a quarter of the population lives more than 30 minutes drive from a large town
seven secondary schools have fewer than 500 pupils; 43% of primary schools have
fewer than 50
Households/Housing
•
•
•
•
•
•
•
•
•
•
68,408 households (2010 estimate). While the population has remained relatively
static since 2001, the number of households and the associated requirement for
suitable housing options has increased by 5%
72,421 dwellings; 94% occupied, 3% vacant, 3% second homes
the total number of households in the region is predicted to increase by 346 each
year
the numbers of single parent and single person households are projected to increase
by 2019 with the number of family households projected to decrease significantly
the proportion of older person households is projected to increase notably over the
next ten years, particularly the 75+ age group which is expected to increase by 27%
market turnover in the region increased by 6% between 2003-07, significantly lower
than the rest of Scotland
affordability analysis shows that 44% of households in the region cannot afford to
access the private housing market, even at market entry levels
house prices October-December 2009 fell on average by 2%
homelessness rate around 2.3% of all households (national average 2.5%)
1,600 homelessness cases per year
8
128
•
•
82% of all clients of homeless households in priority need secure permanent
accommodation (5th highest in Scotland)
there is an annual shortfall of 510 units of affordable supply in the region
Population Forecast
•
•
•
•
•
•
•
the total population is expected to decline from 148,580 in 2008 to 147,138 in 2033, a
decrease of 1%. This decline is due to more deaths than births despite in-migration
but is a smaller reduction than forecast in the 2006-based projections
the gap between older and younger populations is likely to widen over time. The
over-65s population is likely to grow by 25% by 2018 and 56% by 2033 (29% for
those aged 65-74 and 88% for those aged 75 and over)
the number of residents aged 90 years or over is projected to increase from 1,134 in
2008 to 4,425 in 2033
the number of children aged 0-15 is expected to reduce by 8.1% between 2008 and
2033, declining from 25,157 to 23,111
the working age population is predicted to decline by 10.8% by 2033. This will see a
decrease in the absolute numbers from 86,000 in 2008 to approximately 77,000 in
2033 despite forecast changes in the state pension age for both men and women
the number of deaths exceeds the number of births, which means that the natural
growth of the population is negative (although the population estimate for the region
has been reasonably stable over time)
in terms of migration, the high migration variant shows the population increasing from
148,580 in 2008 to 155,918 in 2033, an increase of 4.9%. The low migration
projection forecasts that the population size will fall to 138,485 in 2033, a decrease of
6.8%
Wh a t d o e s th is m e a n fo r th e fu tu re ?
•
•
•
•
•
•
substantially greater demands on the social and healthcare systems
a reduced workforce which would normally be responsible for providing care
a need to optimise the size of the workforce
a need to increase productivity
a need to enhance independence of the population and build capacity of individuals
and communities
over the next ten years, average future demand for both affordable and market
housing is 4,257 households each year
Data sources
Dumfries and Galloway Council Housing Need and Demand Assessment
Dumfries and Galloway Demographic Factsheet
Dumfries and Galloway Population Profile - NHS D&G Health Intelligence Unit
Household and Dwellings
Household Projections
Mid-2010 Population Estimates Scotland
Mid-2008 Population Estimates for Settlements and Localities in Scotland
Population Projections
Scottish Government website - Statistics
9
129
Scottish Household Survey Annual Report
2001 Census Results
2009-10 Urban Rural Classification
10
130
5.2
Diversity
The Equality Act 2010 has a public sector equality duty which consists of a general
equality duty and specific equality duties.
Scottish local authorities must have due regard to the need to eliminate unlawful
discrimination, harassment and victimisation; advance equality of opportunity; and foster
good relations between people who share a protected characteristic and those who do
not. The new duty covers the following eight protected characteristics: age, disability,
gender reassignment, pregnancy and maternity, race, religion or belief, sex and sexual
orientation. Public authorities also need to have due regard to the need to eliminate
unlawful discrimination against someone because of their marriage or civil partnership
status.
Race
• the size of the non-white minority ethnic population is 960 or 0.65%
• in 2008-09, less than 10% of migrants came from overseas, around 50% from the rest
of the UK and 40% from within Scotland. Numbers of traditional migrant groups
(Pakistani, Bangladeshi, Chinese, Indian and Caribbean people) are small
• the three main non-English languages spoken by school pupils at home are Polish,
Cantonese and Punjabi
• almost half the total minority ethnic population resides in Nithsdale; just over 20% in
Annandale and Eskdale; and around 15% for both Stewartry and Wigtownshire
• Dumfries and Galloway has a higher proportion of Gypsy/Travellers than the rest of
Scotland. 115 Gypsies/Travellers households as at March 2009
Disability
• adults with learning disabilities: 883, 7.1 per 1,000 population; Scotland 27,391, 6.4
per 1,000 population (July 2010)
• people registered as blind, partially blind and visually impaired: 1,924 (October 2010)
• employment rates for disabled people vary greatly across local authority areas e.g.
50% in Dumfries and Galloway, 70% in Shetland, 34% in Glasgow
Marriages/Civil Partnerships
• marriages in 2010: 4,881, an increase of 5.4% from 2009
• since 2000, the number of marriages has fallen by 23.3%
• civil partnerships increased in 2010: 61, compared with 43 in 2009; Scotland saw a
decrease from 498 in 2009 to 465 in 2010
Pregnancy and Maternity
• number of births in D&G in 2010: 1,445 (2% of Scotland figure 58,792)
• rates of live births per 1,000 women aged 15-44 have increased by 5.4% over the last
five years (54.6 in 2005; 60 in 2010) (Scotland: 51.5 in 2005; 56.5 in 2010; 5%
increase)
11
131
Religion or Belief
• 70.83% of the local population indicated that they have a faith: 69.98% of these
identify as Christian and of these 55% identify as Church of Scotland which is higher
than the Scottish average
Gender
• males 48% population; females 52%
• average age female population greater than males (D&G: females 43.9 yrs; males
42.3 yrs) and both greater than the Scottish average (females 40.6 yrs, males 38.6
yrs)
• female life expectancy at birth (81.5 yrs) greater than male life expectancy (76.7 yrs)
Sexual orientation and Gender reassignment
• it is estimated that between 5% and 10% of people in Scotland are lesbian, gay,
bisexual or transgender (LGBT)
• although societal views are slowly becoming more tolerant of lesbian, gay and
bisexual people, research shows that negative attitudes towards transgender people
remain particularly common
• research indicates that attitudes in rural Scotland are often less tolerant and that the
majority of LGBT people in rural areas feel they need to leave their home area before
they can come out
• invisibility, social isolation, homophobic bullying and discrimination can lead to a range
of other issues for LGBT people including poor mental, physical and sexual health;
poor educational attainment; and poverty and social exclusion
• the small number of people within the protected characteristics and the rurality of the
region mean that discrimination is more likely and awareness of this is essential as
the first step in positive action to tackle it
• research and data is required to ensure services and support are tailored to meet
need
• the discrimination, victimisation and harassment often experienced by minority groups
can make them more likely to become vulnerable in other areas of their lives. This is
particularly true for people who share more than one protected characteristic e.g.
LGBT older people; young disabled people; women from Black or Minority Ethnic
(BME) communities etc. A range of initiatives is therefore required, promoting the
same fundamental principles of fairness and equality but also addressing the specific
issues of different characteristics
Data sources
Births
Dumfries and Galloway Equalities Mapping Report 2010
Getting It Right - Minority Ethnic Health and Wellbeing: Needs Assessment
Life Expectancy
Marriages and Civil Partnerships
12
132
Mid-2010 Population Estimates Scotland
Migration
Scottish Government website - People and Society
Scottish Social Attitudes Survey 2010
Stonewall Scotland, City Lights?
2001 Census Results
13
133
5.3
Economy
General
• key sectors: agriculture, forestry, tourism and food processing
• main employer is public sector (current ratio of private to public sector being 60:40
with the Council and NHS comprising around 33%)
Employment and business opportunities
• high economic activity rates; high business start up rates
• small and medium sized enterprises employ a significant proportion of people in the
region compared to Scotland as a whole
• employment rate 72.4% (Scotland: 73%) with high levels of self employment, parttime and seasonal employment in lower wage jobs
• unemployment rate 3.6% (Scottish average: 4.3%); numbers of unemployed 3,267
(August 2011);
• as at March 2011, 567 known unemployed young people aged 16-19
• 71,600 people are economically active; 18,400 work in public administration,
education and health (2008), which is 31.2% (of total employee jobs of 58,900)
• 7.5 people (Job Seekers Allowance claimants) for every unfilled Job Centre vacancy
(Scotland 9.2; UK 5.6) (August 2011)
• the Local Social Economy is worth around £15M
• 93.5% of travel to work journeys begin and end within the region
• the region needs to ensure that it is attractive to people of working age and thus
attractive for inward investors
• there is a need to ensure people have basic skills for employment
• entrepreneurial activity must be supported
• greater focus is required on supporting sustainability and growth opportunities for
existing business to complement the aim of continuing to increase business start up
rates
• need to consider and address challenges ahead due to the public sector contracting
over the next five years as a result of public spending cuts
• a strategic review of the Council’s Industrial portfolio is required to assess
effectiveness of current provision and identify areas of demand affected by market
failure
• the formation of new policies to direct European Structural Funds and Common
Agriculture Policy Funds post 2013 will require strong lobbying on a South of Scotland
basis to protect future grant support for key economic activity
14
134
Data sources
Dumfries and Galloway Regional Economic Strategy
Dumfries and Galloway SDS Local Authority Profiles
nomis official labour market statistics
Scottish Government website - Business and Industry
Scottish Government website - the Economy
Scottish Government website - Transport
South of Scotland Competitiveness Strategy
15
135
5.4
Poverty, inequality and deprivation
Definition
• deprivation indicates the level of disadvantage for individuals or areas
• it has a strong link with disease and death rates, regardless of how it is measured
Dumfries and Galloway Scottish Index of Multiple Deprivation (SIMD) datazones
• SIMD2009 uses categories such as income, education, unemployment, health,
access to services, housing and crime to calculate the average deprivation for small
areas called datazones
• Dumfries and Galloway has 19 datazones in the 20% most deprived in Scotland i.e. a
1.5% share of all the most deprived areas in Scotland
• number of people living in these most deprived areas is approximately 14,206, 9.6%
of the local population (Scotland: 20% of the population in the 20% most deprived
areas)
• there are six areas of relative deprivation in the region: central Dumfries, Northeast
Annan, Northwest Dumfries, Upper Nithsdale, the Machars and Stranraer
• a minority of income-deprived and employment-deprived people live in these areas of
relative deprivation; the majority (79% of income-deprived and 79% of employmentdeprived people) live outwith them
• there is a need to maximise household income
• caring for vulnerable people is a priority
• there is a need to reduce inequalities in health
Data sources
Deprivation in Dumfries and Galloway - NHS D&G Health Intelligence Unit
Inequalities and Health - NHS D&G Health Intelligence Unit
Scottish Index of Multiple Deprivation 2009
16
136
5.5
Health
Life expectancy
• life expectancy at birth is better than Scotland but worse than the UK for both males
and females (D&G males 76.7 yrs, females 81.5; Scotland males 75.8, females 80.4;
UK males 78.2, females 82.3)
• life expectancy at age 65: D&G males 17.1, females 20.1; Scotland males 16.8,
females 19.3; UK males 18, females 20.6)
• D&G life expectancy at birth ranks in the bottom 25% of all local authorities in the UK
for both males and females
• life expectancy is increasing steadily over time; since 1991-1993 male life expectancy
at birth has increased by 4.2 years and female life expectancy has increased by 4.3
years
• inequalities gap in life expectancy at birth: lower in the most deprived areas of D&G
compared to the least deprived areas for both males (difference 5.8 yrs) and females
(3.7 yrs)
Mortality
• number of deaths in D&G 2010: 1,857 (3% of Scotland total 53,967)
• main causes of death in D&G are cancer, coronary heart disease, and stroke, which
accounted for 54% of all deaths in 2010: cancer 538, coronary heart disease 278, and
stroke 188; they were also responsible for more than 50% of all deaths in Scotland:
cancer 15,618, coronary heart disease 8,138, stroke 4,764
• death rates for cancers, coronary heart disease and respiratory disease are lower
than average compared to Scotland
He a lth
• prevalence of chronic conditions is higher than average for most conditions: D&G
asthma 6%, coronary heart disease 5.3%, diabetes 4.8%, hypertension 15.1%
(Scotland asthma 5.9%, coronary heart disease 4.4%, diabetes 4.1%, hypertension
13.4%)
• lower proportion of the population aged 16+ claiming incapacity benefit or severe
disability allowance compared to Scotland in 2010 (D&G 4.8% adult population;
Scotland 5.6%)
• the biggest single factor influencing social care and health needs in the future is
expected to be the substantial rise in the number of older people
• fewer people of working age means it is likely to become increasingly difficult to attract
the skilled professional and care staff that will be needed - as at March 2011, there
were 2,446 Home Care Clients
• by the age of 65, nearly two-thirds of people will have developed a long term condition
and 27% of people aged 75-84 have two or more such conditions
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137
• there will be more cases of certain diseases associated with older age (for example,
cancer, dementia, osteoarthritis, and diabetes)
• we need to develop more services to prevent unnecessary admissions into hospital;
continued focus is required on the delivery of sustainable improvements in patient
centred services for people living with long term conditions
• we need to do everything possible to prevent people becoming ill, and to encourage
people becoming ill to cope differently with ill health. We will do this by supporting
parents in bringing up their children, by giving people more control over their lives,
and by building social capital in communities
• we need to tackle specific health issues, such as continuing to improve the death
rates for cancer and stroke towards the United Kingdom and European average
Data sources
Better Health, Better Care: Action Plan
Births
Community Health and Wellbeing Profiles
Deaths
Dumfries and Galloway: The Population and its Health
Improving the Health and wellbeing of People with Long Term Conditions in Scotland: A
National Action Plan
Information Services Division Scotland - health information and statistics
Life Expectancy
Scottish Government website - Health and Social Care
Update on Life Expectancy in Dumfries and Galloway - NHS D&G Health Intelligence
Unit
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5.6
Technical infrastructure, transport and travel
Broadband
•
•
•
•
Broadband uptake in Dumfries and Galloway is 59% of homes compared to 61% for
Scotland as a whole. Scotland is low in UK terms
Dumfries and Galloway is near the bottom of the table for broadband availability at
31st out of 32 council areas
approximately 15% of lines across the South of Scotland are not able to support
2Mbps. As the total number of lines served in the South of Scotland is 133,440, this
equates to more than 20,000 lines in the region which are unable to receive a 2Mbps
connection
The South of Scotland Alliance has secured funding for the South of Scotland Next
Generation Broadband project to improve these speeds and availability. Procurement
of a broadband solution for the region is underway
Transport infrastructure
• Local Roads Network comprises some 2,590 miles
• SWestrans Regional Transport Partnership has access to a budget of £2.224M capital
and £600k revenue and an additional £3M for public bus services
• the third year programme of the £6M forward allocation for a Strategic Roads
Programme will be completed in the financial year 2011/12
Travel
• significant improvements in disabled access at Lockerbie Railway Station, the key
station on the main West Coast Main Line and improvements in the train service
available
• development/implementation of the Southern Dumfries Access Strategy to help
secure the continued development of the Crichton Quarter
• lobbying continues to the Scottish Government for improvements to the
TransEuropean routes A75 and A77
• 5.05M passengers per annum travel on subsidised bus services, covering 79 routes
• 68% of people drive to work in Dumfries and Galloway, compared to the national
average of 67%
• cycle travel and walking are below the national average
• investment in the strategic infrastructure is essential because of the scale of the
region’s road network
• the Crichton Quarter requires focussed attention because of the importance of
connectivity and potential traffic volume - an agreed, shared vision for the whole
campus is required to achieve sustainable investment
• alternative forms of transport require promotion and increased attention through the
implementation of the Local Transport Strategy 2011-16
• implementation of the South of Scotland Broadband Plan
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Data sources
Scottish Government website - Transport
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5.7
Education
Looked After Children (LAC)
• 394 LAC (Scotland: 15,892) (July 2010)
• new tracking and monitoring processes are in place in all schools to assist school
management teams in supporting every child to reach their potential
In 2009/10:
• measures were introduced to monitor attendance more closely and these should help
improve average attendance. 88.7% attendance average (Scotland: 87.8%); 443
exclusions per 1,000 pupils (Scotland: 365)
• good average attainment tariff scores (based on total attainment on leaving): D&G
average score 81 (Scotland: 67). D&G average tariff score for all leavers 381
(Scotland: 372)
• good results for positive post-school destinations at initial survey: 59% in positive
destinations (higher education, further education, training, voluntary work and
employment) (Scotland: 59%); at follow-up survey: 43% (Scotland: 44%)
Attainment and achievement
• Key Performance Indicators around attainment and participation are encouraging
• Curriculum for Excellence progressing to planned timeline
• methods to record and report on achievement are in development with national
partners
• increasing numbers of young people are achieving accreditation in recognition of their
achievements through, for example, Duke of Edinburgh Award Scheme, Sports
Leadership Programmes, Youth Achievement Awards and John Muir Trust
Improving participation and access to learning
• higher levels of attendance and lower levels of exclusion than the national average
e.g. in 2009/10 96% level of attendance in primary schools; in 2007/08 and 2008/2009
we ranked 7th in Scotland. Average attendance in secondary schools is 92%;
2008/2009 ranking 11th in Scotland
• in 2009/2010, the rate of exclusion per 1,000 pupils was 9 per primary and 61 in
secondary, an overall 38% reduction in exclusions from our schools on the previous
year
Getting it Right for Every Child (GIRFEC)
• the GIRFEC Plan is in place with six priorities: Keeping children safe; Early
intervention; Early years; Transition; health; Managing risk and responding to crisis.
The GIRFEC Plan is where the vision for integrated working is put into practice. It
contains actions that belong to all partner agencies involved and can only be carried
out through joint working. The actions in the GIRFEC Plan will ensure that the most
vulnerable children in the region have a good start in life and are prepared for
adulthood
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School Estate
• £108M Public Private Partnership to build four new primary schools, three all-through
schools and one refurbishment and extension completed
• three Council-funded new primary schools completed in 2009/2010
Targeting skills training for employment
• more school leavers here go on to work or further study than comparator authorities
In 2009/10:
• 87.6% in positive destinations (Scotland: 86.8%)
• 61.8% entered further or higher education (53.3% in 2006/07)
• 35.2% entered Higher Education (Scotland: 35.7%)
• 26.6% entered Further Education (Scotland: 27.1%)
• 2.9% entered Training (Scotland: 5.2%)
• 22.2% entered Employment (Scotland: 18.5%)
• 0.7% entered Voluntary Work (Scotland: 0.3%)
• 10% unemployed and seeking work/training (Scotland: 11.3%)
• 1.5% unemployed and not seeking work/training (Scotland: 1.3%)
• the destination of 0.9% is unknown (Scotland: 0.6%)
Encouraging responsible citizenship
• core principles embedded in the Curriculum for Excellence
• an active Youth Issues Unit that works with the Scottish Youth Parliament and other
democratic initiatives to encourage responsible citizenship
• the Compact and Community Council activity
• updated Volunteering Strategies and increasing volunteering opportunities
• Community Service is supported and schools are also a focus - for example 100% of
schools are involved in the eco-schools initiative and some are working towards
Fairtrade status
• youth forums and school councils provide an opportunity for young people to influence
decisions that affect them
• inequalities in attainment and participation between Looked After Children and other
pupils must be addressed
• given the current employment/training environment, recognition of difficulties faced by
Looked After school leavers and identification of ways of addressing these
• build on existing good multi-agency practice in terms of early intervention and
providing the right help at the right time to assist vulnerable children to achieve
positive outcomes; continue to improve partnership working, streamline processes
and avoid duplicating activities
• continued support to young people to ensure successful transition from school into
education, employment or training; ongoing work in schools to target skills for
employment and clear liaison with the 16+ More Choices More Chances agenda
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• identify sources of funding to support young people requiring More Choices More
Chances, including through lobbying
• public sector organisations should consider extending the number and range of
Modern Apprenticeships and other training opportunities
• continue to develop and recognise wider achievement of young people
Data sources
Educational Outcomes for Scotland’s Looked After Children
Education Standards and Quality Report
Getting it Right for Every Child (GIRFEC)
More Choices, More Chances National Strategy
Parents Charter
Scottish Government website - Education and Training
Scotland’s School Education Statistics
16+ Policy and Practice Framework: supporting all young people into positive and
sustained destinations
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5.8
Community Safety
Dumfries and Galloway is one of the safest areas to live in Scotland with levels of crime
and road casualties low, and largely improving.
Crime is categorised for the purpose of statistics and the following information shows the
likelihood of someone being a victim of crime as recorded in 2011/12 with comparison to
the position in other police force areas and in Scotland as a whole.
Violent Crime
• lowest level of crime per head of population as compared with the other policing
regions (approximately one third of the rate in Scotland overall)
Sexual Crimes and Offences
regions (approximately half of the rate in Scotland overall)
Crime involving Dishonesty
regions (approximately two thirds of the rate in Scotland overall)
Crimes involving Criminal Damage and Fire-raising
• second lowest level of crime per head of population as compared with the other
policing regions (approximately three quarters of the rate in Scotland overall)
Domestic Abuse
• national research and examination of serious crimes shows a tragically strong
connection between domestic abuse and violent crime including murder and rape;
Dumfries and Galloway does not escape these events
• examination of the breakdown of crimes for which people are held in police custody
shows that domestic abuse is a very regular feature with at least one person arrested
almost daily for this type of behaviour
• the number of reported domestic abuse incidents in this area has ranged from 1,200
to 1,400 over the last four years - the higher number reported in 2010/11. This
reflects a higher rate of victimisation than some areas, but is consistent with the
Scottish average (it should be recognised that a heightened level of recorded
incidents may be a sign that more victims have decided to report their experience
rather than a rise in the number of people who are victims)
Drugs and Alcohol
• there is a clear relationship between crime and the misuse of drugs and alcohol,
which is shown in the offences detected involving the possession, supply and
manufacture/cultivation of drugs. In Dumfries and Galloway the level of drugs
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offences is high compared with other parts of Scotland when population size is taken
into account (although the figure is marginally below that for Scotland as a whole)
• drugs and alcohol also impact on other types of offending e.g. from theft to fund drug
purchases, to alcohol fuelled violence. A high proportion of people coming into police
custody are under the influence of alcohol at the time of their offence and arrest
Racist Incidents and Crimes
•
small numbers of racist incidents and crimes are reported in this region (ranging
from 66 to 99 per annum) and are consistent with or below the national averages
(taking account of population)
Other Offences
•
other types of crime and offences are recorded as a result of police and other
services’ activities e.g. drug and other more minor offences the levels for which are
consistent with the average in Scotland (with the partial exceptions of Breach of the
Peace and Minor Assaults where the rate in this area is about three quarters of that
for Scotland as a whole)
Antisocial Behaviour
•
reductions have continued in relation to vandalism and antisocial behaviour. A
robust Antisocial Behaviour Strategy is in place which encompasses diversionary
activities, tackling repeat offenders, engaging young people in positive citizenship
through schools and targeting Police and Community Warden activity to times and
locations where antisocial behaviour has been taking place
Home fire safety
•
over the last five years home fire deaths have been consistently low with only 7
deaths being recorded in that time period and none recorded since 2010. This can be
attributed to a range of successful initiatives targeted at vulnerable people, including
the home fire safety check programme
Road Casualties
road casualty levels have been falling year on year, and the number of people
killed or seriously injured has been reduced incrementally from 631 in 2007/08 to 461
in 2010/11. This reduction has also led to the relative number of people killed or
seriously injured (per million vehicle kilometres) changing so that this region has gone
from being notably above the Scottish average to being markedly below that average
•
the level of motoring offences reported in this region is almost double the rate in
Scotland overall when population size is taken into account
•
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Strategic response
• a responsive local Strategy and Action Plan is being developed by the Community
Safety Partnership to help address the identified threats to safety
• specialist multi-agency partnerships e.g. the Domestic Abuse and Violence Against
Women Partnership, the Alcohol and Drugs Partnership, the Youth Justice Strategy
Group, the Antisocial Behaviour Strategy Group and the Road Safety Partnership
have outcomes-focussed, robust and up to date plans in place to effectively tackle, in
partnership, the identified issues and prevent them re-occurring in the future
• the likelihood of someone being a victim of any type of crime, or suffering an injury on
the road, is notably lower in Dumfries and Galloway than elsewhere in Scotland so our
focus and efforts must continue on prevention and early intervention
• enforcement of legislation and pursuit of prosecution will continue
• partnership working must continue to be strengthened and focussed so that activities
to tackle the most serious and most prevalent community safety concerns can be
addressed, including:
- Public Protection (Child and Family Protection, including Domestic Abuse and
Violence Against Women, Adult Protection, Youth Crime, Vulnerable Groups)
- Terrorism
- Road Safety
- Substance Misuse
- Antisocial Behaviour
- Violent Crime
- Emergency Planning
Data sources
Adult Support and Protection
Alcohol and Drugs
Antisocial Behaviour
Child Protection
Domestic Abuse and Violence Against Women
Dumfries and Galloway Constabulary
Dumfries and Galloway Fire and Rescue Service
Major Emergencies in Dumfries and Galloway
Road Safety
Scottish Government website - Law, Order and Public Safety
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5.9
Community capacity
Voluntary sector
• there could be up to 3,000 community and voluntary sector organisations in the
region, including 852 charities currently registered with the office of the Scottish
Charity regulator which have a main address in Dumfries and Galloway
• grant support of around £3M is provided by local public sector organisations
Volunteering
• volunteering adds significant value to local service delivery, communities and the
enhancement of our local environment as well as the wellbeing of the individuals
themselves. There are over 390 organisations registered as seeking volunteers
Third Sector Interface
• the Third Sector Interface (TSI) is unique in Scotland as it comprises both
independent members and representatives of six Intermediary bodies (four Councils
of Voluntary Service/The Bridge Dumfries and Galloway, Volunteer Action and the
Social Enterprise Network)
• the TSI’s remit is to develop the Third Sector, social enterprise, volunteering and links
with community planning and other local partners and it will deliver this through the
intermediary organisations
Community Councils
• there are 88 operational Community Councils in an establishment that provides for up
to 107 - this is a significantly higher proportion than the rest of Scotland
Compact between the Third Sector and the Public Sector
• over 100 organisations are signed up to the Compact
• there are 24 Compact champions across the public and Third Sector who promote the
principles and commitments of the Compact
Developing social capital
• social capital is the added value created by community networks working
collaboratively to facilitate solutions
• developing a closer working relationship and different balance between the public and
Third Sectors and individual communities is key to future service planning and
delivery. Pilots are underway about communities taking responsibility for supporting
people during severe winter weather
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What does this mean for the future?
• consideration of new models of joint working are required, including streamlining
funding support arrangements
• capacity releasing support for communities and Third Sector organisations is required
to enable them to participate
• increasing the number and contribution of volunteers in all aspects of life in the region
Data sources
Community Councils
Dumfries and Galloway Compact
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5.10 Environment and natural resources
Environmental resources
• our key industries of food and timber production, tourism and renewable energy
production rely on a clean and healthy environment
• the quality of the landscape has been recognised in the designation of 3 National
Scenic Areas, 10 Regional Scenic Areas, 7 Special Protection Areas, 17 Special
Areas of Conservation, 5 Wetlands of International Importance and 97 Sites of Special
Scientific Interest
• we have 22 habitats and 123 species as local priorities and more than 700 actions to
conserve and enhance local priority habitats and species
• we have 22,000 records of features of archaeological or historical interest
Carbon emissions and footprint
• partner agencies are working to reduce carbon emissions in buildings; reduce
business travel miles; and reduce the waste we produce
Managing our waste
• the Council has increased the diversion of waste from 10% in 2005-06 to 56% in
2010-11 meeting the 2013 EU statutory Landfill Directive Target two years ahead of
schedule
• as part of its Zero Waste Programme the Council will invest £7M over the next four
years on new household and material recycling facilities to divert over 90% of waste
collected from landfill by 2015-16. The Council will also increase recycling towards
70% by 2015-16
What does this mean for the future?
• reducing the region’s carbon footprint will require a commitment from individuals,
businesses and organisations across the region
• transport infrastructure and services which address the needs of our communities, as
well as individual behaviour change, is required to improve our green travel options
• ongoing work is needed with partners, communities and individuals to reduce waste
created and the capability of the eco-deco plant
• the new Local Development Plan, which is subject to Strategic Environmental
Assessment and public participation, must enhance our environmental resources
Data sources
Scottish Government website - the Environment
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6.
Wh a t we will d o - a c tio n s , p e rform a n c e a n d ke y ta rg e ts
P rio rity 1
We will p ro vid e a g o o d s ta rt in life fo r a ll ou r c h ild re n
Ambition 1.1 - Our children will be kept safe
Actions - What we will do
Performance How we will know
Responsibility Who will do it
Key target What and
when will we
do it
Maintain or
increase
proportion of
Strategy
Meetings held
within agreed
timescales
1.1.1 When information is
received that a child may be
at risk, we will respond
appropriately,
proportionately and
timeously
Number of Child
Protection Strategy
Meetings held
within two calendar
days of receipt of
information unless
extension
authorised
Child Protection
Committee
1.1.2 Children (CAPSM*)
and Family members of
people misusing alcohol and
drugs will be safe, well
supported and have
improved life chances
Rate of maternities
recording drug
misuse (Baseline
8.9 Rate per 1000
maternities, 3 year
average 2006-09)
Child Protection
Committee and
Alcohol and
Drugs
Partnership
Year on year
improvement
2012-15
1.1.3 We will continue to
apply the “Whole System
Approach” for youth
offending to maintain the
current low level of offending
by young people (under 18)
and seek to improve on this
wherever possible
Offending rates for
young people
(under 18)
Youth Justice
Strategy Group
Maintain
current low
levels of youth
offending
1.1.4 We will undertake a
review of services currently
supporting vulnerable young
people at risk of requiring an
agency placement to
implement a seamless and
coordinated continuum of
support that both intervenes
early and maximises the
impact of available resources
Produce
recommendations
to reduce
dependency on
high tariff
interventions,
including agency
placements
Getting It Right
For Every Child
Group
Review
recommendati
ons
implemented
by 31 August
2012
*Children Affected by
Parental Substance Misuse
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150
P rio rity 1
We will p ro vid e a g o o d s ta rt in life fo r a ll ou r c h ild re n
Ambition 1.2 - We will make effective interventions
1.2.1 We will fully implement
the Child Assessment
Framework and training
programme to ensure all staff
across children services use
the same assessment
framework to assess, plan
and intervene to improve
outcomes for children
Full
implementation of
standardised
assessment and
planning
processes,
resulting in
improved
outcomes for
children and young
people
Getting It Right
For Every Child
Group
1.2.2 We will implement a
seamless pre-birth to three
years service (Maternity
Services, Public Health
Nurses and Pre-school), to
ensure vulnerable children
are identified at the earliest
stage in their lives and their
needs met
Number of children
identified as
requiring support
Number of children
receiving support
Evidence of
improvement in
outcomes, pre and
post support
Getting It Right
For Every Child
Group
Implement by 31
March 2013
1.2.3 To build parenting
capacity we will offer an
agreed set of parenting
programmes to targeted
families across Dumfries and
Galloway
Number of
targeted families
participating
Getting It Right
For Every Child
Group and Joint
Health &
Wellbeing Unit
Increase in
number of
families
engaged in
parenting
programmes by
2012-13
1.2.4 We will intervene to
manage conduct disorder in
young children
Number of
interventions in
targeted school
clusters
Getting It Right
For Every Child
Group and Joint
Health &
Wellbeing Unit
1.2.5 We will provide
appropriate advice and
Fewer families and
young people
D&G Council,
Registered
3% of children in
nursery classes
and primary 1
classes in
targeted school
clusters
complete
intervention by
March 2013
Reduction in
priority
31
Key target What and when
will we do it
Implement by 31
March 2013
151
assistance to prevent
families and young people
becoming homeless
becoming
homeless.
Social
Landlords,
housing support
providers, third
sector, NHS
D&G
32
homeless
households by
25% (767 in
2010) by April
2016
152
Priority 1
Ambition 1.3 - All children and young people will be supported through transition
1.3.1 We will introduce a
transition tool to improve the
transition experience from
home to pre-school, and in
conjunction with health
screening will ensure that
those children requiring
support receive it
Number of children
participating in the
new transition
process
Getting It Right
For Every Child
Group
1.3.2 We will introduce
GIRFEC locality planning
structures; to coordinate a
unified locality based
approach to identifying
concern, assessing need,
agreeing actions and
outcomes for children, young
people and their families
Locality groups
Getting It Right
established in each For Every Child
of the four
Group
localities sitting
within the Area
Framework
governance
Implement by
31 March 2013
1.3.3 We will support
children and young people,
and their families to ensure
they experience successful
transitions at key transition
points
Implementation of
Transition Steering
Group’s
recommendations
Getting It Right
For Every Child
Group,
Transition
Steering Group
Implement by 31
March 2013
1.3.4 We will ensure that
every young person will be
supported to secure a
positive post-school
destination in education,
employment or training; and
those in need of more
support will be screened
earlier and given additional
support to ensure a
successful transition
Delivery of
Curriculum for
Excellence
employability
activities
Getting It Right
For Every Child
Group
Achievement of
the objectives in
the GIRFEC
Action PlanTransition to
Adulthood
To improve the
transition from
secondary school
to adulthood with a
particular focus on
young people
needing More
Choices and More
Chances
33
More Choices
More Chances
Partnership
will we do it
Implement by 31
August 2012
Achievement of
the objectives in
the MCMC
Action Plan
2011-12 and
annually
thereafter
153
Number of young
people with
disabilities having
successfully
moved into paid
employment or
pre-work activities
34
Social Work
Inspection
Agency,
Learning
Disability Action
Planning Group
20 young people
in paid
employment and
20 young people
in pre-work
activities by
December 2012
154
Priority 1
Ambition 1.4 - All children will have a basic education in numeracy and literacy
1.4.1 We will ensure children
have appropriate literacy and
numeracy skills for their age
% of pupils who
are operating at
stage appropriate
literacy and
numeracy levels
D&G Council
1.4.2 We will provide small
teaching groups for P1 - P3
% of pupils in the
first three years of
primary education
who are in class
sizes of 18 or
fewer, or in 2
teacher classes of
36 or fewer
D&G Council
24.9% pupils in
first three years
by 31 August
2011
1.4.3 We will work with
parents to enable them to
support their children in their
learning
Number of parents
involved in their
children’s learning
D&G Council
Baseline to be
established by
31 March 2012
35
will we do it
Baseline to be
established by
31 August 2012
155
Priority 1
Ambition 1.5 - Our children will have the best possible health and wellbeing
1.5.1 We will adopt the
Scottish Government
maternal and infant nutrition
framework and the Child
Healthy Weight (CHW)
Programme
Percentage of
women who
express an interest
in breast feeding
who have a breast
feeding peer
support contact in
the ante-natal
period
Joint Health &
Wellbeing Unit
and Getting It
Right For Every
Child Group
60% by 31
December 2012
Percentage of
mothers
commencing
breast feeding who
are still breast
feeding by 6-8
weeks
1.5.2 We will implement the
Childsmile Oral Health
Improvement Programme
1.5.3 All schools will
incorporate health and
wellbeing outcomes in the
learning experience
Number of CHW
interventions
Percentage of
nurseries and
primary schools
participating in
tooth brushing
programme
Percentage of
schools with health
and wellbeing
outcomes in school
improvement plans
36
will we do it
70% by 31
December 2012
413 by 31
March 2014
Joint Health &
Wellbeing Unit
and Getting It
Right For Every
Child Group
100% by 31
March 2014
Joint Health &
Wellbeing Unit
and Getting It
Right For Every
Child Group
100% by 31
March 2013
156
Priority 2
Ambition 2.1 - Young people will be supported to make the right choices
2.1.1 We will deliver
Teenage
programmes of work to
pregnancy figures
support health and well being
for young people
Number of schools
who have received
specialist smoking
cessation support
Number of new
Healthy Weight
Communities
established
Percentage of
schools
incorporating the
Health and
Wellbeing
experiences and
outcomes in
planning
assessment and
reporting
All school pupils
have access to a
sustainable
volunteer led extracurricular physical
activity or sport
opportunity
37
D&G Council,
Joint Health &
Wellbeing Unit
will we do it
10% drop in 3yr
rolling average
by 31 March
2014
100% by 31
March 2014
4 new Healthy
Weight
Communities by
31 March 2014
100% by 31
March 2014
All school pupils
by 31 March
2014
157
Priority 2
Ambition 2.2 - We will ensure our young people have high quality learning experiences
and succeed
Actions - what we will do
2.2.1 We will raise
attainment, achievement and
participation
We will implement
Curriculum for
Excellence
Improvement in
National
examination
measures
Increased levels of
accreditation by
young people in
wider achievement
initiatives (e.g.
