argyll & bute chp wednesday 21 august 2013 lecture · pdf filewednesday 21 august 2013...
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ARGYLL & BUTE CHP COMMITTEE MEETING
Wednesday 21 August 2013
Lecture Room, Oban Community Fire Station
12.30pm – Lunch
1pm – Committee Meeting
1. Chairman’s Welcome Robin Creelman 2. Apologies Robin Creelman
3. Conflicts of Interest Robin Creelman
4. Minutes from Previous Meeting Robin Creelman 4.1a Draft Minute of 19 June 2013 (attached) 5. Matters Arising 6. NHS Highland Organisational Issues
6.1 Report of Highland NHS Board of 13-09-13 (verbal) Robin Creelman 6.2 Director of Operations Report (to follow) Derek Leslie 6.3 Feedback from Annual Review (verbal) Derek Leslie
7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 7.3 Community Planning Partnership & Single Outcome Agreement Update (attached) Elaine Garman
10.30am - 12.30pm – Committee Members Development Session
� Early Years Collaborative – Pat Tyrrell � Dementia – Pat Tyrrell � Children’s Services Inspection Report – Pat Tyrrell
3.30pm : Public Session
8. Financial Governance 8.1 Finance Report (attached) George Morrison 9. Staff Governance
9.1 PDP/R and eKSF Implementation (attached) David Logue 9.2 Draft Minute of Partnership Forum Meeting of 04-07-13 (attached) David Logue
10. Partnership Working (verbal) Derek Leslie/ Duncan Martin
11. Performance Management
11.1 Delayed Discharge Update (attached) Derek Leslie
12. Mental Health Modernisation Update (attached) John Dreghorn 13 Noting
• Draft Minute of eHealth Group Meeting – 01-05-13 (attached) 14. AOCB*
15. Date, Time & Venue for Next Meeting
Wednesday 23 October 2013 at 10.30am J03-J07, Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead
* to be notified to Chairman in advance of meeting
The Committee meeting will be followed by:
Argyll & Bute CHP Committee 21 August 2013 Item : 4.1
MINUTE OF MEETING OF THE ARGYLL & BUTE CHP COMMITTEE
Argyll & Bute Community Health Partnership Aros Lochgilphead Argyll PA31 8LB www.nhshighland.scot.nhs.uk/
Mid Argyll Community
Hospital & Integrated Care Centre, Lochgilphead
19 June 2013
Present Present by VC
Mr Robin Creelman, Chairman, Argyll & Bute CHP Mr Derek Leslie, Director of Operations, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Ms Elaine Garman, Public Health Representative, Argyll & Bute CHP Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Ms Elizabeth Reilly, Area Dental Committee Representative Mr Duncan Martin, Chairman, Public Partnership Forum Mr Michael Roberts, Vice Chair, Public Partnership Forum Councillor Elaine Robertson, Argyll & Bute Council Representative
In Attendance Apologies
Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Ms Dawn Gillies, Staffside Representative Ms Liz McMillan, Staffside Representative Cleland Sneddon, Executive Director, Community Services, Argyll & Bute Council Jim Robb, Head of Service, Adult Care, Argyll & Bute Council Councillor George Freeman, Argyll & Bute Council Representative Ms Glenn Heritage, CVO Representative
1. CHAIRMAN’S WELCOME The Chairman opened the meeting by welcoming everyone to Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead. 2. APOLOGIES Apologies for absence were noted as above. 3. CONFLICTS OF INTEREST No conflicts of interest were declared.
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4. MINUTE FROM PREVIOUS MEETING 4.1a Minute of Meeting held on 19 June 2013 The Committee: Approved the content of the Minute of the meeting on 24 April 2013. 4.1b Minute of Public Session of 24 April 2014 The Committee: Approved the content of the Minute of the Public Session on 24 April 2013. 5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 24 April 2013 Page 3 – Major Incident – Mid Argyll, Kintyre & Islay – Councillor Robertson enquired if a ‘common’ list of vulnerable people will be rolled out to each CHP locality. Mr Leslie confirmed this to be the case and that the list will be updated as required by the relevant agencies. Ms Garman stated that a key point will be to agree the criteria of a vulnerable person as the situation for those named can change day to day. Lessons learned from the incident and debriefing notes are due to be discussed at an Emergency Planning Meeting and the outcome shared across localities. 6. NHS Highland Organisational Issues 6.1 Highland NHS Board – 4 June 2013 Mr Creelman reported that Dr Bashford, Board Clinical Director praised the detail of the information provided in the CHP’s Clinical Governance and Risk Management Report to the Committee. The Committee: Noted the above comment. 6.2 Director of Operations Report Mr Leslie provided a summary of key points in the circulated report. Helensburgh & Lomond Out of Hours Nursing Service – the status quo currently remains in the provision of this service. A meeting is scheduled at end July with NHS Greater Glasgow & Clyde to discuss the proposed redesign of the out of hours nursing service for patients in the Helensburgh & Lomond area as a result of an intimation from the West Dunbartonshire CHCP of an intention to effect changes to the SLA. Primary Medical Services Information Sharing - the availability of a significant quantity of information to monitor and understand performance in primary care is being collected by the Primary Care management section of the CHP. Senior managers have been asked to reflect on the extent and value of this information so that any necessary refinements to the arrangements for information and intelligence collection
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can be agreed. The range of information and the outputs will feature at a future development session the CHP Committee. Bereavement Strategy - an action plan has been developed to assist in the delivery of bereavement care guidelines and the development of support which will comply with the “Shaping Bereavement Care – A Framework for Action CEL9 (2011). The CHP Lead AHP has been identified as the link person to take forward the action plan. Early Years Collaborative – this is a significant strategic initiative by the Scottish Government in collaboration with the Council. The need for funding (amounting to £42k) has been added to the cost pressures to be managed by the CHP in order to part fund a Project Manager and Data Manager post for the next 2 years to support the early years collaborative. Patient Management System (PMS) Update - work in relation to implementing the new PMS is progressing to plan and has been formally in operation for two months plus. The specific challenges associated with Argyll & Bute will be addressed as the implementation progresses. It was noted that improved clinical awareness and participation into the implementation of the system will be pursued. Delivery of Sustainable Remote & Rural Health & Social Care – the CHP contributed to a NHS Highland proposal submitted to the Scottish Government to test models for the delivery of sustainable remote and rural health and social care services which would have application across Scotland. Mid Argyll & Kintyre were identified as two strands to be linked into the work to be undertaken.
NHS Highland currently awaits feedback from SGHD on the draft proposal, with the final proposal to be submitted and a decision expected thereafter, with the resourcing availability for the project work still to be confirmed
Campbeltown Community Hospital Continuing Care Beds - members of the CHP management team and locality staff attended a meeting in Campbeltown hosted by the Campbeltown Community Council on Monday 13 May 2013. The two agenda items were the closure of continuing care beds in Campbeltown Community hospital and the substitute prescribing service. The meeting was attended by approx 190 people. Local staff presented information about local service developments and the bed modelling process which has been in progress for two years. In relation to closure of continuing care beds, the main concerns raised were; contingency planning for emergencies, adequate beds available for those who need them locally to avoid transfers out of the area, difficulties recruiting and retaining local staff to take on skilled carers roles, how resource release and the free space in the hospital would be utilised. Reassurance was provided that contingency plans are in place to cope with the peaks and troughs in demand for in-patient beds and that a group with public representatives has been established to identify how resource release should be used to meet local gaps in community service provision. The free space in the hospital will also be reviewed by the redesign group, to identify what local service development might be supported by the use of this additional space. Mr Leslie reaffirmed that the closed beds had not been in use. Substitute Prescribing - the community of Campbeltown voiced many concerns related to the provision of a substitute prescribing service locally. The Kintyre Substance Misuse Working Group (KSMWG) met on 13 June 2013 to review the current position.
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Building the Bridge Together - an event to consider how we can work better together to enable older people to live long, healthy and fulfilling lives in Argyll & Bute was recently held in the Corran Halls, Oban. The event was very well attended by a full range of key stakeholders with an interest and influence in reshaping care for older people who were challenged to develop a shared understanding of the ambition to reshape care for older people and contributing to defining values and behaviour to achieve this. A report on the outcome of the event will be published in due course. Argyll & Bute Hospital 150 Years Anniversary - more than 100 staff past and present gathered on 29 May to celebrate the unveiling of a special plaque by Thomas Byrne, Director of Mental Health Charity, Acumen to celebrate the 150th anniversary of the Argyll & Bute Hospital. Volunteering Awards - the annual Volunteer Awards took place in Council Chambers, Kilmory on 31 May. The event is organised annually by Argyll Voluntary Action to celebrate volunteering across Argyll and Bute and is attended by organisations, Councillors, volunteers, carers and was also attended this year by Jackie Baillie, MSP. For the second year NHS Highland have sponsored a “Health Volunteer Award” for individuals who volunteer in a health environment. This year we had two prize winners. The Committee: Noted the content of Director of Operations Report. 7. Clinical Governance 7.1 Clinical Governance & Risk Management Report Ms Tyrrell spoke to the circulated report and highlighted and summarised a number of items. Risk Management Incidents – the graphs illustrated the number of incidents reported through Datix over the past 13 months. As the information for April 2013–June 2013 was unavailable at the time of reporting, the report to the Committee in June will feature the top five incidents, with categories, details and actions undertaken. Ms Tyrrell advised that the audit scores represent compliance of evidence based practice. Mr Creelman enquired about the availability information to measure adherence to ‘surgical pause’ by surgical staff. Ms Tyrrell confirmed that this practice does take place and she will provide evidence details in future reports. Pressure Ulcer Prevention – there has been a sustained reduction in the number of incidents due to the work of staff in applying the clinical quality indicators, with no Grade 3 or 4 hospital acquired pressure ulcers reported in Argyll & Bute since the last report. A significant amount of work continues in community settings to raise awareness of patients, carers and staff in all sectors to ensure that appropriate risk management is undertaken at all times. The recruitment of an Advance Nurse – Tissue Viability should be completed by September 2013 which will provide additional capacity to undertake this work.
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Falls Prevention - as with Pressure Ulcer prevention considerable amount of work is underway to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn and Islands Hospital in Oban. Some wards are showing a reduction in falls, partly due to the change in patients groups, i.e. vulnerable patients. Serious Untoward Incidents (SUI) - Since the last report there has been one SUI related to patient suicide. The formal SER meeting took place on 10 June 2013. The report and action plan is under development and will be discussed at the next Clinical Governance and Risk Management meeting. Health Improvement Scotland Adverse Event Review - HIS will be reviewing NHS Highland in relation to the Management of Adverse Events on 7 August 2013. In preparation for the review visit NHS Highland has been asked to submit details of all adverse events during the 18 month period November 2011- April 2013. A total of 28 Argyll & Bute CHP incidents have been submitted. The level of review for each of these incidents was as follows: Full Significant Event Review (SER): 17 Local Case Review 8 Significant Event Analysis (Primary Care process) 2 SER not conducted as incident addressed via HR process 1 It is understood that 4 of the total number of incidents submitted by NHSH will be selected for further scrutiny. Further details about arrangements for the review visit are awaited. Complaints Of the 11 complaints received in March/April 2013 the themes can be broadly categorised as follows, with some complaints containing more than one theme :
Care / Treatment 6 Attitude 4 Communication 3 Access 3 Confidentiality 1
Pat undertook to review the detail of the information presented to the Committee around complaints reporting and provide additional detail at the next meeting. External Review Joint Inspection of Children’s Services in Argyll and Bute - the pilot inspection in Argyll and Bute was completed in April 2013 and verbal feedback from the Joint Inspection Team was delivered to Senior Officers on 3 May 3. The findings of the inspection were very similar to our own self evaluation findings and identified a number of strengths as well as areas requiring increased focus. The timescale for delivery of the final report has been lengthened and it is now expected that this will be received in July. The Integrated Children’s Services Plan for Argyll and Bute is under development and will contain all of the actions required to address areas identified within the inspection findings. CPA Surveillance Inspection of LIH, Oban Laboratories – a follow up inspection took place in April and the laboratories retained their accreditation.
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Quality Older People in Acute Care Local inspection visits were conducted at all hospitals/wards within the CHP during May 2013. The purpose of these visits is to share learning across all sites and to ensure that there is a focus on the key priorities for improvements. A range of tools were used during the visits including national tools from HEI/HIS. Inspection included:
• environmental audits • observational audits of interactions with patients; • care planning audit; • inspection of invasive devices (peripheral vascular catheters and urinary
catheters) • interviews with staff patients and carers • mealtime observations
The inspection teams included a range of staff from the CHP (external to the site being visited). Some teams also included a non-executive and patient/public partnership representative. Ms Tyrell will update the Committee in August, detailing the outcome of the visits and of the action plan which will be developed to support improvements and shared learning. Person Centred Care To support our approach to delivering person centre care, the CHP was privileged to learn first hand about the Esther Network, a Swedish healthcare system which is widely recognised as a world leader in patient-centred care, committed to assessing their services “through patients’ eyes”. Two sessions were delivered by the Director of the Esther Network and a colleague on 10 June 2013 in Oban and Inveraray. During these sessions ways to adopt the Esther approach in Argyll and Bute were explored and with the support of the Joint Improvement Team the CHP is continuing this look at this method across the partnership as part of the Reshaping Care for Older People programme. Scottish Patient Safety Programme (SPSP) Acute Services – progress has been sustained across the range of indicators. Mental Health – is in the very early stages of implementing SPSP and a team has been identified to take the programme forward and a progress measurement will be put in place. Health & Safety Revised Health & Safety Work Programme The NHS Highland work programme for Health & Safety 2013-2015 is being revised and updated. The CHP operational plan will contain all the work streams within the corporate plan, together with areas of work to meet local concerns. The plan will be tabled at the CHP Operational Health & Safety Group in August 2013.
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Fire Safety Actions plans are being developed following the recent fire risk assessments carried out by the CHP Risk Advisor-Fire Safety. Councillor Robertson enquired about the timescale of completion of the Fire Service audits. Mr Leslie advised that there were no specific timescales due to the requirement to complete compartmentisation work and he undertook to provide a summary of the outcome of the audits at the date of the next Committee meeting. 7.2 Infection Control Report Ms Tyrrell referred to the circulated report. Staphlococcus Aureus Baceraemia (SAB) (including MRSA) There have been two cases of SAB in Lorn & Islands Hospital since the last report, one due to a contaminated blood sample taken from blood cultures and the other is been subjected to a root cause analysis to identify the cause. There is a robust process in place to look at and factor in all learning from identified cases and actions taken. Responding to an enquiry from Mr Creelman around the long term use of antibiotics at home, Ms Tyrrell advised that the CHP is currently reviewing this practice and work is currently ongoing with Community Nurse in relation to their management of patient at home. Mr Creelman asked if MRSA screening is undertaken in the CHP. Ms Tyrrell confirmed that although compliance is only required in hospital settings, screening has been rolled out CHP wide. Ms Tyrrell emphasised that any evidence of non-compliance by staff of the front line audit process needs to be highlighted to ensure effective control of the guidelines. Clostridium Difficile (CDI) Target There have been two reported cases of CDI in Argyll & Bute since the last report, one in the hospital and one in the community. Further surveillance is underway to identify the root cause of each case. Hand Hygiene Monthly audits continue to be undertaken by all clinical areas, the results displayed and any non-compliance addressed. The CHP continues to demonstrate compliance with standards and quality assurance is consistently monitored to ensure there is no complacency within any areas. Cleaning & Healthcare Environment The CHP monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated 96% compliance for domestic monitoring and 97% for estates monitoring in March/April 2013.
The Committee: Noted the content of the Clinical Governance & Risk Management Report
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Results for all Argyll and Bute Hospitals recorded that all areas achieved above 90% target for April/May 2013 and above 95% for estates issues. However three sites were below the 95% compliance for cleaning standards for May, Rothesay Victoria Hospital, Helensburgh and Islay and work to address the identified deficits has been progressed. Outbreaks/Incidents There have been no outbreaks or incidents in Argyll and Bute since the last report. 7.3 Health Improvement Ms Garman provided an update from submission of first Health Promoting Health Service (HPHS) annual report sent to Health Scotland and Scottish Government. NHS Highland has requested informal feedback with regards to the content and detail but this has not yet been forthcoming. It is clear after discussions with other Boards that reports will vary greatly from Board to Board as there was no real guidance with regard to this. Formal feedback will be sent directly to Elaine Mead, Chief Executive probably by end of July, although the date is yet to be confirmed. Discussions are still ongoing at the National HPHS network meetings with regards to some of the measures e.g. one of the smoking ones is not measureable. The CHP has been assured that the template is still a working document and changes may come on the back of the formal feedback. NHS Health Scotland has worked over past year with Health Practitioners across NHS Health Boards to develop resources that showcase Health Promoting Health Service (HPHS) work undertaken by NHS Boards across Scotland. The resources include, five new HPHS Case Studies illustrating tangible health improvement activities in number of different settings and two new professional profiles highlighting the elements of health improvement in staff’s roles within clinical settings. We will consider how best to disseminate these to make the most impact on developing front line practitioners’ practice. All the resources are underpinned by the HPHS concept that 'every healthcare contact is a health improvement opportunity'. Details on some of these Case Studies and Professional Profiles and where they can be found online and the links are detailed below. http://www.healthscotland.com/documents/21434.aspx http://www.healthscotland.com/documents/21437.aspx Councillor Robertson asked if Health Improvement work is undertaken in partnership with social enterprises, with an SLA in place relating to, for example, Health & Wellbeing.
The Committee: Noted the content of the Infection Control Report
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Ms Garman advised that small grants funds are available for social enterprises through the Health and Wellbeing Partnership and indicated that should larger grants/projects be required that could be considered in the context of the funding available. Councillor Robertson clarified that her enquiry was not just project specific and related to all Health Improvement projects. 8. Financial Governance 8.1 Finance Report 8. Financial Governance 8.1 Report Mr Morrison advised that at end May 2013 the CHP recorded an overspend of £137,000. He summarised the main anticipated financial challenges for the CHP to operate within the budget as :
� Containment of the NHS Greater Glasgow & Clyde Service Level Agreement � Delivery of the £2.4m saving plan � Containment of ongoing locum costs � Increased commissioned service costs � The establishment of the salaried dental service as a cash limited service.
Mr Creelman requested further details of the ongoing locum costs. Mr Morrison advised that with regard to Cowal, plans are being developed to address the necessity for medical locum cover in casualty, out of hours and inpatient services. Within Oban there is currently a time lag in the filling of medical locum positions. Investigation is also underway to look at the unexpected variance in the provision of surgical locums, which relates to annual leave cover. With regard to salaried dental services, Mr Morrison advised that NHS Boards have been requested to review their funding request for salaried dental services and the detail of the Scottish Government allocation is awaited. An update will be provided at the next meeting. Mr Morrison referred to the financial challenges to the CHP to deliver the cost improvement programme 2013/14, which reflects a target of a 2% saving, with the exception of the prescribing budget which is higher due to significant savings on generic drugs and displaced staff which is a specific target relating to a small number of unfunded posts. Mr Leslie advised that budget holders have been requested to bring forward specific initiatives of their savings plans for discussion at the next CHP Core Management Team meeting. The Committee Noted the content of the report and the financial challenge facing the Argyll & Bute CHP in 2013/14.
The Committee: Noted the content of the Health Improvement Report.
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9. Staff Governance 9.1 PDP/R and eKSF Implementation Mr Logue reported the final CHP figures at end of year 2012/13 for agenda for change staff having an eKSF review carried out and recorded on line as 65.42% of staff (all) and 88.61% of staff (excluding Bank). Monitoring progress is underway for 2013/14 and the CHP currently has 2% of all staff (2.68% excluding Bank staff) with reviews and personal development plans signed off in eKSF. Mr Logue emphasised that there needs to be a focus on :
• addressing issues of missing data for a number of staff. • ongoing work in each area to ensure that all bank staff have an identified
manager, outline and review . • planning the dates for PDPs well in advance to spread reviews throughout the
year • ensuring and improving quality of reviews and evidence through guidance notes
and advisory sessions for managers with the Workforce Development Facilitator.
The benefits of the eKSF process being part of the day to day working process to support and inform staff is recognised by Managers. Mr Logue acknowledged the need for re-engagement with CHP focus group to provide support and assurance around the eKSF process and this will be taken forward. Ms Tyrrell suggested the development of feedback questions for team leaders to take forward with staff. It was agreed that, when available, the results of the current staff survey will be submitted to the Committee for discussion. 9.2 Minute of Partnership Forum Meeting of 4 April 2013 Mr Logue highlighted the presentation given to the Partnership Forum by Ms Tyrrell on NHS Mid Staffordshire Report and the circulated Minute reflects the subsequent discussion. The Partnership also discussed the option appraisal around radiography services and it was acknowledged that this is a challenging piece of work.
The Committee: • Noted the end of 2012/13 position • Noted the start of year position • Noted the progress made in embedding this in practi ce and the use to
support and inform staff development in line with C HP and NHS Highland objectives
• Note the plans to ensure reviews and PDPs are start ed early in the year and spread throughout the year
• Note the need to ensure that all bank staff have a review
The Committee: Noted the verbal update and the content of the circ ulated Minute.
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10. Partnership Working 10.1 Public Partnership Forum (PPF) As the notes of the meeting on 21 May 2013 were unavailable, Mr Creelman requested a verbal update. Mr Martin reported that after discussion, and taking into consideration comments from members, it has been agreed to change the core function of the Argyll & Bute PPF with the locality PPF Leads meeting quarterly where issues from each locality PPF would be discussed. Locality PPF groups will continue to meet regularly. 10.2 Minute of CPP Management Committee Meeting of 6 March 2013 Mr Leslie referred to the circulate Minute which was to inform the Committee of the business of the Community Planning Partnership. He advised that the draft Single Outcome Agreement will be submitted in due course to the Committee for discussion and agreement.
The Committee: Noted the content of the circulated Minute. 11. Performance Management 11.1 Delayed Discharge Report The circulated monthly census recorded zero delayed discharges >4 weeks within the CHP as at 15 May 2013. The Committee Noted the details of the circulated report.
12. Mental Health Modernisation Update Mr Leslie highlighted details of the circulated report which gave an update on the implementation of the modernisation of mental health services in Argyll & Bute. Capital Project Stage 1 Approvals - the revised stage 1 report was submitted by Hubco to NHS Highland during May, and has been passed to our advisors for review and comment. The Outline Business Case (OBC) is being updated with information from the stage 1 report. At present no dates have been set for presenting the OBC as discussion are ongoing with regard to “bundling” this project with another NHS Highland or NHS Grampian Project. More detail on this is available later in this report.
Inpatient Services - the bed compliment remains at 28 plus 3 minimal supervision places in the refurbished Firgrove building.
The Committee: Noted the verbal update.
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Budget - The bridging allocation for the project during 2013/14 remains unchanged at £500k as set by the CHP management team. This will largely be used to cover the capital project, project management and advisor costs, which are expected to exceed £400k this year and drop off during 2014/15. A review of the expected capital project costs for 2013/14 will take place after decisions are made regarding “bundling” options. Community Mental Health Team Base - both Kintyre and Dunoon CMHS bases are almost complete. The Kintyre team will move into their new base in Campbeltown Hospital, along their Social work colleagues and the Kintyre ABAT team, later this month. The Cowal Integrated CMHS will also be relocating from Dochas Lodge to their new base in Cowal Community Hospital later in June.
Supported Transfer of Detained Patients - a staff/management working group has been established to take forward the implementation of this service development. Proposals for an increase in hospital nursing staff was taken to the vacancy monitoring group and approved in principle, but requiring approval by the core team due to the cost implications, as this development requires an additional £100k recurring funding to implement. Staff meetings have also been organised to explain the changes to staff, in particular the alteration to their shift patterns to enable the service to operate at times when it will be most effective for patients.
“A Vision for Mental Health Service in Argyll & Bute” – Workshop held on 29th April - the “Vision” working group met recently to review the outputs from the workshop and to use them to update the vision statement. The revised vision statement will be circulated internally and to partners during June/July for comment.
Mr Leslie summarised that while progress continues to be made in establishing new community services and upgrading current hospital services; the capital project is entering a critical phase. Key decisions will soon be made with regard to bundling with another capital project which will enable the project to continue to progress. Decisions taken over the next few weeks will be vital in terms of defining the length of time to complete, and the overall cost of the new mental health unit. The Committee: Noted the current key issues and progress against the action plan. 13. AOCB There was no other business. 14. DATE, TIME & VENUE FOR NEXT MEETING: Wednesday 21 August 2013, Meeting Room, Fire Statio n, Oban
Argyll & Bute CHP Committee Date of Meeting : 21 August 2013 Agenda : 7.1 Argyll and Bute CHP Clinical Governance and Risk Ma nagement Report Report by Pat Tyrrell, Lead Nurse and Fiona Campbel l, Clinical Governance Manager
The CHP Committee is asked to:
• Note the contents of the Clinical Governance and Risk Management Report.
1. CONTRIBUTION TO THE BOARD’S CORPORATE OBJECTIVES The vision of the Highland Quality Approach is:
• Better Health – improving the health of the population • Better Care – enhancing the experience of care for individuals • Better Value – controlling the per capita cost of care
In order to achieve this the key elements of the Quality Strategy have been adopted: Person-Centred There will be mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. Safe There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times. Effective The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
2. RISK MANAGEMENT 2.1 Incidents The following data relates to incidents reported between 1 April to 30 June 2013. The data is correct as of 22 July 2013. FIGURE 1 Argyll and Bute Incidents Last 13 months
FIGURE 2 Incidents by Category
A total of 515 incidents were reported within Argyll & Bute during quarter 1. By locality Cowal & Bute – 81 (15.7%) Helensburgh – 11 (2.1%) Mid Argyll & Kintyre – 257 (49.9%) Oban, Lorn & Isles – 158 (30.7%) Outwith – 8 (1.5%)
In the last financial quarter slips trips and falls remained in the highest category of incidents. The top category for each locality: Cowal & Bute – transfer / discharge (14) Helensburgh – V&A (3) Mid Argyll & Kintyre – V&A (53) Oban, Lorn & Isles – falls (56) Increase in number of incidents related to transfer and discharge is being investigated
FIGURE 3 Incident Grades by Locality
FIGURE 4 Incident with Major and Extreme Consequenc e
During Quarter 1 the incidents reported in Argyll & Bute were graded as follows: Low – 305 (59.2%) Medium – 139 (27.0%) High – 3 (0.6%) The remaining incidents have not yet been graded.
There were 2 incidents, reviewed by a manager and graded with a consequence of major or extreme. Mid Argyll, Kintyre and Islay- Suicide Oban, Lorn & Isles – SAB
FIGURE 5 Incidents by Locality and Outcome
FIGURE 6 RIDDOR Reportable Incidents
Overall outcome for Argyll & Bute: No injury / harm – 307 (59.6%) Near Miss – 57 (11.1%) Injury / harm – 137 (26.6%) Death – 1 ( 0.2%) Property damage – 13 (2.52%)
There were 2 RIDDOR incidents in Quarter 1 . 1 x > 7 day absence – staff accident. Injury to thumb 1 x major injury – staff fall. Fractured patella
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2.1.1 Pressure Ulcer Prevention The graphs below illustrate the trends in Hospital Acquired Pressure Ulcers across NHS Highland. While the overall number remains fairly constant the reduction in Grades 3 and 4 ulcers is sustained. CQI scores for Pressure Ulcer Prevention for each ward in Argyll and Bute are shown in Appendix One. There has been recent increase in capacity of Tissue Viability specialist nursing support within NHS Highland; this will deliver additional support to the clinical staff in ensuring that adherence to standards for pressure ulcer prevention is maintained across all areas. In addition, short life group has been established to develop an action plan to raise awareness, and develop prevention strategies, across community and primary care settings. This will include working with carers and staff in Care Homes and Care at Home services. FIGURE 7: NHS HIGHLAND HOSPITAL ACQUIRED PRESSURE U LCERS JULY 2012-JULY 2013
FIGURE 8: OPERATIONAL UNITS: HOSPITAL ACQUIRED PRES SURE ULCERS JULY 2012-JULY 2013
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FIGURE 8: HOSPITAL ACQUIRED PRESURE ULCERS BY HOSPI TAL APRIL – JUNE 2013
FIGURE 10: PRESSURE ULCERS DEVELOPED IN COMMUNITY J ULY 2012-JULY 2013
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2.1.2 Falls Prevention As with Pressure Ulcer prevention considerable amount of work is underway to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn and Islands Hospital in Oban. The graphs below illustrate trends across NHS Highland. CQI scores for Falls Prevention for each ward in Argyll and Bute are illustrated in Appendix One. FIGURE 11: NHS HIGHLAND NUMBER OF FALLS JULY 2012-J ULY2013
FIGURE 12: NUMBER OF FALLS AND CONSEQUENCE BY OPERA TIONAL UNIT APRIL-JUNE
2013
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2.1.3 Disruptive, Violent and Aggressive Behaviour While incidents related to disruptive, violent and aggressive behaviour are the second highest category reported the numbers for Argyll and Bute are consistently lower than those of the other operational units as shown in the graph below. Training and support for staff is delivered throughout the year to ensure that staff have the right communication and management skills to deal effectively with potential incidents. FIGURE 13: NUMBER OF V&A INCIDENTS BY OPERATIONAL U NIT JULY 2012-JULY 2013
2.1.4 Staff Availability The following graph illustrates the number of incidents reported where there have been problems due to lack of staff availability- the majority of these are due to shortage of nurses in clinical areas. These incidents are kept under close scrutiny. At its July meeting the CHP Core management Team agreed the process for carrying out Argyll and Bute wide review of Nursing and Midwifery establishments during September 2013. This is in line with NHS Highland policy. The process will include representatives from CHP management, finance, HR and staffside as well as the Senior Charge Nurses and Team Leaders. It is anticipated that the revised establishments will be agreed and signed off in December/January FIGURE 14: NUMBER OF INCIDENTS RELATED TO STAFF SHO RTAGES BY OPERATIONAL UNIT JULY 2012-JULY 2013
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2.2 Significant Event Reviews (SER) There have been four SERs since the last report. Each of these has been investigated with the staff who were involved and reports and action plans generated. SERs are an essential element of risk management and form an integral part of the improvement in the safety and quality culture. Feedback from staff about their experience of the SER process continues to inform developments and improvements in the way in which the need for SERs is identified, the way in which the reviews are conducted and in how the action plans are developed and monitored. 2.3 Health Improvement Scotland Adverse Event Revie w Health Improvement Scotland (HIS) Adverse Event Management visit to review NHS Highland in relation to the management of adverse events took place on 07 August 2013. HIS are undertaking review visits to all Boards within NHS Scotland. There were a number of sessions included in the programme which allowed the visiting team to talk to various members of staff about adverse event arrangements within NHS Highland including:
• Discussion with Senior Managers • Demonstration of systems in place e.g. Datix, record storage, staff training • A visit to a clinical area in Raigmore to talk with front-line staff to understand their
perspective about the management of adverse incidents. • Discussion with staff involved in 4 selected incidents. One of these sessions was
with A&B CHP staff in relation to a incident which occurred in Argyll and Bute and which was subject to a Significant Event Review
A draft report will be provided by HIS with final report due to be published on 23 September 2013. 3. COMPLAINTS TABLE 1 Argyll and Bute Complaint Performance repo rt
Target Amber Red April- 13
May- 13
June- 13
Number of complaints received 4 5 ~ 6 7 and over 9 6 7 Achievement against 20 day 80% 70 - 79% Under 69% 33% 0% 0% Number of complaints over 40 working days old * 0 ~ 1 or more 1 2 5 Number of further correspondence over 20 working days old * 0 ~ 1 or more 2 1 1 Number of complaints categorised as high risk 1 2 3 and over 2 4 2
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Of the 7 complaints received in June 2013 the themes contained within complaints can be broadly categorised as follows:
Waiting Times 3 Access to Services 2 Care / Treatment 2
4. EXTERNAL REVIEWS 4.1 Joint Inspection of Children’s Services in Argy ll and Bute The pilot inspection in Argyll and Bute was completed in April 2013. The draft report has been received and the final report is due to be published in September. Work is already underway to address the identified areas for improvement. 5 QUALITY AND SAFETY 5.1 Scottish Patient Safety Programme Acute Services: Detailed run charts for Lorn and Islands Hospital are included in Appendix Two INR: slightly raised due to one patient with a raised INR on admission. Spread across wards all sustaining improvement. Sepsis: data input from two wards now. VTE –to be taken forward when NHS Highland agree the appropriate tool. Mortality review – June – December 2012 looked at and report sent to Dr Bashford. All deaths reviewed and no adverse events identified. January – June 2013 to be audited. Primary Care A local learning event for GPs, Practice Nurses and Practice Managers was held in Inveraray on 6 June 2013 with 24 of the 33 Argyll and Bute GP practices represented at the meeting (44 attendees) The training session was facilitated by Dr Kirsty Vickerstaff, SPSP-PC GP Clinical Lead for NHS Highland, Dr Neil Houston, National Clinical Lead for Healthcare Improvement Scotland and Jill Gillies, SPSP-PC Programme Manager. The event provided information regarding the tools and resources of the primary care safety programme to improve patient safety and specifically supported practices with the two elements which have been included in the Quality and Outcomes framework this year;
• The Safety Climate Survey • Structured Case Note Review using the Primary Care Trigger Tool
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The NHS Highland SPSP-PC working group identified Warfarin Management as a key area of focus for NHS Highland. Argyll and Bute CHP is currently developing an enhanced service for anti-coagulation monitoring incorporating the SPSP-PC Warfarin Care Bundle for introduction across Argyll and Bute CHP from 1 April 2014. A care bundle is a structured way of improving processes of care to deliver enhanced patient safety and clinical outcomes. Dr John Lyon, Argyll and Bute SPSP-PC Clinical Lead and Joyce Robinson, Primary Care Manager are representing Argyll and Bute CHP at an NHS Highland site visit by Healthcare Improvement Scotland on 27 August in Inverness to agree an action plan for future activities, including further learning sessions (National and Local), IT and Data collection and enhanced service progress. 6. HEALTH AND SAFETY 6.1 Revised Health and Safety Work Programme The NHS Highland work programme for Health and Safety 2013 – 2015 is being revised and updated. The programme will be split into corporate and operational work strands and each area of work will have targets and performance measures. The work programme is to be included as part of the Operational Units Delivery Plan and its implementation will be overseen by the Joint Chairs of the Operational Health and Safety Groups and monitored by the Health and Safety Committee. To avoid unnecessary duplication of effort each corporate work stream will have a NHSH Lead. The corporate work programme will be tabled for approval at the August NHSH H&S Committee. The CHP operational plan will contain all the work streams within the corporate plan plus areas of work to meet local concerns, identified e.g. through incident reporting or risk assessment. The A&B CHP Operational Plan will be tabled at the CHP Operational Health and Safety Group on 22 August 2013. Future reports to the CHP Committee will include performance related information in relation to achievement of the work plan 6.2 Moving and Handling Audits The Moving and Handling Advisor along with the area co-ordinator/trainers in moving and handling have begun baseline audits for moving and handling. These baseline audits will be conducted within wards in each hospital. Items covered by the audit include: the level and frequency of training received by staff, the competence of individuals and the availability and quality of moving and handling risk assessments. These audits will help to determine any gaps in competence and written assessments. This will provide essential information as we make the transition from a prescribed frequency of moving and handling training to one based on the competence of individuals.
