Perth and Kinross Health and Social Care Partnership (HSCP) Clinical and Care Governance Assurance Report
Perth and Kinross Council · 20 November 2024
Back to Scrutiny and Performance Committee — 20 November 2024 and its agenda
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PERTH AND KINROSS COUNCIL Scrutiny and Performance Committee 20 November 2024 PERTH AND KINROSS HEALTH & SOCIAL CARE PARTNERSHIP (HSCP) CLINICAL AND CARE GOVERNANCE ASSURANCE REPORT Report by Chief Officer, Perth and Kinross HSCP (Report No.24/316) 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 1st July 2024 and 30 October 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: 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 4. ASSESSMENT 4.1 CLINICAL AND CARE RISK MANAGEMENT: The operational / team level risk registers for Adult Social Work and Social Care services are discussed monthly at the HSCP Care & Professional Governance Forum. 4.2 Managers of red risks provide a written update at every other meeting, and managers of amber risks are asked for update 6 monthly. 4.3 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.
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4.4 P&K HSCP Adult Social Work & Social Care red risks as at 4th November 2024: Risk Risk Exposure – No controls Current Risk Exposure Rating Risk Trend (↑/→/↓) Please include data from previous four reporting periods Nov 2023 Mar 2024 Jul 2024 Oct 2024 L C RER L C RER L C RER L C RER L C RER 4 4 5 20 - - - - - - 3 4 12 4 5 20 ↑ L = Likelihood C = Consequence RER = Risk Exposure Rating 4.5 Adult Social Work and Social Care Risk 1 – Social Worker capacity There is a risk of reduced social worker capacity which may lead to the team not being able to meet statutory requirements due to Social Worker resignations. This may result in increased waiting times for assessments to be completed resulting in increased delayed discharges. This will have an impact on staff morale, staff health & wellbeing, increased workload capacity for existing team and increased delays and reduced time to carry out person centred assessments. Mitigations: • ASP & AWIA discussions will continue to take place amongst all SW team leaders to share the flow where possible without causing wider pressures. • Access team are carrying out assessment for Ninewells hospital. • Locality teams have agreed to keep open cases when service admitted to hospital. • HDT manager & social work acting team leader to support staff daily and ensure health & wellbeing regularly discussed and monitored and workload/capacity is regularly reviewed. • Integrated working approach with discharge coordinators & ward staff to share assessment activities to offset pressures to carry out assessments & prioritise planned date of discharge and avoid delayed discharges at all costs. • 4.6 CLINICAL & CARE GOVERNANCE ARRANGEMENTS: 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. 4.7 Systems and processes have been established to ensure that all three HSCPs receive copies of reports from other Lead Partner Services to support integration, and effective whole system working. 4.8 Full details of the Clinical & Care Governance Arrangements in P&K HSCP are provided within appendix 2. 4.9 Exception reports at recent CPGF meetings:
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All services/localities report exceptions on a two monthly basis, and all service localities reported to the CPGF during this time period. 4.10 Annual reports at recent CPGF meetings: The following services provided annual reports during the time period, and were given assurance levels as follows: • Podiatry (Jul 2024) o Reasonable Assurance • Psychiatry of Old Age Inpatients (Aug 2024) o Reasonable Assurance • Joint Equipment Loan Store (Aug 2024) o Reasonable Assurance • MHO Team (Sept 2024) o Reasonable Assurance • Adult CMHS, iDART, MH Physio & Therapeutics (Sept 2024) o Reasonable Assurance
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4.11 PKC COMPLAINT SUMMARY FOR SEPTEMBER 2024: • Total number of complaints received in September 2024 = 6 • Stage 1 = 6 • 3 Stage 1 complaints progressed to Stage 2 in September. • Total number of complaints closed in September 2024 = 6 • % Stage 2 responded to within timescales = 100% • % Stage 2 not responded to within timescales = 0% • Services the complaints relate to as below o South Locality Kinross - 2 o SCOPE – 1 o North Locality Learning Disability Day Services - 1 o HART & HART+ - 2 • Top themes ▪ Overall (more than one theme can be applicable per complaint) • Service Provision - 2 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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• Employees - 4 • Paying for Care – 1 • Entitlement to Services – 1 • Communication - 1 Upheld or Partially Upheld complaints (more than one theme can be applicable per complaint) • Service provision • Communication 4.12 Actions taken from upheld/partially upheld stage 1 complaints following fact finding: Supervisory Fact Finding Conducted : Improvement measures have been implemented to create a robust and responsive scheduling system to avoid repeated occurrence and additional communication methods have been embedded to ensure the service provision and the service users are aware of changes to scheduling, but it has been acknowledged that this was a rapid unplanned change to the service delivery on the day. Additional note : Services that are registered with Care Opinion actively consider all forms of feedback, positive and negative, which influences lessons learned that we will embrace further. 4.13 Scottish Public Services Ombudsman Reports There have been no complaints referred to the SPSO during the time period. 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. 4.14 External Reports & Inspections No Inspections during the time period.
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4.15 Adult Support & Protection 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. MAT Standards Current RAG scores as at Oct 2024 are: Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6 Standard 7 Standard 8 Standard 9 Standard 10 RAG Score Standard 7 is currently on target 4.16 Quality/Patient Care There are a number of ongoing risks 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. 4.17 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): 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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Local actions to mitigate risks in Perth and Kinross include: • Implementation of Medication Assistant Treatment (MAT) Standards • 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. 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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4.18 Workforce • There are a number of ongoing risks regarding workforce challenges 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. • Staffing RAG status for Adult Social Work Services during the time period is shown below: Financial The composition of the Senior 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 within paragraphs 8-11. 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, with the most recent addition being the Prison healthcare Service. During reporting this reporting period, we have continued to be the most active HSCP in Scotland and are ranked 18th within the top 35 most active Care Opinion subscriptions across the UK. There were 100 stories between Jul – Sept 2024, viewed a total of 4169 times.
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To date we have had 5 changes planned; these changes were promised before this reporting period and 2 of the changes have been made and 3 are being worked on and are yet to be completed. In the bar chart below, you can see month by month how many stories we received over the reporting period. 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 5. RECOMMENDATION • 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
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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.