Duke of Edinburgh
Awards)
Increased number
of young people
involved in
democratic
opportunities
Responsibility - Key target Who will do it
What and when
will we do it
D&G Council
Annual reporting
(ES13-6/12,
ES14-5/6,
ES15-4/6, all
2010)
Comparator
Authority ranking
(1-6) for 1+, 3+,
and 5+ at level
6, by end of S6
Comparator
Authority ranking
(1-6) for 5+ at
level 3 and
English and
Maths at level 3
by end of S4
D&G Council
Establish
baseline by 31
March 2012
10% increase in
number of
young people
achieving
accreditation
D&G Council
Establish
baseline by end
March 2012
Increase number
of young people
involved in
Scottish Youth
Parliament,
Voting System
and Youth
38
158
2.2.2 Young people
preparing to leave school will
have the best advice on
careers, managing finances,
sexuality and sexual health,
preparing for parenthood,
developing mental resilience,
substance use
Pilot projects
established
39
Joint Health &
Wellbeing Unit
and More
Choices More
Chances
Partnership
Forums/Councils
2 pilots agreed
by 31 March
2012
2 pilots
completed and
evaluated by 30
June 2013
159
Priority 3
We will care for our older and vulnerable people
Ambition 3.1 - Older and vulnerable adults will have choice and control in decisions
affecting their lives
Actions - what we will do
3.1.1 We will increase the
number of people in receipt
of support through self
directed support/individual
budgets
Number of people
with Direct
Payments/Individu
al Budgets as a
percentage of all
new referrals for
homecare
Community
Health and
Social Care
Partnership
Board
Increase 30% of
spend each year
2012-15
The spend on
personalised plans
as a proportion of
the overall cost of
home care
3.1.2 We will introduce care
and self assessment based
on maximising capabilities
and wellbeing
Number of service
areas accessed
through selfassessment
Number of self
assessments
completed
40
will we do it
Increase of 10%
each year 201215
D&G Council
To be put in
place during
2012-13
Increase by
10% each year
2012-15
160
Priority 3
Ambition 3.2 - Older and vulnerable adults will be enabled to optimise their health and
independence reducing the need for crisis management
3.2.1 We will reduce
emergency bed day rates in
the over 75 age group
Emergency bed
day rate
3.2.2 We will maximise the
use of assistive technology
to support people to maintain
their health and stay at home
Number of new
referrals to care
services assessed
for telecare
package against
current baseline
Community
Health and
Social Care
Partnership
Board
Community
Health and
Social Care
Partnership
Board
3.2.3 We will provide
opportunities for people with
long term conditions to self
care and be involved with
self help groups
Number of people
directly accessing
telecare services
through developing
service with
Customer
Services.
Number of people
with long term
conditions
accessing LTC
programme
3.2.4 We will provide a range
of learning opportunities and
experiences targeted at older
people to ensure that the
ageing population of
Dumfries and Galloway is
involved, active, engaged to
lead healthy lives in their
own community
Number of older
people involved in
activities in their
own community
3.2.5 We will ensure older
and vulnerable people will
have access to a range of
housing solutions which will
enable them to live
The right type of
services, in the
right location and
of the right quality
will be provided
41
will we do it
Reduction of
current rates by
31 December
2014
Increase by
10% by 2014
100% directly
accessed
packages by 31
December 2014
Joint Health &
Wellbeing Unit
and
‘Putting You
First’
Programme
Board
Learning
Community
Partnerships
150 by 31
March 2012
D&G Council,
Registered
Social
Landlords,
Housing support
20% of new
affordable
housing
delivered
through the
900 by 31
March 2014
1000 by 31
March 2013
161
independently
providers,
Scottish
Government
42
Strategic
Housing
Investment Plan
is housing that
meets particular
needs by 30
April 2016
162
Priority 3
Ambition 3.3 - Older and vulnerable adults will be provided with high quality and reliable
support
Performance Responsibility - Key target How we will know Who will do it
What and when
will we do it
3.3.1 We will maintain the
Number of people
Community
+ 3% by 2014
current high levels of
over 65 remaining Health and
performance in supporting
at home as a
Social Care
older people to remain in
proportion of those Partnership
their homes or be supported in care homes or
Board
in a homely setting, and seek long stay beds
to improve where possible
3.3.2 We will work to ensure
that all people who could
benefit from a short term reablement service can receive
one
Number of people
accessing reablement service
as a proportion of
total referrals for
re-ablement
Community
Health and
Social Care
Partnership
Board
At least 50% of
people receiving
re-ablement
service achieve
a reduction in
their ongoing
care need
Proportion of
people who
receive reablement have
reduced ongoing
care needs
use of aids and adaptations
to help people maintain their
independence at home
Number of people
accessing aids or
adaptations as a
percentage of the
number of people
receiving a service
from the
Occupational
Therapy Service
% of major
adaptations
completed within
agreed timeline
following a
committee decision
43
98% of
appropriate
referrals
accepted by 31
December of
2014
Community
Health and
Social Care
Partnership
Board
99% by 31
December 2014
Increase from
current baseline
by 31 December
2012 and set
target
163
Priority 3
Ambition 3.4 - Unpaid carers will be key partners in care delivery
3.4.1 We will improve
support to carers to enable
them to continue in their
caring role
Number of Carers
Assessments
completed
Community
Health and
Social Care
Partnership
Board
Number of people
accessing respite
through the Short
Breaks Bureau
Number of Keep
Well health checks
completed on
carers
carers’ views are reflected in
service planning and
development
Joint Health &
Wellbeing Unit
Number of carers
supported through
health improving
activities
Joint Health &
Wellbeing Unit
Employers have
policies which
support and
recognise the
needs of carers
Joint Health &
Wellbeing Unit
Advice and support
given to young
carers
Carers Strategy
adopted across the
Community Health
and Social Care
Partnership
Princess Royal
Trust for Young
Carers
Community
Health and
Social Care
Partnership
Board
44
will we do it
Increase by
10% from
current baseline
by end of 2014
100 by 31
December 2014
300 checks on
carers by 31
March 2014
100 by 31
March 2014
15 employers
with policies by
31 March 2013
60 young people
supported each
year
Strategy
adopted by 31
March 2012
164
Priority 3
Ambition 3.5 - Older and vulnerable adults will have good information on their rights
3.5.1 We will provide up to
date, accessible information
in a range of formats
Customer/service
user surveys
evidence
satisfaction on
availability and
access to
information
(includes adult
protection)
Community
Health and
Social Care
Partnership
Board
will we do it
Baseline
satisfaction
levels
established by
31 March 2013
3.5.2 We will continue to
support capacity in the Third
and independent sector to
provide advice and
information to older and
vulnerable people about their
rights
Uptake of services
commissioned and
funded to provide
information
D&G Council,
D&G Third
Sector Interface
Baseline to be
established by
31 March 2012
3.5.3 We will support people
who need financial advice
Number of people
assisted
Target to be
established by
31 March 2012
3.5.4 We will maximise
household income,
particularly for those in
poverty
Amount of
unclaimed benefits
accessed
D&G Council,
DAGCAS.
Poverty
Inequality and
deprivation
Working Group
D&G Council,
DAGCAS,
Poverty
Inequality and
deprivation
Working Group
45
Increase
(baseline from
SOA 2009-11)
165
Priority 3
Ambition 3.6 - We will protect adults at risk
efficiency and effectiveness
of the Adult Protection
Committee
Delivery against
work plan implement actions;
improve monitoring
arrangements
3.6.2 We will respond
appropriately, proportionately
and timeously when
information is received that
an adult may be at risk
Number of
Strategy Meetings
held within agreed
timescales in line
with policies and
procedures
46
Responsibility Key target - Who will do it What and when
will we do it
Adult Protection Work plan
Committee
completed by
2013-14
Adult Protection Maintain or
Committee
increase the
number of
Strategy
Meetings held
within agreed
timescale
166
Priority 3
Ambition 3.7 - Older and vulnerable adults will be supported to improve their health
3.7.1 We will deliver
preventive interventions to
support the health and
wellbeing of older and
vulnerable adults
Number of Keep
Well Health
Checks delivered
Joint Health &
Wellbeing Unit
will we do it
1000 checks
completed by 31
March 2012
100 volunteers
& 1500 service
users through
Building Healthy
Communities by
31 March 2013
Numbers of new
volunteers in
funded projects
By 31 March
2013
Introduce Health
Promoting Prison
within the Dumfries
Prison
people involved with the
criminal justice system have
their health and wellbeing
optimised
3.7.3 We will provide training
for non health professionals/
community
groups/individuals in
recognising those at risk of
mental health issues
physical activity levels of
older and vulnerable adults
by ensuring access to
Percentage of
D&G residents in
Dumfries prison or
on community
sentences who
have had a health
check
Deliver faster
access to mental
health services
Joint Health &
Wellbeing Unit
50% each year
by March 2014
Joint Health &
Wellbeing Unit
26 week referral
to treatment for
specialist Child
and Adolescent
Mental Health
Services from
March 2013
D&G Physical
Activity Index Tool
(PHIT)
Joint Health &
Wellbeing Unit
15% increase in
overall PHIT
score by 31
March 2014
47
167
Ambition 3.7 - Older and vulnerable adults will be supported to improve their health
will we do it
Number of brief
people will be healthier, and
alcohol
take fewer risks as a result of interventions
alcohol and drug use
The number of
drug related
deaths will remain
low (numbers are
low, but can
fluctuate from year
to year)
Alcohol & Drugs
Partnership
1629 by 31
March 2012
Alcohol & Drugs
Partnership
No more than
an average of
10 drug related
deaths each
year
physical activity opportunities
and increasing knowledge
confidence and skills
3.7.6 Alcohol and drugs
services will be high quality,
responsive, and personcentred ensuring people
move through treatment into
sustained recovery
People
Alcohol & Drugs
approaching
Partnership
services with
alcohol and drug
related problems
will be offered
appropriate
interventions within
the time frames
established by the
Scottish
Government
48
By 31 March
2013, 90% of
clients will wait
no longer than 3
weeks from
referral received
to appropriate
drug or alcohol
treatment that
supports their
recovery
168
Priority 4
Ambition 4.1 - We will attract and sustain investment to grow our local economy
Performance How we will
know
ResponsibilityWho will do it
4.1.1 Our transport networks
will be sustained and
developed
Proportion of
population who
can access bus
services
South West
Scotland Regional
Transport
Partnership
(SWestrans)
Implementation of
the roads
investment
programme
4.1.2 We will enable better
digital connectivity
Development of
South of Scotland
bid to Broadband
Development UK
D&G Council
South of Scotland
Alliance, D&G
Council, NHS D&G
Implementation of
pilot for Annan
4.1.3 New and existing
businesses will be supported
and developed
Sustain Gross
D&G Council,
Value Added
Scottish Enterprise
(GVA) at 1%
below the national
average
Number of start
up businesses
created
Number of growth
businesses
supported
Number of
businesses
sustained
49
Key target What and
when will we
do it
Maintain
percentage of
population
served by a
bus route
within 400m/
km of their
home
£12M invested
in D&G roads
surface over
three years by
31 March 2014
Project
procured by 31
March 2013
Annan pilot
successfully
implemented
by July 2012
Sustain GVA at
1% below the
national
average
Achievement of
the targets set
out in the
current
Business
Gateway
contract to
2012 and
subsequentlyd
efining and
achievement of
the contract in
169
4.1.4 We will regenerate the
areas prioritised in the
Regional Economic Strategy
Delivery of
Programmes for
Dumfries Town
centre, Stranraer
and CoRES
(Annan, Gretna,
Lockerbie
Corridor)
D&G Council,
Scottish Enterprise
place to 2014
Dumfries Town
Centre
programme
delivery from
2012
Stranraer
Waterfront
programme
delivery from
2012
CoRES
delivery from
2012
4.1.5 We will ensure a
housing supply for the six
Housing Market Areas
operating in Dumfries and
Galloway
New Housing
Units delivered
across the social
rented and private
sectors
D&G Council,
Registered Social
Landlords,
Private Housing
Developers,
Private Rented
Sector and
the Scottish
Government
7,384 new
housing units
delivered
across the
social rented
and private
sectors by
2024
4.1.6 We will deliver a
sustainable future for the
Crichton Quarter
Deliver and
sustain the
business model
Crichton 2020
Vision Group
Business
Model in place
by 31
December
2012
50
170
Priority 4
Ambition 4.2 - Employment opportunities will be enhanced through innovation and skills
development
4.2.1 We will develop the
skills base of our workforce
to respond to innovation and
opportunity
To be developed
by the
Employability
Partnership
Employability
Partnership
4.2.2 We will support our
local people excluded from
the labour market back into
education, training or
employment
Number of people
in the region on
Job Seekers
Allowance (JSA)
Employability
Partnership
4.2.3 We will support the
maximisation of resources
from Skills Development
Scotland for the people of
Outcomes in the
Skills Development
Scotland 2011-12
Service Delivery
Agreement
Employability
Partnership and
More Chances
More Choices
Partnership
4.2.4 We will develop work
experience/work taster
opportunities for people with
disabilities within the public
sector
Number of work
placement
opportunities
created
D&G Council
will we do it
Mapping
exercise
completed by 31
March 2012.
Action plan to
be developed
thereafter
Maintain JSA
baseline level of
March 2011
(3.5%) by March
2012
Achievement of
outcomes in the
Skills
Development
Scotland 201112 Service
Delivery
Agreement by
April 2012
Agree to pilot a
work taster
programme with
20 placement
opportunities
within DGC by
end March
2012, and
implement this
by 31 October
2012 with a
further 10
placements in
DGC by 31 Dec
2012
Agree to roll out
pilot programme
within the NHS
51
171
4.2.5 Our people will have
the basic skills to function
adequately in individual,
family, community and
working lives
Number of Adult
Literacy and
Numeracy
Learners (ALN)
Number of English
for Speakers of
Other Languages
(ESOL) Learners
Number of
Community Based
Adult Learners
(CBAL)
Number of learners
progressing to
employment,
voluntary work or
further learning
52
Learning
Community
Partnerships
by 31 Dec 2012
700 ALN
learners by 31
March 2013
200 ESOL
learners by 31
March 2013
400 CBAL
learners by 31
March 2013
650 learners
progressing to
employment,
voluntary work
or further
learning by 31
March 2013
172
Priority 4
Ambition 4.3 - We will build the capacity of individuals and communities to support the
economy
4.3.1 We will support
community groups to take
ownership of community
assets, projects and services
Number of
Community
Groups supported
Learning
Community
Partnerships
10 new
Community
Projects
developed by 31
March 2013
Number of
Community
Projects developed
4.3.2 We will support the
development of volunteering
across the region
4.3.3 Develop an
understanding of Dumfries
and Galloway’s Social
Capital
Amount of external
funding secured
To be developed
as part of the
DGTSI business
plan
£750k of
External
Funding
secured by end
of March 2013
D&G Third
Sector Interface
(DGTSI)
D&G Social Capital Joint Health &
Index to be
Wellbeing Unit
developed
and the DGTSI
53
will we do it
148 Community
Groups
supported by 31
March 2013
To be
developed as
part of the
DGTSI business
plan
Index developed
by 31 March
2012
173
Priority 5
Ambition 5.1 - Our people and communities will be safe and secure
5.1.1 Antisocial behaviour
will be tackled.
Increase the % of
residents who feel
safe in local
neighbourhoods
Antisocial
Behaviour
Strategy Group
Baseline
established from
2011/12
figures. Year on
year decrease
2012-15
A reduction in the
number of
recorded Antisocial
Behaviour offences
and incidents
5.1.2 Those involved in the
supply and availability of
controlled drugs will be
targeted.
5.1.3 The number of people
killed or injured on our
roads will be reduced
5.1.4 The people who are
deemed most vulnerable
will be identified, supported
and protected
will we do it
Baseline
established from
2011/12
figures. Year on
year increase
2012-15
Number of supply
and possession
with intent to
supply offences
recorded (3 year
average 2008-10)
Number of road
safety crashes and
casualties
involving
• young people
• rural roads
• trunk roads
Alcohol & Drugs
Partnership
Baseline 309
Year on year
improvement
2012-15
Road Safety
Partnership
In line with
Scottish Road
Safety Targets
by 2015 there
will be a
reduction of
• 30% in
people killed
• 43% seriously
injured
• 35% of
children killed
• 50% of
children
seriously
injured
Number of
identified and
known vulnerable
people who are
repeatedly
Domestic Abuse
Violence Against
Women
Partnership, Child
Protection
Baseline
established from
2011/12
figures. Year on
year decrease
54
174
victimised
5.1.5 The people who pose
a risk to the most vulnerable
people will be identified and
disrupted
Use of early and
effective
interventions for
victims and
perpetrators by
criminal justice
agencies
5.1.6 Communities and
individuals will be safe from
alcohol and drug related
offending and antisocial
behaviour (ASB)
Number of alcohol
related incidents
5.1.7 We will prepare for
effective emergency
response and recovery
5.1.8 We will ensure the
operation of the private
rented sector is properly
regulated to safeguard the
interests of health,
households and
communities
Committee/Gettin
g It Right For
Every Child, Adult
Support and
Protection
Committee
Domestic Abuse
and Violence
Against Women
Partnership, Child
Protection
Committee, Adult
Support and
Protection
Committee,
Community
Justice Authority
MAPPA Strategic
Oversight Group
Alcohol & Drugs
Partnership
2012-15
Strategic
Coordinating
Group
Satisfactory
Statement of
Preparedness
each year
30% increase in
the number of
private landlords
registered by
April 2016
• Number of
alcohol-related
ASB incidents
(baseline 244)
• Number of
alcohol related
violent crimes
(baseline 40)
(3 year averages
2008-10)
Validation of risk
based plans and
arrangements
Number of private
landlords properly
registered
Percentage of
Houses of Multiple
Occupation
licensed
55
D&G Council,
Police, and Fire
and Rescue
Service
Baseline
established from
2011/12
figures. Year on
year increase
2012-15
Year on year
reduction 201215
100% rate of
licensed Houses
of Multiple
Occupation
175
56
176
Priority 5
Ambition 5.2 - We will build individual and community resilience
5.2.1 Individual citizens will
Community
be helped to help themselves resilience capacity
and raised
awareness through
public information
initiatives:
D&G Council,
Police, Fire and
Rescue Service,
NHSD&G
ReadyDG advice
website
Implementation of
Flood Subsidy
Scheme
Implementation of
Winter Resilience
Scheme
Number of
Community
Council Resilience
Plans in place
57
will we do it
Programme
rolled out from
autumn 2011
177
Priority 5
We will maintain the safety and security of our region.
Ambition 5.3 - We will ensure that individuals and communities are treated fairly and
with respect
5.3.1 We will tackle hate
crime.
Awareness
campaign about
hate crime
Diversity Working
Group
Number of third
party reports
Police
Number of projects
and initiatives
tackling prejudice
and inequality (e.g.
LGBT Charter
Mark)
Diversity Working
Group
5.3.2 We will promote
fairness and respect across
our organisations and
communities
58
Key target What and
when will we
do it
31 March 2012
10 new
members to
third party
reporting
scheme by
Programme to
be established
by 31 March
2012
178
Priority 6
We will protect and sustain our environment
Ambition 6.1 - We will be a carbon neutral region
6.1.1 We will reduce carbon
emissions
Level of carbon
emissions
6.1.2 We will reduce energy
consumption.
Energy use in
public buildings;
number of
business miles;
amount of
office space
D&G Council,
NHS D&G,
Scottish
Enterprise,
Scottish Natural
Heritage, Fire
and Rescue
Service, Police
D&G Council,
NHS D&G,
Scottish
Enterprise,
Scottish Natural
Heritage, Fire
and Rescue
Service, Police
6.1.3 We will reduce the
amount of municipal waste
we collect and produce.
Amount of
municipal waste
(tonnes)
D&G Council
93,991 tonnes
by
2012-13
94,931 tonnes
by
2013-14
6.1.4 More municipal waste
will be diverted from landfill
Amount of waste
diverted from
landfill (%)
D&G Council
90% by 2015-16
6.1.5 More people will walk,
cycle or use public transport
to go to work and be
encouraged to car-share
Percentage of
people who travel
to work as a car
driver
Go Smart,
5% reduction in
SWestrans,
Dumfries by 31
D&G Council ,
March 2014
NHSD&G, Police
59
will we do it
20% reduction
by 2015
4% reduction
each year from
2011/12
179
Priority 6
We will protect and sustain our environment.
Ambition 6.2 - Our landscape, natural and built environment will be protected and
enhanced
6.2.1 Our communities and
visitors will be involved in the
management and use of our
landscape and heritage
National Scenic
Areas
management
strategies
implemented
D&G Council,
Scottish Natural
Heritage
Development and
delivery of
strategic guidance
documents
% of those UK
Biodiversity Action
Plan (UKBAP)
habitats occurring
in the Local
Biodiversity Action
Plan (LBAP) that
are subject to
positive
management
will we do it
3 community
projects
developed and
implemented
each year
D&G Council
Local
Development
Plan produced by
2015. Interim
Planning Policy
on Wind Energy
Developments February 2012.
D&G Biodiversity
Partnership
75% of UKBAP
habitats
occurring in the
LBAP that are
subject to
positive
management by
2014
6.2.2 We will protect areas of
high built conservation value
Townscape
Heritage Initiative
(THI)/Conservation
Area schemes in
areas of high built
conservation value
D&G Council,
Scottish Natural
Heritage,
Southern
Partnership
Heritage Lottery
Fund funding
package secured
for Dumfries THI
and completed
by 2017
6.2.3 Local residents and
visitors will be encouraged to
enjoy our landscape and
heritage
Implementation of
Countryside
Service Strategy
D&G Council,
Scottish Natural
Heritage
150 ranger led
environmental
education school
visits each year
Deliver 40
ranger- led
guided walks
60
180
each year
Core Paths Plan
adopted by
Spring 2012
Implementation of
the Outdoor
Access Strategy
and delivery of the
Core Paths
Network
6.2.4 The natural habitats
and species in Dumfries and
Galloway will be protected
and managed
Galloway & South
Ayrshire Biosphere
Reserve (GSABR)
status
All core paths in
reasonable
condition by 2017
D&G Council,
South Ayrshire
Council,
GSABR/Southern
Uplands
Partnership
Completion of the
D&G Council
Forest and
Woodland Strategy
61
Biosphere
designation
awarded May
2012
By 31 March
2014
181
Agenda Item 250
6 February 2012
Author:
RECOMMENDATION
The Board is asked to consider and discuss this important strategy and the current
progress being made in NHS Dumfries and Galloway.
SUMMARY
This paper provides Board members with an overview of Scotland’s Dementia
Strategy and the associated activity being taken forward across NHS Dumfries and
Galloway.
Key Messages:
• The Executive Lead for this work is the Nurse Director.
• We are planning our improvement work jointly with partner agencies to avoid
duplication and gain best value.
• A significant amount of activity is already taking place across the region to
improve outcomes and care experiences for patients and their carers.
GLOSSARY OF TERMS
CMHT
Community Mental Health Team
CPN
Community Psychiatric Nurse
CSO
Chief Scientist Office
ICP
Integrated Care Pathway
HEAT
Health Efficiency Access Treatment
PYF
Putting You First
SDCRN Scottish Dementia Clinical Research Network
182
1. Introduction
Dementia is a significant issue for people in Scotland.
It is a condition which
changes the lives of those diagnosed and of those close to them.
There is
recognition that, despite much good work, there are critical challenges and important
gaps which must be addressed if people are to receive the services they need. This
is particularly urgent in the context of the increasing numbers of people with
dementia due to demographic changes.
The aim of Scotland’s Dementia Strategy is to deliver world class dementia care and
treatment, ensuring that people with dementia and their families are supported in the
best way possible to live well with dementia.
The strategy identifies five key
challenges and addresses these by focusing on two key service delivery areas
described below. It also sets out a further eight specific actions which will support
improvements in care and treatment.
National standards of care for patients with dementia have also been developed and
were published in 2011. These standards are a key tool that will enable Boards to
demonstrate achievement of good practice. Monitoring against these standards is
being undertaken by Healthcare Improvement Scotland as part of the Older People
in Acute Care inspections currently being rolled out across NHSScotland.
2. Background
Scotland’s Dementia Strategy was published in October 2010.
It committed to
transform dementia services by:
• developing common standards of care for the first time;
• producing a framework to ensure that all staff who provide care and support
are skilled and knowledgeable about dementia;
• significantly improving care pathways and strengthening the integration of
health and social care services – including in the area information sharing;
and
• continuing to improve the level of diagnosis of dementia and develop work to
reduce the use of psychoactive drugs in managing the illness.
This large programme of work is being overseen by a monitoring group which will be
a core part of a shared endeavour between the Scottish Government, local
government, the NHS and the voluntary and private sectors.
People who have dementia and those who care for them are entitled to dignity and
respect and should be able to access services that provide support, care and
treatment in a way that meets their personal needs. The Scottish Government, and
its partners in local government and the voluntary and private sectors, are committed
to delivering world-class dementia services in Scotland by:
- developing and implementing standards of care for dementia drawing on the
Charter of Rights produced by the Scottish Parliament’s Cross Party Group on
Dementia;
- improving staff skills and knowledge in both health and social care settings;
- providing integrated support for local change, including through
implementation of the dementia care pathway standards and through better
information about the impact of services and the outcomes they achieve;
183
-
continuing to increase the number of people with dementia who have a
diagnosis to enable them to have better access to information and support;
and
ensuring that people receiving care in all settings get access to treatment and
support that is appropriate, with a particular focus on reducing the
inappropriate use of psychoactive medication and continuing to support
dementia research in Scotland.
In taking this work forward there will be a particular focus on two key areas:
- care and support following diagnosis; and
- care and treatment in general hospital settings by improving the response to
dementia, including through alternatives to admission and better planning for
discharge.
There are approximately 71,000 people with dementia in Scotland, around 2,300 of
whom are under the age of 65. As our population ages, the number of people with
dementia will increase and we expect the number to double over the next 25 years.
Prevalence of dementia increases with age; around 1.5% of the 65 to 69-year-old
population are affected, increasing to about one in three of the 90-plus age groups.
Nationally, 63.5% of people with dementia live at home in the community with an
estimated 36.5% of people with dementia living in care homes. It is estimated that
up to 70% of the care home population may have dementia.
3. NHS Dumfries and Galloway position
A Steering Group has been established, Chaired by the Nurse Director, to coordinate and drive our improvement work to achieve the outcomes of this strategy.
This group has joint membership from across the local authority and the NHS Board.
We are also working closely with our independent and third sector partners as they
are crucial to the success of supporting patients and families in the community. A
significant amount of work is already being taken forward to enable us to deliver
improved outcomes for patients and their carers.
Although the HEAT target with regard to ensuring patients receive a timely diagnosis
ceased in March 2011 this continues to be monitored as a HEAT standard. Our
most recent report for October 2011 shows that we currently have 1464 people on
local GP registers, which is a continued increase since achievement of the target in
March 2011.
A system is in place to help sustain the HEAT standard with a
nominated link CPN in each locality who has responsibility for ongoing liaison
between CMHT and GP practices to co-ordinate secondary and primary care
dementia registers.
A successful proposal to the Putting You First Change Fund focuses on roll out of an
intensive training and support programme in relation to challenging behaviours and
will focus primarily on care homes and care at home services and will include
developing a training/information package to informal carers.
A second PYF project from the third sector that aims to improve the post diagnostic
support to individuals and families/carers has also been approved. This includes
184
linking with the above project in delivering training to carers and further development
of community based supports including dementia friendly cafes to promote dementia
aware communities. These discussions will include local authority sport and leisure
and cultural service provision to ensure people can live a full and active life as
possible post diagnosis. An example of this is that in Stewartry the sports and
leisure officers have been providing training to care home staff on the importance of
activity and movement and plans are being developed to extend this further.
Further work under PYF will see an approach to pro-active anticipatory care planning
that will support the whole system in helping people remain at home or in a homely
setting for as long as possible and support the early identification of potential future
support needs in partnership with the person and their carers.
A dementia integrated care pathway (ICP) has been developed and piloted with the
completed version to be rolled out in the next couple of months. This includes
pathways for diagnosis, post diagnosis support, provision of interventions for
managing distressed behaviours and end of life care planning. At present, the ICP
sits within specialist mental health services and the aim for the next phase of
development is to link this with pathways into acute care and care homes.
A variety of resources have been produced to support implementation of the ICP
including dementia passport, training programme for dealing with challenging
behaviour, cognitive rehab groups, activities and interests toolkit. Some of this work
has received recognition and awards nationally and locally.
We have also
developed a pathway to ensure that staff have the skills and knowledge to provide
appropriate interventions for people with dementia who present with distressed
behaviours.
One of the aims of this is to reduce the amount of inappropriate
prescribing of antipsychotic medication for people with dementia.
Alzheimer Scotland is providing funding to each NHS Board for a dementia nurse
consultant post for three years initially. We are aiming to recruit to this post in the
coming months. This specialist post will primarily focus on the care of people with
dementia in the acute hospitals and will have a pivotal role in raising awareness of
dementia throughout the health service – providing consultative advice and expertise
across all areas.
Over the past 18 months NHS Dumfries and Galloway has been successful in
bidding for funding from the Scottish Dementia Clinical Research Network (SDCRN)
to recruit a CPN for a clinical studies post 2 days per week. SDCRN has been set
up to promote a culture of clinical research in dementia across Scotland and this
post involves engaging with local patients and carers to involve them in high quality
research studies locally, nationally and internationally. In order to support this work
we have recently developed a local dementia research interest group involving a
wide range of people from primary secondary and third sector care. In addition, a
research study has recently been completed across the region to identify the extent
of undiagnosed dementia in care homes. The results of this are currently being
collated and will be presented for publication in the next few weeks.
Our Dementia Champions education programme is now entering its fifth year.
Every clinical area in GCH and DGRI, and every cottage hospital, has at least one
185
dementia champion in place. They have established a Dementia Champion Forum
and use this to challenge and test practice in order to make improvements for
patients.
4. Conclusion
Delivering improvements for patients, their families and carers is the key desirable
outcome of Scotland’s Dementia Strategy.
NHS Dumfries and Galloway is driving this forward using a planned approach,
building on the activity already taking place across the region. We have laid a good
foundation on which to build person-centred services whilst not underestimating the
considerable amount of work that remains in order to achieve our aims.
186
MONITORING FORM
None at this time – but will become more apparent
as work progresses
None at this time – but will become more apparent
as work progresses
Consultation
The national strategy was developed in partnership
with carers and patients.
Consultation with Professional Consultation will take place with regard to specific
pieces of work as they progress
Committees
Risk Assessment
Best Value
Sustainability
There is a reputational risk to the organisation if we
cannot demonstrate that this strategy is being
delivered.
Vision and Leadership
Effective Partnerships
Use of Resources
Equality
Sustainability
Delivering against this strategy will enable NHS
Dumfries and Galloway to provide sustainable
services in partnership
Compliance with Corporate 2, 3, 6
Objectives
Single Outcome Agreement *Indicate here which priority within the Single
Outcome Agreement is addressed.
(SOA)
Impact Assessment
In impact assessment has not yet been carried out as this is in response to a
national strategy focussed on a specific user group
187
Agenda Item 251
6 February 2012
Financial Performance: 9 Months to 31 December 2011
Author:
Katy Lewis, Deputy Director of Finance
Craig Marriott, Director of Finance
RECOMMENDATION
The Board is asked to discuss and consider this paper.
SUMMARY
This report summarises the Boards expenditure for the nine months to
31 December 2011.
Key Message
The Board has a statutory financial target to deliver a breakeven position against its
Revenue Resource Limit (RRL). The Board has carried forward funding of £4.2m
from 2010/11 into 2011/12 and is forecast to have a £2m carry forward at the end of
2011/12.
GLOSSARY OF TERMS
CRES
YTD
RRL
SGHD
MYR
NIC
Cash Releasing Efficiency Scheme
Year To Date
Revenue Resource Limit
Scottish Government Health Department
Mid Year Review
Net Ingredient Cost
Summary Financial Position
1.
The Board has a statutory financial target to deliver a breakeven position
against its Revenue Resource Limit (RRL). The Board has carried forward
funding of £4.2m from 2010/11 into 2011/12 and is forecast to have a £2m
carry forward at the end of 2011/12. This report is to provide the Board with a
monthly update on progress towards delivery of both the £2m surplus for
2011/12 and efficiency savings required to deliver this financial position. The
report provides a narrative on a range of financial analysis which are presented
as appendices to this report and based on the overall Board financial position.
188
This report also highlights the key financial risks and challenges which we must
manage as a Board.
2.
The report includes the following appendices:
• Appendix 1 provides details of all revenue allocations received during the
current month. It also highlights anticipated allocations and the Boards
expected final RRL.
• Appendix 2 provides a detailed analysis of the budgeted and actual financial
position by Operating Directorate for the period to 31st December 2011. It
identifies variances against budget and also highlights where CRES targets
have not been allocated to operating budgets. There has been a change in
the way in which we are reporting the financial position on this schedule
during 2011/12. It now includes on the reserve line at the bottom of the
schedule a proportion (9/12ths - £1.5m) of the £2m carry forward monies for
2011/12. We are working towards this on a monthly basis to achieve
delivery of targets for 2011/12. If we remain on target to deliver our financial
position this will build up on a monthly basis to the £2m sum at March 2012.
• Appendix 3 summarises the CRES plan for 2011/12 and identifies the
phased delivery trajectory for the year.
• Appendix 4 provides a summary of expenditure variances across the
organisation by expenditure type. This provides a more detailed analysis of
expenditure patterns per directorate.
3.
The Board is reporting an underspend against budgets of £2,290k to date
based on nine months information to 31st December 2011 (£2,283k underspend
at November 2011). This is as per the financial analysis presented in
appendix 2 and table 1 below. This is following the approval at the October
Board of additional expenditure of £1.047m, funded through the Quarter One
review projected financial position. Further additional expenditure of £1.332m
was approved at December Board for additional IM&T projects and minor
capital expenditure.
Revenue Resource Limit (RRL)
4.
The Revenue Resource Limit is notified monthly by the Scottish Government
Health Department (SGHD) and once the baseline allocation has been issued,
further allocations are issued in year.
5.
The forecast RRL for 2011/12 (excluding Family Health Services allocation) is
£273.631m. This includes a confirmed revenue allocation of £275.515m based
on the December allocation schedule, with a reduction of £1.884m included as
anticipated allocations, relating to funding or top slices we have been advised
to expect but where the Scottish Government Health Department have not yet
confirmed formally in the allocation schedule.
189
6.
Appendix 1 provides details of allocations received during December 2011.
7.
The Family Health Services Non Discretionary allocation of £15.103m is
unchanged in December giving an overall projected Revenue Resource Limited
for 2011/12 of £288.734m.
Efficiency Delivery Plan (CRES)
8.
The financial plan for 2011/12, identified the need to deliver recurring
efficiencies of £7.5m. A plan has been presented to Board which identifies
potential efficiencies to the level of £7.842m, which is the basis upon which we
will monitor and manage plans in year, the higher level identified allowing for
some potential slippage or under delivery which could potentially occur.
9.
CRES targets have been removed from directorate budgets in the opening
budget release for 2011/12 and so the under and over spend variances
reported in appendix 2 already include the impact of CRES.
10. General Managers will allocate this negative budget to a holding account and
then as CRES schemes are completed, reduce budgets and offset against the
CRES budget until it is all cleared. The CRES amount unallocated, as shown
in appendix 2, corresponds to the £312k in Table 1 below.
Table 1
Directorate
Acute Services Directorate
Diagnostics Directorate
Mental Health Directorate
Operational Services Dir
Prescribing
Primary & Community Care East
Primary & Community Care West
Women’s and Children
Corporate Services
Strategic Services
Non Core
Reserves
Under/(Over) spend
YTD
Service
Variance
£000's
117
123
837
121
(220)
390
133
264
795
(411)
0
453
2,602
YTD CRES
to be
delivered
£000's
0
0
0
(8)
0
0
0
(238)
(66)
0
0
0
(312)
YTD Total
Budget
Variance
£000's
117
123
837
113
(220)
390
133
26
729
(411)
0
453
2,290
11. Further detail on efficiencies is included in appendix 3 which includes details of
the target of £7.842m, confirms how it is allocated across directorates and
confirms progress to date for 2011/12. The plan explains that savings of
£5,798k have been delivered to date against a planned delivery of £5,677k.
190
12. Detailed monitoring of all the efficiency schemes is carried out on an ongoing
basis by the Efficiency Group, supported by the Senior Finance Team, to
assess and highlight risks of CRES delivery.
13. Work is ongoing through a range of Efficiency workshops is supporting the
development of plans for 2012/13 and beyond. More detail on this will be
presented to the Board as part of financial planning for 2012/13
Acute Services
14. Acute Services are reporting an underspend of £117k year to date (£183k
underspend at November).
15. Medical pays are currently £61k underspent to date (£50k underspent at
November), this is after pulling down £720k from locum reserves year to date.
Locum funding of £72k was issued to budgets in month to cover pressures with
vacancies, sickness and maternity leave particularly within orthopaedics.
16. The drugs budget is underspent by £99k (£107k underspent at November), this
is expected to reduce to £25k underspend by the year end as a result of
expenditure over the winter period. Of the secondary care efficiency target of
£390k all has now been identified in year with all now allocated against
budgets.
17. Clinical supplies are £210k overspent (£106k at November). The majority
relates to Orthopaedics and General Surgery changes in practice which reduce
length of stay e.g. enhanced recovery for knee replacement and laparoscopic
procedures. Orthopaedics has had a large spend in month in order to ensure
adequate stock levels for the winter period. The activity however was lower
than previous year and spend in January should be below average to
compensate.
18. There is a gap on recurring CRES of £70k which is in current plans to be
bridged in 2012-13 and has been found non recurrently this year. Overall the
directorate remains on target to breakeven at the end of the year.
Diagnostics
19. The Diagnostics Directorate is underspent at December 2011 by £123k (£124k
underspent at November 2011). Medical pays are underspent by £3k, with
£390k claimed year to date from locum reserve to cover consultant vacancies
and sick leave.
20. Diagnostics non pay expenditure currently £50k underspent (£72k at
November), is assumed to show an increased spend over the final quarter of
2011/12 to achieve breakeven. .
21. All CRES has now been allocated to budgets as and the directorate has plans
in place to deliver CRES in year, however there is still a £67k gap on recurring
CRES which is in current plans to be bridged.
191
22. Mental Health Directorate expenditure is reporting a £837k overall underspend
to December (£758k underspend to November), primarily in staffing budgets.
The level of monthly underspend is slowing down following the opening of the
new hospital. There have been no changes in month which are anticipated to
impact on the projected year end position which is expected to reach £1m
underspend.
Operational Services
23. Operational Services are reporting an underspend of £114k to December
(£116k underspend at November).
24. The year to date position includes CRES of £8k which has yet to be allocated to
budgets, this is a relatively small risk and will be reviewed this month.