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7. FIRE SAFETY 7.1 Fire Risk Assessments Fire risk assessments carried out by the CHP Risk Advisor, Fire Safety, using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay, Lorn & Islands, Dunoon, Rothesay and Mid Argyll are now complete and have been issued. Action plans are being prioritised locally. The target for completion of the risk assessment for Mull and Iona Community Hospital is the end of August. 7.2 Compartmentation Survey Recent fire service audits have highlighted the need for compartmentation work to be undertaken. Sub-compartmentation of wards is a key priority. The fire alarm systems have been upgraded to L1 standard in Dunoon and Oban. 7.3 Unwanted Fire Alarm Signals TABLE 2: ARGYLL AND BUTE INCIDENTS CODED TO FIRE CA TGEORY APRIL 2013- JUNE 2013 A&B CHP Incidents coded to Category Fire 1st Q 1.4.13-30.6.13
Failure
with alarm system
Fire (actual)
Unwanted fire alarm signal (false alarm)
Total
Hospital - Argyll & Bute 0 0 1 1 Hospital - Bute - Rothesay Victoria Hospital 0 0 3 3 Hospital - Campbeltown 0 1 2 3 Hospital - Dunoon - Cowal Community Hospital 0 0 2 2 Hospital - Lochgilphead - Mid Argyll Community Hospital, Integrated Care 0 0 2 2 Hospital - Oban - Lorn and Islands General Hospital 1 1 2 4 Workbase / Office / Training - Aros 0 0 1 1 Total 1 2 13 16
The two Fires (actual) in Campbeltown and Lorn and Islands Hospital were as a result of overheating of equipment. Some unwanted signals were attributed to new alarm systems. Staff have been informed of the higher level of detection due to the new alarm systems and have been reminded to prevent unwanted calls by inappropriate actions e.g. using nebulisers, kettles or toaster in non designated areas or rooms. Six calls were due to works carried out by contractors. Procedures for the management of contractors need to reviewed by Estates to ensure they are fully implemented.
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7.4 Fire Service Audits The enforcing authority, Scottish Fire and Rescue Service (SFR), has now completed audits in Cowal, Rothesay, Islay, Campbeltown and Oban hospitals. Duty holders have received letters of recommendations; no formal action has been issued. Duty holders have responded by letter to the fire authority. Although SFR detail the full scope of works required, the letters indicate an immediate need for some interim works. These centre on the sub division of ward areas. All sites have Fire Safety Action Plans in place both as a result of the 3i risk assessments and the Fire Service Audits. Immediate actions are being progressed at all sites. Further funding is being sought to deal with some of the estates issues required.
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APPENDIX ONE: CLINICAL QUALITY INDICATOR COMPLIANCE SCORES CQI Rates: % compliance with standards for Pressure Ulcer Prevention SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY COWAL AND BUTE Victoria Hospital
100 95 100 100 93 93 98 95 98 93 96
CCH Ward 1 98 96 96 98 96 100 100
98 CCH Ward 2
98 100 96
MID ARGYLL, KINTYRE AND ISLAY Glenaray 95 100 95 93 95 95 100 100 83 100 100
Glassary 100 100 100 100 100 100 Cara Knapdale
100 100 100
Campbeltown NR 97 95 100 100 100 100 98 98
100 100 Islay 90 90 90 90 92 95 100 100 100 100 100
OBAN, LORN AND ISLES Ward A 95 100 100 100 100 100 83 100 100 100 100
Ward B 100 100 98 100 93 95 100 100 95 98 Ward I 100 100 100 100 100 100 100 100 100 100 100
MICH 95 NR NR 78 100 NR 91 92 100 100
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APPENDIX ONE: CLINICAL QUALITY INDICATOR COMPLIANCE SCORES CQI rates: % compliance with Standards for Falls Pr evention SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY COWAL AND BUTE Victoria Hospital
100 100 100 91 96 100 100 100 100 91 100
CCH Ward 1 96 97 97 97 97 100 96 95
CCH Ward 2
100 96 98
MID ARGYLL, KINTYRE AND ISLAY Glenaray 100 100 100 100 100 100 100 100 100 100 100
Glassary 100 100 100 100 100 100 100 100
Cara Knapdale
100 100 100
Campbeltown NR 100 94 100 96 76 89 100 96.3 100 98
Islay NR 87 90 90 93 67 96 84 82 100 96 OBAN, LORN AND ISLES Ward A 96 96 97 100 97 96 100 100 100 100 100
Ward B NR 100 98 98 87 100 100 100 97 98 Ward I 100 100 100 100 100 100 100 100 100 100 100
MICH 100 NR NR 61 94 NR 100 100 100 100
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APPENDIX ONE: CLINICAL QUALITY INDICATOR COMPLIANCE SCORES CQI Rates: %compliance with Standards for Food, Flu ids and Nutritional Care SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY COWAL AND BUTE Victoria Hospital
99 97 93 NR NR 98 96 97 NR 97 98
CCH Ward 1 92 96 95 95 97 100 98 100
CCH Ward 2
97 99 100
MID ARGYLL, KINTYRE AND ISLAY Glenaray 67 89 100 100 99 100 94 100 91 100 97
Glassary 100 100 100 100 100 100 100 100
Cara Knapdale
100 100 100
Campbeltown 96 94
Islay 100 OBAN, LORN AND ISLES Ward A 100 100 100 100 100 100 100 100 100 100 100
Ward B 100 100 99 94 95 100 100 100 97 97 Ward I 100 93 100 100 100 100 100 100 100 100 100
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APPENDIX TWO LORN AND ISLANDS SPSP PROCESS AND OUTCOME MEASURES
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APPENDIX TWO LORN AND ISLANDS SPSP PROCESS AND OUTCOME MEASURES
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APPENDIX TWO LORN AND ISLANDS SPSP PROCESS AND OUTCOME MEASURES
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APPENDIX TWO LORN AND ISLANDS SPSP PROCESS AND OUTCOME MEASURES
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APPENDIX TWO LORN AND ISLANDS SPSP PROCESS AND OUTCOME MEASURES
Argyll & Bute CHP Committee Date of Meeting: 21 August 2013
Item No: 7.2
INFECTION CONTROL REPORT Report by Pat Tyrrell, Lead Nurse The CHP Committee is asked to: • Note the contents of the report.
1. Aim The purpose of this paper is to update CHP Committee members of the current status of Healthcare Associated Infections (HAI) and infection control measures in Argyll and Bute CHP and NHS Highland.
2. Contribution to Board Objectives One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. 3. Summary TABLE 1 NHS HIGHLAND INFECTION PREVENTION & CONTROL TARGETS AND PERFORMANCE DATA Group Target NHS
Scotland NHS Highland
Clostridium difficile
Age 65 and over
39.0 (100,000 OBDs)
28.4 April 12 - March 2013
20.8 April 12 – March 2013.
Green
Clostridium difficile
Age 15 and over
New Target 25.0 (100,000 OBDs) to be achieved by 03/15
26.4 April – June 2013 (not validated) Please note* below
Green
Staphylococcus aureus bacteraemia
Age 15 and over
26.0 (100,000) AOBDs
29.8 April12 –March 2013.
21.8 April 12 – March 2013.
Green
Hand Hygiene 95% 95% 98% Green
Cleaning 90% 95%
95% Green
Estates
90% 97% 96% Green
Source: - Health Protection Scotland/ISD/Local data. * Please note that NHS Highland Local Delivery Plan Target Trajectory for Clostridium difficile cases in patients aged 15 and over at June 2013 is 34 per 100,000 OBDs.
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4. Achievements NHS Highland has met the HEAT targets for Staphylococcus aureus bacteraemia (SAB) and Clostridium difficile in patients aged 65 and over as at March 2013.
5. Challenges
• To influence the prevention and reduction of Clostridium difficile infections acquired in the community in the 15 – 64 age group.
• To reduce MSSA bacteraemias by engaging all clinical staff in hospitals and the community in initiatives to prevent and reduce device/healthcare related infections.
• To address the need for risk assessment and screening for Multi-Drug Resistant bacteria (Carbapenemase producers) in light of recent Interim Guidance from Health Protection Scotland.
Argyll and Bute CHP Healthcare Associated Infection Report –
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August 2013
Section 1 – NHS Highland Board Wide and Argyll and Bute Issues
1. Staphylococcus aureus (including MRSA)
1.1 Staphylococcus aureus bacteraemia target NHS Highland has met the HEAT target of 26.0 cases per 100,000 acute occupied bed days or lower by year ending March 2013. The annual rate, April 2012 – March 2013, is 21.8 per 100,000 acute bed days (55 cases). From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, S taphylococcus aureus bacteraemia (including MRSA) cases are 24.0 cases or less per 1 00,000 acute bed days. For NHS Highland that means no more than 60 cases.
1.2 Trends National data published by Health Protection Scotland identifies that NHS Scotland Staphylococcus aureus bacteraemia rate January – March 2013 was 30.1 per 100,000 acute occupied bed days. NHS Highland rate for the same period was 21.7 per 100,000 acute occupied bed days (14 cases).
Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:
Staphylococcus aureus :
http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346
MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252
NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of Section 1 and for each hospital in Section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248
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FIGURE 1 STAPHYLOCOCCUS AUREUS BACTERAEMIA (MRSA AN D MSSA) CASES PER 100,000 OCCUPIED BED DAYS ALL AGES JANUARY 2010 – J UNE 2013
With 95% confidence interval (vertical lines), linear trend (black line) and target (red line) = 26, ci = confidence interval TABLE 2 SHOWS THE CUMULATIVE TOTALS FOR SAB WITHIN ARGYLL AND BUTE CHP FOR THE YEARS SINCE 2009-2010: Hospitals 09/10 10/11 11/12 12/13 13/14 Lorn and Islands, Oban 8 3 0 5 2 Victoria Hospital, Rothesay 1 1 0 0 0 Mid Argyll Hospital, Lochgilphead 0 1 0 0 0 Argyll & Bute Hospital, Lochgilphead 0 0 0 0 0 Campbeltown Hospital 0 0 0 0 0 Dunaros, Mull 0 0 0 0 0 Islay Hospital, Bowmore 0 0 0 0 0 Cowal Community Hospital, Dunoon 0 0 0 0 0 Both cases of SAB that occurred in Lorn and Islands Hospital, Oban have been scrutinised using the Root Cause Assessment tool. The first case appears to have been related to contaminated blood cultures and therefore not a true SAB. To ensure that correct aseptic technique is used when taking blood cultures, work is underway with medical staff at Lorn and Islands Hospital. The second case occurred in a patient with an invasive device (PICC Line) undergoing chemotherapy as a day case. As a result of the case analysis we are reviewing the need to undertake routine MRSA screening for all day case patients ( not currently included in the guidance).
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2. Clostridium difficile
2.1 Clostridium Difficile Target NHS Highland has met the HEAT target of 39 cases per 100,000 total occupied bed days or lower in patients aged 65 and over by year ending March 2013. The annual rate, April 2012 – March 2013 is 20.8 cases per 100,000 OBDs (40 cases). National data published by Health Protection Scotland identifies that NHS Scotland Clostridium difficile infection rate in patients aged 65 years and over, January – March 2013 was 24.2 cases per 100,000 bed days. NHS Highland rate for the same period was 10.3 cases per 100,000 bed days (5 cases). National data identifies that NHS Scotland Clostridium difficile infection rate in patients aged 15 – 64 years, January – March 2013 was 28.4 cases per 100,000 bed days. NHS Highland rate for the same period was 43.9 cases per 100,000 bed days (7 cases). From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, the r ate of Clostridium difficile infections in patients aged 15 years and over is 25 .0 cases or less per 100,000 total occupied bed days. For NHS Highland that means no more than 70 cases. 2.2 Trends FIGURE 2 CLOSTRIDIUM DIFFICILE CASES PER 100,000 OCCUPIED BED DAYS, 65 YEARS AND OVER JANUARY 2010 – MARCH 2013
Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at:
http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx
NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of Section 1 and for each hospital within the CHP in Section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at:
http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277
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April – June 2013 rate (not yet validated by HPS) of Clostridium difficile infections in patients aged 15 and over is 26.4 cases per 100,000 total occupied bed days, 17 cases of which 6 were in hospital and 11 were out of hospital. FIGURE 3 SHOWS THE RATE OF CLOSTRIDIUM DIFFICILE INFECTIONS IN PATIENTS AGED 15 AND OVER FROM APRIL 2012 to June 2013 IN NHS HIGHLA ND
TABLE 3 SHOWS THE CUMULATIVE CD TOXIN POSITIVE CASE S IN EACH CHP HOSPITAL FOR THE YEARS SINCE 2009
Hospitals 09/10 10/11 11/12 12/13 13/14
Lorn and Islands Hospital, Oban 0 1 2 1 1
Cowal Community Hospital, Dunoon 3 1 2 2 1
Victoria Hospital, Rothesay 3 0 1 0 1
Dunaros, Mull 0 1 0 0 0
Argyll & Bute Hospital, Lochgilphead 0 0 0 0 1
Mid Argyll Hospital, Lochgilphead 0 0 1 0 0
Campbeltown Hospital 0 0 1 1 2
Islay Hospital, Bowmore 0 0 0 0 0
TABLE 4 SHOWS THE CUMULATIVE CD TOXIN POSITIVE CASE S IN COMMUNITY FOR THE YEARS SINCE 2009
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09/10 10/11 11/12 12/13
13/14
North and West Unit 22 3
South and Mid Reported as CHPs 21 2
Argyll & Bute CHP 2 4 2 2 2
There has been an increase in cases of CDI in Argyll and Bute since April 2013, with a total of 8 cases recorded- 6 in hospital and 2 in community. Of the 6 hospital cases, two of these were a recurrence of infection within the same two patients. There has been no epidemiological connection between the cases, no spread of infection within the wards in which the patients were being cared for and all patients have recovered. Point prevalence study of antimicrobial prescribing practice will take place across each hospital in September to identify how well we are complying with the guidance. In addition education sessions are being delivered in sites across the CHP for all prescribers to maintain the focus on appropriate prescribing of anti microbial agents. 3. Hand Hygiene
3.1 Trends NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining 98% compliance in May and June 2013 The July 2013 National Hand Hygiene Audit report shows NHS Highland compliance as 98%, National compliance was 96%. 3.2 Initiatives Hand hygiene audits continue to be undertaken monthly by all clinical areas, the results displayed and any non compliance addressed. All areas in Argyll and Bute continue to demonstrate compliance with the standards- the results for each hospital are included within the charts in section 2 of the report. 4. Cleaning and the Healthcare Environment
Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at:
http://www.washyourhandsofthem.com/
NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital and community hospitals within each CHP in section 2. Information on national hand hygiene monitoring can be found at:
http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx
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4.1 Current Rates The monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated 95% compliance in May and 94% in June 2013 for domestic monitoring and 97% for estates monitoring in May and 95% in June 2013. results for Argyll and Bute hospitals are included in the scorecards and show compliance across all sites. 5. Outbreaks/Incidents There have been no outbreaks or incidents in Argyll and Bute since the last report. 6. Education Following the findings of the HSE visit to Lochaber and the subsequent improvement work that was undertaken, NHS Highland has developed minimum standards for Infection Control education for community nurses. These require that all team members undertake the following:
- NHS Highland Hand Hygiene module - HAI Mandatory Induction Training Programme - Principles of Aseptic Technique
All teams in Argyll and Bute are currently progressing with these, with most expected to complete by the end of September 2013. In addition Team Leaders/ Case Load Holders are requested to undertake the Cleanliness Champion Programme by March 2014. 7. Audit National audit tools have been developed in order to measure compliance with the national Infection Prevention and Control Manual Standard Infection Control Precautions. Baseline audits have been carried out in Lorn and Islands Hospital and Campbeltown Hospital. Plans are being progressed to implement a rolling audit plan within each hospital; when these have been implemented results from the audits, which will be reported monthly, will be utilised to identify areas of good practice and areas where improvement is required. 8. Argyll and Bute Workplan 2013-2014 The annual Infection Control Workplan for 2013-2014 is attached to this report as Appendix One.
Healthcare Associated Infection Reporting Template (HAIRT)
Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%. The cleaning compliance score for the Board can be found at the end of Section 1 and for each hospital and community hospitals within each CHP in Section 2. Information on national cleanliness compliance monitoring can be found at:
http://www.hfs.scot.nhs.uk/online-services/publications/hai/
Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at:
http://www.nhshealthquality.org/nhsqis/6710.140.1366.html
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Section 2 – Healthcare Associated Infection Report Cards The following section is a series of ‘Report Cards’ which provide information on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections. Hand hygiene and cleaning compliance completes the report card. This includes information for pan Highland, Lorn and Islands Hospital, Oban, Community Hospitals collectively for Argyll and Bute and NHS Highland out of hospital infections. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up-to-date information on HAI activities at local level than is possible to provide through the national statistics. Understanding the Report Cards – Infection Case Num bers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month and the community hospitals within each CHP. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data is presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website: Clostridium difficile : http://www.nhs24.com/content/default.asp?page=s5_4& articleID=2139§ionID=1 Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346 MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252§ionID=1 For each acute hospital and community hospitals in the CHP, the total cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out-of-hospital” report card. Understanding the Report Cards – Hand Hygiene Compl iance Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website: http://www.washyourhandsofthem.com/ Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital/CHP report card presents the percentage of hand hygiene compliance for all staff in both graph and table form.
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Understanding the Report Cards – Cleaning Complianc e Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ The Report Cards show the hospitals’ cleaning compliance percentage in both graph and table form.
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Abbreviations AMT Antimicrobial Prescribing Team
AMAU Acute Medical Admissions Unit
CHP Community Health Partnership
CDI Clostridium difficile Infection
CNO Chief Nursing Officer
CVC Central Venous Catheter
CSM Clinical Services Manager
ECDC European Centre for Disease Prevention & Control
GDP General Dental Practitioner
HAI Healthcare Associated Infection
HAIRT Healthcare Associated Infection Reporting Template
HEAT Health Improvement, Efficiency, Access, Treatment
HEI Healthcare Environment Inspectorate
Hemi arthroplasty An operation used to treat fractured hip similar to a total hip replacement, but involves only half of the hip.
ICU Intensive Care Unit
JAG Joint Advisory Group
MSSA Meticillin Sensitive Staphylococcus Aureus
MRSA Meticillin Resistant Staphylococcus Aureus
PICC Peripherally Inserted Central Catheter
PPI Proton Pump Inhibitor
PVC Peripheral Venous Catheter
QUAD Quality Assurance Document
RIDDOR Reporting of Injuries, Diseases and Dangerous Occupational Regulations 1995
SAB Staphylococcus aureus Bacteraemia
SCN Senior Charge Nurse
SHPN Scottish Health Planning note
SHTM 64 Scottish Health Technical Memoranda – Sanitary assemblies.
SPC Statistical Process Chart
SAPG Scottish Antimicrobial Prescribing Group
SICPs Standard Infection Control Precautions
SPSP Scottish Patient Safety Programme
VAP Ventilator Associated Pneumonia
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Staphylococcus Aureus Bacteraemia (SAB) criteria
Contaminated blood culture
• Staphylococcus aureus isolated from blood, and • SAB diagnosis incompatible with clinical picture, i.e. no or minimal
clinical signs and symptoms indicating SAB.
Hospital acquired infection
• Staphylococcus aureus isolated from blood cultures taken 48 hours after admission or within 48 hours of discharge, and,
• The presence of clinical signs and symptoms indicating SAB
Community onset-healthcare associated infection
• Staphylococcus aureus isolated from blood cultures taken <48 hours after admission, and
• The presence of clinical signs and symptoms indicating SAB, and • At least one of the following within the past 12 months:
o Hospitalisation or invasive device management as an outpatient / community patient, or dialysis as an outpatient / community patient.
True community infection
• Staphylococcus aureus isolated from blood, and • No hospitalisation within the past 12 months • No dialysis within the past 12 months • No community or outpatient healthcare for invasive device
management in the past 12 months
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APPENDIX ONE: NHS Highland Infection Prevention & Control Annual Work Plan 2013/2014 Argyll and Bute CHP
Objective
Activity Timescale Lead Officer
1.HEAT Targets
1.1 To continue to reduce the number of SAB cases to achieve the HEAT Target of 24 cases per 100,000 acute occupied beds days or lower by March 2015
a) By ensuring compliance with device related bundles – PVC, CVC, PICC, CAUTI b) By ensuring compliance with NHS Highland wound management guidelines & formulary. c) By reviewing the causes of community acquired SABs, to give an understanding of what preventable measures are required. d) By reviewing the causes of healthcare acquired SABs, to give an understanding of what preventable measures are required.
March 2015
Lead Nurse Supported by the Infection Prevention & Control Team
a) By monitoring the adherence to the Clostridium difficile policy – to highlight areas for improvement (compliance with hand hygiene, antimicrobial & proton pump inhibitor prescribing, environmental cleanliness & fabric maintenance, appropriate isolation)
March 2015
Lead Nurse Supported by the Infection Prevention & Control Team
1.2. To reduce the number of Clostridium difficile cases to achieve the HEAT Target of 25 cases per 100,000 occupied bed days in patient’s age 15 years and over by March 2015.
b)By ensuring the delivery of the most up to date testing
c)By the use of high quality local data to inform primary and secondary care
March 2014 Infection Control Doctor/Consultant Microbiologists
24
2. Infection Prevention & Control is everyone’s business
2.1 Embed the importance of Infection Prevention & Control into everyday practice.
a) By ensuring that the ten elements of Standard Infection Control Precautions are implemented and audited to ensure compliant practice. b) By ensuring that there is Infection Prevention & Control input in all new builds/refurbishments as per HAI Scribe. c) By having risk assessed plans in place regarding non- compliant sinks & poor fabric maintenance. d) By ensuring there are systems in place to minimise the health & safety risks to staff using cleaning products e) By auditing compliance with NHS Scotland MRSA Screening policy. f) By ensuring that staff who are exposed to biological agents i.e. aerosol generating procedures, have access to and comply with wearing appropriate PPE.
March 2014 Lead Nurse Supported by the Infection Prevention & Control Team
3.HAI Standards 3.1 Embed the process and governance arrangements for HAI Standards Monitoring.
a) By ensuring there is a programme of HAI standards monitoring visits in each Operational Unit. b) By ensuring that there is a system in place to escalate any actions which cannot be progressed through the line management structure and if necessary to the Chief Operating Officer. c) By submitting quarterly reports to the Infection Control Improvement Group.
March 2014 Lead Nurse Supported by the Infection Prevention & Control Team
4.HAI Education 4.1 Ensure Patient/Service Users safety is achieved in relation to Infection Prevention & Control by standardising HAI education and
a) Implement NHS Highland guidance on Infection Control training for all staff
March 2014 NHS Highland HAI Education Group
25
training, targeted at different staff groups across NHS Highland in
• Hospitals • Community • Primary Care • Care Homes • Care at Home • Adult Day Care Centres • Learning Disability • Bank Staff • Social Work Staff • Volunteers and Contractors
b) ensure that staff have HAI objective within their PDPs c) ensure that Community Nurses complete the required modules and records of training are available
d) Identify what protected learning time is required for HAI training
e) Look at barriers preventing HAI training
f)Ensure that NHS Highland has a robust system of recording what training has been undertaken
5.Decontamination
5.1 Achieve compliance with all aspects of decontamination.
a) By ensuring that there are systems, processes and facilities for safe endoscopy decontamination. a) By putting systems in place around procurement of equipment to ensure effective decontamination. b) By ensuring that there are systems, processes and facilities for safe decontamination. c) By ensuring that there are plans in place for all (General Dental Practitioners) GDP independent contractors to be able to provide LDU facilities within their practices for the decontamination of instruments which are compliant with SHPN 13 Part 2.
March 2014 Head of dental Services/ Locality Managers/ Infection Control Nurses
6.Water Safety 8.1 Ensure Argyll and Bute has robust and consistent arrangements in place for the safety of the water systems in NHS Highland comply with legal duties and relevant guidance
a) By implementing NHS H procedures for the prevention of water-borne infection which include risk assessment, analysis and planned preventative maintenance.
b) By ensuring that daily water flushing is carried out to reduce the risk of water borne infection
March 2014 Estates Manager and Hotel services Managers
26
7.Domestic Services
7.1 To support Domestic Services to achieve 90% Cleaning compliance.
a) By the development and implementation of Standard Operating Procedures (SOPs), including products used and reports to Senior Charge Nurses b) By the development and implementation of Domestic Services SOPs Training c) By the development and implementation of Domestic Services Standard Monitoring Procedures and Monitoring Training. d) By assessing Domestic Services staffing levels based on the agreed SOPs. e) By monitoring the implementation of COSHH procedures & Risk Assessments.
March 2014 Hotel Services Managers
8. Catering Services
8.1 To support Catering Services & Clinical Staff to ensure food safety from production to delivery.
a) Through education & training such as • Elementary Food Hygiene Certificate • Hazard Analysis and Critical Control Points
(HACCP) Training • Food Service at Ward Level
b) By monitoring compliance with food safety standards.
March 2014 Hotel Services Manager
Argyll & Bute CHP Committee 21 August 2013
Item : 7.3 Community Planning and Single Outcome Agreement Report by Elaine Garman Public Health Specialist The Committee is asked to: • Note this paper
1 Background and Summary 1.1 In March 2012, the Scottish Government and COSLA jointly issued a Statement of Ambition signalling their agreement that Community Planning Partnerships (CPPs) will be at the heart of public service reform. This statement went on to say: “They [CPPs] will drive the pace of service integration, increase the focus on prevention and secure continuous improvement in public service delivery, in order to achieve better outcomes for communities. Community planning and SOAs will provide the foundation for effective partnership working within which wider reform initiatives, such as the integration of health and adult social care and the establishment of single police and fire services, will happen.” 1.2 The document is clear that Government expects CPPs to: • strengthen their governance, accountability and operating arrangements; • ensure a greater pace of change and decisiveness in impact; • develop new and different ways of working and behaviour within and across partners; • take a more systematic and collaborative approach to performance improvement and
quality standards, including national requirements where appropriate, with robust self-assessment as a starting point.
• to report on progress and performance in ways that are clear to local elected members, CPP partners, local communities, the Scottish Government and audit and inspection bodies.
1.3 The paper goes on to emphasise that the development, delivery and performance management of Single Outcome Agreements (SOAs) are key to this. It requires new SOAs to be developed that:
• Show a clear understanding of place providing a clear and robust link and strong line of sight between that understanding and the priorities, outcomes, and performance commitments set out in the new SOA.
• Plan and deliver for outcomes demonstrating what will be different for communities in
10 years and what will be done to secure those improved outcomes on a rolling 3 year basis.
• Show how the total resource available to the CPP and partners has been
considered and deployed in support of the agreed outcomes • Focus on reducing outcome gaps within populations and between areas i.e.
addressing and reducing inequalities
• Promote early intervention and preventative approaches defined by the national community planning group as, “Actions which prevent problems and ease future demand on services by intervening early, thereby delivering better outcomes and value for money”. Each SOA is to include a specific plan for prevention which demonstrates
2
commitment to the approach extending beyond any Change Fund type budgets and into mainstream services. The prevention plan is to quantify the resources allocated to prevention and to evidence commitment to increasing them over time.
• Demonstrate genuine community engagement and evidence that the CPP is planning, resourcing and integrating work to support communities to engage and deliver for themselves.
• Focus on national policy priorities by aiming to achieve transformational, not incremental, performance improvement. The six priorities are:
• Economic recovery and growth;
• Employment;
• Early years;
• Safer and stronger communities, and reducing offending;
• Health inequalities and physical activity; and
• Outcomes for older people. 1.4 In March 2013, Audit Scotland published its report into Improving Community Planning
in Scotland. Amongst the key audit findings were that: • CPPs cannot show that they have made a sustained and significant difference in
improving outcomes for their communities and they have not made an impact on reducing social inequality.
• SOAs have not been clear enough about the key improvements that community planning aims to deliver and have lacked clear focus on the added value of CPPs and of partnership working
• There is long way to go before services are truly designed around local communities and the potential of local people to participate in, shape and improve local services is realised.
• Community planning has had little influence over mainstream resources and collective resources are not well known or used.
• CPPs need to get better at managing performance. • CPPs have had weak governance and accountability structures. • CPPs have not been subject to comprehensive external scrutiny to date and this has
contributed to weaknesses in the overall accountability framework for community planning
• The broader public service reform agenda does not appear to be well ‘joined up’ when viewed from a local perspective
1.5 The report makes five groups of recommendations, each reflecting aspects for CPPs
themselves, for The National Community Planning Group, and for The Scottish Government. For CPPs, the recommendations are:
• Strong Shared Leadership: Community planning needs to become a truly shared
enterprise, rather than a council-led exercise. This will mean changes in behaviour and more effective engagement and participation by partners, both executive and non-executive. CPPs need to start acting as true leadership boards, setting a stretching ambitious programme for change and holding people to account for delivering them.
• Governance and accountability: CPPs need to significantly improve their governance
and accountability, and planning and performance management arrangements by successfully mobilising resources towards agreed goals; showing that partnership
3
working is making a significant difference in improving services and delivering better outcomes for communities; clarifying roles and responsibilities for elected members, non-executives and officers; and ensuring that CPP decision-making is reflected fully within the governance structures of all partners. CPPs need to assure themselves that the proposed arrangements for health and social care integration in their area reflect local circumstances and priorities; are clear about the respective roles and responsibilities of the CPP and H&SCP; will improve the quality of care and outcomes for older people; and will deliver improved value for money.
