7b
Delivering for Quality
Integrated Performance Report
January 2016
Page 1
Contents
Page(s)
Executive Summary
3-4
Section A – LDP Standards Performance Summary
5-7
Targets on Track Short Report
8
Chief Executive’s Performance Escalation
Colour Coding Key
9
Cancer 62-Day RTT
10 - 11
18 Weeks RTT
12
Patient TTG
13 - 14
Outpatient Waiting Times
15 - 16
A&E 4-Hour Waits
17
HAI Sabs / HAI Report
18 - 31
Sickness Absence / Workforce
32 - 41
Dementia
42 - 43
Delayed Discharge
44 - 45
Smoking Cessation
46
Alcohol Brief Interventions
47
CAMHS Waiting Times
48
Psychological Therapies Waiting Times
49 - 50
Section B - Capital Programme
52 - 56
Section C - Financial Position
57 - 63
Section D - Scottish Patient Safety Programme
64 - 72
Section E - FOI
73 - 74
Section F - Complaints
75 - 78
Section G - Programme Management Initiatives
79 - 81
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EXECUTIVE SUMMARY
OBJECTIVE OF THE REPORT
The object of the Integrated Performance Report (IPR) is to provide assurance to the Board
on the overall performance of NHS Fife against the corporate aims relating to National
Standards (as described in the Local Delivery Plan), local priorities and significant risks.
INTRODUCTION
This report is comprised of Sections A to G as per the Contents page.
In compiling this report, the most up to date information is used to populate the various
sections. Due to different reporting timetables, the most current month’s information is not
always available.
The Executive Directors Group reviews the Board’s performance every month prior to
presentation to the Board or Finance and Resources Committee. This process is further
supported by the scrutiny undertaken by the Acute Services Division and Health and Social
Care Services.
KEY PERFORMANCE OBSERVATIONS
In considering the December performance, the following areas for highlighting have been
noted:
Section A – LDP Standards:

The continued sustainment of A&E Waiting Times performance above 95%

There is a continuing improvement in Outpatients Waiting Times, with over 93% of
patients waiting no more than 12 weeks at month end, the highest figure of the FY to
date

There have been no Diagnostics Waiting Times 6-week breaches for the third
successive month

There is a continuing improvement against the CAMHS target (now at 80.7% against
a target of 90% and Psychological Therapies Waiting Times standards, which have
improved from 69.8% in November to 71.1% in December.

There is an improvement in the Cancer 62-Day RTT performance which is now
recording 90.8 % in December compared to 87.3% in November

There has been a slight increase, from 43 to 45 patients in delay over 14 days
compared to last month

The number of patients failing to meet the 12 week TTG target has increased to 15 in
December compared to 8 in November

The increase in HAI Sabs infections rate is continuing from 0.38 in November to 0.4
in December

There has been a significant increase in the number of Alcohol Brief Interventions
delivered in Q3, with the total number delivered now at 3916, being above plan and
close to the full-year target of 4187.

The nationally produced sickness absence figure for NHS Fife for December 2015 is
5.44% and while this is an increase of 0.15% from the November 2015 figure of
5.29%. NHS Fife’s rate remains below the NHS Scotland average. Both November
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and December has seen the workforce subject to both norovirus and other
respiratory illnesses that were highly prevalent across the community during this
period.
Section B – Capital:
The overall programme continues to be in line with the plan to deliver the target against the
CRL.
Section C – Financial Position to 31 January 2016:
The in-month position continues to be in line with previous months reports at an overspend
of £1.927m and with the level of outstanding efficiency savings required reducing. The yearend outturn forecast to deliver a break even position continues to be challenging with a
further adverse movement this month in prescribing overspend.
Section F – Complaints:
There has been a further improvement in the 20-day complaints response rate from 52% in
November to 60% in December.
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SECTION A: LDP STANDARDS PERFORMANCE SUMMARY
The source of data in the IPR is either from validated published sources or is local management information from a variety of internal sources. It
is important to note that whilst local management information provides a more up to date position, data validation processes may not have been
completed and this information may therefore be subject to change.
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TARGETS ON TRACK
NHS Fife continues to meet or perform ahead of the following National Targets and
Standards:
Antenatal Access: at least 80% of pregnant women in each SIMD quintile will book for
antenatal care by the 12th week of gestation
Local management information shows that NHS Fife has continued to record a performance level
of over 80% in all SIMD quintiles. The lowest-performing quintile for the 3-month period ending
October 2015 was Quintile 3 (Quintile 1 is most-deprived, Quintile 5 is least-deprived), with a figure
of 83.7%. The highest-performing quintile was Quintile 2 (91.4%), while the overall NHS Fife figure
was 88.2%.
HAI: we will achieve a maximum rate of C diff infection in the over 15s of 0.32
Local management data for the year ending January indicates a C difficile rate of 0.24, significantly
better than the standard of 0.32.
IVF: no eligible patient will wait longer than 12 months for screening following referral from
Secondary Care
All NHS Fife patients continue to be screened within 12 months, via the service run by NHS
Tayside, with 68 patients having been screened in 2015-16 up to the end of December. The latest
management information showed that 16 patients were on the waiting list, none of whom had
waited more than 12 months.
Cancer Waiting Times - we will treat any cancer patient within 31 days of decision to treat
Local management information shows that NHS Fife has exceeded the 95% standard in every
month of 2015-16 to date, the most recent monthly figures being 95.3% (November) and 99.0%
(December).
Drug and Alcohol Waiting Times: at least 90% of clients will wait no longer than 3 weeks
from referral to treatment
The December ISD publication showed that 98.6% of patients were seen within 3 weeks of referral
for treatment between July and September. This remains significantly above the 90% standard, a
position NHS Fife has sustained since the start of 2013. We remain in the top quartile of Health
Boards as far as performance against this standard is concerned, despite first appointments
increasing year-on-year by around 20%. For Drugs alone, the increase was almost 40%.
Diagnostics Waiting Times: No patient will wait more than 6 weeks to receive one of the 8
key diagnostic tests - barium studies, non-obstetric ultrasound, CT, MRI, upper endoscopy,
lower endoscopy, colonoscopy, cystoscopy
No patients were waiting more than 6 weeks for a test at the end of December, the third successive
month the standard has been achieved. The total number of patients on the list rose slightly, with
over 85% of the 3,922 patients waiting for a CT Scan, MRI or Non-Obstetric Ultrasound test.
Detect Cancer Early: at least 29% of cancer patients will be diagnosed and treated in the
first stage of breast, colorectal and lung cancer
The measure for this target covers a rolling 2-year period, and the NHS Fife target of 29% covers
2014 and 2015. Local management information for the 2-year period ending September 2015
shows that we remained slightly behind plan, though improving in both Breast and Lung specialties
since the last update. The Stage 1 Detection Rate for Lung Cancer was 20.1%, more than twice
the measurement at the base time of December 2011.
Page 8
CHIEF EXECUTIVE’S PERFORMANCE ESCALATION
In the following sections, cells in the Recovery Trajectory tables and Recovery Plan charts
are shaded as follows:
Recovery Trajectory
Recovery Plan
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ACUTE SERVICES
CLINICAL ACCESS & SUPPORT
CANCER 62 DAY REFERRAL TO TREATMENT
At least 95% of patients urgently referred with a suspicion of cancer will start
treatment within 62 days
Key Concerns & Risks
As described in previous reports there are a number of areas of risk in achieving this target,
namely around Urology and more recently Gynaecology and Head & Neck Cancers due to
liaison with tertiary providers, visiting oncology capacity and surgical capacity.
Performance against the 62-day target remains a significant challenge.
Recovery Trajectory
Recovery Plan
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Situational Analysis
In the recovery plan for this target there are 7 actions which have a Red or Amber RAG
status.
Challenges with vacancies in Respiratory medicine continue with interim arrangements in
place to release capacity to enable urgent outpatients slots to be maintained. A locum has
been appointed and targeted additional activity continues which has resulted in improvement
in waits to 1st appointment. Respiratory posts are advertised and the timescale for interviews
is March. The actions taken have moved the status from Amber to Green.
The review of EBUS provision in NHS Fife is delayed until the current vacancies have been
addressed.
A draft Outline Business Case for Robotic Assisted Laparoscopic Prostatectomy within
SEAT has been developed. This is being taken forward at a regional Level and a Fife based
consultant has been identified to be trained to undertake these procedures. This has moved
this status from Red to Amber.
A new administrative support structure has been implemented in urology and it is anticipated
that these actions will move the status for action 2.6 from Amber to Green
Patients who have been delayed in the initial part of their pathway are now progressing to
treatment however this together with the increased throughput of general urology outpatients
has resulted in increased demand for surgery. This will result in deterioration in performance
in the next few months. The status remains at Amber for surgical capacity.
Waits for urology oncology appointments continue to be a challenge. The review of oncology
provision as a whole is underway and additional capacity is being provided when possible.
A solution to allow electronic referrals between Boards has been investigated and is unlikely
until a replacement PAS system is implemented in 2017. An alternative solution has
improved the speed of communications and has moved this status from Red to Amber.
The GP direct access to imaging is a national project there has been a delay at national level
and there is no revised timescale available. This has moved from Amber to Red.
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18 WEEKS REFERRAL TO TREATMENT
At least 90% of planned/elective patients will commence treatment within 18 weeks of
referral
Following three successive months when performance was above trajectory, we slipped
behind plan in August, and have remained behind since. Performance improved in
December.
Key Concerns & Risks
As previously reported the key specialties at risk of not meeting 18 weeks RTT are Urology,
Oral Surgery, General Surgery, Vascular Surgery, Neurology and Respiratory. This is driven
by vacancies, increasing demand and an ongoing demand-capacity gap.
Additional activity continues to be undertaken to improve and sustain outpatient, diagnostic
and inpatient/daycase waiting times. The positive impact of this was seen in December and
should continue for the rest of Quarter 4. NHS Fife continues to meet with Scottish
Government regarding resilience around this target and discussion continues regarding the
size and resourcing of the demand-capacity gap.
Recovery Trajectory
Recovery Plan
The Recovery Plan for 18 Weeks RTT is covered by the delivery of the Patient Treatment
Time Guarantee and Outpatient Waiting Times Recovery Plans shown in the relevant
sections on the following pages.
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PATIENT TREATMENT TIME GUARANTEE
We will ensure that all eligible patients receive inpatient or day case treatment within 12
weeks of such treatment being agreed
Performance in December and January slipped behind trajectory after 7 months of being on or
ahead of plan.
Key Concerns & Risks
At risk specialties for Inpatients and Day Cases are Orthopaedics, General Surgery, Urology,
Ophthalmology and Gynaecology. There is increased demand for inpatient and day case
procedures as a result of additional outpatient activity undertaken and balancing elective capacity
due to pressure on beds.
Additional activity is being undertaken internally when possible to manage this increase in demand.
This is not as resilient as we would wish due to issues such as the availability of anaesthetic cover,
use of locums, availability of Operating Department Practitioner (ODP) staff and availability of beds
during winter months. It is likely that this pressure will continue until the end of March.
Recovery Trajectory
Recovery Plan
Situational Analysis
There are 5 actions which have an Amber RAG status.
Efforts continue to deliver sufficient additional activity internally to meet the increased demand for
inpatient and day case activity resulting from the outpatient work undertaken. It is a significant
challenge to provide the volume of additional activity required internally to meet this demand
particularly at a time of increased pressure on beds which is reflected in the continued Amber
status.
Active recruitment to a number of consultant posts is underway as potential candidates have been
identified. The timescale for recruitment has been extended to March.
The use of other healthcare providers continues to be considered if appropriate but there is
currently limited capacity for inpatient and day case work and limited resources available to
undertake this. This is reflected in the continued Amber status.
The Day Surgery clinical group continues to meet monthly with the aim of improving usage of the
Day Surgery Unit in QMH and improvements are being implemented in terms of theatre utilisation,
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pre-assessment and procedure selection. It is anticipated that this action will move this measure
from Amber to Green RAG within the revised timescale.
The action to transfer Phase 2 to Phase 3 theatres is being explored via the review of theatres as
part of the Optimising Surgical Efficiencies project. The timescale for this has been extended.
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OUTPATIENT WAITING TIMES
At least 95% of patients (stretch target of 100%) will have their first outpatient appointment
within 12 weeks of referral. Additionally, we must eradicate waits over 16 weeks.
Key Concerns & Risks
Performance in outpatients has improved month on month for the last 6 months.
The at-risk specialties are Urology, Dermatology, Neurology, Gastroenterology, Cardiology and
Respiratory Medicine. Recruitment into Consultant vacancies in key specialties is particularly
challenging.
Whilst there has been a significant improvement in performance in the at risk specialties, work
continues to clear the remaining backlog particularly in Neurology, Gastroenterology, Urology and
Respiratory Medicine, as well as sustainable solutions to meet the ongoing gap in outpatient
capacity.
Activity is being outsourced and local waiting times initiatives continue in all of the at-risk
specialties. Given the size of the challenge the timescale for delivery of improvement has been
extended until March.
Recovery Trajectory
Recovery Plan
Situational Analysis
The recovery plan shows that 3 actions are rated as Amber for delivery.
The focus continues to be on recovery of the backlog in outpatients waiting over 12 weeks and
plans are in place for additional activity to deliver further improvements by March. This remains
highly dependent on the availability of skilled workforce across a number of specialties and
departments.
Work by directorates to identify solutions to meet the gap in outpatient capacity continues but
consultant vacancies in a number of key specialities is making planning for this a significant
challenge reflecting the continued Amber status.
There is an active programme of work in place to redesign the urology DTC with an extended
timescale for delivery of March. The number of outpatients waiting over 12 weeks continues to
improve.
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Recruitment to vacant consultant posts continues to be a challenge. Adverts have been placed for
Gastroenterology and Respiratory but there are difficulties in recruiting to Cardiology and
Neurology, reflected in the continuing Amber status for this action.
The outpatient redesign work is a three year programme. Resource to support project
Management is being put in place to support the development and delivery of this work. Once in
place this will move this action to Green.
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EMERGENCY CARE
A&E 4-HOUR WAITING TIME
At least 95% of patients (stretch target of 98%) will wait less than 4 hours from arrival to
admission, discharge, or transfer for accident and emergency treatment
For 9 successive months performance has been ahead of trajectory and is on target to achieve the
year end required performance.
Key Concerns & Risks
A number of risks remain in the system including recruitment to vacant medical posts across the
Directorate, admission numbers, flexibility of the ambulance service response to same day
discharge and a significant increase in the number of patients in delay.
Recovery Trajectory
Note that the ‘Actual Performance’ figures shown are 12-month averages, not figures for the
individual months.
The performance figure for all Fife for the single month of January was 94.1%, with the ED at VHK
itself recording a performance of 92.0%, the lowest this year. The combined monthly performance
in all A&E and MIU sites has exceeded 95% in every month of 2015-16 to date.
Detailed work is underway to minimize misdirections to the Emergency Department which will
encompass internal transfers and primary care.
The additional discharge vehicle and internal transport option have proven invaluable since their
introduction in October. This resource is being supplemented on an ad hoc basis by the ambulance
service at weekends.
The new assessment model in AU1 continues to discharge 30% of new patients on the day of
admission. ECAS continues to expand the range of interventions available preventing short-stay
emergency admissions to hospital.
Recovery Plan
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BOARD WIDE
HAI SABS
We will achieve a maximum rate of staphylococcus aureas bacteraemia (including MRSA) of
0.24
Key Concerns & Risks
The actions described will support the reductions in preventable (hospital acquired) SAB numbers
being maintained and increased. Infections related to invasive devices such as peripheral venous
cannulae (PVC) constitute the single biggest preventable cause and are a particular area of focus.
Hospital SABs made up 32% of the total in the last twelve months (35 of 108), with the remainder
arising spontaneously in the community. There is a risk that community case numbers may negate
gains made through hospital improvement programmes.
Recovery Trajectory
Recovery Plan
Situational Analysis
Various improvement initiatives have been started in order to address areas of concern in relation
to the incidence of SAB infections. It is hoped that these will result in reduced infections in 2016.
The collaborative work is looking at early intervention in needle exchange schemes to see if this
can identify localised infection and offer treatment to prevent invasive infection in the intravenous
drug population. Other Health Boards will be involved in this study. This work remains at the early
stages of implementation.
Where any improvements are noted, areas of good practice will be shared with peers. Continuing
and new challenges will also be reported widely.
Page 18
NHS Scotland HAI Reporting Template (HAIRT)
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.
1.
Key Healthcare Associated Infection Headlines for January 2016
1.1
Achievements

