Perth And Kinross Health & Social Care Partnership (HSCP) Clinical And Care Governance Ass
Perth and Kinross Council · 18 September 2024
Back to Scrutiny and Performance Committee — 18 September 2024 and its agenda
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Perth And Kinross Council Scrutiny and Performance Committee 18 September 2024 PERTH AND KINROSS HEALTH & SOCIAL CARE PARTNERSHIP (HSCP) CLINICAL AND CARE GOVERNANCE ASSURANCE REPORT Chief Officer, Perth and Kinross HSCP (Report No. 24/256) 1. PURPOSE OF REPORT 1.1 This purpose of this report is to provide assurance to Perth & Kinross Council’s Scrutiny and Performance Committee on the Clinical Care and Professional Governance of the Perth and Kinross HSCP. 2. SITUATION 2.1 This report provides assurance on the clinical and care governance arrangements for services delegated within the Perth and Kinross Integration Scheme (approved June 2022) and delivered by the HSCP. The clinical and care governance arrangements adhere to the Getting It Right For Everyone (GIRFE) Framework. Clinical Governance is a statutory reporting requirement at NHS Board level and our integrated approach enables Perth & Kinross Council to be assured about the standards and quality of social work and social care services 2.2 The Scrutiny and Performance Committee is asked to scrutinise this report and agree the level of assurance. The timescale for the data within this report are the four months between 1 March 2024 and 30 June 2024. 2.3 The recommended level of assurance is: Reasonable Assurance; due to the following factors: • recent annual reports received in line with the agreed reporting framework demonstrated reasonable levels of assurance to the Care and Professional Governance Forum co-chaired by the Clinical Director for the HSCP and the Council’s Chief Social Work Officer. Reporting and escalation of operational risks which have a bearing on clinical and care governance and associated mitigating actions and an established process for ensuring that the strategic risks to the Perth & Kinross Integration Joint Board take account of this where appropriate 3. BACKGROUND 3.1 The role of the Perth & Kinross Care and Professional Governance Forum is to provide assurance that there are effective and embedded systems for Clinical, Care and Professional Governance in all services within Perth & Kinross HSCP.
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3.2 The GIRFE Framework is an agreed tool used by all three HSCPs to ensure consistency of approach between Local Authorities, Tayside NHS Board and the IJBs for the three HSCPs; quality assurance is assessed against an agreed, prioritised common data set for each of the governance domains as detailed below. A GIRFE Steering Group continues to meet, with representatives from each of the three Partnerships and part of its remit is to support additional common assurance measures and this template 3.3 The six domains continue to evolve over time and must be adaptable and responsive to the changes in legislation and external support and monitoring. The domains reflect the principles set out in the Health and Social Care Standards, My support, My life; Scottish Government, 2018 and the Quality of Care Approach, HIS and Care Inspectorate, September 2018. The domains are: 4. ASSESSMENT 4.1 Exceptions: There was a risk in relation to Occupational Therapy staffing across both inpatient and locality community services. 4.2 A risk had previously existed on DATIX regarding OT staffing challenges, and this risk had been archived due to positive progress and a period of stability. This risk was reinstated, and rag rated as red. 4.3 There was also an ongoing red risk within Adult Social Work and Social Care for OT capacity as a result of increased demand and staff vacancies. All vacancies are now advertised and some successfully recruited to. Controls were put in place to manage the risk, such as daily site huddles to prioritise work and communicate with the wards. 4.4 The reduced Adult Social Work & Social Care OT capacity for assessment for aids and adaptations had impacted on waiting times (currently >400 people) and response times for non-urgent cases. 4.5 P&K locality OT teams had also experienced staffing difficulties due to resignations and staff absences adding to the risk. Information Governance Professional Regulation and Workforce Development Patient/Service user/Carer and Staff Safety Patient/Service user/Carer and Staff Experience Quality and effectiveness of care Promotion of Equality and Social Justice
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4.6 The Chief Officer commissioned a review of the Allied Health Professional workforce across the HSCP and this has now been completed by the Director of Allied Health Professions along with the HSCP Lead. As a result, a redesign of AHP provision will commence in October led by a suitably qualified and experienced manager to improve the longer-term effectiveness and efficiency of AHP provision, including Occupational Therapy 5. CLINICAL AND CARE RISK MANAGEMENT 5.1 The operational / team level risk registers for HSCP Health and for Adult Social Work and Social Care (appendices 2 & 3) services are discussed monthly at the HSCP Care & Professional Governance Forum. 5.2 Managers of red risks provide a written update at every meeting, and managers of amber risks are asked for update at every other meeting. 5.3 This supports assurances that the relevant risks are being regularly monitored; ensures measures are put in place to minimise the risk; what alternative mitigations plans and actions are in place to minimise the risk; that where the risk affects, or is impacted by, other parts of the health or social care system, or indeed other agency, we are assured that they are fully informed and engaged in the process. 