• Clear priorities for improvement and for use of resources: CPPs need to focus more clearly on where they can make the greatest difference in meeting the complex challenges facing their communities. They need to make their SOAs a true plan for the areas and communities that they serve. They need to show how they are using the significant public money and other resources available to CPP partners to target inequalities and improve outcomes. SOAs need to specify what will improve, how it will be done, by whom, and when. CPPs need to ensure that partners align their service and financial planning arrangements with community planning priorities. This means ensuring that budget setting and business planning decisions by CPP partners such as councils and NHS boards take full account of community planning priorities and SOA commitments.
• Community engagement and empowerment: CPPs need to extend and improve their
approach to engaging with communities if the potential of local people to participate, shape and improve local services is to be realised.
• Improvement support and capacity building: CPPs need to establish effective self-
evaluation arrangements that will allow them to target their local improvement activity (leadership, governance, service delivery, etc) appropriately and demonstrate continuous improvement in their operation. They also need to establish effective arrangements for learning and sharing good practice with each other.
2 Community Planning and the SOA in Argyll & Bute 2.1 A&B CPP has developed a draft SOA (see Appendix 1) and has had a visit from a nationally organised ‘peer review scrutiny panel’ from which written feedback is awaited although we have received initial feedback (see Appendix 2) with regard to the draft SOA prior to the scrutiny visit. 2.2 Each CPP has to undertake a form of self assessment against the Audit Scotland report and the national guidelines for CPPs and SOAs. This is being done following work on the SOA and this will also consider again the Audit Scotland Inequalities report response. 2.3 An action plan to address the issues arising from the self assessment is also required for each CPP. The final SOA is to be agreed and submitted to Scottish Government by 31 March 2014. 2.4 In addition to contributing to the specific health components of the SOA, as part of the Local Delivery Plan (LDP) the CHP illustrated (see Appendix 3) how it is contributing to the six national priorities to improve performance set out in the last bullet point of 1.3 above by providing some examples of their specific contributions to the SOAs for their area, demonstrating how they are contributing to better outcomes through collaborative gain. Scottish Government sees this part of the LDP as a key tool for non-Executive and Executive Board members (see Appendix 4) to exercise oversight and suggest that Boards will want to be sighted on the outcome of the quality assurance of SOAs in their area and in particular the key areas for development and/or improvement arising from the quality assurance process.
4
2.5 The LDP submission was to be with Government by the end of June, only part way through the national timetable set for SOA development, peer review and partnership improvement, so our submission reflects an interim position. To date, no feedback has been received from Government. 2.6 The next steps for the CHP are to ensure that plans are in place through the Health & Wellbeing Partnership, the public health team and locality clinical teams to deliver on all aspects of the SOA. The process for agreeing performance indicators has not yet been decided within the CPP but preparatory work for that can begin in the CHP. 3 Contribution to Board Objectives The work on the SOA and community planning overall contributes to all three NHS Highland quality objectives (Better Health – improving the health of the population; Better Care – enhancing the experience of care for individuals; and Better Value – controlling the per capita cost of care) 4 Governance Implications • Patient and Public Involvement
Significant community engagement is required to ensure good partnership working for community planning.
• Clinical Governance
Interventions require to be evidence-informed. • Financial Impact
One of the aims of the SOA and community planning generally is to direct mainstream budgets increasingly to tackle inequalities and prevention. All aspects investment and disinvestment will be considered with regard to potential impacts.
5 Risk Assessment No risks are identified at this time. 6 Planning for Fairness There is no requirement to impact assess until specific changes are being suggested to policy or practice. Elaine C Garman Public Health Specialist 2 August 2013
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relia
nce
on f
err
ies f
or
tra
ve
l. A
lmost
80
% o
f th
e
po
pu
latio
n liv
e w
ith
in o
ne
kilo
me
tre
of
the
co
ast
(Sco
ttis
h C
oa
sta
l F
oru
m, 2
002
).
The
ma
in s
ett
lem
en
ts te
nd
to
be
at
the
extr
em
ity o
f th
e m
ain
lan
d a
rea
cre
atin
g s
ign
ific
ant p
opu
latio
n d
ispe
rsio
n in
add
itio
n to
lo
w
po
pu
latio
n d
en
sity.
The
pop
ula
tio
n is b
roa
dly
sp
lit b
etw
ee
n t
ho
se
wh
o liv
e in
se
ttle
me
nts
of
3,0
00
or
mo
re p
eop
le (
48
%)
and
th
ose
wh
o liv
e in
se
ttle
men
ts o
f fe
we
r th
an
3,0
00
peo
ple
or
ou
twith
se
ttle
me
nts
alto
ge
the
r (5
2%
) (N
RS
20
11
Mid
-Ye
ar
Estim
ate
s;
SG
U
rba
n-R
ura
l C
lassific
atio
n 2
01
1-
201
2).
T
he
siz
e o
f th
e a
rea
and
pop
ula
tio
n d
isp
ers
ion
re
qu
ire
mu
ltip
le fa
cilt
ies f
or
se
rvic
e d
eliv
ery
to
en
su
re s
erv
ice
s a
re d
eliv
ere
d c
lose
to
u
se
rs a
nd
com
mun
itie
s.
Th
e d
ista
nce
be
twe
en
ma
in s
ett
lem
en
ts a
nd
use
of fe
rry s
erv
ice
s c
rea
te c
ha
llen
ge
s in
te
rms o
f re
liab
ility
a
nd
tim
e a
nd
co
st
of
tra
ve
l. T
he
ge
ogra
ph
y o
f A
rgyll
an
d B
ute
ca
nnot
be
ch
an
ge
d s
o th
e c
ha
llen
ge
is h
ow
to
ma
xim
ise
th
e
ad
va
nta
ge
s it off
ers
and
min
imis
e th
e im
pa
ct of
an
y r
ea
l o
r p
erc
eiv
ed
ob
sta
cle
s.
The
im
po
rtan
ce
of
the
na
tura
l e
nviro
nm
en
t is
in
dic
ate
d b
y t
he 1
21
Site
s o
f S
pe
cia
l S
cie
ntific I
nte
rest
(SN
H,
as a
t D
ece
mb
er
20
12
) th
at h
ave
be
en
de
sig
na
ted w
ith
in t
he
are
a w
hic
h in
to
tal co
ve
r a
lmost
ten p
er
ce
nt of
Arg
yll
an
d B
ute
’s la
nd
are
a. A
dd
itio
na
lly,
alm
ost th
irty
pe
r cen
t of
the L
och
Lo
mo
nd
an
d t
he
Tro
ssa
ch
s N
atio
na
l P
ark
are
a fa
lls w
ith
in t
he
lo
ca
l a
uth
ority
’s b
ou
nd
arie
s
Po
pu
lati
on
an
d D
em
og
rap
hic
s
The
tota
l po
pu
lation
of A
rgyll
an
d B
ute
is 8
8,2
00
ba
se
d o
n t
he
20
11 c
en
su
s. T
his
com
pa
res t
o a
to
tal po
pu
latio
n fo
r th
e a
rea o
f 9
1,3
06
in t
he
20
01 c
ensu
s a
red
uction
of
3.4
%.
Arg
yll
an
d B
ute
was o
ne o
f o
nly
4 lo
ca
l a
uth
ority
are
as to
sh
ow
a d
ecre
ase
in
p
opu
latio
n.
Fu
ture
po
pu
latio
n p
roje
ctio
ns s
ugge
st
a r
edu
ctio
n in
to
tal p
opu
latio
n o
f 7
.2%
fro
m 2
01
0 t
o 2
03
5.
Page 27 7.3i - Appendix 1
��
� The
cha
nge
in
pop
ula
tio
n f
rom
20
01
to
201
1 is d
iffe
ren
t a
cro
ss t
he
4 a
rea
s o
f A
rgyll
an
d B
ute
as s
et o
ut b
elo
w.
•
He
len
sb
urg
h a
nd
Lom
on
d -
6.8
%
•
Bu
te a
nd
Co
wa
l -3
.8%
•
Mid
Arg
yll,
Kin
tyre
an
d I
sla
y -
1.3
%
•
Ob
an,
Lo
rn a
nd
th
e Isle
s +
6.8
%
The
de
clin
e in p
op
ula
tio
n e
xp
erie
nce
d to
da
te a
nd t
ha
t p
roje
cte
d in
th
e fu
ture
pre
sen
ts a
sig
nific
ant
ch
alle
nge
to th
e o
ve
rall
via
bili
ty
of
the
are
a. T
his
ch
alle
nge
is m
ad
e m
ore
difficu
lt b
y t
he
va
ria
tio
n in
po
pu
latio
n c
han
ge
s o
ve
r th
e a
rea
s w
ith
in A
rgyll
an
d B
ute
. H
ow
d
oe
s th
e C
PP
bu
ild o
n e
xis
tin
g s
ucce
ss in
are
as t
ha
t ha
ve
actu
al o
r p
ote
ntia
l fo
r gro
wth
wh
ilst
at
the
sam
e t
ime
turn
ing r
ou
nd
th
e
po
sitio
n in
are
as w
he
re d
eclin
e is p
roje
cte
d?
In a
dd
itio
n t
o t
he c
hange
s in
to
tal p
op
ula
tio
n th
e d
em
ogra
ph
ic b
ala
nce
is a
lso
ch
an
gin
g. T
he
tab
le b
elo
w s
ho
ws t
he
ch
an
ge
in
p
opu
latio
n o
ve
r a
ge
coh
ort
s p
roje
cte
d f
or
20
10
and
20
35 a
nd
als
o t
he
ch
an
ge
s in
dem
ogra
ph
ics b
etw
ee
n 2
00
1 a
nd
20
11.
A
ge
Ra
nge
Ch
an
ge
20
01 t
o 2
01
1
Pro
jectio
ns 2
01
0 to
203
5
Un
de
r 15
-16
.6%
-8
.7%
1
5-6
4
-5.2
%
-14
.4%
O
ve
r 6
5
+1
5.0
%
+3
9.7
%
Mo
re p
eo
ple
liv
ing lo
nge
r is
a r
ea
l su
cce
ss. T
he
de
mo
gra
ph
ic c
ha
nge
s d
o h
ow
eve
r cre
ate
a n
um
be
r of
cha
llen
ges.
Th
ese
ch
alle
nge
s r
an
ge
fro
m c
ha
nge
s to
se
rvic
e d
eliv
ery
re
qu
ire
me
nts
fo
r C
PP
pa
rtn
ers
, th
e a
va
ilab
ility
of
pe
op
le to
jo
in t
he
ove
rall
wo
rkfo
rce
in
Arg
yll
an
d B
ute
, a s
ma
ller
poo
l of
pe
op
le c
rea
tin
g w
ea
lth
and
ho
w t
o e
nh
an
ce
th
e e
co
no
mic
or
com
mu
nity c
on
trib
utio
n
ma
de
by p
eo
ple
. E
co
no
my a
nd
Em
plo
ym
en
t A
rgyll
an
d B
ute
’s e
co
no
my is p
red
om
ina
ntly s
erv
ice
-ba
se
d.
Ove
r 8
5%
of
em
plo
ye
e jo
bs in
th
e a
rea
are
pro
vid
ed w
ith
in t
he
se
rvic
e
se
cto
r. 1
4.9
% o
f em
plo
ye
e jo
bs in
Arg
yll
an
d B
ute
are
in t
ou
rism
-re
late
d a
ctivitie
s c
om
pa
red
to
a S
co
ttis
h a
ve
rage
of
8.9
% (
Off
ice
fo
r N
atio
na
l S
tatistics (
ON
S)
An
nu
al B
usin
ess I
nqu
iry e
mp
loye
e a
na
lysis
, 2
00
8 d
ata
(N
OM
IS,
Ma
rch
20
13
)).
Page 28 7.3i - Appendix 1
��
�Arg
yll
an
d B
ute
ha
s r
ela
tive
ly h
igh
le
ve
ls o
f em
plo
ym
en
t in
agricu
ltu
re, fo
restr
y a
nd f
ish
ing (
6%
co
mp
are
d t
o a
Sco
ttis
h a
ve
rage
of
2%
) a
nd
pub
lic a
dm
inis
tra
tio
n, e
du
ca
tion
an
d h
ea
lth
(3
6%
com
pa
red
to
a S
co
ttis
h a
ve
rage
of
31
%).
Fe
we
r p
eop
le in
Arg
yll
an
d
Bu
te w
ork
in
ma
nufa
ctu
rin
g (
3%
co
mp
are
d t
o a
Scott
ish
ave
rage
of
8%
).
In 2
00
9 t
he
re w
ere
55
,80
0 p
eop
le o
f w
ork
ing a
ge
(m
ale
s a
nd
fem
ale
s a
ge
d 1
6-6
4)
in A
rgyll
an
d B
ute
. O
f th
ese
, 78
% (
42
,40
0)
we
re
eco
no
mic
ally
active
. T
his
pro
po
rtio
n is s
imila
r to
th
e S
co
ttis
h a
ve
rage
of
77
% (
ON
S A
nn
ua
l P
opu
lation
Su
rve
y,
Octo
be
r 2
011
-S
ep
tem
be
r 20
11
da
ta (
NO
MIS
, M
arc
h 2
013
)). W
ith
in t
his
gro
up,
the
ma
jority
of
wo
rke
rs (
59%
) w
ere
em
plo
ye
es.
Ra
tes o
f se
lfe
mp
loym
ent
(12
%)
are
notice
ab
ly h
igh
er
tha
n th
e S
co
ttis
h a
ve
rage
(8
%)
(fig
ure
2).
F
igu
res f
rom
th
e O
NS
An
nua
l P
op
ula
tio
n S
urv
ey (
Octo
be
r 20
11
-Sep
tem
be
r 2
012
(N
OM
IS,
Ma
rch
20
13
)) s
ugge
st
that
Arg
yll
an
d
Bu
te h
as a
slig
htly h
igh
er
pro
po
rtio
n o
f d
ire
cto
rs,
ma
na
ge
rs a
nd
se
nio
r off
icia
ls a
mon
gst
its w
ork
forc
e th
an t
he S
co
ttis
h a
ve
rage
(A
rgyll
an
d B
ute
: 10
.0%
; S
co
tla
nd:
8.3
%).
A r
ela
tive
ly h
igh
pro
po
rtio
n o
f em
plo
ym
en
t in
skill
ed
tra
de
s (
15
% in A
rgyll
an
d B
ute
(O
NS
A
nn
ua
l P
op
ula
tio
n S
urv
ey (
Octo
be
r 20
11
- S
ep
tem
be
r 2
012
(N
OM
IS,
Ma
rch
20
13
)) is d
rive
n b
y t
he
agricu
ltu
ral secto
r. T
he
pro
po
rtio
n o
f p
eo
ple
em
plo
ye
d a
s p
roce
ss,
pla
nt a
nd m
ach
ine
op
era
tive
s is lo
w (
5.6
% in
Arg
yll
an
d B
ute
), in
lin
e w
ith
th
e lo
w
pro
po
rtio
n o
f p
eo
ple
em
plo
ye
d in m
an
ufa
ctu
rin
g.
The
re
lative
ly h
igh
pe
rce
nta
ge
s o
f a
sso
cia
te p
rofe
ssio
na
l a
nd t
ech
nic
al jo
bs in
th
e
Co
mm
ute
r B
elt ide
ntifie
d in
th
e C
en
su
s r
esu
lt f
rom
th
e p
resen
ce
th
e n
ava
l b
ase a
t F
asla
ne,
as s
erv
ice
me
n a
nd
wo
men
fa
ll in
to th
is
gro
up
. G
ross V
alu
e A
dd
ed
is a
n ind
ica
tor
of
we
alth
cre
atio
n a
nd
me
asu
res th
e c
on
trib
utio
n to
th
e e
co
nom
y o
f ea
ch
ind
ivid
ua
l p
rod
uce
r,
ind
ustr
y o
r se
cto
r. O
ve
r re
ce
nt
ye
ars
Arg
yll
an
d B
ute
ha
s w
itn
essed a
n im
pro
ve
me
nt
with
re
ga
rd t
o its
GV
A p
er
em
plo
ye
e f
igu
res.
At
the
Arg
yll
an
d B
ute
lo
ca
l au
tho
rity
are
a le
ve
l ke
y s
ecto
rs s
uch
man
ufa
ctu
rin
g,
co
nstr
uctio
n,
se
rvic
es a
nd
to
urism
are
90
%,
12
3%
, 8
2%
an
d 9
3%
re
sp
ective
ly o
f th
e S
co
ttis
h a
ve
rage
. A
cco
rdin
g t
o th
e A
nn
ua
l S
urv
ey o
f H
ou
rs a
nd E
arn
ings (
AS
HE
) (N
OM
IS,
Ma
y 2
01
2),
in
201
2 th
e a
ve
rage
re
sid
ent
in A
rgyll
an
d
Bu
te e
arn
ed
£4
62
pe
r w
ee
k,
7%
lo
we
r th
an
th
e a
ve
rage
fo
r S
co
tland
. U
ne
mp
loym
en
t ra
tes in
Arg
yll
an
d B
ute
are
be
low
th
e n
atio
na
l a
ve
rage
alth
ou
gh
, be
cau
se o
f th
e h
igh
le
ve
ls o
f sea
so
na
l e
mp
loym
en
t in
the
are
a,
rate
s v
ary
acco
rdin
g t
o t
ime
of
ye
ar.
T
he
re a
re a
num
be
r of
ch
alle
nge
s r
ela
tin
g t
o e
co
no
my a
nd
em
plo
ym
ent.
A h
igh
de
pen
den
ce
on
sea
so
na
l in
du
str
ies r
esu
lts in
man
y
ch
alle
nge
s w
he
re b
y w
ork
ers
ma
y t
ake
mu
ltip
le jo
bs d
urin
g t
he s
um
me
r pe
rio
d to
ma
xim
ise
in
com
e a
nd
lo
ok f
or
oth
er
job
s w
he
n
Page 29 7.3i - Appendix 1
�
�the
“sea
so
n”
is o
ve
r o
r co
mm
ute
to
oth
er
are
as t
o s
ee
k e
mp
loym
en
t o
r h
igh
er
ea
rnin
gs.
In g
en
era
l te
rms G
VA
and
in
com
e is lo
we
r th
an t
he
Scott
ish
ave
rage
. T
he
re is a
hig
he
r de
pen
den
cy o
n s
ea
so
na
l in
du
str
ies a
nd
th
e p
ub
lic s
ecto
r th
an
oth
er
are
as.
Arg
yll
an
d B
ute
als
o h
as a
ran
ge
of
opp
ort
unitie
s w
he
re it
po
sse
sses f
acto
rs o
f com
pe
titive
ad
va
nta
ge
th
at w
he
n ta
ke
n in
the
ir
en
tire
ty m
ake
s it a
un
iqu
e lo
ca
l e
co
nom
y a
nd
one
th
at h
as m
uch
to o
ffe
r S
co
tlan
d’s
lon
g-t
erm
eco
no
mic
gro
wth
an
d s
ecu
rity
. T
he
se
in
clu
de
an
ab
un
da
nce o
f su
sta
inab
le e
co
no
mic
asse
ts e
spe
cia
lly in
te
rms o
f re
ne
wa
ble
energ
y,
fore
str
y,
qu
alit
y f
oo
d a
nd
drin
k a
nd
to
urism
, a
nd
its
bo
un
da
ry w
ith
Sco
tla
nd
’s C
en
tra
l B
elt.
Ma
rin
e s
cie
nce
and
cu
ltu
re a
nd
he
rita
ge
are
fu
rthe
r a
rea
s o
f sig
nific
an
t gro
wth
po
ten
tia
l. In
add
itio
n to
pu
rsu
ing g
row
th in
th
ese
ke
y s
ecto
rs it
will
be
im
po
rta
nt
to e
nsu
re th
ere
is a
fo
cu
s o
n s
up
po
rtin
g
exis
tin
g b
usin
esse
s to
gro
w a
s w
ell
as d
eve
lop
ing n
ew
bu
sin
esse
s.
De
ve
lop
men
t of
the
eco
nom
y a
nd
em
plo
ym
en
t w
ill r
equ
ire
in
ve
stm
en
t to
en
su
re infr
astr
uctu
re is n
ot
a b
arr
ier
to g
row
th a
nd
th
at
su
ppo
rt f
or
ed
uca
tio
n, skill
s a
nd
tra
inin
g c
rea
tes t
he
con
ditio
ns t
o d
eve
lop
an
ap
pro
pria
tely
skill
ed
an
d e
xp
erie
nced
wo
rkfo
rce
. D
ep
riva
tio
n
The
Sco
ttis
h In
de
x o
f M
ultip
le D
ep
riva
tio
n (
SIM
D),
pro
du
ced
by t
he
Sco
ttis
h G
ove
rnm
en
t, id
en
tifie
s s
ma
ll-a
rea
con
ce
ntr
atio
ns o
f m
ultip
le d
ep
riva
tio
n a
cro
ss S
co
tlan
d. T
he
SIM
D is p
rod
uced
at d
ata
zo
ne
le
ve
l. T
he
re a
re 6
505
da
tazo
ne
s in
Sco
tla
nd
and
12
2
da
tazo
ne
s a
re in
Arg
yll
an
d B
ute
. T
he
re
su
lts f
or
Arg
yll
an
d B
ute
fro
m t
he
SIM
D 2
012
sho
w
•
10
da
tazo
ne
s in
Arg
yll
an
d B
ute
in
th
e 1
5%
mo
st
ove
rall
dep
rive
d d
ata
zo
ne
s.
•
9 d
ata
zo
ne
s a
re in
th
e 1
5%
mo
st in
com
e d
ep
rive
d d
ata
zo
ne
s.
•
8 d
ata
zo
ne
s a
re in
th
e 1
5%
mo
st em
plo
ym
en
t d
ep
rive
d d
ata
zo
ne
s.
•
12
da
tazo
ne
s a
re in
the
15
% m
ost h
ea
lth
de
pri
ve
d d
ata
zo
ne
s.
•
41
,73
8 p
eop
le liv
e in
th
e 5
3 d
ata
zo
ne
s (
43
%)
tha
t a
re a
mon
gst
the
15
% m
ost a
cce
ss d
ep
rive
d d
ata
zo
ne
s.
•
13
of
Arg
yll
an
d B
ute
’s d
ata
zo
ne
s –
mo
re t
han
10
% –
are
in
th
e 1
% m
ost a
cce
ss d
ep
rive
d d
ata
zo
ne
s .
The
mo
st a
cce
ss d
ep
rive
d d
ata
zo
ne in
Sco
tlan
d c
ove
rs t
he
isla
nd
s o
f C
oll
and
Tire
e.
All
of
the
da
tazo
ne
s t
ha
t a
re in
the
15
% m
ost O
ve
rall,
In
com
e, E
mp
loym
en
t a
nd H
ea
lth
dep
rive
d d
ata
zo
ne
s in
Sco
tla
nd
are
in
ou
r m
ain
to
wn
s.
Co
nve
rse
ly,
Acce
ss D
ep
riva
tio
n is m
ost p
ron
oun
ce
d in
ou
r ru
ral a
rea
s.
Page 30 7.3i - Appendix 1
�
�De
priva
tio
n d
oe
s e
xis
t in
its
va
rio
us f
orm
s in
Arg
yll
an
d B
ute
. W
he
re it
rela
tes t
o in
com
e, e
mp
loym
en
t a
nd
he
alth
it
ten
ds to
be
d
isp
ers
ed in
sm
all
conce
ntr
ation
s in
ou
r m
ain
to
wn
s.
Giv
en
th
e d
ispe
rse
d n
atu
re o
f A
rgyll
an
d B
ute
th
is c
rea
tes c
ha
llen
ge
s in
id
en
tify
ing a
nd
ad
dre
ssin
g d
ep
riva
tio
n a
nd
its
ca
use
s.
It is c
lea
r th
at in
equ
alit
ies d
o e
xis
t w
ith
in
Arg
yll
an
d B
ute
and
the
CP
P m
ust
pla
n to
ad
dre
ss th
ese
. H
ea
lth
P
hysic
al in
activity is a
sig
nific
an
t h
ea
lth
issue n
ation
ally
an
d in A
rgyll
an
d B
ute
. It c
ontr
ibu
tes t
o m
an
y lo
ng t
erm
he
alth
co
nd
itio
ns
su
ch
as C
HD
, d
iabe
tes a
nd s
om
e c
an
ce
rs, a
s w
ell
as o
ve
rwe
igh
t a
nd
hig
h b
loo
d p
ressu
re. T
he
re a
re s
tro
ng lin
ks b
etw
ee
n
incre
ase
d p
hysic
al a
ctivity le
ve
ls a
nd
im
pro
ve
d m
en
tal w
ellb
ein
g.
Me
nta
l he
alth
pro
ble
ms a
re v
ery
co
mm
on
in
Sco
tla
nd
with
one
in
4 p
eop
le e
xp
erie
ncin
g the
m d
urin
g t
he
ir lifetim
e.
Th
is h
as a
sig
nific
an
t im
pa
ct o
n loca
l a
rea
s a
nd
eco
nom
ies, fo
r e
xa
mp
le w
ork
lessn
ess a
nd
dem
an
d for
he
alth
ca
re s
erv
ice
s. T
he
World
He
alth
O
rga
nis
atio
n r
eco
gn
ise
s t
he
im
po
rtan
ce
of
me
nta
l h
ea
lth
im
pro
ve
me
nt a
nd s
tate
s “
the
re c
an
be
no
he
alth w
ith
out
me
nta
l h
ea
lth
”.
In 2
01
1 it
wa
s e
stim
ate
d t
he
re w
ere
77
0 p
rob
lem
dru
g u
se
rs in
Arg
yll
& B
ute
wh
ich
wa
s a
40
% in
cre
ase
fro
m 2
006
. S
tatistics o
n
the
use
of
alc
oh
ol a
mon
gst
yo
un
g p
eo
ple
in
Arg
yll
& B
ute
sho
w t
ha
t th
ere
is a
hig
he
r th
an
ave
rage
exp
erim
en
tation
and
use
of
alc
oh
ol th
an
the
re
st of
Sco
tlan
d.
De
ath
ra
tes d
rugs a
nd
alc
oho
l lo
we
r th
an
ave
rage
L
ife
exp
ecta
ncy 7
5.8
an
d 8
0.4
is a
bo
ve
Sco
ttis
h a
ve
rage
74
.5 a
nd
79
.5. O
ur
he
alth
y life
exp
ecta
ncy is 6
8.5
ye
ars
(m
ale
s)
an
d 7
2.5
ye
ars
(fe
ma
les)
com
pare
d t
o th
e S
cott
ish
ave
rage
of
66
.3 (
ma
les)
an
d 7
0.2
(fe
ma
les)
(1999
-20
03
; S
co
tPH
O).
E
du
ca
tio
n
The
ed
ucatio
na
l a
tta
inm
ent
in A
rgyll
an
d B
ute
is a
bo
ve
th
e n
atio
na
l a
ve
rage
in
mo
st m
ea
su
res a
nd
in
201
1-1
2,
90
.1%
of
scho
ol
lea
ve
rs a
ch
ieve
d a
po
sitiv
e a
nd
su
sta
ined
de
stin
ation
. S
ch
oo
ls in
cre
asin
gly
off
er
acce
ss to
a r
an
ge
of
wid
er
qu
alif
ica
tio
ns to
assis
t p
up
ils w
ith
vo
ca
tio
na
l ro
ute
s p
rovid
ing a
cce
ss t
o F
E/H
E c
ou
rse
s in
sch
oo
ls. A
tota
l of
56
3 p
up
ils a
cce
sse
d s
kill
s f
or
wo
rk t
hro
ugh
2
0 c
ou
rse
s in
201
2-1
3 w
ith
1,4
91
pu
pils
accessin
g w
ide
r qu
alif
ica
tion
s t
hro
ugh
31 c
ou
rse
s in
201
2-1
3.
At le
ast 2
40
adu
lts p
er
qu
art
er
(ap
pro
x.
0.2
6%
of
the
po
pu
lation
) a
cce
ss a
du
lt le
arn
ing n
etw
ork
se
rvic
e p
rovis
ion
acro
ss A
rgyll
an
d B
ute
T
he
cha
llen
ge
is to
ensu
re w
e c
an
cre
ate
opp
ort
un
itie
s t
o r
eta
in a
nd
en
co
ura
ge
yo
un
g p
eo
ple
to
fu
rth
er
the
ir e
du
ca
tion
, de
ve
lop
skill
s a
nd
bu
ild c
are
ers
, b
usin
ess a
nd
fu
lfill
ing liv
es in
Arg
yll
an
d B
ute
.
Page 31 7.3i - Appendix 1
���
� Ou
r C
ha
lle
ng
es
The
ke
y c
ha
llen
ge
s w
e f
ace
re
late
to
:
•
Ou
r g
eo
gra
ph
y –
A h
igh
ly r
ura
l a
rea
with
man
y s
ma
ll com
mu
nitie
s, oft
en
sep
ara
ted
by w
ate
r. A
cce
ss to
th
e a
rea
an
d to
ke
y
se
rvic
es a
re p
ere
nn
ial ch
alle
nge
s.
•
Re
du
cin
g p
op
ula
tio
n –
Th
e p
roje
cte
d d
eclin
e in
to
tal p
opu
lation
is a
re
al th
rea
t to
th
e v
iab
ility
of
the
are
a w
ith
a p
ote
ntia
l to
a
dve
rse
ly im
pa
ct
on
the
econ
om
y/w
ea
lth
cre
atio
n, w
ork
forc
e a
va
ilab
ility
an
d e
ffic
ien
t se
rvic
e d
eliv
ery
.
•
Ch
an
gin
g p
op
ula
tio
n –
With
mo
re e
xtr
em
es t
han
mo
st of
Sco
tlan
d a
nd
th
e d
iffe
ren
ce
s a
re g
ett
ing g
rea
ter
we
fa
ce
in
cre
asin
g c
osts
an
d c
ha
llen
ge
s to
de
live
r se
rvic
es t
o o
lde
r p
eo
ple
an
d th
e n
ee
d to
en
coura
ge
yo
un
ge
r p
eo
ple
to
mo
ve
to
th
e a
rea
so
tha
t o
ur
eco
nom
y c
an
gro
w
•
Ec
on
om
y –
Un
lockin
g t
he
opp
ort
un
itie
s o
ffe
red
by its
sig
nific
an
t, s
usta
inab
le e
co
nom
ic a
sse
ts f
or
the
ben
efit of
its
co
mm
un
itie
s a
nd
th
e c
om
pe
titive
ne
ss a
nd s
ecu
rity
of
the
Sco
ttis
h a
nd
EU
eco
no
mie
s.
•
Em
plo
ym
en
t –
De
ve
lop
ing e
du
ca
tio
n,
skill
s a
nd
tra
inin
g t
o m
axim
ise
opp
ort
un
itie
s fo
r a
ll an
d c
reate
a w
ork
forc
e to
su
pp
ort
e
co
no
mic
gro
wth
.
•
Infr
as
tru
ctu
re –
Im
pro
vin
g a
nd
ma
kin
g b
ette
r u
se
of
infr
astr
uctu
re in o
rde
r to
pro
mote
th
e c
on
ditio
ns f
or
econ
om
ic g
row
th
inclu
din
g e
nh
an
cin
g t
he
bu
ilt e
nviro
nm
en
t.
•
Su
sta
ina
bilit
y –
En
su
rin
g a
su
sta
ina
ble
fu
ture
by p
rote
ctin
g t
he
na
tura
l e
nviro
nm
en
t a
nd m
itig
atin
g c
lima
te c
hange
.
•
He
alt
h –
Imp
rovin
g h
ealth
and
we
ll b
ein
g a
nd
re
du
cin
g h
ea
lth
ine
qu
alit
ies.
•
De
pri
va
tio
n –
Ine
qu
alit
ies e
xis
t in
Arg
yll
an
d B
ute
so
we
nee
d to
im
pro
ve
ho
w w
e id
en
tify
an
d im
ple
men
t a
ctio
n to
add
ress
them
.
