Public reports pack
Argyll and Bute Council · 12 May 2026
Back to Argyll and Bute HSCP Clinical and Care Governance Committee — 12 May 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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5 May 2026 NOTICE OF MEETING A meeting of the ARGYLL AND BUTE HSCP CLINICAL AND CARE GOVERNANCE COMMITTEE will be held BY MICROSOFT TEAMS on TUESDAY, 12 MAY 2026 at 2:00 PM, which you are requested to attend. BUSINESS 1. WELCOME AND APOLOGIES 2. MINUTES (a) Minute of the previous meeting of the Clinical and Care Governance Committee held on 5 February 2026 (Pages 3 - 6) (b) Minute of the previous Clinical and Care Governance Group, held on 5 March 2026 (Pages 7 - 14) 3. ACTION LOG (Pages 15 - 18) 4. EMERGING ISSUES 5. HEALTH AND SOCIAL CARE PARTNERSHIP - PERFORMANCE REPORT - FQ3 2025/26 (OCTOBER - DECEMBER) (Pages 19 - 58) Report by Head of Strategic Planning, Performance and Technology 6. DASHBOARD REPORT (Pages 59 - 72) Report by Clinical Governance Manager 7. INTEGRATED INSPECTIONS AND SCRUTINY OVERVIEW (Pages 73 - 80) Report by Clinical Governance Manager 8. SOCIAL WORK GOVERNANCE AND LEADERSHIP - TO FOLLOW Report by Senior Manager Justice Social Work/Acting Chief Social Work Officer 9. NEURODIVERSE PATHWAYS - GOVERNANCE UPDATE (Pages 81 - 84) Report by Head of Complex Care and Registered Services 10. DATE OF NEXT MEETING - 13 AUGUST 2026 Public Document Pack
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Argyll and Bute HSCP Clinical and Care Governance Committee Duncan Scott Karen Leach Graham Bell (Chair) Evan Beswick Rebecca Helliwell Fiona Broderick Kevin McIntosh David Gibson Alison McGrory Councillor Dougie McFadzean Councillor Ross Moreland Louise Bussell Contact: Lynsey Innis, Committee and Democratic Services Officer Tel: 01546 604338
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MINUTES of MEETING of ARGYLL AND BUTE HSCP CLINICAL AND CARE GOVERNANCE COMMITTEE HELD BY MICROSOFT TEAMS on THURSDAY, 5 FEBRUARY 2026 Present: Graham Bell (Chair) Karen Leach Evan Beswick Rebecca Helliwell Fiona Broderick Alison McGrory Councillor Dougie McFadzean Councillor Ross Moreland Attending: Eilidh Gallagher, Head of Primary Care Caroline Robertson, Head of Hospitals and Community Care Nicola Gillespie, Head of Complex Care and Registered Services Kristin Gillies, Head of Strategic Planning, Performance and Technology Leah Smith, Clinical Governance Manager Charlotte Craig, Business Improvement Manager Lynsey Callaghan, Professional Lead, Maternity and Child Health Fiona Thomson, Associate Director of Pharmacy Linda Currie, Associate Director of AHP Lorien Cameron-Ross, Clinical Lead, NHS Highland Lynsey Innis, Committee and Democratic Services Officer 1. WELCOME AND APOLOGIES The Chair welcomed everyone to the meeting. Apologies for absence were intimated on behalf of:- David Gibson, Head of Children, Families and Justice/Chief Social Work Officer Dr Duncan Scott, Secondary Care Representative 2. MINUTES (a) Minute of the previous meeting of the Clinical and Care Governance Committee held on 6 November 2025 The Minute of the previous meeting of the Clinical and Care Governance Committee, held on 6 November 2025 was approved as an accurate record. (b) Minute of the previous meeting of the Clinical and Care Governance Group, held on 11 December 2025 Page 3 Agenda Item 2a
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The Minute of the previous meeting of the Clinical and Care Governance Group, held on 11 December 2025, were noted. 3. ACTION LOG Having given consideration to the Action Log, the Committee noted that an update report would be provided in relation to Action 1 (Overlap of inspections spreadsheet) to their meeting in May 2026. The Chair advised that going forward the intention was that a deep dive report would be presented at each meeting, focusing on topics of particular interest or concern to the Committee. He invited Members to identify and suggest areas that would benefit from more detailed consideration by the Committee. It was noted that a deep dive on Primary Care should be brought forward to a future meeting of the Committee. 4. HEALTH AND SOCIAL CARE PARTNERSHIP - PERFORMANCE REPORT - FQ2 2025/26 (JULY - SEPTEMBER) The Committee gave consideration to a report which detailed performance for the Financial Quarter (FQ) 2 2025/26 (July – September). The report also provided details on performance against each of the service areas and supporting IPMF Key Performance Indicators; the latest National Delayed Discharge Sitrep and the National Health and Wellbeing Indicators. The Head of Strategic Planning, Performance and Technology outlined a number of changes that would be implemented in the reporting format going forward. Discussion took place around the governance processes, noting that these had implications for reporting timelines, with it being noted that going forward verbal updates would be provided outlining the most up-to-date position, where possible. Further discussion was held regarding the worsening national benchmarking position for Delayed Discharges since the data contained within the report had been produced. Decision The Clinical and Care Governance Committee:- 1. Acknowledged performance for FQ2 2025/26 (July – September). 2. Noted that the performance KPI’s would be reviewed for FQ3 with improved alignment to the Operational Improvement Plan indicators and National measures and the format of the Argyll and Bute performance reports with Head of Service collaboration will be reviewed. 3. Noted the Delayed Discharge Sitrep as of 15 December 2025, as outlined in Appendix 1 to the report. Page 4
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4. Acknowledged the performance update on the National Health and Wellbeing Outcomes and Ministerial Steering Group Integration Indicators, as outlined at Appendix 2 to the report. 5. Noted supporting Service Feedback commentary from Heads of Service and Service Leads, as outlined at Appendix 3 to the report. (Reference: Report by Head of Strategic Planning, Performance and Technology, dated 5 February 2026, submitted) 5. DASHBOARD REPORT Consideration was given to the dashboard report, which provided information on stage 2 complaints; Social Work and Care complaints; adverse events; inpatient falls; tissue viability incidents; violence and aggression incidents and medication errors over the last 13 months. Decision The Clinical and Care Governance Committee considered and note the information contained within the dashboard report. (Reference: Report by Clinical and Care Governance Manager, submitted) 6. REALISTIC MEDICINE AND VALUE BASED HEALTH AND CARE Having noted that all Health Boards in Scotland are required to report to the Scottish Government on the implementation of Realistic Medicine and Value Based Health and Care, the Committee gave consideration to a report which presented the Realistic Medicine and Value Based Health and Care Action Plan for 2025-26 and the 6-month progress report which were submitted to the Scottish Government by NHS Highland outlining current challenges and successes. Discussion took place around collaborative working to ensure a personalised approach to care. It was noted that the Scottish Government’s long-term aim is that, by 2030, all health and care professionals will be supported to deliver value based health and care. Decision The Clinical and Care Governance Committee:- 1. Noted the refreshed Action Plan and Report. 2. Agreed that consideration be given to updating the reporting template to incorporate the principles of Realistic Medicine and Value Based Health and Care. (Reference: Report by Project Manager, Strategy and Transformation, NHS Highland, dated 5 February 2026, submitted) 7. NEURODIVERSE PATHWAY UPDATE Page 5
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The Committee gave consideration to a report which provided an update on the work undertaken to develop a neurodiversity strategy and the ongoing work to tailor strategic ambitions to the unique strengths, capacities and needs of local services. Decision The Clinical and Care Governance Committee:- 1. Noted the position paper. 2. Noted the concerns regarding capacity and sustainability for ASD and ADHD diagnostic services. 3. Noted that the Senior Manager for Learning Disability, with support from the SIO, will re-establish a SLWG to ensure all services are involved in developing pathways. 4. Noted that a further update report will be provided once significant progress has been achieved. (Reference: Report by Head of Complex Care and Registered Services, dated 5 February 2026, submitted) 8. 6.1 ARGYLL AND BUTE JAN REPORT FOR NORTH HIGHLAND CLINICAL GOVERNANCE COMMITTEE The Committee gave consideration to a report which had been presented to the NHS Highland Clinical Governance Committee on 15 January 2026 and provided a summary of key clinical governance topics from each of the services within the Argyll and Bute HSCP. The report sought to provide assurance of effective Clinical Governance frameworks in place within the Partnership. Decision The Clinical and Care Governance Committee reviewed the report for transparency. (Reference: Report by Clinical Governance Manager, dated 5 February 2026, submitted) 9. DATE OF NEXT MEETING It was noted that the next meeting of the Clinical and Care Governance Committee was scheduled to take place on Thursday, 30 April 2026. Page 6
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Argyll & Bute Clinical & Care Governance Group Date: 5 March 2026 Time: 10.30am Location: MS Teams Chair: Dr Rebecca Helliwell Attendees: Rebecca Helliwell, L Smith, C West, L Callaghan, F Thomson, D Watt, K Gillies, N Gillespie, C Tanner, A Roexe, C Robertson 1. Welcome, Introductions & Apologies • Meeting opened with introductions from members • Apologies: Alison McGrory. 2. Previous Minutes & Action Log • Previous minutes approved as an accurate record. • Action log will remain active; items appearing on today’s agenda will be closed. 3. Chronic Pain Service • Presenter absent; unable to progress full discussion. • Paper taken for noting; will return next meeting. • Planning team highlighted uncertainty about what elements fall under Argyll & Bute vs North Highland. • ACTION CG Team: Paper to be added to Agenda. Page 7 Agenda Item 2b
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4. Complex Care (Nicola Gillespie) 4.1 Neurodiversity Pathway (ASD & ADHD) • Significant and escalating pressures. • ASD post (0.7 WTE) vacant for months; several hundred people waiting. • ADHD referrals rising rapidly; consultants preparing to withdraw due to lack of safe follow-up and inability to continue prescribing/monitoring. • Risk of closing referral lists imminently. • ~120 patients currently on ADHD medication in Oban without sustainable follow-up. • NG indicated Short Life Working Group is being convened. FT has asked to be included in this group. • LS also asked about comes with people on the w/l and NG indicated this being considered although may need to await decisions from SLWG • NG also indicated paper has been to Committee already and being presented to Group to keep updated of risks, . 4.2 Dementia Pathway & LD/IPCU Issues • NG indicated paper is for noting and has been to Committee • Continued difficulty securing appropriate beds, leading to distress for staff, families, and patients. • Cross-regional work underway with Forth Valley, Fife and others on LD pathways. • Confirmed that the Risk is recorded on the risk register. • CW asked if there are comms updates provided to clinicians regarding the ongoing issues - NG confirmed regular comms 4.3 Mental Health Unscheduled Care Data • NG indicated paper for noting Page 8
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• Team working with HIS to refine new dashboard requirements. • Current data collection still spreadsheet-based. 4.4 Governance Alignments • Mental Health SMT cycles being realigned to ensure proper flow into CCG processes. 1 5. Maternity Services – Mid Argyll (Lynsey Callaghan) • LS indicated that paper has been to SLT therefore has come to group for noting of risk. • CW enquired re timescales for reduced service provision. LC confirmed that a temporary reduced service remains in place. • Improvements in recruitment, but on-call remains fragile. • Some local births supported case-by-case with help from wider teams. • Recent staff injury has added pressure. • Further updated paper required. 6. Hospitals & Community Care (Caroline Robertson) 6.1 Staffing Pressures • Widespread staffing shortages across multiple professions. This includes issues with pharmacy recruitment. • Negative wellbeing impact on individuals noted and being supported. CH also indicated these issues could impact statutory duties. • Situation is being closely monitored Page 9