5.4 P&K HSCP health red risks as at 9th July 2024 Datix Ref Risk Exposure – No controls Current Risk Exposure Rating Planned Risk Exposure Risk Trend Please include data from previous four reporting periods Aug 2023 Nov 2023 Mar 2024 Jul 2024 L C RER L C RER L C RER L C RER L C RER L C RER 829 4 5 20 4 5 20 4 5 20 4 5 20 4 5 20 2 5 10 ↓ 886 5 4 20 - - - - - - 5 4 20 5 4 20 2 4 8 ↓ L = Likelihood C = Consequence RER = Risk Exposure Rating 5.4.1 Risk 829 - Challenges in relation to accommodation for clinical and non-clinical staff across P&K In June, the movement of iDART (Integrated Drug & Alcohol Team) from Drumhar Health Centre to Birnam Day Centre at Murray Royal Hospital was noted to be making progress within key timescales. The movement of services (Speech and Language Therapy, vaccination team, and incontinence service) needed further support from support services to enable the Care & Treatment Service to relocate from Beechgrove to Drumhar Health Centre. By end of July 2024, a series of successful moves had been completed addressing the immediate premises and accommodation risks for health and social care services as follows:
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• iDART has relocated from Drumhar to Birnam Day Centre at Murray Royal Hospital. • the Perth City Care & Treatment Service has relocated from Beechgrove (former PKC Care Home) to Drumhar Health Centre The child immunisation clinic has relocated from Drumhar Health Centre to Pullar House along with the community vaccination centre which relocated from a leased shop front to Pullar House. 5.4.2 Risk 886 - Staffing challenges within the OT service at Perth Royal Infirmary The Chief Officer commissioned a review of the Allied Health Professional workforce across the HSCP and this has now been completed by the Director of Allied Health Professions along with the HSCP Lead. As a result, a redesign of AHP provision will commence in October led by a suitably qualified and experienced manager to improve the longer-term effectiveness and efficiency of AHP provision, including Occupational Therapy across the HSCP. 5.5 P&K HSCP Adult Social Work & Social Care red risks as at 9th July 2024: Risk Risk Exposure – No controls Current Risk Exposure Rating Risk Trend (↑/→/↓) Please include data from previous four reporting periods Jul 2023 Nov 2023 Mar 2024 Jul 2024 L C RER L C RER L C RER L C RER L C RER 1 4 5 20 4 5 20 4 5 20 4 5 20 4 5 20 → 2 4 5 20 4 5 20 4 5 20 4 5 20 4 5 20 → L = Likelihood C = Consequence RER = Risk Exposure Rating 5.5.1 Adult Social Work and Social Care Risk 1 – Lack of Care at Home capacity, especially around rural P&K. Recruitment was ongoing for a number of posts within HART, HART Plus and Living well, with several posts recruited to, and interviews planned. The internal Care at Home Service is now fully staffed and there has been a successful international recruitment with six new employees sponsored by PKC and joining the HSCP in July 2024. 5.5.2 Adult Social Work and Social Care Risk 2 – Lack of OT capacity Staffing vacancies are being recruited to with support from agency OT staff and temporary additional management capacity in place. The Chief Officer commissioned a review of the Allied Health Professional workforce across the HSCP and this has now been completed by the Director of Allied Health Professions along with the HSCP Lead.
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As a result, a redesign of AHP provision will commence in October led by a suitably qualified and experienced manager to improve the longer-term effectiveness and efficiency of AHP provision, including Occupational Therapy across the HSCP. 6. CLINICAL & CARE GOVERNANCE ARRANGEMENTS: 6.1 As per the Integration Scheme (June 2022) each HSCP in Tayside is a Lead Partner for a number of services that are better planned for and managed by one HSCP but provided for all communities across Tayside. These services report through to the Clinical Care and Professional Governance Forum for that HSCP. At the Clinical Care and Professional Governance Forum the Lead Partner Service reports receive the relevant level of scrutiny as other reports. 6.2 Systems and processes are being established to ensure that all three HSCPs receive copies of reports from other Lead Partner Services to support integration, and effective whole system working. 6.3 Full details of the Clinical & Care Governance Arrangements in P&K HSCP are provided within appendix 1. 7. SUMMARY OF KEY EXCEPTIONS RAISED AT RECENT CPGF MEETINGS: 7.1 Key exceptions identified within the exception reports from the CPGF meetings held in March, April, May and June 2024: • North Locality: o DATIX raised in regards to parallel bars (PCH) Physio department. Procurement options being explored. o Enhanced support provided through multi-disciplinary team approach to a commissioned care home. • Urgent Care: o Hospital at Home – transitional process to close the service from July 2024. Evaluation of learning being captured. • Podiatry: o At end April 24, there was a caseload of approx 7,000 patients. Of 627 people on the Podiatry waiting list 354 had been waiting over 12 weeks. Slight improvements noted. • Perth City: o Community Rehabilitation Team Occupational Therapy at Red RAG staffing due to vacancy, planned and unplanned leave. Recruitment to vacant and fixed term posts progressing with use of Locum in the interim. • South Locality o Psychiatry of Old Age Community Team RED staffing risk. Leadership support from South OT Lead & Clinical Practice Team Manager. Recruitment progressing. • Prison Healthcare o Prison Healthcare: Dentist – only urgent appointments being seen due to capacity. Waiting time 22 weeks in HMP Perth for routine. HMP Castle
