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MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE
Board Room,Assynt House,
Inverness /
24 NOVEMBER 2009 – 11.10 am
Present: / Heidi May (in the Chair)Doreen Bell
Helen Bryers
Jonathan Gray
Sandra Harrington
Hilda Hope
Alison Hudson
Chrissie Lane
Paula McCormack
Gill McNeill
Margaret McRae
Mhairi Will
Faith Wilson
Eric Wiseman
In Attendance: / Susan Donaldson, Stoma Care Nurse
Cathie Fraser, Stoma Care Nurse
Brian Mitchell, Board Committee Administrator
1 / WELCOME AND APOLOGIES
Apologies were received from Carole Bridge, Mary Burnside, Peter Cartwright, Kathleen Clarke, Morag Greenshields, Veronica Kennedy, Jennifer Lobban, Stephen Loch, Una Lyon, Alison MacLean, Liz McClurg, Iona McGauran, Sarah Macleod, Ruth Miller, Helen Morrison, Tricia Morrison, Lesley Randall, Pat Tyrrell, Mary Vance, and Sandie Young.
2 / MINUTE OF MEETING OF 20 OCTOBER 2009
The Committee Approved the Minute of meeting held on 20 October 2009, and associated Action Plan.
The Committee Agreed to consider the following Item at this point in the meeting.
4 / COLORECTAL/STOMA CARE ANNUAL REPORT
Ms Donaldson and Ms Fraser gave a presentation to the Committee in relation to the Colorectal/Stoma Care Annual Report 2008, providing an overview of the Colorectal/Stoma CNS service, identifying achievements in 2008, and commenting on the challenges facing the CSCNS service through 2009 and beyond. It was stated that in Highland there were on average 800-1,000 patients with a Stoma at any one time and that, for these patients, the service provides evidence-based advanced nursing practice; conducted research, audit, and service development; provided education throughout Highland; and helped to lead, motivate and facilitate service provision. One of the main current workstreams related to seeking to reduce the number of community and home visits undertaken, with a view to driving further efficiencies in associated time and financial resource management. Service achievements in 2008 had included an increased number of patients being seen at relevant clinics, initial steps introduced to follow up patients with resectable hepatic metastasis, staff development activity to ensure future service sustainability, continuation of the PROPHECI study, conducting a telephone audit, ongoing service audit activity, staff completion of BSc and Clinical Leadership Programme training, and ongoing involvement with National Procurement activity. With regard to the challenges for 2009 and beyond these would include continuing to provide a quality service within existing constraints, maintaining professional development, implications arising from the introduction of the bowel screening programme from December 2009, ongoing costs associated with stoma appliance provision, and expansion of the Colorectal Team. Ms May thanked those presenting for an informative presentation and expressed admiration for the level of service being provided year on year.
During discussion, there was concern expressed regarding the increased service level expectations being placed on the Team in a difficult resource environment. Given the current financial climate it was emphasised that all parts of the organisation required to engage in potential service change activity, and that all should look to utilise any resource in new and innovative ways to meet service demand. Staff flexibility would be an important tool and it was stated that availability of Specialist Nurses on wards would bring an associated impact by providing senior clinical leadership. It was stated that Stoma Nurses already operated at ward level and sought to provide help where possible. The view was expressed that a management presence at ward level would also be beneficial at this time and that those in a leadership role should seek to provide such leadership during this time. Communication with staff at all levels was crucial.
After discussion, the Committee Noted the Colorectal/Stoma Care Annual Report 2008.
Ms Donaldson and Ms Fraser left the meeting at 12 noon.
3 / MATTERS ARISING
3.1 Future Committee Arrangements
Ms J Catherwood spoke to the circulated report outlining a proposal to create an Area Nursing, Midwifery and Allied Health Professions Advisory Committee, this replacing the two existing Committees and reporting through the Area Clinical Forum (ACF) to the NHS Board. The membership proposed was as outlined and it was stated that the existing four seats on the ACF would be maintained from the new membership, with at least one seat elected from each of the three professional groups, so as to ensure a balance to representation. The new Committee would perform an advisory, steering and assurance function in line with a structured agenda, with the advisory element chaired by one of the ACF representatives and the assurance element chaired by the Director of Nursing. It was confirmed that there would be three Sub Groups reporting to the new Committee and these would be tasked with the delivery of the NMAHP Strategy. The Committee, and the three associated Sub Groups, would meet monthly in the week preceding the meeting of the NHS Board.