•
Pe
op
le o
n t
he f
rin
ge
– M
an
y o
f ou
r com
mu
nitie
s a
re v
ery
iso
late
d a
nd
ris
k c
olla
psin
g a
s p
op
ula
tio
n c
ha
nge
s ta
ke
aff
ect
alo
ngsid
e u
rba
n c
om
mu
nitie
s w
he
re d
ep
riva
tio
n c
an
cre
ate
rea
l h
ard
sh
ips
Page 32 7.3i - Appendix 1
���
�PL
AN
NIN
G F
OR
SU
CC
ES
S
Ove
rall
Ob
jec
tive
T
he
evid
en
ce
co
llate
d in
und
ers
tan
din
g A
rgyll
an
d B
ute
se
ts o
ut
a c
lea
r th
reat
to t
he
futu
re s
ucce
ss o
f th
e a
rea
. W
hils
t th
ere
are
a
ran
ge
of
so
cia
l an
d c
om
mu
nity c
ha
llen
ge
s b
y f
ar
the
mo
st
sig
nific
ant
ch
alle
nge
fa
cin
g t
he
are
a r
ela
tes to
th
e e
con
om
y a
nd
p
opu
latio
n.
Un
less th
ese
sp
ecific
issue
s a
re a
dd
resse
d th
e s
co
pe
an
d c
ap
acity t
o a
dd
ress s
om
e o
f th
e o
the
r ch
alle
nge
s f
acin
g
Arg
yll
an
d B
ute
will
be
gre
atly r
ed
uce
d. T
he
re is a
cle
ar
ch
oic
e b
etw
ee
n m
an
agin
g d
eclin
e a
nd
co
mm
ittin
g to
cre
atin
g a
virtu
ou
s
circle
ba
se
d a
roun
d s
tab
ilisa
tio
n a
nd
gro
wth
of
the
eco
no
my a
nd
pop
ula
tion
le
ad
ing t
o im
pro
ve
d s
ocia
l a
nd
com
mu
nity f
acto
rs.
The
ove
rall
ob
jective
of
the S
OA
fo
r th
e 1
0 y
ea
rs t
o 2
023
is -
Arg
yll
an
d B
ute
’s e
co
no
mic
su
cce
ss i
s b
uilt
on
a g
row
ing
p
op
ula
tio
n.
Th
is o
utc
om
e is e
ntire
ly s
up
po
rtiv
e o
f th
e 6
na
tio
na
l p
olic
y p
rio
ritie
s s
et
ou
t in
th
e n
atio
na
l gu
ida
nce
on
co
mm
un
ity p
lan
nin
g a
nd w
ill
als
o s
ee
Arg
yll
an
d B
ute
co
ntr
ibu
te t
o th
e n
atio
na
l o
utc
om
es f
or
Sco
tla
nd
. L
on
g T
erm
Ou
tco
mes
T
o a
ch
ieve
th
e o
ve
rall
ob
jective
se
t o
ut a
bo
ve
6 lo
ng te
rm o
utc
om
es h
ave
be
en
ide
ntified
. T
he
se
ou
tco
me
s w
ill s
up
po
rt th
e o
ve
rall
ob
jective
of
“Arg
yll
an
d B
ute
’s e
con
om
ic s
ucce
ss is b
uilt
on
a g
row
ing p
op
ula
tio
n”
an
d a
lso
ad
dre
ss th
e 6
na
tion
al p
olic
y p
rio
ritie
s
for
com
mu
nity p
lann
ing.
Th
e 6
lon
g t
erm
outc
om
es a
re s
et o
ut b
elo
w.
In A
rgyll
an
d B
ute
:
•
The
eco
nom
y is d
ive
rse
and
th
rivin
g.
•
We h
ave
infr
astr
uctu
re t
ha
t su
pp
ort
s s
usta
inab
le g
row
th.
•
Ed
ucatio
n, skill
s a
nd t
rain
ing m
axim
ise
s o
pport
un
itie
s fo
r a
ll.
•
Ch
ildre
n a
nd
yo
un
g p
eo
ple
ha
ve
th
e b
est
po
ssib
le s
tart
.
•
Pe
op
le liv
e a
ctive
, h
ea
lth
ier
and
ind
epe
nde
nt liv
es.
•
Pe
op
le liv
e in
safe
r a
nd
str
on
ge
r com
mu
nitie
s.
To a
ch
ieve
ea
ch
of
the 6
lo
ng te
rm o
utc
om
es w
ill r
equ
ire
sig
nific
ant co
mm
itm
en
t a
nd
eff
ort
by a
ll p
art
ne
rs a
nd
als
o f
rom
the
wh
ole
of
Arg
yll
an
d B
ute
. T
he a
pp
roa
ch
fo
r ea
ch
long t
erm
ou
tcom
e w
ill b
e:
Page 33 7.3i - Appendix 1
���
�
•
De
ve
lop
a c
lea
r p
olic
y a
nd
str
ate
gy f
or
the o
utc
om
e.
•
Ide
ntify
th
e a
ctio
ns th
at
are
re
qu
ire
d.
•
Pre
pa
re d
eliv
ery
pla
ns t
ha
t a
re c
lea
r a
roun
d r
eso
urc
es a
nd
ris
ks.
•
Ide
ntify
th
e s
ucce
ss m
ea
su
res a
nd
mile
sto
nes.
•
Allo
ca
te r
esp
on
sib
ility
to
pa
rtn
ers
so t
he
re is c
lea
r lin
e o
f sig
ht.
Th
is a
pp
roa
ch
will
be
ba
cke
d u
p b
y P
lan
, D
o, C
he
ck,
Act cycle
to
ensu
re p
rogre
ss is m
on
ito
red
, le
sso
ns a
re lea
rne
d a
nd
pla
ns a
nd
p
roce
du
res u
pd
ate
d.
Pe
rfo
rma
nce w
ill b
e m
an
age
d q
ua
rte
rly a
nd
an
nu
ally
an
d a
lso
ove
r th
e 1
0 y
ea
r pe
rio
d o
f th
e S
OA
. P
erf
orm
an
ce
sco
reca
rds w
ill b
e
use
d. O
n a
qu
art
erly b
asis
pe
rfo
rman
ce
will
be
mo
nito
red
to
asse
ss w
he
the
r a
ction
s h
ave
be
en
ta
ke
n o
r m
ilesto
ne
s r
ea
che
d a
nd
th
ere
ma
y b
e a
n e
mp
ha
sis
on
in
pu
t m
ea
su
res o
r sim
ply
th
at
thin
gs h
ave
be
en
do
ne
bu
t a
ll re
late
d t
o th
e lo
ng t
erm
ou
tcom
es.
An
nua
lly p
erf
orm
an
ce
will
be
asse
ssed
in
te
rms w
ha
t im
pa
ct is
th
is a
ctivity h
avin
g b
ase
d o
n p
erf
orm
an
ce
mea
su
res d
eve
lope
d a
s
pa
rt o
f d
eta
iled p
lan
nin
g a
nd
th
is is lik
ely
to
be
mo
re o
utp
ut fo
cu
ssed
but
rela
ted
to
Arg
yll
an
d B
ute
an
d th
e lo
ng te
rm o
utc
om
es.
Ove
r th
e 1
0 y
ea
r lif
etim
e o
f th
e S
OA
th
e n
atio
na
l o
utc
om
e in
dic
ato
rs a
nd o
the
r na
tio
na
l in
dic
ato
r sets
will
be
used
to
asse
ss lo
ng
term
pro
gre
ss a
nd a
lso t
he
co
mp
ara
tive
pe
rform
an
ce
of
Arg
yll
an
d B
ute
– t
his
will
asse
ss t
he
issu
e o
f “s
o w
ha
t d
iffe
ren
ce
is th
is
ma
kin
g?
”.
The
na
tio
na
l gu
ida
nce
on
com
mu
nity p
lan
nin
g s
et
ou
t 6
na
tion
al po
licy p
rio
ritie
s f
or
com
mu
nity p
lan
nin
g. T
he
se w
ere
:
•
Eco
nom
ic r
eco
ve
ry a
nd
gro
wth
;
•
Em
plo
ym
en
t;
•
Ea
rly y
ea
rs;
•
Safe
r a
nd s
tro
nge
r com
mu
nitie
s,
and
red
ucin
g o
ffen
din
g;
•
He
alth
ine
qu
alit
ies a
nd p
hysic
al a
ctivity;
an
d
•
Ou
tcom
es fo
r o
lde
r peo
ple
.
Page 34 7.3i - Appendix 1
���
�The
tab
le b
elo
w s
ho
ws h
ow
th
e 6
lo
ng t
erm
ou
tcom
es c
on
trib
ute
to
th
e n
atio
na
l p
rio
ritie
s for
co
mm
un
ity p
lan
nin
g.
Arg
yll
an
d B
ute
Lo
ng
Te
rm O
utc
om
es
Re
late
s t
o N
ati
on
al
Po
lic
y P
rio
riti
es
The
eco
nom
y is d
ive
rse
and
th
rivin
g
E
co
nom
ic r
eco
ve
ry a
nd
gro
wth
an
d E
mp
loym
en
t;
We h
ave
infr
astr
uctu
re t
ha
t su
pp
ort
s s
usta
inab
le g
row
th.
E
co
nom
ic r
eco
ve
ry a
nd
gro
wth
Ed
ucatio
n, skill
s a
nd t
rain
ing m
axim
ise
s o
pport
un
itie
s fo
r a
ll.
E
co
nom
ic r
eco
ve
ry a
nd
gro
wth
an
d E
mp
loym
en
t;
Ch
ildre
n a
nd
yo
un
g p
eo
ple
ha
ve
th
e b
est
po
ssib
le s
tart
.
Ea
rly y
ea
rs a
nd
He
alth in
equ
alit
ies a
nd
ph
ysic
al a
ctivity
Pe
op
le liv
e a
ctive
, h
ea
lth
ier
and
ind
epe
nde
nt liv
es.
Ou
tcom
es fo
r o
lde
r peo
ple
an
d H
ea
lth in
equa
litie
s a
nd
ph
ysic
al
activity
Pe
op
le liv
e in
safe
r a
nd
str
on
ge
r com
mu
nitie
s.
S
afe
r a
nd s
tro
nge
r com
mu
nitie
s,
and
red
ucin
g o
ffen
din
g
Fu
rth
er
de
tail
on
ea
ch
lo
ng t
erm
outc
om
e in
clu
din
g o
ur
vis
ion
of
su
cce
ss in
10
ye
ars
are
se
t ou
t on
th
e p
age
s t
hat fo
llow
.
Page 357.3i - Appendix 1
���
�Lo
ng
Te
rm O
utc
om
e -
In
Arg
yll
an
d B
ute
th
e e
co
no
my i
s d
ive
rse
an
d t
hri
vin
g
Wh
at
su
cc
es
s w
ill
be l
ike i
n 1
0 y
ea
rs
Th
rivin
g b
roa
d b
ase
d e
co
nom
y t
ha
t h
as r
ea
lise
d its
fu
ll co
ntr
ibu
tion
to
Sco
tla
nd
’s e
con
om
ic d
eve
lopm
ent
via
th
e g
row
th in
se
cto
rs
su
ch
as r
en
ew
ab
les, to
urism
, fo
od a
nd
drin
k, m
arin
e s
cie
nce a
nd
dig
ita
l kn
ow
led
ge
eco
nom
y.
He
len
sbu
rgh
and
Lo
mo
nd
will
be
a
thrivin
g lo
ca
l e
co
nom
y b
ased
on a
gro
win
g e
mp
loym
en
t ba
se
and
fu
rth
er
inte
gra
tio
n w
ith
th
e w
ide
r w
est
of
Sco
tla
nd
la
bou
r m
ark
et. T
he
op
po
rtu
nitie
s a
nd
po
ten
tia
l fo
r gro
wth
in
Ob
an
an
d L
orn
are
be
ing d
eve
lop
ed
an
d r
ea
lised
. R
ege
ne
ratio
n a
ctivity in
D
un
oon
an
d R
oth
esa
y h
as t
ran
sfo
rme
d t
he
m in
to
th
rivin
g lo
ca
l e
co
no
mie
s. T
he s
ucce
ss o
f C
am
pb
elto
wn
/ M
ach
rih
an
ish N
RIP
site
is
ke
y t
o e
nsu
rin
g t
he
lo
ca
l e
co
nom
y h
as a
susta
inab
le f
utu
re. O
ve
rall
incre
ase
d le
ve
ls o
f in
co
me a
nd
em
plo
ym
en
t.
Th
is i
s t
he p
rog
ress
we e
xp
ec
t to
mak
e in
3 y
ea
rs
Co
ntr
ibu
tion
an
d r
ole
of
Arg
yll
an
d B
ute
to
th
e G
ove
rnm
en
t E
co
no
mic
Str
ate
gy is u
nd
ers
tood
and
fu
lly s
up
po
rted
by n
atio
na
l an
d
regio
na
l a
ge
ncie
s. G
row
ing o
pp
ort
un
itie
s fo
r o
nsho
re a
nd
off
sho
re r
en
ew
ab
le e
ne
rgy t
hro
ugh
ou
t A
rgyll
an
d B
ute
an
d a
n a
ctive
lo
ca
l su
pp
ly c
ha
in f
ocuse
d a
rou
nd
the
Cam
pbe
lto
wn
/ M
ach
rih
an
ish
NR
IP s
ite
an
d o
ppo
rtun
itie
s a
rou
nd N
ort
h A
rgyll.
Eu
rop
ean
M
arin
e S
cie
nce
Pa
rk o
ccu
pie
d a
nd
a g
row
ing
clu
ste
r of
edu
ca
tio
n,
rese
arc
h a
nd
com
me
rcia
l a
ctivity a
t D
un
sta
ffna
ge
with
futu
re
ph
ase
s w
ell
ad
va
nce
d. R
ep
ositio
nin
g t
he A
rgyll
an
d B
ute
tou
rism
pro
du
ct a
nd
pro
file
, in
cre
asin
gly
active
ne
two
rks e
sta
blis
he
d,
cre
atin
g n
ew
to
urism
exp
erie
nce
s,
drivin
g u
p a
dde
d v
alu
e lo
ca
lly,
rais
ing t
he
qu
alit
y o
f th
e a
cco
mm
od
atio
n a
cro
ss t
he
are
a. A
cle
ar
str
ate
gic
an
d h
olis
tic focu
s o
n t
he
re
ge
ne
ration
ch
alle
nge
s in
Dun
oon
and
Ro
the
sa
y w
ill b
egin
to
sh
ow
po
sitiv
e r
esu
lts w
ith
o
ppo
rtu
nitie
s t
hro
ugh
im
pro
ve
d c
on
ne
ctivity b
ein
g r
ea
lise
d,
incre
asin
g a
ctivity in
th
e h
ou
sin
g m
ark
et a
nd in
wa
rd in
ve
stm
en
t su
cce
sse
s. T
he
de
live
ry o
f a r
an
ge
of
pu
blic
an
d p
riva
te s
ecto
r in
ve
stm
en
ts in
th
e H
ele
nsb
urg
h a
nd
Lo
mo
nd
are
a h
as e
nco
ura
ge
d
furt
he
r e
co
no
mic
de
ve
lop
me
nt a
nd
in
ve
stm
ent
opp
ort
un
itie
s th
at a
re s
ign
ific
an
t a
t th
e r
egio
na
l le
ve
l a
nd t
ha
t ra
ises t
he
are
a’s
p
rofile
. B
usin
ess a
nd
co
mm
erc
ial op
po
rtu
nitie
s a
re p
rom
ote
d a
cro
ss a
ll co
mm
un
itie
s in
Arg
yll
an
d B
ute
and
op
po
rtu
nitie
s r
ela
tin
g t
o
ke
y s
ecto
rs s
uch
as tou
rism
, th
e d
igita
l e
co
no
my, fo
od
an
d d
rin
k (
incl. w
his
ky)
an
d r
en
ew
ab
les a
re b
ein
g e
xp
loited
by lo
ca
l b
usin
esse
s.
Th
is i
s w
he
re w
e a
re n
ow
T
he
bu
sin
ess b
ase
rem
ain
s n
arr
ow
an
d th
e p
ub
lic s
ecto
r is
do
min
an
t. A
cce
ss t
o f
inan
ce
an
d a
la
ck o
f confid
en
ce a
re a
ctin
g a
s a
b
rake
on
bu
sin
ess in
ve
stm
en
t. L
ow
le
ve
ls o
f re
se
arc
h a
nd
de
ve
lop
me
nt a
ctivity.
Un
em
plo
ym
ent
is a
bo
ve
the
re
gio
na
l a
ve
rage
. H
igh
le
ve
l o
f se
lf e
mp
loym
en
t a
nd p
ropo
rtio
n o
f m
icro
bu
sin
esse
s w
ith
fe
w b
usin
esse
s o
f sca
le.
Th
es
e a
re t
he
ke
y s
tra
teg
ies a
nd
de
live
ry p
lan
s
A s
epa
rate
str
ate
gy f
or
eco
no
mic
re
co
ve
ry a
nd
gro
wth
is b
ein
g d
eve
lop
ed
tha
t w
ill s
et
ou
t ho
w t
he
CP
P p
lan
s to
take
th
is fo
rwa
rd.
Th
is w
ill s
up
ple
me
nt
exis
tin
g p
lan
s a
nd
co
mm
itm
en
ts f
rom
Hig
hla
nd
s a
nd
Isla
nd
s E
nte
rprise
Ope
ratin
g P
lan a
nd
th
e C
ou
ncil’
s
Page 36 7.3i - Appendix 1
���
�Eco
nom
ic D
eve
lopm
en
t A
ction
Pla
n a
nd
Re
ne
wa
ble
En
erg
y A
ctio
n P
lan
an
d th
e w
ork
of
the
Bu
sin
ess G
ate
wa
y t
ea
m. E
xis
tin
g
pa
rtn
ers
hip
s a
rou
nd r
en
ew
ab
le e
ne
rgy (
Arg
yll
an
d B
ute
Ren
ew
ab
les A
llia
nce
) an
d to
urism
(A
rgyll
an
d t
he I
sle
s S
tra
tegic
To
urism
P
art
ne
rsh
ip)
will
be
su
pp
lem
ente
d b
y o
the
r se
cto
r spe
cific
pa
rtn
ers
hip
s a
nd
en
ha
nced
enga
ge
me
nt
with
the
bu
sin
ess c
om
mu
nity a
t a
lo
ca
l le
ve
l a
nd
Arg
yll
an
d B
ute
wid
e t
o e
nsu
re w
e c
rea
te th
e r
igh
t co
nd
itio
ns f
or
econ
om
ic g
row
th.
Th
es
e a
re s
om
e o
f th
e m
ain
are
as
of
foc
us i
nc
lud
ed
wit
hin
th
is o
utc
om
e
Bu
sin
ess g
row
th,
su
sta
ina
bili
ty a
nd
sta
rt u
p. D
eve
lop
men
t of
spe
cific
se
cto
rs –
tou
rism
, m
arin
e s
cie
nce
, re
ne
wa
ble
s,
dig
ita
l e
co
no
my,
cu
ltu
re a
nd
he
rita
ge
, fo
od a
nd
drink a
nd t
rad
itio
na
l se
cto
rs.
Page 37 7.3i - Appendix 1
���
�Lo
ng
Te
rm O
utc
om
e –
We
ha
ve
in
fra
str
uc
ture
th
at
su
pp
ort
s s
usta
ina
ble
gro
wth
. W
ha
t s
ucc
es
s w
ill
be l
ike i
n 1
0 y
ea
rs
Lo
ng t
erm
str
ate
gic
infr
astr
uctu
re p
lann
ing u
nd
ert
aken
in
pa
rtne
rsh
ip w
ith
th
e S
cott
ish
Go
ve
rnm
en
t an
d th
e p
riva
te s
ecto
r ha
s
imp
rove
d A
rgyll
& B
ute
’s r
oa
d,
rail,
fe
rry,
air a
nd
wid
er
tra
nspo
rta
tion infr
astr
uctu
re t
o s
upp
ort
th
e g
row
th o
f o
ur
eco
nom
y a
nd
th
e
su
sta
ina
bili
ty o
f o
ur
com
mu
nitie
s.
The
de
ve
lop
me
nt of
the e
lectr
ical tr
an
sm
issio
n a
nd
dis
trib
utio
n g
rid
ha
s b
ee
n s
tre
ngth
ene
d to
su
ppo
rt t
he
con
tin
ue
d d
eve
lop
me
nt of
ren
ew
ab
le te
ch
no
logy a
nd
to p
rovid
e a
dd
itio
na
l com
mu
nity r
esili
en
ce
. T
he
wa
ter
utilit
y
infr
astr
uctu
re c
ontin
ues t
o b
e d
eve
lop
ed in
bo
th o
ur
tow
n a
nd
ru
ral a
rea
s to
sup
po
rt e
con
om
ic d
eve
lopm
en
t a
nd h
ou
sin
g.
In
te
n
ye
ars
, A
rgyll
an
d B
ute
will
ha
ve
wo
rld
cla
ss d
igita
l a
nd
mob
ile infr
astr
uctu
re th
at p
rom
ote
s s
usta
ina
ble
eco
no
mic
de
ve
lop
me
nt,
co
mm
un
ity r
esili
en
ce
an
d s
erv
ice
de
live
ry a
nd
ma
ke
s A
rgyll
& B
ute
a m
ore
com
pe
llin
g p
lace
to
liv
e a
nd
wo
rk.
Inve
stm
en
t in
h
ou
sin
g a
nd
co
mm
un
ity f
acili
tie
s s
upp
ort
su
sta
ina
ble
econ
om
ic g
row
th a
nd
alo
ng w
ith
re
ge
ne
ration
of
ou
r to
wn
cen
tre
s a
nd
bu
ilt
en
viro
nm
ent
en
han
ce
th
e c
om
pe
titive
ne
ss o
f A
rgyll
an
d B
ute
. T
his
is
th
e p
rog
ress
we e
xp
ec
t to
mak
e in
3 y
ea
rs
Pro
gra
mm
e o
f A
83
im
pro
ve
me
nts
com
ple
ted b
y T
ran
sp
ort
Sco
tla
nd.
A82
im
pro
ve
men
ts a
t P
ulp
it R
ock &
Cria
nla
rich
co
mp
lete
d
an
d fu
rthe
r im
pro
vem
en
ts b
etw
ee
n T
arb
et
and
Cria
nla
rich
id
en
tified
with
in a
fu
nde
d p
rogra
mm
e.
C
oun
cil
pro
gre
sse
s its
po
licy
ob
jective
of
on
go
ing im
pro
ve
me
nt
to r
oa
d c
ond
itio
n th
rou
gh
its
co
mm
itm
en
t to
its
Ro
ad
s A
sse
t M
ana
ge
men
t &
Ma
inte
na
nce
S
tra
tegy.
Esta
blis
hm
en
t of
a h
igh
qu
alit
y a
nd r
elia
ble
to
wn
ce
ntr
e to t
ow
n c
en
tre
ve
hic
ula
r fe
rry s
erv
ice
be
twe
en
Du
no
on
&
Go
uro
ck a
nd u
pgra
de
of
sup
po
rtin
g s
ho
re s
ide
and
pu
blic
tra
nsp
ort
atio
n infr
astr
uctu
re a
nd
se
rvic
es.
Tim
eta
ble
for
the
C
am
pb
elto
wn
-Ard
rossa
n fe
rry s
erv
ice
fin
alis
ed
. F
utu
re o
f th
e C
ou
ncil’
s f
err
y s
erv
ice
s d
ete
rmin
ed
. F
utu
re o
f th
e K
err
era
fe
rry
se
rvic
e d
ete
rmin
ed
. Im
pro
ve
d r
ail
co
nne
ctivity b
etw
ee
n O
ban
, B
ute
& C
ow
al a
nd
He
len
sburg
h a
nd
Lo
mo
nd
w
ith
Gla
sgo
w a
nd
E
din
bu
rgh
with
th
e s
ix G
lasgo
w-O
ba
n s
erv
ice
s c
on
tinu
ed w
ith
sle
epe
r co
nne
ctivity.
In
tro
du
ctio
n o
f n
ew
Pa
rk a
nd R
ide
o
ppo
rtu
nitie
s in
He
len
sb
urg
h a
nd
Du
no
on;
part
icu
larly t
ho
se
pro
vid
ing c
om
mu
ter
links to
Gla
sgo
w.
Ove
r 8
0%
of
the
Arg
yll
an
d B
ute
co
mm
un
itie
s w
ith
in t
he N
ext
Ge
ne
ratio
n B
road
ban
d a
rea
will
ha
ve
acce
ss t
o th
e im
pro
ve
d s
erv
ice
, a
s w
ill 1
00
% in
the
He
len
sb
urg
h
are
a th
rou
gh
th
e R
est of
Scotla
nd
pro
gra
mm
e.
Imp
rove
d c
on
ne
ctivity b
etw
ee
n A
rgyll
& B
ute
’s isla
nd a
nd
ma
inla
nd
airp
ort
s w
ith
G
lasgo
w A
irp
ort
an
d w
ith
the
Weste
rn I
sle
s. C
om
ple
tio
n o
f th
e c
on
str
uctio
n o
f th
e C
arr
ad
ale
-Hu
nte
rsto
n u
nde
rse
a g
rid
lin
k.
D
eliv
ery
of
the
Str
ate
gic
Ho
usin
g I
nve
stm
en
t P
lan
20
13
-18
Th
is i
s w
he
re w
e a
re n
ow
T
he
re is a
pe
rcep
tion
th
at
the
infr
astr
uctu
re in A
rgyll
an
d B
ute
is a
ba
rrie
r to
gro
wth
. T
his
is e
vid
en
ce
d b
y u
nde
r in
ve
stm
en
t in
in
fra
str
uctu
re o
ve
r a
nu
mbe
r of
ye
ars
by b
oth
priva
te a
nd p
ub
lic s
ecto
rs a
nd p
oo
r m
ob
ile p
ho
ne
an
d b
roa
dba
nd s
erv
ice
s,
lack o
f e
lectr
icity g
rid
ca
pa
city a
nd s
tan
da
rd o
f str
ate
gic
ro
ad
s. W
hils
t th
ere
is a
cle
ar
ne
ed
to in
ve
st
in im
pro
ve
men
ts to
infr
astr
uctu
re
Page 38 7.3i - Appendix 1
���
�mu
ch o
f th
e c
ore
asse
t b
ase is s
oun
d. C
PP
pa
rtn
ers
ha
ve
de
ve
lop
ed
str
en
gth
en
ing w
ork
ing r
ela
tio
nsh
ips w
ith
the k
ey p
ub
lic a
nd
p
riva
te s
ecto
r sta
ke
ho
lde
rs a
nd
ha
ve
app
roa
ch
ed
th
e r
equ
ire
men
t to
de
ve
lop
a m
ore
str
ate
gic
an
d in
tegra
ted
ap
pro
ach
to
wa
rds
po
licy d
eve
lop
men
t th
rou
gh
AB
RA
, H
ITR
AN
s a
nd t
hro
ugh
dire
ct p
art
ne
rsh
ip w
ork
ing w
ith
Tra
nsp
ort
Sco
tlan
d.
Th
es
e a
re t
he
ke
y s
tra
teg
ies a
nd
de
live
ry p
lan
s
Acro
ss t
he
CP
P e
ach p
art
ne
r h
as s
tra
tegie
s a
nd
pla
ns w
hic
h w
ill c
on
trib
ute
to
th
e d
eve
lopm
ent
of
infr
astr
uctu
re p
rovis
ion
with
in
Arg
yll
& B
ute
. T
he
de
ve
lopm
ent
an
d r
eso
urc
ing o
f th
e p
rop
ose
d S
tra
tegic
Infr
astr
uctu
re P
lan
, d
eve
lop
ed
in
pa
rtne
rsh
ip w
ith
th
e
Sco
ttis
h G
ove
rnm
en
t, w
ill p
rovid
e t
he
me
chan
ism
to
ach
ieve
th
e r
equ
ire
d im
pro
ve
me
nt to
in
fra
str
uctu
re a
nd
ho
usin
g n
ee
de
d to
su
ppo
rt t
he
de
live
ry o
f th
e S
OA
ou
tco
me
s o
f e
co
no
mic
an
d p
op
ula
tio
n g
row
th.
Oth
er
pla
ns a
nd s
tra
tegie
s in
clu
de -
Lo
ca
l D
eve
lop
men
t P
lan
, E
co
nom
ic D
eve
lopm
ent P
lan
, R
en
ew
ab
le E
ne
rgy A
ctio
n P
lan
, R
oa
ds A
sse
t M
an
age
me
nt a
nd
Ma
inte
nan
ce
S
tra
tegy,
Sco
ttis
h F
err
ies P
lan,
Str
ate
gic
Ho
usin
g I
nve
stm
ent
Pla
n 2
01
3-1
8,
CH
OR
D p
rogra
mm
e, H
IE O
pe
ratin
g P
lan
an
d p
lan
s
for
roll
ou
t of
bro
ad
band
. T
he
se
are
so
me
of
the
ma
in a
rea
s o
f fo
cu
s i
nc
lud
ed
wit
hin
th
is o
utc
om
e
Th
is o
utc
om
e in
clu
de
s th
e fo
llow
ing in
fra
str
uctu
re,
ho
usin
g,
com
mun
ity f
acili
tie
s to
sup
po
rt h
ou
sin
g,
road
tra
nsp
ort
, o
the
r m
od
es o
f tr
an
sp
ort
(a
ir, fe
rrie
s,
rail,
pie
rs a
nd
ha
rbou
rs),
utilit
ies (
ele
ctr
icity g
rid
and
wa
ter
and
se
we
rage
ne
two
rk)
an
d IT
/IC
T (
mo
bile
pho
ne
an
d b
road
ban
d).
Page 39 7.3i - Appendix 1
��
�Lo
ng
Te
rm O
utc
om
e -
In
Arg
yll
an
d B
ute
ed
uc
ati
on
, sk
ills
an
d t
rain
ing
max
imis
es o
pp
ort
un
itie
s f
or
all
. W
ha
t s
ucc
es
s w
ill
be l
ike i
n 1
0 y
ea
rs
All
of
ou
r yo
un
g p
eop
le h
ave
the
op
po
rtu
nity t
o a
ch
ieve
a p
ositiv
e a
nd
su
sta
ine
d d
estin
atio
n.
Lo
ca
l la
bou
r m
ark
et
info
rma
tion
sh
ape
s h
ow
hig
he
r e
du
ca
tion
and
fu
rth
er
edu
ca
tion
cu
rric
ulu
m a
nd t
rain
ing a
re b
ein
g d
eve
lop
ed
. E
ve
ryo
ne
ha
s a
cce
ss to
tra
inin
g
an
d s
kill
s d
eve
lop
me
nt o
ppo
rtu
nitie
s o
f th
eir c
ho
ice
. A
lign
ing e
du
ca
tio
n,
skill
an
d t
rain
ing p
rovis
ion
with
la
bou
r m
ark
et
ne
ed
s w
ill
ma
xim
ise
op
po
rtu
nity fo
r o
ur
pe
op
le b
ut
als
o e
nsu
re a
sup
ply
of
ed
uca
ted,
skill
ed
an
d tra
ine
d p
eo
ple
to s
upp
ort
the
lo
ca
l e
co
no
my.
Th
is i
s t
he p
rog
ress
we e
xp
ec
t to
mak
e in
3 y
ea
rs
Fu
rth
er
pro
gre
ss in
re
latio
n to
th
e r
ed
uctio
n in
the
nu
mb
er
of
yo
un
g p
eop
le lea
vin
g s
ch
oo
l w
ith
ou
t a
po
sitiv
e a
nd
su
sta
ine
d
de
stina
tio
n. S
cho
ols
ha
ve
un
de
rta
ken
fu
rth
er
cu
rric
ulu
m r
efo
rm to
su
ppo
rt t
he
ne
w n
atio
nal qu
alif
ica
tion
s a
nd
to
en
su
re y
ou
ng
pe
op
le h
ave
th
e o
pp
ort
un
ity t
o f
ollo
w a
pro
gra
mm
e ta
ilore
d to
th
eir n
ee
ds. In
cre
ase
d o
pp
ort
un
itie
s fo
r a
lte
rna
tive
qu
alif
ica
tio
ns.