25. Heating and power budgets have been reviewed at month nine and are still on
target to deliver within the forecast position. The impact of the Acute Mental
Health Services development will need to be factored into forecasts and energy
costs monitored carefully over the winter period.
26. Transport services are overspending mainly in non pays and work in ongoing to
review pool car usage, postage costs and confidential waste disposal.
Prescribing
27. Primary care prescribing data is reporting a £220k overspend to date for the
first nine months of 2011/12. Figures are based on seven months actual
expenditure and stabilised with a projected position of £300k overspent at year
end. GP prescribing expenditure this year is down on the same period last year
and is performing better than the Scottish average as a result of the work done
by both prescribers and the Prescribing Support Team.
Primary and Community Care East
28. Primary and Community Care East Directorate is reporting an overall
underspend of £390k to the end of December (£373k underspend to
November).
29. Nursing pays are the most significant underspend of £213k underspent across
community hospitals and community nursing (£186k at November). The level
of staff underspend is not anticipated to continue at this rate for the remaining
quarter of 2011/12. Both the potential impact of the DGRI reconfiguration on
community hospital activity and potential winter pressures will influence the
forecast expenditure position.
30. The improved position within management and governance reflects progress
on delivery of efficiency plans for 2012/13.
192
31. The directorate is well progressed with development and delivery of efficiency
schemes in year with all efficiencies allocated to budgets and on target for
delivery for 2011/12.
Primary and Community Care West
32. Primary and Community Care West Directorate is £133k underspent based on
December 2011 figures (£123k underspend at November).
33. Nursing pays are £167k underspent primarily in community hospitals and
community nursing.
34. Medical staffing is overspent by £261k this month (£252k overspend in
November). These are additional costs of providing medical cover in the west
due to medical staff vacancies requiring locum in the Dalrymple Ward and
Rural Hospital Practioners rota.
35. All CRES has now been allocated to budgets as at December reports.
Women’s and Children’s
36. The Women’s and Children’s Directorate is reporting an underspend of £26k at
December (£71k underspend at November).
37. The main area of overspend continues to be Midwifery which is currently
overspent by £83k at December (£69k at November). The service continues to
be reviewed to determine how the financial challenges can be resolved.
38. There are no other significant variances but the directorate still has most of its
efficiency target (£238k year to date, £318k for full year) to allocate to budgets.
This is under review to ensure delivery of CRES is achieved. The directorates
recovery plan confirms non recurring savings are available in year to deliver a
breakeven position.
Corporate Services
39. Corporate Services are reporting an underspend of £729k to December 2011
(£826k underspend to November).
40. It is proposed that corporate budgets are reviewed to more easily analyse the
impact of slippage on ring fenced projects which are primarily included within
this budget to make in year management, analyse and reporting more
transparent.
Strategic Services
41. Strategic services overall is £411k overspent (£340k at November) which
includes an overspend in the externals budget of £207k (£164k at November)
and an under recovery of central income of £330k (£287k at November).
193
42. The UNPACs budget is forecasting a year end overspend of £691k mainly as a
result of increased cost of out of area placements for Mental Health Inpatients.
This cost is expected to reduce as we move into 2012/12 and more patients
can be accommodated locally in the new hospital. This has been offset by a
central provision of £300k which had been made in anticipation of such delays
as part of the cost pressures analysis in the opening financial plan.
43. Activity for non Dumfries and Galloway patients treated within our area has
been lower than expected in the first 9 months of the year. As a result the
forecast loss of income is £67k.
Non Core Expenditure
44. Non core expenditure comprises spend on depreciation, PFI charges, certain
provisions and building impairments and is funded by a separate Revenue
Resource Limit. This is reported separately by the Scottish Government and
for 2011/12 we have separated out expenditure in our monthly reporting
information for clarity of presentation.
Forecast Outturn Position
45. The key financial risks for 2011/12 for the NHS Dumfries and Galloway are
identified as follows:
• Delivery of in year Cash Releasing Efficiencies.
• Delivery of balanced position by the Directorate teams.
• Costs associated with medical locums, rota cover and costs associated with
new medical contracts.
• GP prescribing and the uncertainty of the position at this early stage in the
year.
• Increased costs associated with out of region activity.
Further Financial Risks
46. There are still a number of risks which remain to be managed although there
are some ongoing challenges with delivering CRES recurrently there remain a
number of significant financial risks (and opportunities) which will need to be
managed, monitored and action taken as required to ensure that the £2m
carryforward position is delivered. These have been summarised below:
• Whilst an overspend position in GP prescribing has now been reflected in
the financial position it is recognised that both the delays in receipt of
prescribing information and volatility require this to be identified as an
ongoing risk throughout the year.
• Although substantial cost pressures were recognised in the opening financial
plan for Dumfries and Galloway patients treated outwith the region, there
remains an ongoing risk that specifically the Glasgow and Lothian costing
model will identify additional costs attributable to D&G patients.
194
• This month has seen a request for funding through the exceptional prescribing
panel for a High Cost Drug not previously budgeted. The financial
implications for a full year are likely to exceed £300k.
• Previous years have seen overspends in the budget for unplanned activity.
Whilst additional controls are now in place to manage this spend more
effectively due the nature of the spend there remains a residual financial risk.
• A combination of increased VAT recoveries, review of provisions, additional
debt recovery and backdated claim of legal fees have seen non recurring
benefits in year although any new provisions or claims not provided for or
identified could present a further financial risk.
• Additional funding has been set aside to cover the protection costs and non
recurring pressures identified by the directorates to support the service
change.
• The Board has received funding of £2.561m for the Change Fund for
2011/12 on behalf of the NHS, Council and 3rd sector partners. Plans have
been developed to use this funding within the partnership over the next 12
months and management of this resource over the year end is being agreed
through the partnerships.
• The Board receives a range of ringfenced allocations in year for specific
allocations which will need to be managed through the year end where there
has been slippage on the plans which are in place for spending the
allocation. There is also the risk of late allocations which could impact on
the outturn position.
195
Summary Position
47. The Boards forecast outturn position is summarised below:
Table 2
Agreed surplus position at LDP
£000's
2,000
Increased forecast underspend by operating directorates
Approval by Board of increased revenue to capital transfer
1,528
-1,047
Projected Outturn at Mid Year Review
VAT recoveries/ additional debt recovery/ recovery of legal fees/
provision review
Prescribing VAT saving for dispensing doctors/ additional pharmacy
benefits
CNORIS reduced premium for 2011/12 (non recurring)
Slippage on reserves not required in year (spend to save/ secondary
care drugs)
Reduce by Additional Expenditure Approvals
Locum requirements
Staff protection costs/ support to Acute Services
Accelerated IM&T expenditure
Revenue to capital - additional expenditure Crichton Roof
Forecast Outturn Carry Forward at Mid Year Review
Changes to provision and year end expenditure estimates
Forecast Outturn Carry Forward at Month 9
2,481
316
375
188
798
-350
-90
-1,112
-220
2,386
-200
2,186
48. This table details changes since the original Local Delivery Plan agreed
forecast surplus of £2m, updated for both the Quarter One, Mid Year Review
and Month 9 position. This provides reassurance to the Board that achievement
of the projected surplus of £2m remains on track for 2011/12 although highlights
that there are still significant risks which will require to be managed. The Board
will be updated on these risks through the monthly finance reports as
appropriate.
196
MONITORING FORM
Supports agreed financial strategy in Local Delivery
Plan
Not required
Financial reporting paper presented by Director of
Finance as part of the financial planning and
reporting cycle
Consultation
Not required
Consultation with Professional Not required
Committees
Risk Assessment
Financial Risks included in paper
Best Value
This paper contributes to Best Value goals of sound
governance, accountability, performance scrutiny
and sound use of resources.
Sustainability
Financial plan supports the sustainability agenda
through the delivery of efficient solutions to the
delivery of CRES.
Compliance
Objectives
Single
(SOA)
with
Outcome
Corporate To maximise the benefit of the financial allocation
by delivering efficient services, to ensure that we
sustain and improve services and support the
future model of services.
To meet and where possible exceed Scottish
Government goals and targets for NHS Scotland.
Agreement Not required
Impact Assessment
Not required
197
Appendix 1
REVENUE RESOURCE ANALYSIS
As At 31st December 2011
Baseline
Recurring
£000s
Revenue Allocation as at 30th November 2011
Open University - 3rd Quarter
Cross Border Prescribing - Baseline Adjustment
Distinction Awards for NHS Consultants
Developing Effective & Sustainable Leadership
Medical Revalidation Activities
Releasing time to care facilitation and roll out
IASS - contract extensions
Other Non Cash Expenditure - Depreciation
Total Allocations
Revenue Allocation as at 31st December 2011
Anticipated Allocations
Total Revenue Allocation (excl FHS)
Family Health Services Non Discretionary Allocation
Total Revenue Allocation (incl FHS)
241,543
(417)
(417)
241,126
241,126
Earmarked
Recurring
£000s
25,994
Non
Recurring
£000s
1,532
Non
Core
£000s
6,584
275,653
(72)
33
(417)
230
6
7
15
(12)
0
33
230
230
26,224
190
26,414
6
7
15
(12)
72
121
1,653
(2,074)
(421)
Total
£000s
(72)
6,512
6,512
(138)
275,515
(1,884)
273,631
15,103
288,734
Appendix 2
198
EXPENDITURE ANALYSIS
9 Months Ended 31st December 2011
Annual Budget
Pays Ytd
Pay
Non Pay
Income
Total
£000
£000
£000
£000
Area
Non Pay Ytd
Income Ytd
Total Ytd
CRES not
allocated
Total
Ytd
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Variance
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000's
£000's
866
111
326
1,278
1,362
7,248
7,391
6,341
7,794
32,717
866
108
359
1,265
1,311
7,207
7,402
6,285
7,785
32,587
0
3
(33)
12
51
42
(11)
56
10
130
238
23
72
26
1,670
1,692
3,135
1,727
1,870
10,453
238
28
13
19
1,724
1,676
3,090
1,714
1,965
10,465
(0)
(5)
59
7
(54)
17
45
13
(95)
(13)
(2)
(7)
(6)
(24)
(27)
(0)
(49)
(54)
(168)
(3)
(6)
(8)
(28)
(28)
(2)
(40)
(52)
(167)
0
1
(1)
2
4
1
1
(9)
(2)
(1)
1,103
132
391
1,298
3,008
8,914
10,525
8,019
9,611
43,002
1,103
133
365
1,277
3,007
8,854
10,490
7,959
9,697
42,885
0
(1)
26
21
1
60
35
60
(87)
117
0
117
401
4,485
2,197
7,082
412
4,427
2,153
6,993
(12)
58
43
90
193
1,768
451
2,412
213
1,727
421
2,362
(20)
41
29
50
(15)
(80)
(7)
(103)
(13)
(64)
(9)
(86)
(2)
(17)
2
(17)
578
6,173
2,640
9,391
612
6,091
2,566
9,268
(34)
82
75
123
0
123
2,143
295
2,270
4,227
93
249
1,743
499
1,514
13,032
1,974
288
2,158
4,078
90
310
1,569
413
1,363
12,243
170
7
112
148
2
(61)
174
86
151
789
122
51
306
215
13
0
52
25
107
891
80
20
311
241
16
4
46
25
99
842
42
32
(5)
(26)
(3)
(4)
6
(0)
8
49
(726)
(711)
(58)
(4)
(2)
0
(55)
(2)
(206)
(1,052)
(63)
(4)
(2)
(6)
(57)
(3)
(205)
(1,051)
(14)
0
5
0
0
6
3
1
(1)
(1)
1,540
346
2,519
4,438
104
249
1,740
522
1,414
12,871
1,343
308
2,407
4,316
104
307
1,557
435
1,256
12,034
197
38
112
122
(0)
(58)
183
87
158
837
0
837
126
142
1,086
5,604
6,959
122
141
1,050
5,453
6,766
4
1
36
151
193
54
1,523
4,440
2,023
8,041
45
1,571
4,376
2,066
8,059
9
(48)
63
(43)
(18)
0
(281)
(533)
(814)
(1)
(295)
(465)
(760)
0
1
14
(69)
(53)
181
1,665
5,246
7,094
14,186
167
1,711
5,132
7,054
14,064
14
(46)
114
40
121
(8)
114
(124)
14,167
8,179
22,223
(85)
14,230
8,296
22,442
(39)
(63)
(117)
(219)
0
1
0
0
0
0
0
0
1
(1)
0
0
(1)
(124)
14,167
8,179
22,223
(84)
14,230
8,296
22,443
(40)
(63)
(117)
(220)
0
(220)
Operating Directorates
1,176
148
332
1,714
1,815
9,703
9,808
8,408
10,159
43,263
238
31
146
35
2,233
2,256
4,180
2,297
2,476
13,891
(2)
(10)
(9)
(29)
(28)
(0)
(62)
(56)
(196)
530
5,825
2,924
9,279
257
2,326
600
3,183
(17)
(105)
(10)
(132)
2,858
382
3,024
5,697
124
349
2,366
665
2,007
17,472
146
68
408
287
18
0
68
33
142
1,171
(951)
(74)
(4)
(3)
0
(70)
(2)
(277)
(1,381)
158
189
1,449
7,437
9,233
73
3,098
6,074
2,691
11,935
0
(391)
(711)
(1,102)
0
(163)
18,930
10,929
29,696
0
0
1,414
176
468
1,740
4,019
11,932
13,988
10,643
12,579
56,958
Acute Services Directorate
Access Target
Acute Allied Health Prof
Acute General Management
Admin
Cancer Services
Critical Care
Medicine
Perioperative
Surgery
Diagnostics Directorate
771 Audiology / ECG
8,045 Labs
3,514 Radiology
12,330
2,053 Learning Disabilities Dir
451 Mental Health Admin
3,358 Mental Health Community
5,980 Mental Health Inpatient
139 Mental Health Lead Nurse
349 Mental Health Management
2,364 Mental Health Medical
696 Mental Health Occupational Therapy
1,872 Psychology Directorate
17,261
Operational Services Dir
231 Business Management
3,287 Property Projects
7,132 Property Services
9,416 Support Services
20,066
Prescribing
(163) Primary Care Prescribing Centr
18,930 Primary Care Prescribing East
10,929 Primary Care Prescribing West
29,696
0
Appendix 2
199
Annual Budget
Pays Ytd
Pay
Non Pay
Income
Total
£000
£000
£000
£000
116
361
2,421
4,939
2,067
121
600
258
686
322
625
12,514
2,547
1,183
443
2,965
5,205
1,698
22
1,419
659
1,033
464
17,638
0
7
245
364
699
168
4
51
50
76
97
1,761
227
573
38
309
496
253
259
249
74
14
190
2,681
(24)
(524)
(45)
(134)
(13)
(3)
(54)
(11)
(807)
(7)
(85)
(3)
(18)
(33)
(102)
(316)
(68)
(5)
(11)
(12)
(659)
116
368
2,642
4,780
2,721
155
604
295
733
344
711
13,468
2,767
1,671
478
3,257
5,667
1,849
(35)
1,601
728
1,036
641
19,660
586
1,552
1,361
77
774
357
3,768
4,001
822
2,504
1,417
17,220
51
152
98
71
32
17
65
374
77
199
218
1,354
(2)
(352)
(99)
(200)
(47)
(2)
(30)
(9)
(98)
(40)
(877)
636
1,353
1,360
149
606
326
3,832
4,345
890
2,605
1,595
17,696
126,619
65,671
(5,154)
187,135
Area
Primary & Community Care East
East Medical
Pcc East Admin
Pcc East Allied Health Prof
Pcc East Community Hospitals
Pcc East Community Nursing
Pcc East Health Centres/Clinic
Pcc East Hotel Services
Pcc East Managed Clinical Netw
Pcc East Management/Governance
Pcc East Public Health
Pcc East Sexual Health
Primary & Community Care West
Gp Oohs
Substance Misuse
West Admin
West Allied Health Prof
West Community Hospitals
West Community Nursing
West Health Centres/Clinics
West Hotel Services
West Management/Governance
West Medical
West Public Health
Womens & Childrens Directorate
W&C Admin
W&C Ahp
W&C Cmhs
W&C Gynaecology
W&C Learning Disability
W&C Management & Governance
W&C Medical
W&C Midwifery
W&C Neonatal
W&C Public Health Nursing
W&C Ward 15
Sub Total - Operating Directorates
Non Pay Ytd
Income Ytd
Total Ytd
CRES not
allocated
Total
Ytd
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Variance
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000's
£000's
87
271
1,816
3,706
1,551
90
451
194
514
241
466
9,387
88
275
1,799
3,544
1,508
79
429
187
395
231
454
8,989
(1)
(4)
17
162
44
11
23
7
119
10
12
398
0
5
184
273
524
126
3
34
37
54
73
1,315
0
5
193
274
520
148
2
35
24
34
69
1,307
(0)
0
(9)
(1)
4
(22)
1
(0)
13
20
3
8
(18)
(393)
(34)
(100)
(19)
(362)
(46)
(97)
(6)
(2)
(34)
(6)
(592)
(7)
(5)
(35)
(7)
(576)
0
0
0
(31)
12
(3)
0
0
3
1
1
(16)
1,910
889
332
2,222
3,903
1,274
16
1,063
494
774
347
13,225
1,928
854
331
2,205
3,773
1,253
18
1,047
446
993
325
13,174
(18)
35
2
17
130
20
(2)
16
48
(218)
22
51
170
430
28
232
372
190
194
187
56
10
141
2,010
170
373
29
245
381
185
216
191
48
9
90
1,936
438
1,175
1,021
58
695
312
2,917
3,003
614
1,883
1,055
13,173
431
1,132
994
58
678
316
2,893
3,086
579
1,774
974
12,916
8
44
27
0
17
(3)
24
(83)
35
109
81
257
38
114
73
54
24
12
49
280
58
149
158
1,010
95,575
93,667
1,909
48,353
87
276
1,981
3,586
2,042
116
455
222
550
261
533
10,109
89
280
1,974
3,456
1,982
131
431
215
415
230
517
9,719
(2)
(4)
8
130
60
(14)
24
7
135
31
17
390
0
390
(0)
57
(0)
(13)
(8)
4
(22)
(4)
8
2
51
74
(5)
(64)
(2)
(13)
(25)
(76)
(237)
(51)
(4)
(8)
(9)
(494)
(3)
(64)
(1)
(14)
(32)
(80)
(234)
(46)
(6)
(7)
(14)
(502)
(2)
(0)
(1)
1
7
4
(3)
(4)
2
(1)
5
8
2,075
1,254
359
2,441
4,250
1,387
(27)
1,199
546
777
479
14,741
2,095
1,163
359
2,435
4,122
1,358
1
1,192
488
994
401
14,608
(20)
91
(0)
5
128
29
(28)
7
58
(217)
78
133
0
133
29
134
69
56
16
12
52
280
49
164
130
991
10
(20)
4
(3)
8
1
(3)
(0)
9
(15)
28
19
(1)
(275)
(74)
(1)
(275)
(73)
(150)
(35)
(1)
(22)
(6)
(74)
(30)
(669)
(150)
(35)
(1)
(22)
(6)
(62)
(30)
(657)
0
0
(1)
0
0
0
0
(0)
(0)
(11)
0
(12)
476
1,015
1,020
112
569
290
2,965
3,261
665
1,959
1,183
13,514
458
990
991
114
544
292
2,944
3,344
621
1,876
1,075
13,250
18
24
29
(3)
25
(3)
21
(83)
44
83
109
264
(238)
26
48,402
(49)
(3,893)
(3,799)
(94)
140,036
138,271
1,765
(246)
1,519
Appendix 2
200
Annual Budget
Pays Ytd
Pay
Non Pay
Income
Total
£000
£000
£000
£000
Area
Non Pay Ytd
Income Ytd
Total Ytd
CRES not
allocated
Total
Ytd
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Actual
Variance
Budget
Variance
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000's
£000's
384
245
2,095
1,759
3,865
2,053
522
1,191
12,114
348
242
2,034
1,750
3,698
1,884
486
1,173
11,615
36
3
60
9
167
169
36
18
499
1,299
30
591
87
2,903
439
782
296
6,428
1,300
28
559
77
2,770
288
782
265
6,068
(1)
2
32
10
133
151
0
31
360
(256)
(178)
(778)
(413)
(43)
(158)
(1,825)
12,114
11,615
499
6,428
6,068
360
0
23,702
28,984
52,687
31
23,859
28,857
52,748
Corporate Services
Corporate Services
Chief Executive
Dir Nursing, Midwifery & Ahp's
Finance Directorate
Medical Director
Public Health
Strategic Planning
499
327
2,857
2,366
5,078
2,725
743
1,621
16,217
1,727
171
984
376
4,494
580
1,076
429
9,837
(446)
(207)
(975)
(540)
(80)
(202)
(2,449)
2,226
498
3,395
2,536
8,597
2,765
1,740
1,848
23,604
16,217
9,837
(2,449)
23,604
370
370
0
33,488
38,676
72,163
(5,146)
(2,944)
(1,593)
(9,684)
Strategic
(5,146) Central Income
30,543 External & Resource Transfer
37,453 Primary Care
62,850
278
278
278
278
0
0
(1)
(1)
370
72,163
(9,684)
62,850
278
278
(1)
52,687
Sub Total - Corporate Services
(258)
(194)
(778)
(305)
(47)
(179)
(1,761)
0
0
2
15
0
(107)
4
21
(64)
1,683
275
2,430
1,668
5,990
2,079
1,262
1,329
16,717
1,647
270
2,335
1,633
5,689
1,867
1,222
1,258
15,922
35
5
95
35
301
213
40
71
795
(1,825)
(1,761)
(64)
16,717
15,922
(31)
(157)
127
(62)
(3,860)
(2,228)
(1,195)
(7,282)
(3,561)
(2,178)
(1,195)
(6,934)
(299)
(50)
(0)
(349)
(3,860)
21,475
28,067
45,682
52,748
(62)
(7,282)
(6,934)
(349)
(9)
(66)
26
5
95
35
260
213
25
71
729
795
(66)
729
(3,530)
21,682
27,941
46,093
(330)
(207)
126
(411)
0
(411)
45,682
46,093
(411)
0
(411)
(41)
(15)
Strategic
Sub Total - Strategic
0
7,112
7,112
(233)
(233)
6,879 Non Core Expenditure
6,879
0
0
0
0
4,929
4,929
4,929
4,929
(0)
(0)
(159)
(159)
(159)
(159)
0
0
4,770
4,770
4,770
4,770
(0)
(0)
0
(0)
0
7,112
(233)
6,879
0
0
0
4,929
4,929
(0)
(159)
(159)
0
4,770
4,770
(0)
0
(0)
143,206
154,783
(17,520)
280,469
112,397
112,148
(13,160)
(12,652)
(507)
207,204
205,056
1,500
(1,047)
453
Sub Total - Non Core
Total Operating Budgets 107,967
105,560
2,407
249
2,148
(312)
1,837
0
1,500
(1,047)
453
0
453
Reserves
0
Reserves
2,000 Carry Forward Reserve
6,267 Reserves
8,267
0
7,721
0
8,267
0
162,504
(17,520)
288,735
546
546
2,000
5,721
7,721
546
143,752
Sub Total - Reserves
Grand Total 107,967
0
0
0
0
1,500
(1,047)
453
0
0
105,560
2,407
0
1,500
(1,047)
453
0
0
0
0
0
0
453
0
453
0
0
0
453
0
453
0
453
112,850
112,148
702
(13,160)
(12,652)
(507)
207,657
205,056
2,601
(312)
2,290
201
Appendix 3
POSITION AT 31st December 2011
Efficiency Delivery Plan 2011-12
Savings
Target
(Revised
Q1)
Forecast Outturn Savings
CRES GAP
Delivered Savings
Recurring 12- YTD plan
2011/12
13
£
£
YTD actual
2011/12
£
YTD
Variance
£
960,247
960,247
0
-67,000
268,572
271,072
2,500
-70,108
499,491
453,375
-46,116
0
0
393,012
393,012
0
390,000
0
0
292,491
292,491
0
535,000
0
0
401,265
401,265
0
£
In Year
2011-12
£
Full Year
Recurring
£
In Year
2011-12
£
1,388,000
1,388,000
1,318,000
0
-70,000
Diagnostics
425,000
425,000
358,000
0
Womens and Children
666,000
604,507
595,892
-61,493
524,000
524,000
524,000
Primary and Community Care East
390,000
390,000
Primary and Community Care West
535,000
535,000
Description
Operating Divisions
Acute Services
Operational Services
Operating Divisions Total
496,000
496,000
496,000
0
0
368,621
368,621
0
4,424,000
4,362,507
4,216,892
-61,493
-207,108
3,183,699
3,140,083
-43,616
Corporate
94,000
94,000
94,000
0
0
67,740
67,740
0
Director of Nursing
120,909
120,909
120,909
0
0
83,205
83,205
0
Medical Director
82,529
82,529
82,529
0
0
61,902
61,902
0
390,000
390,000
390,000
0
0
292,491
292,491
0
Finance Directorate
134,942
134,942
141,034
0
6,092
101,214
101,214
0
Public Health
98,582
98,582
98,582
0
0
73,935
73,935
0
Chief Executive
29,190
29,190
16,535
0
-12,655
21,488
21,488
0
13,610
13,610
13,610
0
0
10,209
10,209
0
Strategic Planning
46,537
46,537
46,537
0
0
34,904
34,904
0
1,010,299
1,010,299
1,003,736
0
-6,563
747,088
747,088
0
Pharmacy (Secondary care drugs)
Corporate Total
Other
Prescribing (Primary care drugs)
1,450,000
1,450,000
1,450,000
0
0
1,030,375
1,065,834
35,459
eHealth
198,000
198,000
198,000
0
0
145,374
145,374
0
Procurement
500,000
500,000
500,000
0
0
375,000
375,000
0
Disinvestment
60,000
50,000
50,000
-10,000
-10,000
45,000
37,500
-7,500
200,000
383,000
383,000
183,000
183,000
150,000
287,250
137,250
Other Total
IFRS Compliance
2,408,000
2,581,000
2,581,000
173,000
173,000
1,745,749
1,910,958
165,209
Combined Total
7,842,299
7,953,806
7,801,628
111,507
-40,671
5,676,536
5,798,129
121,593
Appendix 4
202
NHS D&G: Subjective Report
Year
Acute
Services
Directorate
Account
Type
Pays
Account Summary
Admin & Clerical
Ahp
Ancillary
Health Science Services
Med/Dental Suport
Medical & Dental
Miscellaneous
Nursing
Senior Managers
Diagnostics Mental Health Operational
Directorate
Directorate Services Dir
19
3
(10)
(0)
(15)
61
(16)
86
0
7
40
12
29
(19)
86
(8)
150
3
1
(4)
2
175
(1)
407
8
(1)
0
19
111
213
5
(261)
25
167
(0)
166
4
398
51
257
499
11
(11)
(2)
15
(31)
(0)
(125)
0
40
(0)
14
1
11
43
4
(7)
1
(4)
(6)
108
(70)
103
3
(13)
50
49
(18)
0
(6)
5
(23)
6
(10)
9
(0)
(53)
(1)
(17)
(1)
(53)
TOTAL
Corporate
Services
153
19
(39)
17
20
(14)
CRES Not Allocated to Budgets
Womens &
Childrens
Directorate
236
(4)
15
61
35
109
(25)
56
16
(210)
99
(5)
(1)
(0)
101
9
8
(5)
(9)
TOTAL
Primary &
Community
Care West
47
42
42
(10)
Non Pay Clinical
Drugs
Equipment & Service Contracts
Externals
Family Health Services
General Services
Hotel Services
Other
Property
Travel/ Training/ Recruitment
Income
Primary &
Community
Care East
2
16
23
10
90
Fhs Income
Hch Income
Other Operating Income
789
13
130
Income
Prescribing
9
Non Core
Expenditure
Strategic
Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance Ytd Variance
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
Pays
Non Pay
Variances - Year To Date Month:
2011
117
123
837
0
0
0
117
123
837
193
121
(8)
114
0
2
(218)
(3)
(219)
(1)
(1)
21
54
(12)
24
(18)
4
(20)
2
(26)
8
(8)
42
(2)
25
(14)
64
(4)
2
(2)
(8)
(14)
89
(15)
(22)
(13)
0
9
(0)
(1)
(6)
(1)
12
(4)
23
6
30
(10)
0
(1)
47
(26)
284
(15)
45
8
74
19
(1)
0
(154)
146
(25)
(29)
(0)
360
(62)
(0)
(20)
4
8
0
(14)
2
(106)
41
(0)
(355)
6
(16)
8
(12)
(64)
(349)
0
(411)
(0)
0
0
(411)
(0)
(220)
390
133
0
0
0
(220)
390
133
264
(238)
26
795
(66)
729
Ytd
Variance
£000
325
237
226
247
21
132
103
1,088
27
(0)
(1)
Total
2,407
(308)
206
(137)
(149)
(102)
219
71
343
35
71
249
(1)
(526)
20
(507)
2,148
(312)
1,837
203
Agenda Item 252
6 February 2012
2011-12 CAPITAL PLAN
Author:
Susan McMeckan, Divisional Finance Manager
20 January 2012
Date:
RECOMMENDATION
The Board is asked to note:
•
•
•
The position to end of December 2011;
The project updates;
The risks around the capital programme.
The Board is asked to approve:
•
The amendments to the capital plan.
SUMMARY
•
Plan to deliver £18.336m of schemes in 2011-12.
GLOSSARY OF TERMS
SGHD
YTD
SG CIG
Scottish Government Health Directorate
Year to Date
Scottish Government Capital Investment Group
2011-12 Capital Plan Allocations
1.
Appendix 1 sets out the anticipated allocations and the actual allocations that
have been received.
Page 1 of 5
204
2.
Two allocation adjustments require approval:
•
•
the transfer of £1m underspend back to Scottish Government as a result
of the anticipated under spend on the Acute Mental Health project; and
an additional £214k is required to transfer from revenue following a
review of all schemes and the likely capital/revenue split. The total
transfer is now £2.2m as previously reported though the Financial
Performance report.
2011-12 Capital Plan Expenditure
3.
Appendix 1 sets out the current approved budgets for 2011-12 and the
associated expenditure up to 31 December 2011.
4.
£18.336m of expenditure has now been committed for this financial year
against anticipated allocations to the same value. This is a reduction of £786k
to that previously presented.
The change relates to the adjustments
highlighted in allocations and the reflection through the expenditure programme
as detailed below under adjustment requiring approval.
5.
Expenditure for the first 9 months is £12.363m leaving a balance of £5.973m to
be expended in the final quarter of the year. The chart below shows the split
by each type of expenditure.
Total Expenditure and Outstanding expenditure by Group
£14,000
£12,000
£2,141
£10,000
£8,000
Balance to Spend
YTD Expenditure
£6,000
£10,056
£4,000
£2,372
£2,000
£1,307
£416
£592
£1,044
Estates
Equipment
eHealth
£0
Strategic Projects
Page 2 of 5
£408
205
Amendments requiring approval
6.
Agreement has been reached with Scottish Government with regards to the
under spend on the Acute Mental Health project. It is anticipated that this will
deliver a £1m saving against approved budget and as this is a centrally funded
project this requires to be returned. Both assumed allocations and expenditure
have been reduced accordingly.
7.
CIG have approved the proposal to replace four CSSD washers which are at
the end of their useful life, these were prioritised tenth as part of the equipment
prioritisation process that took place earlier this financial year. This project has
a total cost of £247k of which £205k is expected to be incurred in 2011/12.
The project is part funded by £113k of the original equipment budget with the
remainder funded from the agreed revenue flexibility in year.
8.
As highlighted in the previous Financial Performance report an additional £1.1m
has been allocated to support additional IT investment. A review of anticipated
expenditure against this allocation indicates that £500k of this funding will be
required in capital expenditure. The Board is therefore asked to recognise that
of the additional £1.1m already approved £500k will be spent as capital.
9.
The allocation for equipment has been reduced by £113k to reflect the approval
and set up of a separate budget line for the CSSD washers’ replacement
programme.
In addition a number of the items approved as part of the
prioritisation exercise have came in under £5k and must be transferred to
revenue. This has been reviewed as part of identifying the revised revenue to
capital requirement.
10. Funding available for the estates work currently being undertaken which was
approved by Scrutiny Committee has been increased to recognise the change
in tender received for the CRH Roof repairs. Further review of the schemes
has identified a change in the split of capital and revenue and as a result a net
reduction of £378k is required to the capital plan to support these changes.
This does not impact on the final total cost of approved projects. This is
reflected in the revised revenue to capital virement of £2.2m.
Project Update
11. The Acute Mental Health project is now complete and the hospital is fully
operational with patients transferring successfully week commencing 9 January
2012.
12. The build of the new primary care premises at Lochfield Road commenced as
planned in October with a planned completion date of September 2012.
13. The refurbishment programme at Oakfield is scheduled to complete early April
2012 within budget.
Page 3 of 5
206
14.
The three schemes in excess of £250k, Nithbank Boilers, CRH roof repairs and
Newton Stewart fabrication repairs which are within the property strategy
allocation are all proceeding well and are still on target to complete by the end
of the financial year.
15. The land take for the Dalbeattie and Dunscore sites has now been completed
and this is anticipated to be the final position in terms of expenditure.
16. All purchases against the equipment programme have been ordered and are
expected to complete by 31 March 2012. £56k currently remains unallocated
against the equipment contingency.
17. The installation of the endoscopy washers is now complete, the previous Board
Paper reported anoverspend against this project; however, following
investigation it has been identified the ledger had not reflected a credit note
which was expected for a double charge. This has now been received and is
reflected in the revised expenditure position.
18. All laboratory hardware replacement is now complete and a disaster recovery
test is being planned.
The Order Comms procurement has now reached
preferred bidder stage and will hopefully complete by end of January 2012.
19. IT developments are all on target to deliver as planned within budget and within
the agreed timescale. The additional funding allocated (£1.112m) has been
planned and is being prioritised through the eHealth Board and again no
slippage is envisaged. Major procurements (Document Management System
and the establishment of a Scanning Bureau ) are now complete and orders
placed with suppliers.
Significant amount of mobile equipment is being
procured and deployed to support the introduction of these systems into clinical
areas.
20. As highlighted under the individual projects CIG at this time have no indication
that the capital programme will not deliver expenditure of £18.336m as planned
assuming the risks identified below are mitigated.
Key Financial Risks
21. The outstanding spend against the estates and IT investment presents a risk in
terms of ability to deliver this level of expenditure within the required
timescales; however, both teams are signed up to delivery by 31 March and no
serious concerns have been raised about deliverability.
Page 4 of 5
207
MONITORING FORM
Policy/Strategy Implications
Capital Plan, Property Strategy & IM&T Strategy
Not Applicable
Capital charge and recurring revenue consequences built
in as part of the financial planning and reporting cycle
Consultation
Heads of Service and Project Leads
Consultation
with Yes as appropriate
Professional Committees
No
Risk Assessment
Best Value
This paper contributes to Best Value goals of sound
governance, accountability, performance scrutiny and
sound use of resources.
Sustainability
The capital plan supports the sustainability agenda through
the delivery of capital schemes in line with the property
strategy and efficiency procurement of equipment.
Compliance with Corporate To maximise the benefit of the financial allocation by
delivering efficient services, to ensure that we sustain and
Objectives
improve services and support the future model of services.
Single Outcome Agreement Not applicable.
(SOA)
Impact Assessment
Not Applicable
Page 5 of 5
208
APPENDIX 1
DUMFRIES & GALLOWAY NHS BOARD - 2011-12 CAPITAL PLAN
MONTH 9 - TO END OF DECEMBER 2011
Anticipated Allocations
Allocation Letter received
Formula
2010-11 Slippage agreed anticipated
Transfer from Revenue anticipated
HFS Equipping
Cresswell Maternity PFI adjustment
Deduction for Quarriers topslice anticipated
TOTAL AVAILABLE FOR COMMITMENT
SOURCE
Current
Adjustment
Board
Approval
£000s
(12,300)
(2,200)
(2,650)
(1,986)
(57)
71
0
(19,122)
1,000
0
(214)
0
0
0
786
Revised for
Approval
Board
£000s
(11,300)
(2,200)
(2,650)
(2,200)
(57)
71
0
(18,336)
Allocation
Received
Allocation
Outstanding
£000s
£000s
(12,700)
(2,200)
(2,650)
0
0
0
0
(17,550)
1,400
0
0
(2,200)
(57)
71
0
(786)
APPLICATION
Current
Board
Approval
Legally Committed & Proceeding
Acute Mental Health Developments
North West Dumfries
HFS Equipping Costs
Locally Approved & Proceeding
Labs hardware refresh and order comms
Oakfield/Netherlea co-location project
Endoscopy Washer replacement DGRI & GCH
4 x CSSD Washers replacement programme
Land - Primary Care Modernisation-Dalbeattie
Land - Primary Care Modernisation-Dunscore
Rolling Programmes
IM&T (inc. addt'l schemes)
Equipment inc. medical, X-ray, general & catering
Statutory Compliance inc. Energy & Property strategy
TOTAL EXPENDITURE COMMITMENTS
Less Capital Income
NET CAPITAL EXPENDITURE
TOTAL AVAILABLE AFTER COMMITMENTS
Adjustment
£000s
£000s
10,740
2,400
57
13197
Revised for
Approval
Expenditure Expenditure
Incurred
Outstanding
£000s
£000s
(1,000)
0
0
(1,000)
£000s
0
9,740
2,400
57
12197
9,272
784
0
10056
468
1,616
57
2141
462
905
366
0
185
156
2074
0
0
0
205
0
0
205
462
905
366
205
185
156
2279
102
371
369
0
184
156
1182
360
534
(3)
205
1
0
1097
490
550
2,811
3,851
19,122
500
(113)
(378)
9
(786)
19,122
(786)
990
437
2,433
3,860
18,336
0
18,336
306
223
596
1,125
12,363
0
12,363
684
214
1,837
2,735
5,973
0
5,973
0
0
0
209
Agenda Item 253
6 February 2012
Performance Report
Author:
Nicole Connell, Assistant General Manager
Julie White, Interim Chief Operating
Officer
RECOMMENDATION
The Board is asked to discuss and note the contents of this report.