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Huntly / HMP Bella patients are appointed by Kings Cross Hospital. Dentists triage all referrals. • Public Dental Service: o Awaiting input from Property Department to progress essential ventilation and building works. Work has been approved in principle and funding in place. • Medicine for the Elderly, Allied Health Professionals and discharge services: o Awaiting input from Property Department to progress essential ventilation and building works. Work has been approved in principle and funding in place. 7.2 Key exceptions identified within the annual reports from the CPGF meetings held in March, April, May and June 2024: • Access Team o The Team has introduced Quality Assurance measures to complement feedback received from Care Opinion. The team has undertaken two peer audit sessions and shared learning. • North Locality o To create more sustainability within care at home, we have identified difficult to reach geographical areas where Care at Home provision will be delivered solely by HART. In addition, HART will continue to provide Care at Home for individuals assessed and waiting more than 3 months for a commissioned option 3 provider. o AHP workforce tool has been completed in line with Safer Staffing requirements, which has evidenced a significant shortfall within Physiotherapy. o Social Work Community OT waiting lists remain high as a result of long- term vacancies which are difficult to recruit to. Kept under review at the Social Care / Social Work Forum. o The locality is recovering from a period of shortage within AHP teams due to vacancy and sickness but sharing resources to spread risk. • Medicine for the Elderly, AHP and discharge services at PRI: o Tay Ward has recently reduced to its core bed footprint. Over the past reporting year, there have been difficulties experienced with lengthy delayed discharges. The target length of stay for Tay Ward is <28 days and this was achieved in February 2024, following reduction in bed capacity. The Optimising Flow work stream has developed monthly meetings to review data commencing April 2024, The Integrated Discharge Hub supports Tay Ward with an allocated Social Worker and Discharge Coordinator. o The Integrated Discharge Hub has worked with multidisciplinary teams in PRI and community services to achieve a steady amber status (local target) for delayed discharges throughout winter. There have been several instances when there has been a sharp increase into red status and the teams have responded with immediate actions to regain a positive position. A new management structure was introduced in the last year to include an Integrated Service Manager and Improvement Officer.
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o The MSK team have successfully been able to reduce the number of patients waiting on MSK physiotherapy since the start of 23-24 financial year. (Latest waiting 935 as of week 21/03/24). o Both Tay Ward and Stroke Unit are self assessing in order to be ‘Inspection Ready’. Service Manager and Senior Nurse have met with both Senior Charge Nurses March 2024 and Care Assurance Toolkit assessments will be completed by Senior Nurse every 2 months. 8. ADVERSE EVENTS 8.1 Systems are in place for services/localities to review DATIX incidents. The Nursing & AHP leads meet along with the Clinical Governance Coordinator on monthly basis to review the top 5 incident categories. This helps to identify any trends or any appropriate action and supports closing the loop. 8.2 Regarding adverse events, the main themes reported during the months between March and June 2024 were: Highest frequency events: 1. Slips, Trips and Falls 2. Medication 3. Pressure Ulcer 4. Clinical Challenging behaviour 5. Violence & Aggression Harm is defined as an outcome with a negative effect. Harm to a person or groups of people may result from worsening of a medical condition, the inherent risk of an investigation or treatment, system failure provider performance issues, service disruption, financial loss or adverse publicity. 8.2.1 Slip, Trip & Falls During the time period between March and June 2024, there were 160 incidents recorded, of which 22 involved harm. 44 occurred at MRH, 18 at PRI, 58 in Community Hospitals and the remaining 40 in other areas.
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The Prevention & Early Intervention Manager continues to: • review all of the wards in-patient falls Datix reports and provide feedback to the ward with a breakdown of their falls, outlining any trends, highlighting patients who fall repeatedly and enquiring if further information is required • Supports all of the HSCP wards to have strength and balance exercise panels fitted on their walls and suitable patients also receive a set of strength and balance cue cards which they can take home with them. Along with that they receive a Care About Walking booklet and record charts for recording activity / steps. 8.2.2 Medication During the time period between March and June 2024, there were 79 incidents recorded, of which 5 involved harm. 11 occurred at MRH, 4 at PRI, 14 in Community Hospitals, 28 within a Prison Establishment and the remaining 22 in other areas. The majority of medication adverse events occurred with the Prison Healthcare service. The prison healthcare service manages and administers a high volume of medication across three sites across Tayside - HMP Perth, HMP Castle Huntly and HMP & YOI Bella. 8.2.3 Violence & Aggression During the time period between March and June 2024, there were 28 incidents recorded, of which 6 involved harm. 7 occurred at MRH, 9 at PRI, 4 in Community Hospitals, and the remaining 8 in other areas.
