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Delivering for QualityIntegrated Performance Report

February 2016

Contents Page(s)

Executive Summary 3 - 4

Section A – LDP Standards Performance Summary 5 - 7

Targets on Track Short Report 8

Chief Executive’s Performance Escalation

Colour Coding Key 9

Cancer 62-Day RTT 10 - 12

18 Weeks RTT 13

Patient TTG 14 - 15

Outpatient Waiting Times 16 - 17

A&E 4-Hour Waits 18

HAI Sabs 19

Sickness Absence 20 - 23

Dementia 24 - 26

Delayed Discharge 27 - 28

Smoking Cessation 29

Alcohol Brief Interventions 30

CAMHS Waiting Times 31

Psychological Therapies Waiting Times 32 - 33

Section B - Capital Programme 35 - 42

Section C - Financial Position 43 - 48

Section D - Scottish Patient Safety Programme 49 - 56

Section E - FOI 57 - 58

Section F - Complaints 59 - 61

Section G - Programme Management Initiatives 62 - 64

EXECUTIVE SUMMARYOBJECTIVE OF THE REPORT

The object of the Integrated Performance Report (IPR) is to provide assurance to the Board on the overall performance of NHS Fife against the corporate aims relating to National Standards (as described in the Local Delivery Plan), local priorities and significant risks.

INTRODUCTION

This report is comprised of Sections A to G as per the Contents page.

In compiling this report, the most up to date information is used to populate the various sections. Due to different reporting timetables, the most current month’s information is not always available.

The Executive Directors Group reviews the Board’s performance every month prior to presentation to the Board or Finance and Resources Committee. This process is further supported by the scrutiny undertaken by the Acute Services Division and Health and Social Care Services.

The Healthcheck, which is presented at each Board Meeting, contains some areas of duplication, and a review of this is in progress, with a view to producing an overarching Quality Report in its place.

KEY PERFORMANCE OBSERVATIONS

In considering the February performance, the following areas for highlighting have been noted:

Section A – LDP Standards:

The continued sustainment of A&E Waiting Times performance above the 95% target is being sustained (rolling 12 month average). However the day to day performance in the current weeks has proved to be particularly challenging

The % of patients treated within 18 Weeks of referral is remaining just under the 90% standard (89.9% and 89.3% in January and February, respectively)

After a slight deterioration in Outpatients Waiting Times in January (91.8% of patients waiting no more than 12 weeks for their first appointment), performance rose again in February to 94.2%, the highest we have achieved under this measure; in addition, the overall waiting list numbers continued to decrease

The number of patients waiting more than 6 weeks for a Diagnostic MRI test recovered in February to only a single breach compared to 161 in January.

There is a continuing small improvement against the CAMHS Waiting Times standard, with the % of patients starting treatment within 18 weeks of referral increasing to 83.0% (from previous months of 82.9% and 80.7%)

There is a continuing small improvement against the Psychological Therapies Waiting Times standard, with the % of patients starting treatment within 18 weeks of referral increasing to 72.2% in January (against 71.1% in December)

The current monthly performance against both Cancer Treatment measures deteriorated with 86.2% of patients starting treatment within 62 days of an urgent referral and 91.9% of patients starting treatment within 31 days of a decision to treat;

the performance against the latter measure was the first time we had failed to meet the 95% standard in this Financial Year .

A breakdown By Specialty for all Cancer Treatment is supplied on Page 12 to show the performance across the different clinical specialties

There has been a further fall in the number of patients in delay for over 14 days, from 43 at the January Census to 37 at the February Census

There has been a further small increase in the number of patients failing to meet the 12 week TTG target, from 15 in December and 19 in January to 23 in February

The increase in the HAI Sabs infections rate has continued, from 0.40 in January to 0.43 in February

The locally produced sickness absence figure for NHS Fife for January was 5.21%, a reduction of 0.31% on the December figure. The average for the 12-month period ending January was 5.11%, the lowest since December 2014. Particular improvement challenges remain within the Fife West and Fife East Health and Social Care Divisions.

Section B – Capital:

The overall programme continues to be in line with the plan to deliver the target against the CRL.

Section C – Financial Position to 29 February 2016:

The in-month position has improved with an overspend of £0.489 to the end of February with the level of outstanding efficiency savings also reducing. The year-end outturn forecast to deliver a break even position continues to be challenging but has improved in the current month to a more optimistic position

Section D – SPSP:

The Charts in this section of the report now cover NHS Fife as a whole, having previously only reported on activity within the Acute Services Division.

Section F – Complaints:

There has been a further improvement in the 20-day complaints closure rate from 60% in December to 76% in January.

The IPR does not include the Hospital Associated Infection Reporting Template (HAIRT). This information is reported through the Infection Control Committee and the Clinical Governance Committee.

SECTION A: LDP STANDARDS PERFORMANCE SUMMARYThe source of data in the IPR is either from validated published sources or is local management information from a variety of internal sources. It is important to note that whilst local management information provides a more up to date position, data validation processes may not have been completed and this information may therefore be subject to change.

TARGETS ON TRACKNHS Fife continues to meet or perform ahead of the following National Targets and Standards:

Antenatal Access: at least 80% of pregnant women in each SIMD quintile will book for antenatal care by the 12th week of gestationLocal management information shows that NHS Fife has continued to record a performance level of over 80% in all SIMD quintiles. The lowest-performing quintile for the final quarter of 2015 was Quintile 3 (Quintile 1 is most-deprived, Quintile 5 is least-deprived), with a figure of 86.3%. The highest-performing quintile was Quintile 5 (95.7%), while the overall NHS Fife figure was 91.0%.

HAI: we will achieve a maximum rate of C diff infection in the over 15s of 0.32Local management data for the year ending February indicates a C difficile rate of 0.26, better than the standard of 0.32.

IVF: no eligible patient will wait longer than 12 months for screening following referral from Secondary CareAll NHS Fife patients continue to be screened within 12 months, via the service run by NHS Tayside, with 75 patients having been screened in 2015-16 up to the end of January. The latest management information showed that 23 patients were on the waiting list, none of whom had waited more than 12 months.

Cancer Waiting Times - we will treat any cancer patient within 31 days of decision to treatLocal management information shows that January performance dipped to 91.9% due to surgical capacity within Gynaecology and Urology. Prior to this, NHS Fife had exceeded the 95% standard in every month of 2015-16. It is anticipated that performance will recover in February.

Drug and Alcohol Waiting Times: at least 90% of clients will wait no longer than 3 weeks from referral to treatmentThe December ISD publication showed that 98.6% of patients were seen within 3 weeks of referral for treatment between July and September. This remains significantly above the 90% standard, a position NHS Fife has sustained since the start of 2013. We remain in the top quartile of Health Boards as far as performance against this standard is concerned, despite first appointments increasing year-on-year by around 20%. For Drugs alone, the increase was almost 40%.

Diagnostics Waiting Times: No patient will wait more than 6 weeks to receive one of the 8 key diagnostic tests - barium studies, non-obstetric ultrasound, CT, MRI, upper endoscopy, lower endoscopy, colonoscopy, cystoscopyLocal Management information shows that 161 patients were waiting more than 6 weeks for an MRI at the end of January having had no patients waiting over 6 weeks for the previous 3 months. This was due to a spike in referrals for MRI associated with additional outpatient activity and a reduction in capacity due to vacancies in MRI. Additional activity was undertaken in February and only a single breach (for Cystoscopy) was recorded at the end of that month.Detect Cancer Early: at least 29% of cancer patients will be diagnosed and treated in the first stage of breast, colorectal and lung cancerThe measure for this target covers a rolling 2-year period, and the NHS Fife target of 29% covers 2014 and 2015. Local management information for the 2-year period ending September 2015 shows that we remained slightly behind plan, though improving in both Breast and Lung specialties since the last update. The Stage 1 Detection Rate for Lung Cancer was 20.1%, more than twice the measurement at the base time of December 2011.

CHIEF EXECUTIVE’S PERFORMANCE ESCALATIONIn the following sections, cells in the Recovery Trajectory tables and Recovery Plan charts are shaded as follows:

Recovery Trajectory

Recovery Plan

ACUTE SERVICESCLINICAL ACCESS & SUPPORTCANCER 62 DAY REFERRAL TO TREATMENT

At least 95% of patients urgently referred with a suspicion of cancer will start treatment within 62 days

Key Concerns & Risks

As described in previous reports, there are a number of areas of risk in achieving this target, namely around Urology and Gynaecology. Gynaecology waits are improving, however, there are capacity issues for outpatients and surgery. Head & Neck and Lung cancers remain at risk due to complexity, liaison with tertiary providers, visiting oncology capacity and surgical capacity.

Performance against the 62-day target remains a significant challenge.

Recovery Trajectory

Recovery Plan

Situational Analysis

In the recovery plan for this target there are 8 actions which have a Red or Amber RAG status.

Challenges with vacancies in Respiratory medicine continue with interim arrangements in place to release capacity to enable urgent outpatient slots to be maintained. A locum has been appointed and targeted additional activity continues which has resulted in improvement in waits to 1st appointment. Two Respiratory posts have now been recruited to. The actions taken have moved the status from Amber to Green.

The review of EBUS provision in NHS Fife has been delayed until the current vacancies are filled.

A draft Outline Business Case for Robotic Assisted Laparoscopic Prostatectomy within SEAT has been developed. This is being taken forward at a regional Level and a Fife based consultant has been identified to be trained to undertake these procedures. This has moved this status from Red to Amber.

A new administrative support structure has been implemented in Urology. Whilst there are still challenges the new process has resulted in timely information to facilitate waiting list management. It is anticipated that these actions will move the status for action 2.6 from Amber to Green

Patients who have been delayed in the initial part of their pathway are now progressing to treatment however this together with the increased throughput of general urology outpatients has resulted in increased demand for surgery. This will result in deterioration in performance in the next few months. The status remains at Amber for surgical capacity.