Clo
se
r lin
ks t
o lo
ca
l la
bo
ur
ma
rke
t a
na
lysis
and
the
op
tio
ns o
ffe
red
by s
ch
oo
ls a
nd H
igh
er
an
d F
urt
he
r E
du
ca
tio
n p
rovid
ers
. In
cre
ased
op
po
rtu
nitie
s f
or
me
an
ingfu
l sh
ort
an
d lo
ng t
erm
em
plo
ym
ent
exp
erie
nce
. T
he
co
rpo
rate
pa
ren
tin
g s
up
po
rt b
y C
PP
p
art
ne
rs fo
r Lo
oked
Afte
r C
hild
ren
is im
pro
ve
d a
nd
is n
arr
ow
ing t
he
in
equ
alit
y g
ap
fo
r th
em
. O
ngo
ing r
evie
w o
f sco
pe
of
skill
s a
nd
tr
ain
ing d
eve
lopm
ent
to r
efle
ct d
em
an
d a
nd ta
ke
op
po
rtu
nitie
s t
o incre
ase
scop
e a
nd
ra
nge
of
this
pro
vis
ion
. T
his
is
wh
ere
we
are
no
w
The
ed
ucatio
na
l a
tta
inm
ent
in A
rgyll
an
d B
ute
is a
bo
ve
th
e n
atio
na
l a
ve
rage
in
mo
st m
ea
su
res.
Sch
oo
ls in
cre
asin
gly
off
er
acce
ss t
o
a r
an
ge
of
wid
er
qu
alif
ica
tio
ns to
assis
t p
up
ils w
ith
vo
ca
tio
na
l ro
ute
s p
rovid
ing a
cce
ss t
o F
E/H
E c
ou
rse
s in
scho
ols
. T
he
re a
re
incre
asin
g t
ren
ds in
the
num
be
r of
adu
lts w
ho
are
acce
ssin
g a
ctivitie
s s
upp
ort
ing t
he
ir lite
racy a
nd
nu
me
racy.
Inde
pen
den
t, th
ird
a
nd
pu
blic
se
cto
r p
rovid
ers
off
er
a r
an
ge
of
skill
s a
nd
tra
inin
g d
eve
lop
me
nt.
Th
es
e a
re t
he
ke
y s
tra
teg
ies a
nd
de
live
ry p
lan
s
Ed
ucatio
n A
ctio
n P
lan
, C
urr
icu
lum
fo
r E
xce
llen
ce
Im
ple
men
tatio
n P
lan
, In
div
idu
al scho
ol im
pro
ve
me
nt p
lan
s,
Opp
ort
un
itie
s f
or
All
De
ve
lop
men
t P
lan
, A
rgyll
an
d B
ute
Skill
s P
ipe
line
, A
rgyll
an
d B
ute
Yo
uth
Em
plo
ym
en
t A
ctivity P
lan
, T
hird
Se
cto
r P
art
ne
rsh
ip
Bu
sin
ess P
lan
, A
rgyll
Vo
lun
tary
Actio
n S
tra
tegic
Pla
n
Th
es
e a
re s
om
e o
f th
e m
ain
are
as
of
foc
us i
nc
lud
ed
wit
hin
th
is o
utc
om
e
Yo
un
g p
eop
le w
ith
a p
ositiv
e a
nd
su
sta
ine
d d
estin
atio
n. A
lign
me
nt
of
FE
/ H
E c
ou
rse
pro
vis
ion
with
lo
ca
l la
bo
ur
mark
et
ana
lysis
. M
ore
adu
lts w
ith
lite
racy,
nu
me
racy,
or
ba
sic
IC
T issu
es a
re s
up
po
rte
d to
acce
ss a
nd
pro
gre
ss in
"firs
t ste
ps"
lea
rnin
g
op
po
rtu
nitie
s.
Prim
ary
, se
co
nd
ary
an
d te
rtia
ry e
du
ca
tio
n a
nd
tra
inin
g/s
kill
s d
eve
lop
me
nt.
Page 40 7.3i - Appendix 1
��
�Lo
ng
Te
rm O
utc
om
e -
In
Arg
yll
an
d B
ute
ch
ild
ren
an
d y
ou
ng
pe
op
le h
ave
th
e b
es
t p
os
sib
le s
tart
Wh
at
su
cc
es
s w
ill
be l
ike i
n 1
0 y
ea
rs
All
ou
r ch
ildre
n w
ill b
e m
ore
active
an
d h
ave
in
cre
ased
op
po
rtu
nitie
s t
o p
art
icip
ate
in
pla
y,
recre
ation
an
d s
po
rt. T
he
re w
ill b
e a
n
incre
ase
in im
pro
ve
men
t in
ch
ildre
n’s
he
alth a
nd
we
llbe
ing.
Re
du
ced
num
be
rs o
f lo
oked
afte
r ch
ildre
n w
ill b
e a
ble
to
rem
ain
in
th
eir lo
ca
l co
mm
un
ity a
s a
re
su
lt o
f fle
xib
le s
up
po
rt p
acka
ge
s. In
tegra
ted d
eliv
ery
of
pu
blic
pro
tection
sup
po
rts v
uln
era
ble
ch
ildre
n
an
d y
ou
ng p
eop
le.
Con
tin
ue
d d
eve
lop
me
nt of
hig
h q
ua
lity le
arn
ing o
ppo
rtu
nitie
s
Th
is i
s t
he p
rog
ress
we e
xp
ec
t to
mak
e in
3 y
ea
rs
Lite
racy le
ve
ls o
f ch
ildre
n c
on
tin
ue
to
im
pro
ve
. T
he
re a
re in
cre
ase
d le
ve
ls o
f p
art
icip
atio
n f
or
ch
ildre
n a
nd
yo
un
g p
eo
ple
in
ph
ysic
al
activity.
Th
e t
reatm
en
t ga
ps in
se
rvic
es f
or
ch
ildre
n a
nd
yo
un
g p
eo
ple
ha
ve
be
en a
dd
ressed
with
ap
pro
pria
te s
erv
ice
s.
Atta
inm
ent
of
loo
ke
d a
fte
r ch
ildre
n is im
pro
vin
g a
nd
le
ve
ls o
f e
xclu
sio
n r
ed
ucin
g.
Go
od
qu
alit
y s
up
po
rt is a
va
ilab
le t
o a
llow
ch
ildre
n t
o r
em
ain
w
ith
in t
he
ir o
wn
co
mm
un
itie
s. Im
pro
ve
d q
ua
lity &
co
nsis
ten
cy t
o e
nsu
re a
ll ch
ildre
n a
re p
rote
cte
d f
rom
ab
use
, n
egle
ct
an
d h
arm
. C
o-p
rod
uction
is e
mbed
ded
acro
ss A
rgyll
an
d B
ute
. T
his
is
wh
ere
we
are
no
w
Arg
yll
an
d B
ute
ha
s a
co
mp
reh
en
siv
e e
arly y
ea
rs s
erv
ice
off
erin
g g
oo
d q
ua
lity s
upp
ort
to
wo
me
n t
hro
ugh
the
ir p
regn
an
cy a
nd
b
eyo
nd
. Q
ua
lity o
f a
sse
ssm
en
t is
im
pro
vin
g h
ow
eve
r qu
alit
y o
f ca
re p
lan
nin
g a
nd
ris
k a
ssessm
ent
ne
ed
s f
urt
he
r su
ppo
rt.
W
e a
re d
eve
lop
ing c
opro
du
ction
of
all
leve
ls w
ith
ch
ildre
n a
nd
yo
ung p
eo
ple
in
com
mu
nitie
s t
o info
rm h
ow
we
bu
ild c
apa
city a
nd
sta
bili
ty
Th
es
e a
re t
he
ke
y s
tra
teg
ies a
nd
de
live
ry p
lan
s
The
Inte
gra
ted
Ch
ildre
n’s
Se
rvic
e P
lan
will
be
th
e m
ain
do
cum
ent
tha
t w
ill b
e u
se
d a
cro
ss a
ll p
art
ne
rs o
ve
r th
e n
ext
thre
e y
ea
rs t
o
drive
pe
rfo
rman
ce
aga
inst
ke
y o
utc
om
es.
Th
es
e a
re s
om
e o
f th
e m
ain
are
as
of
foc
us i
nc
lud
ed
wit
hin
th
is o
utc
om
e
Th
is in
clu
de
s e
nsu
rin
g c
hild
ren
an
d y
ou
ng p
eo
ple
are
pro
tecte
d f
rom
ab
use,
ne
gle
ct
and
ha
rm, a
re m
ore
active
an
d h
ave
mo
re
op
po
rtu
nitie
s t
o p
art
icip
ate
in
pla
y, r
ecre
ation a
nd s
po
rt, liv
e w
ith
in a
fam
ily s
up
po
rtiv
e e
nvir
on
me
nt, h
ave
th
e h
igh
est
po
ssib
le
sta
nda
rds o
f ph
ysic
al a
nd
me
nta
l he
alth
, can
acce
ss to
po
sitiv
e le
arn
ing e
nviro
nm
en
ts a
nd o
ppo
rtu
nitie
s t
o d
eve
lop
skill
s a
nd
ha
ve
th
eir v
oic
es h
ea
rd a
nd
are
en
co
ura
ge
d t
o p
lay a
n a
ctive
an
d r
esp
on
sib
le r
ole
in
co
mm
un
itie
s.
Co
llab
ora
tive
wo
rkin
g t
o d
eliv
er
qu
alit
y s
erv
ice
s e
arly in
life
off
ers
rea
l a
nd
tan
gib
le o
utc
om
es fo
r child
ren
, yo
un
g p
eo
ple
an
d th
eir f
am
ilie
s. T
his
in
clu
de
s p
rom
otin
g
pre
ve
ntio
n a
nd t
acklin
g p
ove
rty,
ine
qu
alit
y a
nd
po
or
ou
tcom
es b
y e
mp
ow
erin
g c
om
mun
itie
s t
o w
ork
to
ge
the
r.
Page 41 7.3i - Appendix 1
���
�Lo
ng
Te
rm O
utc
om
e –
Pe
op
le l
ive
ac
tive
, h
ea
lth
ier
an
d i
nd
ep
en
de
nt
live
s.
Wh
at
su
cc
es
s w
ill
be l
ike i
n 1
0 y
ea
rs
Pe
op
le a
re a
ctive
and
he
alth
ier
acro
ss a
ll d
ime
nsio
ns o
f h
ea
lth
an
d w
ellb
ein
g.
Th
ose
wh
o a
re o
lde
r, liv
ing w
ith
lo
ng t
erm
co
nd
itio
ns
or
vu
lne
rab
le a
re in
cre
asin
gly
be
ing s
up
po
rted
to
ma
inta
in t
he
ir in
dep
end
en
ce
fo
r a
s lon
g a
s t
he
y c
hoo
se
. L
ife
exp
ecta
ncy is s
till
ab
ove
the
Sco
ttis
h a
ve
rage
with
in
cre
asin
g h
ea
lth
y life
exp
ecta
ncy.
The
he
alth o
utc
om
es fo
r th
ose
liv
ing in
ou
r m
ost
de
prive
d
co
mm
un
itie
s a
re c
loser
to t
ho
se
of
ou
r m
ost aff
luen
t a
rea
s.
Co
mm
un
itie
s a
re a
ctive
in
co
-pro
du
cin
g t
he
se
rvic
es t
he
y h
ave
a
sp
ira
tio
ns f
or.
Pe
op
le le
ad
mo
re a
ctive
hea
lth
ier
live
s t
hro
ugh
in
cre
ase
d p
art
icip
atio
n in s
po
rt a
nd
ph
ysic
al a
ctivity.
Th
is i
s t
he p
rog
ress
we e
xp
ec
t to
mak
e in
3 y
ea
rs
Co
ntin
uin
g to
be
ab
ove
the
Scott
ish
ave
rage
in
te
rms o
f lif
e e
xp
ecta
ncy a
nd
he
alth
y life
exp
ecta
ncy w
ith
wo
rk in
pla
ce
to
re
du
ce
h
ea
lth
in
equ
alit
ies a
nd
ta
rge
t a
ctivity t
o t
ho
se
mo
st
in n
ee
d.
Old
er
peo
ple
rep
ort
ing t
ha
t th
ey f
ee
l su
ppo
rte
d t
o liv
e in
dep
end
ently
wh
ere
th
ey c
ho
ose
. M
ore
peo
ple
with
he
alth a
nd
ca
re n
eed
s liv
e a
t h
om
e o
r in
a h
om
ely
se
ttin
g.
Fe
we
r e
me
rge
ncy a
dm
issio
ns o
f o
lde
r pe
op
le.
Th
is i
s w
he
re w
e a
re n
ow
A
rgyll
an
d B
ute
is a
bo
ve
the
Scott
ish
ave
rage
in
te
rms o
f lif
e e
xp
ecta
ncy.
Ou
r h
ea
lth
y life
exp
ecta
ncy is 6
8.5
ye
ars
(m
ale
s)
an
d
72
.5 y
ea
rs (
fem
ale
s)
co
mpa
red t
o th
e S
co
ttis
h a
ve
rage
of
66
.3 (
ma
les)
an
d 7
0.2
(fe
ma
les).
With
in t
he
are
a h
ow
eve
r w
e h
ave
h
ea
lth
in
equ
alit
ies. T
he
se
are
ma
nife
st
thro
ugh
ou
t ou
r ru
ral com
mun
itie
s a
nd
are
no
t ea
sily
me
asu
red.
Ho
we
ve
r w
e s
ee
th
e e
ffe
ct
of
the
se
in
equ
alit
ies in o
ur
tow
ns. T
he
re a
re 1
0 a
rea
s in
to
tal, w
ith
in C
am
pb
elto
wn
, D
uno
on,
He
len
sb
urg
h,
Oba
n a
nd
Ro
the
sa
y,
inclu
de
d in
th
e 1
5%
mo
st
de
prive
d s
ma
ll a
rea
s in
Sco
tla
nd
. M
ost o
lde
r p
eo
ple
(6
5+
) in
Arg
yll
an
d B
ute
loo
k a
fte
r th
em
se
lve
s a
t h
om
e,
with
va
ryin
g d
egre
es o
f he
lp. 3
% a
re c
are
d fo
r in
th
e ‘fo
rma
l’ se
ttin
g o
f a
ca
re h
om
e o
r sim
ilar.
T
he
se
are
th
e k
ey s
tra
teg
ies a
nd
de
live
ry p
lan
s
The
re a
re m
an
y p
lan
s a
cro
ss t
he
CP
P a
nd
with
in ind
ivid
ua
l p
art
ne
rs.
T
he
se
are
so
me
of
the
ma
in a
rea
s o
f fo
cu
s i
nc
lud
ed
wit
hin
th
is o
utc
om
e
Eve
ryo
ne
ha
s t
he
op
po
rtu
nity t
o b
e a
ctive
me
mbe
rs o
f th
eir c
om
mun
ity.
Pe
op
le a
re e
nab
led
to
liv
e in
dep
en
den
tly,
with
me
an
ing
an
d p
urp
ose
, w
ith
in the
ir o
wn
co
mm
un
ity.
Peo
ple
are
em
po
we
red
to le
ad
th
e h
ea
lth
iest liv
es p
ossib
le.
He
alth
ier
ch
oic
es r
ega
rdin
g
alc
oh
ol a
nd d
rugs a
nd
re
co
ve
ry f
rom
sub
sta
nce
mis
use
. M
en
tal h
ea
lth
im
pro
ve
men
t str
ate
gie
s a
re p
rom
ote
d b
y t
he
CP
P. T
he
ga
p
be
twe
en
th
e b
est of
and
the
wo
rst
off
in
Arg
yll
an
d B
ute
is r
ed
uced
.
Page 42 7.3i - Appendix 1
���
�Lo
ng
Te
rm O
utc
om
e –
Pe
op
le l
ive
in
sa
fer
an
d s
tro
ng
er
co
mm
un
itie
s
Wh
at
su
cc
es
s w
ill
be l
ike i
n 1
0 y
ea
rs
We h
ave
safe
an
d s
tron
g c
om
mu
nitie
s w
he
re o
ur
pe
op
le liv
e f
ree
fro
m h
arm
, fe
ar
and
ad
vers
ity in
an
equ
al so
cie
ty.
Th
ere
are
th
rivin
g a
nd
su
sta
ina
ble
com
mu
nitie
s p
art
icip
atin
g in
and
con
trib
uting t
o t
he s
ocia
l a
nd
fis
ca
l h
ea
lth
of
Arg
yll
& B
ute
. O
ur
pe
op
le
are
co
nfid
en
t in
th
e s
erv
ice
s w
hic
h s
up
po
rt q
ua
lity o
f lif
e t
hro
ugh
the
ir o
wn
de
sig
n a
nd d
eliv
ery
of
the
se s
erv
ice
s.
Ou
r to
wn
ce
ntr
es
are
th
rivin
g a
nd
vib
ran
t. R
ege
ne
ratio
n o
f th
e b
uilt
en
viro
nm
en
t e
nha
nce
s t
he
com
pe
titive
ne
ss o
f A
rgyll
an
d B
ute
.
Th
is i
s t
he p
rog
ress
we e
xp
ec
t to
mak
e in
3 y
ea
rs
A s
tre
ngth
en
ed
com
mu
nity s
afe
ty p
art
ne
rsh
ip s
tru
ctu
re t
o e
nsu
re a
ll co
mm
un
itie
s a
re d
yn
am
ic a
nd
su
sta
ina
ble
. E
vid
en
ce
of
safe
r,
mo
re r
ob
ust a
nd
he
alth
y c
om
mu
nitie
s a
nd
red
ucin
g le
ve
ls o
f in
equalit
ies.
Co
mm
un
ity e
nga
ge
me
nt is
enh
an
ce
d a
nd
pe
op
le c
ho
ose
to e
nga
ge
with
th
e d
esig
n a
nd
de
live
ry o
f p
ublic
se
rvic
es a
nd
und
ers
tan
d s
afe
ty is e
ve
ryo
ne
’s b
usin
ess.
Ea
rly in
terv
en
tio
n a
nd
p
reve
ntio
n is b
egin
nin
g t
o d
eliv
er
be
tte
r o
utc
om
es.
Cle
ar
pla
ns fo
r d
eve
lop
me
nt of
tow
n c
en
tre
s a
nd b
uilt
en
viro
nm
en
t w
ith
in
ve
stm
en
t u
nd
erw
ay.
Th
is i
s w
he
re w
e a
re n
ow
T
he
com
mu
nitie
s in
Arg
yll
in B
ute
are
safe
pla
ce
s to
liv
e,.
Th
ey a
re s
tro
ng a
nd v
ibra
nt
in m
an
y a
rea
bu
t w
e a
lso
ha
ve
so
me a
rea
s
wh
ere
pe
op
le a
re le
ss e
nga
ge
d w
he
re a
cce
ss a
nd s
ocia
l de
priva
tio
n c
ha
llen
ge
qu
alit
y o
f lif
e. W
e h
ave
a g
ood
reco
rd in
ma
inta
inin
g
pu
blic
safe
ty a
nd r
ecogn
ise
th
at to
im
pro
ve
th
is w
e m
ust e
nha
nce
ou
r p
art
ne
rsh
ips a
nd m
ake
str
on
ge
r lo
ca
l lin
ks w
hic
h c
on
trib
ute
to
com
mu
nity life
. W
e h
ave
a p
rove
n r
eco
rd o
f vo
lun
tary
actio
n a
nd c
om
mun
itie
s w
ork
ing a
nd
we
ha
ve
to
bu
ild o
n c
urr
en
t ca
pa
city
an
d s
et fo
un
da
tio
ns fo
r gre
ate
r su
sta
ina
bili
ty a
nd
th
rivin
g c
om
mun
ity life
. T
he
se
are
th
e k
ey s
tra
teg
ies a
nd
de
live
ry p
lan
s
The
Com
mu
nity P
lann
ing p
art
ne
rsh
ip s
up
po
rte
d b
y lo
ca
l P
olic
e p
lan
, F
ire
pla
n, T
hird
Se
cto
r P
art
ne
rsh
ip B
usin
ess P
lan
an
d
Co
mm
un
ity E
nga
ge
men
t S
trate
gy c
urr
en
tly a
ll d
rive
th
is o
utc
om
e. T
he
lo
ca
l a
rea
Gro
up
s, C
om
mun
ity s
afe
ty p
art
ne
rsh
ips a
nd
d
evo
lve
d A
SB
gro
up
s a
ga
in t
actica
lly d
rive
th
e o
utc
om
e,
wh
ere
it
is e
sse
ntia
l th
at
we
lo
ok c
lose
r a
t th
e d
eliv
ery
an
d o
ur
ab
ility
to
T
ask a
nd
Co
ord
ina
te th
rou
gh
ou
r m
ulti-a
ge
ncy p
art
ne
rsh
ips. O
utc
om
e fo
cu
sse
d c
om
mun
ity s
afe
ty p
lan
s d
eve
lope
d.
Th
es
e a
re s
om
e o
f th
e m
ain
are
as
of
foc
us i
nc
lud
ed
wit
hin
th
is o
utc
om
e
En
su
rin
g c
om
mu
nitie
s fe
el safe
r an
d th
at A
rgyll
an
d B
ute
is a
safe
r p
lace
. S
upp
ort
ing c
om
mu
nitie
s t
o b
eco
me
str
on
g,
resili
en
t a
nd
se
lf-r
elia
nt.
E
nsu
rin
g th
e n
atu
ral a
nd
bu
ilt e
nvir
on
men
t is
safe
, re
spe
cte
d,
va
lue
d a
nd f
ree o
f en
viro
nm
en
tal crim
e. W
ork
ing in
p
art
ne
rsh
ip t
o d
eliv
er
ou
tcom
es e
ffe
ctive
ly a
nd
eff
icie
ntly e
nsu
rin
g b
est
va
lue
.
Page 43 7.3i - Appendix 1
���
�EQ
UA
LIT
IES
Arg
yll
& B
ute
Com
mu
nity P
lan
nin
g P
art
ne
rsh
ip p
lace
s e
qu
alit
y,
div
ers
ity a
nd
in
clu
siv
en
ess a
t th
e c
en
tre
of
all
its s
erv
ice
s a
nd
a
ctio
ns.
De
live
rin
g a
ga
inst
this
we
co
mm
it to
red
ucin
g in
equ
alit
ies in
all
form
s.
In
add
itio
n t
o th
ose id
en
tifie
d in
th
e E
qu
alit
y A
ct
20
10
, ou
r co
mm
un
itie
s in
Arg
yll
an
d B
ute
fa
ce
th
ree
key a
rea
s o
f po
ten
tia
l in
equ
alit
y t
ha
t w
e m
ust e
nsu
re a
re p
lann
ed f
or
in t
he
SO
A. T
he
se
a
re: •
Ge
ogra
ph
ica
l In
equ
alit
ies –
rem
ote
ne
ss a
nd
pe
rip
he
ralit
y c
an
re
su
lt in
acce
ss a
nd
am
en
ity issu
es
•
He
alth
ine
qu
alit
ies
•
Eco
nom
ic ine
qu
alit
ies
To a
dd
ress th
ese
ma
ny a
nd
ch
alle
ngin
g issu
es w
ill r
equ
ire
an
ap
pro
ach
wh
ich
refle
cts
the p
rin
cip
les o
f co
-pro
ductio
n a
nd
wh
ich
e
mb
race
s c
ha
nge
s to
eco
no
mic
, cu
ltu
ral a
nd e
nviro
nm
en
tal co
nd
itio
ns a
nd
pre
va
ilin
g c
ircu
msta
nce
s,
imp
rovin
g infr
astr
uctu
re t
o a
id
an
d o
ve
rco
me
issu
es w
ith
acce
ss t
o s
erv
ice
s;
and
to s
tre
ngth
en
ing c
om
mun
itie
s a
nd
ind
ivid
ua
ls.
Ad
dre
ssin
g t
he
se
will
re
qu
ire
th
e C
PP
pa
rtn
ers
to
co
llate
evid
en
ce
an
d ide
ntify
wh
ere
th
e a
gre
ed
prio
rity
actio
n a
rea
s a
re. T
his
will
b
e a
lign
ed w
ith
th
e s
tra
tegic
ou
tco
me
s in
th
e S
OA
, id
entify
ing c
lea
r a
ctio
ns fo
r de
live
ry.
Ge
ogra
ph
ica
l in
equ
alit
ies a
nd
a c
lea
r an
aly
sis
of
pla
ce
will
be
fu
rthe
r h
igh
ligh
ted
in
th
e a
dd
itio
na
l ce
nsu
s info
rma
tio
n a
t lo
ca
l a
rea
s
wh
ich
will
be
pu
blis
hed t
hro
ugh
ou
t 2
013
. T
his
an
aly
sis
will
in
form
the
str
ate
gic
ap
pro
ach
to o
ur
com
mu
nitie
s a
nd
su
ppo
rt t
he
d
eve
lop
me
nt of
loca
lise
d p
lan
nin
g w
he
re t
his
is a
prio
rity
.
Eco
nom
ic ine
qu
alit
ies, u
nem
plo
ym
en
t a
nd u
nd
er
em
plo
ym
en
t a
re k
ey d
rive
rs f
or
he
alth a
nd g
eo
gra
ph
ica
l in
equ
alit
ies.
Lo
w in
co
me
is w
ide
ly r
eco
gn
ise
d a
s a
drive
r fo
r m
an
y o
the
r a
rea
s o
f in
equ
alit
y.
The
fo
cu
s o
f th
e S
OA
on
eco
nom
ic a
ctivity a
nd
gro
wth
is
fun
da
me
nta
l to
add
ressin
g t
his
.
The
Arg
yll
an
d B
ute
Co
mm
un
ity P
lan
nin
g P
art
ne
rsh
ip:
•
Un
de
rsta
nd
s its
le
ga
l an
d e
thic
al e
qua
litie
s r
esp
on
sib
ilitie
s to
se
rvic
e u
se
rs,
sta
ff a
nd c
om
mu
nitie
s
•
Bu
ilds its
ap
pro
ach
to
equ
alit
ies o
n h
um
an
rig
hts
prin
cip
les
•
Ta
ke
s a
ctio
n to
en
su
re s
erv
ice
s b
eco
me
in
clu
siv
e a
nd
acce
ssib
le to
all
Page 44 7.3i - Appendix 1
���
�
•
Use
s E
qu
alit
y I
mp
act A
sse
ssm
en
t, E
qu
al P
ay A
ud
it a
nd
sim
ilar
ap
pro
ach
es to
ide
ntify
in
equ
alit
ies a
nd w
ays o
f ad
dre
ssin
g
them
•
Pro
vid
es e
qu
alit
ies t
rain
ing,
de
ve
lopm
ent
an
d s
up
po
rt t
o its
Ma
na
ge
me
nt
Bo
ard
, sta
ff a
nd
pa
rtn
ers
•
pro
vid
es le
ade
rsh
ip o
n e
qu
alit
ies a
nd
hum
an r
igh
ts
•
Co
llects
mo
nito
rin
g info
rma
tio
n e
ffe
ctive
ly,
se
nsitiv
ely
an
d in
lin
e w
ith
data
pro
tectio
n la
w to
asse
ss le
ve
ls o
f in
equ
alit
y a
nd
a
rea
s o
f con
ce
rn
•
Th
rou
gh
its
pa
rtn
ers
en
ga
ge
s w
ith
sta
ff,
se
rvic
e u
se
rs a
nd o
the
r sta
ke
ho
lde
rs in
ord
er
to u
nd
ers
tan
d th
eir n
eed
s
Page 45 7.3i - Appendix 1
���
�PR
EV
EN
TIO
N P
LA
N
The
CP
P is c
om
mitte
d to
ea
rly in
terv
en
tio
n a
nd
pre
ve
ntion
. P
reve
nta
tive
sp
en
d is d
efine
d a
s “
Actio
ns w
hic
h p
reven
t p
rob
lem
s a
nd
e
ase
fu
ture
de
ma
nd o
n s
erv
ice
s b
y in
terv
en
ing e
arly,
the
reb
y d
eliv
erin
g b
ett
er
ou
tco
me
s a
nd
va
lue
fo
r m
one
y”.
Su
ch
an
ap
pro
ach
is
esse
ntia
l if t
he
cha
llen
ge
s f
acin
g A
rgyll
an
d B
ute
are
to b
e a
dd
resse
d s
ucce
ssfu
lly a
nd
in
a s
usta
ina
ble
ma
nner.
The
ra
nge
of
ch
alle
nge
s fa
cin
g A
rgyll
an
d B
ute
is s
ign
ific
ant
and
wid
e r
an
gin
g a
nd a
mu
lti-fa
cete
d a
pp
roach
to
pre
ve
ntio
n is r
equ
ire
d.
Rath
er
tha
n id
entify
a s
pe
cific
ou
tcom
e r
ela
ted
to
pre
ve
ntio
n t
he
CP
P h
as e
mb
ed
de
d p
reve
ntio
n in t
he
Co
mm
un
ity P
lan
an
d S
ingle
O
utc
om
e A
gre
em
en
t. It
is a
ke
y a
spe
ct of
ea
ch
of
the lo
ng t
erm
ou
tco
me
s.
Ine
qu
alit
ies in h
ea
lth
, ed
uca
tio
n a
nd
em
plo
ym
en
t re
ma
in a
ch
alle
nge a
nd s
om
e o
f th
e p
rob
lem
s fa
ced
by o
ur
com
mu
nitie
s h
ave
b
een
re
sis
tan
t to
im
pro
ve
me
nt a
nd h
ave
en
dure
d f
or
de
cad
es. T
he C
om
mu
nity P
lann
ing P
art
ne
rsh
ip is c
om
mitte
d t
o b
rea
kin
g th
at
cycle
th
rou
gh
pre
ve
ntio
n a
nd
ea
rly in
terv
en
tio
n.
Critica
l to
th
is is the
co
ntin
ued
im
pro
ve
me
nts
in in
tegra
tin
g a
nd
sh
arin
g info
rma
tio
n
be
twe
en
pa
rtne
rs,
ana
lysin
g t
ha
t in
form
atio
n a
nd
en
su
rin
g th
at
it is u
se
d to
de
ve
lop
a s
ha
red
ap
pro
ach
to
ach
ieve
ou
r o
utc
om
es.
Str
ate
gic
Pre
ve
nti
on
Pri
ori
tie
s
The
pro
po
sa
ls s
et o
ut
in t
he
Sin
gle
Ou
tcom
e A
gre
em
en
t see
k to
add
ress p
reve
ntion
in
te
rms o
f:
•
Ad
dre
ssin
g p
op
ula
tio
n d
eclin
e to
pre
ve
nt
the
difficu
ltie
s th
at w
ill a
rise
ba
se
d o
n p
roje
cte
d d
em
ogra
ph
ic c
han
ge
and
p
opu
latio
n r
ed
uctio
n.