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All of the 7 incidents within Murray Royal Hospital were within the Psychiatry of Old Age wards. All 9 of the incidents at PRI were at Cairnwell (Perth City CMHT base) 8.2.4 Clinical Challenging Behaviour (such as patient unable to understand risks, sexual disinhibition, general agitation) During the time period between March and June 2024, there were 57 incidents recorded, of which 4 involved harm. 48 occurred at MRH, 3 at PRI, 4 in Community Hospitals and 3 others. The vast majority of these incidents were within the Psychiatry of Old Age wards at Murray Royal Hospital. The rise in incidents (albeit of negligible grading) in October 2023 appears to be attributable to a small group of patients in one particular POA ward who are exhibiting these behaviours. The wards have sought input from the NHST PMVA team regarding the ongoing management of Violence & Aggression and Clinical Challenging Behaviour. 8.2.5 Pressure Ulcers During the time period between March and June 2024, there were 67 incidents recorded, of which 57 involved harm. 26 were within the patients home, 19 within Care Homes, 11 within Community Hospitals, and the remaining 11 in other areas.
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The yellow graded events are discussed at the relevant locality Care Governance meeting. It should be noted that some of these pressure ulcer incidents are regarding patients who have been discharged from hospital to the community with a pressure ulcer, which has then been picked up and reported by a service in P&K HSCP. Each geographical locality in P&K is provided with a summary of adverse events specific to their locality to enable them to identify trends and any learning. Adverse events are regularly reviewed and form a standing agenda item at the locality governance groups to identify learning, improvements, training needs or themes. It has been identified and acknowledged by the CPGF that further performance improvement is required regarding the timescales for reporting and verifying DATIX incidents. This continues to improve and to be monitored at CPGF meetings. 8.3 Adult Social Work & Social Care Incident Summary: Information for recent quarters not yet available. 8.4 Significant Adverse Event Reviews One SAER regarding the care and treatment of a resident in a Care Home has been commissioned. SAER processes ensure that there is oversight and sign off by the Executive Director of Nursing and Medical Director. Pressure Ulcers & Falls Details regarding both of the types of Adverse events has been provided above in section 8.2. Pressure ulcers are reviewed on an individual basis to ensure that all mitigating actions are in place and any themes in relation to learning are identified. Complaints Current Health Complaints as at 16/07/2024 - Stage 1 Service Area 0-5 Days 6-9 Days Total Perth & Kinross HSCP 3 0 3 Current Health Complaints as at 16/07/2024 - Stage 2 Service Area 0-5 days 6-10 days 11 -15 days 16-20 days >20 days Total Perth & Kinross HSCP 2 3 1 2 1 9
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Health Complaint Summary for June 2024 (Part Month): *report created on 26th June 2024 Number of complaints closed by month: • Total number of complaints received in June* 2024 = 35 • Total number of complaints closed in June* 2024 = 28 • Stage 1 = 16 (7 upheld or partially upheld) • Stage 2 = 12 (6 upheld or partially upheld) o % Stage 2 completed within timescales = 100 o % Stage 2 not completed within timescales = 0% ➢ Services • Prison Healthcare – 26 • Mental Health – 1 • North – 1 • Top themes for June* 24 (Prison Healthcare): ➢ Overall (more than one theme can be applicable per complaint) • Medication – 12 • Disagreement with treatment plan or outcome – 8 • Wait times / delay – 5 • Transport not available so unable to attend appointment - 2 ➢ Upheld or Partially Upheld complaints (more than one theme can be applicable per complaint) • Medication – 6 • Disagreement with treatment plan or outcome – 1 • Wait times / delay – 4 • Transport cancelled so unable to attend appointment – 1 • Top themes for June* 24 (other HSCP services): ➢ Overall (more than one theme can be applicable per complaint) 0 10 20 30 40 50 60 Stage 1 Stage 2
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• Missing sample – 1 • Delay in assessment – 1 ➢ Upheld or Partially Upheld complaints (more than one theme can be applicable per complaint) • Missing sample – 1 • Delay in assessment – 1 PKC Complaint Summary For June 2024: • Total number of complaints received in June 2024 = 12 • Services the complaints relate to as below o Access Team - 3 o Perth City Locality North – 1 0 1 2 3 4 5 6 7 8 9 10 April May June July Aug Sept Oct Nov Dec Jan Feb March Complaints Closed 2023 -2024 Stage 1 Stage 2 0 2 4 6 8 10 12 April May June July Aug Sept Oct Nov Dec Jan Feb March Complaints Closed 2024-2025 Stage 1 Stage 2
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o Assessment & Charging – 1 o South Locality Crieff – 2 o Community Alarm – 1 o Hospital Discharge Team – 1 o HART – 1 o North Locality Blair – 1 o OT – 1 • Top themes ➢ Overall (more than one theme can be applicable per complaint) • Quality of Care - 2 • Staff Conduct - 4 • Waiting Times/Delays – 1 • Disagreement with Assessment - 2 • Paying for Care – 1 • Involvement with decisions – 1 • Entitlement to services - 1 • Total number of complaints closed in June 2024 = 12 • Stage 1 = 10 (4 Fully Resolved, 3 Upheld, 3 Not Upheld) • Stage 2 = 2 (1 Not Upheld, 1 Partially Upheld) • Upheld or Partially Upheld complaints (more than one theme can be applicable per complaint) ➢ Stage 1 - • Disagreement with Assessment • Staff Conduct • Waiting times/Delays ➢ Stage 2 – • Complaints Response Actions taken from upheld/partially upheld stage 1 complaints: • Reassessment of needs offered. • Discussions held in supervision and reflections. • Reassurance provided and update on waiting timescales. Scottish Public Services Ombudsman Reports There have been no complaints referred to the SPSO during the time period.