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• DW indicated SafeCare rollout creating confusion; session planned to clarify. 6.2 Chemo Therapy • There was also discussion re Chemotherapy Service Risks as flagged by FT following discussion around pharmacy recruitment issues. • Glasgow cannot support chemo pharmacy verification due to capacity. • This creates a significant service risk for Oban. • Consultants required to undertake more patient review; non-medical prescriber roles require review. • Increasing demand through day-bed unit; nursing workload rising. • AR indicated that direction of travel is for local solutions this also in line with SACT. • Plan required for how to address and take forward. Agreed that there needs to be coordination with N Highland Group. • CR noted that she had not been included in the discussions around these issues and will pick up locally • ACTION: FT to ask the current N Highland Group re involving A&B this to include AB Planning Team. 7. Primary Care (Paper from E Gallagher) • Paper taken for noting. • Risks and updates will feed into next governance report. 8. Planning, Performance & Technology (Anke Roexe) Governance Gaps Affecting Specialist Pathways • Paper highlighted Major issues with obtaining clinical oversight or cooperation for: o Oral surgery / maxillofacial o Ophthalmology • Also indicated that there are other services that are affected by these issues including: o Sexual health o Dialysis Page 10
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o Paediatrics • The issues raised by programming and technology were in regards to the lack of pathways, and how the HIS guidance and reviews on the relevant care practices, is impacted as there is a lack of relevant stakeholder oversight • Some commissioned services (e.g., GGC clinics) operate with no local governance visibility. • AR indicated Group being asked to advise on how to approach getting expert advice and support regarding these services. No formalised approach for escalation of issues. • RH indicated need to formulate list of services affected and escalate to N Highland clinical Governance Group. • Group agreed this is a system-level governance problem requiring escalation. • CW also indicated that EB/ BP and LB should have sight of the paper to ensure awareness • KG indicated we recognise A& B have to take responsibility but we need to know where to go for support and advice when need and this should be a formalised process. • ACTION AR: To provide paper outlining issues and services involved paper to be prepared for presentation at N Highland CG Group 11. Any Other Business 1 Community Paediatrics • RH fagged current risks relating with Community paediatrics nearing service failure due to cumulative vacancies. • Children with complex needs not reviewed appropriately. • There may be a need to approach GGC for assistance • KG indicated paper still required form BW in order to articulate need fully with West Group • BW still finalising paper. • ACTION GC Team. Contact BW re adding paper to Group Agenda for next meeting 2. SAER Outcomes • RH noted these need to be included in Group Agenda for each meeting. • ACTION CG Team to include SAER/Case Review outcomes in future agendas. Actions Page 11
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Actions from Meeting of 5 March 2026 3. Chronic Pain Service • ACTION CG Team: Paper to be added to Agenda. 6. Hospitals & Community Care 6.2 Chemotherapy • ACTION: FT to ask the current N Highland Group re involving A&B this to include AB Planning Team. 8. Planning, Performance & Technology (Anke Roexe) Governance Gaps Affecting Specialist Pathways • ACTION AR: To provide paper outlining issues and services involved paper to be prepared for presentation at N Highland CG Group 11. Any Other Business a. Comm Paediatrcs b. SAER outcomes • ACTION GC Team. Contact BW re adding paper to Group Agenda for next meeting • ACTION CG Team to include SAER/Case Review outcomes in future agendas. Outstanding Actions (22/1/26) Item Actions 3.Children and Family Service • Produce joint SLT paper (Children Services + CTAC) outlining: o Service risks o Optional appraisal o System-wide clinical impact • Reduce the risk formally on the governance risk register. • Continue reporting the risk at each meeting until resolved. Page 12
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4.Primary Care • P Morrison and F Thomson to discuss dispensing practice issues offline and decide whether it should be recorded as a formal clinical risk. • Develop a clearer process for capturing local service gaps in clinical governance reporting. • P Morrison to finalise update paper for GP practices on Open Labs. 6.Hospital and Community Care • L Smith to interrogate DATIX for complaints and incidents trends relating to delayed discharge harm. • Small working group (L Smith, L Currie, C Robertson, others) to: o Develop harm-reduction measures o Review functional data o Consider day-of-care audits • Clarify and implement escalation process for unsafe bed occupancy. • Explore resource options (including Living Well) for active reablement in hospital. 8.AOB • Provide a Hospital at Home update paper for the next meeting covering: o Clinical model o Governance structure o Integration with locality teams o Expansion proposals • Confirm governance and reporting route (likely through this group) Page 13
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Action ID ACTION LEAD Date Added to Action Log TIMESCALE WORK STATUS (open, in progress, complete) Comment 1 Overlap of inspections spreadsheet to be circulated to Members by email Charlotte Craig, Business Improvement Manager April 2024 May 2025 Revised Timescale – April 2026 Ongoing Agreed at meeting held on 6 June 2024 that this item would be brought forward to the next meeting, scheduled to take place on 15 August 2024. Advised at meeting on 15 August 2024 that this piece of work was being taken forward by the C&CG Group and an update would be brought to a future meeting of this Committee in due course. At the meeting held on 28 November 2024, it was agreed that an update on progress would be provided to the next meeting on 6 February 2025. At the meeting held on 6 February 2025, it was agreed that an update on progress would be provided to the next meeting on 1 May 2025. At the meeting on 1 May it was agreed that an update would be provided to the meeting on 14 August. At the meeting on 14 August 2025 it was agreed that an update would be provided to the meeting on 6 November 2025. Page 15 Agenda Item 3
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Report considered at meeting on 6 November 2025 – it was noted that an update report would be brought back to C&CG Committee in May 2026 to identify any themes across inspections. 2 Deep Dive – Primary Care Eilidh Gallagher, Head of Primary Care February 2026 TBC Open It was agreed that a deep dive on Primary Care, focussing on C&CG responsibilities, gaps in service, processes for assurance and general inspection and scrutiny would be brought to a future meeting. It was agreed that the Head of Primary Care would liaise with both the Chair of the Committee (Graham Bell) and the Associate Director (Dr Rebecca Helliwell) to discuss timelines for reporting. 3 Reporting Templates Charlotte Craig, Business Improvement Manager February 2026 TBC Open It was agreed that consideration be given to updating the reporting template to incorporate the principles of Realistic Medicine and Value based Health and Care. 4. Neurodiverse Pathway Update Nicola Gillespie, Head of Complex Care and Registered Services February 2026 TBC Open Consideration to be given to regular reporting to this Committee. Page 16
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5. Emerging Issues – to be added as a regular agenda item Associate Director – Dr Rebecca Helliwell/Nursing Director - James Mullins (when in post – 01/04/2026) and Committee and Democratic Services Officer – Lynsey Innis February 2026 Every meeting Open Agreed that going forward this item to be added to agendas with important issues being brought forward at the relevant times. Page 17
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1 The Clinical & Care Governance Committee Date of Meeting: 12th May 2026 Title of Report: Health & Social Care Partnership - Performance Report – FQ3 2025/26 (October – December) Presented by: Kristin Gillies - Head of Strategic Planning, Performance & Technology The Committee is asked to: • Acknowledge performance for FQ3 2025/26 (October –December) against latest Key Performance Indicators within the Integrated Performance Management Framework for 2025/26 • Note latest Delayed Discharge Sitrep as of 16 Feb 2026 (Appendix 1) • Acknowledge latest performance against the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 2) • Acknowledge the inclusion of additional A&B HSCP performance metrics aligned to national reporting across Centre for Sustainable Delivery (CfSD) Unscheduled Care, and the Planned Care performance focus within the Operational Improvement Plan (OIP) (Appendix 3) EXECUTIVE SUMMARY This report details performance for the Financial Quarter (FQ) 3 2025/26 (October – December). The key performance outputs are taken from the current Integrated Performance Management Framework (IPMF) Reporting Dashboard. Overall performance for FQ3 notes 35 of 77 measures reported as on target (45%). National Delayed Discharge Sitrep and the National Health & Wellbeing Indicators performance are also provided. The HSCP Senior Leadership Team is currently reviewing the content and structure of the Integrated Performance Management Framework and has refreshed the performance metrics being presented before the IJB in a new suite of measures (Appendix 3). The new suite of measures is designed to offer a more focused approach to national pressures around Centre for Sustainable Delivery’s (CfSD) Urgent & Unscheduled Care, Planned Care and NHS Highland Operational Improvement Plan (OIP), including scope for service feedback. 2. RECOMENDATIONS The Clinical & Care Governance Committee is asked to: Page 19 Agenda Item 5
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2 • Acknowledge performance for FQ3 2025/26 (October –December) against latest Key Performance Indicators within the Integrated Performance Management Framework for 2025/26 • Note latest Delayed Discharge Sitrep as of 16 Feb 2026 (Appendix 1) • Acknowledge latest performance against the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 2) • Acknowledge the inclusion of additional A&B HSCP performance metrics aligned to national reporting across Centre for Sustainable Delivery (CfSD) Unscheduled Care, and the Planned Care performance focus within the Operational Improvement Plan (OIP) (Appendix 3) 3. DETAIL OF REPORT The report details the HSCP (Health and Social Care Partnership) performance for FQ 3 2025/26 (October - December), highlighting key performance trends across the 77 KPIs (Key Performance Indicators). For 2025/26, the latest national update on Delayed Discharges (Appendix 1), alongside the latest performance on the National Health and Wellbeing Outcomes Indicators (Appendix 2) have been included. Additional performance metrics aligned to Urgent & Unscheduled Care, Planned Care and NHS Highland OIP NHS Highland’s OIP are reported within Appendix 3. 4. RELEVANT DATA & INDICATORS 4.1 FQ3 2025/26 (October – December) Performance Summary Overall performance for FQ3 notes that 77 KPI’s are scoring against a target, with 36 (47%) reporting as OnTrack. The KPI’s report performance against the target and include the target, actual and variance and is a mix of both quantitative and qualitative indicators. The use of the green, amber and red graphics within the Dashboard is used to give an overview of the HSCP’s total performance for each of the twelve services and 77 KPI’s. The use of only green and red for the KPI’s is used to focus delivery with regards to sustaining performance on or above target. Additional metrics around CfSD and Planned Care are reported within Appendix 3 and will continue to be developed and threaded through A&B performance reporting, in conjunction with the current reporting cycle and the annual IPMF KPI review for 2026/27. 4.2 Analysis of Key Performance This analysis identifies performance across the 12 service reporting categories within the Integrated Performance Management Framework (IPMF). Page 20