SUMMARY
This report provides information on the level of clinical activity and access times
achieved within services to 31 December 2011. It also highlights data on efficiency
of clinical services as measured against current Health, Efficiency, Access and
Treatment (HEAT) targets.
Key Messages:
The organisation has achieved the 18 Weeks Referral to Treatment HEAT target.
This milestone is the culmination of three years work of the clinical and management
teams throughout NHS Dumfries and Galloway.
GLOSSARY OF TERMS
HEAT – Health Improvement, Efficiency, Access and Treatment Quality and Patient
Experience
RTT – Referral to treatment
A&E – Accident & Emergency
BADS – British Association of Day Surgery
DNA – Did not attend
Sleeper/boarder – An inpatient accommodated in a ward not specialising in their
condition
210
1. CURRENT POSITION AGAINST ACCESS TARGETS
Appendix 1 shows the waiting times for stage of treatment targets as at 31
December 2011 for patients waiting for out patient appointments and inpatient / day
case treatment. The appendix also shows the waiting times for the key diagnostic
tests.
Inpatients/Daycases
There were 18 breaches of the 9 week inpatient / day case local guideline, detailed
by specialty below all in general surgical specialties.
Outpatients
There were no breaches of the 12 week outpatient standards.
Diagnostics
There were 3 breaches of diagnostic waiting time standards all relating to specialist
MR investigation in Edinburgh.
Cancer
Cancer performance against targets has been exemplary as shown.
Most recent period Target
of measurement
Cancer
62 Day Referral to Nov 11
Treatment Target for
suspicion of cancer
All cancer treatment Nov 11
31days
Actual
95%
100%
95%
100%
18 Week Referral to Treatment Standard
It is extremely satisfying to report achievement of the most high profile of the Scottish
NHS access targets; the requirement to link 90% of all elective patient pathways
and complete 90% of these within 18 weeks.
Combined 18 week RTT
Combined completeness
Combined performance
Dec 11
Dec 11
Target
for Actual
31/12/11
90%
91.1%
90%
93.3%
This work would not have been possible without the dedication of clinical and
administrative teams across the organisation over the almost three years of progress
towards this outcome.
211
Work will continue to improve data completeness so that invaluable pathway
analysis can be undertaken to further improve performance and deliver an
increasingly efficient and person centred patient pathway.
A&E Attendances
Accident
&
Emergency
(A&E)
attendances
Attendances per 100k
population
% of A&E waits under
4 hours
Most recent period Target
of measurement
Actual
Dec 11
2548
2389
Dec 11
98%
96.1%
We are now undertaking the usual intensive monitoring of key hospital performance
indicators to reflect management of winter pressures. Performance against the 4
hour target is shown in the table below. It should be noted that the final column
relates to elective operations / outpatient appointments cancelled due to severe
weather conditions which resulted in some temporary staffing difficulties.
Week
ending
06.12.2011
Total A&E
No. waiting Compliance
attendances > 4 hours
(%)
721
26
96.4%
No.
Patients
waited >12
hours
0
Longest
wait
(hh:mm)
5:19
No.
cancelled
0
13.12.2011
752
38
94.9%
0
6:01
10 *
20.12.2011
756
36
95.2%
0
6:04
0
27.12.2011
772
28
96.4%
0
5:51
0
* 5 outpatient and 5 theatre slots due to staff unavailability with inclement weather
212
2. CURRENT PERFORMANCE AGAINST CLINICAL EFFICIENCY TARGETS
The table below shows the current average performance against previous years
average and year end target for clinical efficiency targets.
Efficiency Targets
Target
Day Case rates British 81.5%
Association of Day Surgery
(BADS) procedures
83.2%
Average to
date
2011/12
82.7%
Non
routine
Inpatients 4
Average Length of Stay
Review per new outpatient 1.9
attendance
Outpatient Did Not Attend
(DNA) rates – new
4.8%
4.2
4.4
2.2
2.2
4.8%
4.6%
Pre-Operative Length of Stay
0.58
0.46
0.32
Elective Operations cancelled
7%
9.1%
8.6%
Not
comparable
48
1676
453
N/A
95%
Number of letters over 7 days 0
as at 19 January 2012(Acute
Directorate
only
from
Winscribe reporting)
No of letters over 10 days at 0
first
Monday
in
month
(January
2011
versus
January 2012)
Stroke patients transferred to 80%
specialist unit within 24 hours
Average
2010/11
At the January presentation of interim performance data for the festive period an
analysis in trends in ‘Boarding’ was requested. We record boarders (sometimes
known as ‘sleepers’) as patients spending time in a ward that is not the most suitable
for their condition. Typically in winter this might involve a medical patient spending
time in a surgical ward. There is good evidence that boarding increases length of
stay in acute hospitals and may in certain circumstances adversely affect recovery.
The reconfiguration of DGRI inpatient wards that took place in October 2011,
together with the ongoing efforts of the capacity managers and charge nurses,
appears to have had a significant impact on number of boarding days in December.
The chart below compares data from December 2011 with December 2010 and
shows a striking reduction in aggregate boarding days between the two years. It
213
should be noted that this has been achieved in the context of a 24 bed reduction at
the Infirmary.
Analysis of Boarding Days Dec 2010/Dec2011
250
Number
200
150
100
50
0
30.11.2010 07.12.2010 14.12.2010 21.12.2010 28.12.2010 29.11.2011 06.12.2011 13.12.2011 20.12.2011 28.12.2011
Series1
171
170
164
211
162
45
26
29
51
71
Week ending
Whilst this data is encouraging and appears to show that ward reconfiguration has
better aligned capacity to demand, we will need to review a full winter’s data to
ensure robust analysis.
Elective Operations Cancelled
Ninety-nine elective operations were cancelled within December.
provided in the table below:
Reason for Cancellation
Patient DNA / Refusal
List Over-runs
Operation completed in clinic
Patient not fit /ready
Operation no longer required
HDU bed availability
Not fasted/prepared
Other
TOTAL
Number
30
3
2
25
15
0
5
19
99
A breakdown is
214
3. ACTIVITY
Return Appointments
Trend in Waits >8 weeks from Planned Return date
700
600
Cardiology
Neurology
500
Ophthalmology
400
Orthodontics
300
Gastroenterology
Orthopaedics
ENT
200
Diabetes
Endocrinology
100
0
Jan10
Feb- Mar10
10
Apr10
May- Jun10
10
Jul10
Aug- Sep- Oct- Nov10
10
10
10
Dec- Jan10
11
Feb- Mar11
11
Apr-
May-
Jun-
Jul-
11
11
11
11
Aug- Sep11
11
Oct- Nov11
11
Dec11
Medical staffing vacancies within the ophthalmology team are causing pressures
across the speciality including the management of return patients. We currently
have locum cover in place whilst we advertise for replacement consultant posts.
4. CONCLUSIONS
A significant milestone has been reached with the achievement of the 18 week
referral to treatment standard by December 2011. It is important, however, that
redesign work continues at its current pace to deliver continued improvements in
patient access.
Overall activity and performance is satisfactory and there remains no exceptional
seasonal pressure on the health system.
215
MONITORING FORM
Waiting Times
Additional internal capacity
workload/staffing levels
Discussed with Director of Finance and Chief
Operating Officer
Consultation
As above
may
impact
on
Consultation with Professional N/A
Committees
A risk assessment has been undertaken with
Risk Assessment
regards overdue return appointments. This was
assessed initially as high but control measures are
now in place and this currently remains assessed
as medium.
Best Value
Complies with key principles:
• Commitment and leadership
• Sound governance at a strategic, financial
and operational level
• Sound management of resources
• Use of review and option appraisal
• Accountability
Sustainability
This report highlights delivery of efficient clinical
services within a sustainable framework of access
targets
Compliance with Corporate Corporate Objective 7
Objectives
Single Outcome Agreement N/A
(SOA)
Impact Assessment
Not required.
216
Appendix 1
Waiting Times as at 31st Dec 2011
Inpatients and Day Cases
Total
between 0
and 6
between 6
weeks
and 9 weeks Over 9 weeks
Cardiology
Community Dental
Dermatology
ENT
Gastroenterology
General Medicine
General Surgery
Gynaecology
Medical Paediatrics
Neurology
Ophthalmology
Oral Surgery
Pain Relief
Rehabilitation Medicine
Rheumatology
Trauma & Orthopaedics
Urology
Respiratory Medicine
Total
Percentage of total waiting
9
4
0
16
0
1
43
13
0
1
80
16
9
0
0
74
15
1
282
46.84
5
3
0
4
0
0
68
6
0
1
76
26
16
1
0
80
16
0
302
50.17
0
0
0
0
0
0
18
0
0
0
0
0
0
0
0
0
0
0
18
0.96
Total
14
7
0
20
0
1
129
19
0
0
156
42
25
1
0
154
31
1
602
100
Outpatients
between 0
and 6
between 6
weeks
and 9 weeks
made up of
Anaesthetics( Pain)
Cardiology
Clinical Oncology
Dermatology
Clinical Biochemistry
Diabetes
Endocrinology
ENT
Gastro enterology
General Medicine
General Surgery
Geriatric Medicine
Gynaecology
Haematology
Medical Paediatrics
Nephrology
Neurology
Ophthalmology
Oral Surgery
Orthodontics
Palliative Medicine
Rehabilitation
Rheumatology
Trauma & Orthopaedics
Urology
Respiratory
Total
30
119
0
165
25
17
18
104
83
41
343
30
167
9
68
8
72
179
79
46
0
5
81
392
134
50
2265
75.88
between 9
and 12
weeks
9
17
0
28
7
4
0
0
45
5
64
5
10
1
4
1
27
30
4
8
0
3
10
210
21
7
520
17.42
11
10
0
4
0
0
0
0
32
3
12
1
4
0
0
0
13
28
0
0
0
1
0
76
0
5
200
6.70
Diagnostics
Upper Endoscopy
Lower Endoscopy
Colonoscopy
Cystoscopy
CT Scans
MRI
Ultrasound
Barium Studies
DEXA
Isotopes
between 0
and 4
weeks
Over 4 weeks Total
92
0
13
0
91
0
38
0
95
136
247
0
44
19
775
99.6%
0
3
0
0
0
0
3
0.4%
92
13
91
38
95
139
247
0
44
19
778
100.0%
Over 12
weeks
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.00
Total
50
146
0
197
32
21
18
104
160
49
419
36
181
10
72
9
112
237
83
54
0
9
91
678
155
62
2985
100
217
Appendix 2
Comparison of Activity
December 2010/11 and December 2011/12
Cum Dec10
Elective
Cum Dec11
%
Variance
( Acute, Maternity and Geriatric)
Inpatients
Day Cases
Day Patients (Haemodialysis)
New Out patients
Return Outpatients
5638
10256
6,501
27467
5821
11011
6,665
26574
3.2%
7.4%
2.5%
-3.3%
59,329
58,206
-1.9%
14768
37,777
15110
35,897
2.3%
-5.0%
1,105
1,066
-3.5%
27,516
26,083
-5.2%
495
494
-0.2%
Occupied bed days
13,541
11,966
-11.6%
Radiology (GP referral based activity)
11,345
11,553
1.8%
Emergency
( Acute, Maternity and Geriatric)
Inpatients
A&E
Births
Community Hospitals
Occupied bed days
Mental Health
( General & Psychogeriatric - CRH)
Inpatients
218
Agenda Item 254
6 February 2012
NHS Lothian Outline Business Case for Royal Hospital
for Sick Children and Department of Clinical Neurosciences:
Request for NHS Dumfries and Galloway Agreement in Principle
Author:
Mary Harper,
Planning & Commissioning Manager
Date:
Sponsoring Directors:
Judith Proctor, Director of Planning
24 January 2012
RECOMMENDATION
• note that NHS Lothian has produced an outline business case (OBC) for the
reprovision of the Royal Hospital for Sick Children and the Department of Clinical
Neurosciences (DCN) at Little France;
• note that no capital funding from NHS Dumfries and Galloway (D&G) is required;
• note the proposal that all Boards contribute proportionately to funding the
revenue gap, the detail to be agreed through further regional discussions, but
based on the accepted East Coast Costing Model (ECCM); and
• agree that NHS D&G provide NHS Lothian with the requested ‘confirmation in
writing’ of support for the OBC.
SUMMARY
For a number of years NHS Lothian has been working on business cases for the
reprovision of DCN, as well as for the Royal Hospital for Sick Children (RHSC)
Edinburgh. Since 2009 NHS Lothian has linked with partner Boards through the
regional Directors of Finance (DoFs) and Directors of Planning (DoPs) group, which
includes membership of NHS D&G.
In December 2011 NHS D&G received Lothian’s combined OBC for the reprovision
of both RHSC and DCN at Little France, Edinburgh. It should be noted that the
basis of the present OBC is in line with the recommendations agreed by the NHS
D&G Board, when considering the previous draft OBC in 2009, i.e. that no capital
contribution is required and future additional revenue will be agreed through the East
Coast Costing Model.
Following positive meetings and discussions with NHS Lothian, NHS D&G Board
officers are content that the OBC should be approved in principle, with further joint
discussions undertaken in developing the Full Business Case.
219
GLOSSARY OF TERMS
COO
- Chief Operating Officer
DCN
- department of clinical neurosciences
D&G
- Dumfries and Galloway
DoFs
- Directors of Finance
DoPs
- Directors of Planning
ECCM
- East Coast Costing Model
GGC
- Greater Glasgow and Clyde
NHS
- National Health Service
NPD
- Non Profit Distributing
OBC
- Outline Business Case
PFI
- private finance initiative
RHSC
- Royal Hospital for Sick Children
RIE
- Royal Infirmary Edinburgh
SEAT
- South East and Tayside regional planning group
WoS
- West of Scotland
Background
NHS Dumfries and Galloway (D&G) links mainly to NHS Greater Glasgow and Clyde
(GGC) for the provision of tertiary services, including paediatrics. However, the
Board also links to NHS Lothian for some specialties, the key ones being cancer
services and neurosciences.
At present both neurology and neurosurgery are
delivered from the Department of Clinical Neurosciences (DCN) at the Western
General Hospital in Edinburgh.
For a number of years NHS Lothian has been working on business cases for the
reprovision of DCN, as well as for the Royal Hospital for Sick Children (RHSC)
Edinburgh. The aim has been to provide new, fit for purpose facilities in which to
deliver high quality and modern clinical services.
In early 2008 NHS Lothian set up a Project Board to oversee the DCN
redevelopment work.
Membership included representatives from those boards
using the Lothian DCN as the regional centre for specialist neurosciences, namely
Fife, Borders, Forth Valley and Dumfries and Galloway, along with the host board
Lothian. All these boards, apart from NHS D&G, are formal members of the South
East and Tayside regional planning group (SEAT). In 2011 the Project Board was
revised to provide a combined RHSC and DCN Stakeholder Project Board, chaired
by NHS Lothian’s Chief Operating Officer (COO), to ensure informed engagement
with stakeholders of both projects.
During 2011 there was a strategic review of neurology services in Dumfries and
Galloway.
This included reviewing the links to regional networks to consider
whether Dumfries and Galloway should link with Glasgow instead of Edinburgh/
Lothian. Following discussions NHS GGC concluded that, given changes due to
their local acute strategy, there was not enough capacity in GGC to accept Dumfries
and Galloway activity in future. This was presented to the Dumfries and Galloway
220
NHS Board at its meeting on 6 June 2011 when the Board agreed to continue to link
with NHS Lothian / DCN for tertiary neurosciences services.
Draft Outline Business Case (OBC) - 2009
At the Board meeting of 7 December 2009 NHS Dumfries and Galloway considered
NHS Lothian’s draft OBC for reprovision of DCN. As the OBC was confidential the
Board discussed the paper in committee.
In the 2009 OBC the proposed funding of the new DCN was based on south east
Boards providing both capital and revenue contributions which were not within their
financial plans. Consequently Lothian’s regional partners, including NHS Dumfries
and Galloway, could not support the OBC as it was then presented. As the Scottish
Government could not provide capital funding either the 2009 OBC became
redundant.
At the time, south east Boards were in discussion to develop revised cross-border
funding arrangements called the East Coast Costing Model (ECCM).
Therefore
Dumfries and Galloway NHS Board, when discussing the 2009 OBC, considered that
future ‘approval in principle’ might be given on the basis that no capital contribution
was required and that any future additional revenue be limited to that agreed through
the East Coast Costing Model (see below).
Present Outline Business Case (OBC) – draft December 2011
Since 2009 NHS Lothian has linked with partner Boards through the regional SEAT
Directors of Finance (DoFs) and Directors of Planning (DoPs) group, which includes
membership of NHS Dumfries and Galloway. Progress with the development of the
business plans for RHSC and DCN have been presented at meetings of the
DoFs/DoPs, as has an earlier draft of the present combined OBC.
In December 2011 NHS Lothian sent their OBC to NHS Dumfries and Galloway.
This is a combined OBC for the reprovision of both the Royal Hospital for Sick
Children (RHSC) and the Department of Clinical Neurosciences (DCN) at Little
France.
As the OBC contains commercially sensitive material, it is presently
confidential (see covering letter, attached as Appendix 1).
The introduction to the OBC explains that, since 2009, there has been a fundamental
change to the procurement method for the project. This followed the publication of
the Scottish Government Draft Budget in November 2010 which again linked the
RHSC and DCN projects and announced that they would be delivered using the Non
Profit Distributing (NPD) revenue funded model.
This meant that capital
contributions were not required from partner Boards, unlike with the 2009 draft OBC.
Key steps included:
• In March 2011 NHS Lothian submitted a Business Case Update to supplement
the RHSC OBC and the DCN Initial Agreement, setting out the options for
delivering both reprovision projects on the Little France site using an NPD
procurement route.
221
•
The preferred option for the project, a joint build RHSC and DCN, was identified
in the Business Case Update and approval received from the Scottish
Government to develop this OBC in July 2011. This OBC has been written in
accordance with Scottish Capital Investment Manual guidance.
The following extracts from the OBC provide the key elements of the project:
‘The preferred option is a new hospital for children and young people, integrating the
department of clinical neurosciences into the same new build, on car park B at Little
France. The facility will stand-alone in terms of infrastructure and facilities
management, with its own energy centre and goods delivery yard. It will link in to the
Royal Infirmary Edinburgh (RIE) at ground and first floor to ensure clinical
functionality, particularly in the interfaces between emergency departments, theatres
and critical care on site. It will have a helipad on the roof to provide emergency
access to all adult and paediatric specialties on site.
‘Services for children and young people and for adult neuroscience patients will meet
national aims and ambitions laid out in the:
• 2010 NHSScotland Quality Strategy;
• National policy to have two paediatric intensive care units in Scotland;
• Stated aims to deliver neurosurgery on the same site as an Emergency
Department;
• Stated aims to deliver adult and paediatric neurosurgery on the same hospital
site.
‘The preferred site for RHSC and DCN is at Little France, alongside the existing RIE
which is provided via a private finance initiative (PFI) contract with Consort
Healthcare (ERI) Ltd. Negotiations to secure the land and progress enabling works
required before the RHSC and DCN can be built are underway. A full briefing on the
current position with these negotiations between NHS Lothian and Consort
Healthcare…[has been shared with NHS D&G officers].’
Board officers have studied the OBC and met recently with NHS Lothian officers:
• 4 January 2012 - there was a video conference meeting between NHS Dumries
and Galloway (Director of Finance and Planning & Commissioning Manager) and
NHS Lothian (Director of Finance and COO)
• 17 January 2012 – NHS Lothian officers (Deputy Director of Finance and RHSC/
DCN Project Manager) visited NHS Dumfries and Galloway to meet with Director
of Finance and colleagues from (Finance, Planning and Health Intelligence Unit).
Key issues from the OBC
• no comment on RHSC element as vast majority of specialist paediatric care for
Dumfries and Galloway is provided by GGC.
• as stated previously, NHS Dumfries and Galloway clinicians are generally very
happy with the tertiary services provides by DCN and support the overall service
model provided and proposed for the future.
• bed modelling for the future DCN takes account of projected population increase
(mainly Lothian), Lothian redesign of stroke and spinal services.
222
•
•
•
•
the present projected revenue gap for the whole project is estimated as being
£8,368 million (indicative for 2017/18).
discussions are underway regarding the best methodology for how to apportion
shares across Boards, although it is agreed that it be based on the accepted
ECCM (product of Board’s - Activity x Average cost per case x Case mix
complexity index).
the ECCM approach ensures that NHS Dumfries and Galloway (and other
Boards) are only charged for the activity of their residents, and will not cover
costs associated with internal Lothian service redesign, population growth, etc.
the present estimate for the NHS Dumfries and Galloway share is an additional
£283k. This is in the context of the current annual contract with NHS Lothian for
DCN services of £1.82 m.
As shown above, there are a number of issues to be clarified although there are no
fundamental disagreements with the content of the OBC. The Director of Finance
confirms that such discussions can be continued in the development of the
subsequent Full Business Case.
In the meantime, the potential financial cost
pressures will be factored into future years’ financial plans.
It should be noted that the basis of the present OBC is in line with the
recommendations agreed by the NHS Dumfries and Galloway Board when
considering the previous draft OBC in 2009; i.e. ‘that no capital contribution is
required and that any future additional revenue be limited to that agreed through the
East Coast Costing Model’.
Given the above and the positive discussions between NHS Dumfries and Galloway
and NHS Lothian, the assessment is that the OBC should be approved in principle,
as requested by NHS Lothian (see Appendix 1).
Recommendation
• note that NHS Lothian has produced an outline business case (OBC) for the
reprovision of the Royal Hospital for Sick Children and the Department of Clinical
Neurosciences at Little France;
• note that no capital funding from NHS Dumfries and Galloway is required;
• note the proposal that all Boards contribute proportionately to funding the
revenue gap, the detail to be agreed through further regional discussions, but
based on the accepted East Coast Costing Model (ECCM); and
• agree that NHS Dumfries and Galloway provide NHS Lothian with the requested
confirmation in writing of support for the OBC.
223
MONITORING FORM
In line with national Quality Strategy
Supports regional working and patient pathways,
between secondary and tertiary care.
Supports improvement against Neurology Health
Improvement Scotland standards.
None locally
See paper
Consultation
none.
Committees
Risk Assessment
none
Best Value
Based on agreed East Coast Costing model.
See paper
Sustainability
NHS Lothian OBC aims to provide future
sustainable tertiary services.
Compliance with Corporate
Objectives
Complies with following Corporate Objectives:
2. To promote and embed continuous improvement
by connecting a range of quality and safety
activities to deliver the highest quality of service.
5. To maximise the benefit of the financial
allocation by delivering clinically and cost
effective services efficiently.
6. Continue to support and develop partnership
working to improve outcomes for the people of
(SOA)
Healthy and happy lives - Accessing quality health
and care services
See paper – financial risks to be included in future
financial plans..
Impact Assessment
NHS Lothian undertook Equality and Diversity Impact Assessments (EQIA) for
RHSC and DCN projects in 2008 and 2009 respectively.
224
Appendix 1 – Cover letter from NHS Lothian
225
226
Agenda Item 255
6 February 2012
Register of Members’ Interests
2011 / 2012 – Paper 2
Author:
Jennifer Wilson, Corporate Business Manager
RECOMMENDATION
The Board is asked to confirm the accuracy of and note the revised Register of
Members’ Interests.
SUMMARY
Board Members of devolved public bodies are required to give notice of their
interests and the NHS Board is required to maintain a Register of Members’
Interests. The register is updated on a regular basis to reflect changes in Members’
entries.
Whilst it is the responsibility of each Member to advise the Corporate Business
Manager of any changes within one month of the change arising, the register will be
reviewed twice a year and presented to Board for their confirmation of accuracy and
note.
The Corporate Business Manager will keep the register of interests available for
public inspection at the Board’s offices during normal working hours without charge.
1
227
MONITORING FORM
No policy / strategy implications.
No staffing implications.
No financial implications.
Consultation
Complies with regulations, no consultation required.
Consultation with Professional Complies with regulations, no consultation required.
Committees
Risk Assessment
Ensure compliance with regulations.
Best Value
Accountability.
Compliance
Objectives
with
Corporate Corporate Objective 7.
Impact Assessment
Not required.
2
228
REGISTER OF MEMBERS INTERESTS
February 2012
Registration of Interests
Board members of devolved public bodies are required by the Regulations to give the ‘Standards Officer’ notice of their interests The Register
must state:
the name of the board member;
their interests which fall within the categories listed below and as set out in the member’s code of conduct; and
if they have nothing to register they must record that fact under each applicable category.
It is the responsibility of each board member to ensure that their entry in the register is kept up to date. Any changes to the
information first registered, must be given in writing to the standards officer, in the prescribed format, within one month of the
change arising.
The ‘Standards Officer’ (Corporate Business Manager) will keep the register of interests available for public inspection at the Board’s offices
during normal working hours and without charge.
3
229
Column 1
Registerable interest category
Gifts and hospitality
Category 1 - Remuneration
NOTE: You do not need to register
the amount of remuneration
Column 2
Description of interest
Column 3
Members Registering an Interest in this Category
(and Description of interest)
A description of any gifts or hospitality
received.
A description of
MEMBER
Mr M Keggans
(a) remuneration received by virtue of
Mrs H Dykes
being:–
REGISTERED INTEREST
Members interests noted in the Gifts and
Hospitality Register.
Member, BBC Trust Audience Council for
Scotland
AHP Professional Head of Service
(i) employed or self-employed;
Dr A Cameron
Partner, Bygate Hall Farming Partnership
(ii)the holder of an office;
Mr I Hyslop
Local Councillor and Leader, Dumfries and
Galloway Council
Mr A Johnston
Service Development Manager, Multiple
Sclerosis Society
(v) involved in undertaking a trade, Mr A Campbell
profession, vocation or any other work;
Area Co-ordinator and Board Member of
Scottish Natural Heritage
Partner, Messrs Andrew R Campbell
Farming
(iii) a director of an undertaking;
(iv) a partner in a firm; and
(b) any allowance received in relation to
membership of any organisation;
Mr T Sloan
(c) the name, and registered name if
different, and nature of any applicable
employer, self-employment, business, Mrs A Kelly
undertaking or organisation;
Manager for S&A Homes
Manager for Lochview Properties
(d) the nature and regularity of the work Mrs L Garbutt
that is remunerated; and
Senior Library Assistant, Dumfries and
Galloway Council
Partner – W&J Garbutt Agricultural Services
(e) the name of the directorship and the
nature of the applicable business.
4
Practice Nurse, North Surgery, Greencroft
Medical Centre, Annan
230
Category 1 – Remuneration
(continued)
Category 2 - Related undertakings
A description of a directorship that is not
itself remunerated, but is of a company
or undertaking which is a parent or
subsidiary of a company or undertaking
which pays remuneration.
Column 1
Registerable interest category
Column 2
Description of interest
Category 3 - Contracts
Category 4 - Houses, land and
buildings
Mr A Hannay
Nursing Auxiliary, Dumfries and Galloway
Health Board
Assistant Branch Secretary, UNISON
Scottish Council, UNISON
Labour Link, UNISON
Travel Allowance with Trade Union
Mrs P Halliday
Freelance Facilitator, Building Healthy
Communities
Mr J Beattie
Full-time Union Official, NHS Dumfries and
Galloway
Branch Secretary, UNISON
Scottish Health Committee, UNISON
Travel Allowance (UNISON)
A description of the nature and duration, Mr A Hannay
but not the price of, of a contract which is
not fully implemented where:–
(a)
goods and services are to be
provided, or works are to be executed for
the NHS; and
(b) any responsible person has a direct
interest, or an indirect interest as a
partner, owner or shareholder, director or
officer of a business or undertaking, in
such goods and services.
A description of any rights of ownership
or other interests that may be significant
to, of relevance to, or bear upon, the
work or operation of the NHS Board
5
Shareholder, Irving Housing
No Member Recorded an interest in this
category
231
Category 5 - Shares and securities
A description, but not the value, of Mr A Hannay
shares or securities in a company,
undertaking or organisation that may be
significant to, of relevance to, or bear
upon, the work or operation of the NHS
Board
6
£1 Share Irving Housing
232
Category 6 - Non-financial interests A description of such interests as may be Mr M Keggans
significant to, of relevance to, or bear
upon, the work or operation of the NHS
Board, including without prejudice to that Mr A Campbell
generality membership of or office in:–
(a) other public bodies;
(b) clubs, societies and organisations;
(c) trades unions; and
Mr I Hyslop
(d) voluntary organisations.
7
Board Member, Nith District Salmon Fishery
Board
Member, Scottish National Heritage Board
Member, Castle Douglas Rotary
Director, Solway Heritage
Director, Crichton Trust
Mr C Marriott
Past Chair of Chartered Institute of Public
Finance and Accountancy(CIPFA) Scotland
Branch
Mr A Walls
Trustee, Crichton Foundation
Member, Rotary Club of Dumfries
Member, British Medical Association
Fellow of Royal College of Surgeons of
Edinburgh and England
Mr T Sloan
Member, TGWU
Member, Scottish Labour Party
Mrs A Kelly
Member of Royal College of Nursing
Midwifery Council (NM C)
Annan Medical, Nursing and Ambulance
Committee
Mr R Allan
Member, Unison
Dr J Moore
Member, SNP
233
Category 6 - Non-financial interests
(continued)
8
Mr A Hannay
Jon Paul Jones Trust
Burns Trust
Southerness Golf Club
UNISON
Mrs L Garbutt
Chairman, Royal Burgh of Kirkcudbright
Community Council
Chairman, Kirkcudbright Swimming Pool
Ltd
Member, Stewartry Safety Forum
Treasurer, Kirkcudbright Scout Group
Member, Kirkcudbright Chamber of
Commerce
Professor D Hannay
Member of Probus (Newton Stewart)
Member of British Medical Association
Fellow of Royal College of General
Practitioners
Fellow of Faculty of Public Health
Trustee, Crichton Foundation
Mr G Willacy
Chairman of Annan Hospital League of
Friends
Member of Dumfries and Galloway
Valuation Appeals Panel
Mrs P Halliday
Chair, Wigtownshire Food Forum
Treasurer, Wigtownshire Fibromyalgia and
ME Support Group
Member, South Rhins Community Group
Mr R Allan
Director, DG Voice
Vice Chair, Dumfriesshire, Clydesdale and
Tweeddale Conservatives
Mr J Beattie
Member of UNISON
Mr A Johnston
Chair of Cheshire Centre for Independent
Living
234
Election expenses
A description of, and statement of, any Mr T Sloan
assistance towards election expenses
relating to election to the devolved public
body.
9
Labour Party paid for newspaper
advertisement
235
Agenda Item 256
6 February 2012
BOARD BRIEFING
Author:
Rachel Hinchliffe, Administrative Assistant
Date: 24 February 2012
RECOMMENDATION
The Board is asked to
• note the briefing.
SUMMARY
CONTENTS
•
•
•
•
•
•
•
•
•
•
“Awards for All” Grant for Grounds4BetterHealth
Newly Qualified Public Health Nurses
LGBT Charter Mark Award
Charity Dance for the Institute of Transplantation
Exercise Classes for Breast Cancer
Dementia Champions – 31st January 2012
Acute Services Redevelopment – Consultation on Sites
Midpark relocation of staff and Patients
Moving on
New Appointments
REGULAR FEATURES
Retirals
New from the Scottish Executive including HDLs
Freedom of Information
Current Consultations
Chief Executive’s Diary
Chairman’s Diary
Key Messages:
236
GLOSSARY OF TERMS
LGBT Lesbian, Gay, Bisexual & Transgender
“Awards for All” Grant for Grounds4BetterHealth
The Community Garden project Grounds4BetterHealth is well underway at Galloway
and Newton Stewart Hospitals.
A Funding application to Awards for All Scotland was made in the name of
Wigtownshire Health Improvement Team to cover the costs of the aforesaid works
and has recently been successful to the sum of £9,852. This grant together with a
release of funds to cover the delivery of Phase 2 via the Joint Health and Well Being
Unit means that work is now progressing successfully towards fully operational
community gardens at Galloway and Newton Stewart Hospitals by the Spring of
2012 when an Official opening will take place.
Newly Qualified Public Health Nurses
Congratulations to Maggie Moodycliffe, Josie Pennie, Rosemary Macquarrie and
Deborah Hughes who recently graduated from University of the West of Scotland as
Public Health Nurses.
LGBT Charter Mark Award
In late 2010 D&G recognised that work needed to be done to improve both access to
and experience of health services for LGBT (Lesbian, Gay, Bisexual & Transgender)
people in this region. Several Leadership discussions took place between the Chief
Executive, Medical Director, Director for Public Health and the Equality Lead to try
and determine how best to approach this task. It was agreed that the LGBT Charter
Mark would be an excellent way to both demonstrate the organisation's commitment
to this agenda, and facilitate a change in the way health services and employment
are provided to LGBT people.
The Workforce Directorate is delighted to announce that it will receive the LGBT
Charter Mark Award on Monday 30th January, the fourth area of NHSD&G to
achieve this accolade.
Charity Dance for the Institute of Transplantation
A charity dance to raise money for the Institute of Transplantation is being organised
for 4th May at Easterbrook Hall. Tickets are £15.00 per person; contact Mary
Kirkpatrick on 01387 244477 or by e-mail at mary.kirkpatrick@nhs.net to purchase
tickets by the 23rd March 2012
Exercise Classes for Breast Cancer
As part of NHS Dumfries and Galloway’s commitment to the Breakthrough breast
cancer pledged signed in 2011, exercise classes begin February at DG One for
those in recovery from the disease.
237
Dementia Champions – 31st January 2012
The Nursing Directorate presented certificates for the latest successful Dementia
Champions.
Acute Services Redevelopment – Consultation on Sites
The Acute Services Redevelopment is underway holding a series of consultation
events across Dumfries and Galloway to answer question from the public on the 5
site options for the new acute hospital.
Dates are as follows
11th January 1.30-3.30pm
DGRI Foyer
th
18 January 5-7pm
Annan Hospital
25th January 5-7pm
Galloway Community Hospital Stranraer
1st February 5-7pm
Langholm Thomas Hope Day Room
8th February 5-7pm
Dalbeattie Town Hall
15th February 5-7pm
Castle Douglas, Garden Hill Waiting Room
22nd February 5-7pm
Moffat Hospital Day Room
29th February 5-7pm
Kirkcudbright Town Hall
7th March 5-7pm
Thornhill Hospital Rehab Unit
12th March (Monday) 5-7pm
Newton Stewart Macmillan Room,Town Hall
21st March 5-7pm
Sanquhar Town Hall
28th March 5-7pm
Lockerbie Lesser Town Hall
We will also be at events in Dumfries at:
Dumfries Ice Bowl 16th January 10.30-13.30
Stakeford Community Centre 23rd January 10:30 – 13:30
Lochside Community Centre 30th January 10:30 – 13:30
Summerhill Community Centre 6th February 10:30 – 13:30
Locharbriggs Community Centre 13th February 10:30 – 13:30
Bakers Oven 20th February 10:30 – 13:30
Midpark Relocation
Patients and Staff have transferred from wards at the Crichton to the new mental
health hospital at Midpark. Staff are to be commended on a successful move and
for the smooth transition to the new facility.
Moving on
Alison Knox is set to leave to manage the Infection Control Team for Kent Primary
Care Trust. It is an excellent opportunity for her and Kent will gain a lot. Alison’s
input into estates work has been of particular note. She designed and implemented
a risk assessment for use when planning estates and maintenance work in a
healthcare setting here in Dumfries and Galloway. This has been published and
she has been invited to speak at a nationally recognised conference in England.
John Burns, former Chief Executive with NHS Dumfries and Galloway took up his
new post as Chief Executive for NHS Ayrshire and Arran from 1 February.
Julie Burns, Executive Assistant to the Chief Operating Officer. Julie has been here
for 12 years, 4 years in public health and then 8 years in this role.
238
New Appointments
Jeff Ace has been appointed the new Chief Executive for NHS Dumfries and
Galloway from February. Jeff has worked within the NHS for over twenthy years
commencing his career as a Financial Management Trainee in West Glamorgan
Health Authority in 1986. Jeff then moved to Swansea NHS Trust as Assistant
Director of Finance in 1990 before moving to the Welsh Office in 1995. In 1997 Jeff
moved to Southmead NHS Trust in Bristol as Senior Assistant Finance Director
before being appointed in 1999 to Finance Director of the then Dumfries and
Galloway Acute & Maternity Hospitals NHS Trust. Following integration in 2004,
Jeff was appointed to the post of Chief Operating Officer (formerly Director of Health
Services) within NHS Dumfries and Galloway.
Lisa Ashby who currently is working in Smoking Matters Service Admin office was
successful in being appointed to the Smoking Prevention Officers post. Lisa's role
will be working with young people in Primary, Secondary and further education as
well as having a special focus on groups and organisations who provide services for
vulnerable young people
Julie White has been appointed as the interim Chief Operating Officer for a six month
period.
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New from Scottish Executive Health Department
CMO (2011) 14: CARBON MONOXIDE (CO) POISONING: NEEDLESS DEATHS,
UNNECESSARY INJURY
CEL 27 (2011): Up-dated Adult Exceptional Aesthetic Referral Protocol (June 2011)
This letter is to provide Boards with the Adult Exceptional Aesthetic Referral
Protocol. This protocol supersedes the version distributed with CEL 30 in May 2009.
PCA (M)(2011)17: THE PRIMARY MEDICAL SERVICES
DIRECTED ENHANCED SERVICES (SCOTLAND) 2011PALLIATIVE CARE (No. 2)
This Circular provides NHS Boards and GP Practices an updated Reporting
Template to accommodate the extension of the Palliative Care DES for 2011-12.
Details of ‘active’ patients can be transferred from palliative care register for financial
year 2010-11 to the attached 2011-12 reporting template.
PCA (P)(2011) 15: PHARMACEUTICAL SERVICES
AMENDMENT TO DRUG TARIFF DISCOUNT CLAWBACK RATE PT 7 GENERIC
DRUGS
This Circular advises of the discount clawback rate in respect of reimbursement for
items listed at Pt 7 in the Scottish Drug Tariff to be introduced for dispensing from 1
December 2011 onwards.