•
En
su
rin
g a
mo
re e
cono
mic
ally
active
Arg
yll
an
d B
ute
th
at
con
trib
ute
s f
ina
ncia
lly
•
Imp
rovin
g t
he
skill
s a
nd
att
itu
de
s o
f p
eo
ple
to s
usta
in s
ucce
ss w
hic
h w
ill im
pro
ve
re
sili
en
ce a
nd f
lexib
ility
•
Inve
stin
g in
th
rivin
g a
nd
su
sta
ina
ble
com
mu
nitie
s w
hic
h w
ill h
elp
re
info
rce
the
so
cia
l, c
ivic
an
d c
om
mu
nity b
ack u
p t
o s
up
po
rt
a p
reve
nta
tive
ap
pro
ach
•
The
com
mitm
en
ts o
n in
equ
alit
ies w
hic
h w
ill s
ee
eff
ort
dire
cte
d t
o im
pro
ve
th
e liv
es o
f th
e m
ost
vu
lne
rab
le
•
The
spe
cific
outc
om
es a
rou
nd
ch
ildre
n a
nd
peo
ple
liv
ing a
ctive
he
alth
ier
live
s w
hic
h is c
on
sis
ten
t w
ith
the
ob
jective
s o
f p
reve
ntio
n a
nd e
arly in
terv
en
tio
n
•
Ou
r com
mitm
en
t a
nd
ap
pro
ach
to p
art
ne
rsh
ip w
ork
ing,
wo
rkin
g w
ith
th
ird
se
cto
r a
nd
co
–p
rod
uctio
n w
hic
h w
ill f
urt
he
r em
be
d
ea
rly in
terv
en
tio
n a
nd
pre
ve
ntio
n a
t a
ll le
ve
l in
Arg
yll
an
d B
ute
In lin
e w
ith
the
Sco
ttis
h G
ove
rnm
en
ts S
OA
Gu
ida
nce
the
Com
mu
nity P
lan
nin
g P
art
ne
rsh
ip w
ill:
•
Ide
ntify
ke
y p
reve
nta
tive
activitie
s a
lre
ad
y in
pla
ce
re
latin
g to
ea
ch
ou
tcom
e
•
Ide
ntify
be
st
pra
ctice
an
d e
nco
ura
ge
wid
er
rep
lica
tio
n
Page 46 7.3i - Appendix 1
���
�
•
Me
asu
re th
e r
eso
urc
es c
om
mitte
d to
pre
ve
ntio
n a
nd
th
e s
ca
le o
f p
reve
nta
tive
activity;
an
d
•
En
co
ura
ge
and
sup
po
rt o
pp
ort
un
itie
s to
id
en
tify
ne
w a
pp
roa
che
s,
and
ro
ll o
ut o
r in
cre
ase
exis
tin
g a
ctivity
Re
ce
nt S
co
ttis
h G
ove
rnm
en
t C
ha
nge
Fun
ds h
ave
en
ab
led u
s to
deve
lop
jo
int
pla
nn
ing a
nd
com
mis
sio
nin
g p
rocesse
s a
nd
p
reve
nta
tive
sp
en
din
g in
re
latio
n t
o E
arly Y
ea
rs a
nd
Old
er
Pe
op
le is n
ow
a p
rio
rity
. T
he
re
ce
ntly f
orm
ed
Ea
rly Y
ea
rs C
olla
bo
rative
w
ill id
en
tify
evid
en
ce b
ase
d p
reve
nta
tive
activitie
s t
hat
can
be
re
plic
ate
d a
cro
ss A
rgyll
an
d B
ute
. W
e k
no
w t
ha
t by in
ve
stin
g in
ea
rly
ye
ars
we
ca
n r
edu
ce
th
e p
ote
ntia
l p
rob
lem
s o
f th
e fu
ture
and
cha
llen
ge
th
e lin
k b
etw
ee
n p
ove
rty a
nd
po
or
att
ain
me
nt
an
d
ach
ieve
men
t. S
tra
tegic
pre
ve
ntio
n p
rio
ritie
s w
ill r
esp
on
d t
o th
e c
om
ple
x n
ee
ds o
f a
du
lts a
nd c
hild
ren
exp
erie
ncin
g in
equ
alit
ies. A
vita
l p
art
of
imp
rovin
g t
he
so
cia
l a
nd
eco
nom
ic w
ellb
ein
g o
f p
eop
le in
Arg
yll
an
d B
ute
is t
o b
uild
th
e c
ap
acity w
ith
in in
div
idu
als
an
d
co
mm
un
itie
s.
Em
po
we
rin
g p
eo
ple
to h
elp
the
mse
lve
s u
nd
erp
ins t
he
app
roa
ch
of
the
Com
mu
nity P
lann
ing P
art
ne
rsh
ip.
Th
rou
gh
co
-pro
du
ctio
n w
e w
ill p
rovid
e s
erv
ice
s f
or
pe
op
le,
with
pe
op
le. B
y d
oin
g t
his
we
no
t on
ly b
uild
in
div
idu
al a
nd
com
mu
nity c
ap
acity
bu
t a
lso
en
ab
le p
eo
ple
to
se
cu
re b
ette
r o
utc
om
es fo
r th
em
se
lve
s.
The
ap
pro
ach
to
pe
rfo
rma
nce
ma
na
ge
me
nt w
ill p
rovid
e t
he
evid
en
ce t
o a
llow
us to
asse
ss o
ur
pro
gre
ss in
re
latio
n t
o p
reve
ntio
n
an
d w
he
re it
is n
ece
ssa
ry t
o c
ha
nge
ou
r ap
pro
ach
to
ach
ieve
bett
er
resu
lts.
Page 47 7.3i - Appendix 1
���
�EN
GA
GE
ME
NT
AN
D E
MP
OW
ER
ME
NT
Arg
yll
an
d B
ute
is a
n a
rea
defin
ed
by d
ive
rsity o
f ge
ogra
ph
y a
nd
of co
mm
un
ity.
En
ga
ge
men
t w
ith
an
d e
mp
ow
erm
en
t of
ou
r co
mm
un
itie
s is e
sse
ntia
l to
en
su
rin
g t
ha
t A
rgyll
an
d B
ute
Co
mm
un
ity P
lan
nin
g P
art
ne
rs d
esig
n,
de
ve
lop
an
d d
eliv
er
the
se
rvic
es
tha
t o
ur
com
mun
itie
s n
ee
d.
The
pa
rtn
ers
hip
is c
urr
en
tly c
on
su
ltin
g o
n a
ne
w C
om
mun
ity E
nga
ge
men
t S
tra
tegy t
ha
t w
ill h
elp
us a
ll to
le
arn
mo
re a
bo
ut
co
mm
un
ity e
nga
ge
men
t an
d im
pro
ve
the
wa
y w
e w
ork
with
diffe
rent
co
mm
un
itie
s.
The
Lo
ca
l G
ove
rnm
en
t in
Sco
tla
nd A
ct 2
003
in
tro
du
ce
d c
om
mu
nity p
lan
nin
g a
nd
mad
e c
om
mu
nity e
nga
ge
me
nt a
sta
tuto
ry
resp
on
sib
ility
of
all
pa
rtn
er
age
ncie
s.
Imp
ort
antly,
it s
hifte
d th
e r
esp
on
sib
ility
fo
r pa
rtic
ipa
tion
, re
qu
irin
g a
ge
ncie
s to
en
ga
ge
with
th
e
co
mm
un
ity r
ath
er
tha
n a
skin
g t
he
co
mm
un
ity t
o e
nga
ge
with
th
em
.
The
Com
mu
nity P
lann
ing P
art
ne
rsh
ip w
ill w
ork
with
co
mm
un
itie
s to
•
en
su
re th
at
citiz
en
s a
nd
oth
er
ke
y s
takeh
old
ers
in
Arg
yll
an
d B
ute
ha
ve
a
•
vo
ice
an
d a
re a
ble
to
influ
en
ce
th
e d
eve
lopm
en
t of
po
licie
s a
nd
str
ate
gie
s t
hat
•
will
aff
ect
the
ir liv
es.
•
info
rm th
e w
ay in
wh
ich
se
rvic
es in
Arg
yll
an
d B
ute
are
pla
nn
ed
and
de
live
red
.
•
info
rm th
e p
roce
ss t
hro
ugh
wh
ich
ch
an
ge
can
be
ach
ieve
d.
•
de
ve
lop
re
latio
nsh
ips a
nd
en
su
re th
at
ou
r com
mu
nic
atio
n is o
pen
an
d c
lea
r,
•
free
fro
m ja
rgo
n a
nd a
cce
ssib
le t
o a
ll.
The
Sco
ttis
h G
ove
rnm
en
t R
evie
w o
f C
om
mun
ity P
lan
nin
g,
Sta
tem
en
t of
Am
bitio
n p
ub
lish
ed
in
Ma
rch
20
12
ma
kes c
lea
r th
at
co
mm
un
itie
s h
ave
a k
ey r
ole
to
pla
y in
he
lpin
g t
o s
ha
pe
an
d c
o-p
rodu
ce
be
tte
r o
utc
om
es a
nd
th
at u
nlo
ckin
g th
at p
ote
ntia
l re
qu
ire
s
CP
Ps t
o h
ave
a s
tro
ng u
nde
rsta
nd
ing o
f co
mm
un
itie
s a
nd
to
pro
vid
e g
en
uin
e o
pp
ort
un
itie
s t
o c
on
su
lt, e
nga
ge
an
d in
vo
lve
th
em
.
To a
ch
ieve
th
is,
we
wa
nt
to w
ork
alo
ngsid
e a
nd
lis
ten
to o
ur
co
mm
un
itie
s b
y e
nab
ling c
om
mu
nitie
s t
o g
et
invo
lve
d in
ma
kin
g
se
rvic
es b
ett
er
an
d p
rovid
ing w
ays f
or
com
mun
itie
s t
o g
et
an
d e
xch
an
ge
info
rma
tion
. W
e w
an
t to
ba
se
ou
r a
ctio
ns o
n th
e p
rin
cip
les
of
co
-pro
du
ction
th
ere
by s
tre
ngth
en
ing c
om
mu
nitie
s a
nd
en
ha
ncin
g c
om
mu
nity r
esili
en
ce.
The
Com
mu
nity P
lann
ing P
art
ne
rsh
ip r
eco
gn
ise
s t
he
re
spo
nsib
ility
of
ea
ch
an
d e
ve
ry p
art
ne
r a
ge
ncy t
o a
ctive
ly e
nga
ge
with
co
mm
un
itie
s in
a m
ean
ingfu
l w
ay.
Th
is m
ea
ns e
nga
ge
me
nt a
t a
n e
arl
y s
tage
in
the
po
licy c
ycle
, su
pp
ort
an
d e
ncou
rage
men
t fo
r co
mm
un
ity r
ep
rese
nta
tive
s/s
take
ho
lde
rs a
nd
tra
inin
g a
nd
skill
de
ve
lop
men
t fo
r th
eir s
taff
.
Page 48 7.3i - Appendix 1
���
�Wh
at
is c
om
mu
nit
y e
ng
ag
em
en
t?
Co
mm
un
ity e
nga
ge
men
t co
ve
rs m
an
y d
iffe
ren
t a
ctivitie
s c
arr
ied
ou
t w
ith
th
e p
eo
ple
wh
o m
ake
up
com
mu
nitie
s.
At
its c
ore
it is
a
bou
t m
akin
g s
ure
th
at p
eop
le c
an
pa
rtic
ipa
te in
lo
ts o
f d
iffe
rent
wa
ys t
o m
ake A
rgyll
an
d B
ute
a b
ett
er
pla
ce
to
liv
e,
wo
rk,
stu
dy
an
d p
lay.
Th
e P
art
ne
rsh
ip h
as a
do
pte
d th
e f
ollo
win
g d
efin
itio
n o
f com
mu
nity e
nga
ge
me
nt:
Co
mm
un
ity e
nga
ge
men
t is
the
pro
ce
ss o
f in
vo
lvin
g c
om
mu
nitie
s in
th
e d
eve
lop
me
nt a
nd
ma
na
gem
ent
of
se
rvic
es s
uch
as h
ea
lth,
ed
uca
tio
n a
nd
ho
usin
g.
It m
ay a
lso
in
vo
lve
oth
er
issu
es w
hic
h c
on
ce
rn u
s a
ll, o
r it m
ay b
e a
bou
t ta
cklin
g t
he
pro
ble
ms o
f a
n
eig
hb
ou
rho
od
, su
ch
as c
rim
e, d
rug m
isu
se o
r la
ck o
f p
lay f
acili
tie
s fo
r ch
ildre
n.
Co
mm
un
ity e
nga
ge
me
nt ta
ke
s m
an
y s
ha
pe
s a
nd
fo
rms. It
can
in
vo
lve
sim
ple
exe
rcis
es in
co
nsu
lta
tion
th
rou
gh
the
fo
rma
tion
of m
ulti-a
ge
ncy p
art
ne
rsh
ips w
ith
com
mu
nity
rep
rese
nta
tion
at th
e c
en
tre
. U
nd
erlyin
g e
ffe
ctive
co
mm
un
ity e
nga
ge
men
t is
th
e c
om
mitm
en
t of
se
rvic
e p
rovid
ers
an
d p
lann
ers
to
lis
ten
to t
ho
se
fo
r w
ho
m s
erv
ice
s a
re b
ein
g p
lan
ned
’. (
Co
mm
un
itie
s’ S
co
tlan
d,
Co
mm
un
ity E
nga
ge
men
t H
ow
to
Gu
ide
)
Typ
es
of
en
ga
ge
me
nt
•
Em
po
we
rme
nt
•
Invo
lve
me
nt
•
Co
nsu
ltatio
n
•
Co
mm
un
icatio
n
•
Info
rma
tion
Be
ne
fits
The
re a
re m
an
y b
enefits
th
at
can
be
ga
ine
d b
y b
oth
pa
rtn
er
org
an
isa
tio
ns a
nd b
y c
itiz
en
s.
The
fo
llow
ing c
an
be
ach
ieve
d b
y
liste
nin
g t
o a
nd
wo
rkin
g w
ith
co
mm
un
itie
s:
•
Pla
n a
nd
pro
vid
e s
uitab
le a
nd
lo
ca
lise
d s
erv
ice
s t
ha
t a
re t
ailo
red
to th
e n
ee
ds o
f th
e c
om
mu
nity
•
Em
po
we
r p
eo
ple
to d
efine
th
e v
isio
n f
or
the
ir o
wn
co
mm
un
ity
•
Pro
vid
e info
rma
tio
n a
nd
opp
ort
un
itie
s fo
r th
e p
ub
lic to
be b
ett
er
info
rme
d
•
Mo
nito
r &
mea
su
re p
erf
orm
an
ce
•
En
co
ura
ge
lo
ca
l pe
op
le t
o b
eco
me
active
ly in
vo
lve
d in
th
e d
em
ocra
tic p
roce
ss
•
Bu
ild o
n ‘re
sp
on
sib
le c
itiz
en
sh
ip’, c
ohe
siv
e c
om
mu
nitie
s w
ith
a s
ha
red
se
nse
of fa
irne
ss a
nd
so
cia
l re
sp
on
sib
ility
.
Page 49 7.3i - Appendix 1
��
�
•
Imp
rove
s r
ela
tio
nsh
ip b
etw
ee
n p
art
ne
r a
ge
ncie
s a
nd
the
pu
blic
•
Bu
ild c
ap
acity
Ex
isti
ng
Mec
ha
nis
ms f
or
Co
mm
un
ity E
ng
ag
em
en
t
With
in th
e A
rgyll
an
d B
ute
Com
mu
nity P
lan
nin
g P
art
ne
rsh
ip,
the
re a
re m
an
y e
xa
mp
les o
f en
ga
ge
me
nt
activity t
akin
g p
lace
an
d a
re
wo
rkin
g t
ow
ard
s A
rgyll
an
d B
ute
Com
mu
nity P
lan
nin
g P
art
ne
rsh
ip o
bje
ctive
s.
Th
e C
PP
re
ce
ntly d
eve
lop
ed its
Be
tte
r C
om
mun
ity
En
ga
ge
men
t R
eso
urc
e P
ack a
nd
som
e o
f th
e c
om
mun
ity e
nga
ge
men
t an
d e
va
lua
tio
n e
xe
rcis
es a
re a
va
ilab
le o
nlin
e
( htt
p://w
ww
.arg
yll-
bu
te.g
ov.u
k/c
om
mu
nity-life
-an
d-le
isu
re/c
om
mu
nityd
eve
lop
me
nt )
. In
ad
ditio
n, a
nu
mb
er
of
ph
ysic
al re
so
urc
es a
re
ava
ilab
le o
n lo
an t
o C
PP
pa
rtn
ers
to
assis
t en
ga
ge
me
nt
activitie
s. T
he
se
ca
n b
e fo
un
d o
nlin
e a
t h
ttp
://w
ww
.arg
yll-
b
ute
.go
v.u
k/m
otiva
tin
g-y
ou
r-co
mm
un
ity),
or
ca
n b
e b
oo
ked
fro
m th
e C
ou
ncil’
s C
om
mu
nity D
eve
lop
men
t te
am
at
co
mm
un
ityd
eve
lop
men
t@a
rgyll-
bu
te.g
ov.u
k. W
hile
th
e lis
t b
elo
w m
ay n
ot
be
exh
au
stive
, it d
oe
s s
ugge
st
that
the
re is a
ran
ge
and
d
ive
rsity t
ha
t giv
es c
itiz
en
s a
nd
oth
er
sta
ke
ho
lde
rs a
n o
pp
ort
un
ity t
o fe
el th
at
the
ir v
iew
s a
re g
ath
ere
d b
y v
ario
us p
rovid
ers
of
se
rvic
es.
•
Are
a C
om
mu
nity P
lann
ing G
rou
ps
•
Citiz
en
s’ P
an
el
•
Fo
cu
s G
rou
ps
•
Th
ird
Se
cto
r A
rea F
oru
m
•
Mu
lti-a
ge
ncy P
art
ne
rsh
ip G
roup
s in
clu
din
g loca
l p
eo
ple
•
Co
mm
un
ity C
are
Fo
rum
•
Yo
un
g S
co
t
•
Co
mm
un
ity H
ea
lth P
art
ne
rsh
ip -
Pa
tien
t In
vo
lve
me
nt A
ctivitie
s
•
Crim
e P
reve
ntio
n P
ane
ls
•
Co
mm
un
ity S
afe
ty P
art
ne
rsh
ips
•
Do
me
stic A
bu
se
Fo
rum
•
Fe
ed
ba
ck F
orm
s
•
Ele
cte
d M
em
be
rs’ S
urg
erie
s
•
NH
S P
ub
lic P
art
ne
rsh
ip F
oru
m
•
Co
mm
un
ity D
eve
lop
me
nt T
rusts
•
Co
mm
un
ity C
ou
ncils
Page 50 7.3i - Appendix 1
��
�
•
3rd
Se
cto
r P
art
ne
rsh
ip
Ha
rd t
o R
ea
ch
Gro
up
s
It is im
po
rtan
t th
at
we
info
rm,
con
su
lt a
nd
in
vo
lve
all
se
cto
rs o
f th
e c
om
mun
ity w
ho
ma
y b
e a
ffe
cte
d b
y a
ctio
ns a
nd
de
cis
ion
ta
ke
n
by t
he
CP
P o
r a
ny o
f its p
art
ne
rs.
Un
less c
are
is t
ake
n w
e m
ay n
ot suff
icie
ntly c
ap
ture
th
e v
iew
s o
f im
po
rtan
t gro
up
s o
f pe
op
le
with
in o
ur
co
mm
un
ity.
Th
is in
clu
de
s h
ard
to
re
ach
gro
up
s s
uch
as d
isa
ble
d p
eop
le, m
igra
nt
wo
rke
rs,
gyp
sie
s a
nd
tra
ve
llers
, yo
un
g
pe
op
le a
nd
old
er
pe
op
le. T
hro
ugh
co
nsu
lta
tion
we
will
ask t
he
se
, a
nd
oth
er,
gro
up
s a
bo
ut h
ow
th
ey w
ou
ld lik
e u
s t
o e
nga
ge
with
th
em
. A
lso
, th
e lo
ca
tion
s w
he
re w
e e
nga
ge
, th
e b
uild
ings u
sed
, th
e s
up
po
rt p
rovid
ed
an
d w
ays o
f co
mm
un
ica
ting w
ill r
eco
gn
ise
th
e
co
nstr
ain
ts o
f liv
ing in
a r
ura
l a
rea
an
d ta
ke
in
to a
cco
un
t th
e d
iffe
ren
t ne
ed
s o
f th
ose
we
will
be
en
ga
gin
g w
ith
.
Imp
lem
en
tati
on
Co
mm
un
ity e
nga
ge
men
t is
at th
e h
ea
rt o
f com
mu
nity p
lann
ing in
Arg
yll
an
d B
ute
an
d w
e a
s a
pa
rtn
ers
hip
com
mit t
o e
nsu
rin
g t
ha
t it
is a
drivin
g f
orc
e fo
r d
eliv
eri
ng im
pro
ve
d o
utc
om
es t
hro
ugh
ou
t th
e a
rea
. T
he
Action
Pla
n tha
t is
be
ing d
eve
lop
ed
as a
re
su
lt o
f co
nsu
lta
tio
n r
esp
on
se
s t
o th
e n
ew
Co
mm
un
ity E
nga
ge
men
t S
tra
tegy w
ill f
orm
the
ba
sis
fo
r th
e p
art
ne
rsh
ip t
o d
eliv
er
on
th
is
co
mm
itm
en
t w
ith
all
part
ne
rs c
ontr
ibu
tin
g o
utc
om
es f
rom
the
ir o
wn
co
nsu
lta
tio
ns a
nd
en
ga
ge
me
nt to
pro
du
ce
fo
rwa
rd lo
okin
g
actio
n p
lan
s.
Page 51 7.3i - Appendix 1
���
�RE
SO
UR
CE
S,
PA
RT
NE
RS
HIP
WO
RK
ING
AN
D G
OV
ER
NA
NC
E
The
Arg
yll
an
d B
ute
Co
mm
un
ity P
lan
nin
g P
art
ne
rsh
ip h
as a
n a
nnu
al b
ud
ge
t of
ap
pro
xim
ate
ly £
50
0m
pe
r a
nn
um
fo
r se
rvic
es t
o t
he
p
eop
le o
f A
rgyll
an
d B
ute
.
The
pa
rtn
ers
hip
ha
s s
tre
ngth
ene
d o
ve
r its lifetim
e in r
esp
on
se
to
re
vie
w,
imp
rove
me
nt a
nd
on
go
ing c
ha
llen
ge
s tha
t th
e a
rea
fa
ce
s.
Str
on
g w
ork
ing r
ela
tio
nsh
ips a
nd
op
en
com
mu
nic
ation
are
fun
dam
en
tal to
the
eff
ective
ope
ratio
n o
f th
e p
art
ne
rsh
ip a
nd
th
e d
eliv
ery
of
ou
r o
utc
om
es.
The
Com
mu
nity P
lann
ing s
tru
ctu
re in A
rgyll
an
d B
ute
com
prise
s a
se
rie
s o
f le
ve
ls o
f in
tera
ctio
n, e
nga
ge
me
nt a
nd r
ep
resen
tation
. A
rgyll
an
d B
ute
Cou
ncil
ad
min
iste
rs t
he
pa
rtne
rsh
ip a
nd
pro
vid
es p
olit
ica
l re
pre
se
nta
tion
at b
oth
ma
na
ge
men
t a
nd
lo
ca
l a
rea
le
ve
ls.
The
Ch
air o
f th
e M
an
age
me
nt C
om
mitte
e r
ota
tes a
mo
ngst
pa
rtn
ers
on
a b
iann
ua
l b
asis
to
en
su
re a
cle
ar
pa
rtn
ers
hip
ow
ne
rsh
ip o
f th
e p
roce
ss.
The
Arg
yll
an
d B
ute
Co
mm
un
ity P
lan
nin
g P
art
ne
rsh
ip s
tru
ctu
re is illu
str
ate
d b
elo
w.
Th
is s
tru
ctu
re r
efle
cts
the
ge
ogra
ph
ica
l d
ive
rsity
of
the
are
a, e
nga
ge
men
t w
ith
ou
r com
mu
nitie
s,
the le
ad
ers
hip
and
acco
un
tab
ility
at
an a
rea
wid
e le
ve
l a
nd
re
co
gn
itio
n th
at th
e f
ull
pa
rtn
ers
hip
ha
s a
n im
po
rta
nt
str
ate
gic
ro
le in s
ha
pin
g t
he
dire
ctio
n o
ur
ou
tco
me
s a
nd
ou
r se
rvic
es.
Page 52 7.3i - Appendix 1
���
�
Are
a C
om
mu
nit
y P
lan
nin
g G
rou
ps
Arg
yll
& B
ute
is a
la
rge
an
d d
ive
rse
are
a. C
om
mu
nitie
s c
an
ha
ve
diffe
ren
t is
su
es e
ve
n w
ith
in t
he o
ve
rall
um
bre
lla o
f a
co
mm
un
ity
pla
n a
nd
Sin
gle
Outc
om
e A
gre
em
en
t fo
r th
e w
ho
le a
rea
. It is im
po
rta
nt
tha
t th
ere
con
tin
ues t
o b
e e
ffe
ctive
go
ve
rna
nce
ove
r th
e
CP
P a
t a
lo
ca
l le
ve
l. I
t is
th
e r
ole
of
Are
a C
om
mu
nity P
lann
ing G
roups t
o d
isch
arg
e t
his
fu
nctio
n. T
he
ro
le o
f C
PP
Are
a C
om
mu
nity
Pla
nn
ing G
rou
ps is to
:
•
En
ga
ge
with
co
mm
un
itie
s t
o u
nde
rsta
nd
th
eir n
eed
s a
nd
re
qu
ire
me
nts
and
als
o t
o info
rm a
nd
con
su
lt o
n issue
s r
ela
tin
g t
o
the
CP
P a
t a
n a
rea le
ve
l.
•
En
su
re e
ffe
ctive
wo
rkin
g a
cro
ss c
om
mu
nity p
lan
nin
g p
art
ne
rs a
t a
n a
rea
le
ve
l.
•
En
su
re c
on
tinu
ou
s im
pro
ve
me
nt
in t
he
eff
ective
ne
ss o
f th
e C
PP
at
an
are
a le
ve
l.
•
Ma
na
ge
pe
rfo
rma
nce to
en
su
re d
eliv
ery
of
the
com
mu
nity p
lan
at an
are
a le
ve
l.
Are
a C
om
mu
nity P
lann
ing G
rou
ps m
ee
t fo
ur
tim
es a
ye
ar.
Page 53 7.3i - Appendix 1
���
�Th
e M
an
ag
em
en
t C
om
mit
tee
En
su
rin
g t
he
re is e
ffe
ctive
en
ga
ge
me
nt, jo
int w
ork
ing,
po
licy d
eve
lop
men
t, p
lann
ing a
nd
prio
ritisa
tio
n a
nd
pe
rfo
rma
nce
m
ana
ge
me
nt
is a
ke
y r
ole
of
Co
mm
un
ity.
Th
is is t
he
ma
in f
ocu
s o
f th
e M
an
agem
en
t C
om
mitte
e. T
he r
ole
of
the
Ma
na
gem
ent
Co
mm
itte
e is t
o:
•
De
ve
lop
th
e C
om
mun
ity P
lan
an
d S
ingle
Outc
om
e A
gre
em
en
t to
se
t th
e o
ve
rall
dire
ctio
n fo
r co
mm
un
ity p
lan
nin
g p
art
ne
rs
in
Arg
yll
& B
ute
at a
str
ate
gic
le
ve
l.
•
Pe
rfo
rma
nce m
ana
ge
me
nt
with
an
acco
un
tab
le le
ad
id
en
tified
fo
r ea
ch
SO
A o
utc
om
e t
o e
nsu
re d
eliv
ery
of
the c
om
mun
ity
pla
n/S
OA
at
a s
tra
tegic
le
ve
l.
•
Re
po
rt p
erf
orm
an
ce
to t
he
pub
lic
•
De
ve
lop
po
licy a
cro
ss c
om
mun
ity p
lan
nin
g p
art
ne
rs th
at
su
pp
ort
the
de
live
ry o
f th
e C
om
mu
nity P
lan a
nd
Sin
gle
Ou
tcom
e
Agre
em
en
t at
a s
tra
tegic
le
ve
l.
•
En
ga
ge
with
co
mm
un
itie
s t
o u
nde
rsta
nd
th
eir n
eed
s a
nd
re
qu
ire
me
nts
and
als
o t
o info
rm a
nd
con
su
lt o
n issue
s r
ela
tin
g t
o
the
CP
P a
t a
str
ate
gic
le
ve
l.
•
Re
sp
ond
/re
act/
con
trib
ute
to
na
tion
al po
licy d
eve
lop
men
ts a
t a s
tra
tegic
le
ve
l.
•
Work
ing e
ffe
ctive
ly a
cro
ss c
om
mu
nity p
lann
ing p
art
ne
rs a
t a
str
ate
gic
le
ve
l.
•
Fa
cili
tate
th
e s
ha
rin
g o
f in
form
ation
be
twe
en
co
mm
un
ity p
lan
nin
g a
nd
str
ate
gic
pa
rtne
rsh
ips a
nd
id
en
tify
ing o
ppo
rtu
nitie
s fo
r im
pro
ve
d jo
int w
ork
ing.
•
Pro
mote
co
ntinu
ou
s im
pro
ve
me
nt
in th
e e
ffe
ctive
ne
ss o
f th
e C
PP
at a
str
ate
gic
le
ve
l.
The
Ma
na
ge
me
nt
Co
mm
itte
e m
eets
fou
r tim
es a
ye
ar.
Ch
ief
Off
ice
rs G
rou
p (
CO
G)
The
ro
le o
f th
e C
PP
CO
G is t
o:
•
En
su
re issue
s a
re b
ein
g r
ais
ed
and
actio
ned
on
be
ha
lf o
f th
e M
ana
ge
men
t co
mm
itte
e o
f th
e C
PP
•
En
su
re p
art
ne
rs a
re w
ork
ing e
ffic
ien
tly t
oge
the
r.
The
first
role
co
ve
rs a
ctio
n/s
up
po
rt t
o m
ake
rea
l/a
ction
/ope
ration
alis
e t
he
action
s a
nd
activitie
s a
gre
ed
by t
he
Man
age
me
nt
Co
mm
itte
e a
nd
th
ere
by t
o u
nde
rpin
eff
ective
de
live
ry o
f th
e c
om
mun
ity p
lan
. T
he
se
co
nd r
ole
re
late
s t
o c
ontin
uou
s im
pro
ve
me
nt
Page 54 7.3i - Appendix 1
���
�ide
ntify
ing a
nd
ta
kin
g fo
rwa
rd o
pp
ort
un
itie
s for
co
llab
ora
tion
, jo
int
wo
rkin
g a
nd
sha
red
se
rvic
e a
t a
str
ate
gic
le
ve
l. T
his
wo
uld
a
dd
ress th
e f
ollo
win
g k
ey a
sp
ects
of
com
mu
nity p
lan
nin
g:
•
Eff
ective
wo
rkin
g a
cro
ss c
om
mun
ity p
lan
nin
g p
art
ne
rs.
•
Co
ntin
uo
us im
pro
ve
me
nt
in t
he
eff
ective
ne
ss o
f th
e C
PP
.
•
Pe
rfo
rma
nce m
ana
ge
me
nt
to e
nsu
re d
eliv
ery
of
the
co
mm
un
ity p
lan
The
Ch
ief
Off
ice
rs G
rou
p m
eets
fou
r tim
es a
ye
ar
with
th
e o
ption
to
co
nve
ne
ad
ditio
na
l m
ee
tin
gs a
s a
nd
wh
en
requ
ire
d.
SO
A D
eli
ve
rin
g O
utc
om
es
1-6
Ea
ch
of
the
six
te
n-y
ear
ou
tcom
es h
as a
n a
cco
un
tab
le le
ad o
ffic
er
wh
o is r
espo
nsib
le f
or:
•
Ide
ntify
ing t
he
re
leva
nt p
art
ne
rs t
o a
ch
ieve
the
outc
om
e.
•
Esta
blis
hin
g r
epo
rtin
g p
roto
co
ls w
ith
re
leva
nt p
art
ne
rs a
nd s
tra
tegic
pa
rtn
ers
hip
s.
•
Co
-ord
ina
te r
ele
va
nt
info
rmatio
n fo
r pe
rfo
rman
ce
ma
na
ge
me
nt p
urp
ose
s.
•
Qu
art
erly p
erf
orm
an
ce r
ep
ort
ing t
o M
an
agem
en
t C
om
mitte
e.
Str
ate
gic
Pa
rtn
ers
hip
s
The
re a
re a
la
rge
num
be
r of
str
ate
gic
pa
rtn
ers
hip
s a
cro
ss A
rgyll
an
d B
ute
th
at a
re a
lign
ed t
o p
art
icu
lar
po
licy a
nd
se
rvic
e a
rea
s.
The
se
pa
rtne
rsh
ips c
on
trib
ute
to
th
e d
eliv
ery
of
ou
tcom
es a
nd
are
an
essen
tia
l e
lem
en
t of
the
ove
rall
pa
rtn
ers
hip
ne
two
rk.
Th
ey
link in
to th
e o
ve
rall
CP
P s
tru
ctu
re t
hro
ugh
the o
utc
om
e le
ad
s a
nd
are
accou
nta
ble
fo
r se
rvic
e d
eliv
ery
an
d c
ontr
ibu
tio
n to
ou
tco
me
s
thro
ugh
th
e p
erf
orm
ance
ma
na
gem
en
t p
rocess.