During discussion there was concern that the new arrangements may lead to a too structured, rigid approach. It was debated that there was need for greater engagement and supporting processes/structures and that the new structure would provide for an enhancement of the advisory role of the Committee. Membership of the Committee would be open and it was anticipated this will include frontline nursing staff as well as Charge Nurses and senior staff. It was suggested that the Informal Leads Group, comprising Lead Nurses, AHPs, PHOS, Consultant Nurses would be replaced by a Lead AHP meeting chaired by Ms J Catherwood and a Lead Nurse meeting chaired by Ms H May. The issue of proposed membership was debated and there was a strong view expressed that this required to be amended to reflect the range of nursing activity, whilst not totally overshadowing the membership from Allied Health Professions, where each individual service would be represented. Despite debate, no specific gaps were identified but it was agreed to re-consider this.
After further discussion, the Committee:
· Noted the proposals for a new Nursing, Midwifery and Allied Health Professions Advisory Committee.
· Agreed the proposed membership be further discussed and revised by the Area Nursing and Area Allied Health Professions Committees prior to submission to the Area Clinical Forum and the NHS Board for approval.
3.2 Committee Vice Chair Arrangements
The Committee Noted that the position of Vice Chair would be dependent upon the outcome of proposals for a new Committee, as discussed under Item 3.1, and would be brought back to a future meeting.
3.3 Nursing Establishment Setting
Mrs M MacRae advised that concern was being expressed with regards to proposed skill mix ratios, and that despite agreement as to Staffside involvement in such considerations appropriate consultation had not taken place. This had led to a position where the Royal College of Nursing was reluctant to sign up to proposals as part of the relevant process. Ms H May emphasised that no decision on skill mix had yet been taken formally, that this would be dependent upon the outcome of the current establishment review, and would be subject to further discussion. This subject would be discussed at a future meeting of the Committee as appropriate.
The Committee Noted the position.
5 / SCOTTISH PATIENT SAFETY PROGRAMME
Dr LA Smith gave a presentation to the Committee in relation to the Scottish Patient Safety Programme (SPSP) outlining a definition of quality and advising that included within the relevant drivers for change were that one in ten admissions to hospital result in an adverse event, half of which could have been prevented and costing more than £2bn per annum in direct health care costs, possibly contributing to the deaths of 72,000 patients, and involving 10,000 adverse events involving medication. It was stated that HAI cost over £1bn in direct health care costs alone, 15% of which were considered to be preventable, and clinical negligence claims amounted to £400m annually with an estimated potential liability of £2.4bn in existing and expected claims. In terms of reducing waste and associated costs the primary drivers included clinical quality, staffing, patient flows, the supply chain, and mismatched services; each with a range of secondary associated drivers. There were six key changes identified that would save patient lives and these were stated as being the deployment of rapid response teams, delivery of reliable and evidence-based care for acute myocardial infarction, prevention of adverse drug events, prevention of central line and surgical site infections, and prevention of ventilator-associated pneumonia. The objectives for SPSP in Highland were outlined and it was advised that implementation sites in Highland would be at Caithness General, Belford, Raigmore, and Lorn and Isles Hospitals. In terms of SPSP implementation this would be overseen and led by a Senior Leadership Team, and supported by a central support team within the Clinical Governance Department. Hospitals had developed individual infrastructures and core teams to support the relevant indicated workstreams and these included nursing, medical and theatre staff, AHPs, Pharmacists and Hospital Management. Evidence of progress and relevant improvements in relation to the workstreams was outlined, as were areas where issues had been encountered. Moving forward the major challenges and barriers that existed related to cross-professional ownership and integrated working towards SPSP objectives, creation of an infrastructure to support data collection and the streamlining of the demands of this on front line staff, and managing SPSP spread in a coordinated manner.