PCA (M)(2011) 18: Fees arrangements during the Blue Badge application process
This circular has been prepared in response to particular problems over charging
issues for work carried out by GP’s either at the request of Local Authorities or at the
request of members of the general public during the Blue Badge application process.
PCS (AFC) 2011/8: Pay Deductions following Strike Action on 30 November 2011
It has been agreed between NHS Employers, Staff Side and the Scottish
Government that deductions from pay following strike action on 30 November this
year should not be actioned until the January 2012 pay run.
PCA (M) (2011) 19: GENERAL MEDICAL SERVICES STATEMENT OF FINANCIAL
ENTITLEMENTS FOR 2011/12
This circular has been prepared to clarify that use of the SCI – DC electronic foot risk
screening tool is not mandatory in relation to the above QOF indicator, but a
recommendation.
CEL 28 (2011): Review of NHSScotland Pin Policies
Board are encouraged to make use of the Dignity at Work Toolkit and Resources,
which are available from the Staff Governance website, to support implementation of
the revised Preventing and Dealing with Bullying and Harassment in NHSScotland
PIN Policy.
PCA (P)(2011) 14: 2011-12 ELECTRONIC CLAIM TRAINING PAYMENT
AMENDMENT TO CLAIM DEADLINE
This circular advises of an extension to the deadline for reimbursement of claims for
the 2011-12 Electronic Claim Training Payment.
CMO (2011) 15: CHANGES TO THE NEWBORN BLOOD SPOT SCREENING
PROGRAMME
CEL 30 (2011): Ensuring the seamless delivery and reporting of Diagnostic Tests in
order to support achievement the 18 Weeks Referral to Treatment Standard
This letter is to provide Boards with the Diagnostics Task and Finish Group’s Report
and commend action in the key areas detailed below.
CMO (2011) 16: Extension of Emergency Care Summary (ECS) Access to
Scheduled Care Settings in Support of Medicines Reconciliation
The purpose of this letter is to inform you that NHS Boards and GPs have agreed a
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change to access arrangements to ECS so that it supports medicines reconciliation
in scheduled care settings, and that Scottish Government supports this decision.
CEL 32 (2011): REVISED WORKFORCE PLANNING GUIDANCE 2011
CEL 31 (2011): Annual Leave Policy
HDL(2006)49 set out guidelines agreed in partnership by the Scottish Terms and
Conditions Committee (STAC) for the implementation of the Annual Leave policy
contained within the Agenda for Change Agreement. These provisions became
effective from 1 October 2004. The Annex to this letter refreshes that guidance with
the addition of a section covering the carry over of Annual Leave for staff on long
term sick leave (paragraphs 39 and 40). Redundant sections of the previous
guidance have also been removed as part of the updating exercise.
PCA (M) (2011) 20: THE NATIONAL HEALTH SERVICE (PRIMARY MEDICAL
SERVICES PERFORMERS LISTS) (SCOTLAND) AMENDMENT REGULATIONS
2011
This circular introduces amendments to the National Health Service (Primary
Medical Services Performers Lists) (Scotland) Regulations 2004 (‘the 2004
Regulations’) to allow for disclosure checks, the suspension of a performer and to
permit a ‘lead’ Board to carry out pre-listing suitability checks. The above
Regulations come into force on 21 December 2011.
PCA (P)(2011) 16: Pharmaceutical Services: Amendment to Annex A:
Discount Clawback Scale for Proprietary Drugs.
This Circular advises of an amendment to the Drug Tariff Annex A concerning the
discount clawback rate to apply in respect of reimbursement of proprietary drugs with
effect from 1 January 2012
PCA (M)(2011) 21: GENERAL MEDICAL SERVICES STATEMENT OF FINANCIAL
ENTITLEMENTS FOR 2011/12
This circular has been prepared to clarify the use of exception reporting rules
regarding ‘did not attend’ (DNA) letters for the additional services cervical screening
indicators.
PCA (O)(2012) 1: CLARIFICATION OF GENERAL OPHTHALMIC SERVICES
PROCEDURES
The Memorandum to this letter provides advice and clarification on a number of
issues regarding NHS eye examinations and the issue of optical vouchers.
PCA (P)(2012) 1/PC A(M)(2012) 1: SEASONAL INFLUENZA IMMUNISATION 201213:VACCINE SUPPLY ARRANGEMENTS
The arrangements for the provision of vaccine for the 2011-12 season have been
deemed to be successful and have been achieved as a result of all interested parties
co-operating to enable vaccine orders to be placed at an early date.
CNO (2012) 1: National Infection Prevention and Control Manual for NHSScotland –
Chapter 1: Standard Infection Control Precautions (SICPs) Policy
All Boards must have a SICPs policy in their Infection Prevention and Control
Manual. The aim of introducing this revised HPS SICPs policy is to ensure all Boards
have access to current evidenced based SICPs that inform care processes and
facilitate consistency.
CEL 1 (2012): Health Promoting Health Service: Action in Hospital Settings
This CEL is an early product of the Improving Population Health Action Group which
supports the Effective Ambition and the Efficiency and Productivity – Preventative
and Early Intervention workstream.
PCA (M) (2012) 2: PRIMARY MEDICAL SERVICES: SCOTTISH ENHANCED
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SERVICES PROGRAMME (SESP): 2012-13
This circular is to advise, subject to Parliamentary approval of the Draft Budget 201213, funding arrangements for the continuation of the Scottish Enhanced Services
Programme for 2012-13. It also provides revised guidance on the use of that
funding.
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Freedom of Information – November & December 2011
50 requests were submitted in November (total – 32) and December (total 18). 12 were submitted outwith the 20 day requirement. All were acknowledged
within 3 working days. To date 9 remain open.
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Description
Staff information
1. How much did your health board spend on communications and marketing (including advertising and PR),
including all staff costs, in the following years: a) 2008/09 b) 2009/10 c) 2010/11 2. For 2010/11 only, how much
did your health board spend on media and communications staff (please list how many staff were employed FTE,
what their job titles were and their salaries)? 3. For 2010/11 only, please provide the job titles and salaries of all
executive board members. 4. For 2010/11 only, please provide the job titles and salaries of all remaining staff
with the word “director” in their job title.
1. Number of employees in your organisation 2. Number of employees using the childcare voucher scheme 3.
Current childcare voucher scheme provider 4. Current service charge of your childcare voucher scheme 5.
Renewal date for childcare voucher scheme contract (if applicable) 6. Will Dumfries and Galloway NHS Board go
through a tender process when renewing the contract to choose a voucher provider? 7. Do you use a framework
agreement to choose your childcare voucher provider? 8. If yes, can you please supply me with the name of the
framework agreement?
Please can you provide me with data, under the Freedom of Information Act, for the % of invoices paid by your
health board to businesses that are settled within 10 days, in each of the last 5 years?
Closed
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Band 7 and above managers & staff employed by the Trust – actual details of individuals; Title, First Name, Last
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Name, Job Title, Department, Specialty (if applicable) of the above individuals
What is the number of new born babies re-admitted to hospital after they had been discharged following birth in
02/12/11
each of the last four financial years? How many beds have been available specifically for use by new mothers and
expectant mothers in the last four financial years?
Can you tell me how many Newly Qualified Nurses who completed their courses in the summer of 2011 your
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health board has employed this year? Can you also supply the answer to for the year 2010 and the year 2009?
The number of bodies in refrigeration store in mortuaries under the authority's control, which have been there for
01/12/11
more than one week, with the following additional information for each. a) Gender b) Age (or approx if unknown)
c) Ethnicity d) Length of time in storage (including a date when the body was initially put into storage) e) Reason
for still being in storage f) Location of storage (by Mortuary) g) Name of deceased (if known)
I would-be obliged if you will under the terms of the Freedom of Information Act, please furnish us with the
06/12/11
following information with regard to Dumfries & Galloway NHS Trust's contract with the operator of the Facility
known as "Allanbank Nursing Home", Bankend Road, Dumfries. The Owner and Operator of the facility. The
length or duration of the current contractual agreement between the "Operator" and NHS Dumfries & Galloway, its
scope in terms of the numbers of beds currently contracted to NHS Dumfries & Galloway and which are paid for
by D &G NHS funds. The date at which the current contractual agreement between the operator and NHS D&G
ends. The overall patient numbers receiving care at Allanbank by use of Dumfries & Galloway NHS funded beds,
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per year, for the last five years. The bed occupancy numbers On a monthly basis, of NHS funded beds over the
past five years at Allanbank. Please provide details by medical or clinical condition of the patients using these
beds.
I would like to make a request for information regarding Diabetes documentation at NHS Dumfries and Galloway.
Patient Care Pathways relating to Diabetes; Treatment Protocols relating to Diabetes; Clinical Guidelines relating
to Diabetes
Waiting times and lists What were and are the Speech and Language Therapy waiting times for an initial
assessment for the following groups: What are the Speech and Language Therapy waiting times for intervention
following an initial assessment for the following groups: What were and are the number of people on waiting lists
for an initial Speech and Language Therapy assessment for the following groups: What were and are the number
of people on the waiting list for Speech and Language Therapy intervention following an assessment: In 2012 do you anticipate changes to waiting times for assessment - Yes or No? If yes – do you think they will increase –
Yes or No? In 2012 - do you anticipate changes to waiting times for intervention - Yes or No? If yes – do you think
they will increase/decrease? In 2012 - do anticipate changes to waiting lists for assessment - Yes or No? If yes –
do you think they will increase/decrease? In 2012 - do anticipate changes to waiting lists for intervention - Yes or
No? If yes – do you think they will increase/decrease? Annual budgets What is the current health board annual
budget of your Speech and Language Therapy department for (a) 2010/11 (b) 2011/12 and (c) the projected
budget for 2012/13? What was the received income from education authority/ies or other agencies for Speech
and Language provision for (a) 2010/11 (b) 2011/12 and (c) the projected budget for 2012/13? Workforce Whole
Time Equivalent HPC registered Speech and Language Therapy Staff a) posts cancelled or unfilled b) posts filled
overall for (c), (d), (e), (f) and (g) care groups. Whole Time Equivalent non -HPC registered Speech and
Language Therapy Staff compliment a) overall and b) for the following care groups
Salary and Banding Information
Copies of all health and safety inspections carried out in hospital kitchens within the health board between Nov 1
2010 and Nov 1 2011.
How many patients in your health board area were on a methadone maintenance programme in 2007/8? 2008/9?
2009/10? 2010/11? 2011/12? Can you give a breakdown of the length of time these people had been on a
methadone maintenance programme (ie lowest amount in years/highest amount in years)?
I was wondering in your NHS area in the last year how many babies are put on the child protection register before
they are even born? Essentially the number of pregnant women in your area whose unborn baby is on the
register. I'd like the yearly figures to be the newest you have whether that's September 2010 to sep 2011 just the
latest calendar year. Also if there's a reason given for making that decision for them to be put on the register,
can I also have that? Doesn't need to be in great detail. Perhaps tallied up. For example 32 were put on the
register because they were at risk of being exposed to drug abuse.
I would like the information to cover the last three years and be broken down by year I would like to know how
many individual members of staff have received bonuses during this period I would like to know the total amount
of money which was paid out in bonuses to staff during this period. I would to know the range of monetary value
of the bonuses paid out from the highest bonus aid out to the lowest.
What is the name of your Health Board? What is the population of your area? Do you have or commission
specialist secondary care ME/CFS services for ME/CFS patients? If yes are these patients referred to local
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specialist service providers or to specialist service providers out of your area If not what services are ME/CFS
patients referred to? Yes/No Do you commission domiciliary services for ME/CFS patients? For how many of
these patients each year? Yes/No For each of the years 2008/09, 2009/10, 2010/11, how many referrals were
made to the specialist ME/CFS services (a) for adults and (b) for children, living in your area? (a)08/09: (a)09/10:
(a)10/11: (b)08/09: (b)09/10: (b)10/11: What is the budgeted funding for ME/CFS services (a) for adults and (b)
for children in 2011/12? What amount was spent on ME/CFS services (a) for adults and (b) for children, for
each of the years 2008/09, 2009/10, 2010/11? (a)08/09: (a)09/10: (a)10/11: (b)08/09: (b)09/10: (b)10/11: Do you
plan to maintain the levels of funding for these services in the longer term or to increase/decrease financial
provision? For each of the years 2008/09, 2009/10, 2010/11, how many referrals were made to Multiple
sclerosis services (a) for adults and (b) for children living in your area? (a)08/09: (a)09/10: (a)10/11: (b)08/09:
(b)09/10: (b)10/11: What amount was spent on Multiple Sclerosis services (a) for adults and (b) for children for
each of the years 2008/09, 2009/10, 2010/11? (a)08/09: (a)09/10: (a)10/11: (b)08/09: (b)09/10: (b)10/11: What is
the budgeted funding for Multiple Sclerosis services (a) for adults and (b) for children in 2011/12? For each of
the years 2008/09, 2009/10, 2010/11, how many referrals were made to Ataxia services (a) for adults and (b) for
children living in your area? (a)08/09: (a)09/10: (a)10/11: (b)08/09: (b)09/10: (b)10/11: What amount was spent
on Ataxia services (a) for adults and (b) for children for each of the years 2008/09, 2009/10, 2010/11? (a)08/09:
(a)09/10: (a)10/11: (b)08/09: (b)09/10: (b)10/11: What is the budgeted funding for Ataxia services (a) for adults
and (b) for children in 2011/12? For each of the years 2008/09, 2009/10, 2010/11, how many referrals were
made to Parkinson’s services (a) for adults and (b) for children living in your area? (a)08/09: (a)09/10: (a)10/11:
(b)08/09: (b)09/10: (b)10/11: What amount was spent on Parkinson’s (a) for adults and (b) for children for each
of the years 2008/09, 2009/10, 2010/11? (a)08/09: (a)09/10: (a)10/11: (b)08/09: (b)09/10: (b)10/11: What is the
budgeted funding for Parkinson’s services (a) for adults and (b) for children 2011/12? What is your best
estimate in your area of the prevalence of ME/CFS (a) for adults and (b) for children? What is your best
estimate in your area of the prevalence of Multiple Sclerosis (a) for adults and (b) for children? What is your
best estimate in your area of the prevalence of Parkinson’s (a) for adults and (b) for children? What is your best
estimate in your area of the prevalence of Ataxia (a) for adults and (b) for children?
I would like to request a full list of all sub-contractors (with contact details) involved on the construction of the
Midpark field health facility Bankend road Dumfries that are/have been working under the main contractor laing
o’rourke on the development.
Compromise agreements
Trust spend (known and estimated) on Medical Locums Trust total spend (known and estimated) on agency
workers Details of any Trust e-rostering software under licence used to manage agency or substantive workers
Confirmation of which categories of spend the Trust has a staff bank for Confirmation of whether the Trust has
any managed service or master vendor arrangement in any category of agency worker spend and particularly
with regards to medical locums Full details of the commercial arrangement including any gainshare, direct
payments or other payments and / or the current and planned operational model(s) in any category of agency
worker spend and particularly with regards to medical locums Details of what procurement basis, i.e the
methodology or justification used to procure and appoint such a third party to a managed service or master
vendor position in accordance with the Public Contract Regulations 2006 The defined objective(s) from the
revised procurement strategy where such a master vendor or managed service has been put in place
Confirmation of which medical locum suppliers are your tier one and tier two suppliers
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In the past three years how many patients resident within your NHS Board area have been diagnosed with a)
breast cancer, b) lung cancer or c) oral cancer ,and during that period how many patients sadly passed away as a
result of suffering from each of the said illnesses.
I wish to make a request, under Freedom of Information legislation, regarding the numbers of people who have
a diagnosis or co-diagnosis of autism, Asperger's Syndrome or Autistic Spectrum Disorder within the mental
health system in the Dumfries and Galloway Health Board area. To be precise, I would like these statistics for
the month of March 2011. If it would help to collate these statistics by focussing on the day of the Census
(Sunday 27th March), that would be acceptable to me. The categories that I seek statistics for are:INPATIENTS - A mental health diagnosis or co-diagnosis, such as schizophrenia or psychosis, is assumed for
all inpatients - please give separate figures if there are any cases where this does not apply. Total number of
inpatients in mental health hospitals Total number of inpatients with a diagnosis or co-diagnosis of Learning
Disability Total number of inpatients with a Learning Disability diagnosis or co-diagnosis who are also diagnosed
with Autism, Asperger's Syndrome or Autistic Spectrum Disorder Total number of inpatients with a diagnosis or
co-diagnosis of autism, Aspergers' Syndrome or Autistic Spectrum Disorder Within all of these categories, a
breakdown of the numbers of these inpatients who are under 18 years old OUTPATIENTS - Please give
separate figures in cases where a mental health diagnosis or co-diagnosis, such as schizophrenia or psychosis,
does not apply. Total number of outpatients in mental health system Total number of outpatients with a diagnosis
or co-diagnosis of Learning Disability Total number of outpatients with a Learning Disability diagnosis or codiagnosis who are also diagnosed with Autism, Asperger's Syndrome or Autistic Spectrum Disorder Total
number of outpatients with a diagnosis or co-diagnosis of autism, Aspergers' Syndrome or Autistic Spectrum
Disorder Within all of these categories, a breakdown of the numbers of these outpatients who are under 18
years old
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Request 1: Please confirm or deny whether the Health Board has undertaken an assessment of the provision of
physiotherapy services in its region. If confirmed Please provide details and findings of any assessment for i)
adult and ii) paediatric physiotherapy services. Request 2: Please confirm or deny if the Health Board has
undertaken an assessment of the outcomes delivered by physiotherapy services in its locality. If confirmed
Please provide details and findings of any assessment for i) adult and ii) paediatric services. Request 3: Please
provide details of the number of referrals made in a) primary care, b) outpatient secondary care and c) inpatient
secondary care for adult patients to physiotherapy services for the following financial years: i) 2008/09, ii)2009/10,
iii) 2010/11 and iv) 2011/12. Request 4: Please provide details of the number of referrals made in a) primary
care, b) outpatient secondary care and c) inpatient secondary care for paediatric patients to physiotherapy
services for the following financial years: i) 2008/09, ii) 2009/10, iii) 2010/11 and iv) 2011/12. Request 5: Please
provide details of the number of referrals made to musculoskeletal (MSK) physiotherapy for the following financial
years: i) 2008/09, ii) 2009/10, iii) 2010/11 and iv) 2011/12. Request 6: Please confirm or deny whether the Health
Board or Service Managers measures waiting times for MSK physiotherapy from referral to first outpatient
appointment. If confirmed: Please provide details of the maximum waiting time for a) adult and b) paediatric
appointments. Please provide details of the average waiting time for a) adult and b) paediatric appointments.
Please provide details of how many people are currently on a waiting list for a) adult and b) paediatric
physiotherapy appointments. Request 7: Please confirm or deny whether the Health Board has any referral
management schemes for physiotherapy services. If confirmed Please provide details of these schemes for i)
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adult and ii) paediatric services. Please confirm or deny if health professionals are incentivised through any
referral management scheme for physiotherapy services in the health board region. Request 8: Please provide
details of the Health Board a) budget and b) spend for adult physiotherapy services in primary care for the
following financial years: i) 2008/09, ii) 2009/10, iii) 2010/11, iv) 2011/12 and v) 2012/13. Request 9: Please
provide details of the Health Board a) budget and b) spend for paediatric physiotherapy services in primary care
for the following financial years: i) 2008/09, ii) 2009/10, iii) 2010/11, iv) 2011/12 and v) 2012/13. Request 10:
Please provide details of the Health Board a) budget and b) spend for adult physiotherapy services in secondary
care for the following financial years: i) 2008/09, ii) 2009/10, iii) 2010/11, iv) 2011/12 and v) 2012/13. Request 11:
Please provide details of the Health Board a) budget and b) spend for paediatric physiotherapy services in
secondary care for the following financial years: i) 2008/09 ii) 2009/10, iii) 2010/11, iv) 2011/12 and v) 2012/13.
Request 12: Please confirm or deny whether the Health Board has found any efficiency savings physiotherapy
services over the following financial years: i) 2008/09, ii) 2009/10, iii) 2010/11 and iv) 2011/12. If confirmed:
Please provide details of these savings for adult physiotherapy services in each of the financial years in question.
Please provide details of these savings for paediatric physiotherapy services in each of the financial years in
question. Request 13: Please confirm or deny whether the Health Board has changed the level of physiotherapy
service provision for patients in each of the financial years: i) 2008/09 ii) 2009/10, iii) 2010/11 and iv) 2011/12. If
confirmed: Please provide details of the change in provision for adult physiotherapy services. Please provide
details of the change in provision for paediatric physiotherapy services. Request 14: Please confirm whether the
Health Board has made any assessment of the average number of outpatient physiotherapy treatment sessions
provided to patients in each of the financial years: i) 2008/09, ii) 2009/10, iii) 2010/11 and iv)2011/12. If
confirmed: Please provide details of the average number of treatments provided to adult patients for each of the
financial years in question. Please provide details of the average number of treatments provided to paediatric
patients for each of the financial years in question. Please provide details of the average number of treatments
provided to adult patients with MSK conditions for each of the financial years in question. Request 15: Please
confirm whether the Health Board has ceased offering physiotherapy services to a) any patient groups or b) for
any conditions in each of the financial years: i) 2008/09, ii) 2009/10, iii) 2010/11 and iv)2011/12. If confirmed:
Please provide details of the patient groups or conditions for which physiotherapy is no longer offered. Request
16: Please provide details of the staffing numbers for for adult MSK physiotherapy. Please confirm: What is the
funded whole time equivalent (WTE) establishment for MSK physiotherapy services in each of the financial years
i) 2009/10 ii) 2010/11 iii) 2011/12? What is the current WTE establishment for MSK physiotherapy services? If
there is a difference between the current establishment and the funded establishment, please provide details of
the number of funded WTE posts vacant due to i) sick leave, ii) unfilled posts, iii) maternity leave and iv) other
[please state]?
1) How many recorded thefts of medical equipment from hospitals in your board’s area have taken place in the
last three years? 2) Specifically, how many incidents of thefts of nitrous oxide (laughing gas), used for medical
purposes, have taken place in the last three years? 3) The dates, times and locations of these incidents, and
details of the equipment stolen, along with the amount stolen (ie how many canisters were taken)? 4) Whether
the property was recovered? 5) The cost of property lost in each theft?
I am seeking information on patients from English NHS Trust Areas offered and receiving treatment at NHS
Dumfries and Galloway. This should be regarded as a Freedom of Information request ; I am seeking: ; 1) the
number of patients from England who have received treatment within NHS Dumfries and Galloway, broken down
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by home NHS Trust, for each of the most recent 12 months for which data is available, broken down whether the
treatment was ; Accident and Emergency ; Admission as day case ; Elective admission ; Non-elective admission ;
Outpatient first attendance ; Outpatient subsequent attendance
Other
1. The Director of Communications 2. The Head of Communications 3. The Director of Estates, or the Assistant /
Associate / Deputy Director of Estates 4. The Director of Facilities, or the Assistant / Associate / Deputy Director
of Facilities 5. The most senior person responsible for Occupational Therapy 6. The most senior person
responsible for the Trust's 18 Weeks Performance, where applicable 7. The Director of HR or Workforce or
Organisational Development 8. The Deputy Director of HR or Workforce or Organisational Development 9. The
Assistant Director of HR or Workforce or Organisational Development 10. The Associate Director of HR or
Workforce or Organisational Development
Business 1. Any and all assessments conducted within or for your Board, since 01 April 2011, identifying risks related to
any of the following : (i) the potential need for a licence from The Copyright Licensing Agency Limited ('CLA'); (ii)
copyright infringement; and (iii) reproducing (e.g. photocopying or scanning), or accessing electronically, third
party copyright protected material from books, journals, magazines or periodicals. 2. Any and all emails sent in
response to, or accompanying, such assessments including copies of any and all attachments.
Academic 1. The complete financial monthly monitoring return (MMR) submitted by NHS Dumfries & Galloway to the
Scottish Government for the 3 month period to June 2011. 2. The complete financial monthly monitoring return
(MMR) submitted by NHS Dumfries & Galloway to the Scottish Government for the 6 month period to
September 2011. The financial performance monitoring returns are in the form of an 11 page excel spreadsheet
template set by the Scottish Government. The complete submissions contain the following tabs: Outturn
Statement, I&E Analysis, Balance Sheet, Cash Flow, Memorandum, Savings, Capital Investment, PMS, Dental
and Ophthalmic, RRL analysis and Anticipated Allocations CRL. 3. The final NHS Dumfries & Galloway full
Workforce Plan for 2011-12 as agreed with Scottish Government or, where not agreed, the most up-to-date draft
(with the status of the paper indicated), including all appendices
Political
I am seeking information on patients from English NHS Trust Areas offered and receiving treatment at NHS
Dumfries and Galloway. This should be regarded as a Freedom of Information request ; I am seeking: ; 1) the
number of patients from England who have received treatment within NHS Dumfries and Galloway, broken down
by home NHS Trust, for each of the most recent 12 months for which data is available, broken down whether the
treatment was ; Accident and Emergency ; Admission as day case ; Elective admission ; Non-elective admission ;
Outpatient first attendance ; Outpatient subsequent attendance
Business
1. How many non formulary requests for medicines accepted by SMC but not yet on formulary did your NHS
board receive in 2009/2010? 2. How many non formulary requests for medicines accepted by SMC but
not yet on formulary did your NHS board receive in 20010/2011? 3. How many of these non formulary
requests received by your NHS board were approved in 2009/2010? 4. How many of these non formulary
requests received by your NHS board were approved in 2010/2011? 5. What guidelines are set out by
your NHS Board for the time that can be taken between a clinician making a non formulary request and a
response being made 6. What has been the shortest and longest time that it has taken for a clinician to be
given a response to his or her formulary request 7. Please supply the guidance on non formulary requests
issued to clinicians by your NHS Board.
2.
Business QP7: The practice participates in an external peer review with a group of practices to compare its secondary care
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outpatient referral data either with practices in the group of practices or with practices in the PCO area and
proposes areas for commissioning or service design improvements to the PCO. QP11: The practice engages
with the development of and follows 3 agreed care pathways in the management and treatment of patients in
aiming to avoid emergency admissions Please complete the table below with the details are requested and attach
the relevant plans. Name of Practice or NHS number QP7 – Service Redesign Priorities x 3 QP11- Emergency
Admission x 3
A list of all new pharmacy applications within the last 7 months up until todays date 30/11/2011 including 1.the
date of application 2.the decision of the pharmacy practices committee 3.whether an appeal was lodged and
4.the decision of the national appeals panel.
I write to ask a) Does your Board have in place a current Oral Health Strategy and/or Action Plan? if the answer is
no, b) has your NHS Board ever had in place a Oral Health Strategy and/or Action Plan. Secondly, how much
funding has been provided each year over the past five years in order to highlight the dangers of poor oral
hygiene as well as informing the population that the level of alcohol consumption, smoking and poor diet, has on
the development and increase of Oral Cancer within the Scottish population and the fact that more younger
people are apparently contracting oral cancer than had been the case in the recent past. Finally, how much of
the budget for Community Health and Care Partnerships within your Board area has been devoted directly to oral
hygiene/oral cancer issues.
Please could you supply the following information:*Referral Pathways / Care Pathways / Prescribing Guidelines
for Anaphylaxis *Referral Pathways / Care Pathways / Prescribing Guidelines for Allergic Rhinitis I would also
like to request: Diabetes Service Specifications / Service Level Agreements (SLAs)
I would like to know the average amount of all surgical procedures per Hospital per year. It can be also the
amount of those per month. And also if its possible more detail information like for example extra amount of
cardio surgery or general surgery or urology.
I would like the information to cover the last three years and to be broken down by year. I would like to know the
aggregated salary costs to the organisation associated with elected trades union representatives given facility
time, whereby they devote all of their time to the duties of their respective unions. I would like to know the
numbers (full time equivalent) of elected union representatives working on 100% facility time within the
organisation.
For the period 01 December 2010 to 30 November 2011:please confirm the number of patients, in your Health
Board area, who have been subject to detention in terms of the Mental Health (Care & Treatment) (Scotland) Act
2003 and have received care & treatment within a locked psychiatric-facility within your Health Board’s area of
responsibility.
1) How many patients do you have with the following conditions? Breast cancer (any type) Prostate cancer
Myeloma Renal cancer Lung cancer 2) What proportion of these have metastatic (advanced) disease? If
convenient please fill in the table below. If data cannot be provided for all fields, please complete as much as
possible. Condition Number of Patients Proportion that have metastatic (advanced) disease Breast cancer (any
type) Prostate cancer Myeloma Renal cancer Lung cancer 3) For any of the below listed conditions,
please supply the number of patients receiving a bisphosphonate (e.g. pamidronate, clodronate, ibandronate,
zoledronic acid), or denosumab : Breast cancer (any type) Prostate cancer Myeloma Renal cancer Lung
cancer Tumour Induced Hypercalcaemia (Hypercalcaemia of malignancy) If convenient please fill in the table
below. If data cannot be provided for all fields, please complete as much as possible. Condition Treatment
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Business
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Breast cancer (any type) Prostate cancer Myeloma Renal cancer Lung cancer Pamidronate Clodronate
Ibandronate Zoledronic acid Denosumab
Number of patients receiving examestane in total Number of patients receiving examestane for the following
descriptions: Early breast cancer (e.g. adjuvant treatment following 2-3 years of tamoxifen)Advanced breast
cancer following progression on tamoxifen)Advanced breast cancer following progression on a non-steroidal
aromatase inhibitor (i.e. anastrozole or letrozole If convenient please fill in the table below. If data cannot be
provided for all fields, please complete as much as possible. If it is not possible to split as described in the table,
please supply a total figure for examestane. Receiving Examestane, and: Patient Type Number of patients Early
breast cancer (e.g. adjuvant treatment following 2-3 years of tamoxifen) Advanced breast cancer following
progression on tamoxifen) Advanced breast cancer following progression on a non-steroidal aromatase inhibitor
(i.e. anastrozole or letrozole Number of patients receiving fulvustrant for the following descriptions: Advanced
breast cancer following progression on a non-steroidal aromatase inhibitor (i.e. anastrozole or letrozole)
Advanced breast cancer following progression on exemestaneAdvanced breast cancer following progression on
tamoxifen If convenient please fill in the table below. If data cannot be provided for all fields, please complete as
much as possible. If it is not possible to split as described in the table, please supply a total figure for Fulvastrant.
Patient Type Number of patients Advanced breast cancer following progression on a non-steroidal aromatase
inhibitor (i.e. anastrozole or letrozole) Advanced breast cancer following progression on exemestane Advanced
breast cancer following progression on tamoxifen
Please supply the unit purchasing price paid by the hospital trust (ie not tariff price) for the following drugs:
Drug/Unit Price Paid Pamidronate 90mg Clodronate 1600mg Ibandronate 50mg Zoledronic acid 4mg Denosumab
120mg
We've recently been trying to collect different trusts transactions on expenditures over £25,000 and have been
unable to locate yours on your website. I have created a short form to enable you to understand what information
we would like from you , any further questions don't hesitate to contact me via email.
Could you please send me the forename, surname and email address of, where in post: The Head of Workforce
Intelligence or Information; The Workforce Information Manager; The Head of Public Health Analysis
Can you tell me how many times in the last year restraints have been used on people suffering from dementia on
wards that care for dementia sufferers? Can you tell me what these restraints were? Were they mechanical,
chemical or physical? For example cot-sides used to keep a patient in their bed would be a physical restraint.
Sedatives would be chemical. Can you tell me in these instances, how often the restraints were reviewed? You
do not need to supply details relating to doors being locked. Can you also supply answers to the above questions
for the years 2008, 2009 and 2010.
How many privately owned and run and how many local authority owned and run, nursing and care homes do
you have in the PCT/PCO? How many residents are in these type of establishments? What proportion of these
people are diabetic? For these people with diabetes requiring insulin/GLP1 injections, what proportion receive this
from a visiting District or Community Nurse? Do any of these facilities have resident Health Care
Professionals/Workers whose role it is to perform this function? How many people with diabetes are visited by a
District or Community Nurse in their own home, to receive an insulin/GLP1 injection? What other type of facilities
do you have in the PCT/PCO where a Health Care Professional/Worker is giving an insulin/GLP1injection? e.g.
Prison, Police Custody Suite, etc On average, how many times a day, will a District or Community Nurse visit any
patient with diabetes to give an injection? e.g. 2 times per day? As a PCT/PCO, are you aware of the EU
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Directive on Needlestick Injuries that will become law in 2013? Do you keep a record of the number of NSIs
experienced by Health Care Professionals/Workers, in the community? e.g. Exposure for District, Community,
Practice Nurses; Community Matrons or others? Who collects these figures and what is the current incidence
level if known? Who is/will be responsible for ensuring new legislation is executed in your PCT/PCO?
Please can you provide me with further information on the supply of agency Staff to your trust/authority. Please
could you advise on the agency/locum spend for the following categories during the following time periods:
Categories: All Allied Health Professions (AHP) All Health Science Services (HSS) Radiography / Medical
Imaging Physiotherapy Pathology Pharmacy Mortuary Nursing Medical Locums (Doctors) Time periods:
2006 (1st Jan-31st Dec) 2007 (1st Jan-31st Dec) 2008 (1st Jan-31st Dec) 2009 (1st Jan-31st Dec) 2010 (Q1 –
1st Jan – 31st March) 2010 (Q2 – 1st April – 30th June) 2010 (Q3 – 1st July – 30th September) 2010 (Q4 – 1st
October – 31st December) 2011 (Q1 – 1st Jan – 31st March) 2011 (Q2 – 1st April – 30th June) 2011 (Q3 – 1st
July – 30th September)
the number of 1.drug and 2.alcohol addicts whom the health board has referred to a residential treatment
programme for each of the last five financial years: 2010/11; 2009/10; 2008/09; 2007/08 and 2006/07.
1. Does the PCO commission memory services for dementia? 2. Please provide the name and address of each of
the memory services commissioned by the PCO in each of the years 2009/10, 2010/11 and 2011/12. 3. Does the
PCO plan to stop commissioning any of its memory services in the foreseeable future? 4. How much did the PCO
spend on memory services in each of 2009/10 and 2010/11? What has the PCO budgeted to spend on memory
services in each of 2011/12 and 2012/13? 5. How many people (unique users) have used the memory services in
the PCO’s area in each of 2009/10, 2010/11 and the financial year to date (April-Dec 2011)? 6. Are any of the
PCO's memory services accredited by the Royal College of Physicians? If so, which are/aren’t? 7. How many
people (unique patients) in the PCO’s area underwent at least one scan (such as MRI, CT or SPECT) to
investigate symptoms of dementia in each of 2009/10 and 2010/11?
How many mental health beds did NHS Dumfries and Galloway have in total in each of the following years:
2006-7; 2007-8, 2008-9; 2009-10; 2010-11 How many inpatient psychiatric units did NHS Dumfries and Galloway
have in each of the following years, including the names of the units: 2006-7; 2007-8, 2008-9; 2009-10; 2010-11
1. The annual figures for the financial year 2010/11 2. The monthly figure for the current financial year from 1
April 2011 to 31 October 2011
1) Number of hospital consultants employed by the board 2) Average number of contracted programmed
activities a week for consultants employed by the board 3) Average number of direct clinical care (DCC)
programmed activities a week for consultants employed by the board 4) Average number of supporting
programmed activities (SPAs) a week for consultants employed by the board 5) Number of new consultant
appointments in the past 12 months (20 Dec 2010 - 20 Dec 2011) 6) Direct clinical care programmed activities
and supporting programmed activities split for consultants appointed in the past 12 months 7) Number of new
consultants appointed on a 9:1 clinical programmed activities: supporting programmed activities contract (also
sometimes known as a 90% contract) in the past 12 months 8) Number of new consultants appointed on 9:1
contracts who are within three years of receiving their certificate of completion of training (CCT)
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Freedom of Information Requests – November/December 2011
A total of 50 requests were received, with 32 submitted in November and 18 in December.
Below reflects the directorate responsible for providing response – with the majority being
issued to acute services.
The media and other submitted the largest number of request – other being recorded as
such due to requester’s detail being limited to name only.
Topics over the two months include:
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Babies put on the child protection register
Contact details for band 7 and above posts
Staff information
Communications spend
Employee numbers
% invoices settled
Babies readmitted after discharge
Childcare vouchers
Newly qualified nurses
Unclaimed bodies kept NHS premises
Details on Allanbank
Salary and banding information
Patients on methadone
Health and safety kitchen inspections
Patients with ME/CFS
Subcontractors for Midpark
Compromise agreements
Number of Aspergers sufferers
Physiotherapy assessment
Monthly monitoring reports
Numbers of DG residents treated at English and Welsh Trusts
Numbers of English or Welsh patients receiving treatment in NHS D&G
Care pathways
Surgical procedures
Trade union representative’s salary costs
Locked psychiatric wards
Cancer patients
Drug unit price
Expenditure over £25K
Restraints for dementia patients
Privately owned nursing and care homes
Staff locum spend
Drug and alcohol addicts
Memory services
Mental health beds
Number of hospital consultants
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Freedom of Information 2011
In total 339 were received for the calendar year 2011, fractionally down on the previous year.
