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New Chief Executive At NHS Highland Makes First Report To The Board Today

26th March 2019

This report was discussed at the NHS Board meeting today 26th March 2019 at Assynt House, Inverness.

CHIEF EXECUTIVE AND DIRECTORS REPORT - EMERGING ISSUES AND UPDATES

Report by Iain Stewart, Chief Executive

Introduction from CEO

I have now been in post for just over a month and it has certainly been a busy timewith plenty of challenges to deal with and opportunities to pursue.

Firstly, I would like to record that I am indebted to Dr Gregor Smith who served in an interim capacity prior to my arrival and to everyone at NHS Highland who has patiently welcomed me into the organisation and supported me as I find my feet here.

As NHS Highland's Chief Executive, I will be focusing upon three main priority areas, namely (1) Patients and Performance, (2) our People and (3) Pounds & Pence. Clearly, our first priority is to ensure that our patients benefit from the highest performance standards and I am encouraged at this early stage by the commitment I have witnessed from colleagues across the organisation. Secondly, we need to ensure that all of our people feel valued and supported and so, as we work through whatever emerges from the forthcoming Sturrock Review, we need to embrace any recommendations which will strengthen our team still further. Lastly, we need to urgently address the need to restore financial balance and, to that end, we have now established a Project Management Office (PMO) specifically to coordinate this effort and as recently announced, we will be engaging the assistance of PWC to supplement our own in-house resources and to ensure that we benefit from best practice elsewhere.

The last month has also been a time of significant leadership hange with the departure of our Chair, David Alston. Although I only worked with David for a short time, I offer him my thanks and my best wishes for the future. It was also announced by our Medical Director, Rod Harvey, that he intends to retire at the end of August, I

will say more about Rod's huge contribution to NHS Highland in the months ahead.

On 27th February, Professor Boyd Robertson was appointed Interim Chair by the Cabinet Secretary for Health and Sport, Jeane Freeman. I very much look forward to working with Boyd in the months ahead to lead the future direction of the health board as we address the priority areas of improvement. The process for recruiting a permanent Chair will begin shortly and Professor Boyd's support in the meanwhile will be extremely valuable and much appreciated.

Following Rod Harvey's announcement that he will be retiring from the post of Medical Director, I will soon be recruiting to the substantive post. In the meantime, from 1st April, I would like to welcome Dr Boyd Peters to the post of Interim Board Medical Director. Boyd is currently an Associate Medical Director and has often acted up in Rod's absence.

Financial Performance

In the last month, we have established a PMO and have recruited a PMO Director, Adrian Ennis who took up post on 5th March and will work closely with PWC to champion our service transformation and ensure that our financial resources are concentrated upon activities which deliver the maximum benefits for our patients.

Meetings with SGHD

Over the last few weeks I have had telephone conversations and meetings with various members of the Scottish Government’s Senior Leadership Team in Health including: the newly appointed Director General for Health and Social Care and Chief Executive of NHS Scotland, Malcolm Wright; Director of Health Finance, Christine McLaughlin; the Chief Performance Officer, John Connaghan; Chief Medical Officer, Dr Catherine Calderwood; the Chief Nursing Officer, Fiona McQueen; Shirley Rogers, Director Health Workforce and Alison Taylor, Head of Integration Division, Health & Social Care Integration. We had extremely productive and positive discussions on our future plans for NHS Highland. It is clear that NHS Highland has the clear support from the Scottish

Government to both reshape services to meet the demands of the future but also to take the steps necessary for achieving financial balance and ensuring that the organisation is fit for the future.

MP/MSPs

Meetings

In the last few weeks, I have conducted face to face meetings with a number of MSPs at the Scottish Parliament in Holyrood in order to foster close working relationships with our elected politicians. It is important that NHS Highland develops and maintains an open and transparent dialogue with its politicians and that we can work together for the benefit of our public/patients and staff across the region. The meetings were all extremely positive and very much welcomed by each of the MSPs with offers of support. I plan to hold these meetings on a quarterly basis.

Treatment Time Guarantees (TTG)

NHS Highland has been successful in securing funding from SGHSCD to help us to improve our performance in terms of meeting Treatment Time Guarantees.

NHS Highland has received funding (£843K) to reduce our longest waiting times in specialities including ophthalmology, general surgery, and endoscopy. Extra work has been taking place in ophthalmology (cataracts) and general surgery which is

expected to continue throughout March with some additional ophthalmology work planned for April and May. In endoscopy we plan to recruit additional staff to increase capacity.

Further funding (c.£1.2m) has been allocated allowing us to install an additional Vanguard Unit at Raigmore Hospital. This will provide increased capacity for the hospital and help to reduce waiting times.

These allocations are in addition to monies already received for waiting time initiatives and I am confident that following discussions with John Connaghan and his team on 8th March that further funding support will be provided. With Access being one of the Cabinet Secretary priorities, it is important that we work to improve

TTG and Outpatient performance.

Team Structure

Board members will note that I am proposing a revised reporting structure for the Senior Leadership Team. In support of this new structure, recruitment is already underway for a new Director of Communications. Within the next month, recruitment

will also commence to identify and appoint a Director of HR and an Executive Director of Finance and Corporate Services. In addition, several other new posts will be proposed to ensure we will have an appropriate senior leadership team in place that will enable us to put service transformation at the heart of our efforts to modernise patient care at the same time as achieving financial balance.

Annual Review

The rescheduled Annual Review to take place on Tuesday 9th April with Jeane Freeman MSP, Cabinet Secretary for Health and Sport, has been postponed and a later date is now being considered for the Annual Review. Nevertheless, I am delighted that the Cabinet Secretary would still like to travel to Inverness on the scheduled date and undertake some visits and meetings; I will communicate the arrangements once finalised.

