Performance And Audit Committee (integration Joint Board) - 24/05/2023

At a MEETING of the PERFORMANCE AND AUDIT COMMITTEE OF THE DUNDEE CITY HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD held remotely on 24th May, 2023.

Present:-

Non-members in attendance at the request of the Chief Finance Officer:-

Prior to commencement of business, the Chair advised the Committee that this would be Annie Buchanans last meeting and paid tribute to the contribution made by her over her period of membership and wished her well for the future.

Ken LYNN, Chairperson, in the Chair.

I APOLOGIES FOR ABSENCE

II DECLARATION OF INTEREST

There were no declarations of interest.

lll MINUTE OF PREVIOUS MEETING AND ACTION TRACKER

(a) MINUTE

The minute of meeting of the Committee held on 1st February, 2023 was submitted and approved.

(b) ACTION TRACKER

There was submitted the Action Tracker, PAC14-2023, for meetings of the Performance and Audit Committee for noting and updating accordingly.

The Committee agreed to note the content of the Action Tracker.

lV ANALYTICAL REVIEW OF EMERGENCY READMISSION RATES UPDATE

There was submitted Agenda Note PAC16-2023 giving an update on the analytical review of emergency readmission rates. Unscheduled hospital care is one of the biggest demands on Partnership resources. Whilst significant improvements had been made in some aspects of unscheduled care, performance in relation to repeat emergency admissions remains an area requiring further understanding and improvement. The Performance and Audit Committee had received a series of in-depth analytical reports for unscheduled care, including readmissions (Article VIII of the minute of the Dundee PAC on 29th May 2018, Article IV of the minute of the Dundee PAC on 25th March 2019 and Article XIV of the minute of the Dundee PAC on 22nd September 2020 referred). At the end of 2021 further analytical work was being planned (Article VII of the minute of the Dundee PAC on 24th November 2021 referred), however this was suspended as local data for readmissions was not available from Q1 2021/22 as NHS Tayside Business Unit (NHST BSU) were undertaking investigation and improvement of coding and recording to ensure greater parity when benchmarking performance across Partnerships (Article XI of the minute of the Dundee PAC on 20th July 2022 referred).

Following completion of the work by NHST BSU reporting of readmissions data had recommenced as at Q3 2022/23 (Article XVII of this minute refers).

Since February 2023, a short-life working group had been meeting to consider readmissions data. This group included NHST BSU, NHST Public Health Directorate, Public Health Scotland LIST and both data and intelligence and operational staff from the Dundee Health and Social Care Partnership. To date the work of the group had focused on developing a robust understanding of local readmissions data and ensuring that local calculation of the readmissions indicator was consistent with the technical definition of the national readmissions indicator. The group had now reached the stage of having as high a level of confidence as is proportionate, given limited analytical resources, in the local data and local calculation methodology. This provided the foundation for moving forward with further work in two areas: data definitions and quality and, analysis to inform improvement.

In relation to data definitions and quality, the immediate focus was on addressing remaining recording and coding issues that had been identified through the process already undertaken by the working group. The group had also opened up channels of communication with Public Health Scotland regarding the technical definition of the national readmissions indicator and were advocating for changes to the methodology to align this with modern pathways of care.

Work to develop a robust understanding of local readmissions data and indicator calculation had also helped the working group to identify specific areas for further analysis, with a view to this informing future improvement activity:-

Further analysis of data by Scottish Index of Multiple Deprivation (SIMD), gender and age.

Analysis of the readmission ratio, which was the number of readmissions observed over the expected readmissions.

Further analysis of short stay admissions and readmissions (0 days and 1-3 days);

Analysis of readmissions activity based on admission routes, including admissions made by GPs.

Analysis of admissions and readmissions by diagnosis, with a focus on instances where initial admissions and subsequent readmissions are for the same diagnosis.

Analysis of instances where there had been a significant number of multiple readmissions.

Confirmation of specialities with highest readmission rates and further analysis of data for each of these specialities.

Working with operational colleagues to contextualise readmissions activity as part of the pathway of unscheduled care and articulate the impact of wider improvement activity on a broader suite of indicators that provided a more holistic overview of unscheduled care performance and quality.

The working group anticipated submitting a full analytical report to the Performance and Audit Committee on 27th September 2023.

The Committee agreed to note the updated position.

V DUNDEE HEALTH AND SOCIAL CARE PARTNERSHIP PERFORMANCE REPORT 2022/2023 QUARTER 3

There was submitted Report No PAC17-2023 by the Chief Finance Officer, providing an update on the 2022/2023 Quarter 3 performance against the National Health and Wellbeing Indicators and Measuring Performance Under Integration indicators. Data was also provided in relation to Social Care Demand for Care at Home services.

The Committee agreed:-

(i) to note the content of the summary report;

(ii) to note the performance of Dundee Health and Social Care Partnership, at both Dundee and Local Community Planning Partnership (LCPP) levels, against the National Health and Wellbeing Indicators as summarised in Appendix 1 (tables 1, 2 and 3) to the report;

(iii) to note the performance of Dundee Health and Social Care Partnership against the Measuring Performance Under Integration indicators as summarised in Appendix 1 (table 3) to the report; and

(iv) to note the number of people waiting for social care assessment and care at home package and associated hours of care yet to be provided as detailed in Appendix 2 of the report.