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3 Additional metrics around CfSD and Planned Care are reporting within appendix 3, and these will continue to be developed and threaded through A&B performance reporting, in conjunction with current reporting cycle and the annual IPMF KPI review for 2026/27. 4.2.1 Delayed Discharges Sitrep Overall trend performance for December 2025 notes a slight weekly variance with a weekly average of (46) delays. With regards to overall benchmarked performance, A&B remain above the Scottish average per 100,00 population. The latest Delayed Discharge sit rep per 100,000 shows increased position in Argyll & Bute HSCP with 73 noted @ 16 Feb 2026. 4.2.2 National Health & Wellbeing Outcome Indicators & Ministerial Steering Group Integration Indicators The National Health and Wellbeing Outcomes provide a strategic framework for the planning and delivery of health and social care services. This suite of outcomes serves to focus on improving the experiences and quality of services for people using those services, carers, and their families. These indicators form the basis of the annual reporting requirement for Health and Social Care Partnerships across Scotland. The national indicators will be updated and reported within A&B HSCP’s Integrated Performance Management Framework to provide the national performance position alongside the local service Key Performance Indicators suite. The latest data in relation to 26 HWBOI and MSG Indicators reports 50% on track, with 13 on track and 13 off track. An overview of A&B HSCP’s latest performance against the 26 measures is reported in Appendix 1. It should be noted that reporting periods vary across the suite of national indicator measures, with some measures reported quarterly affected by national reporting data lag. 4.2.3 A&B HSCP performance metrics aligned to CfSD Urgent & Unscheduled Care, Planned Care NHS Highland OIP The HSCP Senior Leadership Team is currently reviewing the content and structure of the Integrated Performance Management Framework. Page 21
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4 This FQ3 performance report includes several metrics with closer alignment Centre for Sustainable Delivery (CfSD) Unscheduled Care, and Planned Care more aligned to the NHS Highland Boards OIP processes, with the intention of showing A&B’s progress within the content of Board level performance and also to present service-led feedback across the framework. These are provided before the IJB in (Appendix 3). This process will continue to be developed and threaded through A&B performance reporting cycles, in conjunction with the annual IPMF KPI review for 2026/27. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The monitoring and reporting against Key Performance Indicators using the Integrated Performance Management Framework and Dashboard ensures the HSCP is able to deliver against key strategic priorities. This in-turn is aligned with the Strategic Plan and key objectives. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact Financial performance is evidenced within the IPMF Dashboard ensuring best value as well as evidencing the impact and performance against organisational budget savings. 6.2 Staff Governance Key performance indicators within the IPMF ensure that staff governance requirements continue to be progressed and developed include health and safety, wellbeing and new service redesign and working practices. 6.3 Care and Clinical Governance Clinical Governance and patient safety remain at the core of prioritised service delivery against the new IPMF Dashboard and National Health & Wellbeing Outcomes Indicators. The new governance structure supporting the IPMF ensures that the Clinical & Care Governance Committee remain central to performance improvement. The development of the IPMF is focussed on moving away from previous traditional styles of reporting to a fully collaborative approach with Head of Service and Service Lead commentary. 7. PROFESSIONAL ADVISORY Data used within the performance dashboard is fully accessible in SharePoint with data trends and forecasting are identified to give wider strategic context. This provides the HSCP professional advisors with self –service performance information to inform their role in maintaining professional standards and outcomes. 8. EQUALITY & DIVERSITY IMPLICATIONS The Integrated Performance Management Framework captures relevant indictors used to inform the HSCP E&D work. 8.1 PROTECTED CHARACTERISTICS Performance detailed within this report acknowledges the rights of the Child (UNCRC), Islands. Fairer Scotland, Socio-economic Duty, Equalities - protected characteristics. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Data use and sharing within this report and IPMF performance dashboard is covered within the Argyll and Bute Council & NHS Highland Data Sharing Agreement Page 22
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5 10. RISK ASSESSMENT Risks and mitigations associated with performance data sources and reporting are managed and identified within the monthly Performance & Improvement Team- Work Plan. 10.1 STRATEGIC, OPERATIONAL OR CLIMATE RISK Performance reports are used by operational management to identify service delivery risk and to inform mitigation action accordingly. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Performance reporting is available for the public via Argyll and Bute Council and NHS Highland websites. The IPMF dashboard utilises SharePoint to support manager and staff access across the HSCP. 12. CONCLUSION The Clinical & Care Governance Committee is asked to considerer and acknowledge FQ3 2025/26 (October - December) performance position as detailed within the IPMF Dashboard, and the additional metrics within the revised FQ3 Performance Overview Power Point presented at (Appendix 3). 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) REPORT AUTHOR AND CONTACT Author Name: James Brooks – HSCP Performance & Information Team Manager Email: james.brooks@argyll-bute.gov.uk Page 23
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6 Appendix 1 - Delayed Discharge Sitrep – 16th February 2026 The latest Delayed Discharge sit rep per 100,000 shows increased position in Argyll & Bute HSCP with 73 noted @ 16 Feb 2026. This compares with 46 noted at December 2025 census point. With regards to overall benchmarked performance A&B remain above the Scottish average per 100,00 population. Overall trend performance for December 2025 notes a slight weekly variance with a weekly average of (46) delays. Page 24
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7 Appendix 2 – HWBOI & MSG Integration Indicators. Core Suite of Integration Indicators HWBOI-Outcomes Data notes 55.5% (5 of 9) HWBOI Outcomes measures reporting as above the national Scotland Rate. It is worth noting that performance will be influenced and vary in line with the total number of respondents participating in this voluntary survey. As such, caution should be noted with regards to previous comparison and trends. Benchmarking performance against 7 comparator HSCPs is noted below. HWBOI – Outcomes - Benchmarking Page 25
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8 HWBOI- Performance Data Data notes 66.7% (6 of 9) HWBOI Performance measures reporting as above the national Scotland Rate. Note Indicators 17 and 19 are reported at FY 24/25 with measures 11, 12, 13, 14, 15, 16, 18 reported as at Calendar year 2024 as a proxy for 2024/25 due to the national data for 2024/25 being incomplete. This is in line with guidance issued by Public Health Scotland which was communicated to all Health and Social Care Partnerships. Using more complete calendar year data for 2024 should improve the consistency of reporting between Health and Social Care Partnerships. HWBOI- Performance Data – Benchmarking Page 26
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9 Ministerial Steering Group Indicators MSG Indicators have been updated to FY 2024/25 and are presented as a proxy for part year 2025/26 (April – Sep) based on latest available publication. MSG Indicators 1.1 & 1.2 & 2.1 notes slight fall in activity compared to the last reporting year, however this may be due to impact of data lag. Activity around Emergency Admissions, Unplanned Bed Days, A&E attendances and Delayed Discharge Bed Days all noted performance exceeding pre –Covid levels. This highlights the necessity to consider approaches to alleviate systems pressures around Urgent and Unscheduled Care and expedite hospital flow, particularly around significant increases seen in A&E Admissions and Delayed Discharges. Data notes 67% (6 of 9) HWBOI Outcomes measures reporting as above the national Scotland Rate. It is worth noting that performance will be influenced and vary in line with the total number of respondents participating in this voluntary survey. As such, caution should be noted with regards to previous comparison and trends Page 27
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10 Appendix 3 – A&B HSCP performance metrics aligned to NHS Highland’s OIP Please see pdf attached. Page 28
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Argyll & Bute Health and Social Care Partnership FQ3 (Oct –Dec 2025) Performance Overview Update 04 March 2026 Appendix 3 – A&B HSCP performance metrics aligned to NHS Highland’s OIP Page 29
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• HWBOI & MSG Indicators • CfSDUnscheduled Care Trajectories • FQ3 Performance Update • OIP Focus Measures A&B HSCP Performance Overview Metrics FQ3 (Oct- Dec 2025/26) Page 30
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National Health & Wellbeing Outcome Indicators HWBOI-Outcomes • Data notes 55.5% (5 of 9) HWBOI Outcomes measures reporting as above the national Scotland Rate. It is worth noting that performance will be influenced and vary in line with the total number of respondents participating in this voluntary survey. As such, caution should be noted with regards to previous comparison and trends. HWBOI- Performance Data • Data notes 66.7% (6 of 9) HWBOI Performance measures reporting as above the national Scotland Rate. Note Indicators 17 and 19 are reported at FY 24/25 with measures 11, 12, 13, 14, 15, 16, 18 reported as at Calendar year 2024 as a proxy for 2024/25 due to the national data for 2024/25 being incomplete. This is in line with guidance issued by Public Health Scotland which was communicated to all Health and Social Care Partnerships. Using more complete calendar year data for 2024 should improve the consistency of reporting between Health and Social Care Partnerships. Page 31
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Ministerial Steering Group – Performance Indicators Ministerial Steering Group Indicators • MSG Indicators have been updated to FY 2024/25 and are presented as a proxy for part year 2025/26 (April – Sep) based on latest available publication. MSG Indicators 1.1 & 1.2 & 2.1 notes slight fall in activity compared to the last reporting year, however this may be due to impact of data lag. • Activity around Emergency Admissions, Unplanned Bed Days, A&E attendances and Delayed Discharge Bed Days all noted performance exceeding pre –Covid levels. This highlights the necessity to consider approaches to alleviate systems pressures around Urgent and Unscheduled Care and expedite hospital flow, particularly around significant increases seen in A&E Admissions and Delayed Discharges. Page 32
