NHS Forth Valley Assurance Board: letter to the Chair of the Assurance Board

To: Christine McLaughlin, Chair, NHS Forth Valley Assurance Board

From: Cathie Cowan, Chief Executive, NHS Forth Valley

NHS Forth Valley - Escalation Improvement Plan update

A number of changes and improvements have been taken forward in the last four months since NHS Forth Valley was escalated to Stage 4 of NHS Scotland’s Performance Escalation Framework on 23rd November 2022.

The Board’s Escalation Improvement Plan (version 2) sets out actions in response to each of the key areas and a summary of the progress made over the last four months is highlighted below. The plan will continue to evolve to take account of feedback from patients, staff, and trade union representatives as well as a number of partners and other key stakeholders. This includes work to involve members of the public in improvement plans and identify any gaps or further changes they would like to see as well as regular surveys to capture feedback on the experience of local patients and staff.

The Plan, which aims to strengthen leadership supported by effective governance and improved culture, focuses on three key priority areas:

• Putting patients first - everyone who uses local services should expect to receive consistent and high standards of care.
• Supporting staff - ensuring they have the right working conditions and resources to support their own wellbeing and deliver the best care and services possible.
• Working in partnership - building and sustaining a culture of collaboration with partners based on trust and respect, learning, and sharing best practice.

Improving service performance

Action has been taken to develop and improve local GP and Primary Care Out-of-Hours (OOH) services in response to the recommendations from a recent independent review carried out by Professor Sir Lewis Ritchie. This has included making it easier and more flexible for staff to work shifts in OOH services, work with the Scottish Ambulance Service to increase the use of Paramedic Practitioners, the introduction of Healthcare Support Workers to carry out initial checks and observations during home visits to help inform clinical decision making and new arrangements where drivers are able to bring patients to local OOH centres if they require to be seen but are unable to travel there.

There has been investment in CAMHS staffing to reduce long waits and the NHS Board is on track to meet the national waiting times target of 90% in the first quarter of 2023 (April to June). There had also been a small improvement in performance in relation to psychological therapies (4 of the 10 specialist service areas are already achieving the national standard) and work continues to redesign services, introduce new ways of working and increase the options available to local patients, including access to a wider range of group therapies, where appropriate.

The integration of local health and social care services has progressed with the transfer of specialist mental health and learning disabilities, Primary Care and GP out-of-hours services to the two local Health and Social Care Partnerships. Health Promotion services have also been aligned to localities within both Partnerships to further support the focus on improving health and addressing inequalities.

Although there has been a slight increase in performance in relation to the 4hr emergency access standard and a significant reduction in the number of 12 hour waits, performance remains variable due to capacity pressures across the wider health and care system and continuing high numbers of local patients experiencing delays in being transferred or discharged from local hospitals. Senior leads within Health and Social Care Partnerships and acute services are working closely together to take forward a range of actions designed to improve performance, particularly during evenings and weekends.

It is important to highlight that while unscheduled care performance continues to be challenging, ambulance turnaround times, ED triage times and scheduled outpatient, surgical and day care performance at Forth Valley Royal Hospital are amongst some of the best in the country.

Meeting HIS requirements for Forth Valley Royal Hospital

An update on the work underway to implement the requirements from the Health Improvement Scotland (HIS) report on Forth Valley Royal Hospital has been published on the HIS website.

The updated safe delivery of care action plan outlines the progress which has been made in the 18 weeks since the follow up inspection visit took place at the end of September 2022. It highlights action to address the 17 requirements (6 outstanding and 11 new) set out in the HIS report which was published on 5th December 2022.

NHS Forth Valley has implemented a number of changes and improvements over the last few months to improve the experience of local patients and staff. These include the introduction of new care and comfort rounds for patients waiting in the Emergency Department and Assessment Units. A new waiting area with six comfortable chairs has been created within the Emergency Department to provide extra capacity during busy periods and new triage arrangements have been put in place to help reduce overcrowding. Medication checks are also taking place to help address the needs of patients who take regular medication while they are waiting to be assessed or transferred to an inpatient ward

A number of contingency beds across local hospitals have closed in the last few months and efforts continue to reduce the use of the remaining additional beds. In the meantime, action has been taken to strengthen the assessment and monitoring arrangements for patients being cared for in these additional beds.

Over the last few months, there has been significant investment in additional staffing and leadership support, including during the overnight period. New procedures have been introduced to help monitor staffing levels across the site and quickly respond to any issues or concerns. New arrangements are also in place to capture and respond to feedback from local patients and staff and ensure staff who have reported incidents or issues are updated on how these are being addressed.

Strengthening culture, leadership and governance

NHS Forth Valley is about to embark on a Culture Change and Compassionate Leadership programme which will be rolled out across the organisation over the next few months. This is based on a programme which has been successfully introduced within a number of NHS organisations across the UK.

A review of governance arrangements, led by Professor John Brown, Chair of NHS Greater Glasgow and Clyde, is underway and will review the decision making and governance arrangements across the organisation to identify any changes or improvements required.

New performance management meetings have been put in place for Board Directorates and Health & Social Care Partnerships (HSCPs) to manage and monitor performance.

Local staff working across acute, community and primary care services deserve thanks and recognition for their ongoing hard work and commitment to delivering high standards of patient care and treatment, often in very challenging circumstances.

In summary, good progress has been made over the last few months and work continues to take forward the changes and improvements required in response to Escalation.

 

Yours sincerely

Cathie Cowan, Chief Executive