VI MENTAL HEALTH PERFORMANCE

There was submitted Report No PAC20-2023 by the Chief Finance Officer, reporting a suite of measurement relating to the activity of Mental Health services for scrutiny and assurance.

The Committee agreed:-

(i) to note the content of the report;

(ii) to discuss any further areas for development in the content and presentation of the report; and

(iii) to note the operational and strategic supporting narrative in the context of the trends in performance and activity.

VII DUNDEE HEALTH AND SOCIAL CARE PARTNERSHIP CLINICAL, CARE AND PROFESSIONAL GOVERNANCE ASSURANCE REPORT

There was submitted Report No PAC15-2023 by the Clinical Director providing assurance to the Committee on the business of the Dundee Health and Social Care Partnership Clinical, Care and Professional Governance Group.

The report was brought to the Committee to provide assurance on the clinical and care governance activities and arrangements across the Partnership as outlined in the Getting It Right For Everyone (GIRFE) Framework in accordance with the Partnership Integration Scheme. Clinical Governance was a statutory requirement to report, at Board level, from Scottish Government as per NHS MEL (1998) 75. The Performance and Audit Committee was asked to provide their view on the level of assurance the report provided in regard to clinical and care governance within the Partnership. The timescale for the data within the report was to 31st January 2023.

The Committee agreed:-

(i) to note the Exception Report for the Dundee Health and Social Care Partnership Clinical Care and Professional Governance as detailed in Section 4 of the report; and

(ii) that the level of assurance was reasonable due to the factors as indicated.

VIII QUARTERLY COMPLAINTS PERFORMANCE 4TH QUARTER 2022/2023

There was submitted Report No PAC18-2023 by the Chief Finance Officer, summarising the complaints performance for the Health and Social Care Partnership (HSCP) in the fourth quarter of 2022/2023. The complaints included complaints handled using the Dundee Health and Social Care Partnership Social Work Complaint Handling Procedure, the NHS Complaint Procedure and the Dundee City Integration Joint Board Complaint Handling Procedure.

The Committee agreed:-

(i) to note the complaints handling performance for health and social work complaints set out within the report; and

(ii) to note the work which had been undertaken to address outstanding complaints within the HSCP and to improve complaints handling, monitoring and report.

IX DUNDEE HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC RISK REGISTER UPDATE 

There was submitted Report No PAC19-2023 by the Chief Finance Officer, providing an update in relation to the Strategic Risk Register and on strategic risk management activities in Dundee Health and Social Care Partnership.

The Committee agreed:-

(i) to note the content of the Strategic Risk Register Update report;

(ii) to note the extract from the Strategic Risk register attached at Appendix 1 of the report; and

(iii) to note the recent work and future work on the Pentana Risk Management System in Section 7 of the report.

X DUNDEE INTEGRATION JOINT BOARD INTERNAL AUDIT REPORT GOVERNANCE ACTION PLAN

There was submitted Report No PAC10-2023 by the Chief Finance Officer, presenting the findings of the Internal Audit Review of the Governance Action Plan which was presented to each meeting of the Performance and Audit Committee.

The Committee agreed:-

(i) to note the content and recommendations of the Internal Audit Review of the Governance Action Plan as set out in Appendix 1 of the report; and

(ii) to instruct the Chief Finance Officer to implement the recommendations of the report and provide an update on progress at the next meeting of the Committee.

XI GOVERNANCE ACTION PLAN PROGRESS REPORT

There was submitted Report No PAC12-2023 by the Chief Finance Officer, providing an update on the progress of the actions set out in the Governance Action Plan.

The Committee agreed to note the content of the report and the progress made in relation to the actions set out in the Governance Action Plan as outlined in Appendix 1 of the report.

XII DUNDEE INTEGRATION JOINT BOARD INTERNAL AUDIT PLAN PROGRESS REPORT

There was submitted Report No PAC13-2023 by the Chief Finance Officer, providing an update on the completion of the previous years internal audit plans as well as progress against the 2022/2023 plan and work relating to 2023/2024. The report also included internal audit reports that were commissioned by the partner Audit and Risk Committees, where the outputs were considered relevant for assurance purposes to Dundee Integration Joint Board.

The Committee agreed to note the completion of the 2021/2022 Internal Audit Plan and work undertaken relating to 2022/2023 and the commencement of the 2023/2024 plan.

XIII ATTENDANCE LIST

There was submitted Agenda Note PAC21-2023 providing attendance returns for meetings of the Performance and Audit Committee held over 2023.

The Committee agreed to note the position as outlined.

XIV DATE OF NEXT MEETING

The Committee agreed to note that the next meeting of the Committee would be held remotely on Wednesday 27th September, 2023 at 10.00 am.

Ken LYNN, Chairperson.