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Unscheduled Care - CfSD Trajectories Current CfSD Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Percentage of A&E Attendances in LIH meet the 4 hrs wait target 88.2% 95.0% 89.6% Number of A&E Attendances lasting more than 8 hours 23 0 10 Number of A&E Attendances lasting more than 12 hours 8 0 3 Maintain LIH Bed Occupancy Rates below 90% target 76.4% 90.0% 82.4% Reduce the number of patients in hospital affected by Standard Delays 46 31 43 Reduce the number of patients in hospital affected by AWI Delays 7 4 12 CfSD Unscheduled Care – Karl McLeish – FQ 3 (Sep – Dec 2025) Performance Overview Activity around Emergency Admissions, Unplanned Bed Days, A&E attendances and Delayed Discharge Bed Days all noted performance exceeding pre –Covid levels. This highlights the necessity to consider approaches to alleviate systems pressures around Urgent and Unscheduled Care and expedite hospital flow, particularly around A&E Admissions and Delayed Discharges. Additioanl metrics aligning to CfSD ae being developed in conjunction with NHS Highland Page 33
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The HSCP Senior Leadership Team is currently reviewing the content and structure of the Integrated Performance Management Framework. This new suite of measures is designed to offer a more focused approach on national pressures around Centre for Sustainable Delivery (CfSD) Urgent & Unscheduled Care, Planned Care and NHS Highland Operational Improvement Plan (OIP), including scope for service feedback. FQ3 Performance Update - IPMF Page 34
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Children & Families & Justice Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Improve the percentage of Child Protection Register (CPR) cases that have an allocated Social Worker (at end of quarter) 97.0% 100.0% 97.0% OIP - Children & Adolescent Mental Health Services (CAMHS) will see 90% of children and young people within 18 weeks of referral 79.0% 90.0% 80.0% Percentage of Criminal Justice social work reports submitted by 12 noon, 2 days before court 83.0% 90.0% 88.0% Improve the number of statutory individual Health Assessments commenced within four weeks of coming into care 100.0% 96.0% 75.0% Improve the number of teams that have delivered 85% or more of the Universal Health Visiting Pathway (UHVP) 83.0% 85.0% 83.0% Children & Families – David Gibson – FQ 3 (Sep – Dec 2025) Performance Overview C&F have been impacted by staffing, with high levels of vacancies across the service, with Helensburgh being the only fully staffed team. This is compounded by posts being filled by newly qualified Social Workers who cannot hold CP cases. Assurance can be provided that in the absence of an allocated social worker, the cases are managed by Team Managers. While the JSW KPI remains below target, mainly due to staff absence and vacancies across Q3, performance has been improving over this reporting year. The service is now fully staffed and we anticipate this KPI will be met in Q4. The cohort size of care experienced requiring health assessment initiation is small, meaning percentage fluctuations appear more pronounced. We continue to work closely with partners to strengthen timely information sharing and improve overall compliance. The delivery of the Universal Health Visiting Pathway is monitoring close to target despite ongoing workforce pressures. Page 35
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OIP - CAMHS Current Performance Metrics FQ2 Target FQ3 Children & Adolescent Mental Health Services (CAMHS) will see 90% of children and young people within 18 weeks of referral 79.0% 90.0% 80.0% OIP - CAMHS - David Gibson – FQ 3 (Sep – Dec 2025) Performance Overview Plans, Mitigations and Actions Targeted focus on longest waits linked to planned waiting time initiative (WTI). Aim to achieve compliance within all locailities linked to KPI. Reduced capacity due to ongoing vacancies. Changes to partner health capacity (Community Peads) Page 36
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Planning, Performance & Technology Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Increase the number of New Clients to Telecare services 242 200 206 Increase the number of Telecare Service reviews completed 167 85 161 Increase the number of patients utilising 'Near Me' clinics 1126 800 1094 Increase in new referrals to Silvercloud 52 70 63 Increase the utilisation of 'Connect Me' for Blood Pressure monitoring within primary care 120 42 120 OIP - Waiting Times for Cancer Appointments at the 31 Day Targets 17 0 26 OIP - Reduce New OP Waiting Times breaches >12 weeks 48% 46.0% 44% OIP - Reduce OPWL long waits >52 weeks 7.1% 0.0% 6.5% HSCP Freedom of Information Requests are responded to within statutory timescale of 20 working days 93% 100.0% 100% % of Transformation & Improvement Projects on track 90% 85.0% 90% 100 percent resolution rate of IT support requests 98% 100.0% 98% Strategic Planning Performance & Technology – Kristin Gillies – FQ 3 (Sep – Dec 2025) Performance Overview An external provider has been commissioned to see 150 Oral Surgery patients before the end of March 2026 with additional funding awarded in late December 2025 to see a further 70 patients in house. This will ensure we are able to report a zero 52 week position for this specialty at end Q4. Orthodontic activity has been continually high since the new clinic appointing model was implemented in mid 2025 and on this basis we do not forecast any 52 week breaches as at end Q4. Ophthalmology continues to be an area of pressure and we will rely on initiative sessions to ensure a zero 52 week position in this specialty. Assistance has been offered from within NHS Highland NTC for any remaining long waiting patients at year end. Provision of Urology nurse led clinics from NHSGGC has been escalated to SG but NHS Highland are also willing to support if required. Ophthalmology, Urology and Respiratory will be closely monitored and assistance sought from NHS Highland as required to ensure a zero 52 week position wherever possible. Whilst there is a slight decrease from Q2, the number of new Telecare clients to the service is on target. There has been significant absence/vacancies within the team which has impacted on the speed of which new assessments can be carried out. The team have done well to remain on target whilst under pressure. The number of Telecare reviews completed in Q3 is double the target. Again, this is an achievement when considering staff vacancies and absence within the team. Mental Health teams continue to use Near Me as their first preference. We are still exceeding the target despite a very small change in the number of patients using it from the previous quarter. Usage is dependent on Near Me appointments being offered by clinicians and work is ongoing to promote Near Me as an alternative to face to face appointments where appropriate. Silvercloud referrals are dependent upon clinicians referring patients to the service. Whilst we are below target, there has still been a steady increase from both Q1 and Q2. Page 37
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OIP - Planned Care – Long Waits Current Performance Metrics FQ2 Target Q3 Actual OIP - Reduce OPWL long waits >52 weeks 7.1% 0.0% 6.5% OIP - Planned Care - Long Waits – Kristin Gillies – FQ 3 (Sep – Dec 2025) Performance Overview Plans, Mitigations and Actions At end December 2025 there were 170 patients waiting longer than 52 weeks for an outpatient appointment in Argyll & Bute. 36 patients were waiting between 78 and 104 weeks. The longest waiting patient has been on the waiting list for 102 weeks under Urology. An external provider has been commissioned to see 150 Oral Surgery patients before end March 2026 with additional funding awarded in late December 2025 to see a further 70 patients in house. Orthodontic activity has been continually high since the new clinic appointing model was implemented in mid 2025. Ophthalmology continues to be an area of pressure and we will rely on initiative sessions to ensure a zero 52 week position in this specialty. Assistance has been offered from within NHS Highland NTC for any remaining long waiting patients at year end. Provision of Urology nurse led clinics from NHSGGC has been escalated to Scottish Government. Ophthalmology, Urology and Respiratory will be closely monitored and assistance sought from NHS Highland as required to ensure a zero 52 week position wherever possible Page 38
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OIP - Planned Care – Outpatients Source: NHSH – SOT1016 OP Ongoing Waits Details 30122025 & month end files Page 39
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Planned Care - Inpatients Source: Argyll & Bute – Full IPDCWL as at 23/12/2025 Page 40
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OIP - Radiology Current Performance Metrics FQ2 Target Q3 Actual 95% of patients with a referral to Radiology are being seen within 6 weeks 75.7% 95.0% 92.0% OIP - Planned Care - Radiology - Kristin Gillies – FQ 3 (Sep – Dec 2025) Performance Overview Plans, Mitigations and Actions Between Oct and Dec 2025, the waiting list backlog has been reduced, helped by use of locum sonographer, with only small numbers waiting. 0.5WTE post is out to advert for Campbeltown and Rothesay and there may be scope to increase to full time in future 0 50 100 150 200 250 300 350 400 450 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 73% 69% 69% 68% 67% 76% 61% 80% 92% Number of Patients seen Diagnostic Activity by Month -Patients seen within 6 weeks 2025/26 A&B Sites - (Includes CT, Ultrasound and Fluoroscopy only) Within 6 weeks Over 6 weeks Page 41
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Primary Care Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions 80% of children who received Fluoride Varnish treatment did not require to be referred for further dental treatment 80% 80.0% 81.0% Percentage of planned activity carried out to deliver National Oral Health Improvement Programmes against Service Plan 73% 100.0% 89.0% Monitor vaccination delivery against National trends during autumn winter and spring booster programmes 2% 64.0% 65.0% Monitor the % of HSCP run GP practices enacting contingency measures 0 14 0 Monitor available appointments to increase the utilisation of HSCP Dental Clinic appointments 43% 75.0% 51.0% Achieve a minimum 95 percent uptake for 6 in 1 vaccination in children by the time they reach 1 year old 97% 95.0% 97.0% Primary Care – Eilidh Gallagher – FQ 3 (Sep – Dec 2025) Performance Overview Utilisation of available appointments dental - utilisation is measured against a maximum capacity workforce model / establishment. We are carrying a high vacancy level combined with sickness / absence which reduces the utilisation rates as does travel time to and from remote clinics. Discussions are ongoing around the possibility of removing Campbeltown from the scope as they run a different service model. Planned activity in relation to National Oral Health Improvement - The reduction here is due to maternity leave and vacancy factor. Plans in place for recruitment and it is anticipated that performance will improve by Q1 but this will depend on the success of recruitment drives. New OHSW started 01/09/25 in Mid Argyll, Childsmile training in progress. Vacancy in North Argyll filled, new OHSW started 17th November. Childsmile training starting 29th January. Programmes covered by staff based in Lochgilphead and Helensburgh, incurring additional travel and time, reduced ability to provide all national programmes in each locality. Priority 1: Childsmile programme - Priority 2: Caring for Smiles (care home and hospital staff training) - Priority 3: Open Wide (Adults with Additional Care Needs) and Smile4Life (homeless programme). Page 42
