Service Spotlight Acute and Complex Care
Argyll and Bute Council · 29 November 2023
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 29 November 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 Integration Joint Board Date of Meeting: 29 November 2023 Title of Report: Service Spotlight Complex Care Presented by: Jillian Torrens, Head of Adult Services Acute and Complex Care The IJB is asked to: Consider the service spotlight. Invited to discuss 1. EXECUTIVE SUMMARY This service spotlight report takes the opportunity to update on some key areas of priority within Complex Care including Mental Health, Learning Disabilities, Neurodiversity and Adult Support and Protection for the interest of the Integration Joint Board. 2. INTRODUCTION Acute and Complex care has a broad remit across adult services with focus on the Rural General Hospital, Mental Health, Learning Disability and Neurodiversity. This area has a strong focus on improvement and clinical and care governance and is responsive to changing standards, guidance and legislation as approaches to care develop. It shares the wider challenges experienced by the HSCP in respect of workforce however continues to be creative and innovative in developing and delivering services. 3. DETAIL OF REPORT Mental Health Inpatient Care Succoth Ward in Mid Argyll Hospital continues to operate 16 beds. Occupancy has been running consistently at 95%. If there is an occurrence of delayed discharge the team work towards supporting the safe discharge of individuals home or to an alternative community setting as the earliest opportunity. The team continues to be supported by bank and agency staff. We hope that this will reduce in the coming months as we have recently recruited 3 new nurses – 2 newly qualified nurses at Band 5 and a more experienced Nurse at Band 6. All 3 commenced in post in October 2023 and have had a period of induction. A new induction handbook has been developed by the Associate Lead Nurse for Mental Health to support our new employees.
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2 The ward continues to facilitate student Nurse placements and recruitment is ongoing. We are currently working with North Highland on international recruitment and 4 international recruits have been identified to come to work in Succoth Ward on their arrival in the UK in January 2024. Core mental health standards for secondary care were launched in September 2023 and these will underpin both our inpatient and community services moving forward – link attached. Core mental health standards - gov.scot (www.gov.scot) Community Mental Health Teams (CMHTs) CMHTs continue to function in each of our four localities and have close links with our inpatient service, General Practitioners, Addictions Service and acute and community hospital services. The effective function of these teams is crucial to support people to remain in the community and to facilitate timely discharge from hospital. We are in the process of developing an operational framework for CMHTs. This will be in a similar format to the framework developed in NHS GGC. In addition to this we are also looking at how we can implement the MWC recommendations from their 2022 report “Ending the Exclusion” which aims to tackle silo working between mental health and addiction services and address the gaps in service provision to contain and manage the increasing incidence of mental health presentations and comorbid addiction issues. Psychological Therapies There was a national event on 1 November 2023 to launch The New National Specification for Psychological Therapies and Interventions – links to the strategic documents are embedded. Both NHS Highland and Argyll and Bute HSCP were represented at this event. The revised matrix is interactive and should help promote evidence based best practice across our services. Our performance continues to be monitored in relation to meeting waiting times and delivering a range of psychological therapies. Public Health Scotland published revised guidance on this on 26 September 2023 – a link to the guidance and an infographic is below. Psychological Therapies and Interventions Waiting Times Standard Definitions (publichealthscotland.scot) Psychological Therapies Waiting Times Key Measurement Points (publichealthscotland.scot) We have now appointed a new Consultant Clinical Psychologist and Lead for Psychological Therapies. This person will take up post early in 2024 and will lead on scoping and developing a sustainable model to deliver the standards set out within the revised matrix across Argyll & Bute. Adult Support and Protection (ASP)
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3 The Scottish Government published an updated code of practice in July 2022. In response to this the West of Scotland ASP procedures have been updated and Argyll & Bute’s Professional Lead for ASP is currently in the process of updating our local procedures to reflect both these documents. The Care Inspectorate has indicated that they intend to facilitate some “light touch” ASP inspections early in 2024 and we are in the process of reviewing our ASP action plan in preparation for this. ASP awareness day is in February 2024 and via the local ASP committee we propose devoting the whole of February to ASP awareness raising and practice development. Learning Disabilities Argyll & Bute’s integrated Learning Disability Services continue to provide support to approx. 377 people with either a Learning Disability or Autism via a range of services. The Team had a development session on 2 November 2023 to discuss future service provision and agree their objectives. The first iteration of Argyll & Bute’s Dynamic Support Register was submitted to Scottish Government on 11 Oct 2023. This is in line with the recommendations from the Coming Home Implementation report. The first iteration focused on the 50 individuals that we support in out of area placements across the UK. Our intention is that the next iteration will also include the high tariff care packages resident within Argyll & Bute. In February 2021 the Scottish Government allocated a £20 million Community Living Change Fund to Integration Authorities via NHS Boards to: Reduce the delayed discharges of people with complex needs. Repatriate those people inappropriately placed outside of Scotland. Redesign the way services are provided for people with complex needs. Our allocation of this is £300,701. Our two key intentions to use this money were to:- 1. Employ a project manager on a fixed term contract for 18 months to review the care and support needs and arrangements of the 50 individuals who we have placed out with Argyll & Bute and to develop local pathways to support as many of these individuals as possible to return home. 2. Support staff to undertake Positive Behaviour Support Qualifications and become PBS Champions. However, we have been unable to recruit to the proposed Project Manager post thus we have gone out to tender for a third sector organisation to undertake this work for us via a Direct Award. This process is nearing conclusion, and we hope to have an external provider identified in the coming weeks. An oversight group has now been established to support the development and maintenance of the local Dynamic Support Register.
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4 Neurodevelopmental Conditions We are conscious of the lack of a robust infrastructure locally to provide assessment, treatment and support for those with neurodevelopmental conditions. There is an emerging trend nationally within Boards and Authorities to develop a Neurodevelopmental Pathway which is a specialist service responsible for the assessment of neurodevelopmental conditions such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) in adults. A Program Manager has been in post now since Aug 2023. He has made significant headway in terms of scoping, meeting with key stakeholders and the development of a project plan. A power point presentation is attached for information at appendix 1. 4. RELEVANT DATA AND INDICATORS Acute and Complex Care is participating in phase 2 of the development of the Eclipse system and monitors Key Performance Indicator’s through the Integrated Performance Management Framework. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The outlined strategies support the delivery of the IJB Strategic Plan. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact the report notes financial related to national initiatives and development in this area. 6.2 Staff Governance the report notes the developing positive picture for recruitment in key areas whilst mitigating risk in other areas. 6.3 Clinical and Care Governance Practice is in continual development with specific functional governance in place for each of the specialty areas. 7. PROFESSIONAL ADVISORY Acute and Complex Care have a high professional advisory input given the complexity of the care delivered across the integrated functions. We work across the HSCP functional areas to promote relationships to the benefit of individuals who utilise both specialist and general services with complex needs. 8. EQUALITY & DIVERSITY IMPLICATIONS Service delivery, development and change takes into account equality and diversity implications and the impacts this may have especially pertinent with adults without capacity. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Not applicable within this report
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5 10. RISK ASSESSMENT Acute and Complex care has developed its Clinical and Care Governance in line with the refreshed framework and this allows for the continuing development of risk management. We are continuing to focus on key areas of challenge including workforce and our continual development and improvement in line with external guidance. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT The report notes developmental area which are planning or delivering public engagement in line with the IJB engagement guidance. 12. CONCLUSIONS The update report is recommended to the IJB and they are asked to consider and discuss. 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 REPORT AUTHOR AND CONTACT Author Name Jillian Torrens, Head of Acute and Complex Care Email jillian.torrens@nhs.scot