Perth And Kinross Health & Social Care Partnership (HSCP) Clinical And Care Governance Assurance Report
Perth and Kinross Council · 31 January 2024
Back to Scrutiny and Performance Committee — 31 January 2024 and its agenda
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Perth And Kinross Council Scrutiny and Performance Committee 31 January 2024 PERTH AND KINROSS HEALTH & SOCIAL CARE PARTNERSHIP (HSCP) CLINICAL AND CARE GOVERNANCE ASSURANCE REPORT Jacquie Pepper, Chief Officer, Perth and Kinross HSCP (Report No. 24/46) 1. PURPOSE OF REPORT 1.1 The 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. REPORT SUMMARY 2.1 Situation This report is being brought to the meeting to provide assurance on the clinical and care governance activities and arrangements across the Partnership as outlined in the Getting It Right for Everyone (GIRFE) Framework in accordance with the Partnership integration scheme. Clinical Governance is a statutory requirement to report on, at Board level, from Scottish Government as per NHS MEL (1998) 75. The Scrutiny and Performance Committee is being asked to provide their view on the level of assurance this report provides and therefore the level of assurance regards clinical and care governance within the Partnership. The timescale for the data within this report is from 1st July 2023 to 31 October 2023. As Lead Officer for Perth and Kinross HSCP I would suggest that the level of assurance provided is: Reasonable Assurance. 2.2 Background The role of the Perth and Kinross HSCP Governance forum is to provide assurance to the Perth and Kinross HSCP Integration Joint Board (IJB), NHS Tayside Board (through the Care Governance Committee) and Perth and Kinross Council (through the Scrutiny and Performance Committee), that there are effective and embedded systems for Clinical, Care and Professional Governance in all services within Perth and Kinross HSCP. 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
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three Partnerships and part of its remit is to support additional common assurance measures and this template. 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 2.3 Assessment 2.3.1 Exceptions A risk has been identified and recently added to DATIX regarding the ageing decontamination equipment at Broxden Dental Centre, and the resultant risk of failure. The current washers and disinfectors at Broxden Dental Centre were brought into service some time ago, and are now reaching end of life. The equipment also serves as a contingency for CSSD at Ninewells, as part of a reciprocal arrangement. There is a risk of equipment failure, resulting in the service being unable to provide dental care to patients. In the event of a failure, securing spare parts may also be challenging due to the age of the equipment. The Public Dental service will complete and submit a capital equipment replacement plan, which, if accepted and progressed, would result in replacement equipment being installed. This equipment would also be easier to service due to accessibility of spare parts. Preventative planned maintenance is ongoing by estates engineers, and there are daily checks made by staff. A reciprocal arrangement is in place with CSSD at Ninewells regarding use of equipment at either site in the event of disruption. The service intends to submit a capital replacement plan in the near future. Home Office Controlled Drug Licence is outstanding for The Bella Centre. The Bella Centre is a recently opened Community Custody Unit and houses low supervision women and young people. The Prison Healthcare service (hosted in P&K HSCP) provide healthcare to the population of the Centre. Due to a processing delay, the Controlled Drug licenses for HMP Perth, HMP Castle Huntly and The Bella Centre lapsed. Licences for HMP Perth and HMP Castle Huntly have since been successfully renewed.
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Due to a processing delay, the Controlled Drug licence is outstanding for The Bella Centre. The majority of patients at the Centre are prescribed medication via “named patient”, so no stock is required to be held at the Centre. 2.3.2 Clinical and Care Risk Management The risk registers for Health and for Adult Social Work and Social Care are discussed monthly at the P&K HSCP Care & Professional Governance Forum. Managers of red risks provide a written update at every meeting, and managers of amber risks are asked for update at every other meeting. This supports assurances that the relevant risks are being regularly monitored; what measures are 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. The controls listed under each risk are the cumulative efforts being made to mitigate the risk. P&K HSCP health red risks as at 15th Nov 2023: DatixRef Risk Exposure – No controls Current Risk Exposure Rating Planned Risk Exposure Risk Trend (↑/→/↓) Please include data from previous four reporting periods Dec 2022 April 2023 Aug 2023 Nov 2023 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 → 982 5 4 20 5 4 20 5 4 20 5 4 20 5 4 20 2 4 8 → 701 5 3 15 * 3 3 9 5 4 20 5 4 20 5 4 20 1 4 4 → 1321 5 4 20 - - - - - - 5 4 20 5 4 20 2 4 8 → L = Likelihood C = Consequence RER = Risk Exposure Rating * The current risk score is higher than the inherent score due to exacerbations of the risk by further staffing challenges.