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Public Health Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Increase the number of successful quits, supported by NHS smoking cessation advisors or jointly through shared care with pharmacy, by people in the 40% most deprived areas in Argyll and Bute reporting undertaken a quarter in arrears. 16 10 14 Report on the number of people in Argyll and Bute attending training to deliver Community Reinforcement And Family Training (CRAFT) to families. 0 15 19 Increase the number of people in Argyll and Bute attending training in the following areas: Money Counts, Behaviour Change, Speakeasy, Mental Health and Suicide Prevention. 165 78 207 Mitigate health inequalities through increasing the number of referrals to community link workers supported by ‘With You’, ensuring health and wellbeing support is targeted to areas of rural or socio-economic need. 219 119 207 Number of instances working with Scottish Government or National Agencies on National Strategy and Policy Development 6 11 12 Report on the number of engagements relating to planning with people with lived or living experience of alcohol and/or drugs. 6 4 4 Public Health - Alison McGrory – FQ 3 (Sep – Dec 2025) Performance Overview Good progress with the Public Health indicators is noted and green ratings for all is very welcome. These targets are measures of outputs of the work of the Public Health Team and are proxy measures for the longer-term outcomes of this work which centre on improving the health and wellbeing of the people of Argyll and Bute. Several of the indicators are annual measurements, therefore progress will fluctuate over the course of the four quarterly periods. The Public Health Team will continue to review the appropriate levels of the indicators to ensure the right balance between achievability and striving for continuous improvement. Page 43
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Finance Current IPMF Performance Metrics FQ2 FQ3 Target FQ 3 Plans, Mitigations and Actions Monitor Older People (OP) - Internal Residential Budget Spend -27% 0.0% 10% Monitor Older People (OP) - External Residential Budget spend 5% 0.0% 0% Monitor Older People - Homecare Budget spend 0% 0.0% 2% Monitor Lorn & Islands Hospital overall budget 23094 24438 23206 Monitor NHS Savings Recovery to ensure this remains on track (£k) 3937 7852 5259 Monitor Social Work Savings Recovery to ensure this remains on track (£k) 1993 3015 2337 Monitor the HSCP Total Budget to ensure this remains on track (£m) 404 402 405 Finance – James Gow – FQ 3 (Sep – Dec 2025) Performance Overview Financial performance has been improving through Q3 and this is starting to be reflected in the KPIs reported. Specifically, older adult budgets are operating close to budget (care at home and residential care). New processes are in place for managing care at home delivery within budgeted hours and the service is close to operating within this reduced service baseline. The delivery of the threshold of care has contributed to this. It should be noted that there has been an adverse impact on delayed discharges and increasing unmet need. Agency staffing has reduced but remains a challenge. Internal care home budgets continue to be adversely impacted by on-going utilisation of agency staff in KCC and Islay. NHS financial performance is also improving, agency staffing within LIH remains a concern, the overspend here is being managed through underspends elsewhere. The overall HSCP performance against budget is improving and the level of projected overspend can be funded from reserves. Savings performance is also relatively positive. The main risk now relates to the SLA with Glasgow and the budget for 2026/27. Page 44
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Carers Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Increase the number of Adult Carer Support Plans completed across A&B Carers Centres 103 120 90 Increase the number of Young Carer Statements completed across A&B Carers Centres 23 39 26 Increase the number of Unpaid Adult Carers supported across A&B Carers Centres 2731 2600 2827 Increase the number of Unpaid Young Carers supported across A&B Carers Centres 850 783 836 Increase the number of ACSP reviews completed by the various Carers Centres. 2307 1800 2752 Carers – Linda Currie – FQ 3 (Sep – Dec 2025) Performance Overview Following the Fair Access and Efficiencies of Care paper presented to the IJB in November, there has been a notable increase in the number of concerned families seeking and receiving support from the carer services. Routine welfare calls with families supporting an older adult have taken considerably longer, with staff spending additional time providing reassurance and explaining the reasons behind the changes. The IJB paper did acknowledge this potential impact on families. Although fewer formal reviews have been carried out this quarter, a substantial Page 45
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Community Health & AHPs Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Reduce New Out Patient Referral waits breaching > 4 weeks for Musculoskeletal (MSK) 1212 0 1298 Reduce New Out Patient Referral waits breaching >12 week waits for AHP services 485 0 557 Reduce P1 and P2 Community Patient Referral waits breaching > 4 weeks for AHP Services 96 0 97 Reduce P3 and P4 Community Patient Referral waits breaching >12 week waits for AHP services 1067 0 1010 Increase the number of monthly AHP Out Patient Completed Waits 768 945 744 Allied Health Professionals - Linda Currie – FQ 3 (Sep – Dec 2025) Performance Overview The KPI's demonstrate actual capacity in the system including impact of current vacancies across the teams (over 20) and noting the impact of absences and leave which are not backfilled. A workforce establishment tool run is planned for late spring to fully understand demand, capacity, queue and activity in line with the Healthcare Staffing Act. Page 46
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Delayed Discharges Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Reduce the number of overall people delayed in hospital at Monthly Census Point 47 34 47 Reduce the overall length of stay in a hospital (Delayed Discharge Bed Days) at Monthly Census Point 908 634 1126 Reduce the number of people delayed in hospital with AWI code at Monthly Census Point 7 4 12 Reduce the number of people delayed in hospital awaiting a care home placement at Monthly Census Point 5 10 8 Reduce the number of people delayed in hospital due to care at home availability at Monthly Census Point 30 10 23 Reduce the number of people delayed with assessment code at Monthly Census Point 5 10 7 Delayed Discharges – Caroline Robertson – FQ 3 (Sep – Dec 2025) Performance Overview In terms of delayed discharges FQ3 has been a challenging period due to actions out with out control, despite this we have continue to recognise this as a priority and support where we can to ensure people who can be discharged from hospital have been. We have attempted to address the issue of long waits due to AWI by allocating a specific MHO resource to this, unfortunately the market is in demand for MHO’s and this has not been possible to facilitate. Work is ongoing to consider the use of supported decision making and S13ZA of the Social Work (Scotland) Act to facilitate discharge where possible. This has an overall impact on the length of stay for patient’s who require statutory intervention to be able to move. The number of people waiting care at home in Q3 remains above target however there was a slight improvement on Q2, we know this remains the most challenging area and work is ongoing to ensure that we are assured that the assessment of need is accurate and that all possible alternatives have been considered. This is more challenging in specific areas such as Oban. Page 47
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Delayed Discharges cont... • With regards to latest overall benchmarked performance Feb 2026, A&B remain above the Scottish average per 100,00 population. • Overall monthly Delayed Discharge performance for December 25 notes a consistently higher number of delays for hospitals in A&B (46) when compared to GG&C (40) • Overall Delayed Discharge Bed Days at the end of FQ3 noted 1451 days with 57.5% in GG&C hospitals. Page 48
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Community Hospitals Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Reduce the rate of unplanned admission to Community Hospitals for 65+ population 416 450 469 Reduce the average Length of Stay for inpatients in A&B Community Hospitals 8.1 7.5 7.6 A&E Attendances in A&B Community Hospitals meeting the 4 hrs wait target 94.6% 95% 93% Maintain A&B Community Hospitals Bed Occupancy Rates below 80% target 70.1% 80.0% 71.4% Reduce the number of Falls being reported in a Community Hospital setting in A&B 65 38 43 Community Hospitals – Caroline Robertson – FQ 3 (Sep – Dec 2025) Performance Overview In terms of the performance for community hospitals we have experienced continued challenges across this area including: • increase in unplanned admissions, this is currently being addressed around A&E standards and the whole system approach to ensure that where possible admission is prevented and are able to receive the treatment and support they require at home. This is at very early stages and will be monitored closely in terms of KPI’s. • The number of falls whilst in hospital continue to rise, this is being monitored through Datix, where any correlation between falls and patients who are delayed will be monitored. This has improved significantly since Q2. • The length of stay for patient’s has increased for the second period running and is a reflection on the overall impact on being able to provide support to enable return to a homely setting. The test of change in Cowal and Helensburgh has demonstrated the potential to facilitate discharge to assess, work is ongoing to monitor the impact of this and potential to roll out across the partnership. • In terms of the 4 hour waiting target our performance has again not met the target this has potentially been impacted by our ability to transfer patients timelessly to GGC due to transport availability. Page 49
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Rural General Hospital (LIH) Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Reduce the rate of unplanned admission to LIH for 65+ population 359 345 367 Reduce the total number of Unplanned Bed Days in LIH 2876 3323 2908 Reduce the average Length of Stay for inpatients in LIH 3.9 5 3.5 Maintain LIH Bed Occupancy Rates below 90% target 76.4% 90.0% 82.4% Reduce the number of A&E Attendances in LIH that result in an unplanned admission 16.6% 19.2% 17.9% A&E Attendances in LIH meet the 4 hrs wait target 88.2% 95.0% 89.6% Reduce the number of Falls being reported in a hospital setting in LIH 11 26 26 Reduce number of instances of tissue viability in LIH 2 4 1 Reduce the number of medication errors in LIH 14 6 12 Rural General Hospitals (LIH) – Caroline Robertson – FQ 3 (Sep – Dec 2025) Performance Overview In response to the reducing the rate of unplanned admissions of over 65, we are currently working to review the A&E standards alongside the development of a whole system approach which will aim to prevent admission and access to the treatment they require within their own home or homely setting resulting in a reduction of unplanned admissions. The reduction in medication errors continues to be out with target although a slight improvement on the last quarter. This is being monitored through datix in terms of location/staff/times to be able to implement any improvement action, promoting a culture of learning and development. Despite a slight improvement in the 4 hour waiting target since Q2 we remain slightly off target, this is being monitored in line with the whole system plan. Page 50
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OIP – Hospital @ Home Current Performance Metrics FQ2 Target Q3 Actual Implement 12 Hospital @ Home beds in Oban, and an additional 4 beds A&B Wide by March 2026 10 Beds 16 Beds 11 Beds OIP - Hospital @ Home – Caroline Robertson – FQ 3 (Sep – Dec 2025) Performance Overview Plans, Mitigations and Actions Argyll & Bute’s Hospital at Home service provides treatment for a range of conditions, including frailty, cardiac, respiratory and OPAT. From April to December 2025, 153 patients were admitted accounting for 1,248 bed days. Hospital at Home contribution to improved patient flow through Lorn and Islands Hospital will continue to be monitored. Work is ongoing to scope A&B for additional H@H bed locations with consideration being given to an island site. Page 51