The C difficile HEAT target for March 2015 was surpassed and rates continue to fall; NHS
Fife is on target to meet the Local Delivery Plan (LDP) standard for this FY

The MRSA Screening Key Performance Indicator (KPI) was again surpassed by Fife staff
1.2
Challenges

SAB case rates continue to rise (primarily from community sources). PVC related SABs are
being identified as an ongoing issue. A number of multi-agency improvement initiatives are
being explored specifically relating to community associated SABs.

The 2015-16 winter norovirus season has commenced. To date, only one ward at Victoria
Hospital Kirkcaldy has been closed to admissions and transfers as a result of a confirmed
Norovirus Outbreak (in November).

In January, Ward 34 at Victoria Hospital Kirkcaldy witnessed an increase in cases of
Respiratory Syncytial Virus (RSV), with seven patients affected
2.
Staphylococcus aureus (including MRSA)
Staphylococcus aureus is an organism which is responsible for a large number of healthcare
associated infections, although it can also cause infections in people who have not had any
recent contact with the healthcare system. The most common form of this is Meticillin
Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin
Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant
to certain antibiotics and is therefore more difficult to treat. More information on these
organisms can be found at:
Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346
MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252
NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known
as bacteraemias. These are a serious form of infection and there is a national target to
reduce them. The number of patients with MSSA and MRSA bacteraemias for NHS Fife
overall and by hospital can be found in Section 2. Information on the national surveillance
programme for Staphylococcus aureus bacteraemias can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248
2.1
Trends

NHS Fife had 24 cases in Q4 (0.38 per 1000 AOBDs) down from 37 cases in Q3 (0.56 per
1000 AOBDs)

This remains RED against the Local Delivery Plan (LDP) Standard for SABs; 0.24 cases
per 1000 AOBDs (local rate for trajectory @ December 2015 0.28).

On this basis there is a high risk that the Mar 2016 LDP Standard will not be met
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2.2
National MRSA Screening Programme

NHS Fife remains well ahead of the target of 90% compliance with the Clinical Risk
Assessment (CRA) and well ahead of the national average.
Q1 Jan-Mar 2015
98%
2.3
Q2 Apr-Jun 2015
100%
Q3 Jul-Sep 2015
100%
NHS Fife Local Targets for SAB Reduction, 2016

2.4
At this stage of the year, local targets for 2016 have not yet been set
Current Initiatives
Fife-wide Collaborative Improvement Initiatives:
Review every SAB to establish source of infection:

Every PVC SAB entered on Datix and subject to SAER, with a time-limited action plan

Monthly SAB reports to directorates highlighting sources of infection and actions to be
taken. Reports will celebrate areas of good practice as well as challenges and
improvements required.

SPSP PVC audits reported monthly to wards and directorates

Urinary catheter insertion and maintenance bundles to be rolled out to acute and
community wards throughout NHS Fife. Areas where bundle embedded and showing
sustained improvement to share areas of good practice with peers; tests of change
continue. This programme of work is being reviewed; meeting being convened to discuss
process and outcome measures.
Community Improvement Initiatives:

Collaborative work with addiction services: community based research project
commissioned to investigate if early intervention in needle exchange schemes can identify
localised infection and offer treatment to prevent invasive infection in the intravenous drug
user population in Fife

Collaborative work with other health boards to address SAB risk within the intravenous drug
user population
Reduction of Other Hospital Acquired SABs
3.

Continue joint action planning with Health Protection Scotland and other Scottish health
boards to identify other areas for intervention

Reinforce blood samples guidance to junior doctors to reduce contaminated samples

Target IP&C training based on SAB reports, SAERs and PVC audits
Clostridium difficile
Clostridium difficile is an organism which is responsible for a large number of healthcare
associated infections, although it can also cause infections in people who have not had any
recent contact with the healthcare system. More information can be found at:
http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx
NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a
national target to reduce these. The number of patients with CDI for NHS Fife overall and by
hospital can be found in Section 2. Information on the national surveillance programme for
Clostridium difficile infections can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277
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3.1
Trends

Age 15+, NHS Fife had 19 cases in Q4 (versus 20 the previous quarter). This equates to
0.28 cases per 1000 TOBD.

This quarter is GREEN against the LDP Standard trajectory (0.32) and the 12 month rate of
0.23 was also GREEN.

Fife is below the national average (0.357) for the quarter and below the trajectory for yearly
rates to September 2015 (0.25)

As with SABs, community cases averaged 60% of the total during 2015
3.2
Current initiatives
Continued follow up of all hospital and community cases.
4
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 ensure a zero tolerance approach to non
compliance. The hand hygiene compliance score for NHS Fife overall and for each acute
hospital can be found in Section 2. Information on national hand hygiene monitoring can be
found at:
http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx
4.1
Trends

From October 2013, reporting of Hand Hygiene performance is based on local data from
the Scottish Patient Safety Programme (SPSP). From November 2013, results include a
breakdown by staff group.

NHS Fife overall results remain consistent. There is some fluctuation from month to month
when broken down to separate staff groups, due primarily to the small numbers involved.
5.
Cleaning and the Healthcare Environment
Keeping the healthcare environment clean is essential to prevent the spread of infections.
NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain
compliance with standards above 90%.The cleaning compliance score for NHS Fife overall
and for each acute hospital can be found in Section 2. Information on national cleanliness
compliance monitoring can be found at:
http://www.hfs.scot.nhs.uk/online-services/publications/hai/
Healthcare environment standards are also independently inspected by the Healthcare
Environment Inspectorate. More details can be found at:
http://www.nhshealthquality.org/nhsqis/6710.140.1366.html
5.1
Trends

All hospitals and health centres throughout NHS Fife have participated in the National
Monitoring Framework for NHS Scotland National Cleaning Services Specification. Since
April 2006 all wards and departments have been regularly monitored with quarterly reports
being produced through Health Facilities Scotland (HFS).

The National Cleaning Services Specification – quarterly compliance report result for
October to December 2015 (quarter 3) shows NHS Fife achieving GREEN status with
95.6%; Scottish average for the quarter is 95.7%
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
5.2
6.
The Estates Monitoring quarterly compliance result for October to December 2015 (quarter
3) shows NHS Fife achieving GREEN status with 97.7%; Scottish average for the quarter is
97.5%
Current Initiatives

Areas with results below 90% for all Hospital & Healthcare facilities have been identified to
relevant managers for action.

HFS is making steady progress with the iOS development work.
Outbreaks
This section should give details on any outbreaks that have taken place in the Board since
the last report, or a brief note confirming that none have taken place. Where there has been
an outbreak then for most organisms as a minimum this section should state when it was
declared, number of patients affected, number of deaths (if any), actions being taken to bring
the outbreak under control and whether this was reported to the Scottish Government. For
outbreaks of norovirus a more general outline of the outbreak may be more appropriate.
6.1
Norovirus
Nil to report since last update
6.2
Other Outbreaks
Respiratory Syncytial Virus
During late December and early January 2016 Ward 34 at Victoria Hospital witnessed an
increase in cases of Respiratory Syncytial Virus (RSV). Seven patients were affected with
one patient acquiring the virus as a result of cross-transmission. This outbreak was reported
to Health Protection Scotland and the Scottish Government Health and Social Care
Directorate Policy Unit. The majority of patients were potentially acquiring the virus in the
community. The outbreak was declared over on 19 January.
Avian Influenza in Poultry
In January 2016 the Scottish Government urged poultry producers to maintain vigilance
following the reporting of a suspected case of avian influenza in chickens on a farm in
Dunfermline. Initial test results had indicated the presence of a notifiable strain of avian
influenza (H5) while the clinical picture suggested a low pathogenic strain. In order to limit
the further spread of disease, appropriate restrictions were being imposed on the premises
and any identified contact premises. The risk to human health in this case should be
considered very low.
There have been a number of recent cases of avian influenza across continental Europe in
recent months including three cases in other parts of the UK in 2015.
Other Outbreaks: Global Significance
Ebola: Viral Haemorrhagic Fever
WHO reported a continuing drop of Ebola virus disease (EVD) cases in West Africa but
warns that there is growing evidence of persistence of the virus for some months in
recovered patients. The two-year Ebola epidemic that killed more than 11,000 people in
West Africa was declared officially over on 14 January.
Page 22
7.
Other HAI Related Activity
Surgical Site Infection Surveillance

NHS Fife continue to perform well under the national rate for orthopaedic procedures

C-Section rates were higher than the national average for Q2 (April to June 2015) in
comparison with Q1 and Q3.
 Q1 2015 overall SSI rate 1.8%
 Q2 2015 overall SSI rate 4.7%
 Q3 2015 overall SSI rate 2.4%
See Table 1 below
Graph Showing Quarterly Trend in Caesarean Sections NHS Fife
Total C
sections
Exception Report Issued
16
261
249 14
248
246249
243
241
250
236
230
227
221219 219 226 221
217218
12
207
207
206
199194
196
200
10
150
8
6
100
Number of infections
Number of operations
300
4
50
2
2012 Q3
2012 Q4
2013 Q1
2013 Q2
2013 Q3
2013 Q4
2014 Q1
2014 Q2
2014 Q3
2014 Q4
2015 Q1
2015 Q2`
2015 Q3
0
2010 Q1
2010 Q2
2010 Q3
2010 Q4
2011 Q1
2011 Q2
2011 Q3
2011 Q4
2012 Q1
2012 Q2
0
Quarter
Table 1
Since 2013, NHS Fife has been issued with 5 Exception Reports for Caesarean Section and this
has resulted in a huge amount of work being carried out to improve clinical practice and patients
outcomes. As a result of these improvement measures the SSI rate has returned to a more
favourable rate in Q3. NHS Fife continues to ensure that these changes are embedded in practice;
there are robust feedback mechanisms in place, including reports to relevant clinical teams and
attendance at regular clinical meetings.
NHS Fife has been identified as an exemplar in Scotland and has been commended on a national
level for in depth feedback sessions which include presentation of SSI rates, analysis of data,
Page 23
recommendations for improvements in clinical practice, case review presentations and
microbiology teaching input.
7.1
Healthcare Environment Inspectorate (HEI) inspections

An unannounced HEI inspection was conducted in Victoria Hospital on 25-26 August to
follow-up on the requirements and recommendations made following the inspection in
December 2014. This follow-up inspection resulted in one new requirement, one
requirement unmet from the December 2014 inspection and one unmet
recommendation also from the December 2014 inspection.