Waits for Urology oncology appointments continue to be a challenge. The review of oncology provision as a whole is underway and additional capacity is being provided when possible. Recruitment of a second Acute Oncologist with an interest in Uro-Oncology is currently at advertisement.

A solution to allow electronic referrals between Boards has been investigated and is unlikely until a replacement PAS system is implemented in 2017. An alternative solution has improved the speed of communications and has moved this status from Red to Amber.

The GP direct access to imaging is a national project; there has been a delay at national level and there is no revised timescale available. This has moved from Amber to Red.

Two new actions have been added for Gynaecological cancer, 4.1 and 4.2 with the aim of improving performance for this cancer site.

Cancer Performance Trend by Specialty

The Performance Trend for both Cancer Treatment measures, broken down by Specialty, is shown in the tables below. (In certain specialties the numbers are very low ie <5 so are not disclosed as actual numbers)

62-Day RTT

31-Day DTT

18 WEEKS REFERRAL TO TREATMENT

At least 90% of planned/elective patients will commence treatment within 18 weeks of referral

Following three successive months when performance was above trajectory, we slipped behind plan in August, and have remained behind since, albeit with a narrowing gap.


The key specialties currently at risk of not meeting 18 weeks RTT are Urology, Oral Surgery, General Surgery, Vascular Surgery and Neurology. This is driven by vacancies, increasing demand and an ongoing demand-capacity gap.

Additional activity continues to be undertaken to improve and sustain Outpatient, Diagnostic and Inpatient / Day Case waiting times, and the positive impact of this was seen in January. NHS Fife continues to meet with Scottish Government regarding resilience around this target and work is being undertaken to review the size and resourcing of the demand-capacity gap.

Recovery Trajectory

Recovery Plan

The Recovery Plan for 18 Weeks RTT is covered by the delivery of the Patient Treatment Time Guarantee and Outpatient Waiting Times Recovery Plans shown in the relevant sections on the following pages.

PATIENT TREATMENT TIME GUARANTEE

We will ensure that all eligible patients receive inpatient or day case treatment within 12 weeks of such treatment being agreed

Performance in December, January and February slipped behind trajectory after 7 months of being on or ahead of plan.


At-risk specialties for Inpatients and Day Cases are Orthopaedics, General Surgery, Urology, Ophthalmology and Oral Maxillo Facial. There is increased demand for procedures particularly in Oral Maxillo Facial and Urology as a result of additional outpatient activity undertaken and balancing elective capacity due to pressure on beds.

Additional activity is being undertaken internally when possible to manage this increase in demand. This is not as resilient as we would wish due to issues such as the availability of anaesthetic cover, use of locums, availability of Operating Department Practitioner (ODP) staff and availability of beds. It is likely that this pressure will continue in the first quarter of 2016.

Recovery Trajectory

Recovery Plan


There are 5 actions which have an Amber or Red RAG status.

It is a significant challenge to provide sufficient additional activity internally to meet the increased demand for Inpatient and Day Case activity resulting from the outpatient work undertaken, particularly at a time of increased pressure on beds, and this is reflected in the Red status.

Recruitment to a number of consultant posts has been successful in February and March but challenges remain in some specialities.

The use of other healthcare providers continues to be considered if appropriate but there is currently limited capacity for Inpatient and Day Case work and limited resources available to undertake this. This is reflected in the continued Amber status.

The Day Surgery clinical group continues to meet monthly alongside the work of the Optimising Surgical Efficiency project aim of improving usage of the Day Surgery Unit in QMH and improvements in terms of theatre utilisation, pre-assessment and procedure selection. It is anticipated that this action will move this measure from Amber to Green RAG within the revised timescale.

The action to transfer Phase 2 to Phase 3 theatres is being explored via the review of theatres as part of the Optimising Surgical Efficiencies project. The timescale for this has been extended.

OUTPATIENT WAITING TIMES

At least 95% of patients (stretch target of 100%) will have their first outpatient appointment within 12 weeks of referral. Additionally, we must eradicate waits over 16 weeks.


Performance in outpatients improved month on month from July to December. The performance in January slipped but recovered again in February and is expected to be sustained into March.

The at-risk specialties are Neurology, Urology, Dermatology, Gastroenterology, Oral, Cardiology and Respiratory Medicine. Recruitment into Consultant vacancies in Neurology is particularly challenging.

Whilst there has been improvement in performance in the at-risk specialties, work continues to identify and secure sustainable solutions to meet the ongoing gap in outpatient capacity. Neurology remains a significant challenge in this respect.

Activity is being outsourced and local waiting times initiatives continue in all of the at-risk specialties. Given the size of the challenge the timescale for delivery of improvement has been extended until March.

Recovery Trajectory

Recovery Plan


The recovery plan shows that 4 actions are rated as Amber for delivery.

The focus continues to be on recovery of the backlog in outpatients waiting over 12 weeks. The plans in place are being delivered, but there have been particular difficulties in securing the volume of additional activity required for Neurology and this is reflected in the movement of this action to Amber status.

Work by directorates to review the size of the gap in outpatient capacity and identify solutions to meet this continues. Whilst there has been successful recruitment to Consultant

posts in some specialities vacancies remain in a number of key specialities reflecting the continued Amber status.

There is an active programme of work in place to redesign the urology DTC with an extended timescale for delivery of March. The number of outpatients waiting over 12 weeks has improved month on month for the last 6 months.

The outpatient redesign work is a three year programme. Resource to support project Management has been secured and will enable the development and delivery of this work. Once in place this will move this action to Green.

EMERGENCY CAREA&E 4-HOUR WAITING TIME

At least 95% of patients (stretch target of 98%) will wait less than 4 hours from arrival to admission, discharge, or transfer for accident and emergency treatment

For 10 successive months performance has been ahead of trajectory and is on target to achieve the year end required performance.


A number of risks remain in the system including recruitment to vacant medical posts across the Directorate, admission numbers, flexibility of the ambulance service response to same day discharge and a significant increase in the number of patients in delay.

Recovery Trajectory

Note that the ‘Actual Performance’ figures shown are 12-month averages, not figures for the individual months.

The performance figure for all Fife for the single month of February was 95.9%, with the ED at VHK itself recording a performance of 94.1%, a 2% improvement on January. The combined monthly performance in all A&E and MIU sites has exceeded 95% in every month of 2015-16 to date.

From the beginning of October through to mid February, the NHS Fife performance in the Emergency Department was better than the Scottish Emergency Department average in all but two weeks.

The additional discharge vehicle and internal transport option have proven invaluable since their introduction in October. This resource is being supplemented on an ad hoc basis by the ambulance service at weekends, which supports hospital discharges and transfers.

The new assessment model in AU1 continues to discharge 30% of new patients on the day of admission. ECAS continues to expand the range of interventions available, preventing short-stay emergency admissions to hospital.

Recovery Plan

BOARD WIDEHAI SABS

We will achieve a maximum rate of staphylococcus aureas bacteraemia (including MRSA) of 0.24


The actions described will support the reductions in preventable (hospital acquired) SAB numbers being maintained and increased. Infections related to invasive devices such as peripheral venous cannulae (PVC) constitute the single biggest preventable cause and are a particular area of focus.

Hospital SABs made up 34% of the total in the last twelve months (40 of 116), with the remainder arising spontaneously in the community. There is a risk that community case numbers may negate gains made through hospital improvement programmes.

Recovery Trajectory

Recovery Plan


Various improvement initiatives have been started in order to address areas of concern in relation to the incidence of SAB infections. It is hoped that these will result in reduced infections in 2016.

The collaborative work is looking at early intervention in needle exchange schemes to see if this can identify localised infection and offer treatment to prevent invasive infection in the intravenous drug population. Other Health Boards will be involved in this study. This work remains at the early stages of implementation. Reducing the number of PVC related SAB infections will be a particular focus in the coming months with a re-introduction of an improvement package to support safe harm-free care.

Where any improvements are noted, areas of good practice will be shared with peers. Continuing and new challenges will also be reported widely.

SICKNESS ABSENCEWe will achieve and sustain a sickness absence rate of no more than 4%


As previously reported, each of the operational parts of the system have developed action plans in partnership or are reviewing existing plans to reflect the move to the Health & Social Care structure. At a time of significant change, this is more difficult to manage and monitor for services in the community.

The three biggest risks to sustaining the planned reductions are:

Management and HR capacity.

Any community outbreak of illness (e.g. norovirus) which can impact on short term absence.

Increased pressure on the system in terms of patient numbers which in turn increases pressure on staff capacity and can result in increased absence.

Recovery Trajectory

Month Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-16 Jan-16 Feb-16 Mar-16

Actual Performance 5.30%

5.29% 5.31% 5.32% 5.27%

5.22% 5.20% 5.20% 5.18% 5.11%

Recovery Trajectory 5.29% 5.29% 5.25% 5.20%

5.15% 5.11% 5.07% 5.01% 4.91% 4.89% 4.81%

National Standard 4.00%

4.00% 4.00% 4.00% 4.00%

4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00%

NOTE – the figures quoted are 12-month rolling absence rates, not those for the individual month. This is a better way of demonstrating an improvement trend.

In reviewing absence levels between April 2015 and January 2016, there are continuing concerns about the current sickness absence position, albeit that the January position has improved slightly. The January sickness absence rate for NHS Fife was 5.21%, a decrease of 0.31% from 5.52% in December. The rate for the year to date is 0.89% below the equivalent period of 2014/15, with an average rate of 5.03% from April 2015 to January 2016.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

NHS Fife Sickness Absence% comparison of hours lost between April 2015

to January 2016

2014/152015/16

Despite the levels of sickness absence increasing in November and December, rates have remained at a lower rate for the months of December and January than those of the corresponding period in the 2014/15 financial year.

