CHIEF EXECUTIVE’S EMERGING ISSUES AND UPDATES REPORT

1CHILD PROTECTION

(i)HMIe Interim Follow-Through Inspection Briefing

HMIe (Her Majesties Inspectorate of Education) have announced a multi-agency interim follow through inspection following their visit to Highland in January – March 2005. The visit will commence the week beginning 5 June 2006 and will last for 5 days.

Specifically HMIe have advised Highland that during the visit they will:

  • Evaluate progress made in responding to main points for action from the last visit
  • Assess the extent to which services protecting children are continuing to improve the quality of their work
  • Evaluate the progress made in meeting the recommendations contained within “The Independent Review into the Circumstances Surrounding the Death of Daniel Reid” by Dr Jean Herbison

This visit will not include the new Argyll and Bute CHP which will have a full HMIe inspection undertaken in October of this year.

The inspection team will comprise of:

  • Marion Martin (Lead)
  • Joanna McCreadie (Deputy Lead)
  • Fiona McManus
  • Jacqui Mok
  • Kevin Mitchell
  • Jacquie Pepper
  • Alan Milliken (Associate inspector)

A briefing session was held for the Highland Agencies on Friday 12 May lead by Marion Martin with Joanna McCreadie present, the following was discussed;

A fieldwork programme has been confirmed by the inspection team; activities will include a presentation from the Child Protection Committee (confirmed for 5 June 11am), focus groups, visits, individual interviews and observations including observations of good practice. The team will meet and talk to young children, young people and families whilst visiting services. Following the briefing by Marion Martin a timed programme of events will be completed shortly and as requested by the inspection team will comprise of the following:

Focus Groups:

  • One group of staff from each of the different agencies who work directly with children
  • One group of managers who manage staff who work directly with children from the different agencies
  • One group of staff who work directly with children from Social Work Services
  • One group of staff who work directly with children from Health Services

Visits:

  • A social work office
  • A health centre or GP practices
  • A primary school
  • A secondary School
  • A police station
  • A throughcare and aftercare service
  • A family centre
  • The social work out of hours duty service

Observations:

  • Two children’s hearings
  • Two child protection case conferences
  • Two child protection planning meetings

Individual Interviews:

These are to be confirmed by the Inspection team but are likely to include the following:

  • Multi-agency Chief Officers
  • Multi-agency Lead Officers
  • Lead Child Protection Doctor from Health – Dr Malcolm Baxter
  • Senior Manager from the voluntary sector
  • Child Protection Development Officer

Since the last visit new legislation has been passed (Joint Inspection of Children’s Services and Inspection of Social Work Services [Scotland] Bill). This will now allow the inspection team to view patient records; this will be done on the basis of implied consent.

Verbal feedback from the inspection will take place on the 13 or 16 June. The full report will be available in July. A further full follow up inspection will take place in approximately July 2007.

Jan Baird and Heidi May are the leads for the health aspect of the visit. The Child Protection Chief Officers have appointed a lead co-ordinator for the inspection – Bill Alexander.

(ii)Letters of Assurance

The Scottish Executive has requested an update to the last Child Protection Letter of Assurance (2004). This letter is due to be returned to the SE by the 31 May and will be a co-ordinated multi-agency response. A separate letter covering the Argyll and Bute area will be submitted. It is advised that the letter provides assurance that:

  • The new guidance for Child Protection Committees has been implemented; and
  • You as part of the Chief Officers Group, are confident that you have in place the appropriate mechanisms to ensure that the functions now required of the CPCs can be effectively carried out
  • How implementation of the new guidelines for CPCs are being applied in practice and what impact this is having in ensuring effective joint working to deliver the outcomes needed to ensure children are adequately protected.

In relation to issues raised by cases of children affected by drug abuse the assurance re the following has been requested:

You are taking all reasonable steps to ensure that

  • You have identified all children who are adversely affected by drug abuse, or are involved in drug abuse themselves
  • You have assessed their needs; and
  • There is a plan for meeting their needs which is being implemented

And as part of that for every known drug abuser in your area

  • All children adversely affected by their drug abuse have been identified and their needs have been assessed; and
  • There is a plan for meeting those needs which is being implemented.