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P&K HSCP Adult Social Work & Social Care red risks as at 15th Nov 2023: Risk Risk Exposure – No controls Current Risk Exposure Rating Risk Trend (↑/→/↓) Please include data from previous four reporting periods Dec 2022 April 2023 Jul 2023 Nov 2023 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 → 2 4 5 20 1 3 3 4 5 20 4 5 20 4 5 20 → Health Risk 829 - Challenges in relation to accommodation for clinical and non- clinical staff across P&K Accommodation walkrounds have been completed across Health & Social care sites with a view to mapping sites to accommodate future teams. A short life working group has been recommenced with NHST support service and Estates in order to review the accommodation needs for CCATS, IDART, Urgent Care and Community AHP's. A consultation paper to be completed in relation to engaging with staff re: accommodation moves. Paper to be written to describe the options going forward (option appraisal) in conjunction with NHST estates and support services. Smartsheet is being used to capture the current situation at each site where accommodation required review, and supporting SBAR’s being used. Health Risk 982 - Mental Health Medical Workforce in P&K HSCP A meeting has taken place to discuss medical workforce. Current redesign of inpatient services and CMHT is progressing, and this will include medical workforce as well as other professionals in future design. Services remain reliant on locum agencies to fill consultant psychiatry gaps and regularly advertising substantive positions, but to no avail. Nursing workforce situation has improved recently in terms of recruitment. There continue to be challenges with Medical and AHP recruitment however. Health Risk 701 - Mental Health Waiting Times within the Prison Healthcare Service Two additional nurses have been recruited, and start dates are awaited. Mental Health ANP recruitment is also underway. The service has also been seeking agency nursing staff to reduce the time spent by the team administering medication.
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It is anticipated that the listening service will be able to support appointments categorised as green. It is also noted that staffing levels within the Mental Health team are beginning to improve. Health Risk 1321 - Inadequate environment for the Perth City CCATS service This risk was added in April 2023, as in relation to the current CCATS service which is located within Beechgrove House, Perth. A recent Infection Prevention and Control team visit to the site found numerous environmental Infection Control concerns. A site visit has taken place from the current cleaning contractor, soft facilities and PKC estates to explore gaps and potential solutions within current provision. There is in place a Short Life Working Group regarding accommodation across P&K HSCP, and the CCATS service in Perth City is part of this working group. CCATS continue to undertake risk mitigation such as additional cleaning and handwashing. Property application for CCATS submitted to short life working group. Adult Social Work and Social Care Risk 1 – Lack of Care at Home capacity, especially around rural P&K. Care at Home Transformation group and workstreams are in action. HART continue to be in a +3 position each month with domestic recruitment. Overseas recruitment pilot in progress with aim for 4-5 staff in place for 1st cohort by Dec 23 and a second cohort by March 24. Automated scheduling went live 20 September. HART and Living Well Rotas being reviewed. PinPoint system being investigated to support easier access to unmet need across all internal and external providers. Alliance contracting with independent sector progressing. Adult Social Work and Social Care Risk 2 – Lack of OT capacity There are currently 1.5 North OTs out to advert, as well as one admin advert. The service is no currently meeting priority targets and no M & H reviews taking place. the Duty Team now stable and making a positive impact. 2.3.3 Clinical & Care Governance Arrangements Lead Partners Services Each HSCP is a Lead Partner for a number of services. 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. 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.