During discussion, the issue of long term support for the Programme was raised and in response Dr Smith stated that whilst relevant targets were set for 2010 the main aim for the Programme was the embedding of the concept of continuous change and improvement. It was stated that work in this area provided a good fit with issues involved in the Senior Charge Nurse Review and ‘Productive Ward’ and Ms H May advised that given the range of current need for change the key to success would be to emphasise to staff why this was required and was to be embedded. Dr Smith echoed this point, adding that the existing culture and working methods would be influenced by reflecting that this work related to patient care, and evidencing the impact/ results being achieved.
After discussion, the Committee Noted the position in relation to the Scottish Patient Safety Programme.
6 / FRAMEWORK FOR DELIVERY OF OUT OF HOURS SERVICES
The Committee Agreed to Defer consideration of this Item to the next meeting.
7 / REVIEW OF NURSING IN THE COMMUNITY/MODERNISING COMMUNITY NURSING
The Committee Agreed to Defer consideration of this Item to the next meeting.
8 / RESPONSE TO INTERNAL AUDIT REPORT ON REGISTRATION
Mrs D Bell spoke to the circulated report relating to Nursing, Midwifery and AHP Professional Registration Monitoring in NHS Highland, following an Internal Audit Review of NHS Highland processes to monitor registrations and the testing of the robustness and consistency of these processes. The review by Deloitte, sponsored by the Nurse Director had identified a number of process weaknesses within a variety of units across the organisation. An Action Plan based on the relevant findings had been developed and a procedure covering aspects relating to the new start appointment process, NMAHP registration Monitoring Process, internal monitoring of the procedure, and local management of lapses in NMAHP registration, had been developed to improve existing processes organisation-wide as indicated. A relevant briefing had also been developed for all registered NMAHP staff to highlight the importance of their maintaining their own registrations and the consequences to both them, and the organisation, where this was not maintained. The agreed briefing would be sent to all relevant staff. Mrs Bell emphasised that the review had evidenced a range of good practice within the organisation however the Action Plan was required to ensure that this was consistent in all areas. Ongoing monitoring in this area would be undertaken and Mr J Mackay, Workforce Information Officer would collate and hold the relevant data.
During discussion, there was reference to regulation of Health Care Support Workers (HCSW), the notification of appropriate staff where an issue arose, and relevant process options. Ms H May advised that for HCSWs, processes would be in line with NMC regulations however would be reviewed in light of relevant Regulations being introduced.
The Committee:
· Agreed to the implementation of the internal procedure to ensure robust systems are in place to monitor registration and re-registration processes.
· Noted the development of a briefing for all registered NMAHP staff to highlight their responsibilities in maintaining up to date registration with their regulatory body.
· Noted that Lead Nurses and Lead AHPs will be required to implement this procedure in their Units and ensure the new procedure is communicated robustly via local CHP/Unit Governance Committees.
9 / ‘A SAFE PRESCRIPTION’ – NMAHP PRESCRIBING GUIDANCE DOCUMENT AND REGISTRATION AMONG NON-MEDICAL PRESCRIBERS
Ms H May spoke to the circulated document and requested that a report on progress against the various recommendations contained within that would be brought to a future meeting of the Committee, by Hilda Hope.
The Committee so Noted.
10 / INFECTION CONTROL
10.1 Infection Control Board Report
Ms H May spoke to the circulated report which had been considered by the NHS Board, at their meeting held on 1 December 2009. Particular issues highlighted included CDAD cases in MacKinnon Memorial Hospital and these had been investigated in terms of respective timelines, potential links etc. Other issues highlighted related to environmental audits and Hand Hygiene Audit activity. Ms H May also advised the Committee that Ms Morag Greenshields was to step down from her role as Infection Control Manager, that the relevant post had been considered by the Vacancy Monitoring Group and would be advertised on the basis of a 4 to 6 secondment early in the new year. Future arrangements for this role would be considered further.
The Committee:
· Noted the Infection Control Report to 31 October 2009.
· Noted the proposed HEI visit to Raigmore Hospital.
· Noted the position in relation to the post of Infection Control Manager.
10.2 SCRIBE Toolkit Testing (HAI Environment)