Th
e F
ull
Pa
rtn
ers
hip
Re
sp
on
sib
ility
fo
r th
e o
ve
rall
de
ve
lop
me
nt
of co
mm
un
ity p
lan
nin
g in
Arg
yll
& B
ute
lie
s w
ith
th
e F
ull
pa
rtn
ers
hip
. It d
oe
s th
is b
y
de
lega
tin
g r
esp
on
sib
ility
fo
r in
div
idu
al a
sp
ects
of
com
mun
ity p
lan
nin
g t
o A
rea
Co
mm
un
ity P
lan
nin
g G
rou
ps,
Ma
na
ge
men
t C
om
mitte
e a
nd
CP
P C
hie
f O
ffic
ers
Gro
up
. T
he
activitie
s o
f th
e C
PP
ca
n b
e b
roke
n d
ow
n into
the
fo
llow
ing:
•
Str
ate
gic
ove
rsig
ht
of
co
mm
un
ity p
lan
nin
g.
•
De
ve
lop
ing t
he
Com
mu
nity P
lan
an
d S
ingle
Ou
tcom
e A
gre
em
en
t to
se
t th
e o
ve
rall
dire
ctio
n fo
r com
mu
nity p
lann
ing p
art
ne
rs
in A
rgyll
& B
ute
.
Page 55 7.3i - Appendix 1
���
�
•
Po
licy d
eve
lop
men
t a
cro
ss c
om
mun
ity p
lan
nin
g p
art
ne
rs th
at
su
pp
ort
th
e d
eliv
ery
of
the
com
mu
nity p
lan
.
•
En
ga
gin
g w
ith
co
mm
un
itie
s t
o u
nd
ers
tan
d the
ir n
eed
s a
nd
re
qu
irem
ents
an
d a
lso
to
info
rm a
nd
co
nsu
lt o
n issu
es r
ela
tin
g t
o
the
CP
P.
•
Re
sp
ond
ing /
re
actin
g t
o n
atio
na
l p
olic
y d
eve
lop
me
nts
.
•
Eff
ective
wo
rkin
g a
cro
ss c
om
mun
ity p
lan
nin
g p
art
ne
rs.
•
Co
ntin
uo
us im
pro
ve
me
nt
in t
he
eff
ective
ne
ss o
f th
e C
PP
.
•
Pe
rfo
rma
nce m
ana
ge
me
nt
to e
nsu
re d
eliv
ery
of
the
co
mm
un
ity p
lan
.
•
Re
po
rtin
g p
erf
orm
an
ce t
o th
e p
ub
lic.
The
Fu
ll P
art
ne
rsh
ip o
f th
e C
PP
will
no
rma
lly m
eet
on
ce
ea
ch y
ea
r to
:
•
Re
vie
w t
he
ann
ua
l re
po
rt f
or
the
pre
vio
us y
ea
r.
•
Re
vie
w p
rogre
ss t
o d
ate
fo
r th
e c
urr
en
t ye
ar.
•
Se
t d
ire
ctio
n fo
r th
e n
ext
ye
ar.
Tim
e L
imit
ed
Gro
up
s
The
se
gro
up
s a
re c
om
ple
me
nte
d b
y T
ime
Lim
ite
d G
roup
s c
om
prisin
g r
ele
va
nt
CP
P p
art
ne
rs w
ith
a d
esig
na
ted
le
ad
. T
ime lim
ited
w
ork
ing g
rou
ps a
re f
orm
ed t
o a
dd
ress s
pe
cific
issu
es a
nd
ma
ke
re
co
mm
en
datio
ns to
th
e M
an
age
me
nt
Co
mm
itte
e,
Ch
ief
Off
ice
rs
Gro
up
an
d o
the
r str
ate
gic
pa
rtn
ers
hip
s.
�
Page 56 7.3i - Appendix 1
7.3ii – Appendix 2
ARGYLL AND BUTE CPP: INITIAL FEEDBACK FROM QA TEAM Summary Narrative Still very much a work in progress, which requires significant ongoing development in a range of areas. As a result, it is difficult to form a cohesive judgement on the SOA at this stage. The draft benefits from a strong high level area profile which supports a clear set of specific challenges. Further understanding and analysis below that high level (by geography and with an emphasis on inequalities) would help shape and focus specific plans and interventions. There is at this point no clear alignment between these challenges and the CPP’s expression of priorities in its Long Term Outcomes. Nor does the draft SOA at this stage provide a sense about what impact the CPP expects to make on its priorities. Key Strengths • The “Understanding Argyll and Bute” section provides an informative area
profile, which helps to demonstrate an understanding of place. • Page 10 of the draft sets out a clear set of specific challenges for the Argyll
and Bute area. • Some positive features about Long Term Outcomes (e.g. attempt made to
set out 10 year horizons for outcomes, narrative of where Argyll and Bute is includes some reasonably honest assessments).
• A method for action (page 12), although at an early stage. Key Areas for Development • First and foremost, the CPP needs to complete its Plan for Place. Having
produced good work on understanding and demonstrating place specific challenges for Argyll and Bute, there then needs to be a clear line of sight between those challenges and the CPP’s priorities for the area (which are generic in nature).
• How the CPPs demonstrates that its Long Term Outcomes will inform local
resourcing decisions.
• Building in more place-specific 10 year visions for each outcome, to give a clearer sense of how Argyll and Bute will be different, especially in relation to its key challenges – i.e. the “impact” issue.
• Providing indicators and specific milestones (more outcome-based where
possible), so the scale of ambition and progress towards Long Term Outcomes can be assessed. This includes translating descriptive progress which the CPP expects to make in 3 years into realistic, measurable outcomes.
7.3ii – Appendix 2
• Progress generally required on a range of fronts, including setting out plans for
each outcome, resourcing, community engagement plan and prevention plan. Suggested Themes for Discussion • How can the CPP demonstrate a clearer line of sight between its challenges and
its Long Term Outcomes, and how will the CPP ensure its Long Term Outcomes feed through into key activities?
• How can the CPP ensure and demonstrate that shifts in resources will be driven
in particular by its local and prevention priorities? • What plans does the CPP have to develop measurable indicators which give a
better sense of its expectations and progress towards its local and prevention priorities?
• What are the CPP’s plans, phasings and timescales for concluding work on the
elements of the SOA (e.g. plans for delivering outcomes, prevention and engagement) that are not yet in place? How will the CPP ensure that it can fulfil its other responsibilities effectively while the SOA is being finalised?
• What value does the Partnership expect to add to the individual contributions of
partners at strategic level, in driving and supporting the Long-Term Outcomes? • How is the CPP able to assure itself that it has the necessary leadership, and
governance and accountability arrangements, in practice to secure meaningful continuous improvement?
7.3iii – Appendix 3
NHS Board Contribution to Community Planning Partn ership NHS Board: Highland Improving partnerships during 2013/14 Contributing to better outcomes through collaborative gain Argyll & Bute Community Planning Partnership In a similar way to Highland Community Planning Partnership, Argyll & Bute Community Planning Partnership has been reviewing structures, processes, performance management and governance. The previous SOA saw the CHP move to measuring performance through the Council Pyramid system and with the new SOA we will continue to be developing the focus on outcomes and their measures.
Community Planning Partnerships: NHS Highland Summary of the key tangible contributions that the NHS Board will make during 2013/14 towards improved outcomes Clearly national improvements through HEAT and other programmes play an important role, however, this part of the LDP is expected to focus on locally developed improvements Strong emphasis on changes to NHS services which reduce future demand by preventing problems arising or dealing with them early on
Priority
NHS Board Contribution in 2013/14
Current and Planned Performance Levels
Economic recovery and growth
Healthy Working Lives for Highland and Argyll & Bute CPPs – the focus this year is on SMEs and on those employers where we can make most impact in terms of reducing health inequalities. By supporting employers to protect and improve the mental & physical health of their workforce, this initiative contributes to economic growth & recovery – by reducing sickness and other absence levels and supporting increased productivity; to employment – by promoting and supporting employability initiatives; and to reducing health inequalities - through targeting those employers where more than 30% of their workforce are earning low pay (defined as earning below the Living Wage).
Healthy Working Lives - KPI 1 Number of employers accessing our services KPI 2 Number of employers represented at training and awareness sessions. KPI 3 Number of employers supported in detecting health, safety and wellbeing issues to prepare an HWL action plan. KPI 4 Number of employers engaging with HWL services KPI 5 Number of employers supported in developing policies
Employment
A&B CPP Public Health staff involved in the regeneration plans for Inveraray, Rothesay and Dunoon Partnership working to increase the proportion of our young people going into positive destinations in Argyll & Bute.
Still to be determined by the CPP (timeframe for doing this June 2013) Still to be determined by the CPP (timeframe for doing this June 2013)
Involvement in increasing public sector employment and training opportunities including work experience, graduate placement schemes, research etc.
Still to be determined by the CPP (timeframe for doing this June 2013)
Early years and early intervention
A&B CHP Working to ensure all babies experience the best possible pre and peri-natal environment Work with partners to ensure all children are developmentally ready to start to school. Support the development of parenting skills through targeted services. Work with partners to ensure children, young people and families at risk are safeguarded
Still to be determined by the CPP (timeframe for doing this June 2013)
Safer and stronger communities, and offending
A&B CHP All Looked After and Accomodated Children have a named Public Health Nurse with two main areas of responsibility (i) being the health partner to the child’s plan; (ii) ensure the health needs of all LAAC are met. Nurse Co-ordinators take responsibility to ensure public health nurses are aware of LAAC in their area and monitor the needs of young people in residential units, making sure there is effective co-ordination of their health plans Develop existing services for vulnerable pregnant women & babies and embed pre-birth assessment pathway Develop our responses to children affected by parental substance misuse and families involved in CPA.
Pre-birth assessment pathway implemented
The new ADP Strategy has identified the following actions: • Ensure that parents are
identified during assessment by drug and alcohol services to embed GIRFEC guidelines in the Single Shared Assessment
• Develop local data on children affected by substance misuse
• Build strong links between the ADP and Children and Families Services to ensure shared policy and procedures for child protection
• Further research young people’s drinking patterns in Argyll & Bute to understand the reasons for the high level of alcohol consumption locally
• Further develop diversionary activities to support alternatives to substance use and to build capacity and resilience in young people
• Continue to work with vulnerable at risk groups of young people to support their needs and aspirations
Health inequalities and physical activity
The A&B CPP is considering the best way to structure emphasis on inequalities having previously had a specific plan and group focussing on it and latterly having it integrated throughout all work. The CHP will work with whatever the outcome of that deliberation. The CHP is currently working on implementation of Keep Well in areas and with groups that particularly experience
health inequalities. As well as work already mentioned the CHP Committee is being asked to endorse increasing the work on physical activity in tandem with CPP partners. This will link with Keep Well and other initiatives. The CHP is also funding work on and evaluation of a physical activity scheme in Oban run by a social enterprise company which provides enhanced support for access to physical activity. Outcomes from this will help inform future work.
Older people
In A&B the CHP works with Argyll & Bute Council, Scottish Care, Argyll Voluntary Action and Argyll Carers Network on the Older Peoples Change Fund agenda. Their work has been nationally recognised and this programme of work extends into 13/14.
The specific outcomes are in the workstreams described from page 15 onwards in the attached document.
P:\Elaine Garman\A&B CHP - Shared\joint commissioning\JSNA\Meetings\2013\14 Jan\Argyll and Bute Change Plan.pdf
7.3iv – Appendix 4
Health Workforce and
Performance Directorate
John Connaghan, Director
T: 0131-244 3480
E:
αβχδεφγηιϕ NHS Chief Executives Copied to NHS Chairs
___ 31 May 2013 Dear Colleague LOCAL DELIVERY PLAN NHS BOARD CONTRIBUTION TO COMMUNITY PLANNING PARTNERSHIP
The Statement of Ambition issued following the Review of Community Planning and Single Outcome Agreements made it clear that effective community planning arrangements are important strategic building blocks at the core of public service reform. NHS Boards are key partners within Community Planning Partnerships.
In this year’s LDP, NHS Boards were asked to include a concise summary of the key tangible contributions that will be made during 2013/14 towards improved outcomes in economic recovery and growth; employment; early years and early intervention; safer and stronger communities, and offending; health inequalities and physical activity; and older people.
There is increasing scrutiny on NHS Boards leadership in community planning and I would like to take this opportunity to thank those of you who will be working with public sector colleagues to quality assure SOAs.
We see this part of the LDP as a key tool for non-Executive and Executive Board members to exercise oversight. The draft LDPs set out a number of actions NHS Boards are taking, however we noted that, whilst summaries were not meant to be comprehensive, they did not always reflect key activity that we know is going on - this was true across all policy areas. In addition, NHS Boards will wish to reflect on the outcome of the quality assurance of SOAs in their area and in particular the key areas for development and/or improvement arising from the quality assurance process.
We expect that your Board will sign-off the LDP NHS Board Contribution to Community Planning Partnership before end of September and send a copy to the Scottish Government.
St Andrew’s House, Regent Road, Edinburgh EH1 3DGwww.scotland.gov.uk αβχδε αβχ α
As set out in the LDP Guidance we will consider progress at this year’s mid-year stocktakes and next year’s Annual Review. At the mid-year stocktake we want to discuss how progress against the LDP NHS Board Contribution to Community Planning Partnership actions and other important work with CPPs is reported to your Board on an on-going basis.
Yours sincerely
JOHN CONNAGHAN
Director of Workforce and Performance
Argyll & Bute CHP Committee 21 August 2013
Item No 8.1
FINANCE REPORT REPORT BY GEORGE MORRISON The CHP Committee is asked to; • Note the financial position at month 4 • Note the requirement for management action to achieve a year-end break-even position • Note the further challenges likely to be faced in 2014/15 arising from service improvements 1. Argyll & Bute CHP - Month 4 Financial Position For the four months ended 31st July 2013, Argyll & Bute CHP recorded an overspend of £274,000. This is an increase of £74,000 on the overspend reported at the end of June. Table 1 below provides details of budgetary performance across the CHP at month 4.
Table 1: Financial performance by budget at 31 st July 2013 Year to Date
Budget Annual Budget Budget Actual Variance
Forecast Outturn
£’000 £’000 £’000 £’000 £’000 Oban, Lorn & Isles Locality 18,942 6,250 6,508 (258) (311) Mid Argyll, Kintyre & Islay Locality 17,014 5,588 5,586 2 (94) Mental Health In-Patient Services 7,364 2,347 2,349 (2) 67 Cowal & Bute Locality 12,626 4,190 4,300 (110) (300) Helensburgh & Lomond Locality 4,884 1,628 1,581 47 50 Salaried Dental Service 4,300 1,231 1,231 0 0 Other Clinical Services 4,933 1,509 1,513 (4) 0 General Medical Services 15,422 5,006 5,120 (114) (150) Prescribing 17,077 5,536 5,506 30 0 Dental, Ophthalmic & Pharmacy 7,781 2,835 2,835 0 0 Services from NHS GG & C 49,437 16,148 16,163 (15) (46) Commissioned Services 4,074 1,339 1,382 (43) (437) Resource Transfer 4,658 1,553 1,553 0 0 Depreciation 3,300 1,112 1,112 0 0 Management & Corporate 7,924 2,542 2,535 7 0 Budget Reserves 1,300 150 0 150 400 Planned Management Action 0 0 0 0 800 Total Expenditure 181,036 58,964 59,274 (310) (21) Income (1,251) (450) (487) 36 21 Net Budget Position 179,785 58,514 58,788 (274) 0
The five main factors creating the overspend are;
• medical locum costs in Dunoon and Oban • nurse staffing costs in Ward B and A&E at Lorn & Islands Hospital • an overspend on the general medical services budget • an increase in individual care packages, especially referrals to Huntercombe • unachieved savings
2
2. Budget Variance Analysis
The most significant budget variances are; Oban, Lorn & Isles Locality - overspent £258k Medical locums - £66k overspent due to a consultant physician vacancy. Surgical locums - £25k overspent due to annual leave cover. It is expected that this overspend will decrease as the year progresses. Ward B nursing pay costs - £59k overspent in due to sickness absence, maternity leave and special care nursing requirements. A&E nursing pay costs - £22k overspent due to sickness absence. Unachieved savings - £111k shortfall at month 4 reflecting a low declaration of achieved savings to date. Cowal & Bute Locality - overspent £110k Medical locums in Dunoon covering gaps in the casualty and out of hours rota - £99k overspent. Medical locums in Dunoon covering the hospital in-patient service - £31k overspent. Unachieved savings - £84k shortfall at month 4 reflecting 4/12ths of the locality's £252k target. No savings have been declared to date. General Medical Services - overspent £114k Locums covering vacant small practices and maternity leave - £72k overspent. Palliative Care enhanced service - £23k overspent due to payment of claims relating to 2012/13. Minor Surgery - £11k overspent due to an increase in claims. Seniority payments - £8k overspent due to an increase in claims. Commissioned Services – overspent £43k Two factors are contributing to an overspend on the commissioned services budget; increased charges from North Highland relating to acute activity, and in-patent admissions to Huntercombe. We currently have four patients in Huntercombe and at a monthly cost of £75,000 this has the potential to create a significant overspend on the budget if the patients remain there for several months, as seems likely. Greater Glasgow & Clyde SLA - overspent £15k The reported overspend relates specifically to increased activity at WestMARC which is a variable charge related to activity levels. It is assumed that the main patients services SLA will be settled in line with budget (£47m) however this is a significant financial risk to the CHP as GG&C claim a significant underpayment in the region of £5m. 3. Salaried Dental Service
3
With regard to the Salaried Dental Service, it has been assumed that the service will be funded at cost and therefore a nil variance has been reported at month 4. A bid for funding of £4.3m has been with SGHD for several months now, however we are still awaiting confirmation of the level of funding that will be made available. 4. Cost Improvement Programme 2013/14 The CHPs savings plan for 2013/14 totals £2.4m. Savings in prescribing, commissioned services and depreciation look likely to be achieved. However the savings targets for Localities (totalling £1.05m) and management and corporate services remain challenging.
Table 2 below provides details of savings target performance.
Table 2: Argyll & Bute CHP Cost Improvement Plan 20 13/14
Recurring Savings Targets Responsible Manager
Target £' 000
DeclaredAchieved
£' 000 Outstanding
£’ 000
Forecast Achievement
£' 000
Likely Shortfall
£' 000 Oban, Lorn & Isles V Kennedy 365 31 334 200 165 Mid Argyll, Kintyre & Islay C West 331 89 242 271 60 Cowal & Bute V Smith 252 0 252 152 100 Helensburgh & Lomond V Smith 102 54 48 102 0 Unfunded Displaced Staff D Leslie 90 15 75 15 75 Prescribing F Thomson 1,000 687 313 1,000 0 Lead Nurse P Tyrell 20 0 20 20 0 Public Health E Garman 21 21 0 21 0 Management and Corporate D Leslie 76 0 76 76 0 Commissioned Services D Leslie 77 0 77 77 0 Depreciation G Morrison 66 66 0 66 0 Totals 2,400 963 1,437 2,000 400
A shortfall of £400k on the savings plan is currently forecast as some plans are not yet fully developed. Addressing this shortfall in the savings plan is included in the planned management action required to achieve a year-end break-even position. 5. 2013/14 Year-end Forecast Outturn Argyll & Bute CHP is currently forecasting a year-end break-even position, however this is dependent on management action to achieve this outturn. 6. Future Commitments As noted earlier in this paper, the CHP is finding it challenging to deliver savings in the current financial year. Looking ahead, funding uplifts for the next few years are likely to remain low and the financial challenge is likely to be unrelenting. A number of commitments have been identified that will require to be underwritten by efficiencies made elsewhere in the CHP.
4
These include;
Table 3: Service Improvements to be Funded in 2014/ 15
Service £’000 Pain Relief Service 47 Point of Care Testing 70 Lead OT 13 Early Years Collaborative 42 Psychiatric Emergency Patient Transfer Service 100 Sustainable High Quality Healthcare in Remote Areas (potentially higher) 287 Pharmacy Data Analyst/Technician 19
Total 578
Whilst the need for these service improvements has been considered and acknowledged by the Core Team as necessary and indeed desirable, there implementation must be considered and contained within the limits of affordability and will be revisited and risk assessed as the financial position develops. George Morrison Head of Finance Argyll & Bute CHP 15th August 2013
Argyll & Bute CHP Committee 21 August 2013
Item No : 9.1
PDP/R AND e-KSF IMPLEMENTATION 2013/14 Report by : David Logue, Head of HR 1. BACKGROUND AND SUMMARY The NHS Highland target for 2012/13 was that all Agenda for Change staff have a review against a Knowledge and Skills Framework (KSF) post outline, with at least 80% of reviews being carried out and recorded online using the web based system, e-KSF. At the end of year 2012/13 in the Argyll and Bute CHP 65% of all staff had a review completed, and 88% of permanent staff. This reflected positively against comparisons with other areas. All of NHS Highland is now in the position to be able state exactly the number of staff who have had reviews, that these follow the same process, and that staff are actively involved. This provides positive evidence to support how NHS Highland is addressing the national Staff Governance Standards. The ongoing target is likely to remain that 80% of all staff have a KSF review completed and recorded on e-KSF at least annually. 2. MONITORING PROGRESS 2013/14. The PDP&R programme has now moved towards ensuring a continuing high level of activity and National and Board wide monitoring is now focussing on a rolling level of activity over twelve month periods. This is shown in the two right hand columns of the table below. The position across NHS Highland at 30 June 2013 is as follows:
Area
All AfC staff
Reviews signed
off
% of AfC staff (all)
% of AfC staff (excl bank)
Reviews completed
within last 12 months
(excl bank)
% Reviews completed
within last 12 months
(excl bank) Argyll and Bute CHP 2031 76 3.74 5.05 1309 86.98 Corporate Services 717 65 9.07 9.27 463 66.05 West 922 62 6.72 9.38 516 78.06 Mid Highland 451 14 3.10 4.40 260 81.76 North Highland 962 39 3.41 4.97 475 72.30 Raigmore Hospital 3296 112 2.91 3.79 1840 72.78 South Highland 757 21 1.97 2.52 408 69.15
Note : Extract from eKSF-30.6-13 At 30.6.2013 the CHP currently had 3.74% of all staff (5.05% excl bank) with reviews and personal development plans signed off in e-KSF for this year so far. The total percentage for NHS Highland is 3.98% (5.16% excl bank posts).
The CHP Committee is asked to:
• Note the position In June 2013 • Note the trend to embed this in practice and use to support and direct staff
development in line with CHP and NHS Highland objectives • Note the need to ensure bank staff have review • Note the actions in place to maintain and improve progress.
:
2 Sally Munro Workforce Development Facilitator 09-08-13
Over the preceding 12 months 86.98% of CHP substantive staff completed a review. 3. ACTIONS FOR 2013/14 In order to maintain progress and improve the proportion of staff that have an annual review, there will be a focus in 2013/14 on the following :
• Continue to addressing issues of missing data re a number of staff, particularly Bank, who do not have one or more of the following: named manager, e-mail address, no KSF outline or no review.
• Local managers and team leads planning and spreading reviews throughout the year
• The Workforce Development Facilitator will undertake a quality review through meetings
with local management forums and by asking members of A&B CHP Partnership Forum to complete a short survey questionnaire. This feedback will then be used to identify ways to improve and develop the quality of the programme.
4. NATIONAL SUPPORT ACTIVITIES New resources which have been recently developed by NHS Scotland in collaboration with NES and WEA (Workers Education Association) are now available on line:
• An internet based site has been developed specifically for KSF titled KSF Guidance; the site covers all aspects of KSF and the PDP&R process and contains links to key policy documents, (NHS Scotland Quality Strategy, PDP&R PIN Policy, Staff Governance Standards).The site details are www.ksf.scot.nhs.uk
• A PDP&R resource is now available on The Knowledge Network (within the Learning
and CPD area); the resource hosts a series of filmed workshops and videos of staff describing their experience of KSF.
• An e-KSF Guidance Tool is now also available on The Knowledge Network (within the
Learning and CPD area); the resource provides information regarding all aspects of using e-KSF.
Local KSF training and guidance material will be reviewed to take advantage of and encompass the key functions of these new resources. 5. QUALITATIVE BENEFITS OF KSF Regular development reviews and agreeing personal development plans support service quality, improvement, staff and clinical governance. Examples are:
• E-KSF is used to support redesign and service improvement processes by using the KSF
outlines to support staff in changing roles, and identifying differences in knowledge and skills required.
• The use of Foundation outlines for staff moving into new roles particularly as part of
service change/redesign should ensure supported development into these roles leading to more confident staff more efficient and effective services.
• The evidence is also being used as support for Continuous Professional Development
(CPD) and re-registration. In addition it allows for Mandatory and Statutory training to be included in every staff members’ PDP, which raises the profile and acts as a reminder and
:
3 Sally Munro Workforce Development Facilitator 09-08-13
record enabling reporting of the levels of completion of required training across the organisation.
• This links directly to Professional leadership and registration and Health Care Support
Workers (HCSW) Standards to ensure public protection and maintenance of professional standards within our workforce.
6 CONTRIBUTION TO BOARD OBJECTIVES The achievement of the target is in line with the NHS Highland Board objectives. 7 GOVERNANCE IMPLICATIONS Staff Governance KSF and e-KSF are vital components of meeting Staff Governance standards. Patient focus and public involvement The KSF process enables performance management to assist with improved patient focus and public involvement where appropriate for roles. Clinical Governance KSF process provides the opportunity to monitor development activities of staff including clinical skills and ensures that staff develop and apply the appropriate knowledge and skills in order to be effective in their work. Financial Governance This is part of normal management processes. In addition, workforce costs are a large proportion of the allocated budget. KSF PDP/R and e-KSF support the effective use of staff, in particular through service change and redesign. 8. IMPACT ASSESSMENT The KSF and e-KSF processes are impact assessed at National level and will be monitored as part of overall staff engagement measures.
ARGYLL & BUTE CHP
ARGYLL & BUTE CHP PARTNERSHIP FORUM
DRAFT MINUTE OF MEETING HELD
4th July in Aros Boardroom
Present: Dawn Gillies (DG) Unison (Co-Chair) Elizabeth McMillan (EM) Unison (Co Chair) Alastair Craig (AC) Senior Management Accountant Colin Crawford (CC) British Dental Association Veronica Kennedy (VK) Acting Locality Manager OLI Gaye Boyd (GB) Personnel Manager Pay Tyrrell (PT) CHP Lead Nurse Derek Leslie (DLe) Director of Operations Co-Chair Helen Duthie (HD) Unison Fiona Campbell (FC) Clinical Governance Manager By VC Lorna Low (LL) Royal College of Midwives Sally Munro (SM) Workforce Development Facilitator Pauline Murty (PM) Acting Hotel Services Manager Apologies : Viv Hamilton (VH) Locality Manager B &C and H & L David Logue (DLo) Head of HR Barbara McGilp (BM) Society of Radiographers Angela Dewsnap (AD) Personnel Officer Douglas Niven (DN) Unison Kate McAulay (KM) Clinical Service Manager MAKI Mark Middleton (MM) Risk/Heath & Safety Manager Bill Staley (BS) Information & Projects Manager John Dreghorn (JD) Mental Health Project Director - Mental Health Modernisation George Morrison (GM) Head of Finance Fiona Broderick (FB) Unite Christina West (CW) Locality Manager MAKI Stephen Whiston (SW) Head of Planning, Contracting and Performance Elizabeth Cowan (EC) Royal College of Nurses Linda Skrastin (LS) Clinical Services Manager H& L Moira Gillies (MG) Assistant Locality Manager Julian Gasgoigne (JG) Risk/Health & Safety Manager, Clinical Governance & Health & Safety Team Minutes: Rose MacVicar (RM) HR & Planning Contracting & Performance
Subject Action 1. Welcome and introductions
EM welcomed all to the meeting and asked all present for introductions.
2 Mins of meeting 16 th May 2013. Accepted.
2
Subject Action 3 Matters arising
a) Datix As DLo was unable to attend the meeting today it was agreed that the item will be carried forward to the next meeting of the group on 15th August.
b) Text availability of shifts
VK advised issue of text messages has been discussed at bank staff meetings. VK has had no further feedback but understands the situation has been addressed.
c) X Ray Out of Hours VK advised that the Options Appraisal Non Financial Benefit workshop was held on 13th June and Optional Appraisal Risk workshop on the 14th June. An Options Appraisal paper was circulated but as this is the first stage of the process the report is confidential. Next Options Appraisal meetings are to be held on 29th August and 2nd September. Action carried forward that SW will table report on the above at a future Partnership Forum meeting.
d) Highland Partnership Forum
As requested DLo circulated previous minutes of the meeting. e) HCSW
SM advised that a further open day was held recently for bank staff. Unfortunately only 5 bank staff attended although those in attendance were very keen and positive. If other events are to be organised localities must ensure:-
� events are advertised widely e.g. displayed on information boards. � bank staff are aware what information will be available � possible use of text messaging to invite/remind bank staff of the event.
It was noted that events should incorporate all bank staff. Payment for attendance at the events will have to be agreed by Locality Managers.
f) RCOP – Dental Care
The issue was discussed at the local meeting of the RCOP. It was felt that, as this is an Argyll & Bute wide issue, it should be brought to the attention of Elizabeth Reilly (ER), Associate Clinical Director Dentistry who would be best placed to advise.
Copy of the minute of 16th May to be forwarded to ER for information/feedback.
g) Mileage/Travel
CC advised medical and dental staff have their own system in place for travel claims. It was also noted any changes to the rates will not affect lease car users. One scenario discussed was where a member of staff normally travels 20 miles to work has to travel 15 miles from home to meeting/home visit elsewhere. Under the system it would mean they cannot claim for this journey.
DLo SW RM
3
Subject Action 3 Matters arising
g) Mileage/Travel continued Issue of the 5 unused miles was discussed. Concerns were raised that this could be deducted from the next journey claim. It was felt that this and other issues regarding travel claims may be of concern to staff and would require to be clarified. To ensure that all issues relating to travel claims are addressed it was agreed that the Partnership Forum members be contacted for comment. Points raised will be collated and raised at the next Partnership Forum meeting in August.
It was noted that an email had been distributed to all NHS Highland staff giving details of reimbursement of employee business travel costs. It was agreed that it might be helpful to re-circulate the email for information. It was also noted staff who are redeployed have protection on their excess travel costs for a period of 4 years. (Mileage paid is based on public transport rates.)
h) Pecos VK advised OLI has been able to identify some savings on stationery items etc using the Pecos system. It was noted Pecos is to be rolled out to all areas in the near future. VK advised dental admin staff had been trained on the use of Pecos and, if required, further training sessions can be arranged. CC stated translating orders from the catalogues used to Pecos can be time consuming. CC is of the view that details on the prices and differing quality of items are insufficient.
DG/RM GB/FC/ RM
4 Update on Children’s Services a) Argyll & Bute Children’s Services Inspection.
� PT reaffirmed content of DLe’s report tabled at the meeting on 16th May.
Additional areas of concerns were highlighted regarding the support for children/young people who
- have parents with Addiction issues - are receiving support from Mental Health Services.
Steps must be taken to ensure any possible gaps in services are addressed to ensure smooth transition for the young person from child to adult services. PT advised that actions/guidance arising from the above will be fed into the Integrated Children Service Plan.
b) Improving The Public’s Health In Scotland
PT advised the Scottish Government are conducting a review of the workload/role of Nurses, Midwives and Health Visitors. It is acknowledged that they have an important contribution to make in improving public health but that contribution needs to be considered alongside those of Social Work, Education etc. The purpose of the review is to maximise the effectiveness of services, to build upon existing strengths and to ensure co-ordinated systematic approach to improving the public’s health.
4
Subject Action
4 Update on Children’s services b) Improving The Public’s Health In Scotland contin ued
It was noted that the current Public Health Nurse posts are to be redesigned with the reintroduction of Health Visitors posts working with children aged 0 – 5 years and School Nurses working with children/young people aged 5 – 19 years.
Copy of the paper will be forwarded for circulation to the Partnership Forum
c) Review and redesign of Campbeltown Nursing staff
PT advised the proposals for the redesign of the Campbeltown Nursing staff were agreed at the last Core Team meeting.
PT/RM
5 Finance Report AC presented an overview of the Finance Report (copy of the report was circulated prior to meeting). The report confirmed the CHP financial position as at 31st May 2013. It was noted that:-
a) the Budget is currently showing slight overspends, most of which are caused by use of locum medical staff though it was noted that planned management action is in place to bring the budget back in line with targets.
b) the underspend in MAKI budget is mainly through the underspend in
Campbeltown Hospital nursing posts.
c) SLAs with G G & C for patient services will be settled in line with the budget.
d) the budget for salaried dental service is now shown separately. AC advised the CHP are awaiting confirmation on the budget allocation from the Scottish Government.