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Full details of the Clinical & Care Governance Arrangements in P&K HSCP are provided within appendix 1. Summary of key exceptions raised at recent CPGF meetings: Key exceptions identified within the exception reports from the CPGF meetings held in August, September and October 2023: • Prison Healthcare: o Mental Health Waiting Times within the Prison Healthcare Service. There are plans in place to address Green list including Listening Service and Safety & Stabilisation groups, as well as ongoing recruitment. o Non Emergency Transfer of Patients to Hospital. This is being monitored locally and nationally and escalated regularly. Cancellations have been increasing • North Locality: o Some examples of of poor planning / communication from acute sites on discharge to P&K have been noted. Datix linked to NWH EM Consultant for review. CPTM North collating information from LInCS to understand issues and provide evidence to share with acute sites and discharge teams. Current individual cases being wrapped around by the LInCS team to ensure immediate safety, assurance and care. o National issues with HEPMA. Additional transmitters added to the service have now resolved this problem. Locally the WiFi in Blairgowrie has also been problematic. IT attending site on 2nd of October to upgrade the system and signal (this will take approx one week Ongoing issues with generator testing knocking outIT systems – ongoing discussions with IT and Estates to find solution or mitigate risk. • South Locality: o Ongoing Social Work vacancies impacting availability of AP trained capacity and general service delivery. • Perth City Locality: o Within the CCATS service, additional Asylum assessments proving challenging to support timely given staffing pressures, sickness and vacancies in the service. North Locality supporting from CCATS. o There are limited Care Home placements due to care homes being at full capacity especially in nursing and EMI units. The service is reviewing officers and staff are ensuring only clients that require EMI care are in EMI beds. Staff are checking during reviews that the level of care is suitable for client needs. • Public Dental service o Awaiting input from Property Department to progress essential ventilation and building works. Work has been approved in principle by AMG and funding in place.
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• Tay & Stroke wards and Intermediate Care o Hospital Discharge Team – Discharge Coordinator shortage. Service Manager has escalated to ‘Hot Red’ staffing status. Recruitment is ongoing – poor applicant uptake due to temporary posts. 1 part time post has been filled. Service Manager and Senior Nurse providing operational support to maintain HDT service and support patient discharge planning and flow. Key exceptions identified within the annual reports from the CPGF meetings held in August, September and October 2023: • Podiatry o Ongoing DATIX risks regarding the staffing recruitment challenges nationally, along with recent unexpected resignations. This has created a risk of the Podiatry service being unable to treat higher risk patients, and to positively address the existing patient waiting times. o The transition from paper records onto EMIS has provided a more secure clinical record keeping system. The improved quality of note keeping and allows improved communication with other healthcare professionals supporting better patient outcomes. o There is currently insufficient capacity to meet patient demand for Podiatry within Justice Healthcare • Registered Services o Kinnoull Community Day Opportunities and Gleneagles Day Opportunities both retain staff well, but struggle to recruit to vany vacant social care posts. • Mental Health Services o With an increasing understanding of ADHD as a lifelong condition, services have seen a significant increase in referral for people with potential ADHD and are overwhelmed by the demand. o Red DATIX risk regarding an NHST inability to recruit and retain Consultant Psychaitrists. o Amber DATIX risk regarding ligature anchor points in P&K POA wards. o Mental Welfare Comission visits to the P&K POA wards in early 2023, which was overall positive. Several recommendations were made, and good progress is being made with these. • Urgent Care o Hospital at Home experienced IT issues affecting the ability of the team to use eKORA. This delayed the service’s soft launch date and required an alternative way of recording patient information to support escalation and safety netting in both the in hours and the out of hours periods. This issue is now resolved and the team are able to utilise Trakcare and eKORA in the management of patient’s within the community. • Primary Care o DATIX risk regarding seven practices who are at high risk of closure or transition to 2C, which would lead to disruption to service provision for that practice population. This is a result of a combination of workforce and workload factors.