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The last complaint which was referred to the SPSO was from December 2021, and SPSO found that the Boards complaint response was reasonable and decided not to investigate further. 8.5 External Reports & Inspections No Inspections during the time period. 9. ADULT SUPPORT & PROTECTION 9.1 Responding to concerns about adults at risk of harm is prioritised and, despite this increase in referrals, 97% of all concerns are screened within 24-hours. This indicator, together with the wider performance framework, is monitored at locality governance meetings, the Public Protection Group, Chief Officers Group and the Adult Protection Committee. 9.2 MAT Standards Current RAG scores as at Jun 2024 are: Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6 Standard 7 Standard 8 Standard 9 Standard 10 RAG Score 0 50 100 150 200 250 9th March - 5th April 2023 6th April - 3rd May 2023 4th May - 31 May 2023 1st June - 28th June 2023 29th June - 26th July 2023 27th July - 23 Aug 2023 24 Aug - 20 Sept 2023 21 Sep - 18 Oct 2023 19 Oct - 15 Nov 2023 16th Nov - 13 Dec 2023 14 Dec 2024 - 10 Jan 2024 11 Jan - 7 Feb 2024 8 Feb - 6 Mar 2024 7 Mar - 3 Apr 2024 Number of individual ASP referrals over the last four weeks Number of adult concerns (from Police Scotland) over the last four weeks
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Standard 1 – All people accessing services have the option to start MAT from the same day of presentation. GREEN Standard 2 – All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose. GREEN Standard 3 – All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. GREEN Standard 4 – All people are offered evidence based harm reduction at the point of MAT delivery. GREEN Standard 5 – All people will receive support to remain in treatment for as long as requested. GREEN Standard 6 – The system that provides MAT is psychologically informed (tier 1); routinely delivers evidence-based low intensity psychosocial interventions (tier 2); and supports individuals to grow social networks. AWAITING ASSESSMENT – EVIDENCE BEING GATHERED AND SUBMITTED Standard 7 – All people have the option of MAT shared with Primary Care. AWAITING ASSESSMENT – EVIDENCE BEING GATHERED AND SUBMITTED Standard 8 – All people have access to advocacy and support for housing, welfare and income needs. AWAITING ASSESSMENT – EVIDENCE BEING GATHERED AND SUBMITTED Standard 9 – All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. AWAITING ASSESSMENT – EVIDENCE BEING GATHERED AND SUBMITTED Standard 10 – All people receive trauma informed care. AWAITING ASSESSMENT – EVIDENCE BEING GATHERED AND SUBMITTED Mental Health waiting times (1st Jan 2024 – 1 Jun 2024)
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The following is waiting time data for teams where their referral to assessment or their assessment to treatment intervention wait time standard has breached Team Wait Time Standards Breach Status Adult Mental Health Occupational Therapy Team P1 – 5 Working Days P2 – 6 Weeks P3 – 12 Weeks Community Learning Disabilities Team (Wait times currently being explored for Dietetics, Speech & Language, Clinical Psychology) 12 Weeks Clinical Psychology, Adult Community Mental Health Teams 18 Weeks Garry Ward, Psychiatry of Old Age Inpatients 0 Days Integrated Drug and Alcohol Recovery Team 3 Weeks Learning Disability Intensive Support Service 12 Weeks Leven Ward, Psychiatry of Old Age Inpatients 0 Days Mental Health Officers 0 Days Mental Health Physiotherapy P1 – 3 Working Days P2 – 5 Working Days P3 – 10 Working Days MoveAhead 12 Weeks North Perthshire Adult Community Mental Health Teams Urgent – 72 Hours Routine - 12 Weeks North Perthshire Primary Care Mental Health and Wellbeing Team 12 Weeks Perth City Adult Community Mental Health Team Urgent – 72 Hours Routine - 12 Weeks Perth City Primary Care Mental Health and Wellbeing Team 12 Weeks SCOPE AP Concerns – 24 hrs ASP Inquiry – 10 days ASP Investigation – 28 Days South Perthshire Adult Community Mental Health Team Urgent – 72 Hours Routine - 12 Weeks South Perthshire Primary Care Mental Health and Wellbeing Team 12 Weeks Therapeutics & ECT Team 0 Weeks The Wellbeing Support Team Tummel Ward, Psychiatry of Old Age Inpatients 0 Days ⚫ No Wait Time Breaches ⚫ Wait Time Breached ⚫ Data Pending (work being explored) .