Long Term / Short Term Trend Analysis

Detailed analysis of the sickness absence trends between April 2015 and January 2016 show that the deterioration in the level of sickness absence between October and December 2015 has been as a result of increases in both long and short term absence. However, there has been an improvement in the sickness absence rates for both long term and short term absence in January.

Apr-15

May-15

Jun-15Jul-1

5

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

05,000

10,00015,00020,00025,00030,00035,00040,00045,000

Sickness Absence Trend 2015Hours Lost by Short and Long Absence

Long TermShort Term

Tota

l Hou

rs

The January sickness absence data indicates that this decrease is due to reductions in the levels of both long term and short term sickness absence, with the breakdown of long term and short term absence for the Board indicating that long term hours lost reduced by 1,718 hours and short term hours lost reduced by 1,549 hours sickness absence in January, compared with the December position.

The hours lost as a result of short term sickness absence has increased from 22,284 hours in April 2015 to 32,196 hours in January 2016. This represents a deterioration of 9,912 hours, or 61 WTE staff per month. For long term sickness absence the total hours lost has reduced from 36,500 hours in April to 30,024 hours lost in January. This represents an improvement of approximately 6,476 hours, or 40 WTE staff per month.

Following further analysis of the information detailed in the graph above, it is evident that the increasing trend within short term absence in the year to date, combined with the increase in long term absence over the months of August to November 2015, that the sickness absence trajectory is still not being met, albeit that there is a reduction in both short term and long term absence in January.

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-164.00

4.20

4.40

4.60

4.80

5.00

5.20

5.40

5.60

5.80

6.00

NHS Fife Sickness Absence Data by Operational Unit from April 2015 to January 2016

NHS FifeAcute ServicesCommunity ServicesCorporate Services

Analysis of the Sickness Absence trends within NHS Fife in the current financial year shows that the sickness absence levels within the Acute Services Division have remained within the 4% range for eight out of the ten month period ending at 31 January, with the absence rate remaining static at 5.36% in December and January. In contrast, the Community Services areas have been above 5% for each month apart from August 2015.

Next Steps

The Health & Well Being Strategy for the Board was launched in February, along with a new Staff Well@Work Handbook, with the emphasis on staff well being in support of the ambition to achieve the Gold Healthy Working Lives Award this year. Our Gold Healthy Working Lives Award Assessment dates have been set for Wednesday 20 and 27 April.

All areas of the Board, supported by HR and the Programme Management Office, continue to review their Action Plans detailing the recovery steps required within their areas to ensure NHS Fife as a whole achieves the agreed 4.81% sickness absence trajectory by 31 March.

These recovery plans have incorporated the following points:

Dates for Review & Improvement Panel meetings to be set for all areas throughout 2016 to review short and long term absence cases:

Identification of the core reasons for sickness absence within the Directorate, and what supportive steps can be implemented to minimise absences occurring in future;

Analysis of the sickness absence trends (e.g. are instances of short term sickness absence increasing, or are the duration of instances increasing);

What steps are to be taken to prevent increases in short term absence during the first two years of continuous service;

What steps are to be taken to support the return to work of staff on long term absence;

Whether there is a correlation between sickness absence trends within the Directorate and an employee”s Occupational Sick Pay entitlement, and what steps are to be taken to address this.

Roll-out of Management of Attendance Resource pack.

Recovery Plan

HEALTH & SOCIAL CARE INTEGRATIONThe Chief Officer (Director of Health and Social Care) reports to the Chief Executive, NHS Fife and the Chief Executive, Fife Council. Joint performance review meetings involving both Chief Executives and the Director of Health and Social Care take place on a regular basis in accordance with each organisation’s normal performance management arrangements. The Director of Health & Social Care has overall responsibility for the delivery of the Standards reported in this section and for determining further activity, commissioning and performance data for measuring progress in delivering the aims and objectives of the partnership.

DEMENTIA REGISTRATION AND POST-DIAGNOSTIC SUPPORT

We will have a QOF-registered proportion of diagnosed dementia patients consistent with the European measure of prevalence, all of whom will have a minimum of a year’s post-diagnostic support and a person centred support plan

Post-Diagnostic Support Background

The offer of Dementia Post-Diagnostic Support (PDS) which meets the Alzheimer’s Scotland (5 Pillars) standard is relatively new and is in direct response to the national standard having been set. It is in addition to other support/care/treatment which would have been taking place as a matter of routine work.

The current workforce identified for the task comprises a mixture of mental health, psychology, Alzheimer’s Scotland and other resources operating from three geographically based hubs. There has been success in clearly articulating and streamlining pathways to diagnosis and to PDS. This success has now left us with the challenge of managing high referral volumes.

In order to future proof the offer of Dementia PDS in Fife we have reviewed existing workforce/budgets and devised a management arrangement which provides a functional level of coordination, standardisation and quality assurance.

Post-Diagnostic Support Performance

Guidance for measuring and reporting on this target, and the target itself, was expected to be available in December, possibly as part of the guidance for the 2016-17 Local Delivery Plan. The latter was not issued until mid-January, but guidance regarding PDS performance was not included. This is being pursued with ISD and the SGHSCD.

It is likely that the focus of the PDS measure will be on patients diagnosed with dementia and their initial contact with a link/support worker, rather than the previous focus of having 1-year post-diagnostic support and a support plan. When this is clarified, we expect to be able to provide some local performance information and to then consider what type of recovery/improvement is required.


Dementia Registrations

The main risks to achieving the standard are:

Failure to respond adequately to demands for PDS (as it is the existence of PDS which has been used to incentivise GPs and others to refer early to secondary care for diagnosis)

Failure to keep the profile of dementia and dementia registration high with Primary Care colleagues

Dementia Post-Diagnostic Support

The main risk to achieving this target is:

Managing demand and capacity

Dementia Registration

Recovery Trajectory

Recovery Plan

Dementia Post-Diagnostic Support

Recovery Trajectory

This is not available at present, pending further guidance from the Scottish Government around predicted dementia prevalence and the support target.

In the absence of a meaningful measure and improvement trajectory, we are able to provide some relevant data from the monthly Management Reports produced by ISD. The table below summarises activity over the last 13 months.

Patients Contacted

Patients No Contact

% Waiting for Contact

Patients Waiting > 3 Months for

Contact

% Waiting > 3 Months for

Contact

Jan-15 210 126 84 40.0% 4 1.9%

Feb-15 278 211 67 24.1% 10 3.6%

Mar-15 332 223 109 32.8% 29 8.7%

Apr-15 413 328 85 20.6% 27 6.5%

May-15 450 373 77 17.1% 26 5.8%

Jun-15 499 383 116 23.2% 28 5.6%

Jul-15 601 433 168 28.0% 39 6.5%

Aug-15 697 488 209 30.0% 52 7.5%

Sep-15 767 504 263 34.3% 82 10.7%

Oct-15 800 494 306 38.3% 117 14.6%

Nov-15 829 529 300 36.2% 141 17.0%

Dec-15 839 566 273 32.5% 150 17.9%

Jan-16 859 589 270 31.4% 176 20.5%

MonthCumulative Referrals for

Dementia PDS

Link Worker - Patient Contact Summary

Looking at the last 3 months, the number of patients not yet contacted by a link worker has decreased whilst the number waiting more than 3 months has increased.

Recovery Plan


Task 1.3 We have been unable to identify additional capacity within the existing workforce. However, new management arrangements have been put in place, and this has enabled a review of existing provision and implementation of systems and processes which will ensure a more flexible and efficient use of the existing resource.

Small month on month improvements in the form of shorter waits are anticipated from the beginning of April.

DELAYED DISCHARGE

No patient will be delayed in hospital for more than 2 weeks after being judged fit for discharge


The actions described in the recovery plan below are expected to support a working solution to the target that no patient will be delayed in hospital 2 weeks beyond being clinically fit for discharge.

The joint Delayed Discharge Task Group continues to monitor and manage the demand for placements and services across the partnership on a weekly basis. A significant amount of modeling work has been undertaken to try to understand the pressures across the system and in particular the reason people are in delay, and this has resulted in additional funding being made available to support discharge. A memorandum of understanding has been signed by both NHS Fife and Fife Council which highlights a number of actions and requirements, and this has resulted in significant movement of patients from both acute and community hospitals.

A short term support model to enable a person to recover from an acute illness at home with support has been developed in conjunction with a private care agency and initial feedback has been positive. The project has now concluded and a full evaluation will be available shortly.

As part of the Delayed Discharge Action Plan there will be an increase in STAR facilities over the winter and work is underway to determine the capacity available across Fife. This will ensure people will be supported to return home following a period of reablement. A Coordinator is in post to ensure that people move through the system as quickly as possible. Plans are in place for the STAR facility to be delivered within Ostlers Way Care Home in Kirkcaldy, and it is hoped this will commence in mid-March.

The START programme, which supports people to leave the acute hospital within 72 hours with a care package, has been introduced. Evidence has shown that people have been able to leave hospital quickly and feedback from families has been positive, so a plan is now in place to deliver this within a range of community hospital sites. The delivery plan is closely monitored and every effort will be made to mitigate any risk.

Recovery Trajectory

Note that the ‘Actual Performance’ figures relate to the situation at the monthly census, generally taken around the 15 th of the month – the number in delay will vary from day to day.


The actions listed in the plan on the next page are largely on track.

Task 8.1 has been deferred pending the discharge of the existing patients in Step down beds at which point the charging policy will be further considered.

Recovery Plan

SMOKING CESSATION

We will deliver a minimum of 602 post 12 weeks smoking quits in the 40% most deprived areas of Fife


The actions described will ensure NHS Fife delivers good outcomes in relation to quit rates. The data trend, however, suggests we will not achieve the target of successful quits by March.