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Adverse Events: 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. Regarding adverse events, the main themes reported during the months between July 2023 and October 2023 were: Highest frequency events: 1. Slips, Trips and Falls 2. Medication 3. Clinical Challenging behaviour 4. Violence & Aggression 5. Pressure Ulcer 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. Slip, Trip & Falls During the time period between July 2023 and October 2023, there were 180 incidents recorded, of which 24 involved harm. 82 occurred at MRH, 29 at PRI, 58 in Community Hospitals and the remaining 11 in other areas. The Psychiatry of Old Age inpatient wards at Murray Royal Hospital experienced a higher than usual number of falls at the end of 2021 due to several patients who had multiple falls (many of which were controlled). Ward staff were doing all they could to manage the falls, and they had support from the Falls coordinator during this time.
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In addition, the Falls Coordinator 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. • Medication During the time period between March July 2023 and October 2023, there were 102 incidents recorded, of which 5 involved harm. 10 occurred at MRH, 7 at PRI, 27 in Community Hospitals, 42 within a Prison Establishment and the remaining 16 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. • Violence & Aggression During the time period between July 2023 and October 2023, there were 35 incidents recorded, of which 3 involved harm. 15 occurred at MRH, 9 at PRI, 4 in Community Hospitals, and the remaining 7 in other areas.
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The 15 incidents within Murray Royal Hospital were within the Psychiatry of Old Age wards. The 3 incidents which involved harm were all in different inpatient wards, 2 of which were physical and one verbal. All three incidents are graded green. • Clinical Challenging Behaviour (such as patient unable to understand risks, sexual disinhibition, general agitation) During the time period between July 2023 and October 2023, there were 72 incidents recorded, of which 5 involved harm. 64 occurred at MRH, 4 at PRI and 4 in Community Hospitals. 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 have been noted by the service. This 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. • Pressure Ulcers During the time period between July 2023 and October 2023, there were 31 incidents recorded, of which 28 involved harm. 15 were within the patients home, 3 within Care Homes, 5 within Community Hospitals, and the remaining 8 in other areas.
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Further exploration on DATIX regarding the recent moderate events taken place. 3 of these were recorded by the Community Nursing service regarding patients in their own home, and 3 by Podiatry. 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 be monitored at CPGF meetings. 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 be monitored at CPGF meetings. Incident Record Dashboard for Adult Social Work & Social Care:
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2.3.4 Significant Adverse Event Reviews Report and action plan for DATIX 136987 fully signed off. Action plan being progressed through the P&K HSCP Mental Health Care Governance Group. 5/15 actions completed at present. 2.3.5 Pressure Ulcers & Falls Details regarding both of the types of Adverse events has been provided above in section 2.3.3. 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. 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. 2.3.6 Complaints Current Health Complaints as at 14/07/2023 - Stage 1 Service Area 0-4 Days 5-9 Days Total Perth & Kinross HSCP 6 0 5 Current Health Complaints as at 14/07/2023 - Stage 2 Service Area 0-5 days 6-10 days >20 days >60 days Total Perth & Kinross HSCP 3 1 0 2 6 Current Adult Social Work & Social Care Complaints for July 2023: Stage 1: There were 10 stage 1 complaints received in the time frame noted. Reasons for stage 1 complaints: Service Provision - 5 Complaints regarding employees - 3 Policy and procedure - 2 Stage 1 complaints by general theme: Quality of Care – 5 Waiting times – 1
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Staff conduct – 3 Paying for Care – 1 Stage 2: There were 2 stage 2 complaints. 2 stage 2 complaints were upheld in the reporting period. Reasons for stage 2 complaints: Service Provision – 1 Policy and Procedure - 1 Stage 2 complaints by general theme: Disagreement with Ax (assessments) - 1 Paying for Care : 1 2.3.7 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 October 2020, and further information has recently been provided to the SPSO regarding this complaint. 2.3.8 External Reports & Inspections Mental Welfare Commission (MWC) announced visits to Garry and Tummel Wards at Murray Royal Hospital on the 31th and 31st January 2023. Garry and Tummel wards are both 12 bedded wards and provide assessment, care and treatment for people with dementia. The wards uses a multi-professional approach to ensure person centred, recovery focussed care. The MWC last visited these wards in July 2019, and made recommendations regarding the auditing of care plans, authority to treat certificates, discharge planning arrangements and improving the décor in Garry ward. From staff that the inspectors spoke with, they heard how challenging the last two years had been since the start of the Covid-19 pandemic, and the inspectors were pleased to hear that there has been a focus on staff wellbeing throughout the pandemic and this has continued. The MWC found that on both wards, nursing staff interacted in a kind and supportive way. The patients were not able to engage in a discussion about their care and treatment due to the extent of their cognitive impairment, but relatives were overwhelmingly positive about the care, treatment and support on the wards.