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Clinical Psychology – Adult CMHTs Clinical Psychologists provide psychological therapies for people with complex mental illness who are working with the North Perthshire, Perth City and South Perthshire CMHTs. All patients on the Clinical Psychology waiting list will have received an initial mental health assessment, will be engaged in treatment interventions with another member(s) of the Adult CMHT and will have access to the CMHT Duty Worker. Clinical Psychology is a Dundee HSCP hosted service and monthly wait times are reported via this route. Clinical Psychologists work to a 12 week waiting time target. North CMHT CP Perth City CMHT CP South CMHT CP January June +/- January June +/- January June +/- Total Patients 11 15 +4 55 51 -4 7 9 +2 Within 3 months 10 5 -5 31 0 -31 0 2 +2 Outwith 3 months 1 10 +9 24 51 +27 7 7 0 Adherence to standard 91% 33% -58% 56% 0% -56% 0% 22% +22% Greatest Distribution 6-12 26-52 - 0-6 52+ - 18-22 22-26 -
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Adult Mental Health Occupational Therapy Team Adult Mental Health Occupational Therapists provide OT interventions for people with complex mental illness who are working with the North Perthshire, Perth City and South Perthshire CMHTs. All patients on the OT waiting list will have received an initial mental health assessment prior to being referred to the Mental Health OT Team and will have access to the CMHT Duty Worker. OT wait times have traditionally been extensive however a proactive approach to waiting list management over the last reporting period has resulted in significant improvements in waiting times for patients. The longest wait time has reduced from 22 months to 5 months. The Team are to be commended for their waiting list management work which is supporting people to engage with OT interventions. North CMHT OT South CMHT OT Perth City CMHT OT January June +/- January June +/- January June +/- Total Patients 9 0 -9 10 2 -8 16 5 -11 Within 3 months 0 0 0 0 0 0 0 1 +1 Outwith 3 months 0 0 0 10 2 -8 16 4 -12 Adherence to standard 0% 100% +100% 0% 0% 0% 0% 20% +20% Average Wait (Months) 15 0 -15 15 5 -10 13 3 -10 1 2 2 1 1 1 1 2 1 2 1 1 3 1 1 2 1 1 1 1 1 1 2 1 2 11 3 1 1 1 0 1 2 3 4 6 11 14 18 20 21 22 1 3 4 5 7 8 9 12 14 15 16 17 19 22 4 5 6 8 10 15 17 18 20 21 North CMHT OT PC CMHT OT South CMHT OT # of Patients # of Months Wait Times Adult Mental Health OTs Jan vs June 2024 (Months) January June
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Mental Health Physiotherapy Mental Health Physiotherapy provides interventions for people with complex mental illness who are currently engaged in treatment with the Adult and Older People’s CMHTs within North Perthshire, Perth City and South Perthshire (6 Teams), to all inpatients within the Perth and Kinross Psychiatry of Old Age Inpatient Unit (3 wards) and the General Adult Psychiatry Inpatient Unit (3 wards). The Team has a wide remit and a small staffing resource consisting of 1.4wte Specialist Physiotherapy staff and 1.0wte Community Support Worker staff. An SBAR detailing the range of pressures the Team are experiencing is currently being explored at senior management level. The Team works efficiently and effectively and will continue to experience wait time breaches unless there is investment to enhance what is a small staffing resource. Priority Banding 2 Priority Banding 3 January June +/- January June +/- Total Patients 6 3 -3 14 10 -4 Within Banding Limit 0 0 0 0 0 0 Out with Banding Limit 6 3 0 14 10 -4 Adherence to standard 0% 0% 0% 0% 0% 0% Average Wait (Weeks) 7 3 -4 6 5 -1 1 1 1 1 1 1 3 2 4 1 2 2 1 1 1 5 1 2 1 1 0 1 2 3 4 5 6 2 3 4 6 7 8 9 10 3 4 5 6 7 8 9 10 Priority Banding 2 Priority Banding 3 MH Physio # of Patients # Weeks Waiting MH Physios Wait Times Jan vs June (Weeks) (In Priority Bandings) Jan June
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North Perthshire Adult CMHT – ADHD Wait Times The Adult CMHTs have seen a significant increase in referrals for people with potential ADHD and are overwhelmed by the demand. This correlates with the emerging data across Scotland and rates are expected to increase exponentially. All patients on the ADHD waiting list have received baseline screening tools to determine whether they require to be assessed by a CMHT, self help information to access whilst they wait for initial assessment and will have access to the CMHT Duty Worker. Whilst we do await the outcome of the Tayside Neurodevelopmental Pathway, locally we have been successful in recruiting a Neurodevelopmental Disorder Nurse Coordinator who once in post will work across the Teams with staff to progress assessments and treatment interventions. The North Perthshire CMHT have a lower wait time compared to the other two Teams given they had an ANP in post who was progressing assessments however they have now left post. 2 4 3 8 1 3 1 1 2 1 2 2 4 10 2 4 6 2 3 9 1 4 1 2 2 1 2 1 0 2 4 6 8 10 12 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 North Perth ADHD # of Patients # of Months Waiting North CMHT ADHD Jan vs June Wait Times (Months) January June North CMHT ADHD January June +/- Total Patients 30 54 +24 Within 3 months 0 4 +4 Outwith 3 months 30 50 +20 Adherence to standard 0% 7% +7% Average Wait (Months) 8 8 0