The 16 week follow-up improvement action plan was returned to HEI on 12 January
2016. This update reported one requirement for Hand Hygiene now being met and the
remaining requirement still outstanding – SICPs monitoring. NHS Fife is currently
working in collaboration with Health Improvement Scotland (HIS) and Health Protection
Scotland (HPS) to review the SICPs monitoring tools currently available in NHS Fife and to
support the development of a monitoring tool that is fit for purpose and accurately reflects
SICPs monitoring across all care settings. This project is expected to take a minimum of 9
months and therefore completion is anticipated September 2016. The roll out to all clinical
areas will progress following completion of project

An unannounced HEI inspection was conducted in Queen Margaret Hospital on 29-30
September, with the final report published 24 November. The inspection resulted in four
requirements for which there is an associated improvement action plan for the board.

The 16 week follow-up improvement action plan was returned to HEI on 2 February 2016.
This update reported three requirements now met with one requirement partially met – use
of PPE by domestic services. Work is ongoing to address this requirement.

An unannounced HEI inspection was conducted in Cameron Hospital on 21-22 October,
with the final report published 12 January 2015. The request for the 16 week follow-up
improvement action plan is expected to reach the board by 11 February 2016.
Actions will be monitored via the clinical directorates involved in the inspections, the NHS
Fife Inspection Coordinating Group and the Infection Control Committee.
8.
Assessment

SAB numbers continue to fluctuate from quarter to quarter, but the latest data shows the fall
in cases seen earlier this year is not being sustained, and further work is needed if the
March 2016 HEAT target is to be achieved.

Continuing low levels of C difficile indicate that the initiatives in place to reduce infection
rates are working long-term.
Page 24
Healthcare Associated Infection Reporting Template (HAIRT)
Section 2 – Healthcare Associated Infection Report Cards
The following section is a series of ‘Report Cards’ that provide information, for each NHS Fife acute hospital,
on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and
MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition,
there is a single report card which covers all community hospitals [which do not have individual cards], and a
report which covers infections identified as having been contracted from outwith hospital. The information in
the report cards is provisional local data, and may differ from the national surveillance reports carried out by
Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which
undergo rigorous validation, which means final national figures may differ from those reported here.
However, these reports aim to provide more detailed and up to date information on HAI activities at local
level than is possible to provide through the national statistics.
Understanding the Report Cards – Infection Case Numbers
Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for
each hospital, broken down by month. SAB cases are further broken down into Meticillin Sensitive
Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). 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.
Targets
There are national targets associated with reductions in C.diff and SABs. More information on these can be
found on the Scotland Performs website:
http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance
Understanding the Report Cards – Hand Hygiene Compliance
Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital
report card presents the combined percentage of hand hygiene compliance with both opportunity taken and
technique used.
Understanding the Report Cards – Cleaning Compliance
Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and
estates compliance audits. More information on how hospitals carry out these audits can be found on the
Health Facilities Scotland website:
http://www.hfs.scot.nhs.uk/online-services/publications/hai/
Understanding the Report Cards – ‘Out of Hospital Infections’
Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all
associated with being treated in hospitals. However, this is not the only place a patient may contract an
infection. This total will also include infection from community sources. The final Report Card report in this
section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to NHS Fife which are
not attributable to a hospital.
Page 25
NHS FIFE REPORT CARD
Staphylococcus aureus bacteraemia (SAB) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
MRSA
0
0
1
1
0
1
3
0
0
0
0
2
MSSA
1
7
8
14
6
11
10
10
7
8
9
9
Total
1
7
9
15
6
12
13
10
7
8
9
11
Clostridium difficile infection (CDI) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
Ages 15-64
0
0
0
1
1
2
0
4
3
2
2
0
Ages > 65
6
5
2
4
8
2
7
2
6
2
4
3
Total 15+
6
5
2
5
9
4
7
6
9
4
6
3
Hand Hygiene Monitoring Compliance (%)
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
AHP
98
98
99
96
97
99
99
98
98
100
96
99
Ancillary
95
97
97
95
95
97
90
88
97
94
92
95
Medical
93
95
94
95
94
98
94
97
96
95
97
96
Nurse
97
98
99
97
98
98
99
97
97
98
98
98
Overall
97
97
98
96
97
98
97
96
96
96
97
97
Cleaning Compliance (%)
Overall
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
96.4
96.9
95.0
96.2
96.1
94.8
95.5
95.8
95.9
95.0
96.0
95.6
Estates Monitoring Compliance (%)
Overall
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
96.4
97.5
94.4
96.8
96.9
97.2
97.8
97.7
97.5
97.7
98.0
97.9
Page 26
VICTORIA HOSPITAL, KIRKCALDY REPORT CARD
Staphylococcus aureus bacteraemia (SAB) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
MRSA
0
0
0
1
0
0
1
0
0
0
0
0
MSSA
0
3
2
4
2
3
4
2
2
1
1
4
Total
0
3
2
5
2
3
5
2
2
1
1
4
Clostridium difficile infection (CDI) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
Ages 15-64
0
0
0
0
0
0
0
2
1
1
0
0
Ages > 65
2
3
0
1
1
1
0
0
1
0
1
1
Total 15+
2
3
0
1
1
1
0
2
2
1
1
1
Cleaning Compliance (%)
Overall
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
96
96
95
96
96
95
96
96
95
96
95
96
May
2015
97
Jun
2015
97
Jul
2015
98
Aug
2015
98
Sep
2015
98
Oct
2015
97
Nov
2015
97
Dec
2015
97
Jan
2016
98
Estates Monitoring Compliance (%)
Overall
Feb
2015
97
Mar
2015
97
Apr
2015
97
Page 27
QUEEN MARGARET HOSPITAL, DUNFERMLINE REPORT CARD
Staphylococcus aureus bacteraemia (SAB) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
MRSA
0
0
1
0
0
0
0
0
0
0
0
1
MSSA
0
0
0
0
0
0
0
0
1
0
2
0
Total SABS
0
0
1
0
0
0
0
0
1
0
2
1
Clostridium difficile infection (CDI) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
Ages 15-64
0
0
0
0
0
0
0
0
0
0
0
0
Ages > 65
0
0
0
0
0
0
0
0
0
0
2
0
Total 15+
0
0
0
0
0
0
0
0
0
0
2
0
Cleaning Compliance (%)
Overall
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
99
98
98
98
98
98
99
98
99
99
99
98
Estates Monitoring Compliance (%)
Overall
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
98
98
98
98
98
98
99
99
99
99
100
99
Page 28
NHS FIFE COMMUNITY HOSPITALS REPORT CARD
Staphylococcus aureus bacteraemia (SAB) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
MRSA
0
0
0
0
0
1
0
0
0
0
0
0
MSSA
0
0
0
0
0
0
0
1
0
0
0
0
Total SABS
0
0
0
0
0
1
0
1
0
0
0
0
Clostridium difficile infection (CDI) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
Ages 15-64
0
0
0
0
0
1
0
0
0
0
0
0
Ages > 65
0
0
1
0
2
1
0
1
0
0
0
0
Total 15+
0
0
1
0
2
2
0
1
0
0
0
0
OUT OF HOSPITAL INFECTIONS REPORT CARD
Staphylococcus aureus bacteraemia (SAB) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
MRSA
0
0
0
0
0
0
1
0
0
0
0
1
MSSA
1
4
6
10
4
8
6
7
4
7
6
5
Total SABS
1
4
6
10
4
8
7
7
4
7
6
6
Clostridium difficile infection (CDI) monthly case numbers
Feb
2015
Mar
2015
Apr
2015
May
2015
Jun
2015
Jul
2015
Aug
2015
Sep
2015
Oct
2015
Nov
2015
Dec
2015
Jan
2016
Ages 15-64
0
0
0
1
1
1
0
2
2
1
2
0
Ages > 65
4
2
1
3
5
0
7
1
5
2
1
2
Total 15+
4
2
1
4
6
1
7
3
7
3
3
2
Page 29
National Statistics
National surveillance data for C difficile and for SABs (including data for MRSA) has been
published by Health Protection Scotland (HPS) for the period to September 2015, and is
illustrated in Figures 1, 2, 5 and 6, below. NHS Fife is denoted by ‘FF’.
For C difficile, the NHS Fife quarterly rate was 0.29 cases per 1,000 Total Occupied Bed Days
(TOBD). This is below the Scottish quarterly average of 0.36
For all SABs the NHS Fife quarterly rate rose to 0.56 cases per 1,000 Acute Occupied Bed
Days (AOBD), above the Scottish quarterly average of 0.32
Page 30
Page 31
SICKNESS ABSENCE
We will achieve and sustain a sickness absence rate of no more than 4%
Key Concerns & Risks
Each of the operational parts of the system have developed action plans in partnership or
are reviewing existing plans to reflect the move to the Health & Social Care structure. At a
time of significant change, this is more difficult to manage and monitor for services in the
community.
The three biggest risks to sustaining the planned reductions are:



Management and HR capacity
Any community outbreak of illness (e.g. norovirus) which can impact on short term
absence
Increased pressure on the system in terms of patient numbers which in turn increases
pressure on staff capacity and can result in increased absence
Recovery Trajectory
NOTE – the figures quoted are 12-month rolling absence rates, not those for the individual
month. This is a better way of demonstrating an improvement trend.
THE DECEMBER FIGURE HAS BEEN CALCULATED LOCALLY AS PROBLEMS WITH
THE NATIONAL SWISS SYSTEM HAVE DELAYED ITS AVAILABILITY FROM ISD
Page 32
1.
INTRODUCTION
1.1
The NHS Fife sickness absence rates have been below 5% for five out of the first
nine months of the 2015/16 financial year, with an average rate in the year to date of
5.01%. The Board’s position is 0.13% better than the equivalent period of 2014/15.
This is detailed in Graph 1.
Graph 1
NHS Fife Sickness Absence
% comparison of hours lost between April to November 2014 and 2015
7.00%
6.00%
5.00%
4.00%
2014/15
3.00%
2015/16
2.00%
1.00%
0.00%
Apr
1.2
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
This is as a result of improvements in the Acute Services Division (ASD) sickness
absence rates prior to November and to a reducing long term sickness absence trend
for the Board as a whole. This is demonstrated by an 11.87% reduction in long term
sickness absence over the first nine months of the current financial year. The NHS
Fife sickness absence trend is illustrated in Graph 2.
Graph 2
Page 33
1.3
The Scottish Workforce Information Standards System (SWISS) sickness absence
figure for NHS Fife for December is 5.44%. This is an increase of 0.15% from the
November figure of 5.29%. The NHS Fife rate is 0.04% below the NHS Scotland
average rate for December and is 0.02% below the NHS Scotland average rate for
the first nine months of the year.
2.
NHS FIFE LOCAL ABSENCE STATISTICS
2.1
Locally produced comparative sickness absence information for 2015 for each area
of NHS Fife is summarised in the tables below for ease of reference.
Table 1
Area
Jan
2015
% Rate
Feb
2015
% Rate
Mar
2015
% Rate
April
2015
% Rate
May
2015
% Rate
June
2015
% Rate
Acute Services
5.78
5.05
5.55
4.39
4.39
4.42
Corporate Services
5.74
4.85
5.45
4.61
4.74
4.90
Health and Social Care
6.63
5.72
6.11
5.34
5.30
5.51
NHS Fife
6.10
5.27
5.75
4.79
4.80
4.93
July
2015
% Rate
Aug
2015
% Rate
Sept
2015
% Rate
Oct
2015
% Rate
Nov
2015
% Rate
Dec
2015
% Rate
Acute Services
4.80
4.45
4.55
4.68
5.04
5.36
Corporate Services
5.45
4.91
4.77
5.52
5.45
5.29
Health and Social Care
5.75
4.58
5.15
5.18
5.53
5.84
NHS Fife
5.29
4.58
4.82
5.03
5.30
5.52
Area
2.2
The reason for the increase in December is due to slight increases in the ASD rate
(0.32%) and Health and Social Care (0.31%), balanced by a reduction in Corporate
Services (0.16%).
2.3
The sickness absence figures for each operational unit of NHS Fife for 2015/16 to
date are detailed in graph format in Graph 3.
Graph 3
NHS Fife Sickness Absence Data
by Operational Unit
January to December 2015
7
6
5
4
3
2
1
0
Acute Services
Corporate Services
Health and Social Care
NHS Fife
Page 34
2.4
Analysis of the Sickness Absence trends within NHS Fife in the current financial year
shows that the sickness absence levels within the ASD have remained within the 4%
range for seven out of the nine month period ending at 31 December, with an
increase to 5.36% in December. This has been attributed to an outbreak of Norovirus
and staff being affected by respiratory infections. In contrast, Health and Social Care
areas have been above 5% for each month apart from August.
2.5
The ASD sickness absence for 2015/16 is detailed in Graph 4 and shows that the
sickness absence rate has been below the NHS Fife rate for the period of this report.
Graph 4
8.00
Acute Services Division
Acute
Services
Sickness Absence Data per Directorates
January to December 2015
Planned
Care
7.00
6.00
5.00
Emergency
Care
4.00
3.00
2.00
Clinical
Support
and Access
1.00
0.00
NHS Fife
Please note that areas within Planned Care and Clinical Support and Access (formerly Ambulatory
Care) have changed with effect from October 2015.
2.6
Attendance Management activity within the ASD has been focused on Review and
Improvement panels, Management Teams, the Acute Services Division Staff
Governance Board and Performance Review meetings. The Emergency Care
Directorate is the area of most concern within Acute Services with a rate of 6.50% in
December, predominately clinical staff.
2.7
The sickness absence figures for Health and Social Care are shown in Graph 5.
Graph 5
Health and Social Care Partnership
Sickness Absence Data per HSCP Division - January to December
2015
10.00
5.00
0.00
NHS Fife
HSCP East Division
HSCP West Division
HSCP Fife Wide Division
HSCP Total
Page 35
2.8
Within the Health and Social Care Partnership, the focus on attendance management
has been through local management teams and their respective attendance
management group meetings, which meet regularly. All areas of the Health and
Social Care Partnership now have Review and Improvement meetings in place. The
East Division is the area of most concern, with long term sickness absence cases
and several wards with specific issues, which are being addressed and supported.
2.9
Attendance Management activity within Estates, Facilities and Capital Services is
focused via regular “Direct Reports” meetings and the Directorate also has Review
and Improvement panels in place. Within Support Services in Central Fife, the rate
has reduced to the lowest this year at 5.36%, with a reduction from an average of
6.42%, due to reductions in long term sickness.
3.
ABSENCE TRENDS
3.1
The long-term / short-term trend for NHS Fife is detailed in Graph 6.
Graph 6
Sickness Absence Trend 2015
Total Hours
Hours Lost by Short and Long Absence
50,000
40,000
30,000
20,000
10,000
0
Long Term
Short Term
3.2
Detailed analysis of the sickness absence trends between April and December
indicates that the improvements achieved in the Summer months have not been
sustained. The deterioration in the level of sickness absence between October and
December have been as a result of increases in short term absence with
an additional 4,624 hours lost in the short term category. However, there has been an
improvement in the long term absence category, with a reduction of 2,571 hours lost
in December.
3.3
The hours lost as a result of short term sickness absence has increased from 22,284
hours in April 2015 to 33,745 hours in December. This increase equates to 69.46
WTE staff per month. For long term sickness absence the total hours lost has
reduced from 36,500 hours in April to 31,742 hours lost in December. This represents
a reduction of approximately 4,758 hours, or 28.83 WTE staff per month.
3.4
On-going work is being undertaken in respect of the reasons for absence, the age
profile and trends within the reasons. Details of the “top ten” known reasons for
absence by hours lost within NHS Fife within the year to date are detailed in Table 2.
Page 36
Table 2
Absence Reason Description
Hours Lost
1.
Anxiety / stress / depression / other psychiatric illnesses
13364.52
2.
Other musculoskeletal problems
6852.41
3.
Gastro-intestinal problems
5005.57
4.
Other known causes
4924.03
5.
Back problems
4082.11
6.
Injury, fracture
4009.46
7.
Cold, cough, influenza
3053.60
8.
Chest & respiratory problems
2159.50
9.
Genitourinary & gynaecological disorders
2131.00
10.
Ear, nose, throat
1529.26
This data shows we need to consider providing additional support for staff suffering
from mental health related illnesses and musculoskeletal problems. This will be
addressed through the Health and Well-being Strategy.
3.5
The NHS Fife absence figures for December, broken down into staff bands and age
range, are detailed in Tables 3 and 4.
Table 3
Band
Headcount
Absence %
Band 1
117
5.70%
Band 2
283
7.43%
Band 3
158
6.52%
Band 4
83
4.18%
Band 5
353
6.12%
Band 6
184
5.00%
Band 7
72
2.93%
Band 8 and above
65
2.18%
There will be more detailed analysis undertaken to understand the causes for the
high absence rates within Band 2 and Band 5 staff groups, which are our largest staff
groups and predominately nursing staff.
Table 4
Age Range
Headcount
Absence %
16-19
3
0%
20-24
50
2.19%
25-29
114
3.29%
30-34
124
4.11%
35-39
137
3.92%
40-44
146
4.63%
Page 37
Age Range
Headcount
Absence %
45-49
213
4.96%
50-54
238
6.38%
55-59
184
7.06%
60-64
79
6.35%
65+
18
6.50%
This data shows that future Staff Well-Being activities need to be directed towards
staff in the age 50+ age groups.
4.
ACTIONS
4.1
An Attendance Management Resource pack for managers to use at ward and
department level has been developed with the support of the Programme
Management Office and will be initially distributed on a priority basis, based on the
identification of areas where absence is a significant issue. Additional support will be
offered to managers in these areas. This will be rolled out across the whole
organisation.
4.2
As part of the Well@Work Project, managerial competencies for managing
attendance are being developed and will be used to support improved practice in
managing sickness absence.
4.3
Monthly Attendance Management Training sessions, delivered in partnership, have
been undertaken within NHS Fife, together with bespoke sessions as required. Dates
for regular monthly sessions have been set for 2016. 280 Managers / Supervisors
were trained during 2015 and 68 managers and supervisors participated in
eLearning.
5.
APPROACH TO STAFF HEALTH AND WELL-BEING
5.1
Improving the health and well-being of staff is a key priority moving into 2016. The
Health & Well Being Strategy, being formally launched in February, along with a Staff
Well@Work Handbook, provides a foundation for the Board to move forward,
coupled with the ambition to achieve the Gold Healthy Working Lives Award in Spring
2016.
5.2
The focus thereafter will be on the transformation of the Occupational Health and
Safety Service to become a Staff Health and Well-being Service and this means
developing the future service into a bespoke model which will deal with each episode
of staff absence on a pro active basis. For example, the Board’s absence levels peak
in July, October, December and January each year. Modernising the occupational
health provision combined with the ability to understand reasons for and timing of
absence will provide the basis to ensure that the opportunities to improve staff health
and well being are maximised.
5.3
In addition, the Well@Work project has detailed plans in place in terms of assisting
the Board to submit for assessment for the Gold Healthy Working Lives Award this
year. Assessment is planned for Spring 2016.
Page 38
WORKFORCE – CONSULTANT RECRUITMENT
1.
INTRODUCTION
1.1
As at 31 January, NHS Fife has 30.49 wte Consultant vacancies, (taking account of
confirmed appointments). Some specialties have had notable recent success in
recruiting, with 38 new substantive Consultants taking up post during 2015. There are
inherent risks in posts being vacant in terms of capacity, service delivery, potential
impact on ability to provide training for junior medical staff and costs of internal and
agency locum cover.
1.2
There is a requirement to ensure that the Board has a plan in place to recruit to
vacant posts. Most other NHS Boards across Scotland and the wider UK experience
similar issues, resulting in significant competition for the same candidates. Data
available shows that the majority of candidates are recruited from within NHS
Scotland, with a handful of applicants from South of the Border / overseas. Other
avenues have been explored to date, with limited success.
2.
HISTORICAL POSITION
2.1
From mid 2014, NHS Fife has participated in a number of initiatives to attract
Consultants to vacant posts including a campaign within the British Medical Journal
in July 2014, a social media campaign in the Autumn of 2014 and has used Global
Medical Careers and Doctors.net to promote posts. This has been supplemented by
promotions within the NHS Scotland Medical Recruitment Micro Site and generic
rolling adverts on Scotland’s Health on the Web throughout 2015. These efforts
resulted in limited appointments.
2.2
Emergency Medicine and Radiology pursued the agency / overseas doctor route,
with limited success in the recruitment and retention of EU doctors. There have been
additional costs and disruption to service from this approach – for example, extended
leave to return home for family reasons. Family and housing / “settling in” issues
were also experienced and there has been attrition from the cohort of doctors
recruited, with only one of these Consultants now remaining in post.
2.3
NHS Fife has also participated in recent Scottish Government and EURES
(European Job Network) initiatives, for example our hard to fill posts were included at
a recruitment fair in the Netherlands in May 2015, (due to an EU Government
convention, at governmental level member states do not seek to recruit Consultants
in each others’ territories, but individual employers can do so). This did not generate
any suitable candidates.
2.4
In July 2015, NHS Fife participated in an online European initiative also run by
EURES, advertising Consultant posts in the areas listed below and GP opportunities
available at Linburn Road Health Centre. In addition, NHS Fife participated in the
Scottish Medical Training Careers Fair in 2014 and 2015, and was represented at the
Irish Medical Careers Fair in October 2015. The latter did not provide any suitable
candidates.
2.5
Posts in the following specialties were successfully filled from standard advertising
during the course of 2015: Anaesthetics, Care of the Elderly, Dermatology,
Endocrinology, Emergency Medicine, General Surgery, Microbiology, Obstetrics &
Gynaecology, Occupational Medicine, Oncology, Ophthalmology, Orthopaedics,
Palliative Medicine, Pathology, Psychiatry, (Child & Adolescent, Forensic, General
and Old Age), Radiology, Rehabilitation Medicine and Rheumatology. The majority
(38) of these new Consultants have now taken up post, and a further 6 Consultants
Page 39
(5.4 wte), including those from the December interviews, scheduled to start during
2016.
2.6
The graph below details the current percentage Consultant establishment and
vacancy information by whole time equivalent:
Graph 1
Consultant Workforce
(Establishment - 265.14 WTE)
Vacancies
(30.37 wte)
11.45%
Consultants
(229.37 wte)
in post
86.5%
Appointments
(5.4 wte) due to
start 2.05%
3.
CURRENT POSTITION
3.1
In December, posts in the following specialties were advertised in the BMJ and
Doctors.net: Acute Geriatric Medicine, Acute Medicine, Gastroenterology,
Paediatrics, Pathology, Radiology and Respiratory Medicine. Applications have been
received for all posts with the exception of Pathology and Radiology and interviews
are scheduled for these vacancies in February and March. An advert has also been
placed for Consultants in Urological Surgery.
3.2
The current advertising plans and recruitment update in respect of the remaining
main areas of vacancies / hard to fill posts are detailed below.
Table 1
Post
Current Recruitment Update
Anaesthetics
(2.0 wte vacancies)
Adverts placed in the BMJ and SHOW in February 2016
Cardiology
(1.6 wte vacancies)
Intention is to advertise in the BMJ and SHOW in February
2016, timed to secure trainees approaching CCT
Emergency Medicine
(3.0 wte vacancies)
Intention is to re-advertise the full-time posts in February
2016, as it is anticipated that recent new appointees will
make service more attractive to potential candidates
Neurology
(2.0 wte vacancies)
Clinical Director reviewing service provision, outcome
anticipated in March 2016. External cover in place.
Page 40
Post
Current Recruitment Update
Pathology
(1.7 wte vacancies)
No applications received in response to recent
advertisement and agency locums now secured from April
2016 as well as NHS Forth Valley providing assistance, with
a view to making posts more attractive. Consideration of
Healthcare Scientist input to reduce reliance on Consultant
Workforce. Will re-advertise in Summer 2016.
Radiology
(5.27 wte vacancies)
One further resignation received. Links being explored with
St Andrews and other Universities prior to next
advertisement. Two overseas locums are at preemployment check stage. NHS Fife is working with the
National Shared Services agenda for Radiology provision.
4.
ASSESSMENT
4.1
None of the options for overseas recruitment tried so far, (standard and non standard
advertising, EURES and Netherlands events, agencies etc), have generated
appropriate interest, with there continuing to be vacancies for some time within
following specialties: Anaesthetics, Cardiology, Neurology, Paediatrics and
Radiology. It is clear that predicted trained Consultant output, attrition and
participation rate within NHS Scotland does not meet the numbers of Consultant
posts and the anticipated bulge in numbers has not materialised. There is national
work ongoing on tracking where Scottish medical trainees seek employment on
completion of higher specialty training, (CCT).
4.2
The Medical Workforce Group, chaired by Dr Elliot, has the overview of Consultant
recruitment and planning. Services are also exploring the opportunity for joint
appointments with other Boards, which may be more attractive to certain specialties.
Contingency arrangements and service redesign where we have an inability to recruit
are also in place, e.g. Emergency Medicine and Radiology, together with the
development of joint appointments with St Andrews and other Universities.
4.3
One of the important lessons is making NHS Fife an attractive place for existing
trainees to consider for their long term career, linked to what can be offered within job
plans. Clinical Leads have been successful in networking with trainees approaching
CCT and established Consultants who wish to relocate to Fife.
Page 41
HEALTH & SOCIAL CARE INTEGRATION
The Chief Officer (Director of Health and Social Care) reports to the Chief Executive, NHS
Fife and the Chief Executive, Fife Council. Joint performance review meetings involving both
Chief Executives and the Director of Health and Social Care take place on a regular basis in
accordance with each organisation’s normal performance management arrangements. The
Director of Health & Social Care has overall responsibility for the delivery of the Standards
reported in this section and for determining further activity, commissioning and performance
data for measuring progress in delivering the aims and objectives of the partnership.
DEMENTIA REGISTRATION AND POST-DIAGNOSTIC SUPPORT
We will have a QOF-registered proportion of diagnosed dementia patients consistent
with the European measure of prevalence, all of whom will have a minimum of a
year’s post-diagnostic support and a person centred support plan
Post-Diagnostic Support Background
The offer of Dementia Post-Diagnostic Support (PDS) which meets the Alzheimer’s Scotland
(5 Pillars) standard is relatively new and is in direct response to the national standard having
been set. It is in addition to other support/care/treatment which would have been taking
place as a matter of routine work.
The current workforce identified for the task comprises a mixture of mental health,
psychology, Alzheimer’s Scotland and other resources operating from three geographically
based hubs. There has been success in clearly articulating and streamlining pathways to
diagnosis and to PDS. This success has now left us with the challenge of managing high
referral volumes.
In order to future proof the offer of Dementia PDS in Fife we need to do two things:


Identify additional resources (from within our existing workforce/budgets)
Devise a management arrangement which provides a functional level of coordination,
standardisation and quality assurance
Identifying additional resource is currently proving challenging but recent clarification of
responsibilities for the Dementia target should make the second action easier to achieve.
Post-Diagnostic Support Performance
Guidance for measuring and reporting on this target, and the target itself, was expected to
be available in December, possibly as part of the guidance for the 2016-17 Local Delivery
Plan. The latter was not issued until mid-January, but guidance regarding PDS performance
was not included. This is being pursued with ISD and the SGHSCD.
It is likely that the focus of the PDS measure will be on patients diagnosed with dementia
and their initial contact with a link/support worker, rather than the previous focus of having 1year post-diagnostic support and a support plan. When this is clarified, we expect to be able
to provide some local performance information and to then consider what type of
recovery/improvement is required.
Key Concerns & Risks
Dementia Registrations
The main risks to achieving the standard are:

Failure to respond adequately to demands for PDS (as it is the existence of PDS
which has been used to incentivise GPs and others to refer early to secondary care
for diagnosis)
Page 42

Failure to keep the profile of dementia and dementia registration high with Primary
Care colleagues
Dementia Post-Diagnostic Support
The main risk to achieving this target is:

Managing demand and capacity
Dementia Registration
Recovery Trajectory
Recovery Plan
Dementia Post-Diagnostic Support
Recovery Trajectory
Not available at present, pending further guidance from the Scottish Government around
prevalence and the target.
Recovery Plan
Situational Analysis
Task 1.3
We have been unable to identify additional capacity within the existing workforce.
As of the December ISD report, there were 273 people waiting for postdiagnostic support in Fife, in comparison to 300 the previous month. Until
additional workers can be found we are focusing on maximising efficiencies.
A short piece of scoping conducted by a Senior Nurse has been concluded. An
action plan is being created to establish a Fife-wide Team leader from within
current resources, to manage and report performance, and to provide a Fife-wide
consistent approach to PDS which enhances flexibility and efficiencies.
Page 43
DELAYED DISCHARGE
No patient will be delayed in hospital for more than 2 weeks after being judged fit for
discharge
Key Concerns & Risks
The actions described in the recovery plan below are expected to support a working solution
to the target that no patient will be delayed in hospital 2 weeks beyond being clinically fit for
discharge.
The joint Delayed Discharge Task Group continues to monitor and manage the demand for
placements and services across the partnership on a weekly basis. A significant amount of
modeling work has been undertaken to try to understand the pressures across the system
and in particular the reason people are in delay, and this has resulted in additional funding
being made available to support discharge. A memorandum of understanding has been
signed by both NHS Fife and Fife Council which highlights a number of actions and
requirements, and this has resulted in significant movement of patients from both acute and
community hospitals.
A short term support model to enable a person to recover from an acute illness at home with
support has been developed in conjunction with a private care agency and initial feedback
has been positive. The project is due to finish in February, and a full evaluation will be
available.
As part of the Delayed Discharge Action Plan there will be an increase in STAR facilities
over the winter and work is underway to determine the capacity available across Fife. This
will ensure people will be supported to return home following a period of reablement. A
Coordinator is in post to ensure that people move through the system as quickly as possible.
The START programme, which will support people to leave the acute hospital within 72
hours with a care package, has now been introduced. This is at an early stage and will be
evaluated closely to determine the capacity.
The delivery plan is closely monitored and every effort will be made to mitigate any risk.
Recovery Trajectory
Note that the ‘Actual Performance’ figures relate to the situation at the monthly census,
generally taken around the 15th of the month – the number in delay will vary from day to day.
Situational Analysis
The actions listed in the plan on the next page are largely on track.
Task 8.1 has been deferred pending the discharge of the existing patients in Step down
beds at which point the charging policy will be further considered.
Page 44
Recovery Plan
Page 45
SMOKING CESSATION
We will deliver a minimum of 602 post 12 weeks smoking quits in the 40% most
deprived areas of Fife
Key Concerns & Risks
The actions described will ensure NHS Fife delivers good outcomes in relation to quit rates.
This may not however mean we meet the target of successful quits by March.
There are a number of risks that must be considered:


Pharmacy changes which require a new follow-up model to become embedded
The increasing rise of e-cigarettes which are being seen by smokers as a stop
smoking aid
These challenges are addressed at a monthly task meeting and actions are put in place
where possible.
Recovery Trajectory
The service completed a mapping exercise based on capacity and community needs as
measured by smoking prevalence and SIMD data, and clinic activity has been re-orientated
accordingly. In addition six new clinics have been established in the Glenrothes area within
GP practices due to additional capacity as a result of the move to the Fife-wide model.
The redesign to a Fife wide model with East and West Divisions and a single management
structure has been completed, with local coordinators for each Division in place.
New pathways are being developed in populations with highest smoking prevalence which
include clients with mental health issues, teenage parents, pregnant woman from SIMD 1 &
2 and patients with diabetes.
Recovery Plan
Page 46
ALCOHOL BRIEF INTERVENTIONS
We will deliver a minimum of 4,187 interventions, at least 80% of which will be in
priority settings
Key Concerns & Risks
The actions described are to ensure that NHS Fife will deliver the required number of ABI
during the year.
There are a number of risks that must be considered:



Embedding of alcohol brief interventions in geographical areas of multiple deprivation
No identified ABI training co-ordinator post
Funding provided from SG in previous years no longer ring fenced for ABI activity
Recovery Trajectory
In Q3, there was an increase in the number of alcohol brief interventions undertaken,
resulting in the overall performance being above trajectory.
Recovery Plan
Situational Analysis
Task 1.2
A meeting with various social groups to discuss ABI activity in wider settings has
been scheduled for 19th February
In relation to the identified risks, a meeting to discuss the embedding of ABI activity across
Fife is required. As training will be required, Health Promotion input will be required.
Page 47
CHILD AND ADOLESCENT MENTAL HEALTH SERVICE WAITING TIMES
At least 90% of clients will wait no longer than 18 Weeks from referral received to
treatment for specialist child and adolescent mental Health Services (CAMHS)
Key Concerns & Risks
Current improvement plans have been focused heavily on investing in additional staff. Part
of our small allocation through the mental health innovation fund will be invested in additional
capacity. This will have the greatest impact on therapeutic services for looked after children
and in the training of the school nurses. In addition, the Scottish Government are still
devising their allocation strategy for the new funding (£85M over 5 years), some of which is
specifically to improve access to CAMHS.
The current improvement plan and predicted trajectory has been contingent upon receipt of
this second, additional larger tranche of new funding.
However, in reaction to an increase in demand, CAMHS has restructured its management
and have introduced better electronic systems to support the gathering of accurate demand
and activity data. We are now able to accurately measure the current staffing capacity,
waiting list and referral demand rate. We are now focusing on an attempt to increase activity
within current resources. We are doing this by reducing non-patient facing activity and
removing the generic waiting list and proportionately allocating all waiting cases and all new
referrals to individual clinicians.
Once the allocation strategy for this new funding has been determined and shared it will be
possible to predict more accurately when the target can be achieved. In the current absence
of significant new investment there is now a focus on improving the productivity of the clinical
staff working with the high volume low intensity cases.
Recovery Trajectory
Note that the ‘Actual Performance’ figures shown are for 3-month periods ending those
months, not for the individual months themselves.
Recovery Plan
Situational Analysis
While planning redesign in many areas is underway, and waiting times have improved due to
changes to current working practices, sustained improvement resulting from the completion
of the RED tasks on the Recovery Plan is reliant on the availability of additional funding from
the Scottish Government. This will not be available in the current FY.
Page 48
PSYCHOLOGICAL THERAPIES WAITING TIMES
At least 90% of clients will wait no longer than 18 weeks from referral received to
treatment for psychological therapies
Key Concerns & Risks
Poor performance against this target is primarily the result of a lack of overall capacity. This
assertion has been confirmed by work that was done with Scottish Government QuEST
Current improvement plans are focused heavily on investing in additional therapists utilising
the Scottish Government new funding (£85M over 5 years) some of which is specifically to
improve access to Psychological Therapies.
The current improvement plan and predicted trajectory - which sees us achieving the target
by the end of the financial year – is based on using this funding. More accurate plans can
now be determined as to when the target can be achieved. In the meantime strategies are
being progressed for:


diverting referrals at an earlier stage towards self help
expanding our group work programme (appropriate for a proportion of new referrals
for people with anxiety and depression).
A recent success in relation to self help has been the rollout of computerised CBT ('Beating
the Blues') as part of an EU wide programme being organised and supported in Scotland by
NHS24. Within Fife 647 people have been referred to 'Beating the Blues' since it was first
made available a year ago.
The main risks to achieving the standard are as follows:



Inadequate capacity to meet demand
An absence of other signposting options for referrers leading to high referral volumes
An absence of suitable community venues across Fife
The risks are being managed by bidding for anticipated additional nationally (Scottish
Government) allocated resources; and by supporting developments such as an investment
in a European wide initiative widening access to computerised CBT as an alternative to
referral.
Recovery Trajectory
Note that the ‘Actual Performance’ figures shown are for 3-month periods ending those
months, not for the individual months themselves.
Page 49
Recovery Plan
Situational Analysis
Task 1.4
Although clinic space has been identified, the completion of this task is
contingent on aligning staff to run the therapeutic group work. This ties in
therefore with task 1.5.
Task 1.7
Progress has been made with this task. The main problem area for underprovision is Levenmouth, and work is ongoing to attempt to resolve this. The
Psychological Therapies Development Lead has joined an H&SC group set up to
allocate accommodation across the partnership.
Page 50
RECOMMENDATION
The Board is asked to:

Note the key items of information highlighted within the Integrated Performance Report,
in particular those listed in the Executive Summary
CHRIS BOWRING
Director of Finance
23 February 2016
Page 51
SECTION B
CAPITAL PROGRAMME 2015/16
1.
INTRODUCTION
1.1
This report provides an update on the 2015/16 Capital Programme as approved by
the Board at its meeting on 24 February 2015.
1.2
The report provides information on the following:

Expenditure to 31 January 2016;

Changes to the Board’s Capital Resource Limit (CRL);

Details of changes in Planned Expenditure;

Estimated Capital Expenditure outturn; and

Capital Receipts
2.
EXPENDITURE TO DATE
2.1
The expenditure position shown is for the period to 31 January 2016. Appendix A
provides details of the current expenditure.
2.2
For 2015/16 each of the Project Leads have provided an estimated spend profile
against which actual expenditure is being monitored.
2.3
The estimated spend profile for the period to 31 January 2016 is £9.309m (70% of
the total allocation).
2.4
The expenditure to date amounts to £8.276m. This represents 63% of the estimated
annual expenditure (Appendix B). The main areas where expenditure has been
incurred since the previous report to the Board are as follows:




Stratheden IPCU
£0.680m
General Hospitals and Maternity Services £0.422m
Equipment
£0.334m
Information Technology £0.411m
2.5
Total expenditure to date is £1.032m behind the profiled trajectory and this is
primarily due to the Statutory Compliance/Backlog Maintenance, Minor Capital Works
schemes and Radiology Equipment slipping from their projected timescales.
3.
CHANGES TO CAPITAL RESOURCE LIMIT
3.1
Since the previous report to the Board a reduction in allocation of £0.500m has been
received. This is in respect of a Capital to Revenue transfer for capital expenditure
which does not add to the overall value of an asset. To ensure budgetary control any
Page 52
such projects continue to be managed in full with expenditure transferred to revenue
at the completion of a project or at the financial year end.
4.
CHANGES TO PLANNED EXPENDITURE 2015/16
4.1
Appendix C shows the changes in the plan resulting from changes in allocations and
from updated estimates for schemes already approved. Since the previous report
there have been no significant changes to the plan.
5.
CAPITAL EXPENDITURE OUTTURN
5.1
At this stage of the financial year it is currently estimated that the Board will spend
the Capital Resource Limit in full.
6.
CAPITAL RECEIPTS
6.1
With the SGHSCD providing additional funding to cover the slippage in sale of
Lynebank land and Forth Park Hospital, the Board was left with a requirement to
securing capital receipts of £150k. Current estimates suggest that a shortfall of £76k
against the budget will exist at the year end. To cover this an underspend of £76k will
be required to be made on the expenditure budget. To date £68k of the required
underspend has been identified.
7.
RECOMMENDATION
7.1
The Board is asked to:

note the Capital Expenditure to 31 January 2016;

note the current Capital Resource Limit position;

note the changes in Planned Expenditure;