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Staff were described as outstanding, exceptionally kind and that the care and attitude of staff was above and beyond. Relatives fedback that staff kept in contact with them and they felt listened to. Some of the relatives said they had been invited to meetings, others had not, and all the relatives we spoke to had been given copies of care plans. During the visit, care plans were reviewed and found to be person-centred and it was clear that staff knew patients on the ward very well. There was thorough background personal information in care plans. The care plans inspected addressed a range of needs including mental and physical health needs and outlined goals and interventions required to meet needs. The inspectors hears that an activity support worker had recently trained in ‘playlist for life’, an evidence-based initiative to support people living with dementia to create a playlist of personally meaningful music, with the aim to reduce stress and distress. The inspectors also heard about the development of a transitional care nurse who supports discharge planning. This nurse supports patients for a transitional period when they had moved from hospital to long-term care, thereby bridging the gap between hospital and community mental health teams. The MWC made 6 recommendations from their visit, these being that managers should: • ensure that staff completing care plans undertake care plan training and refer to NHS Tayside’s person-centred care planning standards. • ensure that nursing staff include summative evaluations of care plans in patient notes that clearly indicate the effectiveness of the interventions being carried out and any required. • ensure that patient/relative involvement in care planning is encouraged and recorded. • ensure that MDT meetings are fully recorded • ensure that where a patient lacks capacity in relation to medical treatment, S47 certificates and treatment plans must cover all relevant medical treatment the individual is receiving. Treatment should be described in full and abbreviations should not be used. • explore solutions to ensure patients are able to look out of the ward windows, without their privacy being compromised. Good progress is being made with recommendations, with one fully complete as of June 2023. Mental Welfare Commission (MWC) announced visit to Leven Ward at Murray Royal Hospital on the 20th March 2023. Leven ward is a 14 bedded ward for patients who have a mental health diagnosis and are over 65. The ward uses a multi-professional approach to ensure person centred, recovery focussed care. We last visited this service on 5 September 2018, along with two other wards, and made recommendations regarding the auditing of care plans, authority to treat certificates and auditing the provision of activities.
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The patients the inspectors met with during our visit were very complimentary about the staff on Leven ward. They were described as wonderful, cheery, approachable, kind and friendly. Staff took the time to get to know the patients on the ward. One patient however was not sure who their named nurse was. The relatives spoken to were equally positive about staff and told us that staff were concerned not just about patients, but about the wider family also. Relatives told inspectors that they had been linked in with a carer support worker who provided support and had arranged for a carer’s assessment to be undertaken. The inspectors heard from relatives that treatment on the ward was superb and that they were very happy with the care their relative had received. Inspectors were told by relatives that the ward was well staffed, relatives felt listened to and that information and suggestions they provided were acted upon. Relatives told us they felt part of the care team. Inspectors heard about the work that was taking place in relation to anticipatory care planning (ACP) with a focus on involving patients and their families in drawing up an individualised ACP. The risk assessments the inspectors saw were comprehensive and of a good standard, showing appropriate interventions to manage risk. Risk management plans were clear and corresponded to risks identified. Inspectors heard that Leven ward had a full-time activity support worker (ASW) who worked alongside the clinical team, patients, carers and families developing and delivering person-centred activities on a daily basis. During the visit, inspectors saw patient’s engaging in activities on the ward with staff and other patients. The patients and relatives who we met with during our visit spoke positively about the range of activities on offer on Leven ward and told us that staff encouraged patients to participate in activities. During the visit inspectors saw an up-to-date activities timetable on the ward. In patients’ files, inspectors found evidence of daily recordings of activities that had been offered to patients and whether they had participated or declined. All patients had an individualised activity care plan which was very detailed, person-centred and regularly updated. Activities on offer to patients included both one-to-one and group activities. Summary of recommendations: • Managers should ensure that when a welfare proxy is in place for a patient, a copy of the document stating the powers of the proxy should be held within the case notes. • Managers should ensure that staff completing care plans undertake care plan training and refer to NHS Tayside’s person-centred care planning standards. • Managers should ensure that nursing staff include summative evaluations of care plans in patient notes that clearly indicate the effectiveness of the interventions being carried out and any required changes to meet care goals.