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Perth City Adult CMHT – ADHD Wait Times The Adult CMHTs have seen a significant increase in referrals for people with potential ADHD and are overwhelmed by the demand. This correlates with the emerging data across Scotland and rates are expected to increase exponentially. All patients on the ADHD waiting list have received baseline screening tools to determine whether they require to be assessed by a CMHT, self help information to access whilst they wait for initial assessment and will have access to the CMHT Duty Worker. Whilst we do await the outcome of the Tayside Neurodevelopmental Pathway, locally we have been successful in recruiting a Neurodevelopmental Disorder Nurse Coordinator who once in post will work across the Teams with staff to progress assessments and treatment interventions. 40 33 38 22 14 13 70 50 47 27 11 0 10 20 30 40 50 60 70 80 0-6 7-12 13-19 20-26 27-32 33+ Perth City (ADHD) # of Patients # of Months Waiting Perth City Adult CMHT –ADHD Jan vs June Wait Times (Months) January June Perth City ADHD January June +/- Total Patients 160 205 +45 Within 3 months 10 26 +16 Outwith 3 months 150 179 +29 Adherence to standard 6% 13% +7% Average Wait (Months) 15 11 -4
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South Perthshire Adult CMHT – ADHD Wait Times The Adult CMHTs have seen a significant increase in referrals for people with potential ADHD and are overwhelmed by the demand. This correlates with the emerging data across Scotland and rates are expected to increase exponentially. All patients on the ADHD waiting list have received baseline screening tools to determine whether they require to be assessed by a CMHT, self help information to access whilst they wait for initial assessment and will have access to the CMHT Duty Worker. Whilst we do await the outcome of the Tayside Neurodevelopmental Pathway, locally we have been successful in recruiting a Neurodevelopmental Disorder Nurse Coordinator who once in post will work across the Teams with staff to progress assessments and treatment interventions. South Perthshire ADHD January June +/- Total Patients 149 181 +32 Within 3 months 1 14 +13 Outwith 3 months 148 167 +19 Adherence to standard 1% 8% +7% Average Wait (Months) 17 13 -4
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Perth City Adult CMHT – Consultant Psychiatrist Referral to Assessment Wait times for Consultant Psychiatrist/Medical assessments are primarily due to recruitment issues and a reliance on temporary locum staff alongside outdated models of practice where Consultants primarily undertake outpatient clinics largely for people with less complex needs. Work to review the CMHT model of care across Tayside is progressing and this will include new ways of working for Consultant Psychiatrists. Perth City CMHT is showing improvements in the wait time for assessment with an increase in the adherence to the wait time standard by 11% from 33% to 43%. Perth City CP +/- January June Total Patients 149 162 +13 Within 3 months 49 70 +21 Outwith 3 months 100 92 -8 Adherence to standard 33% 43% +11% Average Wait (Months) 4 3 -1
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South Perthshire Adult CMHT – Consultant Psychiatrist Referral to Assessment Wait times for Consultant Psychiatrist/Medical assessments are primarily due to recruitment issues and a reliance on temporary locum staff alongside outdated models of practice where Consultants primarily undertake outpatient clinics largely for people with less complex needs. Work to review the CMHT model of care across Tayside is progressing and this will include new ways of working for Consultant Psychiatrists. South Perthshire CMHT is showing improvements in the wait time for assessment with an increase in the adherence to the wait time standard by 34% from 25% to 59%. South Perth CP January June +/- Total Patients 36 39 +4 Within 3 months 9 23 +14 Outwith 3 months 27 16 -11 Adherence to standard 25% 59% +34% Average Wait (Months) 5 3 -2
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9.3 Development of HSCP Mental Health Key Performance Indicators (KPIs) The development of the suite of KPIs for Mental Health across Tayside has continued with initial approval for the indicator suite having been reached. P&K HSCP are now in a data source/discovery phase. For data which sits within NHST systems we have agreement that the Business Unit will produce a data report covering each of the KPIs. This will be produced for Tayside, and each of the HSCPs and will therefore allow us to report independently but using the same suite of KPI data. We were due to receive the first draft of that data report by the end of Feb and so this is now overdue. This may be due to additional work which has been undertaken within NHST to produce NHST’s Annual Delivery Plan and 3 year Strategic Plan. In terms of the KPIs which are based on Local Government based data we have met recently with colleagues in Dundee and Angus to discuss the approaches that need to be taken to extract the data. Largely this will relate to our use of Social Care systems. In P&K with the move to MOSIAC upon us it may take a little longer to work through the detail and extract a first draft. We have made good progress on this piece of