There are a number of risks that must be considered:

Pharmacy changes which require a new follow-up model to become embedded The increasing rise of e-cigarettes which are being seen by smokers as a stop

smoking aid

These challenges are addressed at a monthly task meeting and actions are put in place where possible.

Recovery Trajectory

The service completed a mapping exercise based on capacity and community needs as measured by smoking prevalence and SIMD data, and clinic activity has been re-orientated accordingly. In addition six new clinics have been established in the Glenrothes area within GP practices due to additional capacity as a result of the move to the Fife-wide model.

The redesign to a Fife wide model with East and West Divisions and a single management structure has been completed, with local coordinators for each Division in place.

New pathways are being developed in populations with highest smoking prevalence which include clients with mental health issues, teenage parents, pregnant woman from SIMD 1 & 2 and patients with diabetes. It is expected that the impact of these initiatives will become more visible in 2016-17.

Recovery Plan

ALCOHOL BRIEF INTERVENTIONS

We will deliver a minimum of 4,187 interventions, at least 80% of which will be in priority settings


The actions described are to ensure that NHS Fife will deliver the required number of ABI during the year.

There are a number of risks that must be considered:

Embedding of alcohol brief interventions in geographical areas of multiple deprivation No identified ABI training co-ordinator post Funding provided from SG in previous years no longer ring fenced for ABI activity

Recovery Trajectory

In Q3, there was an increase in the number of alcohol brief interventions undertaken, resulting in the overall performance being above trajectory.

Recovery Plan


Task 1.2 A meeting with various social groups to discuss ABI activity in wider settings was initially scheduled for February but did not take place and is yet to be re-arranged

In relation to the identified risks, a discussion regarding ABI training has taken place and a meeting to discuss ABI planning and the embedding of ABIs across NHS Fife is to be held. This will involve targeted training, and the number of staff already trained is being reviewed with Health Promotion.

CHILD AND ADOLESCENT MENTAL HEALTH SERVICE WAITING TIMES

At least 90% of clients will wait no longer than 18 Weeks from referral received to treatment for specialist child and adolescent mental Health Services (CAMHS)


Improvement plans initially focused heavily on investing in additional staff, with part of our small allocation through the mental health innovation fund being invested in additional capacity. This will have the greatest impact on therapeutic services for looked after children and in the training of the school nurses.

The Scottish Government are still devising their allocation strategy for additional new funding, some of which is specifically to improve access to CAMHS. The 2015-16 improvement plan and trajectory was contingent upon receipt of this second, larger tranche of new funding.

In reaction to an increase in demand, CAMHS restructured its management and introduced better electronic systems to support the gathering of accurate demand and activity data. We are now able to accurately measure the current staffing capacity, waiting list and referral demand rate, and are focusing on increasing activity within current resources. This is being done by reducing non-patient facing activity and removing the generic waiting list and proportionately allocating all waiting cases and all new referrals to individual clinicians.

Once the allocation strategy for this new funding has been determined and shared it will be possible to predict more accurately when the target can be achieved. In the current absence of significant new investment there is now a focus on improving the productivity of the clinical staff working with the high volume low intensity cases.

Recovery Trajectory

Note that the ‘Actual Performance’ figures shown are for 3-month periods ending those months, not for the individual months themselves.

Recovery Plan


While planning redesign in many areas is underway, and waiting times have improved due to changes to current working practices, sustained improvement resulting from the completion of the RED tasks on the Recovery Plan is reliant on the availability of additional funding from the Scottish Government. This will not be available in the current FY.

PSYCHOLOGICAL THERAPIES WAITING TIMES

At least 90% of clients will wait no longer than 18 weeks from referral received to treatment for psychological therapies


Poor performance against this target is primarily the result of a lack of overall capacity. This assertion has been confirmed by work that was done with Scottish Government QuEST

The improvement plan initially focused heavily on investing in additional therapists utilising the Scottish Government new funding, some of which is specifically to improve access to Psychological Therapies. This in turn drove the predicted improvement trajectory, which saw us achieving the standard by the end of March.

The plan and trajectory will be reviewed during the next period, but in the meantime strategies are being progressed for:

diverting referrals at an earlier stage towards self help expanding our group work programme (appropriate for a proportion of new referrals

for people with anxiety and depression).

A recent success in relation to self help has been the rollout of computerised CBT ('Beating the Blues') as part of an EU wide programme being organised and supported in Scotland by NHS24. Within Fife 647 people have been referred to 'Beating the Blues' since it was first made available a year ago.

The main risks to achieving the standard are as follows:

Inadequate capacity to meet demand An absence of other signposting options for referrers leading to high referral volumes An absence of suitable community venues across Fife

The risks are being managed by bidding for anticipated additional nationally (Scottish Government) allocated resources; and by supporting developments such as an investment in a European wide initiative widening access to computerised CBT as an alternative to referral.

Recovery Trajectory

Note that the ‘Actual Performance’ figures shown are for 3-month periods ending those months, not for the individual months themselves.

Recovery Plan


Task 1.4 Although clinic space has been identified, the completion of this task is contingent on aligning staff to run the therapeutic group work. This ties in therefore with task 1.5.

Task 1.7 Progress has been made with this task. The main problem area for under-provision is Levenmouth, and work is ongoing to attempt to resolve this. The Psychological Therapies Development Lead has joined an H&SC group set up to allocate accommodation across the partnership.

RECOMMENDATION

The Finance & Resources Committee is asked to:

Note the key items of information highlighted within the Integrated Performance Report, in particular those listed in the Executive Summary

CHRIS BOWRINGDirector of Finance29 March 2016

SECTION BCAPITAL PROGRAMME 2015/16

1. INTRODUCTION

1.1 This report provides an update on the 2015/16 Capital Programme as approved by the Board at its meeting on 24 February 2015.

1.2 The report provides information on the following:

Expenditure to 29 February 2016 / Major Scheme Progress;

Changes to the Board’s Capital Resource Limit (CRL);

Details of changes in Planned Expenditure;

Estimated Capital Expenditure outturn; and

Capital Receipts

2. EXPENDITURE TO DATE / MAJOR SCHEME PROGRESS

2.1 The expenditure position shown is for the period to 29 February 2016. Appendix A provides details of the current expenditure.

2.2 For 2015/16 each of the Project Leads have provided an estimated spend profile against which actual expenditure is being monitored.

2.3 The estimated spend profile for the period to 29 February 2016 is £10.493m (80% of the total allocation).

2.4 The expenditure to date amounts to £9.897m. This represents 75% of the estimated annual expenditure (Appendix B). The main areas where expenditure has been incurred since the previous report to the Board are as follows:

Stratheden IPCU £0.451m Radiology £0.351m General Hospitals and Maternity Services £0.323m Information Technology £0.214m Statutory Compliance/Backlog Maintenance £0.156m Minor Capital Schemes £0.120m

2.5 Total expenditure to date is £0.598m behind the profiled trajectory and this is primarily due to the Statutory Compliance/Backlog Maintenance and Minor Capital Works schemes slipping from their projected timescales

2.6 Both of the Board’s major construction Capital Schemes are due for completion in the next Financial Year. Work on the Stratheden IPCU is progressing well being approximately 81% complete as at the end of February. The project was due for completion by the contractor on 29 April 2016 but is running 1 week behind plan with an estimated completion date of 5 May 2016. Equipment for the unit has been ordered and is now starting to be delivered. The project remains within budget.

2.7 The final element of the funded General Hospitals and Maternity Services Project is the completion of the Carnegie Unit on the Queen Margaret Hospital site. The project is currently running to timescale with a completion date of the end of July. Although the project is running within budget, remaining contingencies are low and careful monitoring of progress is required to ensure the budget is not breached.

2.8 The Replacement Telephone System is a scheme costing £4.3m in total. The project has started with the installation of the Core Kit and the first of the deployments on the Lynebank Hospital site. The system is due to go live at Lynebank in mid April with deployment then being rolled out to other premises with the final community hospitals live in February 2017.

3. CHANGES TO CAPITAL RESOURCE LIMIT

3.1 Since the previous report to the Board there have been no new allocations received.

4. CHANGES TO PLANNED EXPENDITURE 2015/16

4.1 Appendix C shows the changes in the plan resulting from changes in allocations and from updated estimates for schemes already approved. Since the previous report there have been two major changes in individual budgets. Firstly unallocated funding in the Radiology budget of £171k has been transferred to the Equipment budget to allow the purchase of equipment which was already prioritised for purchase in 2016/17. Secondly the estimated spend profile of the new Telephone System changed requiring a re-profiling of IT Expenditure of £73k to ensure no in year overspend.

5. CAPITAL EXPENDITURE OUTTURN

5.1 At this stage of the financial year it is currently estimated that the Board will spend the Capital Resource Limit in full.

6. CAPITAL RECEIPTS

6.1 With the SGHSCD providing additional funding to cover the slippage in sale of Lynebank land and Forth Park Hospital the Board was left with a requirement to securing capital receipts of £150k. Current estimates suggest that a shortfall of £60k against the budget will exist at the year end. To cover this an underspend of £60k will be required to be made on the expenditure budget. To date the full funding has been identified.

7. RECOMMENDATION

7.1 The Board is asked to:

note the Capital Expenditure to 29 February 2016;

note the current Capital Resource Limit position;

note the changes in Planned Expenditure;

note the Capital Expenditure outturn; and

note the Capital Receipts position.