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• Managers should ensure that patient/relative involvement in care planning is encouraged and recorded. • Managers should ensure that communication between the MDT and patients/relatives is formalised and that MDT meetings are fully recorded including patient/relative involvement. 2.3.9 Adult Support & Protection
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This above shows a significant increase in both AP concerns and VPRs. This is, at least partly, a result of increased awareness due to ongoing information campaigns and improved multi-agency working. Extra social worker posts have been recruited to respond to this increased demand. 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 June 2023 are: Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6 Standard 7 Standard 8 Standard 9 Standard 10 RAG Score PROV PROV PROV PROV PROV PROV Standard 1 – All people accessing services have the option to start MAT from the same day of presentation. AMBER because we are offering same day prescribing one day a week. To supplement the existing Tuesday all-day clinic, from Monday 5th June, one slot a day has been made available on Mondays, Wednesday, Thursday and Friday which MIST (MATS Implementation Support Team) has confirmed is sufficient to achieve a green RAG. Standard 2 – All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose. AMBER because we have an evidence gap for a process for people out with Perth City to enable them to commence OST where they live, and that long-acting injectable buprenorphine can be used. To fill this gap and meet the requirements of the standards, a process has been devised and a named patient SOP. This document is being reviewed with an intention to submit this to MIST by the end of June to enable a green RAG to be achieved for this standard. Standard 3 – All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. PROVISIONAL GREEN
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Standard 4 – All people are offered evidence based harm reduction at the point of MAT delivery. PROVISIONAL GREEN Standard 5 – All people will receive support to remain in treatment for as long as requested. PROVISIONAL 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. PROVISIONAL AMBER Standard 7 – All people have the option of MAT shared with Primary Care. AMBER Standard 8 – All people have access to advocacy and support for housing, welfare and income needs. AMBER Standard 9 – All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. PROVISIONAL AMBER Standard 10 – All people receive trauma informed care. PROVISIONAL AMBER Note: The acceptance criteria for standards 6 to 10 has not been finalised and so green ratings have not been available for these. The current expectation is that MIST will release this information in October 2023. Practical changes that have been introduced as part of the MAT standards implementation include: • Same day prescribing available via a Tuesday clinic, but now expanded to be available five days a week (standard 1)
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• Information about treatment options provided to service users to enable informed decisions to be taken (standard 2) • Linkages to other supports developed or strengthened to identify individuals at risk and enable support to be offered (standard 3) • All staff trained in harm reduction and equipped with carry packs containing necessary supplies to support harm reduction delivery. IDART rooms in Drumhar Health Centre also appropriately stocked (standard 4) • Deeper review of IDART worker caseloads undertaken as part of supervision with agreement on any necessary actions to ensure individuals remain engaged with service whenever possible (standard 5) • A working group established to review and reconfigure referral routes and resources between substance use services, general practice and community mental health teams (stands 7and 9) • Training delivered to staff on independent advocacy and social supports to increase the awareness of these supports and increase referrals (standard 8)
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2.3.10 Mental Health Community Mental Health Service Activity (PERTH CITY)
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Community Mental Health Service Activity (NORTH)
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Community Mental Health Service Activity (SOUTH) The above data is provided to HSCP’s routinely by the NHS Health & Business Intelligence Team. Some further improvement activity is ongoing within the CMHT’s