Equality Outcomes and Mainstreaming Progress Report

There is a statutory duty for NHS Highland to publish, in an accessible manner, information to comply with Specific Duties under the Equality Act 2010. The duty involves creating fresh Equality Outcomes every 4 years and to report on progress midway through the cycle as well as providing annualised workforce data. By April 2019, NHS Highland is required to report on the progress made in

mainstreaming equality and achieving equality outcomes set in 2017. It is an opportunity to highlight some of the work we have been doing to promote equality and diversity within our functions, with partners and with the wider community and to identify areas for further improvement. Publication of the report will be provided on the NHS Highland internet site and will be submitted as evidence to the Equality and Human Rights Commission.

Celebrating Success

Highland and Islands GP Mentors Graduation

It was wonderful to see our very first group of GP mentors graduate recently at an event staged at the Centre for Health Science last month. NHS Highland’s Mentoring Scheme aims to provide doctors at any stage across primary and secondary care with a safe space to discuss challenges, issues and decisions. It also highlights the

desire of NHS Highland to provide medical staff with access to activities that promote staff health and wellbeing which will, in turn, lead to improved quality in all aspects of clinical work.

New Badenoch and Strathspey community hospital takes a step forward The redesign of health and care services in Badenoch and Strathspey has taken another big step forward with the approval of a planning application for permission to build the new Badenoch and Strathspey community hospital in Aviemore.

Once completed, the new, modern facility will feature a community hospital and health centre, bringing together inpatient services with Aviemore Medical Practice, the Scottish Ambulance Service and community health and care teams.

Health board recognised for innovative approach to nutrition prescribing NHS Highland has been shortlisted for a prestigious award for the second time in four years.

Over the past two years, NHS Highland has led the way in Scotland by transforming nutrition prescribing across all health and social care settings. The Board’s ONS prescribing group has now been shortlisted in their category at the Advanced Healthcare Awards, which will be held in London on the 12th of April. The awards recognise innovative work carried out by allied health professionals (AHPs) in improving quality, demonstrating impact and leadership, which impacts on both patient and staff experience.

Major Upgrade to Raigmore’s Life-Saving Helipad

A programme of work to upgrade the helipad at Raigmore Hospital has now been successfully completed with the helipad now fully operational and equipped to meet increasing demands.

With over 500 flights each year, the upgrade to the current landing site will allow the helipad to meet the increasing demands for larger and more frequent aircraft use as well as new standards such as landing lights and helipad size. At a cost of just under £600,000 the upgrade was only possible thanks to two charitable donations. A financial grant of £480,000 was offered to NHS Highland from the HELP Appeal, the only charity in the country dedicated to funding hospital helipads and just under £120,000 was received from the Highland Health Board Endowment Fund.

Planning Permission Obtained for New Elective Care Centre

Planning Permission has been obtained from Highland Council for a major new Elective Care Centre to be located at the Inverness Campus. This development represents a significant investment by the Scottish Government enabling the development of a state of the art facility to deliver hip and knee joint replacement surgery and a fully integrated eye care centre. The elective care wing of the building will help in meeting the predicted rising demand for a range of orthopaedic and ophthalmology procedures, providing extra capacity to ensure NHS waiting times are reduced and offering improved services and facilities. The business case has been clinically led and developed through partnership working with University of the Highlands & Islands and Highlands & Islands

Enterprise, generating a different way of thinking about the delivery of care through research, development and local innovation.

This development will provide a significant opportunity to deliver excellent quality care, not only for the people of the Highlands, but for all those people requiring orthopaedic joint replacement and ophthalmic service support across the north of Scotland.

The facility will include a proposed NHS elective care centre, a University of the Highlands and Islands’ life sciences innovation centre and a new life science business incubator owned by Highlands and Islands Enterprise designed to nurture embryonic business ideas. The centre will promote further engagement between the health service, the academic sector and commercial partners.

NHS Highland using VR headsets to help patients prepare for MRIs

NHS Highland in partnership with NHS Education for Scotland (NES) is launching an innovative new project that aims to make it easier for patients to undergo MRI scans with the help of virtual reality (VR). Before going in for an MRI scan, patients will be given a virtual MRI experience using VR headsets. They will be able to see the MRI scanner up close and hear the noise it makes. It is hoped that this will help them become more comfortable with the

process.

The project builds on a successful trial of the VR scheme in NHS Highland that saw headsets given to children who were preparing for scans. NHS Highland and NES have secured funding from independent charity The Health Foundation to expand

the pilot scheme to include adults and evaluate its effectiveness.

Queen's Nurse contributes to online respiratory learning modules

An NHS Highland Queen’s Nurse has contributed to a new online education resource designed to provide non-specialist healthcare professionals with basic knowledge of common respiratory conditions.

Michelle Duffy, the advanced practice respiratory nurse for the board’s North & West area, is one of the authors of the learning modules available on the new Respiratory Education to Support Professionals through e-learning (RESPe) website.

RESPe was developed by the charity Chest, Heart & Stroke Scotland (CHSS) in partnership with the University of Edinburgh and NHS Scotland respiratory clinicians.

The full agenda from today's board meeting can be found at -

https://www.nhshighland.scot.nhs.uk/Meetings/BoardsMeetings/Pages/March2019.aspx

A webcast of the meeting is available at - http://www.invernesstv.net/nhs-archive.html#clip=9ob69q79i7ks&time=388