note the Capital Expenditure outturn; and

note the Capital Receipts position.
CHRIS BOWRING
Director of Finance
23 February 2016
Page 53
NHS FIFE - TOTAL REPORTS SUMMARY
CAPITAL PROGRAMME EXPENDITURE REPORT - JANUARY 2016
FOR FINANCIAL YEAR 2015/16
Project
COMMUNITY & PRIMARY CARE
Stratheden Hospital - IPCU
Statutory Compliance
Capital Minor Works
Capital Equipment
Condemned Equipment
Total Community & Primary Care
ACUTE SERVICES DIVISION
Capital Equipment
GHMS - Tasks
Statutory Compliance
Total Minor Works
Total Condemned Equipment
Total Acute Services Division
NHS FIFE WIDE SCHEMES
Condemned Equipment
Information Technology
Radiology Equipment
Vehicles
Scheme Development
Capital Receipts Shortfall
Total Fife Wide Statutory Compliance
Total NHS Fife Wide
TOTAL ALLOCATION FOR 2015/16
CRL
Total
Projected
New
Funding
£
Expenditure
to Date
£
Expenditure
2015/16
£
Projected
Variance
£
3,757,000
2,808,217
3,757,000
387,170
366,832
171,616
170,198
127,399
157,698
387,170
366,832
171,616
4,682,618
3,263,512
4,682,618
640,783
3,279,000
1,291,321
204,011
618,389
2,297,144
909,381
136,221
640,783
3,279,000
1,291,321
204,011
131,211
131,211
131,211
5,546,326
4,092,346
5,546,326
1,563,000
1,083,076
75,000
25,000
67,525
159,455
731,697
138,813
11,722
3,872
1,563,000
1,083,076
75,000
25,000
34,055
159,455
2,973,056
920,159
2,905,531
(67,525)
13,202,000
8,276,017
13,134,475
(67,525)
(67,525)
Page 54
Capital Spend Profile 2015/16
20000
Cumulative £000's
15000
10000
Actual
Forecast
5000
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Months
Page 55
Capital Expenditure Proposals 2015/16
Board
22/12/2015
£'000
Dec
Adj
£'000
F&R
26/01/2016
£'000
Board
Adj
£'000
£'000
Specific Schemes
Dunfermline & West Fife CHP
Glenrothes & North East Fife CHP
Kirkcaldy & Levenmouth CHP
Stratheden IPCU
3757
3757
3757
Acute Services Division
General Hospitals & Maternity Services - Aseptic Suite
VHK
General Hospitals & Maternity Services - QMH Carnegie
General Hospitals & Maternity Services - QMH Dental
General Hospitals & Maternity Services - QMH Audiology
General Hospitals & Maternity Services - VHK White Space
General Hospitals & Maternity Services - General
984
1664
109
112
230
180
984
1664
109
112
230
180
984
1664
109
112
230
180
511
511
511
7547
7547
7547
Fife Wide
Telephone System
Routine Expenditure
Community & Primary Care
Minor Capital
Capital Equipment
Statutory Compliance
Condemned Equipment
Acute Services Division
Capital Equipment
Minor Capital
Statutory Compliance
Condemned Equipment
Fife Wide
Vehicles
Information Technology
Radiology Equipment
Backlog Maintenance/Statutory Compliance
Condemned Equipment
Scheme Development
Fife Wide Equipment
Capital Receipts Shortfall
379
140
432
-1
30
-40
378
170
392
-11
2
-5
367
172
387
648
197
1269
131
-7
641
197
1278
131
7
13
641
204
1291
131
9
75
1052
1083
174
75
1052
1083
174
-14
75
1052
1083
160
37
37
-12
25
47
20
67
38
9
5655
5655
5655
13202
13202
13202
Page 56
SECTION C
FINANCIAL POSITION TO 31 JANUARY 2016
REVENUE RESOURCE LIMIT
Health Boards are required to work within the revenue resource limit set by the Scottish
Government Health & Social Care Directorates (SGHSCD). This is monitored by SGHSCD
via the monthly Financial Performance Return.
Performance at the end of January remains ahead of trajectory. The month on month trend
continues to be very positive; however there is an increasing likelihood that this improvement
may not be sufficient to deliver a break even position at the year end.
Key Concerns & Risks
The Revenue Resource Limit position for NHS Fife for the ten months to 31 January 2016 is
showing an overspend of £1.927m compared with the £2.140m estimated overspend as set out
in the Board’s Local Delivery Plan at the start of the year. The continuing improvement in the
monthly expenditure position is encouraging and tighter control of cost pressures is clearly
evident. However, GP prescribing costs have seen a marked increase over recent months. This
is driven by an increase in both the volume and average unit price of prescriptions, compounded
by the difficulty in delivering the anticipated level of savings. This increase has been offset to an
extent as a result of an improving forecast outturn within the Acute Services Division, Estates &
Facilities, Fife-wide community services, and a number of corporate areas.
Delivery of a breakeven position at the year end is a statutory requirement, however due
to the change in the cost of prescribing this is becoming ever more challenging.
Financial Performance
against Trajectory 2015/16
£000
0
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
March
(500)
Plan
Actual
(1,000)
(1,500)
(2,000)
(2,500)
(3,000)
(3,500)
Page 57
Recovery Trajectory
Month
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Actual
(1,294)
(1,848)
(2,238)
(2,234)
(2,465)
(2,263)
(2,231)
(2,139)
(1,927)
Plan
Forecast
Outturn
Overall
Target
(1,131)
(1,696)
(2,134)
(2,581)
(3,104)
(3,045)
(2,994)
(2,758)
(2,140)
0
0
(2,705)
(1,458)
(1,712)
0
0
0
0
0
0
0
0
0
Feb
Mar
(1,023)
0
0
0
Recovery Plan
There is an increasing risk to be able to breakeven by 31 March 2016. This is predominantly
due to the difficulty throughout the year in identifying and delivering the level of efficiency
savings required across the system, on top of the reduction in operational budget
overspends being achieved. The new additional pressure driven by GP prescribing
expenditure (as noted in the Key Concerns section above) is having a significant impact on
the overall forecast outturn.
The Executive Director Group continues to scrutinise the position and to consider what
options might be available to manage the position as we head into the final weeks of the
year. It is likely that further discussion will be required with Scottish Government colleagues
through the formal monthly performance monitoring process.
Situational Analysis
An overview of the overall financial position is set out below.
1.
Financial Framework
1.1. The Financial Framework for 2015/16 was approved by the NHS Fife Board on 28
April 2015, subject to further action to close the gap in the level of savings identified at
that time. Approval of the Financial Framework by the NHS Board enabled Executive
Directors to receive details of their initial annual budgets for 2015/16. All opening
budgets have been signed off by the relevant Executive Director.
2.
Allocations
2.1. Since the previous report to the NHS Board, we have received additional core
allocations from the Scottish Government Health and Social Care Directorate
(SGHSCD) of £1.917m. These include a reduction in recurring funding of £1.276m and
additional earmarked recurring funding of £0.694m and non-recurring funding of
£2.499m.
2.2. The new allocations include £1.5m for Delayed Discharges and £0.500m for a Capital
to Revenue transfer to cover the cost of expenditure within the Capital Programme
which does not add capital value. Also included is £0.407m in respect of Distinction
Awards for Consultants, £0.252m from the New Medicines Fund and £0.203m for the
final tranche of funding for the Family Nurse Partnership Project.
2.3. Included in the above is a reduction in allocation of £1.247m in respect of recharges
for national risk share services.
Page 58
2.4. A full list of allocations received is shown in Appendix A.
2.5. In addition to allocations from SGHSCD the Board also received miscellaneous
income from other sources. Since the previous report to the Board additional sources
of income amounted to £0.898m with the main area of increase being CNORIS £465k.
3.
Analysis of Financial Performance to Date
3.1. A summary is shown in the table below.
Budget
Expenditure
FY
CY
YTD
Actual
Variance
Variance
£'000
£'000
£'000
£'000
£'000
%
180,988
186,247
154,504
161,059
6,556
4.24%
137,851
148,317
123,373
123,073
(300)
(0.24%)
FHS
35,889
40,389
33,662
33,662
(0)
0.00%
Prescribing
72,336
74,131
61,985
63,020
1,035
1.67%
PMS
46,859
48,985
40,772
40,733
(39)
(0.10%)
Estates & Facilities
65,236
65,146
54,119
53,624
(496)
(0.92%)
Board Services
31,871
51,505
44,530
43,065
(1,465)
(3.29%)
Other Healthcare Providers
97,087
105,380
88,820
88,907
88
0.10%
3,815
4,591
3,830
3,744
(86)
(2.24%)
18,028
19,361
16,315
16,315
(0)
0.00%
Impairments & provisions
10,000
23,166
0
0.00%
General
29,089
6,962
4,704
(4,704)
(100.00%)
Efficiency Savings
(2,914)
(4,193)
(1,868)
1,868
(100.00%)
Total Expenditure
726,136
769,987
624,745
627,202
2,457
0.39%
Miscellaneous Income
(64,266)
(87,765)
(75,168)
(75,698)
(530)
0.71%
Net position
661,870
682,222
549,577
551,504
1,927
0.35%
Acute Services Division
Integration Services
Community & Primary Care
OHSAS
Depreciation
Reserves
Acute Services
3.2. The Acute Services Division is reporting an overspend of £6.556m for the period. The
list of key drivers for this overspend continues to include the purchase of healthcare
from other providers, medical staffing, nursing and drugs:
 There is an overspend (£460k) on the use of independent healthcare providers for
Orthopaedic activity, Dermatology activity, Laboratories and Radiology. The
measures put in place to control the use of the independent sector capacity to
address treatment time guarantees continue to reduce the rate of overspend.
 The use of agency and locum medical staffing to meet the recruitment challenges
continues to have a major impact within Orthopaedics, General Surgery,
Anaesthetics, Urology, General Medicine, Paediatrics, Neurology, Obstetrics &
Gynaecology and Ophthalmology.
Page 59
 There is a relatively significant overspend reported within nursing (£2.6m) which is
attributed to both bank and agency usage, and the residual impact of incremental
progression. The pressures continue across a number of specialties including:
Orthopaedics, Obstetrics & Gynaecology, Elderly Medicine, Theatres and Critical
Care. Strict controls on the use of agency staff are now in place and whilst any
specific requests on the grounds of patient safety need to be considered, this action
is reducing the level of additional expenditure with the rate of overspend continuing
to slow down.
 High cost drugs, particularly in Emergency Care specialties, are contributing to an
overspend in this area.
Integration Services
3.3. Across the former CHP budgets, primary medical services, primary care emergency
service (PCES) and family health services, the budgets are showing a net overspend
of £696k for the period to date. This position comprises overspends across both
prescribing and PCES, offset in part by an underspend across the former CHP
budgets.
3.4. The overspend has increased in month and is principally due to an increase in
prescribing spend. This reflects an increase in volumes being dispensed and an
increase in the average cost per item, coupled with the impact of delay to the delivery
of anticipated cash efficiency savings.
3.5. There also remains an issue within the Primary Care Emergency service due to
sessional rates.
3.6. The former CHP budgets continue to report an underspend across a range of budgets
(vacancies in community nursing, health visiting, school nursing, administrative posts,
and dental services) which continue to offset some of the cost pressures (level of
expenditure on complex care packages, incremental progression within the Palliative
Care service, Mental Health nursing and medical locums, and the transfer in of Wards
5 and 6 (with an associated overspend) from the Acute Division).
Corporate Services
3.7. Within the Board’s corporate services, including Estates & Facilities, there is an
underspend of £1,959k due mainly to vacancies across a number of departments.
However, this continues to mask a pressure within Estates & Facilities on energy and
equipment costs relating to service contracts across the system.
Non Fife and Other Healthcare Providers
3.8. The budget for healthcare services provided out with NHS Fife is showing an
overspend of £88k for the period. This is based on an estimated underspend of £848k
on Service Level Agreements with other Health Boards and an overspend of £948k on
Unplanned Activity (UNPACs) and Out of Area Treatments (OATS) activity. The major
driver of this overspend is the estimated increased UNPACs activity with NHS Lothian
for cancer and other high cost drugs and an increase in bone marrow transplants. The
OATS expenditure has increased due an additional Learning Disability patient being
treated in England. These remain estimates at this point in the year pending ongoing
discussions.
Page 60
Reserves
3.9. Current estimates suggest that the Board could incur a further £2.6m on property
impairments and provisions during 2015/16. The actual costs are matched with
additional funding from SGHSCD. Similarly, an estimate of £20.6m is included in the
reserve balance, as the NHS Fife share of the national Clinical Negligence & Other
Risks Indemnity Scheme (CNORIS) increase in provisions.
3.10. Funding of £4.704m has been recognised from the Fife-wide general reserve,
offsetting the overall financial position across the system. This takes account of
slippage from financial plan commitments and new allocations received.
Miscellaneous Income
3.11. An over-recovery in income of £530k is shown for the first ten months of the financial
year.
4.
Efficiency Savings
4.1. The Board’s Financial Framework set out the need to deliver a total of £10.143m cash
efficiency savings to support financial balance. At the end of January, cash releasing
schemes totalling £5.950m had been identified. There are developed plans in place to
deliver a further £0.633m of savings, leaving a balance of £3.560m to be achieved. At
the time of reporting, this is assumed in the overall year end forecast.
4.2. This balance comprises a range of initiatives, some of which had been scoped as
options at the time of the Financial Framework sign off last May, and the more recent
£1.5m target set by EGD for operational budgets in November, which had not been
fully worked into specific proposals:
£'000
Original proposals which will not deliver this year:
Medicines and Prescribing
Voluntary Organisations
Workforce
Original proposals which are now delivering
through operational performance (run rate):
Sickness Absence
Endowments
Procurement
Other
Balance of £1.5m target
Asset Disposal
500
100
446
37
710
1,000
Shortfall in savings
3,560
367
150
250
4.3. The graph below highlights that the planned trajectory assumes back-loading of
savings toward the second half of the year and delivery of savings is behind trajectory
for the period, as the commentary above has indicated.
Page 61
Value (£k)
12,000
Cash Releasing Efficiency Savings Delivery Against Trajectory
Plan
10,000
8,000
6,000
4,000
2,000
0
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16
Period
5.
RECOMMENDATION
5.1. The Board is asked to:

note the financial position for the ten month period to 31 January 2016
CHRIS BOWRING
Director of Finance
23 February 2016
Page 62
Appendix A
New Allocations Received
Description
Baseline
Recurring
£
Delayed Discharges
Capital to Revenue Transfer
Distinction Awards for Consultants
New Medicine Fund
Family Nurse Partnership
Outpatient Waiting Times
Pre-Registration Pharmacist Scheme
National Ophthalmology Workstream
Fit for Work
Implementation of Nursing Revalidation
Eyecare Integration
Demand Capacity Bed Model
Disabled Graduate Scheme
IT Toolkit
Managed Diagnostic Networks
National Risk Share - Bone Marrow
National Risk Share - Specialist Services
(29,012)
(236,397)
(1,010,112)
Total New Allocations Received
(1,275,521)
Earmarked
Recurring
£
Non Recurring
£
1,500,000
500,000
407,116
252,000
203,000
100,000
84,049
75,000
34,632
19,469
6,175
5,000
4,849
1,500
694,165
2,498,625
Total
£
1,500,000
500,000
407,116
252,000
203,000
100,000
84,049
75,000
34,632
19,469
6,175
5,000
4,849
1,500
(29,012)
(236,397)
(1,010,112)
1,917,269
Page 63
SECTION D
THE SCOTTISH PATIENT SAFETY PROGRAMME (SPSP)
1.
PURPOSE
The purpose of this report is to update the NHS Fife Board of the ongoing activity
underway across NHS Fife to implement the Scottish Patient Safety Programme
(SPSP). This report incorporates progress in December.
2.
SITUATION
The aim of the SPSP is to reduce the HSMR by 20% by December 2015; and to
ensure that 95% of patients receiving acute care should be free from harms as
identified by the Scottish Patient Safety Indicator (SPSI).
The (three) SPSI harms are:



Cardiac arrests
Falls
Pressure ulcers
A revised measurement plan has been released in response to feedback from NHS
Boards on the challenges in providing adequate support across the broad SPSP
agenda. The amended measurement plan focuses on elements of work which will best
support the aims of reduction in mortality and harm. To facilitate this, measures have
been separated in to core and supplementary for the purpose of national reporting.
Core:



Outcome measures relating to the harms of SPSI (including CAUTI)
Process measures relating to the harms of SPSI (including CAUTI and Sepsis)
Measures relating to Medicines
Supplementary:

Process measures relating to VTE, Heart Failure and Surgical Site Infection
One of the key changes to the measurement plan is the amendment to the pressure
ulcer indicator. The revised aim is seeking a 50% reduction in the pressure ulcer rate
by December 2017.
The “Cauti” harm which was removed from reporting temporarily is expected to join the
suite of outcome measures in December since a new definition has been agreed.
Page 64
2.1
HSMR
Chart 1: HSMR (Fife v Scotland)
Chart 1 shows the NHS Fife HSMR in comparison to NHS Scotland. The most recent
HSMR data, released in November demonstrated a reduction of 22.7% since
December 2007 with a HSMR of 0.92, unchanged from the previous quarter. The next
release of the HSMR data is due for publication on 16th February.
Chart 2: HSMR (Fife and Regression Line)
TARGET REACHED
Chart 2 demonstrates NHS Fife’s HSMR with regression line.
Page 65
2.2
SPSI HARMS
Chart 3: Cardiac Arrests (Acute Hospitals)
SUSTAINED DETERIORATION
Chart 3 demonstrates an increase in the median from January 2014 when it increased
from 1.3 to 1.6. The daily hospital huddle was introduced during July 2015. The data
points for July, August and November sit just on and under the median. The data has
been extracted from the Resuscitation Officer database.
Chart 4: Fall With Harms (Acute Hospitals)
RANDOM VARIATION
Chart 4 demonstrates random variation. However although run chart rules cannot be applied
yet, the performance from November 2014 appears visually more stable. Data has been
extracted from the Datix system.
Page 66
Chart 5: Pressure Ulcer Rate Grade 2 to 4 “Developed” in Acute Hospitals
RANDOM VARIATION
All areas
NHS Fife
Pressure ulcers
1.8
1.6
Rate per 1000 OBDs
1.4
1.2
1.0
0.8
0.6
0.4
0.2
Dec 15
Oct 15
Aug 15
Jun 15
Apr 15
Feb 15
Dec 14
Oct 14
Aug 14
Jun 14
Apr 14
Feb 14
Dec 13
Oct 13
Aug 13
Jun 13
Apr 13
0.0
Median 1 is based on the first 12 months’ data (to provide a benchmark); Median 2 is
based on a new median from month 14 (April 2014) to provide a more stable
benchmark of activity (recording of pressure ulcers on Datix began with Phase 2 of
SPSP which may explain why the first 12 months appear artificially low).
The Associate Director of Nursing leading on the tissue viability improvement work is
currently reviewing data from April 2014 onwards to determine that the amendments
and prompts made to Datix for this particular measure has made the reporting more
robust across NHS Fife. The outcome will be reported at the Quality Safety and
Governance Group in March.
3.
BACKGROUND
3.1
In September 2013, CEL 19 outlined ten patient safety interventions “ten essentials”
that should be reliably delivered to every patient in NHSScotland that can benefit from
them.
The ten patient safety essentials are:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Hand washing
Leadership walkrounds
Communications: surgical pause and brief
Communications: general ward safety brief
ICU daily goals
VAP bundle
Early warning scores
CVC insertion
CVC maintenance
PVC maintenance
Page 67
3.2
Healthcare Improvement Scotland has stipulated that external assurance of the
reliable implementation of the ten essentials will be sought via the new Quality of Care
Reviews, within the scope of the annual review processes and through ad hoc
Ministerial updates. Boards are expected to have internal processes in place to ensure
internal assurance.
3.3
An NHS Fife dashboard is currently being created to provide a NHS Fife overview of
process and outcome compliance. “Hand hygiene” and “ward safety briefs” are the first
two process measures that have been implemented across NHS Fife using the Lanqip
system. Ward staff enter data via the Lanqip system and this is then extracted
automatically onto the dashboard. The outcome measures “Staphaureus
bacteraemias” and “Clostridium difficile” are now also displayed on the system. Work is
progressing to ensure that all of the process and outcome measures are incorporated
into the dashboard. The Team are currently focusing on testing the reporting of
pressure ulcer data and consideration of Patientrack data
3.4
A number of dashboard reports are currently being tested and include: Rag status
overview of process compliance for every inpatient area sorted by site and Directorate,
compliance overview covering 13 months and exception reports detailing clinical areas
with low compliance, failure to record and inadequate sample sizes. These automated
reports should reduce duplication by staff that currently provide some of this data
manually. The reports which are viewed via the “Microstrategy” portal are accessed by
staff in both the Acute and Community Hospitals . The reports will be refreshed at the
end of each month and should facilitate a more timely improvement intervention if this
is required.
3.5
In the meantime, the RAG reports previously developed will continue to be used locally
to provide an overview of the implementation and spread of the ten essentials within
the Acute and Community Hospitals.
3.6
The Leadership Walkround process is being reviewed to increase capacity and to
ensure that the system is more capable of identifying themes for improvement.
4.
ASSESSMENT
4.1
SPSI HARMS
Cardiac Arrest / Deteriorating Patient
The Deteriorating Patient Short Life Working Group was established to oversee
actions in relation to the this workstream. The group on five initial priorities:





Robust processes are in place to ensure that Patientrack is embedded.
Appropriate management of patients that trigger FEWS by ensuring that the
correct skills and education around Acute Illness Management Training are
available to staff
Clear escalation processes in every clinical area
Improved decision making around DNACPR and clear management plans
Standardised review processes for patients that have previously triggered
Improvements to date include:

The use of the Scottish Structured Response is embedded in practice and has
actions in relation to patients with a FEWs score of 4+ discussed at the daily
safety huddle

The DPSLWG with support from relevant clinical teams has developed a
Hospital Anticipatory Care Plan to support the appropriate care of deteriorating
Page 68
patients, and in particular offer specific guidance for patients who are not
appropriate for cardio pulmonary resuscitation. The document had been
approved for pilot in 2 clinical areas within VHK. In addition the VHK hospice is
keen to pilot its applicability within this care setting also.
5.

A proposal has recently been agreed to introduce mandatory reporting of
cardiac arrest via DATIX as a major harm event to allow a specific SBAR
review by the responsible clinical team, followed by an independent review
from the emergency bleep group, with internal investigation through an
emergency bleep meeting as required. The implementation of this new
approach is expected by April 2016.

Ongoing review of all cardiac arrests will continue in the interim until the
emergency bleep process is introduced.

Patientrack has now been implemented in inpatient wards across VHK.
Compliance performance with observation timeliness is reported in the
Directorate Performance Reports.
FALLS – PROCESS
A “Falls Call to Action” Update and Review took place on 11th December. The Inpatient
Falls Prevention Group delivered a revised Falls Pathway across the Organisation and
a new Falls Toolkit was launched at this event.
Going forward, any new change ideas relating to falls will be tested on Ward 15 as part
of the Older People’s Collaborative, led by Dr Aylene Kelman. Inpatient wards across
Fife should implement the toolkit in their respective areas.
As part of the improvement work, Ward 15 is testing a revised process measure to
simplify recording. The staff are also improving learning opportunities for all of the staff
by ensuring that the outcome of “falls investigations” are shared with staff.
6.
PRESSURE ULCERS - PROCESS
The improvement work around pressure ulcer care is being led by the Associate
Director of Nursing/Head of Service Delivery GNEF. The group have progressed a
number of interventions which include:

A new national pressure ulcer grading tool was introduced in December across
NHS Fife

Guidance for Reporters and Reviewers developed

Development of Pressure Ulcer REI tool

Discussions held with the University of Dundee re Undergraduate training

Amendments to Datix to reduce duplicate reporting of pressure ulcers across
primary and secondary care

The Cluster review process is embedded in practice and from January
meetings will happen monthly to review incidents of major harm “real time” to
improve opportunity for learning and clinical improvement

The introduction of the “Tissue Viability Times” to provide a froum for Fife wide
communication in relation to pressure ulcer prevention and management, and
shared learning /actions following cluster reviews
Page 69
7.

Leading Better Care event planned for January focussing on pressure ulcer
prevention and management for nurses across NHS Fife.

The “Be aware of pressure area care” poster was introduced across NHS Ffie
to illustrate the process of pressure ulcer risk assessment and appropriate
action and management, identifying key learning points identified from cluster
review meeting outcomes.

Substantive recruitment to specialist tissue viability nursing posts in the acute
and community setting underway which will allow the stability of the clinical
teams across NHS Fife.

Review of Datix to improve reporting fields to inform clinical practice and reflect
new criteria following introduction of the new national pressure ulcer grading
tool.
CAUTI
The improvement work around CAUTI care is being led by the Associate Director of
Nursing NHS Fife. A SLWG has been formed to progress improvements:

The NHS Fife CAUTI Prevention, Insertion and Maintenance bundles have
been developed for use across inpatient areas in both Acute and Community
hospitals

The group has identified that the improvement work should not focus solely on
patients with “urinary catheters”, but should consider the wider improvement
initiatives relating to patients with continence issues, the prevention of urinary
catheter insertion if appropriate, optimal maintenance and early removal.

The group identified an apparent under use of urinary catheter packs that are
available at no cost for patients being discharged from hospital

A “CAUTI Drop In” session for staff took place on November 12th at VHK. The
aim of the session was to provide a forum for staff to discuss the bundles and
any other issues pertaining to the reduction of CAUTI.
Page 70
NINE PRIORITIES
1. Sepsis - Improvement work around sepsis began in 2012.
Chart 6: A & E Sepsis 6
Patients who triggered the Sepsis Six Tool in Resus A & E
Dec 2012 - Nov 2015
70
69
64
60
51
50
44
43
Patients
40
38
30
32
30
22
20
21 21
16
10
13 12
18
15
23
31
27
24
22
41
40
39
32
27
20
49
44
42
27
23
25
27
17
0
Ja
n
Fe -13
M b- 13
ar
Ap - 13
r
M -13
ay
J u -13
n1
Ju 3
l
Au -13
g
Se - 13
p
Oc - 13
t
No -13
v
De -13
c
J a -13
n
Fe -14
b
M - 14
ar
Ap - 14
M r-14
ay
J u -14
n1
Ju 4
l
Au -14
g
Se - 14
p
Oc - 14
t
No -14
v
De -14
c
J a -14
n
Fe -15
M b- 15
ar
Ap - 15
r
M -15
ay
J u -15
nJu 15
l
Au -15
g
Se - 15
p
Oc - 15
t
No -15
v15
8.
Chart 6 demonstrates the overall increase in patients triggering the Sepsis tool.
Chart 7: Average time Antibiotic Administered
Chart 7 demonstrates the average time taken for patients to receive their antibiotic
if the sepsis 6 is triggered. The target is 60 minutes. The data spans from 2013 to
2015.
Page 71
8.1
2
Deteriorating patients - covered earlier in the report
3
Heart failure - embedded
4
Pressure ulcers – covered earlier in the report
5
Surgical site infections
6
Venous thromboembolism (VTE) - the assessment bundle has been
implemented within AU1, and the reassessment bundles have been
implemented within Ward 52 (Surgical). Plans to implement the VTE
improvement interventions more widely are currently being developed.
7
CAUTI – covered earlier in the report
8
Falls with Harm – covered earlier in the report
9
Safer Medicines - the Pharmacist based in AU1 is measuring compliance
with medicines reconciliation on admission within AU1.
Forthcoming Events

SPSP Medicines Learning Session 1 on 24th February

SPSP Healthcare Associated Infections Learning Session 21st March
RECOMMENDATIONS
The Board is asked to:

Note the overview of progress for each work stream.