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to improve the consistency of recording within the source system (Trakcare). This will improve the accuracy of this data for future reports. Development of HSCP Mental Health KPIs Work continues across the three HSCP’s to agree a series of Mental Health KPI’s which can be used for consistent reporting within HSCP’s and for onward reporting to this Committee and others where appropriate. The mapping undertaken thus far has shown that there is commonality in the data set across the three HSCP’s , with P&K and Angus using the same data set and Dundee using a slightly different set. A draft set of proposed indicators which are common across all three HSCP’s will be created and shared with a view to having these agreed and finalised. Public Health Scotland (PHS) now produces national data sets quarterly rather than monthly, and we will look to work with the Business Unit to ensure accessibility and supply of the relevant data. 2.4 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. Hospital at Home Hospital at home is a team of healthcare professionals who provide hospital level treatment at home as an alternative to hospital admission. Hospital at home is proven to be a safe cost-effective and patient centred approach which started looking after patients within Perth City on 17th July 2023. The service in Perth City is currently available between 0800 – 1800 (Mon-Fri), but P&K HSCP ultimately plans to offer hospital at home as an option to patients across Perth & Kinross, 7 days per week. Public Consultation in Bridge of Earn The healthcare needs assessment went live from Monday 15th May and ran until 25th June 2023. It invites patients to complete a survey to give feedback about health and care services in their local areas and was targeted at Bridge of Earn and surrounding area. The responses will help P&K HSCP understand what patients need locally and if the current service provision are meeting those needs. The survey was available online on the Your Community Perth and Kinross Facebook page, and on Practice websites, NHS Tayside also promoting this through their Facebook page. Paper copies were available at all local GP practices that Bridge of Earn patients were dispersed to, Community Care and Treatment centres, pharmacies, and identified community venues and noticeboards. P&K Community and Engagement workers attended many local events and were able to support people complete a submission. The recent Stronger Communities event was attended by several
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HSCP representatives and approximately 35 community members and was positively received. Earn Community Council was fully involved and supported the engagement process. A total of 600 responses were received and are currently being reviewed. An evaluation report with recommendations will be undertaken and the results widely publicised. 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): The following shows data regarding confirmed drug deaths in P&K as compared to across Scotland (please note the two y-axes): • Local actions to mitigate risks in Perth and Kinross include: • Implementation of Medication Assistant Treatment (MAT) Standards 1-5 by April 2023 • Implementation 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.
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2.4 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. P&K HSCP ensures alignment with NHS Tayside’s approved 3-year workforce strategy and PKC workforce plan. Workload tools are in use within the Community Nursing service, and workload tools have also been used in the past within services such as POA, and these requires to be conducted again. There are a number of workload tools which can be used, and the purpose of each tool is to provide information and recommendations on staffing levels based on patient workload. AHP staff have also been engaging in testing Workforce Templates in some of our services in conjunction with Healthcare Improvement Scotland (HIS) colleagues, as part of the Common Staffing Method approach. A Workforce Steering Group has been established to oversee the implementation of the P & K HSCP Workforce Plan. 2.5 Financial The composition of the Executive Management Team allows for a discussion of any financial issues from the perspective of Care & Professional Governance. 2.6 Risk Assessment/Management Key risks and risk assurance process is detailed under section 2.3a. 2.7 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. 2.8 Other impacts N/A 2.9 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 HSCP is working with the Strategic Planning and Communication and Engagement Groups to support more effective communication, engagement and involvement, and exploring the most appropriate way to respond to the feedback we have received. The North Locality is also trialling a ‘you said, we did’ approach to a recent community consultation.
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The HSCP took out a subscription to Care Opinion in May 2022, following a Test period. We continue to receive feedback from people who use our services from this public platform. To date we have had over 150 feedback stories submitted with 96% of the feedback received being positive. We are rolling Care Opinion out across all of our services in a cumulative approach and teams are now using its performance generated reporting data within their business activities. We are currently one of the best performing HSCPs in Scotland with regards to utilisation and growth of Care Opinion. 2.10 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) 3 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; due to the following factors: Please ✓ the level of assurance you are providing: 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.
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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.