Following the initial letter requesting the above assurances and following debate at the Child Protection Reform Steering Group and feedback from the Chairs of Child Protection Committees about the degree of assurance being requested in relation to children affected by drug abuse a subsequent letter has been issued clarifying what is required by ministers:

  • That local agencies are taking all reasonable steps to identify those children who are adversely affected, particularly those cases where the risk of serious impact is high; and
  • That in all such cases, the needs of children come first and are being met
  • In relation to the first point Ministers are seeking information about the systems you have to ensure that children adversely affected by drug misuse are identified, including related quality assurance mechanisms, and your assessment of how well these systems are working
  • In relation to the second point, Ministers are not asking you to carry out fresh audit of every single case. They expect you will have an up to date assessment of the needs of those children known to be adversely affected, and a plan to meet those needs. If so, all you need to do is describe your local systems for ensuring these plans exist and are meeting needs, and your assessment of how well children’s needs are being assessed and met.
  • If you are unable to provide either of these assurances, Ministers are seeking assurance that you are taking the necessary action to establish effective systems. In particular, if you have systems, but do not know how well they are working, can you describe what you are doing to find out.

Letters, signed by Chief Executives, will be finalised and submitted by 31 May.

2CORONARY HEART DISEASE

2.1Background and Summary

This report outlines the activities of and issues for the Coronary Heart Disease Managed Clinical Network [CHD MCN] for Highland.

Dr Stephen Cross, Cardiologist based at Raigmore is the Lead Clinician for the network.

The Steering Group of the CHD MCN meets regularly on a bi-monthly basis in the Highland Heartbeat Centre. It is multi disciplinary and representation is Highland-wide. The Network is working jointly with the Primary Care Collaborative in the Mid and North Highland Community Health Partnerships. This has increased communication and support from Primary Care.

All waiting time targets for CHD have been met during the 2005/2006 period

2.2Percutaneous Coronary Intervention (PCI) (angioplasty)

In 2004 the Scottish Executive Health Department conducted a capacity review of the provision of angioplasty in Scotland. This led to Regional Planning discussions on how to provide this in the North of Scotland (NoS).

Background work has been undertaken to investigate the viability of establishing a Catheterisation Laboratory for Angioplasty in Highland.

An NoS business case has been developed and is in the process of being presented to various NHS Highland committees for approval. If this should this be agreed the development would start in 2006 with the aim of having the lab functioning in 2008. Item 5.3 on the NHS Board agenda will consider this issue.

A replacement Cardiologist has recently been recruited and will work in Raigmore with sessions in Aberdeen Royal Infirmary until a PCI service is established in Highland.

This project meets Corporate Objectives 1, 2, 4, 5 and 6.

Details of the impact for NHS Highland will be outlined in a separate business case.

2.3Cardiac Rehabilitation

Cardiac rehabilitation has been established across Highland following funding from New Opportunities Funding. Phase 3 rehabilitation is running well in most areas. The limiting factor for areas that it is not running in is the inability to recruit staff.

Resource has been identified in the 5-year financial plan to continue this service in the event of positive final evaluation. Interim feedback is very encouraging.

This project meets Corporate Objectives 1, 2, 4 and 5.

There will be a financial impact for NHS Highland in April 2007.

2.4Heart Failure Liaison Nurse Service

A Heart Failure Liaison Nurse Service will be established in Highland between 2006 and 2007. A team of three (whole time equivalent) specialist nurses will be set up across Highland to provide care locally while maintaining close links with acute services. These nurses will be funded fully by British Heart Foundation for three years and then 50% for a further two years at which point depending on positive evaluation NHS Highland will continue to support. The Team leader for this service will be recruited in August 2006.

This project meets Corporate Objectives 1, 2, 4, 5 and 6.

There will be a financial impact for NHS Highland in April 2009.

2.5Rapid Access Chest Pain Clinic

This service was evaluated last year and proved to be popular with patients who liked having tests completed in the same day where possible.

There has been a significant rise in referral to this clinic over the past 2 months and waiting times have risen to 7 weeks, which is out with the recommendation of 2 weeks.

Review of provision of Cardiac Clinics in Raigmore will take place in view of recruitment of new Cardiologist.

This project meets Corporate Objectives 2, 4 and 6.

2.6Access to Echocardiography

Recruitment issues within Echocardiography have been causing pressure on the service for the past 2 years. This is about to increase due to staff retirement in summer 2006. There is a potential for this to affect cardiac waiting times by preventing development of plans to provide direct access for GPs to the service.

2.7The Future

The network is now engaging with people across Highland in a multi-agency manner. At a recent planning event it was identified that this year’s focus would be on Angina and equity of provision of CHD services across Highland.

The CHD website is under construction and will be complete by July 2006.

3DELIVERING A HEALTHY FUTURE – AN ACTION FRAMEWORK FOR CHILDREN AND YOUNG PEOPLE’S HEALTH IN SCOTLAND

An Action Framework for Children and Young People’s Health in Scotland, details within one document, the key actions required to meet the challenges for children and young people’s health in 21st century Scotland.