159 (47%) were submitted outwith the 20 working days, all were acknowledged within 3
working days. The majority of requests were forwarded to the Chief Operating Officer/Health
Services to provide a response with a total of 30%, closely followed by the Medical
Directorate with 28%. The majority of requests were from media representatives with a total
of 42%, followed by political parties with 18%
254
Current Consultations
From
Topic
Scottish Government
Mental Health Strategy for Scotland
Response
due by
31/01/12
SPPA
The National Health Service Superannuation Scheme Scotland
03/02/12
Scottish Government
Redeployment within NHSScotland
13/02/12
COSLA
Service Specification for Permanent Placements in Care Homes
17/02/12
Scottish Government
The Children’s Hearings (Scotland) Act 2011
23/02/12
Scottish Government
Proposals for a Freedom of Information (Amendments) (Scotland) Bill
08/03/12
Scottish Government
The Management of HIV-infected Healthcare Workers in Scotland
09/03/12
255
Chief Executive’s Diary
Key Events
February
6
NHS Board
7
BMG
8
Scrutiny Committee
15 Board Chief Executives Meeting - Edinbrugh
16 APF
20 MSN for Children and Young People with
Cancer
21 BMG
22 SPSP Boards on Board event
24 Annual Performance Review - Mental Health
27 Annual Performance Review - P&CCD West
28 Annual Performance Review - Operational
Services
28 Annual Performance Review - Acute
Services
Chairman’s Diary
Key Events
February
6
NHS Board
8
Scrutiny Committee
16 Consultant Neurologist Interviews
20 NHS Chairs' Meeting - Edinburgh
Chief Executive Appointments to Regional and National Groups
Member of Children and Young People’s Cancer MSN
Facilities Shared Services Programme Board
256
MONITORING FORM
None
None
None
Consultation
None
Consultation
Committees
with
Professional None. However, Briefing is populated with items of
interest provided by any member of staff.
Risk Assessment
Not applicable
Best Value
Not applicable
Sustainability
Not applicable
Compliance with Corporate Objectives
Single Outcome Agreement (SOA)
3
Not applicable
Impact Assessment
Not applicable.
257
Agenda Item 259
6 February 2012
Dumfries and Galloway Alcohol and Drugs Strategy
2011-2014
Author:
James Park, Lead Officer - Substance Misuse
Judith Proctor, Director of Planning
RECOMMENDATION
The Board is asked to
 note the key features of the Strategy and accompanying Action Plan; and
 endorse the decision of the Community Planning Executive Group and agree the
Alcohol and Drugs Strategy 2011-14
SUMMARY
The Dumfries and Galloway Alcohol and Drugs Strategy 2011-14 has been
developed as required by Scottish Government and sets out key local and national
priorities against which annual progress reports on outcomes can be prepared.
NHS Dumfries and Galloway is a key partner in the Dumfries and Galloway ADP
and, as such, it is important that the Board endorse decisions taken within the
Community Planning Partnership Executive regarding the strategy.
A number of the key service delivery areas and outcomes required by the NHS
services are highlighted in the report and within the body of the strategy.
GLOSSARY OF TERMS
ADP
SOA
Dumfries and Galloway Alcohol and Drugs Partnership
258
BACKGROUND
1. Alcohol and Drugs Partnership (ADPs) are the key local delivery agents for the
national alcohol and drug policies contained in the documents ‘Alcohol
Framework’ and ‘The Road to Recovery’. ADPs are responsible for developing
local strategies to deliver improved outcomes on the basis of local need and for
making investment decisions regarding both earmarked funding from Scottish
Government (via NHS Boards) and from partners’ core funding to achieve these
aims.
2. Dumfries and Galloway ADP, chaired by the Chief Constable of Dumfries and
Galloway Constabulary, brings together key personnel from Health, the Council,
the Police, Her Majesty’s Prison Dumfries, the full range of Criminal Justice
Services and the local Third Sector to take such decisions collectively and on
behalf of their host organisations. NHS Dumfries and Galloway is represented
on the ADP by a non Executive Board Member, the Director of Public Health, the
Director of Planning and the Consultant Psychiatrist with clinical lead
responsibilities for addictions. The ADP is a thematic, strategic partnership
which contributes directly to the Single Outcome Agreement (SOA) for Dumfries
and Galloway. It reports to the Dumfries and Galloway Strategic Partnership
through the Community Planning Executive Group.
3. Dumfries and Galloway Alcohol and Drugs Strategy 2011-14 (the strategy)
delivers on a key requirement of the Scottish Government that all ADPs have a
three year strategy in place accompanied by an Action Plan on which progress
against key priorities can be reported both locally and to Government on an
annual basis.
4. The strategy involves all local partners involved in the planning and development
of effective responses to alcohol and drug issues in Dumfries and Galloway. It
is based on a clear commitment to prevention and recovery, underpinned by two
fundamental principles, namely: substance misuse is not inevitable but can be
prevented through education, information and enforcement and, where
substance misuse has become an issue for an individual, recovery is possible.
5. These two principles are recurring themes throughout the strategy and are
supported by a commitment to structures and processes which are dynamic and
responsive to our ever changing situation. The work of the ADP will form an
overarching programme ensuring a cohesive approach, working to consistent
standards with shared outcomes. Featuring in this programme will be a series
of activities or initiatives designed as projects which will include, for example,
planning activities, needs assessments, commissioning services and other
discrete areas of work which will deliver specific organisational outcomes.
6. The programme for the ADP will deliver on the following:
 Benefits Management - outcomes delivery which links outcomes at
various levels;
 Stakeholder Engagement - ensuring that service users and their
families are at the centre of the services that are available and offered
to them; and
259
 Strategy Performance and Monitoring - to provide support for the
strategy and the process of quality improvement for the partnership as
a whole.
ROLE OF THE NHS
7. NHS Dumfries and Galloway has a key role in delivering the Dumfries and
Galloway Alcohol and Drugs Strategy at strategic, tactical and operational levels.
8. As previously mentioned, the NHS has four representatives on the ADP at the
strategic level (strategic), has representatives on each of the working groups that
translate the strategy into service delivery (tactical) and, alongside partners in the
Third Sector, is key to the delivery of a range of services across the region
(operational).
9. From its core budgets the NHS allocates around £1m to services delivered by
the Specialist Substance Misuse Services.
From main services bases in
Dumfries and Stranraer and satellites in other towns across the region, a range
of interventions are offered to individuals and families encompassing preventing,
harm reduction, detoxification, treatment and aftercare.
10. Earmarked resources from the Scottish Government for drug and alcohol
treatment services and ADP support services are held by the NHS and put at the
ADPs disposal for allocation towards the priorities outlined in the strategy.
These resources total around £2m and are augmented by resources provided by
Dumfries and Galloway Council through its Social Work Department and other
resources levered into Dumfries and Galloway by our Third Sector partners. In
total, substance misuse budgets total around £3.8m and are further augmented
by ‘in-kind’ resource provision by other partners who sit around the ADP table.
11. These resources provide the services identified as priority in the strategy. Key
outcomes delivered in the past year include the following:
 The H4 Heat Target (Alcohol Brief Interventions) successfully
achieved;
 The A11 Heat Target (Waiting Times for Services) successfully
achieved;
 Reduction in the prevalence of adult drug misusers; and
 Less young people reporting using alcohol or drugs.
12. In addition to the above, the ADP has successfully contracted with Addaction, a
highly regarded national service provider, to deliver services in partnership with
the Specialist NHS Service. It has also trained over fifty staff across sectors in
the use of the Outcomes Star to collect meaningful outcome data for service
users and services in pursuance of driving continuous improvement throughout
our services. Drugs related deaths have reduced in each of the last two years
and service users are now involved in both their own treatment plans and the
planning and design of current and future services.
13. The role of the NHS as regards ensuring the appropriate use and financial
monitoring and government over earmarked funds for substance misuse has
260
been key to the ability to deliver the progress detailed above. To build on these
successes it is crucial that the NHS retain this position within the partnership and
continue to positively influence the development of collaborative services across
APPENDICES:
1. Dumfries and Galloway Alcohol and Drugs Strategy 2011-14.
2. ADP Strategy 2011-14 Draft Action Plan (version 1.2)*
(*This Action Plan is marked ‘draft’ as it is as yet incomplete as we await
confirmation from Scottish Government of the core indicators which will inform the
national outcomes).
261
MONITORING FORM
The Strategy embodies the Board’s strategic and
operational policies concerning substance misuse
and the partners approach to tackling the problems
created by substance misuse for individuals,
families and communities across Dumfries and
Galloway
There are currently no staffing implications for the
Board within the Strategy. However, as financial
allocations for substance misuse are made
annually by the Scottish Government, there are
implications of ‘risk’ for the Board regarding staff
employed using these resources.
All of the priority areas identified in the Strategy will
be addressed according to budget availability and
within budget allocations.
Consultation
In its development, consultation on the strategy has
included the following:
• Services users, potential users and families
region wide.
• Constituent partners to the ADP.
• Scottish Government.
• Dumfries and Galloway Community Planning
Executive Group
In addition, draft copies of the developing strategy
have been available on the ADP website for
comment throughout its development.
Consultation with Professional The Board’s Professional Advisory Committee’s
Committees
have not been consulted separately in the
development of the Strategy.
Risk Assessment
A full Risk Assessment has been carried out and
potential risks identified.
Best Value
The Strategy encompasses key principles of Best
Value including joint working, equal opportunity and
access to services, accountability, sound
management of resources and sound governance
at strategic, operational and financial levels.
Compliance
Objectives
with
Corporate The Strategy aims to reduce inequalities, promote
continuous improvement in services and service
delivery, maximise the benefits of financial
allocations and to develop and support partnership
working, both within and between sectors. Target
262
setting meets and aspires to exceed Scottish
Government set targets.
Impact Assessment
An EQIA on the Strategy has been carried out. The NHS Equality Lead has
commented on and approved the assessment which is published on the Council
website.
263
ADP Draft Strategy 2011-2014
Alcohol and Drugs Partnership
Draft Strategy
2011 - 2014
Prepared By:
ADP Support Team
Lochar West, Crichton Hall, Dumfries
Version # 5.0 Updated on 20/05/2011
Page 1 of 48
264
Version Control
Version Date
Author
Change Description
1.0
14/07/2010
Kevin Flett
Document created
1.1
13/08/2010
Kevin Flett
Re formatting
1.2
07/09/2010
Kevin Flett
Additional information
2.0
10/11/2010
Kevin Flett
Revision incorporating feedback
2.1
26/11/2010
Kevin Flett
Update Outcome delivery and
performance frameworks
2.2
01/12/2010
Kevin Flett
Revision incorporating support
team feedback
3.0
27/01/2011
Kevin Flett
Redevelopment of Performance
Plan incorporating GIRFEC
model. Inclusion of additional
information on Homelessness
and substance misuse and
Workforce development
3.1
15/02/2011
Kevin Flett
Revision incorporating ADP
feedback
4.0
11/04/2011
Kevin Flett
Redrafting following consultation
feedback
4.1
19/04/2011
Kevin Flett
Full redraft, including financial
information
4.2
20/04/2011
Kevin Flett
Final Draft
5.0
20/05/2011
Kevin Flett
Final amendments in response
to committee comments,
including criminal justice
information
Document Name
Date Created (Draft)
13/08/2010
Date Approved
Archive Location
Lochar West, Crichton Hall
Medium of Distribution
electronic
Page 2 of 48
265
TABLE OF CONTENTS
1
FOREWORD ............................................................................................................................ 5
2
EXECUTIVE SUMMARY ......................................................................................................... 6
3
GLOSSARY OF TERMS .......................................................................................................... 8
4
STRATEGIC VISION AND VALUES ....................................................................................... 9
4.1 ADP Vision......................................................................................................................... 9
4.2 Shared Values ................................................................................................................... 9
5
BACKGROUND ..................................................................................................................... 11
5.1 ADP Formation ................................................................................................................ 11
5.2 Previous Strategies ......................................................................................................... 11
5.3 Strategy Scope ................................................................................................................ 12
5.4 Strategic Links ................................................................................................................. 12
6
THE CURRENT CONTEXT ................................................................................................... 14
6.1 Review and Assessment ................................................................................................. 14
6.2 Integrated Drug Service Review ...................................................................................... 14
6.3 Service User Involvement ................................................................................................ 14
6.4 Integrated Alcohol Services ............................................................................................. 15
6.5 Criminal Justice ............................................................................................................... 16
6.6 Protecting Vulnerable People .......................................................................................... 16
6.6.1 Adult Support and Protection ................................................................................ 16
6.6.2 Child Protection ..................................................................................................... 17
6.6.3 Domestic Abuse and Violence Against Women ................................................... 17
6.7 Needs Assessment .......................................................................................................... 17
6.8 Information Analysis ........................................................................................................ 19
6.9 National Research ........................................................................................................... 20
6.9.1 Homelessness and Substance Misuse ................................................................. 20
6.9.2 Workforce Development ....................................................................................... 20
6.10 Funding and Budgets..................................................................................................... 21
7
DELIVERING IMPROVEMENT.............................................................................................. 23
7.1 ADP Functions ................................................................................................................. 23
7.2 From Structure to Process ............................................................................................... 23
7.3 Driving Change ................................................................................................................ 24
7.4 Quality and Delivery ........................................................................................................ 24
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266
7.5 Programme and Project Management ............................................................................ 25
7.6 Monitoring Effectiveness ................................................................................................. 25
7.6.1 Management control and governance .................................................................. 25
7.6.2 Finance and resource management ..................................................................... 25
7.6.3 Risk management ................................................................................................. 26
7.6.4 Benefits (outcomes) management ........................................................................ 26
7.6.5 Stakeholder engagement ...................................................................................... 27
8
BENEFITS MANAGEMENT (OUTCOME DELIVERY) ......................................................... 28
8.1 Service Delivery Outcomes ............................................................................................. 28
8.2 Future Priorities ............................................................................................................... 29
9
STAKEHOLDER ENGAGEMENT ......................................................................................... 30
10 PERFORMANCE AND MONITORING .................................................................................. 32
10.1 Supporting Structures .................................................................................................... 32
11 PERFORMANCE PLAN ........................................................................................................ 34
11.1 Performance Plan .......................................................................................................... 34
11.2 Triangulating the evidence ............................................................................................ 35
12 KEY DOCUMENTS ................................................................................................................ 36
13 APPENDICES ........................................................................................................................ 38
13.1 Appendix 1 – Outcomes ................................................................................................ 38
13.2 Appendix 2 – Templates, Tools and Frameworks ......................................................... 41
13.3 Appendix 3 – Performance Monitoring Tools ................................................................ 46
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1
FOREWORD
Significant changes have taken place over the past four years in
how alcohol and drug services are planned and delivered. A great
deal has already been achieved in Dumfries and Galloway in
improving local approaches to tackle alcohol and drug misuse.
Integrated services have delivered improved access to treatment,
with waiting times amongst the best in the country. New protocols
have been established ensuring better protection for children at
risk. Innovative approaches to the delivery of Alcohol Brief
Interventions were piloted locally, providing the basis for a model
which was largely replicated nationally.
Progress was evidenced by a range of indicators, not least a reduction in the
prevalence of drug misuse across Dumfries and Galloway. However there is a strong,
shared commitment by all ADP Partners to progress yet further and this commitment is
reflected in this new Strategy.
The Strategy establishes fresh direction and renewed impetus based on two recurring
themes of prevention and recovery. The premise is that substance misuse is not
inevitable. Through carefully targeted activities including information, education and
brief interventions, problems can be prevented altogether or be dealt with more
effectively if picked up at an early stage. Yet we know that some people do become
dependent on alcohol or drugs and the message of this Strategy is that recovery is
possible.
Closely linked to these two themes is an ongoing commitment to protecting those who
are vulnerable, as well as maintaining a focus on enforcement and limiting the
availability of alcohol and drugs.
Supporting this work across Dumfries and Galloway is a greater concentration on
achieving better outcomes for those affected by alcohol and drug misuse, be they
individuals, families or wider communities. More meaningful involvement of all
stakeholders in ensuring that responses are more effective is also vital, as is the
creation of systems which ensure that the ADP is increasingly open and transparent in
its activities, and able to demonstrate the value of its work more clearly.
We believe this fresh approach will bring long term change and benefit to individuals
and communities across Dumfries and Galloway, and on behalf of all ADP partners I
commend it to you.
Patrick Shearer
Chief Constable, Dumfries and Galloway Constabulary
Chair, Dumfries and Galloway Alcohol and Drugs Partnership
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2
EXECUTIVE SUMMARY
This Strategy delivers on a key requirement of the Scottish Government, that all
Alcohol and Drugs Partnerships (ADPs) create new strategies by April 2011. It is
targeted at those involved in the planning and development of effective responses to
alcohol and drug issues in Dumfries and Galloway, and forms one strand of our broad
approach to involving as wide a range of stakeholders as possible in ADP activities.
The Strategy establishes a balanced approach to these issues, based on clear
commitments to prevention and recovery. Prevention demands initiatives that are long
term, and require perseverance. It takes time to shift perceptions and attitudes, so as
to ensure that more people make better informed, healthier choices. Planning for
recovery is also challenging. The recovery model draws on well established models in
mental health services and has two significant features. First it is person centred.
People will trace their recovery route in different ways. Recovery changes the balance
of power, and this challenges the way in which services are designed and
commissioned. The second main feature is hope. Outcomes are central to the strategy,
changes which positively impact on the lives of individuals, with the ripple effect on
families, communities and wider society. Approaches which, though remaining
grounded in the hard realities of alcohol and drug dependence, encourage the setting
of goals, which may be small steps, but establish a positive direction and say to people
your life can change, you can recover.
The Strategy develops structures and initiatives which support these themes. Linking in
to the Dumfries and Galloway Single Outcome Agreement, and feeding in to national
HEAT targets and high level outcomes, requires a local delivery structure which is
flexible and responsive. Based on proven models which encourage improvement in the
delivery of services, there are three features of the planned approach:
-
There will be a clear commitment to benefits management (the delivery of good
outcomes), with systems in place which record progress for individuals in their
personal journeys of recovery, as well as at local and regional levels;
There will be the involvement of a wide range of stakeholders in all aspects of
the ADP‟s work, including in planning and decision making processes as well as
at a service level, with people defining their own priorities for recovery;
There will be lighter structures, and clear mechanisms established for reporting
on the work of the ADP, offering greater accountability.
Underpinning this will be a commitment to achieving clear outcomes in relation to:
-
improving people‟s health;
reducing the prevalence of harmful alcohol and drug misuse;
developing a recovery centred ethos;
supporting children and families affected by others‟ alcohol and drug misuse;
promoting safer communities;
reducing the availability of alcohol and drugs;
delivering high quality and effective alcohol and drug services.
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This demands a commitment to quality standards, continuous improvement,
partnership working, protecting those who are vulnerable, evidence based practice and
person centred approaches.
The strategy commits the ADP and its partners to demonstrating its performance, using
a range of evidence to show where it has achieved as well as where it has not. The
process of continuous monitoring will allow this information to reinforce the positive and
successful, while challenging and improving areas which are proving to be less
effective.
This will be achieved through an ADP which is more accountable, and more focussed
on clear objectives (particularly around the use of its resources, the gathering and use
of information about outcomes, the processes for designing and commissioning
services and reviewing its effectiveness) contributing to achieving the vision of a region
where people are healthier, happier and safer.
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3
GLOSSARY OF TERMS
Term / Acronym
ABI
ADAT
ADP
ARBD
Audit
Scotland
BBV
CAPSM
CJ
CP
CSP
CPO
DAVAW
DDRG
DoH
DRG
DTTO
GOPR
HEAT Target
IAS
IDS
Lifebelt
NQS
OGC
Outcomes
-
RPL
SDF
SG
SIGN 74
-
Stakeholder
-
SUI
SWS
SWSCJA
Third Sector
-
Tiered
Approach
-
UKDPC
-
Alcohol Brief Intervention
Alcohol and Drug Action Team (forerunner to ADP)
Alcohol and Drugs Partnership
Alcohol-Related Brain Damage
Scottish Government body which ensures that organisations which spend
public money in Scotland use it properly, efficiently and effectively
Blood Borne Virus
Children Affected by Parental Substance Misuse
Criminal Justice
Community Planning
Community Safety Partnership
Community Payback Order
Domestic Abuse and Violence against Women
Drug-related Death Review Group
Department of Health (UK Government Department)
Delivery Reform Group
Drug Treatment and Testing Order
Getting Our Priorities Right
Scottish Government Targets (Health-Efficiency-Access-Treatment)
Integrated Alcohol Services
Integrated Drug Services
Local partnership looking at “moving on” and other services for people
with substance misuse issues
National Quality Standards for Substance Misuse Services
Office of Government Commerce
The outcomes approach focuses on real and lasting results affecting both
individuals‟ lives and wider society
ADP Recognised Partners List
Scottish Drugs Forum
Scottish Government
Scottish Intercollegiate Guidelines Network (National Clinical guidelines).
SIGN 74 covers the management of harmful drinking and alcohol
dependence in primary care
a person, group or organisation that affects, or can be affected by the
ADP‟s activities
Service User Involvement
Social Work Services
South West Scotland Community Justice Authority
Term used to refer to voluntary, not for profit or community sector
organisations (i.e. not private or public sector)
A four level approach to substance misuse developed by the National
Treatment Agency (NTA)
(http://www.nta.nhs.uk/uploads/nta_modelsofcare_update_2006_moc3.pdf
for further information)
UK Drug Policy Commission
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4
4.1
STRATEGIC VISION AND VALUES
ADP Vision
The vision of the Dumfries and Galloway Alcohol and Drugs Partnership (ADP) is of a
region where people are healthier, happier and safer. Recognising the harm that
alcohol and drug misuse can cause, it is vital that we establish a strategic approach
which both prevents such misuse, and deals effectively with it when it begins to have
an impact on individuals and communities.
These two themes of prevention and recovery run throughout this Strategy. They
underpin short term outcomes which will improve the lives of those affected by
substance misuse, and the longer term vision of communities where alcohol and drug
misuse are reduced for the benefit of all.
This vision ties in strongly to outcomes inherent in the Scottish Government‟s drugs
strategy (The Road to Recovery)1 and alcohol plan (Changing Scotland’s Relationship
with Alcohol).2 These are linked to national outcomes, which are reflected in the
Dumfries and Galloway Single Outcome Agreement (SOA).3 Substance misuse is one
of nine community safety priorities in the Dumfries and Galloway Community Safety
Partnership‟s Strategic Assessment 4 and has been identified as a substantial risk.
The vision finds a practical focus in the seven National Core Outcomes (Appendix 1),
derived from national strategies, which will have a sustained impact on the people of
Whilst the themes of prevention and recovery run throughout the Strategy, closely
linked with them is a necessary commitment to other key areas of work. Most notable
is the commitment to children, through education and prevention as well as protecting
and supporting those who are affected by their parents‟ or carers‟ substance misuse
and also a wide spectrum of enforcement issues from licensing through to the seizure
of illegal drugs.
4.2
Shared Values
Underpinning this vision is a set of values which “shape what the organisation does
and the way the organisation does it – how it manages, how decisions are made, the
manner in which people work.” 5
The Report of the 21st Century Social Work Review makes explicit the need for shared
values, concluding “High performing teams are interdependent. They have common
1
Scottish Government (2008) The Road to Recovery. Edinburgh: The Scottish Government
Scottish Government (2009) Changing Scotland‟s Relationship with Alcohol: A Framework for
Action. Edinburgh: The Scottish Government
3
Dumfries and Galloway Strategic Partnership (2011) Single Outcome Agreement. Dumfries: The
Dumfries and Galloway Strategic Partnership
4
Dumfries and Galloway Community Safety Partnership (2009) Dumfries and Galloway
Community Safety Partnership Strategic Assessment 2009-2010. Dumfries: The Dumfries and
Galloway Community Safety Partnership
5
Blake, G. Robinson, D. and Smerdon, M. (2006) Living Values. London: Community Links
2
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goals, shared values, shared knowledge about the needs of clients and the opportunity
to share expertise, and learn together.” 6
The 10 Essential Shared Capabilities for Mental Health Workers (NHS Education for
Scotland, 2007) recognises that values (of service users, professionals and
organisations) can affect an individual‟s recovery. Values Based Practice “is about
working in a positive and constructive way with differences and diversity of values.” 7
Deriving from the values shared across a range of professional bodies, the ADP
recognises the following as shaping and guiding its approach:
Accountability
Competence
Confidentiality
Diversity, Equality and Inclusion
Empowerment
Evidence based decisions
Integrity
Minimising risk
Partnership working
Promoting recovery
Quality improvement
Respect
Self determination
Service user participation
Social justice
Central to these shared values are the principles of recovery. The UK Drug Policy
Commission defines recovery as a process of “voluntarily sustained control over
substance use which maximises health and wellbeing and participation in the rights,
roles and responsibilities of society” 8 The Scottish Government states that “recovery is
most effective when service users‟ needs and aspirations are placed at the centre of
their care and treatment. In short, an aspirational, person-centred process.” 9 This
suggests a dynamic, personalised approach which for many people will include
complimentary episodes of harm reduction and abstinence based approaches.
So the recurring themes of prevention and recovery rest on two fundamental principles:
Substance misuse is not inevitable, it can be prevented through education, information and
enforcement, and when initial signs of substance misuse appear, early, brief interventions can
prevent further harm.
Where substance misuse has become a serious issue for an individual, affecting them, their
family and community, recovery is possible, and people can be “enabled to move from their
problem drug use, towards a drug-free life as an active and contributing member of society.” 10
6
st
Scottish Executive (2006) The Report of the 21 Century Social Work Review. Edinburgh: The
Scottish Executive
7
NHS Education for Scotland (2007) The 10 Essential Shared Capabilities for Mental Health
Workers. Edinburgh: NHS Education for Scotland
8
UK Drug Policy Commission (2008) A Vision of Recovery. London: UKDPC
9
Scottish Government (2008) The Road to Recovery. Edinburgh: The Scottish Government
10
ibid
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5
5.1
BACKGROUND
ADP Formation
Dumfries and Galloway Alcohol and Drugs Partnership was formed in September
2009, following a review by the Scottish Government of the delivery of alcohol and drug
services across Scotland. There had also been a significant shift in the expectations
and priorities around the types of services delivered, made clear in new government
plans for alcohol and drugs. In the future the focus, particularly with respect to drug
misuse, would be on recovery, where people move towards a drug free life. Linked with
this is the greater emphasis on preventing alcohol or drug problems occurring or
getting worse, through education, public information, screening and early intervention.
The overarching aim of the ADP is to drive forward this agenda through the planning,
design and commissioning of services and approaches which are effective and
constantly improving, even during a period of more restricted public finances.
5.2
Previous Strategies
The work in this Strategy is not new; it builds on the achievements of the former
Alcohol and Drug Action Team (ADAT). The ADAT 2006-09 Strategy11 successfully
delivered in a number of key areas:
A significant rise in numbers of people accessing treatment;
Waiting times for accessing treatment amongst the best in Scotland;
Creation of processes for involving service users in the design and
development of services;
Development of a Recognised Partners List, linked to National Quality
Standards;
Implementation of robust systems for identifying children at risk from the
misuse of substances;
Successful Alcohol Brief Intervention Pilot in Annandale and Eskdale, rolled
out regionally, and mirrored now in national approaches;
Development of the Drug-related Death Review Group, including new
processes for dealing with non-fatal overdose;
Establishing service user groups and the development of service user
involvement;
Supporting the development of local licensing forums across the region.
In the period following the completion of the 2006-09 Strategy, an interim plan guided
the development of new local structures for the planning and delivery of alcohol and
drug services. These interim arrangements have:
Developed governance guidance, linking the ADP to local Community Planning
structures;
Reviewed the activities of its key services to provide a basis for future service
development;
11
Dumfries and Galloway ADAT (2006) Strategy 2006-2009. Dumfries: Dumfries and Galloway
Alcohol and Drug Action Team
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Developed commissioning frameworks, to ensure that new services are
focused on achieving clear outcomes;
Agreed outcomes which will underpin the work of commissioned services and
the activities of other partners;
Commissioned an independent Needs Assessment to inform the priorities for
forward planning.
This new Strategy builds on the achievements of the past, but also recognises the
significant challenges which exist and the improvements which are required.
5.3
Strategy Scope
The work of the ADP is in one sense wide ranging, in that it draws together a range of
partners from areas such as health, education, social work and law enforcement. This
is indicative of the reach of alcohol and drug issues, touching many aspects of Scottish
society. However the work of the ADP is also sharply focused, addressing specific
issues associated with alcohol and drug misuse as they impact on society. The
activities of the ADP must support and inform the work done in front line service
delivery, but delivery remains the responsibility of our partners. This is reflected in our
approach to outcomes based commissioning, where the ADP will define the outcomes
to be achieved, and ensure that current standards and frameworks are adhered to, but
our commissioned partners will be expected to develop dynamic and responsive
services which achieve those outcomes. Furthermore it is a responsibility of the ADP to
ensure the quality of delivery; a good understanding of current best practice; that
resources are targeted at the area of greatest need and that services work together in
ways which combine to meet overall goals. This approach moves us to a model where
the work of the ADP, incorporating aspects such as quality, financial planning,
commissioning and procurement, and a range of other processes and activities all
combine to support and enhance the delivery of positive outcomes through our
partners.
5.4
Strategic Links
This Strategy recognises that a clear strategic framework is essential if effective
outcomes are to be delivered. However, the Strategy is not a standalone document. In
addition to The Road to Recovery, Changing Scotland’s Relationship with Alcohol and
the Dumfries and Galloway Single Outcome Agreement (SOA), there is a series of
NHS performance targets (HEAT targets) to which alcohol and drugs services must
contribute.12
Health Improvement for the people of Scotland – improving life expectancy and
healthy life expectancy;
Efficiency and Governance Improvements – continually improve the efficiency
and effectiveness of the NHS;
Access to Services – recognising patients‟ need for quicker and easier use of
NHS services; and
Treatment Appropriate to Individuals – ensure patients receive high quality
services that meet their needs.
12
Scottish Government (2010) NHS Performance Targets. Edinburgh: The Scottish Government
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/17273/targets (accessed 23/08/2010)
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Although the HEAT targets sit at a national level and are driven by national priorities,
they remain intrinsically linked to the day to day work of local services. The resources
given to the ADP are to be used in the delivery of the HEAT targets H4 and A11.
H4 – Achieve agreed number of screenings using the setting-appropriate
screening tool and appropriate alcohol brief intervention, in line with SIGN74
guidelines by 2010/11. (Further extended for the year 2011/12).
A11 – By March 2013, 90% of clients will wait no longer than 3 weeks from
referral received to appropriate drug or alcohol treatment that supports their
recovery.
Both of the targets support the two key themes of this Strategy, prevention and
recovery as well as many of the high level and longer term outcomes. The inclusion of
targets incorporating alcohol and drugs ensures that both are given adequate priority.
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6
6.1
THE CURRENT CONTEXT
Review and Assessment
Over the past two years the ADP and others have undertaken or commissioned
independent studies to guide its priorities for coming years. A significant proportion of
ADP resources fund the provision of core services for the treatment of alcohol and drug
problems, therefore the Partnership has a keen interest in how well these core services
are delivered.
6.2
Integrated Drug Service Review
Since 2006 there has been an Integrated Drug Service (IDS) operating across
Dumfries and Galloway. Delivered from five locality bases, the service was designed to
achieve two key targets; (i) to increase the numbers of those with drug problems
entering treatment services, and (ii) to ensure that those entering such services did so
quickly. Initially there was a waiting time target of 4 weeks. These targets were
achieved, and currently almost 100% of those approaching the IDS for support are
offered an appointment for assessment within 4 weeks.
In order to get behind the headline figures, Partners in Evaluation Scotland was
commissioned to conduct an independent review of the IDS in 2008/9, with a report
published in May 2009.13 It made the following recommendations:
1. Ensure local structures are in place to deliver reform;
2. Set up themed time limited working groups to consider:
a. Access to counselling, self help and psychological support;
b. Access to structured constructive activities;
c. Increased use of pharmacy locations as a base to deliver more services;
d. The role of families in recovery;
e. Widening access to education and employability programmes;
f. Transition housing and resettlement;
3. Focus all staff roles on incorporating recovery;
4. Better outcomes reporting.
The overarching theme of the report was that future development should ensure that
responses are designed to take service users beyond maintenance, with a recovery
focus which supports people to move through services.
6.3
Service User Involvement
In 2006 the Scottish Executive published National Quality Standards for Substance
Misuse Services (NQS).14 These clearly place a duty on service providers, planners
and commissioners to ensure that service users and their families are at the centre of
the services that are offered to them.
13
Bitel, M. (2009) Review of the Integrated Drugs Service in Dumfries and Galloway. Edinburgh:
Partners in Evaluation Scotland
14
Scottish Executive (2006) National Quality Standards for Substance Misuse Services.
Edinburgh: The Scottish Executive
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The NQS were a key driver in establishing Service User Involvement (SUI) across
Dumfries and Galloway. The then ADAT commissioned the Scottish Drugs Forum
(SDF) to run a two year pilot project to develop SUI, part of which involved the
seconding of an ADAT team member to SDF to oversee the project.
The rationale behind SUI is that it ensures:
Service users have a greater say in the planning and delivery of the services
they receive;
Services will be more efficient and effective by taking into account the views of
service users;
Purchasers and planners will make more informed decisions as a result of
effective service user involvement structures being in place;
Responses towards people who use drugs by the general public are better
informed;
The channelling of the skills of drug users and the promotion of social inclusion.
The SUI project has undertaken a range of specialist activities, including:
Conducting focus groups for the ADP needs assessment and contributing to a
paper on the NHS specialist service;
Working with NHS specialist nurses on developing methadone dispensing
protocols;
Carrying out focus groups and one to one interviews with Criminal Justice
Service clients and reporting findings to the Criminal Justice team;
Working with the ADP on the commissioning process for the new integrated
service contract, including conducting service user interviews during site visits.
6.4
Integrated Alcohol Services
In 2005 the Scottish Executive requested expressions of interest to develop a new
model of service delivery based around SIGN74.15 The approach was to support the
early detection of hazardous drinkers using a validated screening tool and then offer
individualised brief interventions to those who screened positive.
A Dumfries and Galloway pilot took place in a number of GP practices, demonstrating
success in reducing risk taking behaviours and consumption levels. The approach was
highlighted in the Scottish Executive‟s update to the Plan for Action on Alcohol
Problems 16 and informed the implementation of the Scottish Government‟s national
approach to Alcohol Brief Interventions.
Integrated Alcohol Services across Dumfries and Galloway developed around locality
teams including Alcohol Liaison Nurses, Counsellors and Relapse Prevention Workers
delivering services in community and Primary Care settings as well as Antenatal and
Accident and Emergency Departments.
15
Scottish Intercollegiate Guidelines Network (2003) The management of harmful drinking and
alcohol dependence in primary care. Edinburgh: Royal College of Physicians
16
Scottish Executive (2007) Plan for action on alcohol problems: update. Edinburgh: The Scottish
Executive
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6.5
Criminal Justice
The links between criminal justice and alcohol and drug misuse are well established.
For example 58% of offenders were under the influence of alcohol at the time of their
offence, and 26% were under the influence of drugs.
The South West Scotland Community Justice Authority (SWSCJA) is one of 8 CJA‟s
established in 2007, with the purpose of reducing reoffending and reconviction rates
and to contribute to safer and stronger communities.
Links between the ADP (and previously the ADAT) and criminal justice services in
Dumfries and Galloway have been consistently strong, with representatives from the
Scottish Prison Service(SPS), the Crown Office and Procurator Fiscal Service
(COPFS), Criminal Justice Social Work Services, Dumfries and Galloway Constabulary
and Third Sector Partners, participating at all levels of the ADP‟s work. There is also
representation from the SWSCJA on the ADP.
Significant developments in recent years, including the implementation of the Criminal
Justice and Licensing (Scotland) Act 2010 and the reorganisation of health services
within the SPS, present opportunities to progress in a number of areas of work,
including,
integrating prison based health care with the NHS, including addiction
services;
reviewing the arrest referral service;
reviewing the use of Drug Treatment and Testing Orders (DTTO) to reduce
re-offending associated with substance misuse;
implementing community payback orders (particularly with a requirement for
alcohol or drug treatment).
These shared approaches will strengthen the delivery of our shared outcomes,
particularly core outcome 5, “Communities and individuals are safe from alcohol and
drug related offending and antisocial behaviour.”
6.6
Protecting Vulnerable People
In the past five years significant policy developments have taken place to ensure the
better protection of vulnerable people. The recent introduction of the Protecting
Vulnerable Groups Scheme 17 will be reflected in the ADP‟s processes, particularly in
relation to the commissioning of partners to deliver services. Three further areas
impact directly on the work of the ADP:
6.6.1 Adult Support and Protection
New Adult Support and Protection legislation was implemented in October 2008
to ensure that local multi agency structures and processes were developed for
the protection of adults considered to be at risk of harm. The Dumfries and
Galloway Adult Protection Committee (APC) was formed, with an independent
chair, and has recently developed its first strategy.18 ADP partners will be able to
17
Scottish Government (2010) Protecting Vulnerable Groups Scheme Guidance for individuals,
organisations and personal employers. Edinburgh: The Scottish Government
18
Dumfries and Galloway Adult Protection Committee (2010) Adult Protection Committee.
Dumfries: Dumfries and Galloway Council
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benefit from the development of single referral processes, multi agency training
and professional development, which will ultimately be of benefit to service
users.
6.6.2 Child Protection
The ADP and the Dumfries and Galloway Child Protection Committee (CPC)
worked in partnership with Scottish Training on Drugs and Alcohol (STRADA) to
develop Getting our priorities right, inter agency protocols 19 in 2007. These
protocols were supported by a practitioners‟ guide and staged training for staff.
Over a period of 18 months around 1000 staff were trained. Following the
publication of new National Guidance for Child Protection in Scotland 20 local
protocols will be reviewed and updated as required.
6.6.3 Domestic Abuse and Violence Against Women
The recent report of the Scottish Ministerial Advisory Group on Alcohol
Problems Essential Services Working Group, “Quality Alcohol Treatment and
Support” 21 made a number of recommendations. These included advice on
good practice for specialist services in screening for harm against women and
children as part of the service‟s assessment process. The ADP will work with the
Domestic Abuse and Violence Against Women Partnership (DAVAWP), with
local alcohol and drug service providers and other partners to develop this
screening, and in line with the guidance on adult and child protection outlined
above, extend this screening where practicable to be inclusive of harm against
all vulnerable people.