NHS FIFE - TOTAL REPORTSCAPITAL PROGRAMME EXPENDITURE REPORT - FEBRUARY 2016FOR FINANCIAL YEAR 2015/16

CRL Total Projected

NewExpenditu

reExpenditu

re Projected Funding to Date 2015/16 VarianceProject £ £ £ £ Major Capital Stratheden - IPCU 3,724,000 3,259,421 3,724,000 Statutory Compliance Cameron - Heating & Drainage Pipework Wds 1&2 52,489 52,489 52,489 RMWH - Kitchen Improvements 40,000 8,153 40,000 Stratheden - Generator Installation Stratheden - Roofing Replacement 40,000 10,000 40,000 Whytemans Brae - Ravenscraig Refurbishment 5,899 5,899 5,899 High Valleyfield Heating 12,000 10,844 12,000 Kelty Health Centre - Boiler Replacement 20,000 7,000 20,000 Lynebank - Roofing Works 130,000 61,592 130,000 Lynebank - Water Mains 20,000 2,271 20,000 Lynebank - Window Replacement 20,000 18,619 20,000 West Fife - Asbestos Removal 30,000 11,805 30,000 West Fife - Legionella Works 20,000 10,622 20,000 Central & NEF - Asbestos Removal 10,000 5,000 10,000 Leslie Dental Clinic - Roof Protection 8,181 8,181 8,181 North East Fife - Legionella Works 10,000 6,834 10,000 Total Statutory Compliance 418,569 219,309 418,569 Capital Minor Works Cameron - SGSU OT Bathroom 8,864 8,864 8,864 Kirkcaldy Health Centre - Nursing Offices 12,000 9,353 12,000 Stratheden - Ceres Centre - Electronic Doors 13,000 13,000 13,000 Stratheden - Lomond Ward 120,000 31,131 120,000 Whytemans Brae - Ravenscraig Reception 60,854 4,017 60,854 Whytemans Brae - Rheumatology Office Conversion 9,876 9,876 9,876 Whytemans Brae & RWMH - Podiatry Clinical Stores 13,775 13,775 13,775 Lynebank - Campsie Flat 3 Works 25,000 15,000 25,000 Lynebank - OT Corridor 20,000 16,000 20,000 Glenrothes Hospital - PCES 17,863 17,863 17,863 Glenrothes Hospital - Ward 3 41,883 41,883 41,883 Total Minor Works 343,115 180,762 343,115 Capital Equipment Cameron Hosp - Bladder Scanner 6,750 6,750 6,750 Cameron Hosp - Diabetic Retina Camera 20,150 20,150 20,150 Stratheden Hosp - Boiling Kettle 8,516 7,964 8,516 Stratheden Hosp - Oven 7,284 7,284 7,284 Whytemans Brae Hosp - Portable Fibroscan 34,606 34,606 34,606 Care at Home - Ventilators 13,723 13,256 13,723 Lynebank Hosp - Electric Profiling Bed 6,203 6,203 6,203 QMH - 2 * Burlodge Food Trolleys 12,126 12,126 12,126 QMH - OccupEye 9,745 9,745 9,745 Adamson Hosp - Bladder Scanner 6,750 6,750 6,750 Glenrothes Hosp - 3 * Multigen Trollies 19,986 19,986 19,986 Glenrothes Hosp - Falls Guard System 7,677 7,677 7,677 Dental - Portable Dental Domiciliary System 10,000 10,000 10,000 Dental - Under Bench Washer Disinfector 8,100 8,100 8,100

Total Capital Equipment 171,616 170,597 171,616 Information Technology Telephone System 584,186 584,186 584,186 Desktop Replacement 344,147 332,467 344,147 Network Development 28,972 28,931 28,972 Server/System Replacement 605,695 605,695

Total I.T.1,563,00

0 945,584 1,563,000 Radiology Equipment NHS Fife Wide Radiology Equipment Balance 3,925 3,925 Insufflator 9,563 9563 9,563 Blood Fridge (CT Colon) 5,640 5,640 Interventional Radiology Works 35,923 35,923 35,923 A&E Ultrasound 30,024 30,024 30,024 Fundus Camera 72,866 72,866 72,866 Gamma Camera 341,000 250,000 341,000 Immediate Reporting 72,171 35,000 72,171 VHK & QMH - Ultrasounds * 5 265,204 265,204 Mammo Room Biopsy/Wheelchair Access 76,114 57,086 76,114 Total Radiology Equipment 912,430 490,462 912,430 Vehicle Replacement Vehicle Balance 1,043 1,043 Citroen Berlingo Panel Van 12,730 12,442 12,730 Peugeot Expert Tepee People Carrier 16,540 16,540 Peugeot Boxer Van 24,622 24,622 Peugeot Expert Van 15,365 15,365 Total Vehicle Replacement 70,300 12,442 70,300 Acute Services Division Main Schemes Aseptic Suite VHK 984,000 984,000 984,000 White Space VHK 234,000 234,000 234,000 Carnegie QMH 1,664,000 1,056,699 1,664,000 Dental QMH 108,710 108,710 108,710 Audiology QMH 112,290 112,290 112,290 General 180,000 124,139 180,000

Total Main Schemes3,283,00

0 2,619,838 3,283,000 Acute Services Div Statutory Compliance VHK - Workplace Transport 96,500 52,136 96,500 VHK - Water Ingress 5,000 5,000 5,000 VHK - Ward 9 Refurbishment 761,905 761,905 761,905 VHK - Ward 13 Hazard Rooms 40,000 1,479 40,000 VHK - Stairwell Alterations Ph 1 & 2 VHK 102,095 102,095 VHK - Recycled Waste Compactor 24,000 24,000 VHK - Mortuary De-Commission 5,844 5,844 5,844 VHK - LV System 68,294 28,088 68,294 VHK - Legionella Works 20,000 7,181 20,000 VHK - Hayfield House Cladding 18,139 18,139 18,139 VHK - Diabetic Access Ramp 34,419 34,419 34,419 VHK - Ward 9 Urology 14,456 14,456 QMH - Theatre Lights 11,286 11,286 11,286 QMH - Roof Works 11,351 11,351 11,351 QMH - Lighting 5,187 5,187 5,187 QMH - Renal Dialysis UPS 7,176 7,176 7,176 QMH - Medical Air Plant 60,441 60,441 60,441

Total Statutory Compliance1,286,09

3 1,009,632 1,286,093 Acute Services Division Minor Capital VHK - Plaster Room 16,000 14,400 16,000 VHK - Phase 3 Reception Area 15,400 5,000 15,400 VHK - Pharmacy Works 8,344 8,344 8,344 VHK - Outpatients Ph2 Upgrade 45,173 45,173 45,173 VHK - Ophthalmology Clean Room 41,692 41,692 41,692 VHK - Level 12 Office Works 24,746 22,853 24,746 VHK - Laser Clinic Works 25,000 22,500 25,000 VHK - Basement Tunnel 25,000 23,657 25,000 . Total Minor Works 201,355 183,619 201,355 Acute Services Division Capital Equipment Theatre Table Transfer System 344,750 274,424 344,750 Flexible Laryngoscopes 36,754 36,754 36,754 Plasmajet 36,000 36,000 36,000 Endoscopy Stack 63,552 63,552 63,552 Ophthalmology Slit Lamp * 2 15,756 15,756 15,756 Laparascopic Camera 17,604 17,604 17,604 Renal Machines * 5 79,500 30,000 79,500 Ultrasound Scanner (Babies Hips) 25,908 25,908 25,908 Endoscope Storage Cabinets * 2 26,727 26,727 26,727 Ultrasound Scanner (Neonatal) 40,860 40,860 40,860 Respiratory Machine 22,394 22,394 Treadmill (CCU) 27,600 27,600 27,600 Coverslipper (Labs) 30,975 30,975 30,975 Concentric Bone Graft Kit 5,820 5,820 Newborn Hearing Screening Equipment * 4 36,000 36,000 Home Renal Dialysis & Set Up 22,000 22,000 Lab Instrument Management 20,000 20,000 Total Capital Equipment 852,200 626,160 852,200 Condemned Equipment Ultrasound 16,850 16,850 16,850 Labs Coverslipper 30,975 30,975 30,975 Micro Torque Drill System 12,810 12,810 12,810 Birthing Beds * 7 70,576 70,576 70,576 Total Condemned Equipment 131,211 131,211 131,211 NHS Fife Wide Statutory Compliance/Backlog Maintenance Central - Asbestos Removal 35,000 17,602 35,000 Food Waste Collection 80,000 203 80,000 Hearing Inducation Loops 4,455 4,455 4,455 Gas Compliance Works 40,000 17,812 40,000 Total Statutory Compliance/Backlog Maintenance 159,455 40,072 159,455 Fife Wide Scheme Development 25,000 7,897 25,000 Capital Receipts Shortfall 60,656 (60,656)

TOTAL ALLOCATION FOR 2015/1613,202,0

00 9,897,00513,141,34

4 (60,656)

Capital Expenditure Proposals 2015/16 Board F & R 23/02/2016 Adj £'000 £'000 £'000 Specific Schemes Dunfermline & West Fife CHP Glenrothes & North East Fife CHP Kirkcaldy & Levenmouth CHP Stratheden IPCU 3757 -33 3724 Acute Services Division General Hospitals & Maternity Services - Aseptic Suite VHK 984 984General Hospitals & Maternity Services - QMH Carnegie 1664 1664General Hospitals & Maternity Services - QMH Dental 109 109General Hospitals & Maternity Services - QMH Audiology 112 112General Hospitals & Maternity Services - VHK White Space 230 4 234General Hospitals & Maternity Services - General 180 180 Fife Wide Telephone System 511 73 584 7547 44 7591Routine Expenditure Community & Primary Care Minor Capital 367 -24 343Capital Equipment 172 172Statutory Compliance 387 32 419Condemned Equipment Acute Services Division Capital Equipment 641 211 852Minor Capital 204 -3 201Statutory Compliance 1291 -5 1286Condemned Equipment 131 131 Fife Wide Vehicles 75 -5 70Information Technology 1052 -73 979Radiology Equipment 1083 -171 912Backlog Maintenance/Statutory Compliance 160 160Condemned Equipment Scheme Development 25 25Fife Wide Equipment Capital Receipts Shortfall 67 -6 61 5655 -44 5611 13202 13202

SECTION CFINANCIAL POSITION TO 29 FEBRUARY 2016

REVENUE RESOURCE LIMIT

Health Boards are required to work within the revenue resource limit set by the Scottish Government Health & Social Care Directorates (SGHSCD). This is monitored by SGHSCD via the monthly Financial Performance Return.