The Framework asserts that children and young people are our investment in Scotland’s future. The investment we put into them through childhood and adolescence will directly impact on the future health of Scotland and our prosperity and stability. In particular our attention is drawn to the following:

  • Within a health care system that is challenged by adult health care needs and the demands on resources of a growing elderly population, specific and conscious and attention has to be given to the very different health needs and requirements of children and young people
  • Despite considerable improvements to child health through public health interventions, immunisation programmes, antibiotics, improved social and environmental circumstances and injury prevention measures, there can be no room for complacency. Some challenges remain unresolved while new health issues have emerged. An example of this is as increasing life expectancy for children with chronic and complex conditions, ensuring infants live into childhood and children live through adolescence. This has come about through enhanced technological interventions and the development of new drug treatments and regimes. These often come with additional costs.
  • Due to differences in physiological, psychological, intellectual and emotional development, children and young people require health care that is organised and delivered in a different way to adults

The Framework details an agenda, actions and targets at a national level and for local and regional health systems that cover the following areas:

  • Health Improvement
  • Providing Care Locally
  • Emergency Care
  • Hospital Care
  • Specialist Services
  • Mental Health Services
  • Complex Needs
  • Remote and Rural Care

A consultation exercise is in progress that closes on July 7 2006. The Child Health Services Network will co ordinate NHS Highland’s response, with an update on our feedback and subsequent implications for Highland at the September 2006 Board.

4FREEDOM OF INFORMATION

Progress Report

Chris Meecham, Head of Media Communications and Corporate Services, acts as the Freedom of Information Officer for NHS Highland.

To date, 207 requests for information have been received and managed as Freedom of Information (Scotland) Act 2002 (FoI) requests. The information was provided (or the requestor told why they could not have the information) in 197 (95%) of these requests within the deadline of 20 working days. These requests are summarised in the attached report (Appendix 1)

The outcomes of these requests were as follows:

Information provided-148 cases

Information provided in part-14 cases

Information not held-14 cases

Information withheld-20 cases

Information being sought-7 cases

Request on hold pending-3 cases

clarification of the request

Request withdrawn-1 case

A staff familiarisation and training programme has been ongoing since September 2004. This has included articles in the Team Update, a leaflet introducing FoI which was circulated to all staff, and a rolling programme of training events. A workbook on FoI is also included in the Induction Training Programme. These materials are freely available on the NHS Highland website.

5HEALTH PROMOTING SCHOOLS - SCOTTISH EDUCATIONAL AWARDS

The Highland Health Promoting Schools Scheme has reached the final three of the ‘Scottish Education Awards’, sponsored by The Scottish Executive, BT, Daily Record, Determined to Exceed and CBI.

The Highland Health Promoting Schools Scheme has been jointly managed and funded by NHS Highland, Public Health Team and The Highland Council, Education, Culture and Sport. The scheme was successful following nominations in the category of ‘Local Authority – making a difference’. This category is about recognising where local authorities make a difference to the lives of young people living in their area. The Highland HPS scheme received three nominations which highlighted the quality of the scheme and the partnership working that has taken place. All 222 schools in Highland were officially accredited by the HPS Team two years ahead of the target set by The Scottish Executive. The HPS team has grown significantly with support of NHS Highland and the Highland Council to ensure schools build on their health promoting status; each Highland CHP has a dedicated HPS Officer who supports all their allocated schools with guidance and training to ensure continuous improvement.

In addition to this good news, the Highland Health Promoting Schools Scheme was examined by the National Endorsement Team (NET). The NET consisted of representatives from the Scottish Executive, NHS Scotland, COSLA and SEED. The Highland Health Promoting schools Team was considered to be a robust, well structured scheme with evidence of close partnership working and a clear philosophy of recognising the schools as part of a wider community. The NET therefore confirmed their endorsement of the Highland scheme. The NET also congratulated the Highland Council/NHS Highland partnership in having all schools achieve health promoting schools accreditation by 2005.

6HIGHLAND CARERS STRATEGY

The Board will be aware of the existence of the Highland Carers Strategy Steering Group, a group led by carers and supported by officers from Health, Housing, Social Work and the voluntary sector. The Group continues to be active in discussing/commenting on/influencing a whole range of carer-related issues, and will receive a new focus with the issuing of the Scottish Executive guidance on NHS Carer Information Strategies.

Recent activities include:

  • Completion of work on a review of the Highland Carers Strategy
  • Continuing to act as a communication network for members/organisations represented
  • Support for carer representative on the JCACC
  • Participation in national work around seeking carers’ views of lives/services etc. (e.g. Care 21).

Planned future activity includes: