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Alder House Cradlehall Business Park Inverness IV2 5GH Tel: 01463 ­ 706948 Fax: 01463 ­ 794712 Minutes of the SE Highland Community Health Partnership Committee Meeting, The Beaufort Hotel, 11 Culduthel Road, Inverness Thursday 30th March 2006 ­ 2:00pm

Present: Mr Jim Cooper, South East Highland CHP Chairman Mr Nigel Small, South East Highland CHP General Manager Dr John Cormack, Associate Medical Director, SSU Ms Fiona Grant, Clinical Lead, Badenoch & Strathspey Ms Sheena Munro, Executive Director, Highland Community Care Forum Ms Margaret Davidson, Highland Council Representative, West Ness Ms Gillian McCreath, Highland Council Representative, Inverness Ms Liz MacDonald, Highland Council Representative, Nairn Mr Laurie Fraser, Highland Council Representative, Nairn Dr Roger Gibbons, Chief Executive, NHS Highland Mr Ian Gibson, Non-Executive Director, NHS Highland Dr Alison Graham, Medical Director, NHS Highland Mrs Jo Veasey, South East Highland CHP Assistant General Manager Ms Anne Mackenzie, South East Highland CHP Management Team Mr Douglas Johnston, South East Highland CHP Personnel Advisor Mr David Garden, South East Highland CHP Accountant Dr Adrian Baker, Clinical Lead, Nairn and Ardersier Mr Campbell Mair, General Manager, Nairn & Ardersier GPs Mr Michael Perera, Service Development Manager, Mental Health Mr Colin Yau, PA to the South East Highland CHP General Manager (Minutes) Apologies: Dr Ian Scott, South East Highland CHP Clinical Director Mr Jean Pierre Sieczkarek, South East Highland CHP Assistant General Manager Ms Hilda Hope, South East Highland CHP Lead Nurse Dr Freda Charters, Clinical Lead, Inverness Dr Alastair Noble, General Practitioner, Nairn & Ardersier Dr Eric Baijal, Director of Public Health, NHS Highland Ms Jackie Agnew, Service Manager, Mental Health & Learning Disabilities Ms Jessie Farquhar, Partnership Rep, Operational Co-ordinator, New Craigs Mr Gregor Rimell, Highland Council Representative, Badenoch & Strathspey


1. Introduction JC welcomed everyone to the CHP Committee meeting and confirmed that it would be his last meeting due to retiral. 2. Presentation ­ "Delivering for Health" ­ Dr Alison Graham, Medical Director, NHS Highland The meeting began with a presentation on "Delivering for Health" by Dr Alison Graham, in the context of what it means for NHS Highland. "Delivering for Health provides a strategic, long-term programme of action and a framework for service change across NHS Scotland. It is a programme of action designed to transform the NHS by further improving quality and efficiency, and by promoting further integration of services. The plan was the product of considerable consultation and input from across the NHS, informed by the report of Professor David Kerr and his team, and it will be important to ensure that the same shared approach is taken to implementation."

(Scottish Executive Health Department HDL(2006)12 28 February 2006)

NS updated the Committee on some pieces of work going on within the SE Highland CHP. For example, there is a lot of work going on re Unscheduled Care, Ward 6A, Activity Data and the Community Resource Hub Concept planned around Community Hospitals etc SM mentioned the Voluntary Sector would have a sizeable role to play in implementation of the Kerr Report. AB commented on access for primary care to near patient testing, investigation, procedure and radiology, with the higher cost drivers being GPs. He explained various options to ensure these types of procedures were carried out locally as near as possible to the patient. RG spoke openly of developing services closer to people's homes, and anticipatory care and asked ­ what can we do more of? JC enquired around the measurement of the success/evaluation process. It was confirmed that Delivering for Health will be performance managed. AG closed with a date for everyone's dairy - Delivering For Health Follow-Up Development Day on the 5 May. She confirmed a wish that work continued where initiatives were already in place to implement the Delivering For Health requirements. JC thanked Dr Alison Graham for her presentation. (A copy of the presentation is attached for information) 3. Minutes of Previous Meeting ­ 22 December 005 Accepted as an accurate record. 4. Matters Arising York Day Hospital, RNI NS informed the Committee re the press interest around the York Day Hospital. Last year a bid was put in to the Scottish Executive to improve primary care