the work but there are some pieces that still need to be completed. As we move forward we will insert a relatively short time horizon for P&K HSCP to review what’s all been included in the suite of KPIs and make an assessment of the value and impact of including each of the indicators. This work will link with the NHST Strategic Plan, Scottish Government Mental Health Quality Indicators and the National Confidential Inquiry into Suicide and Safety in Mental Health Services(NCISH). Quality/Patient Care There are a number of ongoing risks (summarised within Appendices 2 &3) which, if not mitigated, pose a risk to the provision of safe care which is of high quality. The HSCP continues to manage these risks proactively. Drug related deaths: Numbers of suspected drug related deaths are recorded across the three HSCP’s, and is used to inform learning and context within and across the HSCP’s. The following shows data regarding confirmed drug deaths in P&K as compared to across Scotland (please note the two y-axes): 3 5 8 3 9 10 11 19 30 25 34 20 21485 584 581 527 614 706 868 934 1187 1280 1339 1330 1051 0 500 1000 1500 0 10 20 30 40 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Confirmed DD Year Confirmed Drug Deaths P&K Scotland
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Local actions to mitigate risks in Perth and Kinross include: • Implementation of Medication Assistant Treatment (MAT) Standards 1-5 by April 2023Implementation of MAT Standards 6-10 by April 2024 • National Mission to reduce drug deaths funding utilised to increase IDART staff compliment to reduce waiting times and enhance service provision e.g. – provision of an OT service and the creation of a new psychology assistant post to provide low level psychological interventions. • Creation of a multiagency referral pathway for all new substance use referrals. • Creation of a near fatal overdose pathway and multiagency group to review all reported near fatal overdoses with funding provided to third sector partners to employ assertive outreach workers to actively engage with service users. • Creation of a residential rehabilitation pathway and funding panel to facilitate access to rehabilitation services for service users. Workforce There are a number of ongoing risks regarding workforce challenges (summarised within Appendices 2 &3) which, if not mitigated, pose a risk to the provision of safe care which is of high quality. The HSCP continues to manage these risks proactively. Financial The composition of the Executive Management Team allows for a discussion of any financial issues from the perspective of Care & Professional Governance. Risk Assessment/Management Key risks and risk assurance process is detailed under section 2.3a. Equality and Diversity, including health inequalities Equality, diversity and health inequalities are core to the Getting it Right Framework and the domains within. Each service provides exception reports which include this aspect. Currently there are no exceptions requiring to be escalated to CGC. Other impacts N/A Communication, involvement, engagement and consultation All HSCP Staff have been invited to complete the latest iMatter survey, and teams will meet to discuss the results of these and create actions to take forward. The use of Care Opinion continues to expand within the HSCP, and during reporting this reporting period, we have continued to be the most active HSCP in Scotland, and are ranked 16th within the top 35 most active Care Opinion subscriptions across the UK. There were 139 stories between Mar – Jun 2024, viewed a total of 6288 times.
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To date we have had 5 changes planned; these changes were promised before this reporting period. As you can see 2 changes have been made and 3 are being worked on. In this bar chart below, you can see month by month how many stories we received over the reporting period. Looking at the most common word tag added by the authors, we can see by the total number of reactions that people have responded positively when sharing their story; Route to the Meeting This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report. • P&K HSCP Care & Professional Governance Forum members • P&K HSCP Professional Leads and Heads of Service • P&K HSCP Executive Management Team (final draft)
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10. RECOMMENDATION 10.1 This report is being presented for: • Reasonable Assurance As Lead Officer for Perth & Kinross HSCP I would suggest that the level of assurance provided is: Reasonable Assurance Level of Assurance System Adequacy Controls ✓ Substantial Assurance A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited Controls are applied continuously or with only minor lapses. Reasonable Assurance There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited. Controls are applied frequently but with evidence of non-compliance. ✓ Limited Assurance Significant gaps, weaknesses or non- compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited. Controls are applied but with some significant lapses. No Assurance Immediate action is required to address fundamental gaps, weaknesses or non- compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited. Significant breakdown in the application of controls.