CC advised that pressures will be placed on services if there is a reduction in budget for locum dentists.
Though savings targets are challenging for the localities, the managers are encouraged to continue to identify areas where cost savings can be made without impacting on services. The cost improvement programme savings plan for 2013/14 has identified areas where budget targets look likely to be achieved. Reporting forecast year-end break even position however this is contingent on management action to deliver improvements. VK advised NHS Highland are participating in the pilot of Scottish Government National Procurement. Members of the team met with managers to look at all supplies, contracts costs, what is good value for money and what can be negotiated. Possible budget savings could be achieved if the CHP were permitted to commission and negotiate services rather than through the current SLAs with G G & C.
6 & 7
Mental Health Modernisation Update Argyll &Bute CHP Committee Agenda items were moved down agenda to accommodate DLe delayed arrival at the Partnership Forum.
5
Subject Action
8 Highland Partnership Forum a) DG advised that discussions were held on whistle blowing workshops.
It was noted that the confidential contact for Argyll & Bute has left the service. Views expressed were that confidential contacts are an important resource and play a vital role within the CHP. It was agreed appropriate steps to be taken to identify suitable replacement(s). Item to be included as an agenda item at the next meeting.
b) The Cabinet Secretary for Health and Wellbeing Ministerial will conduct a review in Highland on 19th July. This review will include looking at staff engagement.
Co-Chairs /RM
9 HR Update a) PDR and e-KSF
SM presented an overview of the paper on PDR and eKSF (copy of which was circulated prior to the meeting). As this is the start of the reporting process for year 2013-14 completion figures shown are relatively small. In order to ensure progress on meeting the proposed targets, actions will continue to address issues raised regarding email addresses, named managers etc. It is hoped that reviews are carried out over the year rather than the peak of activity occurring in February/March. For easier comparison, figures will be based on a rolling year rather than fiscal year. To accommodate this there will be a slight difference in the reporting process over the next few months. CC advised dental staff were experiencing difficulties in uploading data onto the database. SM advised that if documentation is required as revalidation for professional staff, where possible, paper copies should be retained by staff in their personal portfolios.
b) Learning and Development SM presented an overview of the first draft of the Workforce Development Plan 2013 /14 – Learning and Development (copies of the paper were circulated prior to the meeting) The main function of the group is to encourage and support learning and development in all staff groups across the A & B CHP in line with service plans at NHS Highland and CHP level. No points were raised on the document.
c) Staff survey Attention was drawn to the email sent to all NHS Highland users to encourage completion of the staff survey.
It was noted that paper copies of the survey were circulated via HR to the localities to enable completion by staff who do not have access to computers. Closing date for completion is 5th July SM advised Staff Survey 2010 is a subgroup of Partnership Forum. Minutes of the last meeting have been circulated for approval. Thereafter anything outstanding will be dealt with through PF.
6
Subject Action
9 HR update d) Stress at work
Following analysis of the previous survey concerns were noted regarding the numbers of staff recording stress. As an action focus groups were formed in each of the localities.
It was acknowledged that work has been carried out to reduce stress at all levels but it was felt updated information/feedback is required in order to get a clearer picture and to ensure links with the Healthy Living agenda. It was agreed that the information from the local focus groups be collated and feedback to be tabled at the next meeting.
c) Redeployment
As requested at the last meeting of the Partnership Meeting GB presented an overview of the redeployment paper (copy of the paper was circulated prior to the meeting). An overall reduction in the figures was noted.
GB advised a concerted drive will take place to identify posts for staff on the Secondary Register. It was noted staff may be under the impression that, as they are already in post, it is not necessary for them to apply for alternative posts. GB stated HR are required to advise staff, on this register, of suitable vacancies at the appropriate grade that would meet the level of their protected earnings.
FC
At this point PT left the meeting and DLe joined the meeting.
10 Mental Health redesign As JD was unable to attend the meeting Dle presented an overview of the Mental Health redesign paper which was submitted to the CHP Committee in June.
a) Discussions are ongoing regarding the capital process. Key decisions will be made in the near future with regard to bundling the proposed new build with another capital project which will enable the project to continue to progress. A review of the expected capital project costs for 2013/14 will take place after decisions are made regarding bundling options.
b) Inpatient Services
The bed compliment remains at 28 plus 3 minimal supervision places in the refurbished Firgrove building.
Upgrade works to Succoth are complete and the upgrade works in IPCU continue.
An event to celebrate 150 years of mental health services at Argyll & Bute Hospital took place on 29th May. A brass plaque to commemorate the occasion was unveiled by Mr Thomas Byrn, Chairman of Acumen.
c) Staff Redeployment Nothing new to report since the last update.
d) New Posts Nothing new to report since last meeting.
7
Subject Action
10 Mental Health redesign
e) Supported Transfer of Detained Patients Progress continues to establish patient retrieval service based in Argyll & Bute Hospital. It is anticipated that the number of out of hours calls will be fairly small. Funds have been identified to supplement current levels of staff.
f) CMHS Team Base Both Kintyre and Dunoon CMHT bases are almost complete and staff will be moving into their bases in the near future.
g) Dental Services
It was noted that discussions are ongoing regarding impact on service provision and staff.
DLe will forward copy of the paper to RM for onward circulation to the Partnership Forum.
DLe/RM
11 Argyll & Bute CHP committee DLe presented an overview of the meeting held on 19th June.
a) Helensburgh & Lomond Out of Hours Nursing Servic e Discussions continue with GG & C in relation to the redesign of the Out of hours/overnight nursing service for patients in Helensburgh & Lomond.
b) Bereavement Strategy An action plan has been developed to assist in the delivery of bereavement care guidelines and the development of support which will comply with the “Shaping Bereavement Care – A Framework for Action CEL9 (2011).
c) Recylcing/Waste Regulations
Changes to waste regulations are the subject of a review of the CHP’s waste management processes. These include an extension of recycling requirements, potential changes to handling and transportation and infrastructure arrangements.
d) Delivery of Sustainable Remote & Rural Health & Social Care NHS Highland are awaiting Scottish Government Health Department approval to explore ways to address service provision in remote and rural areas.
e) Campbeltown Community Hospital Continuing Care B eds Members of the CHP management team and locality staff attended a meeting held on 13th May. Discussions were held in relation to closure of continuing care beds. Reassurance was provided that contingency plans are in place to cope with changes in demand for in-patient beds. The free space in the hospital will be reviewed by the redesign group to identify what local service development might be supported by the use of this additional space.
f) Substitute Prescribing
The views of the community were also discussed at the open meeting held in Campbeltown on 13th May.
8
Subject Action
11 g) Building the Bridge Together An event to consider how we can work better together to enable older people to live long, healthy and fulfilling lives in Argyll & Bute was recently held in the Corran Halls, Oban. A report on the outcome of the event will be published in due course.
h) Volunteering Awards The annual Volunteer awards took place in Council Chambers, Kilmory on the 31st May. For the second year NHS Highland sponsored a “Health Volunteer Award” for individuals who volunteer in a health environment. This year we presented two awards, one to the winner and a second in the “highly commended” category.
12 Organisational change � Mid Argyll Kintyre and Islay
It was noted that the MAKI meeting had been cancelled. Full updated to be carried forward to the next Partnership Forum.
� Cowal & Bute, Helensburgh and Lomond
As VH was unable to attend the meeting a brief verbal overview of the up to date position was given by PM.
a) Catering
Bute is now complete -1 displaced staff member remains. Cowal now complete – 1 displaced staff member remains
b) Domestic redesign.
Bute was delayed in terms discussions and mapping for day service. Cowal domestic redesign is underway, letters have gone out to staff confirming new posts, any vacancies will be advertised.
c) Community Nursing Team Helensburgh
PM advised following the notification from NHS G G & C of the proposed termination of the SLA, a meeting has been arranged with to discuss the provision of overnight/OOhs Community Nursing care.
� Oban Lorn & Isles. VK presented an overview of the up to date position.
a) Medical records redesign
Have received a good response from adverts for the vacant posts.
b) Mull Developments are continuing regarding the redesign of the Mull team. A further update will be given at the next Forum meeting.
c) Integrated Equipment store It was noted that the David Ross, Estates Manager has tabled a paper for consideration by the CHP giving the outline proposal for a single integrated equipment store. Concerns have been raised regarding the possible impact on the workforce in Oban as this area has the highest number of staff employed in the equipment stores. Staff have voiced concerns regarding insufficient information on the proposed organisational change.
9
Subject Action
12 d) Integrated Equipment Store continued
DG raised the following concerns :-
- possible delays in delivery of equipment from a central rather than a local base
- decrease in availability of equipment - is the proposed service cost effective
- have job descriptions been amended or devised It was agreed that further clarification is required on the points discussed. It was agreed that DLe contact DR. Item to be included in agenda for next meeting.
Dle Co-Chairs/ RM
13
CHP & Locality Management Organisational Change Gro up EM reported that the first meeting of this group had taken place on the 20th June 2013. The Action Notes from the meeting were circulated to the Forum. The Action Plan was noted and following discussion DLe agreed to discuss the actions with DLo and VH. The action points from this group to be included as a standing item on the agenda under “Organisational change”.
Action DLe to discuss with DLo and VH
14 AOCB a) Public Holiday in September.
Historically Argyll & Bute CHP public holidays are in line with the dates shown for G G & C and Argyll & Bute Council rather than NHS Highland. It was noted that 23rd September is scheduled as a public holiday in Argyll & Bute. On checking internet notifications on the G G & C and ABC websites it was confirmed the Public Holiday for ABC and G G & C will be taken on 30th September. Given the disparity it was agreed that :- - CHP will have to clarify the date of the Public Holiday - as the majority of visiting and local Consultants will already have clinics set up
consider what the consequences will be if the date is altered from 23rd to 30th or vice versa
- if date remains as 23rd September will this lead to reduced availability or impede access to services for both Mondays.
b) Digital Recording of minutes
GB advised that a Digital Recording system has been purchased by HR for use in meetings. Similar equipment is in use in North Highland and was used recently in a disciplinary meeting (with the staff members consent). The aim of the equipment is to aid accurate recordings of meetings. It was noted that a Protocol for use on the equipment has been tabled at the HR subgroup for approval. It was agreed that following approval by the HR Subgroup Partnership Forum that the equipment be used for recording discussions held.
c) Nurse Bank
AC advised the Agenda for Change terms and conditions have been amended to reflect a national agreement on the way in which bank/casual workers were paid during periods of annual leave.
DLo to advise and confirm
10
Subject Action
12 AOCB c) Nurse Bank continued
Annual leave accrued within each financial year quarter must be taken in the following quarter. Where annual leave is not requested it will be allocated in the next quarter by the staff bank and the bank worker will not be allowed to work for the duration of the allocated annual leave.
No payment in lieu of annual leave will be permitted except where the bank/casual contract comes to an end and there is WTR entitlement is outstanding. AC advised staff may not be aware of their leave entitlement as they only work occasional shifts. There is also the issue of leave hours accrued in the previous year. It would appear that staff may not be able to claim remuneration or take this as leave as entitlement may have ceased as at 31st March. It was felt that a number of issues arising from the payments to bank staff need to be addressed. To aid discussions it was agreed that an invitation to join a future meeting be forwarded to Ann Williamson, Unified Bank. VK and AC were tasked to collate specific questions on payments to bank staff. Thereafter DLo will raise with NHS Highland.
VK/AC/ DLo
13 Meeting closed Date, time and venue of next meetings as follows:- 15th August 3rd October 14th November
All to be held in Aros Boardroom at 12.30 p.m. Please note there will be no meeting held in December. Dates for meeting in 2014 as follows 9th January 20th February 3rd April 15th May 26th June 14th August 25th September 6th November 18th December
All meetings to be held in Aros Boardroom commencing at 12.30 p.m.
Glossary HR Human Resources OLI Oban Lorn and Isles MAKI Mid Argyll Kintyre and Islay B &C Bute and Cowal H & L Helensburgh and Lomond CHP Community Health Partnership GG&C Greater Glasgow and Clyde ABC Argyll & Bute Council
Argyll & Bute CHP Committee 21 August 2013 Item ; 11.1
Delayed Discharge Weekly Briefing
as at
01 August 2013
Prepared by Anne Cameron Page 2
Contents
Comments & Current Position Page 3
Delayed Discharge Weekly Update Page 4/5
Comments on Current Position
Prepared by Anne Cameron Page 3
Current Position at 01 August 2013
Total Delayed Discharges = 7 Over 2 weeks = 1* Ov er 4 weeks = 2, Under 2 weeks = 4* 3 clients Coded 9/51x (AWI cases), 1 client Coded 9/71X who are all exempted and 3 clients
Code 100 who are excluded as they are awaiting reprovisioning/recommissioning *The above data is being used for CHP purposes only. The over 2 week target is not due to
be implemented by Scottish Government until April 2014
Planned Discharges = Nil
MONTHLY CENSUS INFORMATION
Scottish Executive Delayed Discharge Targets for Argyll and Bute Partnership for the month of July Census are as follows:-
Over 4 weeks Target is 0 Actual is 0
1 new Delayed Discharge since 26 July 2013
Since 1 st May 2012 any new Delayed Discharges include patien ts delayed 3 days or less. ---------------
Out of Area Hospitals
Hospital
Delayed under 2 weeks
Delayed 2 – 4
weeks
Delayed over 4 weeks
AWI Code 9/51x
Exempt
Other Exempt codes
Excluded Code Recommissioning/
Reprovisioning
Vale of Leven 1 1 2 Western/Gartnavel 1
Southern General
1
-------------
A. 2 patients are delayed over 4 weeks 1 patient in Argyll & Bute hospital from Tarbert area waiting on care package to be implemented to allow discharge to their home whilst awaiting vacancy for sheltered housing. Currently no care providers have capacity to facilitate any service. 1 patient in Lorn& Isles hospital, Oban who is delayed waiting on a care package to be implemented to allow discharge home but there are no care providers with capacity to facilitate this. Patient has been offered and declined an interim carehome placement until home care provider has been sourced.
1 patient is delayed over 2 weeks
1 Oban patient has been assessed by health and SW as requiring residential care but patient adamant that they wish to return to their sheltered housing flat .Revised careplan being completed.
Prepared by Anne Cameron Page 4
B. Code 9/51x. Adult with Incapacity cases (AWI).The numbers have remained at 3 within the CHP and the numbers have remained at 2 patients in an Out of Area hospital.
C. Code 100.
3 Patients in A&B hospital remain as delayed discharges under code 100 and 1 patient in Gartnavel Hospital, Glasgow. These patients are not included in the numbers and are only reported to the Scottish government on an anonymous basis.
D. Code 9/71X
1 Patient in Lorn & Isles Hospital, Oban is awaiting a vacancy in a local residential home, Consultant has stated that patient should only be moved to chosen carehome and an interim placement is not to be considered. 1 Patient from Oban area in Western/Gartnavel Hospital is awaiting a bed vacancy in Fort William area. Patient had been suggested an interim placement in Helensburgh area, but declined this. Consultant has stated the patient’s prognosis is poor and that Fort William placement is the best outcome for them.
Delayed Discharges Weekly Update as at 01 August 2013
Total Numbers 7 Over 2 weeks 1 Over 4 weeks 2
Under 4 weeks 4 Additions 5
Removals/Deaths 4 Exclusions and Exemptions 7
OUT OF AREA
Vale of Leven Hospital, Alexandria .= 4
1 Awaiting completion of Financial Assessment. (Delayed over 2 weeks) 1 Assessment in progress. 2 AWI patients Coded 9/51X who are exempt.
Western/Gartnavel Hospital = 1 Awaiting completion of Financial Assessment. (Delayed over 2 weeks)
Gartnavel Hospital, Glasgow = 1 Patient Excluded as Code 100 under recommissioning/reprovisioning
Prepared by Anne Cameron Page 5
Hospital / Area
Total Number New Removals
Code 9/25X
Code 9/51x
Code 9/71X
Code 100
E12 Under care of GP
Planned Discharge
Argyll & Bute 1 3 Victoria, Bute 1 2 1 2 Campbeltown 1 1 Cowal 1 1 1 Islay & Jura 1 1 Mid Argyll 1 Glassary Ward – Mid Argyll Mull Community
Lorn & Isles, Oban 4 2 3 1
Total 7 5 4 3 1 3 5
• 7 clients in addition there are 7 exemptions / exc lusions • NB. Exemptions are clients coded 9/51x Adults with Incapacity and coded 9/71X
(Interim placement unreasonable) and Coded 9/25X (A waiting complex arrangements to be completed –in order to live in their own home .(Specialist facility)
• Exclusions are code 100 (re-commissioning /re-provi sioning) REMOVALS = 4
Mid Argyll = 1
Patient removed as a Delayed Discharge as now requires further Multi-Disciplinary Team meeting to determine a discharge policy. Meeting arranged for 7th August.
Lorn & Isles = 3 1 Patient discharged to Nursing carehome. 1 Patient removed as a Delayed Discharge as now requires further Multi-Disciplinary Team meeting to determine a discharge policy, date to be arranged. 1 Patient originally coded AWI as disagreement between Powers of Attorney as to best outcome for the patient. Disagreement now resolved and patient’s assessments now being finalised for nursing home placement.
Argyll & Bute CHP Committee 21 August 2013 Item : 12 Modernisation of Mental Health Services Update Report (July 2013) (2) Report by John Dreghorn 1. Background
The following report provides an update on the implementation of the modernisation of mental health services in Argyll & Bute.
2. Progress Report
� Project Governance The Capital Project Board met on 21st June. Next meeting is on 16th August. The Programme Board is due to meet on13 September.
� Capital Project Stage 1 Approvals - The revised stage 1 report, which was submitted by hubco to NHS Highland in May, remains
with our external advisors, and has yet to be accepted or rejected. No further work is taking place on the OBC until the advisors report back. A new approvals timetable has yet to be agreed.
� Inpatient Services
The bed compliment remains at 28 plus 3 minimal supervision places in the refurbished Firgrove building. Upgrade works on the IPCU single rooms is due to commence within the next few weeks which will result in a temporary reduction to 4 beds and a permanent reduction to 5. Occupational Therapy toilets and DSR refurbishment is complete as is the Physiotherapy department relocation which took place in June. Plans to relocate the MAPS/Clinical Psychology/OPD from the portakabin to Cowal Ward are being finalised and work should commence in August/September.
� Staff Redeployment Nil new to report since the last update.
� New Posts Nil new to report since last update
� Budget
Bridging: The bridging allocation for the project during 2013/14 remains unchanged at £500k as set by the CHP management team. We are currently reviewing the capital project funding requirements as we are anticipating a reduction in project management and advisor costs due to the slippage in the capital programme.
� Resettlement Group
Possibility of group home in the Oban area is being explored for 2 patients. In addition one of the places in Lochgilphead is likely to become available allowing another long term patient to move in. This will leave 2 long term/complex cases in the IPCU who require a resettlement plan.
� New Hospital Development � The Bundle: As reported in June it appears almost inevitable now that the new hospital project will not be considered viable as a stand alone project and will need to be bundled with another capital project from the North Scotland Hub area. As previously reported there are two projects; one in NHS Highland (Aviemore); and one in NHS Grampian (Inverurie) ; that appear to be of sufficient size and at a stage of development to meet the criteria to be consider as part of a bundle.
The meeting is asked to: � Note current key issues and progress against the action plan
12 MH Services Modernisation Update Report July 2013 (2) 31/07/2013 J. Dreghorn Page 2 of 2
The need to bundle should be confirmed following the key stage review currently being undertaken by the Scottish Futures Trust (SFT). A decision on which project we will be bundled with should follow soon after that. At present it is unclear how much additional delay this will cause – but it is clear that both of the projects being considered for bundling are at an earlier stage of development, and that bundled projects need to have OBC and FBC approved, and achieve financial close, at the same time. It should also be noted that Crawford Cumming has now left the project. Crawford was appointed in May 2012 as the Capital Project Manager and has made a great contribution to developing the plans for the new hospital over the last year.
� CMHS Team Base Both Kintyre and Dunoon CMHS bases are complete. We await delivery of furniture and installation
of phones etc to allow them to become operational. In Campbeltown there are some discussions with the Kintyre & Islay Addictions Service regarding the best use of the shared space.
� Supported Transfer of Detained Patients The CHP Core team approved the proposal to recruit to a number of posts to support this development at end of June. The posts are currently out to advert. Those posts which will be recruited internally will be filled within the next few weeks, with external applicants being interviewed later in August.
� Recovery � 3 members of staff recently attended a one week Mental Health Recovery course at Boston
University. Teams from a number of countries attending the course which includes ongoing support from the University over the next 12 months for the teams to implement the principles of mental health recover in their area of work. The team (Gillian Davies, Moira Harrison, and Theresa Sinclair) have developed an action plan which will be presented at the next Programme Board for approval.
� Wellness Recovery Action Plans (WRAP)
Earlier this year 4 volunteers undertook training to become WRAP facilitators in Argyll & Bute. The volunteers included NHS staff, service users and an Acumen staff member. The group recently met with the 2 existing WRAP facilitators and began to develop plans to roll out awareness raising sessions and WRAP workshops across Argyll & Bute. The group is being supported and advised by John Moodie from the Scottish Recovery Network.
3. Summary
Uncertainty remains a significant feature of the Capital Project at present. We await advice from the external advisors and the outcome of the SFT key stage review. All the indications are that the project will be bundled, and that this will result in a further delay. The positive message from this though is the knowledge that other bundled projects have progressed beyond hub stage 1 and have benefited from the economies of scale that comes for being part of a larger combined capital project. A key focus for the wider MH modernisation project over the coming months is to roll out and embed “recovery” in all aspects of our work. The use of the SRI 2 tool will identify where we need to make improvements in practice in hospital and community. WRAP will help to ensure that we become more person centred; and the work led by the team that went to Boston will see the benefits of a recovery based values and principles service delivered for all patients. John Dreghorn Programme Director – Mental Health Modernisation
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eHealth Department Aros Lochgilphead Argyll PA31 8LB
Minute of Meeting of the Argyll & Bute CHP eHealth Group
1 May 2013 JO5/JO7
J05/J07,Lochgilphead, Talisman Room, Helensburgh, LM office, Oban, & GG&C
Present: Pat Tyrrell, Chair John Dreghorn, Implementation Director, Mental Health Redesign
Dr John Lyon, Locality Clinical Director Dr Richard Sloan, MAKI Locality Representative
George Morrison, Head of Finance, (via VC) Kathleen Young, Medical Records Officer Kristin Gillies, Planning Manager Veronica Kennedy, Locality Manager Representative Ken Barr, Patient Representative, Dunoon Robin Wright, GG&C Representative (via VC) John McVey ICT Project & Liaison Manager Mary Wilson, AHP Lead (via VC) Derek Leslie, Director of Operations Bill Reid, Head of eHealth, NHS Highland James Brass, interim eHealth Manager Stephen Morrow, IT Development Manager Bill Staley, Information and Projects Manager In Attendance: Lhara Stevenson, PA (via VC) Item 1 Apologies Apologies were noted from the following:
Dr Michael Hall, Clinical Director Dr Grace Ferguson, Clinical Director/Consultant Psychiatrist Elizabeth Reilly, Community Dental Services Dr Brian McLachlan, Locality Clinical Director Item 2 Minute of Previous Meeting The minute of 7 November 2012 was accepted as a true record of the meeting, with the following changes to be made: - spelling correction page 1 & 2 of Elmmediate to elmmediate, page 4, Item 9, Manage to Manager. Item 3 Matters Arising
• Use of Internet: No blanket decision on banning personal use of internet, concerns remaining around network bandwidth issues. Managers asked to raise awareness of this issue with their own teams.
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• ICNET discussions: James & Pat will take this item forward. • A&E System Update: Bill Staley carrying this action forward. • A&B Council Update: Bill will provide update at next meeting re his presentation on NHS
Highland/Highland Council integration experience Item 4 Activity Highlights/Management Report 4.1. eHealth Activity and Strategy Implementation Update James Brass/Stephen Morrow/Bill Staley spoke to the paper.
• OneSign/Single Sign: awaiting boxes being configured at Raigmore – technical issues/barriers. No set timescale.
• Migration to NHS Highland NHS Mail: Lochgilphead completion by end May, then onto Oban and remaining areas. Timescale for completion is November.
• 18 Week RTT/TTG: cancellation letters still in development. Using Helix & manually produced letters for informing patients. It is hoped that when Trakcare is implemented the issue will be resolved. Question raised as to Trakcare’s capacity to store A&B letter formats. James & Bill R will see if they can get some clarification on whether letter capacity on Trakcare is a limited. No breeches to date.
• Telecoms SLA Review: Timescale for project has slipped to June/July. James will clarify with GG&C/BT the site information they hold for us and compare that with the details Locality Managers pass to him re site phone lines. He will work with David Ross on the issue and update parties accordingly. A meeting is to be arranged between James, David Ross, & Veronica Kennedy re the Oban site. It was highlighted that letters sent to patients have contact numbers and should these numbers change notification to the relevant dept must be given asap in order to update patient letter templates. GG&C will likely review the SLA in light of the work they are carrying out in relation to this work.
• NHS Highland Data Repository: A successful meeting took place in April where the team from North Highland and the team from A&B met to discuss Data Repository in light of Trakcare. The teams agreed to a closer collaboration of working.
• Lab Links: Two thirds of Vision practices receiving lab results, all practices should be by July/August. Microbiology results not being received, not likely to be received in future due to a technical issue at GG&C. James will speak to GG&C about other possible options (ICE?).
• Pharmacy System: GG&C accepted ACRIBE arrangements as put forward by us. Ongoing discussions to be had with Janet Boyd.
• Healthcare in Police Custody Suite: Forensics is an issue still to be agreed upon.
James Brass & Pat to progress with ICNET.
Bill S to report back re MiDIS as a potential A&E system out with L&I.
Bill R to provide update on integration experience
James Brass & Bill R to seek clarification on Trakcare’s capability/capacity for storing letter templates.
James, Veronica & David Ross to meet to discuss telecom requirements at Oban site, James will feed this back to
GG&C/BT.
James to speak to GG&C re microbiology.
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Item 5 Finance Report (i) Outturn for 2012/13: George gave an update. It was a successful year for eHealth there was
a departmental budget of £1.3m and this was under spent. The saving target of £35k was achieved. The £440K discretionary spend was fully utilised.
(ii) Plan for 2013/2014: James spoke to the paper. In particular he highlighted that there had been an update to Service Contracts (Chemocare) as per the paper. Iain Ross and James working on the capital bid for this year. The allocation costs of the National Strategy funding were highlighted and in particular a note that iSoft eIDL and ICNET are estimates only. Recurring costs to the schemes outlined are not anticipated.
Item 6 TrakCare implantation Update (i) Update from Project Board Bill Reid informed the group most Trakcare post have been recruited. A Project Executive Group is being established. At a recent Clinical Focus group meeting turnout by clinicians was very poor. Clinical and Administrative demos of Trakcare have and are taking place, however the Clinical demos are poorly attended. Therefore the question is how we get clinicians to engage willingly in the move and use of Trakcare. Derek commented that eHealth can deliver the implementation of the product but for the system to be a true success behavioural change by clinicians is needed. The paper for noting was updated in April and should be re-circulated to clinicians for comment. Pat suggested that Pat, Dr Michael Hall, and Mary could meet to discuss ways for better clinical involvement. The services of Deliotte are engaged to look at the relationship between NHS Scotland and Intersystems. There is a meeting scheduled in May and Bill R is nominating people to attend. Discussions are ongoing about the population of Trakcare from our current PAS systems. Hazel McPhail has been travelling around the localities providing demos on the Trakcare programme. Dr Sloan highlighted an issue about SCI referrals to GG&C when the referral is sent back to the GP for referral elsewhere. The GP is unaware this has happened unless the patient returns to the GP about a lack of hospital appointment or unless the GPs are pro-actively checking SCI Gateway. Bill S said he would investigate. The group was asked to note the demand on eHealth services in light of Trakcare using up a lot of resource.
The group approved the updated spending planning.
James to circulate the updated paper for noting – Patient Management System – A Clinicians View
Pat, Dr Michael Hall & Mary to meet to discuss ways for better clinical involvement.
Bill S to look into referral back to GP issue.
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(ii) Implementation Update: Bill S spoke to the paper. He spoke through the 3 PAS technical stages- Infrastructure, Interfaces and Migration. There is a meeting on 17th May to discuss the amount of data requiring migration. Under the PAS Outpatient/Medical Records & PAS Inpatients section he informed the group that he has met with Brent Craig & Alison MacKay. Brent is the project lead for PAS Outpatients and MRO. Alison is the project lead for PAS inpatients. Bill the spoke through bullet points a-f of re other activity. A&B staff will be attending workshops in Inverness. It is not yet known if there is money in the Trakcare budget to pay for staff attendance at the workshops i.e. travel costs, overnight stays, backfill. It may well have to come from existing budgets within teams. This will be discussed at the Project Executive Group and Core Team Meetings. Kristin asked what processes are in places to ensure that everyone is prepared for the November implementation date. The Business Transformation group should look at the processes prior to November.
Item 7 MiDIS Update James spoke to the paper. He highlighted Tayside have moved the largest MiDIS boards onto discreet environments to isolate any detrimental instances bettering system stability. Under the heading Project Resourcing James wanted the group to note there may be a need for additional form building resources(short term). James informed the group that Tayside have moved to tablets in place of hand held devices but we are considering a combination of tablets & hand held/pens. This will be explored further in the coming months. Lochgilphead would be the first area to access Mental Health Services on MiDIS. The roll-out at Cowal should be complete June/July and based on the experience there rolled-out to other localities. Mary said she had money in her budget to help write the forms for the MF Tool. She would like to see her other AHP services added to MiDIS. Item 8 eIDL Discharge Letter James spoke to the paper. In March funding was agreed to support the work to have cross border sharing/configuration/training for all 33 GP practices. The link is not yet established but once in place letters are sent out from GG&C hub to the Highland hub and onto the GP practice. In the interim handwritten letters are scanned and delivered to the GP practices over NHS Mail. It has also been agreed that iSoft eIDL will be used in A&B, it may stay in use even after Trakcare implementation. The timescale for use of iSoft is dependent on the supplier. Some training on this system has already taken place and James will shortly be visiting Oban to run through the system. There is no guideline stipulating when a GP should receive the discharge letter from the hospital, potentially this could cause a continuity of care problems. Item 9 GG&C Update This item was spoke to at the opening of the meeting by Robin as he had to leave early. ICNET: asked James to contact Janet Boyd to progress. Mircotech: cross border sharing has been set up. Lablinks: GG&C consolidating. Project Manager in place and will touch base with James. Trakcare: Clinical portals will share information - import to see how we engage with clinical portals. Robin will pass to James the contact name & number of the GG&C person dealing with this aspect of the work. Contractual issues will not stand in the way of progress. Robin & Bill R to discuss Scottish government work issues. GG&C are focussing heavily on Trakcare for the next 4 wks and thereafter have more time to dedicate to us. Robin has invited A&B CHP to come and share the learning process surrounding Trakcare implementation. There is an Operational Review Group which A&B CHP should seek membership too.
Robin to pass James contact name & number of clinical portal person.
Robin & Bill R to meet re Scottish Government
Bill R/James to seek members to the Operational Review Group.
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Item 10 A&B Council Update. John was welcomed to the group; John replaces Katrina on the group. He asked if there was anything in particular we wished to raise with him. He is aware of some bridging issues between the Council & NHSH networks and he plans to take this forward. As he had 1 days notice for the meeting he did not bring/submit any items to the meeting. Item 11 Paper for Noting As per previous discussions above. Item 12 Any Other Competent Business Bill S sought the group’s approval to write to a GP re SCI Gateway Internet Explorer default setting as raised by the GP. It was noted that the National view is that Internet Explorer be the default setting as this is the only browser tested on Gateway. The group approved Bill’s request to write to the GP informing him of this. Bill & James shall draft the letter together. 13. Date and Venue of Next Meeting: 14th August 10:30-13:00 hrs, JO5/JO7 MACHICC & Talisman Room, Helensburgh
Bill S to write to GP re Internet Explorer.