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Adult Social Care & ASP Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Increase the percentage of older people who had their homecare monitoring review completed within 6 months 60% 60% 45% Reduce unplanned admissions to A&B hospitals directly from a care home 21 18 25 Increase the occupancy rates across A&B Care Homes 96% 95% 96% Reduce the number of hours of unmet need for care at home 349 500 444 Increase the % of Adult Support Protection Screening Duty to Inquire Assessments completed within 5 working days 45% 70% 55% Increase the % of Adult Support Protection Investigations completed within 15 working days of the ASP Screening Duty to Inquire completion date 42% 70% 41% Adult Social Care & ASP – Nicola Gillespie – FQ 3 (Sep – Dec 2025) Performance Overview Demand for care home beds cross Argyll and Bute continues, teams will continue to progress and support appropriate admissions Although Unmet Need sists within target remits, it is evident that need for care at home is increasing. This will be continued to be monitored and reported as requested. We recognise the impact of being admitted to hospital from a care home and where possible we aim to be able to provide care and treatment within the care home. As part of the overall whole system plan we aim to review the point of contact, linking in with GP practices as well as lead nurse for care homes to prevent admission where possible. ASP continues to be challenged due to vacancies and increased need. The model of delivery is currently under review and progressing via social work governance group. A&D Completed waits are reflective of the volume of referrals received to small teams across A&B. Page 52
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Complex Care & Registered Services Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions Reduce the number of clients on Dynamic Support Register with category Amber/RedUSC 16 10 16 Reduce the number of people waiting for a New Mental Health Out Patient service (>12 weeks) 827 390 846 Reduce the number of people monthly waiting for psychological therapy services ( >18 weeks) 27 175 25 MH Urgent Care Referrals Response Timescales < 2 Hours 100% 90% 99% MH Social Circumstances Report Overdue 64% 33% 67% Drug & Alcohol Completed Waiting Times from Referral to First Treatment (LDP) 83% 90% 87% Complex Care & Registered Services – Nicola Gillespie – FQ 3 (Sep – Dec 2025) Performance Overview The DSR target of reducing to 10 people being recorded as red/amber as opposed to the 16 individuals that are currently recorded will prove challenging to meet and is a reflection of the complexities and challenges to meet the complex needs of the individuals within Argyll and Bute. As a service we will continue to scope possible development opportunities with accommodation and support providers. MHOP waiitng remain significantly above target. Performance continues to be affected by earlier workforce gaps, including a three‑month period without medical cover in Kintyre and Islay during Q1–Q2, which halted assessments and generated a substantial backlog, alongside persistently high demand, notably a high volume of ADHD‑related referrals across all three localities. Despite the stabilising impact of a locum psychiatrist over the past six months, overall capacity has proven insufficient to reduce the backlog or meet current demand, with key risks including prolonged waits for patients with ADHD or complex needs and continued reliance on locum provision. Mitigation actions include efforts to recruit to a substantive psychiatrist for Kintyre and Islay, optimising referral pathways (including ADHD), improving service integration and patient flow through revision of standard operating procedures, enhancing efficiency through the proposed rollout of electronic patient records, and strengthening referral criteria and caseload management at MDT level. Initiative in Helensburgh utilising funds from MIST has targeted the longest waits which were generated due to long term sickness/absence. This is now resolved and should show improvement within next quarter. The staff in Cowal and Bute have continued to work at pace to reduce waits in this locality. Page 53
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Psychological Therapies Current Performance Metrics FQ2 Target Q3 Actual Reduce the number of people monthly waiting for psychological therapy services ( >18 weeks) 27 175 25 Performance Focus - Psychological Therapies – Nicola Gillespie – FQ 3 (Sep – Dec 2025) Performance Overview Plans, Mitigations and Actions Performance continues to improve, with key performance indicators being met and only 25 patients now waiting longer than 18 weeks for assessment. This reflects significant service developments, including the standardisation of referral pathways across the service, clearer referral criteria, and greater overall service stability under consistent clinical leadership. Page 54
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Quality & Patient Safety Current IPMF Performance Metrics FQ2 Target FQ 3 Plans, Mitigations and Actions *Reduce the number of Falls being reported in a hospital setting in LIH 11 26 26 *Reduce number of instances of tissue viability in LIH 2 4 1 *Reduce the number of medication errors in LIH 14 6 12 *Reduce the number of Falls being reported in a Community Hospital setting in A&B 65 38 43 Quality & Patient Safety – Rebecca Helliwell – FQ 3 (Sep – Dec 2025) Performance Overview These metrics appear within current IPMF , under Community and RGH Hospitals, however they will be refined in line with planned consulation with Clinical & Care Governance leads for reporting year FQ1 26/27 Page 55
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A&B Operational Improvement Plan (OIP) Page 56
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Welcome.. We welcome our new Associate Nurse Director, James Mullins to A&B HSCP. A focus is to understand, develop and aspire to drive forward practices to constructively and effectively manage quality and patient safety across A&B HSCP. Key Dates: 8 May 2026 Integrated Clinical and Care governance Workshop 4 June 2026 Healthcare Guardian Go-live Argyll & Bute Clinical and Care Governance| Apr 2026 Data correct as of 22/04/2026 Clinical and Care Governance: Continuous Improvements • Integrated Clinical and Care Governance Structure. Mapping exercise to enhance quality and patient safety • Introduction of new Incident Reporting system (Healthcare Guardian) Planned to go live June 2026 • Training on Incident Reporting (Reporter and Reviewer) and Complaint Handling Procedure • Health Improvement Scotland – Clinical Governance Standards. – working with North Highland on a strategy to roll out the standards and utilise the improvement tool mechanism to support continuous improvements across all areas of our services • Aligned working with North Highland to advance our strategy in patient experience and how we engage with patient feedback to support improvements in practice and decision making • Review and refine our H&S governance structures • Review and refine our Risk Management across A&B HSCP (Includes clinical and operational risk) Page 59 Agenda Item 6
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Argyll & Bute Stage 2 Complaints | April 2026 Data up to date as of 22/04/2026 *excludes cases with stage of further correspondence and SPSO Since December 2025 complaint volumes have begun to increase again.. Aspects such as complaints in Primary Care relating to GP services, quality of consultations,, dental service provision and lack of sexual health services have impacted an increase in volumes. The volume of cases by areas completed within the 20 day target are being specifically impacted as a result of high-level cases related to case reviews and SAERs. A significant factor in Oban relates to operational pressures impacting investigation time scales and time taken to draft responses. SPSO: There are 4 open SPSO cases. 3 are initial enquiries and are awaiting a response from the SPSO. 1 SPSO has come back with a provisional decision of partially upheld regarding complaint handling and urine testing protocols. . Page 60
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Complaint themes in sub categories relate to the length of time it is taking to respond to complaints, this leads to escalated concerns and drives work volumes in the Feedback Team. Poor care, relates to quality and standard of care, this has significantly been observed in Primary Care and CAMHS services. Communication issues relate to patients feeling they haven’t been given enough or consistent information, which ties closely in with staff attitudes and behaviours. Actions to support have involved staff reflections and sharing of complaints with the wider teams to support awareness over the significance of what to communicate, when and how. Argyll & Bute Stage 2 Complaints | April 2026 Data up to date as of 22/04/2026| *excludes cases with stage of further correspondence and SPSO Page 61
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In period a total of 27 Stage 1 complaints received and total of 43 Stage 2 complaints. An average of 5 complaints received per month over the period. A peak n the summer with 11 received. Complaint themes are around: • Provision of social work and social care service • Quality of care and services • Communication with key workers and consistency of communication Argyll & Bute Social Work & Care Complaints| April 2026 Page 62
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Argyll & Bute Adverse Events | April 2026 Data correct as of 22/04/2026 Incident reporting volumes remain fairly consistent. A peak in the Mid Argyll area lends itself to the Succoth Ward, where during the summer of 2025 complex patients were on the ward, where persistent self-harming incidents were repeatedly reported. As patients have moved off the ward there has been a reduction. What we have seen instead is a volume in Succoth relating to dementia patients were falls have been a regular theme. Oban and falls issues are consistent along with medication errors . Since the introduction, we have observed a reduction in medication errors. The ‘other’ category is still too high on review, and further work to understand this is planned for June 2026. Page 63
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Argyll & Bute Adverse Events | Apr 2026 Data correct as of 22/04/2026 What we are observing with incidents is the quality of the incident report, and this has improved over the last 6 months. More information and immediate actions have been detailed to support incident review management which takes place weekly with professional lead input. We have observed a reduction in moderate and extreme cases and also an improvement in the handling, with less time taken to review and close Datix cases down. Page 64
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Inpatient falls have reduced over three consecutive months, demonstrating encouraging progress, although rates remain close to average, and continued focus is required to achieve the falls reduction target. Where falls occur, they are most often associated with a small number of highly complex patients. Argyll & Bute Inpatient Falls | Apr 2026 Data correct as of 22/04/2026 Page 65
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Highlighting falls prevention to staff remains a priority, through continued use of the Safe Care Pause. The Argyll & Bute Inpatient Falls Meeting continues to support shared learning and best practice, with key messages disseminated via the Focus on Falls graphic, which remains well received. The Falls Lead has introduced monthly short educational sessions focused on specific falls-related topics to further strengthen staff knowledge and preventative practice. Next steps: • Maintain focus on staff engagement and Safe Care Pauses • Continue monthly Falls Lead education sessions • Falls lead to target interventions for patients with complex falls risk as appropriate • Monitor trends to sustain and build on recent reductions Argyll & Bute Inpatient Falls | Apr 2026 Data correct as of 22/04/2026 Page 66