Advise on aspects of the report that they found valuable and if they would
value continuing reports in this format
Page 72
SECTION E
FREEDOM OF INFORMATION REQUESTS
1.
INTRODUCTION
The purpose of this report is to update the Board on the Freedom of Information
requests received for the month 1st – 31st January 2016.
2.
BACKGROUND
The Freedom of Information (Scotland) Act is an Act of Scottish Parliament which came
into force in January 2005, and gives everyone the right to ask for any information held
by a Scottish Public Authority. NHS Fife has received a steadily increasing number of
requests every year.
All Public Bodies are required, by law, to respond to all reasonable requests, within 20
working days. There are however, certain conditions and exemptions which are set out
in the Act, for circumstances where a response would be inappropriate.
3.
CURRENT POSITION
Table 1 shows that the number of requests received in January was 58, compared to 42
in the same period last year. The number of requests responded to in the 20 day
timescales so far is 28. Two of the remaining 30 requests have missed the 20 day
deadline therefore the percentage of responses is 96%. The remaining 28 are in line to
respond to, within the timescales.
Table 1
Month
Number of
Requests
Source of Requests
MP / MSP /
Commercial
SGHSCD
Responses
Media
Other
Total
<= 20 Days
> 20 Days
% Within 20
Days
Jan 2016
58
12
13
21
12
28
28
0 **
96% **
Jan 2015
42
9
2
16
15
42
41
1
97.3%
**
Two responses incomplete and already over the 20-day deadline, so % completion calculated as 96% (56 out of 58, including those
not complete but on schedule to be complete within the timescale)
Page 73
Table 2 shows the distribution across Executive Directors responsible for collating the
individual responses.
Table 3 also shows the main source of requests.
Page 74
SECTION F
COMPLAINTS
We will achieve and sustain response times of no less than 95% (acknowledged
within 3 working days) and 65% (responded to fully within 20 working days).
Key Concerns and Risks
Each of the operational parts of the system is developing action plans in partnership with
Patient Relations Team.
The actions described will ensure that response times improve whilst the quality of
responses are maintained.
The biggest risks to achieving and sustaining the planned improvements are:



Complexity of complaints which cross different organisational units
Ownership of complaints
Patient Relations Capacity
Recovery Trajectories
3-day Acknowledgement
20-day Completion
Recovery Plan
Performance is improving following the successful implementation of all identified
actions within the Recovery Plan. There is still outstanding work to establish the
single points of contact across the Community areas.
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Complaints, Concerns, Compliments and Comments
160
140
120
100
80
Compliments
Comments
60
40
Complaints
Concerns
20
0
Context of Complaints in Relation to Other Forms of Feedback
The Patient Relations Team deal with concerns from patients, their families and the
general public. In many instances, this promotes local resolution and prevents issues
being progressed to formal complaints. It often involves meeting with people at an
early stage to identify what can be done to resolve an issue early on. There is no
related target to this work although this forms a significant part of the Patient
Relation Team daily workload.
There was a significant increase in the number of concerns received in November as
a result of issues being raised about changes made to manning the car park at
Whyteman’s Brae Health Centre. Action has been taken to review the parking
situation and to improve accessibility.
Patient Opinion provides a route for people to share their experience of NHS care
anonymously. Nine posts were received in December compared to seven in the
previous month. 56% of the posts provided positive feedback; 22% provided
minimal/mild criticism and a further 22% were moderately critical. One of the Board’s
challenges relates to receiving anonymous critical feedback, where there is no
opportunity to look into the specifics raised. The approach of the Board is to seek
dialogue to ensure appropriate follow up can be arranged.
A range of stories were posted in December including stories about; Cameron
Hospital, Glenrothes Hospital, Queen Margaret Hospital and Victoria Hospital
(A/E/Dermatology/Orthopaedics/Cardiology/Ward 54).
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Scottish Public Service Ombudsman (SPSO) Decisions and reports concluded
in November (following date of report submission) and December 2015
The SPSO published one report concerning the standard of care provided by mental
health services in the Community and in Stratheden Hospital. The Ombudsman
made a number of recommendations, all of which have been actioned to the
satisfaction of the SPSO.
http://www.spso.org.uk/investigation-reports/2015/november/fife-nhs-board
The SPSO reached decisions on the following cases:
The SPSO considered a case about unreasonable care and treatment when a
patient was being cared for by the Hospital at Home Team. In considering the case
the SPSO recognised that the Board had identified failings in relation to processing a
blood sample and apologised appropriately for the failing. Following the complaint
the Service developed a Standing Operating Procedure for obtaining blood samples
and actioning results which was viewed as acceptable by the SPSO advisor.
The SPSO did not uphold a complaint about an avoidable delay by clinicians at the
Victoria Hospital in diagnosing hypersensitivity to a medication used to treat urinary
tract infections. The SPSO concurred with the Board’s view that the reaction to the
medication was extremely rare and that the care and treatment provided was in
accordance with appropriate clinical guidance.
The SPSO did not uphold a complaint about inappropriately discharging a patient
following gall bladder surgery and failing to provide appropriate treatment following a
further referral from the GP. The SPSO did however make a recommendation in
relation to the provision of information to patients at the point of discharge. As a
result of this the Unit concerned is reviewing all written patient information leaflets.
The SPSO upheld a complaint that staff at the Victoria Hospital failed to adequately
monitor a patient following surgery and asked the Board to ensure the case was
discussed in a multi disciplinary setting and to offer an apology to the patient. All
recommendations by the SPSO have been completed and the SPSO have
confirmed their satisfaction with the actions taken by the Board.
The SPSO considered a complaint concerning the standard of nursing care,
communication about the patient’s condition, an issue in relation to dressing a wound
and the amount of time taken to respond to the complaint. The SPSO upheld the
complaints about the standard of nursing care and complaint handling; noting that
appropriate action had been taken by the Board in offering an apology and
identifying improvements in relation to complaint handling performance.
The SPSO upheld a complaint about an avoidable delay in a GP Practice diagnosing
toxicity to a medication used in the treatment of urinary tract infections. As the
Practice had already undertaken a Significant Review and apologised to the patient
and reviewed other patients in the Practice; the SPSO had no recommendations to
make.
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The SPSO upheld a complaint about a GP Practice failing to appropriately assess a
patient at a consultation and failing to appropriately manage a telephone request.
Despite the Practice having undertaken a Significant Review the SPSO
recommended an apology and made specific recommendations to the GP in relation
to managing patients with Chronic Obstructive Airways Disease. The GP was also
asked to discuss the case at next appraisal. All recommendations have been
actioned and the SPSO have confirmed their satisfaction with this.
The final decision reached by the SPSO concerned a GP practice and a number of
complaints including, failure to diagnose a damaged bowel prior to hospital
admission, failure to provide appropriate medication following development of a
urinary tract infection, failure in the transfer of information between primary and
secondary care, inappropriate advice by GP and refusal to prescribe a medication.
One of the five complaints was upheld; failure to diagnose damage to bowel. The
Practice was asked to offer an apology and provide an assurance that the GP would
discuss the case at their next appraisal. All actions have been completed by the
Practice and the SPSO have confirmed their satisfaction with this.
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SECTION G
NHS FIFE
Report to the Fife NHS Board on 23 February 2016
PROGRAMME MANAGEMENT OFFICE UPDATE
1.
INTRODUCTION
1.1
The purpose of this report is to provide an update on the work of the Programme
Management Office (PMO) to support the delivery of the Strategic Programme 20152018.
2.
BACKGROUND
2.1
The report forms a component of the governance arrangements for delivering the
corporate priorities set out in the Board’s Strategic Framework.
2.2
Section 3 summarises the work completed to date (split across the various projects)
and Section 4 sets out the work scheduled to be completed by the end of March,
which will be reported to the April meeting of the Board.
3.
WORK COMPLETED TO DATE
3.1
NHS Fife Optimising Efficiencies in Surgery project - Work completed to date has
largely been focused on data analysis, supplemented by stakeholder interviews,
observations, a culture survey and short working sessions to explore booking and
pre-assessment processes. In addition an orthopaedic options appraisal has been
carried out, which can be used to support a business case for future delivery of
orthopaedic elective surgery.
3.2
Demand & Capacity project – Work completed to date includes the creation of
demand and capacity tables which capture Acute elective, emergency and
diagnostics activity, capacity and demand for Outpatients and Inpatients / Daycases,
including tertiary activity (both primary and secondary). This is currently being
validated with the services.
3.3
Clinical Strategy project – The inaugural meeting of the Clinical Strategy Steering
Group took place on 5th February. All seven of the Clinical Strategy workstreams
have now met at least once, with a number having met twice. These meetings
have considered the existing arrangements for service provision, emerging
models of care and their evidence base. A Communications and Engagement
Plan 2015/16 has been developed for the Clinical Strategy, which will be taken
forward alongside the Participation and Engagement Plan and the Workforce
Strategy Communications Plan.
3.4
Workforce Efficiency project – Key activities completed include carrying out an
analysis of current data collection systems around vacancy management /
recruitment / nurse bank. A Nursing and Midwifery Recruitment Short Life Working
Group has been established together with a Workforce Efficiency Project
Management Steering Group. In addition, links have been developed with a number
of higher education bodies regarding return to practice programmes.
3.5
Outfacing Activity project - Detailed analysis has been undertaken of the outfacing
activity to other NHS Boards from NHS Fife. This analysis requires to be lined up with
the demand and capacity project to consider any activity that could be repatriated to
NHS Fife taking into account resource and workforce issues.
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3.6
Well at Work project – An analysis has been completed on sickness absence data
and hot spots / trends per operational unit and an option appraisal has been
completed to identify areas for improvement. There has been a specific focus
around developing a resource pack to support managers in dealing with local
absence management issues. A mapping exercise has been completed against
the Healthy Working Lives Gold Award criteria to identifying gaps and a delivery
plan has been developed to achieve and maintain the award.
3.7
Estates & Facilities Management Efficiencies project – Work to date has been
focused around two distinct workstreams; namely Central Mailroom and a Transport
Review of fleet vehicle usage. The Central Mailroom project group met twice during
December. The Fleet Vehicle usage group has met once to consider the initial
outputs from the Routemonkey analysis. Work to identify and scope other change
workstreams is already underway with a specific focus on the delivery of cash
releasing savings.
3.8
Prescribing Efficiencies project – The Prescribing Efficiency plan is on track to deliver
the target level of efficiencies for 2015/16. Funded invest to save projects are
underway (such as prescribing support nurses for diabetes, respiratory, woundcare /
stoma / catheters and care home medicines waste). The Scriptswitch (GP IT
prescribing system) commenced rollout to practices Fife-wide on 11th January.
Recruitment of staff for homecare medicines governance is being progressed.
3.9
Workforce Strategy project - A Project Steering Group has been established to
oversee delivery of the Workforce Strategy project, including specific work on
Training and Development which is currently being finalised. Evaluation of Workforce
Strategies from other Boards areas has been undertaken together with an evaluation
of workforce policies and procedures.
4.
WORK SCHEDULED FOR COMPLETION BY THE END OF MARCH 2016
4.1
NHS Fife Optimising Efficiencies in Surgery project – An implementation plan is being
devised using a combination of the data available, overlaid with local knowledge
around culture and constraints. The new anaesthetic rota will be included in 2016 job
plans, but may be subject to further revision. Work continues on a list building project,
which is examining options for the reconfiguration of the Phase 2 Elective Theatres.
4.2
Demand and Capacity project – Work to capture Health and Social Care services
activity will be progressed with a specific focus around mental health and learning
disabilities. Work will be completed on population projections and future demand
profile for services.
4.3
Clinical Strategy project - All workstreams will continue to meet with most
workstreams scheduled to complete meeting 4 of 5 by the end of March. Workstream
meetings have been well attended with high levels of engagement from both clinical
and non-clinical staff. Common themes are emerging which will help to shape the
Clinical Strategy. A Clinical Strategy Development Conference has been scheduled
for 23rd March, which will provide an opportunity for workstreams members to discuss
emerging themes across workstreams. Work will continue to deliver the
Communications and Engagement Plan 2015/16 and the Participation and
Engagement Plan to maximise the engagement of staff, patients, carers and the
public in developing the draft Clinical Strategy.
4.4
Workforce Efficiency project – The workforce review utilising the national tools will be
completed. In addition, work to review the utilisation of bank and agency will be
completed together with a review of the impact of recruitment activity.
4.5
Outfacing Activity project – Work to examine the opportunities for repatriation of
services to NHS Fife is being progressed as an integral part of the workstream
activity for the Clinical Strategy project.
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4.6
Well at Work project – The Healthy Working Lives Gold Award assessment will be
carried and implementation of the delivery plan will commence to support ongoing
compliance. The delivery plan will be finalised and work will commence to deliver
the actions designed to improve absence management performance towards the
defined targets.
4.7
Prescribing Efficiencies project – The inaugural meeting of a new Managed Service
Drugs and Therapeutics Committee is scheduled to take place in February. Work to
develop a new Pharmacy Strategy will be planned.
4.8
Workforce Strategy project - Work will be completed on an analysis of the current
workforce. Work will commence on quantifying the future demands on the workforce
and on shaping the consultation process with staff. An important aspect of this work
will be the flow of information to and from the Clinical Strategy workstreams as well
as other projects within the programme.
5.
RECOMMENDATION
The Fife NHS Board is asked to:


Note the progress to date in completing the stages scheduled for completion
by 31st January for each of the projects in the Strategic Programme 20152018;
Note the next steps required to complete the project stages scheduled for
completion by the end of March 2016.
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