services. Notification was received last week with the news of £800k going towards the relocation of the Day Hospital from the RNI Community Hospital to Raigmore. The resource is a capital sum during the period 06/07 to 07/08. The success of the bid was largely unexpected and had not allowed as much discussion or prior notification to staff as would usually have been desired. Significant discussion and planning would be required between the CHP and SSU. 5. Improving Services & Clinical Issues 5.1 Mental Health ­ "Update on Mental Health Inpatient Services" Jackie Agnew was unavailable, so Michael Perera talked to the paper "Update on Mental Health Inpatient Services". MP up-dated the Committee of the introduction of the Mental Health Act (Scotland) 2003 and its implications. He also informed them of current recruitment issues i.e. vacancies. It is a national problem with regards to attracting people to the profession. Re Bed Usage, there is a Bed Management Group which has been meeting within the hospital to produce a formal protocol for the management of beds when the hospital is busy. MD commented on how impressed she has been with New Craigs' performance under mounting pressures. She also enquired how the delayed discharges were doing. JV replied that currently this had reduced to 4 DDs in New Craigs. She said this was, in particular, due to Jean Pierre Sieczkarek and Jackie Agnew's combined effort and the close attention to individual patient cases. MP ended with the date of the next Mental Welfare Commission Visit - 22 May 2006.

The CHP Committee: a) Noted the updates on the introduction of the Mental Health (Scotland) Act 2003. b) Noted the current situation regarding medical consultant and psychology vacancies. c) Noted the acute bed occupancy in inpatient Mental Health services.

5.2 Learning Disability Reprovision MP talked to JA's paper "Update on Reprovisioning of Learning Disabilities Inpatient Services". MP informed the Committee that the plan is to have appropriate community based health infrastructure to support LD patients following discharge. Work on decommissioning of current LD health services at New Craigs is taken forward by a decommissioning group reporting to the Network. Both of these groups are chaired by the Director of Community Care. Appropriate housing for the current 38 residents has been identified and planned: · 7 residents to move to identified separate existing accommodation in Inverness, plus one to move back to supported accommodation in


· · ·

Western Isles, by July 2006. One further resident to move into separate existing accommodation in Inverness by October 2006. 4 residents to move into a cluster of 4 houses built on the current Laurels Unit within New Craigs, by April 2007. 4 residents to move into a cluster of 4 houses built on the current Beeches Unit within New Craigs, by December 2007 Remaining residents to move into purpose built new housing, arranged in clusters of up to 6 separate houses, in Inverness and surrounding area by December 2007.

He stated that in order to meet the Scottish Executive deadline, it has been necessary to use part of the New Craigs site to build some of the housing. This part of the New Craigs site will therefore no longer be hospital premises, and instead will be part of the planned housing stock to be built around the hospital over the next few years. Arrangements for the first moves identified above are well underway, and plans for the building work to be undertaken are ready to be sent to the Planning Department at the Council. Confirmation of the first year of investment is awaited from the NHS Planning and Prioritisation process, and once this is established various new posts will go to advert.

The CHP Committee: a) Noted the update on the project to provide community based housing and services for patients with a learning disability who are currently resident in the Learning Disability units at New Craigs Hospital.

5.3 Getting It Right For Every Child (GIRFEC) JV informed the Committee of the Pathfinding "Getting It Right For Every Child" in Highland Project. Inverness is the Pathfinding site and implementation site for GIRFEC. There are other Pathfinding sites in Scotland but not to the same detailed, extent. Liz Watson is the Health Lead on the Project Team, which consists: · · · · · Project Manager Assessment Co-ordinator Secondments from Education, Social Work, Police and Health. Project Administrator 2 External Advisors

NS pointed out that GIRFEC remains a standing item on the CHP Management Team agendas due to its significance and the mandatory and speedy nature of the required implementation. MD mentioned that re the Police secondment, Child Protection should be considered also. The CHP Committee: a) Noted the implementation of the Pathfinding Project `Getting it Right for Every Child' in SE Highland CHP. 4

5.4 Ardlarich 3 NS updated the Committee that due to retiral and resignation from the end of June there was likely to be no GP in the Practice. The CHP is currently working with the Patient Group to find out what the patients want. From the patient's pointof-view, there is pressure on Cairn Medical Practice to take on A3's patients. The CHP is looking at various options re premises etc, but a solution is required by the 1 July, even if it is a temporary solution, ahead of a permanent one. Patients have been kept informed by letters and questionnaires. Work is on-going. 5.5 Nairn Hospital Development AB updated the Committee on the Nairn Hospital Development. The Plan is now lodged and waiting to go through the Council Planning Process. It is hoped this will be finalised in around 3 months. The idea is to integrate the entire extended Primary Health Care Team under one roof. The aim is to provide as many local services as possible to the community. The construction phase is expected to be in the region of 18 months. JCor pointed out that SSU would wish to work with the Locality and CHP to look into the most appropriate services to be delivered, thereby avoiding the risk of duplicating services.