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Argyll & Bute Tissue Viability | Apr 2026 Data correct as of 22/04/2026 Grade 2 Pressure Ulcers continue to be the most frequently reported pressure injuries- of the 22 PUs reported (March/April), 1 was for a patient transferred from NHS GG&C, 1 was for a resident of a care home and 1 was device related and acquired in the MacmIllan Day Bed Unit. The remaining 19 PUs were acquired in the community. Within this reporting period a number of the PUs related to falls where there have been a long lie, reflecting the frailty and vulnerability of patients within the community setting. Contributory factors continue to be: - Frailty - Immobility - Acute illness -End of Life -Fall with a Long Lie A level 2a case review undertaken within the reporting period identified the following learning points: - Guidance to be developed to support consistent reporting of wounds/pressure ulcers on DATIX, particularly in primary care setting - Training related to tissue debridement for A&E and community staff to be developed - Awareness raising re use of information leaflet on pressure area care and management for patients and carers Page 67
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Improvement work underway: Re-launch of VIP Pathway and CRP for Feet (mandatory nursing assessment of feet for neuropathy) - joint initiative with TV and podiatry. Note the DATIX reports captured here include PUs which develop on the ankle and below, which are the remit of podiatry. Leg ulcer wound pathway development between A&B and GG&C progressing well - aim to improve early intervention and vascular referral processes. Contracture SLWG commenced – plan audit for prevalence followed by MDT review of current guidelines in terms of postural management and prevention of contractures. Sharp Debridement SOP in development – aim to clarify remit and scope of practice when undertaking this procedure. Care Home skin tear audit underway with ‘Train the Trainer’ sessions planned. Following review of a number of community acquired PUs- training re mattress selection and mattress settings and a Pathway with links to training videos and QR codes to equipment instructions completed . Roll-out of an enhanced Risk Assessment for frail, low weight, bed bound patients who require a high spec mattress. Argyll & Bute Tissue Viability | Apr 2026 Data correct as of 22/04/2026 Page 68
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Argyll & Bute Violence & Aggression | Apr 2026 Data correct as of 22/04/2026 . The graphical data shows a dramatic turn of events for reported V&A cases with a significant drop from September onwards. This correlates with incident volumes overall, as after that time period, 2 key Succoth ward patients were no longer at the location, as such, reported incidents overall dramatically reduced. Post September we have seen a rise in V&A cases reported in GP services, this relates to vaccinations and CTAC services, relating to cancellations, and aggressive behaviours from patients observed n these settings. . Page 69
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There is more 'Physical' subcategory reported in March and previous months than any other subcategory. This does suggest that more verbal form of aggression are perhaps not being logged. Staff are encouraged to log verbal, as these are equally as significant. There are relatively few Adverse Events reported from Oban , with such a large Hospital within the Locality a higher volume is expected. The volume of VA& training cancelled in Oban due to low staff numbers has been an area for concern. There have been four courses cancelled in the last year to March 2025, leaving potentially 48 staff untrained. We have the importance of Datix reporting running through our training, and as such feel with the training the volumes may increase with more consistent reporting. Argyll & Bute Violence & Aggression | Jan 2026 Data correct as of 09/01/2026 Page 70
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Medication error reporting is still an area of need for focus and deep dive, with ‘other’ category still significantly high. HEPMA has now been introduced into the Acute setting in Oban, and although this is the case, there are still high administration errors which are identified through pharmacy regularly. Argyll & Bute Medication Errors | Apr 2026 Data correct as of 22/04/2026 Page 71
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An action which came from the deep dive in Oban, pre HEPMA introduction, was the setting up of a medications error sub meeting. This is still on the agenda, and due to staffing pressures, has not been put into action at this time. A Lead Pharmacist post in Oban is currently vacant and this is a priority of the service to address this need. A recent SBAR has been requested in Oban relating to prescribing, and it is expected a review will support continuous learning in Oban. Argyll & Bute Medication Errors | Apr 2026 Data correct as of 22/04/2026 Page 72
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1 A&B HSCP Clinical Governance Committee Date of Meeting: 12 May 2026 Title of Report: Integrated Inspections and Scrutiny Overview Presented by: Leah Smith, Clinical Governance Manager The committee is asked to: ▪ Review for transparency and assurance regarding continuous improvement arising from external body investigations across A&B HSCP. ▪ Please note all the items within the paper are available in the public domain and that people who make complaints to the SPSO are made aware that their outcome reports are made public and published on their website for learning purposes. 1. EXECUTIVE SUMMARY This report provides an overview of external inspections, investigations, and scrutiny activity across Argyll & Bute HSCP over a 12-month period (March 2025–March 2026), with the primary aim of assuring the Committee that learning is being identified, acted upon, and embedded to support continuous improvement in patient care, staff practice, and governance 2. RECOMMENDATIONS The committee is asked to: Review for transparency and assurance regarding continuous improvement arising from external body investigations across A&B HSCP. Please note all the items within the paper are available in the public domain and that people who make complaints to the SPSO are made aware that their outcome reports are made public and published on their website for learning purposes. 3. DETAIL OF REPORT The following information is taken from a reporting period of the last 12 rolling months (March 2025 – March 2026) Scottish Public Services Ombudsman (SPSO) Investigations Health Board SPSO: Page 73 Agenda Item 7
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2 There are 4 open SPSO cases. 3 are initial enquiries and are awaiting a response from the SPSO to determine if they are taking them forward or not for formal investigation. These cases relate to Mental Health assessments for children and adults and dental service practice. 1 SPSO case has been reviewed by the SPSO and a provisional decision of being partially upheld has been approved by A&B HSCP. This SPSO relates to Community Hospital A and the care and treatment of an elderly patient with dementia. The areas upheld relate to: • Complaint handling; specifically around clarity for complainants over what areas are for the A&B HSCP to respond to, and what areas are for Medical Practice to respond to. • Urine testing protocols in dementia patients. Actions regarding management of such cases had been implemented prior to SPSO review and decision; as such we now have an agreed approach which requires a tailored acknowledgement letter to complainants to clarify areas of responsibility at the first opportunity. Actions regarding review or urine testing protocols are to be reviewed further with professional leads for continuous improvement. A Shared Learning Template will be drafted on the back of the final SPSO letter and this will be communicated to all relevant staff and published in our Library of Learning. In the reporting period 1 SPSO case which is not being taken forward by the SPSO has been returned with feedback regarding complaint handling and the management of communication via a single point of contact. A&B Clinical Governance Manager had already made changes to this practice and assurance has been given to the SPSO. Social work / Social Care SPSO 4 SPSO cases have been reviewed in the reporting period. SPSO cases relate the themes of: • Lack of care home for patients to be discharged to • Patients not receiving a care package • Quality of care Outcomes are: • 2 Partially Upheld • 1 Upheld • 1 Not Upheld The Upheld case related to quality of care at Residential Home A. Actions for improvement are relating to: Page 74
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3 • The need for senior staff reflections and review of care practices, • Staff medication training • Training for “Excellence in care dementia modules” and seeking face-to- face training • Recruitment work to stabilise staffing in the care home GOVERNANCE: - SPSO case discussions are held at local clinical and care governance meetings, e.g Mental Health Incident Groups and outcome of SPSO investigations are discussed at the Clinical and Care Governance Group where actions and learning are presented. Mental health Welfare Commission (MWC) On the 25 November 2025 there was a MWC visit to Succoth Ward specifically, which was successful and recommendation actions are being addressed. 5 recommendations were positioned regarding: • Specialist bed pathways • Engaging more with the police where appropriate, • Increased MDT to include nursing, • How there can be an increase in clinical psychology input • More resources to enhance the outdoor garden areas. Recommendations are currently under work for consideration and completion where possible. GOVERNANCE: - Actions are being discussed through a dedicated forum and outcomes are presented to the local clinical and care governance meeting and Head of Department forum. Oversight is shared at the Clinical and Care Governance Group meeting. Fatal Accident Inquiries (FIA) Enquiry In October 2024 we received a FAI Enquiry with request for information. This case was in regards to a care and treatment and a failure to identify patient as a ‘major trauma’ patient. Information has been shared along with updates on the SAER outcomes and improvement actions; we are awaiting a decision and outcome from the Procurator Fiscal. There is no further action at this time as actions from SAER have been concluded are now supported operationally. In November 2025 we received a Procurator Fiscal enquiry regarding Cowal & Bute A&E. This case related to wound care and onward communication with GG&C. This was also an SAER and A&B HSCP involvement and information has been shared with the PF and we are awaiting response or further instruction. GOVERNANCE – These cases were SAER and therefore, the governance route was via the Quality and Patient Safety Review meeting and outcomes were shared with the Clinical and Care Governance Group at the time. Health and Safety Executive (HSE) Inquiry Improvement notice following suicide – most recent meeting was on the 5 March 2026. Recent activity has been: Page 75
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4 • Refinement of the HSE Education Recommendations Scoping document, which was discussed on the 13 April 2026 – updates to be shared for the next H&S Group meeting. • A draft SOP for Urgent emergency Mental Health Service (EUMHS) was discussed on the 20 March 2026 – This is going forward via clinical governance and hospital/community care meetings for ratification. • Increased Levels of Care Policy draft has been circulated for initial review with a view to coming to the next meeting for discussion. GOVERNANCE: - Regular updates are discussed at the A&B HSCP H&S Group meeting and then shared at the North Highland Health and Safety Committee. Health Improvement Scotland (HIS) – Oban General Hospital Unannounced HIS inspection end of October 2024. The final report was published end of February 2025. At this time a high volume of information is being requested pulled from the site to support with the recommendations and actions which have come out of the report. HIS report and improvement plan work continues. Care Inspectorate (CI) Improvement Tracker A Care Inspectorate Improvement tracker is in progress, with areas of development in medication management, quality assurance, staff induction, and updated fire safety protocols. All such areas have been addressed in target time and shared with the (CI). Most recent update dated the 27 March 2026 is that since November 2025, 2 inspections that have been done were for Ardfenaig and Struan Lodge and neither had any requirements from them. April 2026 sees the start of the new inspection year where we are anticipating there being some new inspections. GOVERNANCE:- Development and improvement actions have been monitored via an Action Log and discussed in a dedicated forum. As actions are completed, update has been shared in the local clinical and care governance forum and any that require escalation of one to the Senior Management Team Leadership meetings and updated via the Clinical and Care Governance Group meeting. Whistleblowing Learning Activity: On the 8 December 2025 a Children’s Services area whistleblowing case was concluded. Meeting with Senior Leadership for Children’s Services and Clinical Governance Manager have been arranged for the actions and learning to be reviewed for onward oversight. Learning areas focus on: Page 76