In each of these three areas of work there are common themes which require cohesive
responses, including:
staff to be aware of the protection needs of children and adults, and when
and how to share concerns;
robust local policies and guidance around identifying, assessing and
managing protection issues related to alcohol and/or drug misuse;
lead professionals to be identified where several services are involved, and;
risk assessment frameworks to be agreed across all partners.
6.7
Needs Assessment
The importance of Alcohol and Drugs Partnerships conducting a needs assessment
has been highlighted in a number of national reports including those produced by the
Delivery Reform Group. 22 More recently a key recommendation from Audit Scotland
was for public sector bodies to:
19
STRADA (2007) Getting our priorities right inter-agency protocol: Working with children and
families affected by drug and/or alcohol misuse. Glasgow: Scottish Training on Drugs and Alcohol
20
Scottish Government (2010) National Guidance for Child Protection in Scotland 2010.
Edinburgh: The Scottish Government
21
Scottish Ministerial Advisory Committee on Alcohol Problems (2011) Quality Alcohol Treatment
and Support (QATS). Edinburgh: The Scottish Government
22
Delivery Reform Group (2008) Alcohol and Drugs Delivery Reform Group – Final Report.
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Ensure that all drug and alcohol services are based on an assessment of local
need and that they are evaluated to ensure value for money. This information
should then be used to inform decision-making in the local area. 23
In response to this recommendation, Sue Irving Ltd. was commissioned to carry out a
substance misuse needs assessment across Dumfries and Galloway.
The Department of Health guidance on Joint Strategic Needs Assessment, defines it
as,
a process that identifies current and future health and wellbeing needs in light
of existing services, and informs future service planning taking into account
evidence of effectiveness.
Joint Strategic Needs Assessment identifies “the big picture” in terms of the
health and wellbeing needs and inequalities of a local population. 24
Locally this work has been done in conjunction with a wide range of stakeholders
including service users involved with the local Service User Project. The Needs
Assessment was produced in November 2010 25 with the following key findings:
Service Design:
better coordination with other services (e.g. housing, prisons, etc);
more focus on moving on and aftercare;
involving stable service users in peer support or buddying;
more diversionary and other activities;
single manager/ leader for all drug and alcohol services.
Service Delivery:
a wider range of treatment options, including residential options;
improved coordination and partnership working (rather than necessarily colocation/ sharing of premises);
improved training for staff, particularly in relation to attitudes and approach;
more welcoming buildings, with security proportional to the risk.
Gaps in Services:
more support needed for families and carers;
more work around prevention;
clearer support for recovery;
some services could be offered outwith normal office hours;
greater awareness of emerging trends.
Much of the finding of the Needs Assessment echoed the findings of previous
research, including the IDS review outlined above, and the report for the Lifebelt
Steering Group. 26
23
Auditor General For Scotland (2009) Drug and Alcohol Services in Scotland. Edinburgh: Audit
Scotland
24
Department of Health (2007) Guidance on Joint Strategic Needs Assessment. London:
Department of Health
25
Irving, S. (2010) Dumfries and Galloway Alcohol and Drugs Partnership Needs Assessment.
Langholm: Sue Irving Ltd.
26
Irving, S. (2009) Lifebelt Business Case. Langholm: Sue Irving Ltd.
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6.8
Information Analysis
An important element of the Needs Assessment was the collation of significant data,
setting local information against Scottish trends and statistics. Key features of this
information include:
Drugs Services:
The number of new service users reported in 2007-08 in Scotland as a whole
was 12,562 and of these 202 new users were in Dumfries and Galloway, a
slight decrease on the previous year. Of these only a very small number
were under the age of 20 with the median age being 28 as compared to the
Scottish median of 30;
The routes into services are of interest ... Dumfries and Galloway has a
considerably higher rate of self referrals (at 53%) than the Scottish average
of 36% ... referrals from the health sector are much lower than the Scottish
average;
Across Scotland as a whole 83% of new service users reported using
opiates as compared with 88% in Dumfries and Galloway;
... between 2006-07 and 2007-08 the number of new heroin using service
users aged under 25 dropped in Scotland by 2% and in Dumfries and
Galloway by 6% from 64% to 58%;
... there is a considerable difference in the numbers injecting in Dumfries and
Galloway than in Scotland as a whole. Those who injected as their only
method of administering drugs totalled 54% as compared to the national
figure of 35% which means that Dumfries and Galloway had at that time a
higher percentage than any other NHS Board area in Scotland.
Social Profile:
In common with the rest of Scotland a small percentage of patients/clients in
Dumfries and Galloway were in employment with the majority, 78%,
unemployed. This is slightly higher than the total Scottish figure of 70%
unemployed. In this region 19% were employed and 3% in the category of
excluded from school, long term sick/disabled or in prison;
78% of people in Dumfries and Galloway were in owned/rented
accommodation and 21% were homeless; this figure for homelessness is 5%
higher than the overall Scottish profile. Engaging housing services in the
Alcohol and Drugs Partnership was highlighted in the professional
stakeholder consultation and this has some significance for future planning
given the accommodation profile of patients/clients.
Alcohol Services:
... referrals to the (NHS Specialist Drug and Alcohol Service in Dumfries and
Galloway) ... for people with alcohol problems increased by 34% whereas
referrals for drugs related problems fell by 4%. The report attributes this
increase to the development of the alcohol liaison service in Dumfries and
Galloway Royal Infirmary. Of the 627 referrals for alcohol problems, 279
(44%) had no previous contact with the service which suggests that this new
route into the service may indeed have resulted in the increase as this was
21% higher than the previous year;
Alcohol Statistics Scotland 2009 shows that in 2007 17 men and 11 women
in Dumfries and Galloway died directly as a result of an alcohol related
condition. However deaths where an alcohol related condition is recorded as
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either an underlying or contributory cause increases these figures to 27 men
and 25 women. Alcohol also has an impact on the use of acute hospital beds
and psychiatric beds so in 2007-08 locally 617 patients were discharged
from general acute hospitals following alcohol related diagnoses and 80 from
the psychiatric hospital.
Also worth noting is that deaths occurring as a direct result of an alcohol related
condition are generally around three times higher than those recorded as drug-related
deaths. In conjunction with partners on the Dual Diagnosis Group, the ADP has
commissioned a needs assessment around the particular requirements of those
affected by Alcohol-Related Brain Damage (ARBD). This will inform responses to the
needs of this particular group, particularly ensuring that services are linked around the
individual.
6.9
National Research
In addition to local studies and assessments, in recent years there has been a range of
specialist reports from Scottish Government which inform the approach of the ADP and
help define some of its priorities. Two key areas have emerged, which need to be
addressed through the ADP‟s activities.
6.9.1 Homelessness and Substance Misuse
The Scottish Government commissioned research into the links between
homelessness and substance misuse issues. The report stated “these studies
paint a picture of homelessness and substance misuse as mutually reinforcing
conditions that are the result of sustained, multiple, compound disadvantage
through childhood and adult life.” 27 Amongst the emerging recommendations
are the need for:
A joint strategic response at a local level to be developed (responsibility
sitting with Alcohol and Drugs Partnerships);
A joint operational response at local level to be developed;
More flexible approaches in rural and island areas;
An individual‟s priorities to be the starting point for the design and delivery of
services and support;
Ongoing evaluation of services in this field to be managed through ADP
planning and monitoring processes;
Targeted service user participation and involvement to be supported;
Training across homelessness, housing, alcohol and drug fields to be
supported in statutory and commissioned services;
The stigmatisation of these populations to be addressed at a local and
national level.
6.9.2 Workforce Development
The Scottish Government and COSLA issued a statement about the
development of Scotland‟s Alcohol and Drug Workforce. 28 Recognising the
27
Pleace, N. (2008) Effective Services for Substance Misuse and Homelessness in Scotland:
Evidence from an International Review. Edinburgh: Scottish Government Social Research
28
Scottish Government and COSLA (2010) Supporting the Development of Scotland‟s Alcohol
and Drug Workforce. Edinburgh: Scottish Government and Convention of Scottish Local
Authorities
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need for a range of organisations to play a role (including commissioners,
professional bodies, service providers, managers and individuals) it also
stresses the need for a shared, person centred vision across specialist and
generic services within all sectors in order to deliver the competencies required
to tackle Scotland‟s alcohol and drug related problems. Specifically ADPs are to:
Promote the agreed national learning priorities for development of the drug
and alcohol misuse workforce;
Identify and articulate local workforce development needs aligned with
national learning priorities and develop local workforce strategies and costed
implementation plans to meet these needs; and
Encourage multi-disciplinary and multi-sector training in generic
competences to develop a shared vocabulary and understanding of alcohol
and drug problems, promote an integrated approach across services that
support individuals on their road to recovery.
To support this it is recommended that ADPs conduct a specific Workforce
Development Needs Assessment, which should also incorporate the views of
service users.
6.10 Funding and Budgets
Tackling alcohol and drug misuse is a priority for the Scottish Government, with funding
normally allocated on an annual basis to resource activities which achieve alcohol and
drug focussed outcomes. Decisions on how this funding is to be spent is the
responsibility of the ADP, and the funding allocation is viewed by government as the
minimum which should be spent locally, with strategic partners able to supplement
ADP funds from main budgets. In addition to the supplementary funding outlined in the
table below, strategic partners such as Dumfries and Galloway Constabulary commit
substantial “in kind” resources, including officer time to both the work of the ADP and
some aspects of service provision.
The Scottish Government expects transparent decision making processes, and will be
working with ADP‟s in 2011-12 to develop national delivery frameworks which support
the Single Outcome Agreement and the achievement of HEAT targets. This includes
the development of seven core outcomes for ADP‟s (Appendix 1), which will sit
alongside local outcomes. These will be reflected in Annual Action Plans (Appendix 3)
to be developed each year during the life of this Strategy.
Scottish Government and local funding allocations for 2011-12 are as follows:
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Scottish Government
Alcohol Misuse
1,228,256
Scottish Government
Alcohol Misuse
(Prison Allocation)
18,084
Scottish Government
Drug Misuse
620,042
Scottish Government
ADP Support
119,796
Dumfries and Galloway Council
Community Safety Partnership
Third Sector Partners
383,791
1,000,000
Guidance
Tackling alcohol misuse is a major public
health priority. Approaches will be based
on the guidance issued in “Quality
Alcohol, Treatment and Support”,29 which
outlines a tiered approach, advocating a
person centred recovery focussed
approach. There is continued
development of the use of Alcohol Brief
Interventions, embedding these into
routine practice. The addition of a prison
allocation reflects the transfer of
responsibility for prisoner health care from
the Scottish Prison Service to the NHS.
Funding to tackle drug misuse has been
maintained, to support the development of
recovery focussed systems of care, using
a tiered approach based on NHS
Scotland “Guidance on Referral
Pathways.” 30
The role of ADP Support is to develop a
local strategy (2010-11), support the
implementation of this strategy (2011-12),
particularly the delivery of core outcomes
and key functions not provided by other
partners.
Based on 2010/11 allocation
Based on 2010/11 allocation
25,000 Based on 2010/11 allocation
Estimate, based on funding drawn in to
the region through grants and awards to
500,000 Third Sector Partners. Further work
required to identify and quantify this
aspect of funding
£3,894,969
Guidance from the Scottish Government is explicit in requiring its allocation to
demonstrably support the delivery of the priority outcomes determined collectively by
the ADP, based on local needs assessment, reflecting national priorities and using
systems which are accountable and transparent. A proportion of both the drug and
alcohol allocations will be combined to support the delivery of alcohol and drug HEAT
target A11.
29
ibid
NHS Scotland (2009) NHS Scotland HEAT Performance management system 2009-10.
30
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7
7.1
DELIVERING IMPROVEMENT
ADP Functions
In addressing the challenges facing the ADP, there is a need for clear structures and
processes which will underpin the work of the Partnership as well as provide a
framework which will strengthen its accountability. Amongst the key features in the
guidance from the Scottish Government, is the need for ADP‟s:
-
to be firmly embedded within wider arrangements for community planning;
-
to be supported by an expert local team;
-
to develop and implement a comprehensive and evidence-based local alcohol and
drugs strategy;
-
to work to an agreed set of national core indicators;
-
to ensure that individual bodies contribute fully and openly to the operation of their
local partnership.
7.2
From Structure to Process
The approach laid out in the ADP‟s initial Operating Arrangements was largely
structural, based on the inherited structures of the ADAT. This included five delivery
groups, each with a distinctive remit, linked to a particular range of outcomes. However
a structures based approach has several weaknesses. Structures tend to be static, and
a more dynamic response to the issues raised by substance misuse is demanded.
Static structures struggle to cope with remits that are not always easily defined, and
which may cross over one or more groups, leading either to duplication or gaps which
are not successfully covered. There are risks that outcomes or activities are forced to
fit into structures, rather than developing responses which support the delivery of
outcomes.
In the past there have been examples of working groups which successfully have dealt
with cross cutting outcomes and themes. One example is the Drug-related Death
Review Group, which continues to deliver tailored responses to the issues raised by
individual drug related deaths as well as wider trends. Another example was the joint
approach to developing shared protocols around child protection, linked to the
guidance in Getting Our Priorities Right (GOPR). 31
The remainder of this section develops a more dynamic model for the delivery of ADP
outcomes, based not on the continuation of current structures but on the development
of responsive processes, with much lighter structures. This will require the dissolution
of the existing standing groups, replacing them with a dynamic set of working groups,
which are project management based, focussing on specific pieces of work agreed in
Annual Action Plans.
31
Scottish Executive (2003) Getting our Priorities Right, Good Practice Guidance for working with
Children and families affected by Substance Misuse. Edinburgh: The Scottish Executive
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7.3
Driving Change
Behind this change in model for the ADP are two key factors.
First, in August 2009, the ADP completed a self assessment, based on guidance from
Audit Scotland. 32 This was updated in March 2010 by a further self assessment, using
a template designed by the Scottish Government‟s National Support Coordinators.
Whilst the ADP demonstrated a number of positive areas of work, there were other
areas requiring further development:
Development of Strategy and planning;
Development of more effective commissioning processes;
Conducting (organisational) risk assessment;
Implementing performance monitoring processes;
Developing a focus on Quality;
Clearer lines of accountability;
Gathering better evidence upon which to base future (service) development
(including engagement with service users, analysing trends and identifying best
practice).
A number of these have seen significant progress, particularly around Strategy
development, commissioning and needs assessment, but there are other aspects
which require further development and attention.
Second, is the need to respond to changes in the funding for support arrangements.
Following a review in 2009, the Scottish Government revised its funding allocations for
ADPs, resulting in a 35% cut in support team funding to be phased in over a three year
period, to 2012/13.
Although this support budget is supplemented locally, there is still an impact on the
capacity of the ADP support team which requires a reconfiguring of its functions and
priorities, shifting from the maintenance of current structures towards supporting the
key functions and processes of the ADP. This necessitates the replacement of the
standing groups with more responsive working groups supporting the delivery of key
ADP outcomes, based on the project management model outlined below.
7.4
Quality and Delivery
To provide a framework for the continued development and reconfiguration of the ADP,
it will, over the life of this Strategy apply principles drawn from the “Maturity Model”,
which is designed to help organisations improve what they do. This model will
strengthen the Partnership‟s accountability. We believe that if we are asking others
(services, partnerships, initiatives etc) to demonstrate to us how effective they are, we
must be able to demonstrate our effectiveness. Two key disciplines within the Maturity
Model are relevant for the ADP, namely Programme and Project Management, which
though not necessarily interdependent can be shown to be complimentary aspects of
the ADP‟s work.
32
Auditor General For Scotland (2009) Drug and Alcohol Services in Scotland. Edinburgh: Audit
Scotland
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7.5
Programme and Project Management
Programme management describes a collection of projects or other activities which
combine to achieve a range of strategic outcomes and benefits for the organisation.
Using the principles of programme management helps to reduce the conflict that can
emerge between projects and activities, and help to ensure that resources are used
most effectively across all of the programme‟s activities.
Project management centres on the creation of temporary structures developed for the
purpose of producing change. The changes produced are defined and described as
outcomes which make a real and tangible difference to behaviour or circumstances.
Project management involves planning, delegating, monitoring and controlling each
aspect of a project within agreed targets.
For the purposes of the ADP as a Partnership, it will be concerned with the full
programme of partners‟ activities, overseeing the achievement of the outcomes and
benefits envisaged and ensuring the best use of resources. Particular programme
functions may be remitted to agreed working groups or to members of the ADP
Support Team, but the ADP retains ownership of these high level functions.
7.6
Monitoring Effectiveness
To assist in this process the ADP will, as part of its internal performance monitoring,
utilise the Office of Government Commerce Portfolio Management Self Assessment
Tool, 33 monitoring the activities of the Partnership in five areas:
7.6.1 Management control and governance
Specifically management control refers to ensuring that systems and processes
are in place to guide and control the work of the ADP by offering leadership and
direction, setting boundaries and ensuring activities are subject to review.
Governance sets this within a wider context, considering how the work of the
ADP is accountable to its partners, including Scottish Government, Dumfries
and Galloway Council, NHS Dumfries and Galloway and Third Sector partners.
Reference has already been made to the ADP Operating Arrangements which
underpin its structures, defining for example membership, chairing
arrangements, meeting arrangements and support arrangements as well as
outlining the ADP‟s commitment to finance, performance, communication,
conduct and standards. These will be reviewed and updated where necessary to
reflect the new Programme / Project Management structures.
7.6.2 Finance and resource management
The ADP is committed to use all of its resources (including the financial
resources for which it is responsible) on the basis of good information (for
example; needs assessments and performance management information) to
ensure that those resources are targeted to activities which respond to the
greatest needs.
33
Office of Government Commerce (2010) Portfolio, Programme and Project Management
®
®
Maturity Model (P3M3 ) Introduction and Guide to P3M3 . London: Office of Government
Commerce
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The ADP will operate within the financial frameworks of Dumfries and Galloway
Council and NHS Dumfries and Galloway, as well as having accountability to
national regulatory requirements including those of Audit Scotland.
Furthermore, the ADP is conscious of the need to align its Strategy development
with planning and commissioning processes. Though not formally responsible
for the procurement and commissioning of services, the ADP has a key strategic
role in ensuring that these functions are supported and informed at a strategic
level and that any subsequent contracts are monitored against outcomes and
targets which are relevant to this Strategy. Such an approach is entirely
consistent with the programme/ project management model, based on a three
yearly cycle.
Planning
National priorities, SOA, HEAT, needs
assessment, financial assessment,
services review.
Review
Strategy Development
Evaluation, delivery against targets, cost
analysis, benefit analysis, stakeholder
engagement.
Identifying gaps, service design,
agreeing targets, defining priorities,
stakeholder engagement.
Delivery
Monitoring contracts, performance,
outcome delivery and data / information.
Commissioning & Procurement
Standard specifications, agreed outcomes,
consistent tendering processes and
contract development.
7.6.3 Risk management
The ADP recognises the need to manage threats and opportunities which
present. These may emerge from developing trends and statistics, information
gathered from various engagement processes or from changes in local and
national policy.
This will require the ADP to develop systems for identifying those risks, thereby
minimising the impact of threats and maximising the opportunities. The
management of risk needs to become an embedded part of the ADP‟s activities
and contribute to its decision making processes.
7.6.4 Benefits (outcomes) management
Benefits management is the process designed to ensure that the desired
outcomes for the ADP are clear and measurable, as well as ultimately delivered.
There needs to be a clear understanding of how the outputs and activities of the
ADP will achieve results in terms of the long term benefits related to the two
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strands of prevention and recovery, underpinning short term outcomes which
will improve the lives of those affected by substance misuse, and the longer
term vision of communities where alcohol and drug misuse are reduced to the
benefit of all.
7.6.5 Stakeholder engagement
Stakeholders at every level, within and outside ADP structures, need to be
engaged with effectively in order to ensure that decisions are well informed and
relevant. This includes an ongoing commitment to service user involvement,
engaging with families and carers, engaging with third sector and statutory
sector partners through the various structures and processes of the ADP and
ensuring that processes for engaging with the wider communities of Dumfries
and Galloway are improved.
This will be carried out through the use of a range of communication tools and
techniques, and will be done in accordance with National Standards for
Community Engagement and in compliance with the National Quality Standards
for Substance Misuse Services.
In order to ensure that the principles of continuous improvement are applied, for the
purposes of this strategy the five areas of work outlined above will be compressed into
three defined work-streams:
Benefits Management (Outcome Delivery);
Stakeholder Engagement;
Strategic Performance and Monitoring.
Performance
and Monitoring
Risk management
Management control and governance
Finance and resource management
Annual reporting
processes
Benefits management
(Outcome delivery)
Stakeholder Engagement
This model 34 will enable the ADP to combine information from each of the three work
streams into reporting processes which in turn will support the overall monitoring and
evaluation of the work the ADP does.
34
The model is derived from work done by the Integrated Children‟s Service Team, Dumfries and
Galloway Council.
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8
BENEFITS MANAGEMENT (OUTCOME DELIVERY)
This first stream adopts a broad project management approach, with a view to
delivering change, identifiable in real and measurable outcomes which contribute to the
benefits that the ADP as a whole will deliver.
8.1
Service Delivery Outcomes
A range of outcomes exist at different levels, as described in Appendix 1. Service
Delivery Outcomes, drawn from the Scottish Government‟s Outcomes Toolkit 35 are
those benefits which are to be delivered by partners such as service providers,
specialist services, voluntary groups and others. The ADP will adopt a twin approach in
supporting the delivery of these outcomes.
Firstly there are some agencies which do not receive direct funding from the ADP. At
one level these organisations cannot be compelled to deliver particular outcomes.
However many do receive some form of government support and the ADP will work
with those commissioning and funding their activities to incorporate agreed outcomes
into service plans and agreements. Also there are many of the ADP‟s partners
delivering statutory services including for example social work services and housing
services, where Tier 1, community focussed approaches could be encouraged to help
individuals to access treatment and support them more fully while in treatment. Not
only will this support the delivery of positive outcomes for those using their services, it
will also enable agencies to demonstrate their relevance and capability and express
their ability to deliver meaningful outcomes, which link clearly with local and national
strategies.
Then there are agencies which are directly funded by the ADP (whether statutory or
Third Sector). In agreeing to commission or fund these activities, the ADP will develop
a clear set of agreed outcomes, directly related to this Strategy. The delivery of these
outcomes will form part of the ongoing monitoring of contracts and service level
agreements. In the longer term, performance will have a bearing on decisions about
continued funding.
The rationale behind this approach is the need to maintain a balance between specific
and clear accountability for the outcomes which ADP funding should be achieving and
continuing to encourage innovation and change through a wider range of activities, but
at the same time offering a framework within which those activities can sit, and through
which partners can demonstrate their effectiveness.
Central to this will be the continuance of the ADP‟s “Recognised Partners List” 36 which
invites application for membership from a broad range of partners, and supports the
implementation of National Quality Standards. Linked with this will be the development
of reporting tools which partners can use to demonstrate their outcomes and their
contribution to higher level outcomes at a regional and national level.
35
Scottish Government (2009) Delivering Better Outcomes: An Outcomes Toolkit for Alcohol and
Drugs Partnerships Version 1. Edinburgh: Scottish Government
36
Dumfries and Galloway ADP (2011) Recognised Partners List Documentation. Dumfries:
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8.2
Future Priorities
The Needs Assessment and other studies also enable the ADP to begin to prioritise
how resources will be used, and beyond the development of core services (delivering
community rehabilitation, harm reduction, prescribing and detoxification outcomes) the
evidence of the needs assessment and other studies consistently indicate that the
following additional activities require further support and development:
Talking Therapies
Improved provision of “talking therapies” (including
psychology, Cognitive Behavioural Therapy, counselling and
mutual aid groups);
Housing
The creation of better links with housing services, including
housing providers, housing support and homelessness
services;
Families
More support for families and the involvement of families in
recovery activities;
Alternative Activities
Better access to constructive and diversionary activities;
Education and
Employment
Wider access to education, training and employability
opportunities.
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9
STAKEHOLDER ENGAGEMENT
The second stream is linked to the Scottish Government‟s National Quality Standards
for Substance Misuse Services which place a clear duty on service providers, planners
and commissioners to ensure that service users and their families are at the centre of
the services that are offered to them. Standard Statement 10 is explicit in stating “The
service you receive has been designed with you, your family, and the needs of the
local community in mind.” Standard Statement 11 states, “Your views will be sought in
order to constantly monitor the type, delivery and development of services.”
In addition to the very specific direction from the National Quality Standards there are
other drivers for ensuring wide participation in the design and delivery of services. The
National Standards for Community Engagement are designed to “develop and support
better working relationships between communities and agencies delivering public
services.” 37 This is a crucial element of community planning processes, enshrined in
the Local Government in Scotland Act 2003.
In December 2007, the Scottish Government published a 5 year action plan for NHS
Scotland called “Better Health, Better Care: Action Plan”. 38 The primary focus was to
ensure that patients and members of the public are involved in their care at every level.
Of particular relevance is standard 2 “Involving people in service planning and
development” which requires that people are given the opportunity and necessary
support to be involved in the planning and development of NHS services. This was
reinforced in May 2010 with the “Healthcare Quality Strategy for NHSScotland” 39
establishing the need to listen to people‟s views, ensuring that people were “at the
heart of the NHS.”
In Dumfries and Galloway the early work of the Service User Involvement group has
already contributed to these processes of engagement, facilitating the participation of
service users in the aspects of service redesign and in the commissioning of new
services. The person-centred approach to care and treatment enshrined in the ADP‟s
values and the principles of recovery are not the responsibility of service providers
alone. It is incumbent upon the ADP to ensure that a wide range of service users‟
views and perspectives are brought into planning and commissioning processes, along
with those of a broad constituency of stakeholders. Though there are clear benefits to
the ADP and its partners of involving service users, a key feature of the approach
taken to involve service users is that the individuals participating can also be involved
in training, in improving their personal and employability skills and developing greater
self awareness and confidence.
Throughout the life of this Strategy the ADP commits to further develop stakeholder
engagement, continuing to expand service user involvement as well as encouraging
the participation of a wide range of stakeholders, engaging more fully with the wider
population around issues of prevention and the need for a change in perceptions about
alcohol and its place within Scottish society. This twin approach supports the two key
themes of this Strategy, prevention and recovery, and in particular supports the
37
Scottish Executive (2005) National Standards for Community Engagement. Edinburgh: The
Scottish Executive
38
Scottish Government (2007) Better Health Better Care: Action Plan. Edinburgh: The Scottish
Government
39
Scottish Government (2010) The Healthcare Quality Strategy for NHSScotland. Edinburgh: The
Scottish Government
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delivery of a number of recovery and prevention outcomes which can be adopted by
individuals, groups and initiatives, including:
1. Service users have improved financial status and stability;
2. Service users have improved participation in meaningful activity;
3. Service users have improved employability status (e.g. moved into
employment / voluntary work);
4. Service users have an increased awareness of work/training opportunities
open to them;
5. Service users have improved engagement with education and training;
6. Service users have improved career aspirations;
7. Service users have an improved understanding of their rights and
responsibilities;
8. Increased knowledge of consequences and risks of alcohol consumption
and drugs use in participants of education programmes;
9. Improved and increased engagement of participants with age appropriate
social activity, positive lifestyle, community activities;
10. Fewer service users drink above recommended daily and weekly guidelines;
11. Improved engagement of participants with learning;
12. Improved parental and community engagement by service users;
13. Service users are fully involved and participate in planning for their own
sustainable recovery (i.e. a person centred approach is used).
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10 PERFORMANCE AND MONITORING
10.1 Supporting Structures
This third stream, combined with the other two, enables the ADP to demonstrate that
its partners have delivered the positive outcomes and impacts associated with the
funding and resources for which it has responsibility. This is more successfully
achieved when there are processes in place to support transparency and
accountability. A drive for quality improvement will enable the Partnership to address
the gaps identified in the Audit Scotland self assessment and the self assessment
designed by the Scottish Government‟s National Support Coordinators.
To support this process the ADP will use the Office of Government Commerce
Management Self Assessment tool 40 (Appendix 3) which will enable the Partnership to
monitor effectiveness on the basis of five levels of “maturity”:
Level 1
Level 2
Level 3
Level 4
Level 5
there is very limited clarity and accountability around each of the
elements, systems are weak and ad hoc;
some aspects of accountability etc exist in pockets within the
organisation, based on key individuals, but there is no consistent or
cohesive approach across the organisation;
processes and controls are centrally defined, roles and responsibilities in
each area are clear and people are accountable;
processes exist which are well proven, and these underpin strategic
success across all areas;
there is strong evidence of excellent processes which result in
organisational excellence, with a commitment to continual improvement.
The organisation is a learning organisation.
This self assessment will be applied to all three of the ADP‟s work streams:
Benefits Management (Outcome Delivery);
Stakeholder Engagement;
Strategic Performance and Monitoring.
To provide a baseline from which to measure improvement, the ADP will undertake a
full self assessment exercise. This will include the identification of areas which should
be monitored, which indicators should be used to demonstrate progress and where
responsibility rests for overseeing each area of work.
The commitment of the ADP is to achieve an average level of 4 across all of its
activities, thus ensuring a meaningful minimum standard of quality.
The benefits of using such a framework are:
it supports the flexible approach envisaged, where new activities or initiatives
(projects) can be incorporated and measured in standardised ways for
quality and effectiveness;
40
®
Office of Government Commerce (2010) P3M3 - Programme Management Self Assessment.
London: Office of Government Commerce
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it offers clarity and accountability;
it supports the „external‟ outcomes which are central to the vision of the ADP
by ensuring that aspects such as financial management, risk management,
commissioning processes and needs assessment are routinely monitored;
it sits alongside the outcomes frameworks in Appendix 1, supporting partners
to demonstrate their strategic „fit‟ within the ADP;
it can be incorporated into contracts and SLAs, supporting a project
management approach.
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11 PERFORMANCE PLAN
11.1 Performance Plan
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The Performance Plan draws together the three work streams and sets them into a
structure incorporating the various local and national mechanisms to which the ADP
has a connection and a degree of accountability, including the Dumfries and Galloway
Single Outcome Agreement (SOA).
11.2 Triangulating the evidence
The evidence gathered from each work stream can be used to corroborate or
contradict the evidence from other streams. This offers on one hand the possibility of
stronger evidence to support the claims of the Partnership or the case for continuing or
further developing a particular approach. On the other hand it may provide evidence of
weakness in particular areas which can inform improvement in performance or
decisions about the further commitment of resources.
Performance and Monitoring information will derive largely from the work of the ADP
support team and the strategic level information from ADP partners. Strategic partners
will be able to identify how their coordinated approaches combine to contribute to
effective change across the region through improved statistics and positive trends. This
gives an overall sense of the improvements in the quality and delivery of services and
activities, as well as the quality of the ADP‟s work, including its financial management
and risk management.
The ultimate aim of an outcomes approach is to achieve positive impacts on, and
changes in, the lives of individuals, local communities and wider society. This is what
the bulk of the resources at the disposal of the ADP will be used for, and it is vital that
these „front line‟ activities can demonstrate their positive contributions to outcomes at
different levels. These outcomes (described in Appendix 1) will be reflected in contracts
and agreements, enabling partners to demonstrate their effectiveness and value
through good quality Benefits Management information. A number of tools, templates
and frameworks are included in Appendix 2 to support this process.
The third area of evidence will emerge from the ADP‟s commitment to Stakeholder
Engagement. For those using services, success will be measured in the attainment of
personal goals and progress towards recovery. Families will have views on the quality
of the services their partners, children or parents have received. Frontline workers will
have ideas and suggestions for improving their own practice and wider services.
Members of the public will have perceptions and views which may be helpful in shaping
responses that are more appropriate to their communities. Communication,
engagement and consultation can all provide useful qualitative information to support
the ADP‟s planning and commissioning cycles.
Together this range of material allows the ADP to triangulate its information which
helps Partners to understand better the developing context within which they work. It is
not anticipated that all of the information would be available at the same time, but its
availability within the planning cycle described in Section 7 will allow for the preparation
of reports which relate to specific timed projects or annual reports relating to the overall
programme of the ADP as a Partnership.
This approach will apply to every aspect of the ADP‟s activities and will underpin
annual planning and reporting processes, contributing to the vision of a region where
people are healthier, happier and safe
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12 KEY DOCUMENTS
Auditor General For Scotland (2009) Drug and Alcohol Services in Scotland.
Edinburgh: Audit Scotland
Bitel, M. (2009) Review of the Integrated Drugs Service in Dumfries and Galloway.
Edinburgh: Partners in Evaluation Scotland
Blake, G., Robinson, D. and Smerdon, M. (2006) Living Values. London:
Community Links
Delivery Reform Group (2008) Alcohol and Drugs Delivery Reform Group – Final
Report. Edinburgh: The Scottish Government
Department of Health (2007) Guidance on Joint Strategic Needs Assessment.
London: The Department of Health
Dumfries and Galloway ADAT (2008) Recognised Partners List Documentation.
Dumfries: Dumfries and Galloway Alcohol and Drug Action Team
Dumfries and Galloway ADAT (2006) Strategy 2006-2009. Dumfries: Dumfries and
Galloway Alcohol and Drug Action Team
Dumfries and Galloway ADP (2009) ADP Operating Arrangements. Dumfries:
Dumfries and Galloway Adult Protection Committee (2010) Adult Protection
Strategy. Dumfries: Dumfries and Galloway Council
Dumfries and Galloway Community Safety Partnership (2009) Dumfries and
Galloway Community Safety Partnership Strategic Assessment 2009-2010.
Dumfries: The Dumfries and Galloway Community Safety Partnership
Dumfries and Galloway Council Integrated Children‟s Service Team (2010)
GIRFEC Plan. Dumfries: Dumfries and Galloway Council
Dumfries and Galloway Strategic Partnership (2011) Single Outcome Agreement.
Dumfries: The Dumfries and Galloway Strategic Partnership
Irving, S. (2010) Dumfries and Galloway Alcohol and Drugs Partnership Needs
Assessment. Langholm: Sue Irving Ltd.
Irving, S. (2009) Lifebelt Business Case. Langholm: Sue Irving Ltd.
NHS Education for Scotland (2007) The 10 Essential Shared Capabilities for
Mental Health Workers. Edinburgh: NHS Education for Scotland
NHS Scotland (2009) NHS Scotland HEAT Performance management system
2009-10. Edinburgh: The Scottish Government
Office of Government Commerce (2010) Portfolio, Programme and Project
Management Maturity Model (P3M3®) Introduction and Guide to P3M3®. London:
Office of Government Commerce
Office of Government Commerce (2010) P3M3® - Programme Management Self
Assessment. London: Office of Government Commerce
Pleace, N. (2008) Effective Services for Substance Misuse and Homelessness in
Scotland: Evidence from an International Review. Edinburgh: Scottish Government
Social Research
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Scottish Executive (2003) Getting our Priorities Right, Good Practice Guidance for
working with Children and families affected by Substance Misuse. Edinburgh: The
Scottish Executive
Scottish Executive (2006) National Quality Standards for Substance Misuse
Services. Edinburgh: The Scottish Executive
Scottish Executive (2005) National Standards for Community Engagement.
Scottish Executive (2007) Plan for action on alcohol problems: update. Edinburgh:
The Scottish Executive
Scottish Executive (2006) The Report of the 21st Century Social Work Review.
Scottish Government (2007) Better Health Better Care: Action Plan. Edinburgh:
The Scottish Government
Scottish Government (2009) Changing Scotland‟s Relationship with Alcohol: A
Framework for Action. Edinburgh: The Scottish Government
Scottish Government (2009) Delivering Better Outcomes: An Outcomes Toolkit for
Alcohol and Drugs Partnerships Version 1. Edinburgh: The Scottish Government
Scottish Government (2010) National Guidance for Child Protection in Scotland
2010. Edinburgh: The Scottish Government
Scottish Government (2010) NHS Performance Targets. Edinburgh: The Scottish
Government http://www.scotland.gov.uk/Topics/Health/NHSScotland/17273/targets (accessed 23/08/2010)
Scottish Government (2010) Protecting Vulnerable Groups Scheme Guidance for
individuals, organisations and personal employers. Edinburgh: The Scottish
Government
Scottish Government (2010) The Healthcare Quality Strategy for NHSScotland.
Scottish Government (2008) The Road to Recovery. Edinburgh: The Scottish
Government
Scottish Government and COSLA (2010) Supporting the Development of
Scotland‟s Alcohol and Drug Workforce. Edinburgh: The Scottish Government and
Convention of Scottish Local Authorities
Scottish Intercollegiate Guidelines Network (2003) The management of harmful
drinking and alcohol dependence in primary care. Edinburgh: Royal College of
Physicians
Scottish Ministerial Advisory Committee on Alcohol Problems (2011) Quality
Alcohol Treatment and Support (QATS). Edinburgh: The Scottish Government
South West Scotland Community Justice Authority (2011) Working in partnership to
reduce re-offending (Area Action Plan 2011-14). Irvine: The South West Scotland
Community Justice Authority
STRADA (2007) Getting our priorities right inter-agency protocol: Working with
children and families affected by drug and/or alcohol misuse. Glasgow: Scottish
Training on Drugs and Alcohol
UK Drug Policy Commission (2008) A Vision of Recovery. London: UKDPC
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13 APPENDICES
13.1 Appendix 1 – Outcomes
The outcomes can be described as a series of layers, with each level contributing to
the level above.
National Outcomes and Targets relating to substance misuse
These are changes envisaged as a result of Government investment, and the delivery of national policy which
are long term, impacting on wider society and measurable at a national level.
2.
4.
5.
6.
7.
8.
9.
Economic potential;
Young people successful learners;
Children get the best start in life;
Longer, healthier lives;
Tackled inequalities;
Improved life chances of those at risk;
Lives safe from crime, danger &
disorder;
11. Strong, resilient communities.
HEAT Targets
H4 - Achieve agreed number of screenings and
alcohol brief intervention, by 2011/12;
A11 – By March 2013, 90% of clients will wait no
longer than 3 weeks from referral received to
appropriate drug or alcohol treatment that
supports their recovery.
High level Outcomes
These have an impact at an area level, and can
be measured by analysing trends and statistical
changes across the whole region.