The CHP Committee: a) Noted the position paper in respect of the current situation in the development of the Nairn and Ardersier Hospital/Primary Care Resource Centre Re-Development.

5.6 Local Delivery Plan In Dec '05, the Scottish Executive Health Dept provided guidance to Health Boards regarding Local Delivery Plans for 2006/07. NS informed the Committee that LDPs will consist of objectives, targets and measures against which the performance of Health Boards would be assessed. The Board's performance would be monitored by a new Delivery Group within the SEHD, headed by a new Director of Delivery. The Delivery Group will bring together the functions and resources of: · · · · National Waiting Times Unit. Centre for Change & Innovation. Performance Management Division. Financial Performance Management.

There are 4 priority objectives: · · · · Health Improvement. Efficiency/Governance Improvements. Access more quickly to services. Treatment or service available, most appropriate to individual.

In addition, there are 32 key performance measures (planned levels agreed in the LDP), plus a further 20 supporting measures.


The initial LDP has been submitted to the SE by NHS Highland. Some additional information and further discussion is required before a final version is signed off by the Health Dept. The process within NHS Highland is being led by Derek Leslie, Director of Planning and Performance. RG commented that this LDP overtakes our Corporate Objectives.

The CHP Committee: a) Noted the Local Delivery Plan and the requirement for the CHP to contribute to its achievement by NHS Highland. b) Noted that LDPs will appear on the agenda in future meetings but not every meeting.

5.7 OOH NS informed the Committee of the requirement that NHS Highland's total spend be brought into budget. He commented that the CHP is playing its part, for example, there is work being done re potential local solutions involving local Practices in Badenoch & Strathspey. In addition, a group was looking into potential integration between A&E/OOH in Inverness. FG commented that this should involve local doctors and be in agreement with locals in the valley. 5.8 Enhanced Services NS informed the Committee of a letter that is going out to all 3 CHPs providing more details on the new proposed LES for Depression. The letter has gone out for discussion, being "less bureaucratic and more patient focused". He confirmed that 5 new DES planned for 06/07 are Cardiovascular Disease, Cancer, Carers Registrar Register, Learning Disabilities and 48 HR Access. By the 7 April submission date, there would be one year's worth of detailed activity and audit data of ES for discussion and dissection. 5.9 Clinical Governance & Risk Group ­ Role, Remit & Membership

The CHP Committee: a) Ratified the Role, Remit and Membership of the CHP Clinical Governance and Risk Management Group.

5.10 Delayed Discharges JV confirmed that significant work is being done at present and on an on-going basis on Delayed Discharges as this is a key target. The Assistant General Managers have been around the Hospitals to discuss with local staff. There are 22 delayed discharges this week (3 are legal issues taking it down to 19). The NHS Highland target is 34 by 15 April. The SE Highland CHP was confident it would assist greatly in meeting this target.


The CHP Committee: a) Noted progress and the on-going work to meet the Delayed Discharges target.

6. Finance DG talked to the "Finance Report to 28 February 2006" paper. He confirmed that the current forecast is an underspend of £875k, which represents an improvement of £331k on the previously reported position. The major component in the improved position relates to additional prescribing savings. The remaining movement in the current forecast totals £84k and is once again, mainly due to unplanned slippage in the recruitment to vacant posts which, at present, are often taking longer to recruit to than would normally be expected. There have been no unexpected items of financial significance within the dayto-day operational budgets in the current year, in fact, other than prescribing there has been very little movement within the Localities. For General Medical Services (GMS), the Out-Of-Hours' budget had been moved to Mid-Highland CHP under a hosting type arrangement in a similar vein to Mental Health and Dental Services. The main area of uncertainty within GMS relates to Enhanced Services as we will not receive final activity information until early April. However, the CHP has met with almost all of the GP Practices to go through activity information and the current forecast is based upon out best estimate at this time and that is a break-even position within the CHP GMS budget. The Hosted Services have improved their positions and this is because the vast majority of vacancy slippage has come from these areas. Mental Health has improved by £55,000 and Dental by £29,000 The NHS Highland Board meets tomorrow re Planning Process 06/07. Decisions are expected, however, it is already apparent that next year will be particularly challenging and it is likely that Savings Targets will again be significant.

The CHP Committee: a) Noted the current projected underspend of £875,000. b) Noted £659,000 of this overspend related to additional prescribing savings. c) Noted the full achievement of the CHP's Saving Target (CRS). d) Noted decisions regarding 2006/07 funding are to be expected at the 31 March Board Meeting.