Performance at the end of February remains ahead of trajectory. The month on month trend continues to be very positive; however there is still a likelihood that this improvement may not be sufficient to deliver a break even position at the year end.


The Revenue Resource Limit position for NHS Fife for the eleven months to 29 February 2016 is showing an overspend of £0.489m compared with the £1.023m estimated overspend as set out in the Board’s Local Delivery Plan at the start of the year. This is a significant improvement on the position reported at the end of January and largely relates to the accounting treatment of historic early retirement and injury benefit provisions which has been agreed with SGHSCD colleagues over recent weeks. Whilst a number of underlying cost pressures remain clearly evident, in particular the increasing overspend on GP Prescribing, there is now a degree of optimism in the forecast, suggesting that a breakeven position at the year end may now be deliverable. It is important to note that this forecast assumes that operational budget pressures continue to be managed downwards.

May June July Aug Sept Oct Nov Dec Jan Feb March

(3,500)

(3,000)

(2,500)

(2,000)

(1,500)

(1,000)

(500)

0

Financial Performanceagainst Trajectory 2015/16

Plan Actual

Period

£000

Recovery Trajectory

Month May June July Aug Sept Oct Nov Dec Jan Feb Mar

Actual(1,294

)(1,848

)(2,238

)(2,234

)(2,465

)(2,263

)(2,231

)(2,139

)(1,927

) (489)

Plan(1,131

)(1,696

)(2,134

)(2,581

)(3,104

)(3,045

)(2,994

)(2,758

)(2,140

)(1,023

) 0Forecast Outturn 0 0

(2,705)

(1,458)

(1,712) (345)

Overall Target 0 0 0 0 0 0 0 0 0 0 0


1. Financial Framework

1.1. The Financial Framework for 2015/16 was approved by the NHS Fife Board on 28 April 2015, subject to further action to close the gap in the level of savings identified at that time. Approval of the Financial Framework by the NHS Board enabled Executive Directors to receive details of their initial annual budgets for 2015/16. All opening budgets have been signed off by the relevant Executive Director.

2. Allocations

2.1. Since the previous report to the NHS Board, we have received a reduction in core allocations from the Scottish Government Health and Social Care Directorate (SGHSCD) of £0.167mm. These include a reduction in earmarked recurring funding of £0.403m and additional non-recurring funding of £0.236m. The new allocations include £0.150m for Unscheduled Care Planning with the main reduction in allocations being for the Fife share of national PET Scanning costs of £0.387m. An additional Non-Core Allocation of £2.297m has also been received in respect of changes in the accounting treatment of Early Retirement and Injury Benefit Provisions. A full list of allocations received is shown in Appendix A. In addition to allocations from SGHSCD the Board also received miscellaneous income from other sources. Since the previous report to the Board additional sources of income amounted to £3.682m with the main area of increase being CNORIS £3.5m(offset by matching expenditure).

3. Analysis of Financial Performance to Date

Budget Expenditure FY CY YTD Actual Variance Variance

£'000 £'000 £'000 £'000 £'000 %Acute Services Division 181,005 186,554 170,185 177,500 7,314 4.30%Integration Services - Community & Primary Care 137,705 148,351 135,884 135,427 (457) (0.34%)- FHS 35,889 40,389 37,002 37,002 0 0.00%- Prescribing 72,336 74,184 68,165 69,492 1,326 1.95%- PMS 46,859 49,018 44,864 44,844 (20) (0.05%)Estates & Facilities 65,236 65,148 59,595 58,845 (750) (1.26%)Board Services 32,001 57,570 53,797 50,046 (3,751) (6.97%)Other Healthcare Providers 97,087 105,495 97,130 97,058 (72) (0.07%)OHSAS 3,815 4,637 4,208 4,099 (108) (2.57%)Depreciation 18,028 19,376 17,834 17,834 0 0.00%Reserves - Impairments & provisions 10,000 23,166 0 0.00%

- General 29,084 5,853 5,088 (5,088)(100.00%

)

Efficiency Savings (2,914) (3,693) (2,646) 2,646(100.00%

)Total Expenditure 726,131 776,048 691,106 692,147 1,041 0.15%

Miscellaneous Income (64,266)(91,448

) (85,058) (85,610) (552) 0.65%

Net position 661,865 684,600 606,048 606,537 489 0.08%

Acute Services

3.1. The Acute Services Division is reporting an overspend of £7.314m for the period. The list of key drivers for this overspend continues to include the purchase of healthcare from other providers, medical staffing, nursing and drugs:

There is an overspend (£666k) on the use of independent healthcare providers for Orthopaedic activity, Dermatology activity, Laboratories and Radiology. The measures put in place to control the use of the independent sector capacity to address treatment time guarantees continue to reduce the rate of overspend.

The use of agency and locum medical staffing to meet the recruitment challenges continues to have a major impact within Orthopaedics, General Surgery, Anaesthetics, Urology, General Medicine, Paediatrics, Neurology, Obstetrics & Gynaecology and Ophthalmology.

There is an overspend reported within nursing (£3.0m) which is attributed to both bank and agency usage, and the residual impact of incremental progression. The pressures continue across a number of specialties including: Orthopaedics, Obstetrics & Gynaecology, Elderly Medicine, Theatres and Critical Care. Strict controls on the use of agency staff are now in place and whilst any specific requests on the grounds of patient safety need to be considered, this action has reduced the level of additional expenditure with the rate of overspend continuing to slow down.

High cost drugs, particularly in Emergency Care specialties, are contributing to an overspend in this area.

Integration Services

3.2. Across the former CHP budgets, primary medical services, primary care emergency service (PCES) and family health services, the budgets are showing a net overspend of £849k for the period to date. This position comprises overspends across both prescribing and PCES amounting to £1.433m, offset in part by an underspend across the former CHP budgets of (£584k).

3.3. The overspend has increased in month and is again principally due to an increase in prescribing spend. This continues to reflect an increase in the average cost per item, coupled with the impact of delay to the delivery of profiled cash efficiency savings.

3.4. There also remains an issue within the Primary Care Emergency service due to sessional rates.

3.5. The former CHP budgets continue to report an underspend across a range of budgets (vacancies in community nursing, health visiting, school nursing, administrative posts, and dental services) which continue to offset some of the cost pressures (level of expenditure on complex care packages, incremental progression within the Palliative Care service, Mental Health nursing and medical locums, and the transfer in of Wards 5 and 6 (with an associated overspend) from the Acute Division).

Corporate Services

3.6. Within the Board’s corporate services, including Estates & Facilities, there is an underspend of £3,749 due mainly to vacancies across a number of departments and a change to accounting treatment for Injury Benefits and Early Retirements. However, this continues to mask a pressure within Estates & Facilities on energy and equipment costs relating to service contracts across the system.

Non Fife and Other Healthcare Providers

3.7. The budget for healthcare services provided out with NHS Fife is showing an underspend of £72k for the period. This is based on an estimated underspend of £970k on Service Level Agreements with other Health Boards and an overspend of £911k on Unplanned Activity (UNPACs) and Out of Area Treatments (OATS) activity. The major driver of this overspend is the estimated increased UNPACs activity with NHS Lothian for cancer and other high cost drugs and an increase in bone marrow transplants. The OATS expenditure has increased due an additional Learning Disability patient being treated in England. These remain estimates at this point in the year pending ongoing discussions.

Reserves

3.8. Current estimates suggest that the Board could incur a further £2.3m on property impairments and provisions during 2015/16. The actual costs are matched with additional funding from SGHSCD. Similarly, an estimate of £20.6m is included in the reserve balance, as the NHS Fife share of the national Clinical Negligence & Other Risks Indemnity Scheme (CNORIS) increase in provisions.

3.9. Funding of £5.088m has been recognised from the Fife-wide general reserve, offsetting the overall financial position across the system. This takes account of slippage from financial plan commitments and new allocations received.

Miscellaneous Income

3.10. An over-recovery in income of £552k is shown for the first eleven months of the financial year.

4. Efficiency Savings

4.1. The Board’s Financial Framework set out the need to deliver a total of £10.143m cash efficiency savings to support financial balance. At the end of February, cash releasing schemes totalling £6.450m had been identified. There are developed plans in place to deliver a further £0.066m of savings, leaving a balance of £3.627m outstanding. This shortfall is assumed in the overall year end forecast. This balance comprises a range of initiatives, some of which had been scoped as options at the time of the Financial Framework sign off last May, and the £1.5m target set by EGD for operational budgets in November, which had not been fully developed into specific proposals:

£'000

Original proposals which will not deliver this year:Medicines and Prescribing 367Workforce 250Original proposals which are now delivering through operational performance (run rate):Sickness Absence 500Endowments 100Other 37Balance of £1.5m target 644Balance 1,729

Shortfall in savings 3,627

4.2. The graph below highlights that the planned trajectory had assumed back-loading of savings toward the second half of the year and delivery of savings remains behind trajectory for the period, as the commentary above has indicated.

Jun-15Jul-1

5

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

0

2,000

4,000

6,000

8,000

10,000

12,000Cash Releasing Efficiency Savings Delivery

Against TrajectoryPlan

Period

Value (£k)

5. RECOMMENDATION

5.1. The Board is asked to:

note the financial position for the eleven month period to 29 February 2016

Appendix A

New Allocations Received

Earmarked Non -

Description Recurring Recurring Total£ £ £

Local Unscheduled Care Plan 150,000 150,000Flu, Shingles and Rota Vaccine 52,886 52,886Nurse Prescribing 21,000 21,000Disability and Management Training 8,000 8,000Development of PDSA system 4,212 4,212Cancer Treatment Helpline (16,564) (16,564)Position Emission Tomography Scans (386,806) (386,806)

Total New Allocations Received (403,370) 236,098 (167,272)

SECTION DSCOTTISH PATIENT SAFETY PROGRAMME REPORT

NHS FIFE BOARD VALUE: Safety First

We aspire to be Clinically excellent

We will:

ensure there is no avoidable harm; embed patient safety consistently across all aspects of healthcare provision

1. Purpose of the Report

1.1. This report presents the report for January and February 2016. The purpose of this report is to provide assurance to the Board on the Scottish Patient Safety Programme provided across NHS fife.