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5 • Safe, Quality and Care – o Ensuring models of practice and consistent with national frameworks. o Staff are supported with using professional judgements o Review staff access to guidance and support o Review staff and patient/client feedback o Review communication methods and systems • Professional Working Standards Planning and Development o Review of integrated governance systems o Training for staff o Workforce reviews o Ensure we are working within Healthcare Staffing Act and time is managed operationally • Professional Practice and Accountability o Reviewing systems for monitoring compliance o Review engagement routes for patients/clients and families o Routes for raising and managing concerns o Assessment of roles and responsibilities • Research Design and Innovation o Review ideas for supporting service transformation and changing professional practice so Health Visitors have access to the woder A&B HSCP teams. o Review technology and how this can be further utilised in the service to support improvements and change. Meetings to progress actions with owners will commence on the 5 May 2026 and oversight meetings will be held with Clinical and Care Governance. GOVERNANCE: - Regular meetings have been set up with Service Lead and the Clinical Governance Manager for oversight and review – Update in activity and actions will also be shared at the Clinical and Care Governance Group meetings. 4. RELEVANT DATA AND INDICATORS As part of the continuous improvements to drive learning and actions from our external scrutiny reports Clinical and Care Governance have created a central repository for all known external scrutiny activity to be monitored and for governance oversight. This will support assurance that there is action on driving the areas of learning across our HSCP. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The recently released Health Improvement Scotland (HIS) Governance Standards have been rolled out to via the Clinical and Care Governance Group and across NHS Highland Quality Assurance Groups. This report of external body scrutiny and assurance mechanism will aid our HSCP to comply with the standards set and provide committee oversight and assurance. Page 77
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6 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact This report is over oversight and transparency, there are no decisions being made impacting financial position. 6.2 Staff Governance This report is giving oversight and transparency. The actions within scope of the various external body reports are driven with the aim of supporting staff governance, quality and patient safety. 6.3 Clinical and Care Governance I can assure the Committee that these areas of governance and improvement contribute to agenda items within the Clinical and Care Governance Group for the A&B HSCP. These items support onward transparency to our Clinical Governance Committee. 7. PROFESSIONAL ADVISORY I can assure the Committee that all areas of scrutiny as detailed in the report are driven with Professional Leadership involvement and Senior Operational Leadership. 8. EQUALITY & DIVERSITY IMPLICATIONS I can assure the Committee that all areas of action for continuous learning and improvement consider the equality and diversity rights of our patients / clients, families and staff. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE I can assure the Committee that this report along with the internal log of actions for learning are monitored in a safe and secure manner, with data protection principles in place. 10. RISK ASSESSMENT As mentioned in the introduction, when reporting with full transparency there is consideration regarding what aspects is published and is in the public domain. The SPSO does inform complainants that their report summaries and decisions are published on their website. Please see Appendix A for link to their findings page. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 12. CONCLUSIONS Page 78
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7 The report concludes that robust systems are in place to capture, monitor, and respond to findings from external scrutiny. Actions arising are actively progressing with professional and operational leadership oversight, contributing to improve clinical and care governance, patient safety, and staff support. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) REPORT AUTHOR AND CONTACT Author Name Leah Smith Email leah.smith2@nhs.scot Appendices: Appendix A - Our findings | SPSO Page 79
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1 Meeting: Clinical & Care Governance Committee Date of Meeting: 12 May 2026 Title of Report: Neurodiverse Pathways – Governance Update Presented by: Nicola Gillespie, Head of Complex Care and Registered Services The CCG committee is asked to: ▪ Note the current update and progress in relation to ASD and ADHD pathways. ▪ Note the identified clinical, operational and governance risks. ▪ Note the interim mitigation actions in place to protect patient safety and service sustainability. EXECUTIVE SUMMARY Demand for neurodevelopmental assessment and support across Argyll & Bute continues to increase at a level that exceeds current service capacity. This has resulted in growing waiting lists, pressure on secondary care services, and identified governance risks, particularly in relation to ADHD prescribing and monitoring arrangements. Immediate interim actions have been taken to stabilise risk, including the decision to move to a Tier 4 only ADHD service, prioritising those with complex needs, comorbid mental illness and risk. A Short Life Working Group (SLWG) has been re‑established to provide coordinated oversight and support longer‑term pathway redesign. While these measures mitigate immediate risks, they do not address underlying system capacity constraints, which require ongoing strategic consideration. 1. RECOMMENDATIONS ▪ Note the current update and progress in relation to ASD and ADHD pathways. ▪ Note the identified clinical, operational and governance risks. ▪ Note the interim mitigation actions in place to protect patient safety and service sustainability. Page 81 Agenda Item 9
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2 2. DETAIL OF REPORT Autistic Spectrum Disorder Pathway The ASD diagnostic service remains significantly constrained, with limited staffing and a waiting list in excess of 200 adults. Despite short‑term mitigation through commissioned external assessments, referral volumes continue to exceed available capacity. The service remains diagnostic only, with no commissioned post‑diagnostic support pathway, limiting the system’s ability to respond holistically to need. Referral quality and consistency continue to impact efficiency, and work is underway through the SLWG to review referral tools and processes, drawing on learning from other Health Boards. ADHD Pathway There is currently no dedicated, tiered ADHD service within Argyll & Bute. As a result, referrals have defaulted into secondary mental health services, creating significant pressure on Community Mental Health Teams (CMHTs) and consultant psychiatrist capacity. Adult ADHD waiting lists now exceed 230 individuals, with particularly high demand in Oban, Lorn and the Isles. A material clinical governance risk has emerged following notification from Lorne Medical Centre of its intention to cease prescribing ADHD medication in the absence of agreed shared care or enhanced service arrangements. This affects a significant cohort of existing patients and highlights broader system challenges around monitoring requirements, private diagnoses, and prescribing responsibility. In response, an interim decision has been taken to move to Tier 4 only acceptance criteria for ADHD referrals, aligning Argyll & Bute with practice in other areas and prioritising individuals where CMHT‑level intervention is clinically appropriate. Next Steps for ASD and ADHD Pathways 1. Move to a tier 4 ADHD service provision and ensure robust communication to GP colleagues and clients 2. Continue to work with our Primary Care colleagues to mitigate risk. 3. Continue to scope ASD service and develop options for in house vs commissioned service 4. Scope gaps and needs for future service 3. RELEVANT DATA AND INDICATORS, - Almost 500 adults are awaiting ASD or ADHD assessments. A review of referrals is underway to ensure appropriate service allocation and reduction of unnecessary demand. 4. CONTRIBUTION TO STRATEGIC PRIORITIES, The strategy aligns with agreed HSCP priorities and supports national policy implementation. Page 82
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3 Strategic Gaps: • No national funding for post-diagnostic support services. • Previous strategy development excluded key stakeholders and LD services. 5. GOVERNANCE IMPLICATIONS Financial Impact: • Current funding models do not support existing demand or sustainable pathway delivery. • Interim arrangements are being managed within existing resource but are not viable long term. • Future pathway options will require explicit consideration of affordability and funding gaps. Staff Governance: • The diagnostic practitioner is managed by the Senior Manager for LD with external mentoring support. Clinical and Care Governance: • Risk of harm associated with delayed diagnosis and interruption to ADHD prescribing and monitoring. • Pressure on CMHT capacity, with diversion of consultant time from people with severe and enduring mental illness. • Increased inequity of access due to geographic variation and reliance on private diagnosis routes. 6. PROFESSIONAL ADVISORY All professional standards and advisory requirements are being met. 7. EQUALITY & DIVERSITY IMPLICATIONS The strategy respects and promotes all protected characteristics and diversity principles, however if the service moves to a tier 3 or 4 only, this may impact those wishing to access services. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Fully compliant. 9. RISK ASSESSMENT Clinical risk associated with delayed or disconnected care. Reputational and legal risk arising from unmet need and variation in service access. These risks are currently mitigated through interim service controls, enhanced senior oversight, and SLWG governance. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Page 83
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4 Clear communication with patients and Primary Care is being prepared and will be prioritised to manage expectations and reduce uncertainty. 11. CONCLUSIONS Significant pressures remain across neurodiverse pathways, driven by rising demand and limited capacity. Interim governance actions have been necessary to protect patient safety and clinical sustainability, however these measures underline the need for longer‑term system redesign 12. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 13. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) e.g. Finance and Policy Committee Budget outlook 01/01/24 e.g. Recommended to the IJB REPORT AUTHOR AND CONTACT Author Name: Nicola Gillespie Email: nicola.gillespie2@nhs.scot Page 84