7. Improving Health Smoking Ban JC asked for an up-date given the recent introduction of the smoking ban in Scotlland. It was confirmed that in relation to the CHP premises, there had been no known complaints from our CHP. Public Health Directorate Dr Eric Baijal had attended the last CHP Management Team meeting and delivered his Public Health presentation. NS confirmed that the CHP has asked for further clarification on how the structure would better support and link to the CHP. 8. Partnership 8.1 SSU Jcor gave a brief update on SSU issues to the Committee. 8.2 Highland Council ­ Community Planning It was confirmed that in Badenoch and Strathspey, JV has been liaising with William Gilfilan re Community Planning. There have been real steps forward in a co-ordinated approach to Community Planning. LM added that it is positive in Nairn also. MD commented that there is no health element in the Inverness City Partnership and this would need to be further discussed. 8.3 Public/Patient Involvement ­ PPF Representative Up-date NS reported that there have been two nominations received. There is a meeting between himself, Gill Keel and the two nominated reps. The situation has moved on since the last Committee meeting but has yet to be resolved. 8.4 Voluntary Sector ­ Voluntary Sector Representative Up-date The Voluntary Sector Representative has not progressed as far on as the PPF Rep. JC thanked Sheena Munro for attending the CHP Committee from time to time. NS agreed to check progress and the process by which a Voluntary Sector rep will be formally appointed to the CHP Committee. 9. Staffing 9.1 Agenda for Change Job Descriptions DJ reported that at the beginning of March, 365 job descriptions were still to be received by the A4C Project Team. 45 of these are from the SEH CHP, including 23 from Mental Health & learning Disabilities and 2 from Dental Services. Progress has continued to be made in submitting job descriptions since that time.


Assimilation DJ reported that assimilation of staff onto A4C paybands commenced at the end of January with Ancillary staff. The group continued through February and in March, Hospital Midwives and Nursing Staff in two Community Hospitals were also assimilated. Arrears of pay are not paid at the same time as assimilation, but it is expected that this will follow three months after. The Personnel Team has set up a Helpline to respond to assimilation queries from staff. 51 calls have been received so far. 9.2 HR Information DJ also provided a HR Monthly Report with figures on ­ · · · Employee Friendly Leave Absence Sickness Absence Turnover

Figures for these headings not only included the SEH CHP, but also Mid CHP, North CHP, SSU, DHS and Corporate Services. JC thanked DJ for his report.

The CHP Committee: a) Noted that in the HR Monthly Report there were a number of outstanding returns thereby rendering the data incomplete. b) Noted that WTE assumes a 5-day week. c) Noted that there was a belief that the actual absence for employee friendly leave is under reported.

9.3 Local Partnership Forum NS explained to the Committee that NHS Highland has an Area Partnership Forum which has a joint Chair CEO and Employee Director, and that it had been proposed that the CHP has a Local Partnership Forum. Topics for discussion could include staff survey issues, PIN guidance and similar issues. NS has already spoken to JF, the Employee Director etc re forming this Forum. The APF meets monthly, and the LPF could meet bi-monthly.

The CHP Committee: a) Gave its support to the formation of a CHP Local Partnership Forum.


10. Organisational Issues 10.1 CHP Management Team: Notes for Information (23 February 2006) JC The CHP Committee: a) Noted the contents of the CHP Management Team meeting notes on the 23 February 2006.

10.2 CHP Committee Remit NS confirmed that the formal CHP Committee Remit had to be submitted to the Audit Committee. AB asked that reference to the CHP Constitution be included. NS informed the Committee that Ian Gibson is currently without a deputy due to Douglas Graham's resignation. Ian Gibson to follow-up.

The CHP Committee: a) Noted and endorsed the Remit, Membership and Workplan. b) Supported its submission for inclusion as an Appendix to the NHS Highland Standing Orders.

10.3 Formation of a CHP Chair Group MD was announced as the Highland Council Representative on the CHP Chair Group. She spoke of the need for an agenda for each meeting.

The CHP Committee: a) Noted and supported progress on the formation of a CHP Chairs Group. b) Agreed that there would be an agenda for each meeting.

11. AOCB JC thanked Dr Alastair Noble and Dr John Cormack for their contribution to the CHP development and wished them both well for their retirement. He wished Ian Gibson the best of luck in his new CHP Chair role. NS thanked JC for his support for the CHP and recognised the substantial role JC had played in promoting the CHP at Board level. He also expressed thanks for the support given to him by JC since he started in post. JC was presented with a gift and everyone wished him well for his retirement. 12. DATE, TIME & VENUE OF THE NEXT MEETING: Thursday 29th June 2006 ­ 2:00pm ­ The Beaufort Hotel, Culduthel Road, Inverness



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