1.2 The SPSI harms identified by the Scottish Patient Safety Indicator (SPSI) are:

Cardiac arrests Falls Pressure ulcers CAUTI ( was temporarily removed)

1.3 A revised measurement plan has been released in response to feedback from NHS Boards on the challenges in providing adequate support across the broad SPSP agenda. The amended measurement plan focuses on elements of work which will best support the aims of reduction in mortality and harm. To facilitate this, measures have been separated in to core and supplementary for the purpose of national reporting.

Core:

Outcome measures relating to the harms of SPSI (including CAUTI) Process measures relating to the harms of SPSI (including CAUTI and Sepsis) Measures relating to Medicines

Supplementary:

Process measures relating to VTE, Heart Failure and Surgical Site Infection

1.4 One of the key changes to the measurement plan is the amendment to the pressure ulcer indicator. The revised aim is seeking a 50% reduction in the pressure ulcer rate by December 2017.

1.5 The key outcome measures are dependent on the key process measures being robustly embedded throughout the organisation. Outcomes are most likely to improve when a sustained improvement in process change is demonstrated on a wide enough scale to impact on the outcomes; by building capacity in the organisation and ensuring that systems are capable of delivering the desired outcomes.

1.6 The use of Pareto principle is being encouraged to drive focused improvement activities in targeted areas that demonstrate the highest need for quality improvement attention and support. The Pareto term in this instance is only being used as “shorthand” for the general distribution of outcome data.

2. Discussion of Key Areas

2.1 HSMR

Title Hospital Standardised Mortality Ratio (Victoria Hospital/Forth Park/Queen Margaret Hospital)

Numerator Total number of in-hospital deaths and deaths within 30 days of discharge from hospital

Denominator Predicted total number of deaths Goal Reduce HSMR by 20% by December 2015.Source ISD Scotland

Chart 1

2.1.1 Chart 1 demonstrates NHS Fife’s current position with regression line. The percentage reduction since October December 2007 is 22.9% and the HSMR ratio is 0.89 as illustrated in Table 1.

Table 1

Chart 2

2.1.2 Chart 2 demonstrates NHS Fife’s HSMR position in comparison to the aggregated performance across NHS Scotland. The data contained in the chart was released in February 2016.

2.2. Falls

Title Falls and falls with harmGoal To reduce falls with harm by 20% by December 2015

To reduce falls by 25% by December 2015Source Datix

Chart 3

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Falls Call to Action Falls Call to Action II Falls Call to Action Update

Chart 4

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Falls Call to Action Falls Call to Action II Falls Call to Action Update

2.2.1 The aggregated NHS Fife data for

NHS Fife (All Falls), Chart 3, demonstrates common cause variation NHS Fife (Falls with Harm), Chart 4, demonstrates a sustained improvement

2.2.2 NHS Fife has not met the targets of 20%/25% reduction in falls with harm/falls, however the data does show some improvement for “falls with harm”.

2.3 Cardiac Arrest

Title Cardiac arrest rate per 1000 dischargesGoal 50% reduction in cardiac arrest rate by December 2015. Source

Chart 5

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Number of Cardiac Arrests Rate Median Trajectory (50% reduction by end of Dec 2015)

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Community Cardiac Arrests(This includes community wards, mental health wards, GP practices/health centres/clinics)

2.3.1 During the last five months, Chart 5 demonstrates a decrease in the number of cardiac arrests in the Acute Services Division.

2.3.2 Chart 6 demonstrates a “count” of the number of cardiac arrests across the Community Health Partnerships. The processes around cardiac arrests differ considerably from those within the Acute Hospitals and also incorporate data from GP practices and therefore the data methodology differs from Chart 5. The data in this chart demonstrates a “count” of the events only with no denominator values attributed.

2.3.3 The 50% reduction in cardiac arrest rate was not achieved by December 2015. Meetings of the Deteriorating Patient Group are being set up to review the programme of work and to review and share learning from the SBAR reviews from the Emergency Bleep Meetings.

2.3.4 The aim is to report inpatient cardiac arrest on the DATIX system. Consideration is being given to ensure that an appropriate communication strategy is adopted to circulate the information to staff.

2.3.5 Charts are currently being developed to demonstrate individual compliance within every clinical area at Victoria Hospital to determine if there has been an impact on the number of cardiac arrests with the implementation and compliance of Patientrack.

2.4 Pressure Ulcers

Title Pressure ulcers reported grade 2-4Goal To reduce pressure ulcer rate by 50% by December 2017 Source Datix

Chart 7

2.4.1 Chart 7 demonstrates Pressure Ulcers grade 2 to 4 that developed across NHS Fife within our care. Work is ongoing (as it is within other Health Boards) to address some of the duplicate reporting of Pressure Ulcers which can occur due to the complex nature of reporting Pressure Ulcers during a patient’s journey across different care provisions.

2.4.2 A second Tissue Viability Update Report has been written for the Quality Safety and Governance Group. The report has generated a number of recommendations for consideration on how this important work should be taken forward. General themes from the report include:

Alignment of Quality Improvement resource to support focused improvement work in areas identified through the Pareto analysis

Education for staff Focussed improvement work relating to the development of pressure ulcers in the

community Education targeting patients, families and carers around prevention and ongoing

care of pressure ulcers Better use of data to support improvement interventions Clear strategies for sharing learning

2.5 Sepsis

Chart 8

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A & E - Average time/month first antibiotic administered

2.5.1 Chart 8 demonstrates the amount of time it takes for patients to receive their first dose of antibiotic when the sepsis screening tool is triggered within A & E. The chart displays comparative data from 2013 to our current position. This measure is part of the Sepsis improvement work that is ongoing. The bundles have been introduced in five clinical areas.

Chart 9

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3. Other Initiatives to Improve Patient Safety

3.1 Dashboard

3.1.1 NHS Fife has been developing a dashboard to provide a standardised and systematic approach to ensure that key improvement processes and outcomes are available and accessible from each operational unit across NHS Fife to Board level.

3.1.2 Monthly exception reporting will support and ease the understanding of data interpretation so that more timely interventions can be applied if escalation protocols are triggered, making quality improvement more intuitive and part of core business within operational units.

3.1.3 Exception criteria already designed include

Insufficient sample size (to contextualise % values) Low compliance Areas with no data submission

4. Events (Recent and Forthcoming)

SPSP Medicines Learning Session 1 on 24th February

SPSP Healthcare Associated Infections Learning Session 21st March

RECOMMENDATIONS

The Finance and Resources Committee is asked to:

Note the overview of progress for each work stream.

Advise on aspects of the report that they found valuable and if they would value continuing reports in this format

SECTION EFREEDOM OF INFORMATION REQUESTS

1. INTRODUCTION

The purpose of this report is to update the Board on the Freedom of Information requests received for the month 1st – 29th February 2016.

2. BACKGROUND

The Freedom of Information (Scotland) Act is an Act of Scottish Parliament which came into force in January 2005, and gives everyone the right to ask for any information held by a Scottish Public Authority. NHS Fife has received a steadily increasing number of requests every year.

All Public Bodies are required, by law, to respond to all reasonable requests, within 20 working days. There are however, certain conditions and exemptions which are set out in the Act, for circumstances where a response would be inappropriate.

3. CURRENT POSITION

Table 1 shows that the number of requests received in February was 37, compared to 47 in the same period last year. The number of requests responded to in the 20-day timescale so far is 27, with 1 request having missed the 20-day deadline. This means that 97.2% of responses in February were provided on time. The remaining 10 are in line to respond to, within the timescales.

Table 1

MP / MSP / SGHSCD Commercial Media Other Total <= 20 Days > 20 Days % Within 20

Days

Feb 2016 37 8 1 16 12 37 36 1 ** 97.2% **

Feb 2015 47 11 1 16 19 42 45 2 95.7%

** One response incomplete and already over the 20-day deadline, so % completion calculated as 97.2% (36 out of 37, including thosenot complete but on schedule to be complete within the timescale)

MonthNumber of Requests

Source of Requests Responses

Table 2 shows the distribution across Executive Directors responsible for collating the individual responses.

Table 2

Table 3 also shows the main source of requests.

Table 3

SECTION FCOMPLAINTS

We will achieve and sustain response times of no less than 95% (acknowledged within 3 working days) and 65% (responded to fully within 20 working days).

Key Concerns and Risks

Each of the operational parts of the system is developing action plans in partnership with Patient Relations Team.

The actions described will ensure that response times improve whilst the quality of responses are maintained.

The biggest risks to achieving and sustaining the planned improvements are:

Complexity of complaints which cross different organisational units Ownership of complaints Patient Relations Capacity

Recovery Trajectories

3-day Acknowledgement

20-day Completion

There are currently 38 complaints open and outstanding, 2 of which are beyond 40 days and 14 of which are beyond 20 days (and are being reviewed weekly). Of the two 40+ complaints, one is subject to an SAER and one has now been sent for approval.

Recovery Plan

Performance has improved significantly following the successful implementation of all identified actions within the Recovery Plan. The improvement trajectory has been stretched to drive further improvement in performance against the 20-day standard.

There is still outstanding work to agree the single points of contact across the Community areas. It is now much easier to identify the areas of delay in the system

as a result of the introduced changes. The sign off process within the Community areas is the single, most significant issue.