- Reduced Drug & Alcohol related deaths;
- Reduced Drug & Alcohol related crime;
- Better employment and education outcomes;
- Improved outcomes for children;
- Safer families and communities.
Dumfries and Galloway Single Outcome Agreement Priorities
Priorities in bold indicate those with specific links to alcohol and drug misuse and ADP Outcomes.
Priority 1 - We will provide a good start in life for all our children;
Priority 2 - We will prepare our young people for adulthood and employment;
Priority 3 - We will care for our older and vulnerable people;
Priority 4 - We will support and stimulate our local economy;
Priority 5 - We will maintain the safety and security of our region;
Priority 6 - We will protect and sustain our environment.
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Seven Core Outcomes
1. Health
2. Prevalence
3. Recovery
4. CAPSM
5. Community Safety
6. Local Environment
7. Services
People are healthier and experience fewer risks as a result of
alcohol and drug use;
Fewer adults and children are drinking or using drugs at levels or
patterns that are damaging to themselves or others;
Individuals are improving their health, well-being and life chances by
recovering from problematic alcohol and drug use;
(Children Affected by Parental Substance Misuse)
Children and family members of people misusing alcohol and drugs
are safe, well supported and have improved life chances;
Communities and individuals are safe from alcohol and drug related
offending and anti-social behaviour;
People live in positive, health-promoting local environments where
alcohol and drugs are less readily available;
Alcohol and drugs services are high quality, continually improving,
efficient, evidence based and responsive, ensuring people move
through treatment into sustained recovery.
ADP Strategic Partners’ Outcomes
These are measured on an area wide basis, but are more directly linked to the services or activities of ADP
Partners including Social Work, Health, Education, Police, Third Sector.
1. Increased number of children in touch with services living in supportive and stable
households/ safe environments;
2. Increased participation in community activities for children affected by parental
substance misuse;
3. Improved school attendance and attainment in children affected by parental substance
misuse and in touch with service;
4. Reduced availability of alcohol;
5. Reduced alcohol and drug related violence and offences;
6. Reduced drug dealing in local area;
7. Fewer individuals drink above recommended daily and weekly guidelines;
8. Reduced mean per capita consumption;
9. Reduced acceptability of hazardous drinking and drunkenness;
10. Increased knowledge and changed attitudes to alcohol, drinking and drugs;
11. Reduced consumption in those below minimum legal purchase age;
12. Fewer women drinking/taking drugs during pregnancy;
13. Individuals in need receive timely, sensitive and appropriate support;
14. Reduction in drug use in local area;
15. Reductions in offending and re-offending associated with alcohol and drug misuse.
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Service Delivery Outcomes
Outcomes
linked to
recovery
Outcomes
linked to
prevention
1.
2.
3.
4.
5.
6.
Outcomes
linked to
children
1.
2.
3.
4.
5.
6.
7.
8.
Outcomes
linked to
enforcement
1.
2.
3.
4.
5.
Services make appropriate referrals to other support or treatment services when required and as
appropriate
Service users reduce chaotic or risky behaviour
Drugs
Service users stop drug misuse
Service users reduce drug use
Service users reduce drug related harm
Alcohol
Service users stop drinking alcohol
Service users reduce amount of alcohol drunk
Service users reduce alcohol related harm
Health
Service users have improved/no deterioration in health
Mental health
Service users have improved/no deterioration in mental health
Service users have increased self-awareness
Service users have increased confidence/self esteem
Social
Service users have improved/no deterioration in social functioning/personal relationships
Service users are more involved/included in their community
Finance and employment
Service users have improved financial status and stability
Service users have improved participation in meaningful activity
Service users have improved employability status (e.g. moved into employment /
voluntary work)
Service users have an increased awareness of work/training opportunities open to them
Service Users have improved engagement with education and training
Service Users have improved career aspirations
Service users have an improved understanding of their rights and responsibilities
Accommodation
Higher proportion of service users are living in safe, settled and appropriate (supported
and non-supported) accommodation
Increased knowledge of consequences and risks of alcohol consumption and drugs use in
participants of education programmes
Improved and increased engagement of participants with age appropriate social activity, positive
lifestyle, community activities
Fewer service users drink above recommended daily and weekly guidelines
Improved engagement of participants with learning
Improved parental and community engagement by service users
Service users are fully involved and participate in planning for their own sustainable recovery (i.e.
a person centred approach is used)
Improved parenting skills of service users
Increased identification and assessment of children affected by parental substance misuse
Increased number of children in touch with services living in supportive and stable
households/safe environments
Increased number of children in touch with services having positive relationships with their
substance misusing parents
Increased participation in community activities for children affected by parental substance misuse
Increase in children using services‟ self confidence, allowing them to be more resilient in their
situation
Increased recognition by parents in touch with services of the impact of their substance use on
their children
Improved school attendance and attainment in children affected by parental substance misuse
and in touch with services
Increase in the enforcement of current legislation
Managers and staff have increased knowledge of their legal obligations
Supply chain of drugs in local area disrupted
Increase in confiscation (seizure) of drugs and assets
Reductions in offending and re-offending associated with alcohol and drug misuse
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13.2 Appendix 2 – Templates, Tools and Frameworks
Example - Linking High Level Outcomes with Service delivery outcomes
The planning template would normally be used at a planning level or in a project context, to enable individual partners or groups of partners to
demonstrate their contribution to and links with a range of national and other high level outcomes. The example describes part of the planning
process for recovery focussed service development, describing the desired outcomes, how these link upward to higher level outcomes and
targets, as well as outlining the resources which would be required and the indicators which are available to evidence progress towards
achieving the general outcome.
The commissioning/ contract template would be used to establish the outcomes associated with a formal contract or Service Level Agreement.
The outcomes and indicators (columns 3 and 4) would be established by commissioners/ funders, based, for example, on service user and
strategic priorities. The activities and outputs (columns 1 and 2) would be largely developed by the provider, defining approaches and methods
which utilise the available resources and capacity. Measurement (column 5) would be negotiated and agreed between commissioners/ funders
and providers including targets, numbers etc and the means of collecting data or evidence.
The third template is an example of a template used to support a small, short term pilot project, involving a range of partners, but focussed on
a specific activity, in this case supporting and facilitating contact with services (by making appropriate referrals) for hard to reach groups,
particularly people experiencing homelessness and other forms of social exclusion. As the initiative is a pilot, targets are less defined, as the
focus is on gathering evidence of demand for such an approach, and assessing the methods employed.
The fourth template is an example of how to monitor community focussed/ Tier 1 prevention and public engagement activities.
Supporting these templates the ADP has a series of frameworks, linking the Scottish Government National Outcomes Toolkit with distinctive
areas of delivery, including Children and Young People, Enforcement & Availability, Public Engagement and Recovery. There is also guidance
on linking higher level (ADP Strategic Partners Outcomes (see above)) with the national toolkit.
All frameworks are available on www.dgadp.com
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Planning template for recovery focussed services
National / High level
Outcomes and / or
targets
SOA Priority/
Seven Core
Outcomes
ADP Strategic
Partners Outcomes
Reach
Outputs
Activities
Inputs
Notes
6. Longer healthier lives
7. Tackled inequalities
8. Improved life chances of those at risk
Priority 3 - We will care for and support older and vulnerable
people
HEAT target - A11
3. Recovery - Individuals are improving in their health ...
7. Services - people move through treatment into sustained
recovery ...
Services make appropriate referrals to other support or treatment services when required and as appropriate
Core services available on open access basis, so potentially anyone in the population experiencing
alcohol of drug problems.
ADP will ensure the availability of up to date/ accurate information
ADP will ensure that the following are in place (and adhered to):
- clear referral policies (including agreed frameworks/ timescales and referral pathways into
shared care);
- protocols for sharing information will be in place;
- clear understanding of HEAT targets and waiting times frameworks;
- Monitoring information and systems are agreed as part of contracts/ SLA‟s.
Services will ensure that all staff are adequately trained and supported to administer the above
functions.
ADP support team to compile from available sources (online, SDF etc) a list of all available services
and ensure its distribution;
All policies protocols to be adhered to in the course of service delivery, including all referrals being
received / made within agreed timescales;
All information will be delivered as required, using the agreed tools and fulfilling all local and national
expectations.
ADP resources, including:
- funding for Integrated Drug and Alcohol Services (statutory and third sector);
- funding for additional services (including talking therapies, moving on services, where
resources allow);
- Support through contract monitoring processes;
- officer support re waiting times, HEAT, and other monitoring requirements.
Indicators
Information about all
services is readily
available
Number of referrals to
other agencies
% assessed as in need of
services after 12 months
% of service users moved
on to other services
% of service users who
return within 3/6/etc
months
% of service users who
are happy to move on
from service/planned
discharges
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Commissioning/ contract template for recovery focussed services
(Example only, based on Camden Council - Sustainable Commissioning Model)
1. Activity
2. Outputs
3. Service Outcomes
Services make appropriate referrals to other
support or treatment services when required and
as appropriate
4. Possible Indicators
-
Service users reduce chaotic or risky behaviour
-
Drugs
Service users stop drug misuse
Service users reduce drug use
Service users reduce drug related harm
-
Alcohol
Service users stop drinking alcohol
Service users reduce amount of alcohol
drunk
Service users reduce alcohol related harm
-
Information about all services is readily
available
Number of referrals to other agencies
% assessed as in need of services after 12
months
% of service users moved on to other
services
% of service users who return within 3/6/etc
months
% of service users who are happy to move
on from service/planned discharges
% of those referred that have stopped
substance use
% of those referred that have reduced
substance use
proportion of intravenous drugs users
reporting sharing needles
routinely using needle exchange services
substance use
substance use
% of service users that protect themselves
from Blood Borne Viruses (BBV)
% of Service users with BBV that participate
in appropriate treatment
reporting sharing needles
Number of drug related deaths and/or drug
related overdoses
substance use
substance use
5. Ways of measuring
e.g.
Contract Monitoring
Outcomes Star
national data
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Outcome and monitoring template for recovery focussed pilot project/ small service
(based on Dumfries “Drop-in” service operated by Bethany Christian Trust)
High Level
Outcomes
Intermediate
(ADP) Outcomes
Short-Term
(service)
Outcomes
Reach
Outputs
Activities
Inputs
6. Longer healthier lives
7. Tackled inequalities
8. Improved life chances of those at risk
SOA Priority 3 - We will care for and support older and vulnerable people
Core 3. Recovery - Individuals are improving in their health ...
Core 7. Services - people move through treatment into sustained recovery ...
i. Reduction in drug use in local area
ii. Individuals in need receive timely, sensitive and appropriate support
iii. Increased knowledge and changed attitudes to alcohol, drinking and drugs
Service users
Services make
Improved
Service user have Service users have
Service users
Higher proportion
reduce chaotic appropriate
engagement of
improved / no
improved / no
have improved/
of service users
or risky
referrals to other participants with
deterioration in
deterioration in
no deterioration
are living in safe,
behaviour
treatment
learning and have
health
mental health
in social
settled and
(drugs &
services
improved
… increased self
functioning
appropriate
alcohol)
understanding of
awareness
accommodation
rights and
… increased
responsibilities
confidence/ self
esteem
Service available on a direct access/ drop-in basis to anyone experiencing homelessness in Dumfries and Galloway aimed at offering a
service user centred, integrated approach to tackling homelessness, substance misuse and other issues experienced by people who
are homeless
Maximum capacity per session is ….
Target to attain an average attendance of 90% of capacity
4 partner agencies will make use of consulting room and other facilities/ opportunities
Target to attain average of 10 service users taking up opportunistic contact with partner professionals each month
To ensure that 100% of regular volunteers have received full induction training within the first six months
To ensure that 50% of regular volunteers can evidence additional training within the first six months (e.g. counselling skills, alcohol/
drug awareness, mental health awareness, BBV training etc)
To provide a healthy meal and warm, safe, welcoming environment
To provide washing, showering and laundry facilities
To offer one to one contact with trained staff and volunteers
To provide confidential consulting/ interview rooms for use by professionals from partner agencies
To facilitate networking and partnership opportunities formally and informally for staff and volunteers from across a range of agencies
Public Health (BBVMCN) - £10,000
ADP - £10,000
Christian Care for the Homeless - £5,000
Bethany Christian Trust – Management costs, start up costs, training, publicity, fund raising, Volunteer Hours - Approximately 15 hours per
session
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Outcome Template for community/ Tier 1 prevention/ public engagement activities
(based on ADP funded community activities, 2010)
Improved health and well being.
Reduced incidents of drink driving, alcohol fuelled violence & alcohol related injury.
Reduced inequalities in healthy life expectancy.
High Level
Outcomes
BEHAVIOUR
Reduced alcohol consumption levels.
Reduced drunkenness, less drink driving etc
Intermediate
outcomes
Short-term
outcomes
Reach
Outputs
Activities
Inputs
Reduction in local
drink driving figures
Awareness of
campaign messages
Awareness of
responsibilities of
being a driver.
Consequences of
loosing licence
Access to alcohol free
events
Awareness of safe &
healthy options
Safer & more coordinated practice
Drivers within groups
of customers
accessing licensed
premises
NHS staff, key
partners & volunteers
at local level who may
deliver on alcohol
Local staff & community Young people drinking
by cascading knowledge
on the streets.
& skills around alcohol Parents of underage
misuse issues
drinkers.
Young Learner
drivers through local
academies.
Events attended by
approx 100 young
people
Creation of
merchandise
Count & report
uptake
Distribute SG Folder &
Pink Handbags
Highlight key issues
2 sessions delivered
to groups of 15
people – still ongoing
Monitor & evaluate
3 afternoon sessions
over 3 weeks
delivered
Culminating award
ceremony
2 events delivered at
the Oasis youth
centre
Evaluation positive
SPENT £500
SPENT £1400
SPENT £3500
Carried out sessions
over a two week
period.
Refer young people to
school nurse or
services
SPENT £2000
SPENT £300
SPENT £500
SPENT £500
Support 12 local
premises to promote
free soft drinks to the
driver in a group
Raise awareness to
key staff & partners of
female drinking
messages for
consistent delivery
Female Binge
Drinking Campaign
Support
Work in partnership
with ADAT & STRADA
to deliver Basic
Alcohol Training
courses
Alcohol Awareness
Training
Support the local
Police operation in
tackling underage
drinking
Deliver key alcohol
workshop relating to
driving safety
Work in partnership
to deliver alcohol free
events & key health
messages
Operation Bibedo
Young Drivers
Scheme
Bluelight Event
Work in partnership
with ADAT &
STRADA to deliver
Basic Alcohol
Training
Alcohol Awareness
Training
I’ll be DES.
Awareness of alcohol
messages & own
drinking choices.
Consistent delivery.
ENVIRONMENTS
Physical: reduced exposure to alcohol hazards
Social: drunkenness less attractive: sensible drinking the norm
Annandale & Eskdale
Reduction of risk to
local young people.
Parents awareness
raised of issues
Reduce youth
drinking
Awareness of
alcohol messages &
own drinking
choices.
Local staff &
community by
cascading knowledge
& skills around issues
2 sessions delivered
each to 15 people –
still ongoing
Monitor & evaluate
Dumfries & Lower Nithsdale
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13.3 Appendix 3 – Performance Monitoring Tools
Annual Action Plan Template (Example only)
Management Control and Governance
What will be done
Why it matters
Indicators
Resources required
Responsibility
Indicative Maturity Level
Level 4 attained Y/N
Y1
Y2
Y3
Review of ADP governance
arrangements (including
membership)
Transparency in all decision
making process
Finance & Resource Management
Financial commitments of all
partners identified and agreed
at least annually
Standardised Commissioning /
procurement framework in
place
Review of NHS Specialist Drug
and Alcohol Service, including
development of outcomes
based SLA
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PRINCE2® Maturity Model (P2MM) Maturity Level self assessment template (adapted)
Maturity Level
Benefits
Management
(Outcome
Delivery)
Performance and Monitoring
Stakeholder
Engagement
Risk
Management
Management
Control and
Governance
Finance and
Resource
Management
Level 5 Optimised
Start, end, route, process optimising, business process ownership,
integrated with strategic direction, lessons learned being applied,
continual improvement, common good for the organisation, seamless
and automatic, sustained, value based behaviour, evidence based
management, innovation
Level 4 Managed
Integration with corporate governance and functions, accurate
information, statistical analysis, competent & qualified staff,
assurance in place, business capacity management, exec board
level ownership, mentors, process management, strategic planning
alignment, approaches reviewed, consistent behaviour, quantitative
approach to management, collaboration, adapting
Level 3 Defined
Organisational wide consistency, process ownership, standards in
place (e.g. roles and responsibilities), processes defined with inputs
and outputs, central control group, consistent use of tools, guidelines
on how to do it, system framework, governance clearly defined,
capable staff, configuration system, evidence of Subject Matter
Experts, good communications and collaboration, strategic planning
links, perceptive approach to management, flexing
Level 2 Repeatable
Locally evolved, acknowledged approach, templates, ad-hoc training,
islands of expertise, initiatives delivered in isolation, minimal evidence
of continual improvement, simple activity based plans, focus may be
on start up and initial documentation, evidence of heroes, weak inter
working
Level 1 Recognised
Undocumented, basic vocabulary (not necessarily aligned or
consistent), no guidelines and supporting documentation. Any system
is ad-hoc and uncontrolled.
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Please contact the ADP Support Office on
01387 244351
to make arrangements for translation or for
the provision of information in larger type,
British Sign Language or on audio tape.
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ADP Strategy 2011-14
Draft Action Plan [version 1.2]
This Action Plan sits alongside the Dumfries and Galloway ADP Strategy 2011-14, which
lays out the vision for the development of the ADP’s work for the period. The Strategy has
been developed within the context of the Dumfries and Galloway Single Outcome
Agreement (SOA), reflecting the SOA reporting framework and using similar language (e.g.
“Ambitions” and “Actions”). It is also aligned to a range of national priorities and objectives, in
particular the seven core (national) outcomes listed below. The fulfilment of the ADP
Strategy is linked to three work streams, and these form the basis for this Action Plan, which
is intended to be focussed and practical.
Seven (National) Core Outcomes
1.
Health
2.
Prevalence
3.
Recovery
4.
CAPSM
Children
Affected by
Parental
Substance
Misuse
5.
Community
Safety
6.
Local
Environment
7.
Services
People are healthier and experience fewer risks as a result of alcohol and drug
use: a range of improvements to physical and mental health, as well wider wellbeing, should be experienced by individuals and communities where harmful drug
and alcohol use is being reduced, including fewer acute and long-term risks to
physical and mental health, and a reduced risk of drug or alcohol-related mortality.
Fewer adults and children are drinking or using drugs at levels or patterns that
are damaging to themselves or others: a reduction in the prevalence of harmful
levels of drug and alcohol use as a result of prevention, changing social attitudes,
and recovery is a vital intermediate outcome in delivering improved long-term health,
social and economic outcomes. Reducing the number of young people misusing
alcohol and drugs will also reduce health risks, improve life-chances and may reduce
the likelihood of individuals developing problematic use in the future.
Individuals are improving their health, well-being and life-chances by
recovering from problematic drug and alcohol use: a range of health,
psychological, social and economic improvements in well-being should be
experienced by individuals who are recovering from problematic drug and alcohol
use, including reduced consumption, fewer co-occurring health issues, improved
family relationships and parenting skills, stable housing; participation in education
and employment, and involvement in social and community activities.
Children and family members of people misusing alcohol and drugs are safe,
well-supported and have improved life-chances: this will include reducing the
risks and impact of drug and alcohol misuse on users’ children and other family
members; supporting the social, educational and economic potential of children and
other family members; and helping family members support the recovery of their
parents, children and significant others.
Communities and individuals are safe from alcohol and drug related offending
and anti-social behaviour: reducing alcohol and drug-related offending, reoffending and anti-social behaviour, including violence, acquisitive crime, drugdealing and driving while intoxicated, will make a positive contribution in ensuring
safer, stronger, happier and more resilient communities.
People live in positive, health-promoting local environments where alcohol and
drugs are less readily available: alcohol and drug misuse is less likely to develop
and recovery from problematic use is more likely to be successful in strong, resilient
communities where healthy lifestyles and wider well-being are promoted, where there
are opportunities to participate in meaningful activities, and where alcohol and drugs
are less readily available. Recovery will not be stigmatised, but supported and
championed in the community.
Alcohol and drugs services are high quality, continually improving, efficient,
evidence-based and responsive, ensuring people move through treatment into
sustained recovery: services should offer timely, sensitive and appropriate support,
which meets the needs of different local groups (including those with particular needs
according to their age, gender, disability, health, race, ethnicity and sexual
orientation) and facilitates their recovery. Services should use local data and
evidence to make decisions about service improvement and re-design.
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Seven (ADP) Supporting Outcomes
8.
Measuring
Local Outcomes
9.
Contextualising
Recovery
10.
Engaging with
communities of
interest
11.
Robust
Commissioning
12.
Managing
Finance and
Resources
13.
14.
Assessing Risk
Management
Control and
Governance
The ADP requires systems which ensure that the desired outcomes for the
ADP are clear and measurable, and that those outcomes are demonstrable.
There needs to be a clear understanding of how the outputs and activities of the
ADP will achieve results in terms of the long term benefits related to the two
strands of prevention and recovery, underpinning short term outcomes which will
improve the lives of those affected by substance misuse, and the longer term
vision of communities where alcohol and drug misuse are reduced to the benefit
of all.
The ADP is committed to ensuring that the recovery agenda is broadened
to include other services, interventions and supports which may be
important to individuals. These include:
Talking therapies - the development of enhanced approaches to the provision of
“talking therapies” (including psychology, Cognitive Behavioural Therapy,
counselling and mutual aid groups);
Housing - the creation of better links with housing services, including housing
providers, housing support and homelessness services;
Families - more support for families and the involvement of families in recovery
activities;
Alternative activities - better access to constructive and diversionary activities;
Education and employment - wider access to education, training and
employability opportunities.
Stakeholders at every level, within and outside ADP structures, need to be
engaged with effectively in order to ensure that decisions are well informed
and relevant. This includes an ongoing commitment to service user
involvement, engaging with families and carers, engaging with third sector and
statutory sector partners through the various structures and processes of the
ADP and ensuring that processes for engaging with the wider communities of
Dumfries and Galloway are improved.
This will be carried out through the use of a range of communication tools and
techniques, and will be done in accordance with National Standards for
Community Engagement and in compliance with the National Quality Standards
for Substance Misuse Services.
The ADP will align its strategy development with planning and
commissioning processes. The ADP has a key strategic role in ensuring that
commissioning priorities are clear and that processes are supported and
informed at a strategic level, with any subsequent contracts monitored against
outcomes and targets which are relevant to its strategy. Such an approach must
be consistent with the programme/ project management model and based on
sound planning cycles.
The ADP is committed to ensuring that all of its resources are targeted to
activities and interventions which respond to the greatest needs. This
includes the financial resources for which it is responsible. With decisions based
on good information (for example; needs assessments and performance
management information).
The ADP will operate within the financial frameworks of Dumfries and Galloway
Council and NHS Dumfries and Galloway, as well as having accountability to
national regulatory requirements including those of Audit Scotland.
The ADP recognises the need to manage threats and opportunities which
arise. These may emerge from developing trends and statistics, information
gathered from various engagement processes or from changes in local and
national policy.
This will require the ADP to develop systems for identifying those risks, thereby
minimising the impact of threats and maximising the opportunities. The
management of risk needs to become an embedded part of the ADP’s activities
and contribute to its decision making processes.
The ADP will ensure that systems and processes are in place to guide and
control its work. This includes leadership and direction, setting boundaries and
ensuring activities are subject to review. Governance sets this within a wider
context, considering how the work of the ADP is accountable to its partners,
Page 2 of 12 including Dumfries and Galloway Council, NHS Dumfries and Galloway, the
Scottish Government, and Third Sector partners.
Stream 1 - Benefits management (Outcome delivery)
Ambition
(Outcome)
Actions
Ambition
(Outcome)
Actions
Ambition
(Outcome)
Actions
Ambition
(Outcome)
Activities within this workstream are intended to ensure that the ADP’s outcomes are clear
and measurable in the two related areas of prevention and recovery. The overarching
objectives are that fewer people will develop drug and alcohol related problems, and that for
those who do, effective interventions will mean that more people recover. These objectives
are expressed as a series of “Actions - what we will do”, reflecting the terminology of the
SOA.
Actions
313
1. Health
People are healthier and experience fewer risks as a result of alcohol and drug use
(for individuals and communities)
Compliance with
HEAT H4
(2011/12 only)
Improvements in
physical and
emotional health
Improvements in
general wellbeing
Fewer acute and
long terms risks to
physical and
emotional health
Reduced risk of
drug and alcohol
mortality
2. Prevalence
Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to
themselves or others
Reduction in the
prevalence of harmful
levels of drug and
alcohol use
Changed social
attitudes to alcohol and
drug use
Recovery established
as an intermediate
outcome
Reducing number of
young people using
drugs or alcohol
3. Recovery
Individuals are improving their health, well-being and life chances by recovering from problematic
(Also linked with 10. Contextualising Recovery)
Individuals
reduce
consumption
of drugs and
alcohol
Fewer cooccurring
health issues
(emotional and
physical)
Improved
family
relationships
Increase in
individuals
with stable
housing
Increase in
individuals
participating in
education and
employment
Increased
involvement in
social and
community
activities
4. CAPSM
Children and family members of people misusing alcohol and drugs are safe, well supported and have
improved life chances
Reducing the risks
and impact of drug
and alcohol misuse
on users’ children
and other family
members
Supporting the
social, educational
and economic
potential of children
and other family
members
Helping family
members support
the recovery of their
parents, children
and significant
others
Ensuring shared processes are in
place to protect vulnerable people,
including: Adult Support and
Protection, Child Protection and
Domestic Abuse and Violence
against Women
Page 3 of 12 314
Ambition
(Outcome)
7. Services
Alcohol and drugs services are high quality, continually improving, efficient, evidence based and
responsive, ensuring people move through treatment into sustained recovery
SOA Target
Actions
Ambition
(Outcome)
Actions
Compliance with H11
Services should offer timely,
sensitive and appropriate
support, which meets the needs
of different local groups
Services should use local data
and evidence to make decisions
about service improvement and
re-design
8. Measuring Local Outcomes
The ADP requires systems which ensure that the desired outcomes for the ADP are clear and
measurable, and that those outcomes are demonstrable
Standardised outcomes monitoring tool in place
for all ADP funded partners.
Outcomes focussed contracts and service level
agreements in place for all ADP funded services.
Actions
(What we will do)
Performance
(How we will
know)
Responsibility
(Who will do it)
Key target
(What and when
will we do it)
Compliance with HEAT
H4
Number of alcohol brief
interventions (ABI)
NHS D&G and ADP
1629 ABI’s by March
2012
The number of drug
related deaths. (3 year average 2008‐10) (Numbers are low, but
can fluctuate from year
to year)
ADP, supported by
partners on the DrugRelated Review group
Baseline 8 Resources
required
Improvements in physical
and emotional health
Improvements in general
wellbeing
SOA Target
Fewer acute and long
terms risks to physical
and emotional health
Reduced risk of drug and
alcohol mortality
Year on year improvement throughout life of SOA
Reduction in the
prevalence of harmful
levels of drug and alcohol
use
Changed social attitudes
to alcohol and drug use
Recovery established as
an intermediate outcome
Page 4 of 12 315
Reducing number of
young people using drugs
Individuals reduce
consumption of drugs and
alcohol
Fewer co-occurring health
issues (emotional and
physical)
Improved family
relationships
Increase in individuals
with stable housing
Increase in individuals
participating in education
and employment
Increased involvement in
social and community
activities
SOA Target
Reducing the risks and
impact of drug and
alcohol misuse on users’
children and other family
members
Supporting the social,
educational and economic
potential of children and
other family members
Rate of maternities
recording drug misuse
(Rate per 1000
maternities, 3 year
average 2006-09)
Child Protection
Committee and Alcohol
and Drugs Partnership
Baseline 8.9
Year on year
improvement
throughout life of SOA
Helping family members
support the recovery of
their parents, children and
significant others
Ensuring shared
processes are in place to
protect vulnerable people,
including: Adult Support
and Protection, Child
Protection and Domestic
Abuse and Violence
against Women
Page 5 of 12 316
People approaching
services with alcohol
and drug related
problems will be
offered appropriate
interventions within the
time frames
established by the
Scottish Government
NHS Dumfries and
Galloway, supported
by ADP Partners
By March 2013, 90%
of clients will wait no
longer than 3 weeks
from referral received
to appropriate drug or
alcohol treatment that
supports their recovery
Standardised outcomes
monitoring tool in place
for all ADP funded
partners.
STAR Outcomes tool
agreed by all partners;
Research &
Information Officer to
coordinate in
partnership with
Service Managers
Tool implemented
within Y1
Outcomes focussed
contracts and service
level agreements in place
for all ADP funded
services.
All services will be
based on contracts
and SLA, with
appropriate monitoring
process in place to
ensure compliance
with agreed standards
and outcomes
Policy Officer to
coordinate, in
partnership with
Services
From Y1 all funded
third sector services
will have outcomes
based contracts (with
SLA) in place;
SOA Target
Compliance with HEAT
A11
Services should offer
timely, sensitive and
appropriate support,
which meets the needs of
different local groups
Services should use local
data and evidence to
make decisions about
service improvement and
re-design
Training completed for
all required staff;
£5K Y1 for Training
and licences;
£1.5K Y2 and Y3 for
licences
Officer and Service
Manager time required
for development and
ongoing monitoring
From Y2 all funded
statutory sector
services (NHS, SPS,
SWS etc) will have
outcomes based SLA’s
in place
Page 6 of 12 Stream 2 - Stakeholder Engagement
Ambition
(Outcome)
Reducing alcohol and drugrelated offending (including
violence, acquisitive crime, drugdealing and driving while
intoxicated)
Ambition
(Outcome)
Actions
Ambition
(Outcome)
Actions
Ambition
(Outcome)
5. Community Safety
Communities and individuals are safe from alcohol and drug related offending and anti-social behaviour
Actions
Stakeholders at every level need to be engaged with effectively to ensure that decision
making is well informed, and that people within our communities are more aware about drug
and alcohol issues. The ADP would wish to engage with service users, families and carers,
frontline staff involved in drug and alcohol work, statutory and third sector partners and wider
communities.
Actions
317
Reducing alcohol and drugrelated re-offending
Reducing alcohol and drugrelated anti-social behaviour
6. Local Environment
People live in positive, health-promoting local environments where alcohol and drugs are less readily
available
Healthy lifestyles and
wider well-being are
promoted
Increased opportunities
to participate in
meaningful activities
Alcohol and drugs are
less readily available
Strong partnerships are
established with local
licensing bodies,
including boards,
forums and LO’s.
9. Contextualising Recovery
The ADP is committed to ensuring that the recovery agenda is broadened to include other services,
interventions and supports which may be important to individuals
(Also linked to 3. Recovery)
Wider range of
therapeutic
approaches are
offered, including
effective talking
therapies
Improved support
for families
affected by others’
substance use
Development of
better links with
Housing, Housing
support and
homelessness
services
Improved
partnership
working with
training,
employment and
employability
agencies
Stronger links with
social support
agencies/
activities (e.g.
befriending,
community groups
etc)
10. Engaging with Communities of Interest
Stakeholders at every level, within and outside ADP structures, need to be engaged with effectively in
order to ensure that decisions are well informed and relevant
Engagement
with Service
Users
Engagement
with Families
and carers
Engaging with
statutory and
third sector
partners
(including with
front line staff)
Ensuring wider communities
and the public in general are
better informed, contributing to
changed social attitudes to
Partnership
with local
licensing
bodies
Page 7 of 12 SOA Target
318
Actions
(What we will do)
Performance
(How we will
know)
Responsibility
(Who will do it)
Key target
(What and when
will we do it)
Reducing alcohol and
drug-related offending
(including violence,
acquisitive crime, drugdealing and driving while
intoxicated)
Number of supply and
possession with intent
to supply offences
recorded.
D&G Constabulary
Baseline 309
Alcohol and Drugs
Partnership
Year on year
improvement
D&G Constabulary
Number of alcohol
related ASB incidents
Resources
required
(3 year average 200810)
Alcohol and drugs are
less readily available
drug-related re-offending
SOA Target
drug-related anti-social
behaviour
Number of alcohol
related incidents
•
•
Number of alcohol
related ASB
incidents
Number of alcohol
related violent
crimes
(3 year averages 200810)
Alcohol and Drugs
Partnership
Baseline 244
Number of alcohol
related violent crimes
Baseline 40
Year on year
improvements
Healthy lifestyles and
wider well-being are
promoted
Increased opportunities to
participate in meaningful
activities
Strong partnerships are
established with local
licensing bodies, including
boards, forums and LO’s.
Wider range of
therapeutic approaches
are offered, including
effective talking therapies
Improved support for
families affected by
others’ substance use
Development of better
links with Housing,
Housing support and
homelessness services
Page 8 of 12 319
Improved partnership
working with training,
employment and
employability agencies
Stronger links with social
support agencies/
activities (e.g. befriending,
community groups etc)
Engagement with Service
Users
Engagement with
Families and carers
Engaging with statutory
and third sector partners
(including with front line
staff)
Ensuring wider
communities and the
public in general are
better informed,
contributing to changed
social attitudes to alcohol
and drug use
Partnership with local
licensing bodies
Page 9 of 12 Stream 3 - Strategic Performance and Monitoring
Ambition
(Outcome)
Actions
Ambition
(Outcome)
Actions
Ambition
(Outcome)
Activities within this workstream are intended to ensure that the ADP’s work is carried out in
a transparent and accountable way. Much of this work supports the delivery of good
outcomes through the creation of systems which ensure quality of delivery and clear
reporting of the impacts of the work that ADP partners do.
11. Robust Commissioning
The ADP will align its strategy development with planning and commissioning processes
Standardised outcomes monitoring tool in place
for all funded partners
Financial commitment
of all partners agreed
annually
Annual budgets agreed
by ADP
Standardised
Outcomes based
commissioning
processes for all
services
Standard processes/
standing orders for
small grants/ short-term
funding (including
evaluation and
outcomes)
13. Assessing Risk
The ADP recognises the need to manage threats and opportunities which arise
Actions
Ambition
(Outcome)
Outcomes focussed contracts and service level
agreements
12. Managing Finance and resources
The ADP is committed to ensuring that all of its resources are targeted to activities and interventions
which respond to the greatest needs
Annual risk assessment process instigated
Actions
320
Review processes/ cycles established for all key
services (NHS, Third Sector/ ISS)
14. Management Control and Governance
The ADP will ensure that systems and processes are in place to guide and control its work
Review ADP
governance and
standing orders
Review and
update needs
assessment
Review strategy
implementation
Review of
Recognised
Partners List and
strengthening of
links with NQS
Compliance with
reporting
processes for
Scottish
Government
Page 10 of 12 321
Actions
(What we will do)
Performance
(How we will know)
Responsibility
(Who will do it)
Key Target
(Indicative Maturity
Level 4 attained Y/N)
Y1
Standardised
outcomes
monitoring tool
in place for all
funded partners
STAR Outcomes tool agreed
by all partners;
Training completed for all
required staff;
Y2
Resources
required
Y3
Research & Information
Officer to coordinate in
partnership with Service
Managers
£5K Y1 for Training
and licences;
Policy Officer to coordinate,
in partnership with
commissioning procurement,
legal services and service
providers
Officer time required
for development and
ongoing monitoring
Lead Officer, reporting to
ADP
ADP
£1.5K Y2 and Y3 for
licences
Tool implemented within Y1
Outcomes
focussed
contracts and
service level
agreements
From Y1 all funded third
sector services will have
outcomes based contracts
(with SLA) in place;
Financial
commitment of
all partners
agreed annually
During Y1 a framework
agreement will be developed
with partners;
From Y2 all funded statutory
sector services (NHS, SPS,
SWS etc) will have
outcomes based SLA’s in
place
provisional commitments for
Y2 agreed by Q4 of Y1;
provisional commitments for
Y3 agreed by Q4 of Y2
Annual budgets
agreed by ADP
Provisional budget for Y2
developed during Q4 of Y1;
Provisional budget for Y3
developed during Q4 of Y2;
Standardised
Outcomes
based
commissioning
processes for all
services
Within Y1 a standardised
framework will be created as
a basis for future
commissioning
Policy Officer
Standard
processes/
standing orders
for small grants/
short-term
funding
(including
evaluation and
outcomes)
Within Y1 standardised
processes will be created as
a basis for future small
grants etc.
Policy Officer
Annual risk
assessment
process
instigated
Within Y1 a risk model will
be agreed;
Policy Officer, reporting to
ADP
Y2 and Y3 annual risk
assessment exercise
completed in Q4 or
Page 11 of 12 322
preceding year to support
planning processes
Review
processes/
cycles
established for
all key services
(NHS, Third
Sector, ISS)
Within Y1 a review process,
and schedule will be agreed;
Review ADP
governance and
standing orders
Within Y1 revised standing
orders, incorporating outline
financial arrangements will
be presented to the ADP;
Finance and Planning Group
Policy Officer, reporting to
ADP
Lead Officer and Research
& Information Officer
reporting to ADP
Y2 and Y3 annual review
exercises will be completed
In Y2 and Y3 the ADP will
review arrangements at
least annually
Review and
update needs
assessment
Within Y1 gaps in the most
recent Needs Assessment
will be identified;
Y2 Workforce needs
assessment to be completed
Y3 Comprehensive needs
Assessment to be
completed by end of Q2 to
support forward planning
Review strategy
implementation
Annual report presented to
the ADP in each year Q1
Policy Officer reporting to
ADP
Review of
Recognised
Partners List
and
strengthening of
links with NQS
RPL reviewed at least
annually (or as required)
with update contained with
annual report to ADP
Policy Officer reporting to
ADP
Lead Officer reporting to
ADP and to SG
Compliance with
reporting
processes for
Scottish
Government
Page 12 of 12

DUMFRIES AND GALLOWAY NHS BOARD

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