Complaints, Concerns, Compliments and Comments

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Context of Complaints in Relation to Other Forms of Feedback

The F&R Committee have requested additional reporting information about concerns; however currently concerns are not coded with the same level of detail as complaints. A new complaint handling procedure due to be introduced in late 2017 will require the majority of concerns to be logged as Stage 1 complaints and this will allow for the additional capture of information and analysis of the data. The focus on Stage 1 complaints will be early resolution, within 5 working days.

A few examples of concerns and how these are currently dealt with are listed for information:

Problems with appointments (delay in notification of appointment/re scheduling/decision following DNA/continuity/issues with consultation). Liaison between departments takes place to bring about resolution.

Family members lack understanding and require explanation of care. With the patient’s consent it is often possible to resolve such issues by arranging an early meeting with key clinical staff.

Third party raises a complaint without the consent of the patient. In this situation there needs to be clear discussion about the requirements. The Patient Relations Team adopt a helpful approach and aim to overcome issues rather than put obstacles in the way of those seeking to raise a complaint.

Patient disagrees with treatment and seeks a second opinion. Again in a situation like this it is normal to encourage dialogue to ensure an adequate explanation and understanding of situation. Where required a second opinion can be sought.

Car parking is a common issue identified as a concern. The Board have seen an increase in the number of concerns received as a result of changes introduced to parking areas (particularly Whyteman’s Brae). A standard response has been prepared by the Director of Estates and Facilities.

Patient Opinion provides a route for people to share their experience of NHS care anonymously. Five posts were received in January and the graph below shows the distribution of stories over the course of one year. The graph demonstrates the ongoing need to promote Patient Opinion. There is a noticeable increase during periods of public engagement. Activity is underway to alter location of promotional materials and to encourage staff to seek feedback using Patient Opinion.

47% of postings over the time period provided positive feedback, 41% were mildly critical and 12% more critical. The approach remains one of encouraging dialogue with people and the Board can cite a number of positive examples such as the one below.

A patient posted about her poor experience of care and commented negatively about the consultation. She felt she had been given conflicting information and this resulted in her not knowing what options were available to her. By encouraging contact we were able to establish the specifics of her situation and arrange for the Consultant to review her situation. The result was an additional appointment to explain the position and to confirm her understanding of the options available.

Scottish Public Service Ombudsman (SPSO) Decisions and reports concluded

No SPSO cases were concluded during the month of January 2016.

SECTION GNHS FIFE

Report to the Finance and Resources Committee on 29 March 2016

PROGRAMME MANAGEMENT OFFICE UPDATE

1. INTRODUCTION1.1 The purpose of this report is to provide an update on the work of the Programme

Management Office (PMO) to support the delivery of the Strategic Programme 2015-2018.

2. BACKGROUND2.1 The report forms a component of the governance arrangements for delivering the

corporate priorities set out in the Board’s Strategic Framework.

2.2 Section 3, below, summarises the work completed to date (split across the various projects) and Section 4 sets out the work which is scheduled to be completed in the next reporting period (essentially the work which is due to be completed by the end of April 2016).

3. WORK COMPLETED TO DATE3.1 NHS Fife Optimising Efficiencies in Surgery project - The first part of the Optimising

Efficiencies in Surgery project has been completed with data analysis shared with specialities. List booking for general surgery and gynaecology has been chosen as the project which will now be taken forward. Two separate workshops were held in the week commencing 7 March 2016 with GE and a multi disciplinary team for general surgery and gynaecology which will allow a detailed action to be developed.

3.2 Demand & Capacity project – Demand and Capacity work completed to date for Acute Services including Diagnostics (Radiology and Endoscopy). 2016/17 Demand & Capacity projections will be signed off by services by 18 March 2016 for acute and diagnostic services. Initial discussions with colleagues at a national level have begun for Mental Health and Learning Disabilities services but are not nationally agreed frameworks or methodology.

3.3 Clinical Strategy project – Workstream meetings for all seven meetings are progressing well with good engagement from a wide variety of stakeholders. All workstreams are on track to deliver a workstream report in line with the agreed timeline using the report format already distributed. The Communications Plan is being delivered with a wide variety of awareness raising and stakeholder engagement ongoing - including Clinical Strategy pop-up sessions across ten sites. Engagement from staff, patients and visitors to date has been excellent.

3.4 Workforce Efficiency project – Work has continued to compile a data pack on vacancy management, recruitment, bank and agency spend as well as a skill mix review. The Nursing and Midwifery Recruitment Short Life Working Group continues to meet to monitor delivery of a comprehensive action plan to address a number of identified recruitment challenges. Work is ongoing to complete the workload tool exercise with a specific focus around community nursing, learning disabilities and mental health.

3.5 Outfacing Activity project - Detailed analysis has been undertaken of the outfacing activity to other NHS Boards from NHS Fife. Discussion with services are underway

that will propose possible repatriation of services taking into account any gaps in the Demand and Capacity Analysis.

3.6 Well at Work project – The roll out has commenced of the Attendance Management Resource Pack, which has been aligned to priority areas in Acute Services and across the HSCP based on an analysis of sickness absence data and hotspots/trends. A mapping exercise has been completed to compare Well at Work activity against the Gold Healthy Working Lives award criteria. Dates have now been set for the Gold Healthy Working Lives award assessment, which will now take place on 20 April 2016 and 27 April 2016. Planning for the assessment visits is well underway. The first meeting of the group which will oversee the separation of the existing SLA for OHSAS was held on 3 March 2016. Work to plan the separation of the services currently provided jointly with NHS Tayside is already underway.

3.7 Estates & Facilities Management Efficiencies project – The Central Mailroom project group continues to meet with the focus now on generating cleaner mail and on reducing the number of franking machines. The Fleet Vehicle usage group has continued to meet to consider the initial outputs from the Routemonkey analysis. This analysis highlights opportunities for re-routing of vehicles but the final report is still awaited, which will drive the definitive actions.

3.8 Prescribing Efficiencies project – The Scriptswitch (GP IT prescribing system) rollout will be completed by the end of March 2016 with £27k efficiencies delivered in the first 6 weeks. A revised Prescribing Efficiency Plan for 2016/17 was submitted to Chief Executive on 3 March 2016. The Managed Services Drug and Therapeutics Committee was established on 23 February 2016. A number of funded invest to save projects are underway (prescribing support nurses for diabetes, respiratory, woundcare/stoma/catheters) with interviews scheduled during March 2016.

3.9 Workforce Strategy project - The Project Plan is being delivered and monitored by a project team and the overarching steering group. The Workforce Strategy template is continuing to be populated. The work to conclude the evaluation of references, tables and diagrams is complete to inform the presentation of the analysis of current workforce information. Work to incorporate an Education, Training and Development workstream into the project has commenced with a draft project initiation document produced.

4. WORK SCHEDULED FOR COMPLETION BY THE END OF APRIL 20164.1 NHS Fife Optimising Efficiencies in Surgery project – A detailed action plan for taking

forward the general surgery and gynaecology project will be finalised and a high level plan for optimising theatres will also be developed to improve quality and flow.

4.2 Demand and Capacity project – Work to capture Health and Social Care services activity will be progressed with a specific focus around mental health and learning disabilities. Work will be completed on population projections and future demand profile for services.

4.3 Clinical Strategy project - All workstreams will continue to meet with all workstreams scheduled to complete their scheduled meetings by the end of April 2016. The Clinical Strategy Event, scheduled for 23 March 2016, will allow further discussion on emerging themes; to consider challenging questions and to consider next steps. Work will continue to deliver the Communications and Engagement Plan 2015/16 and the Participation and Engagement Plan to maximise the engagement of staff, patients, carers and the public in developing the draft Clinical Strategy. Draft workstream reports will be produced for each of the seven workstreams and these will be used to shape the development of the draft Clinical Strategy for NHS Fife.

4.4 Workforce Efficiency project – The workforce review, utilising the national tools will be completed, including the analysis of the outputs from the Adult Inpatient exercise. In addition, work to review the utilisation of bank and agency will be completed together with a review of the impact of recruitment activity. Work has progressed with the Universities to appoint a higher proportion of students than in previous years, in order to significantly reduce the number of overall vacancies thus reducing demand on the nurse bank.

4.5 Outfacing Activity project – Work to examine the opportunities for repatriation of services to NHS Fife is being progressed as an integral part of the workstream activity for the Clinical Strategy project.

4.6 Well at Work project – The Healthy Working Lives Gold Award assessment will be carried out and implementation of the delivery plan will commence to support ongoing compliance. Work to separate the existing SLA for OHSAS will continue in partnership, with a specific focus on efficiently and effectively managing the withdrawal from external contracts for occupational health and safety services.

4.7 Estates and Facilities Management Efficiencies project - Work to refine the project plan for the Mailroom workstream will be completed and a detailed project plan will be developed for the Transport workstream based on the findings of the final report from Routemonkey.

4.8 Prescribing Efficiencies project – Work to develop a new Pharmacy Strategy will be planned. A revised Effective and Efficient Prescribing Project Steering Group will be established on 13 April 2016. Membership will include representation from Clinical Directors and Senior Managers. There will be two distinct workstreams to lead the work: Medicines Governance Implementation and Prescribing Efficiency Delivery.

4.9 Workforce Strategy project - Work will be completed on an analysis of the current workforce. Work will commence work on quantifying the future demands on the workforce which will be informed by the delivery of a communication plan to engage with staff. An important aspect of this work will be the flow of information to and from the Clinical Strategy workstreams as well as other projects within the programme.

5. RECOMMENDATIONThe Finance and Resources Committee is asked to:

Note the progress to date in completing the stages scheduled for completion by 29 February 2016 for each of the projects in the Strategic Programme 2015-2018;

Note the next steps required to complete the project stages scheduled for completion by the end of April 2016.

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