NHS GRAMPIAN
Minute of Meeting of the Area Clinical Forum held
on Wednesday 26 October 2011 at 6.00pm
in the Conference Room, Summerfield House
Present
Mrs Linda Juroszek, Chair/Chair, Area Pharmaceutical Committee
Mr Malcolm McPherson, Chair, Area Optometric Committee
Mrs Lynn Morrison, Chair, Allied Health Professions
Mrs Jane Ormerod, Chair, GANMAC
Dr John Reid, Chair/Chair, Area Medical Committee
Mrs Jennie Tait, Chair, Area Healthcare Science Forum
By Invitation
Dr Roelf Dijkhuizen, Medical Director
Attending
Ms Heather Kelman, Lead General Manager, Change Fund – Reshaping Care for Older People
Mrs Linda Oldroyd, Nurse Consultant, Patient Safety and Patient Experience
Mrs Rosie Gauld, Administrator to the Professional Advisory Committees
No / Issue / Action1 / Chair’s Welcome
2 / Strategic Joint Strategies and Integration
Heather Kelman presented on Reshaping Care for Older People. The Policy goal was to optimise the independence of older people at home or in a homely setting.
The demographic change in the number of people over 75 would be significant, for example in Aberdeenshire the number of those over 75 would increase by 140%.
A logic model was tabled which highlighted 4 key themes:
- Preventative and Anticipatory Care
- Proactive Care and Support and Home
- Effective Care at times of Transition
- Hospital and Care Homes
The enablers around this were Technology, eHealth, Data sharing, Workforce Development , Skill mix and integrated working. NHSG had been allocated £6.73m for 2011/2012. This was divided across the 3 CHPs, each of which were developing their own projects.
This funding would continue until 2015 to facilitate integration of Health and Social Care. The government funding was available to redesign services and implement some preventative. The key strategies and reports that support this work were:
- Healthcare Quality strategy
- Living and Dying Well
- Caring Together
- Christie Commission- prevention and early intervention
- Integration of Health and Social Care
- National Housing Strategy
An important consideration was whether there was sufficient IT development around communication to support the changes in working practice. Mrs Juroszek stated that whilst there was a lot of good work ongoing, committees should be aware of the projects being undertaken and of any evaluations. There was a need to understand what this meant for the different professions, as it was clear different ways of working would be required in the future.
The recent AberdeenCity event around Redesign of Services for Older People had been well attended and very informative. It was suggested that a Newsletter may be helpful in sharing key strands of work.
Dr Dijkhuizen stated that at a City Redesign event there had been a presentation from AberdeenCity about health and exercise classes for those over 50 years of age, a good example of preventative working in partnership. GP clusters across Grampian were key to partnership working as they were able to identify the needs of their population.
In conclusion, it was felt that there was a need for a culture change about what people should expect from the NHS, eg enabling people to have as much control of their own health as they could, but remembering that the NHS was there for support.
3 / Better Together Survey
Mrs Linda Oldroyd introduced herself to members present. Her role sat within the Clinical Governance and Risk Management Unit and she managed the Feedback Service and was designated Bereavement Services Co-ordinator. Her presentation was to focus on the Better together and GP Surveys. A copy of her powerpoint presentation would be circulated. / LO/LJ
She explained that there was focus on three of the Quality Strategy dimensions – Patient Centred; Safe, and Effective, and went on to describe the work undertaken to date. The Better Together results were available on the website – Mrs Oldroyd tabled copies of a questionnaire entitled “Better Together – Patient Experience Survey.
Mrs Oldroyd advised that 4,000 patients had completed an in-patient survey and the Sectors had been asked to look at their bottom five results and form an Action Plan around these. Mental Health had been excluded but would be included in the intervening years.
Mrs Oldroyd then highlighted various aspects of the results from the survey and compared the results between this year and last year. For example, last year 17% felt they were not involved enough in decisions about care, and this year it was down to 13%. Discharge arrangements were being looked at.
It was noted Patient Centred developments in the NHS included patient experience walkrounds; patient experience web page; e-learning for patient centred care; customer care on induction; increased use of Better Together data, and Pledges/Promises work.
General discussion followed and Dr Khan stated that it would be interesting to know about the breakdown of complaints, and Mrs Oldroyd advised that the rate of complaints was higher amongst nursing staff which was expected since they made up a high percentage of the workforce. Medical staff were next, followed by AHPs. From the Datix recording of complaints, there was a mixture of inpatient complaints about the way they were treated, both by clinical and non-clinical staff. It was noted that each GP Practice submitted a report to the Feedback team on a monthly basis.
It was also noted that there had been a decline in the number of complaints about the domestic service and it was reassuring that a lot of work was being done.
An e-learning module had been developed to go with the PDP about patient centred care and patient experience, and the Pledges/Promises was part of that. It would be useful to have this included in all PDPs. Dr Khan intimated that questions regarding complaints were now included in consultant’s appraisal. General Managers had taken patient experience ideas on board and complaints are reviewed at their performance management team meetings.
Discussion concluded by Mrs Juroszek advising that a report on actions taken following the survey would be discussed at the next Clinical Governance committee and questions would also be asked at the Annual Review with regard to what improvements had been made as an organisation.
4 / Apologies
Ms Jenny Gibb, Dr Chris Provan and Mrs Elinor Smith.
5 / Minute of Meeting held on 31 August 2011
Copies of the Minute had been circulated previously with the agenda. Amendments were noted as follows:-
Page 7 – Item 10.5: Mrs Tait would e-mail Rosie Gauld an amendment
Page 8 – Item 10.6.2, second bullet point should read: There was no 24-hour, seven day a week on-call in Radiology Intervention.
Page 8 – Item 10.6.2.1, Second sentence delete One of the and change “managed” to carried out
6 / Matters Arising
6.1Monitoring of Drugs in Primary Care
It was noted that it was the responsibility of Consultants to decide whether a specific drug should be used, and if a shared care protocol was required, there was a process for this.
6.2Culling of Medical Records
Although this issue was minuted under the Mid-Staffordshire Report, that report referred to poor record-keeping which had led to serious circumstances, and was not related to culling of records.
It was noted that there were workload implications around the policy of culling paper medical records after six years. This issue had been discussed extensively in the past and it had been acknowledged, against clinical advice, records were being destroyed. There was a document which detailed all the guidelines as to what should be culled, and when, eg ECGs should be kept for 12 years, and blood transfusions for 30 years. Records could now be stored on Docman but the storage of paper records was impossible and there should be some way of annotating within the records that specific items had to be kept.
Dr Reid alluded to the fact that there were instances where GPs had to fax information to hospital medical staff as the relevant information required by the hospital had been destroyed. Dr Khan also stated that research would be impossible without the records. Dr Dijkhuizen suggested that the policy should be investigated.
An audit cycle nursing records has been established and has demonstrated improvement year on year.
A pilot audit of medical records within Mental Health has been done and there are plans to begin audits of medical records within ARI.
7 / Annual Review – 1 November 2011
It was confirmed that Dr Khan, Mrs Morrison and Mrs Ormerod would attend the annual review with Mrs Juroszek.
Mrs Juroszek had arranged a meeting with the Sharon Duncan, Chair Elect of GAPF as it will be a joint annual review. Mrs Juroszek asked members to feed back to her as soon as possible what areas they wished to be discussed and contribute to.
Dr Khan would speak to the issue of photocopying/copyright as there were huge concerns around this. Photocopying of journal is no longer allowed and although copies can be requested charges of up to £20 can be incurred. However, there was a willingness and understanding that articles were not being copied just for reading.
Mrs Juroszek would circulate her notes for comments and would meet with those attending the annual review at 8.00 am on Tuesday 1 November at Summerfield House. / LJ
8 / Achieving Sustainable Quality in Scotland’s Healthcare
This paper dated September 2011 had been produced by the Scottish Government, and the contents noted for information. Mrs Juroszek suggested that it be shared with the constituent advisory committees. / All
9 / Current Issues from the Advisory Committees:-
9.1AHPC
Lynn Morrison advised that:-
- In relation to the AHP review, the six AHP Sector Leads were being appointed, with the process being completed by Christmas.
- She had arranged a meeting with the Ehealth Manager to look at the Ehealth Strategy for AHPs to ensure that AHP needs were reflected in the NHSG strategy/ workplan
9.2AOC
Malcolm McPherson reported that:-
- A joint educational meeting with pharmacy and optometry, has been arranged, sponsored by NES
- On-going training planned for the Eye Health Network in foreign body removal and uveitis
Dr Dijkhuizen queried whether regular data was recorded with regard to patient satisfaction, critical incidents, morbidity as he felt that all services should keep this type of data; the way of working should be advertised to others and demonstrated how it was working and received; and any network would have complications which comes back to how it was managed and how it was dealt with. There had to be clinical evidence/clinical governance process around it. It was also important to record the normal activity as well.
Mr McPherson confirmed that Stephen McPherson and John Olson were involved in audits and Dr Dijkhuizen would contact them for further information. / RD
9.3 / APC
Linda Juroszek stated that a date has been agreed to discuss Dispensing doctors arrangements
9.4 / GANMAC
Nothing to report.
9.5 / Healthcare Science Forum
Jennie Tait reported that:-
- An important meeting on "Safe Accurate and Effective", the Scottish Government Action Plan (2007) for Healthcare Science with Dr David Stirling was taking place the following day, linked with Highland by video-conference.
- An AGM was taking place, and a Chair would be elected from the Physical side.
- With regard to waiting times, it was part of her remit to look at the breaches and patients waiting for more than four hours. A report had to be submitted to the Board on a daily basis.
AMC
9.6.1GP Sub-Committee
Dr John Reid reported that the following had been raised:-
- There were concerns about the Out of Hours changes. Three GP Sub-Committee representatives would be attending a meeting with GMED to discuss the issues
- Concern about the QIPP component of the contract
- Gold standard medicine
- Prescribing for the Eye Health Network was supported
- Contractual changes in next years QOF
9.6 / 9.6.2Consultants’ Sub-Committee
Dr Izhar Khan reported that the items raised had included:-
- IT update
- Introduction of Rotawath which would store all the rotas at one time in any given specialty
- Photocopying issues
10 / Chair’s Report
The Chair reported that she had attended the ACF Chairs meeting in Edinburgh at which Ann Wales, NES had given a presentation on Getting Knowledge into Action for Healthcare Quality.
She had also met with the Director of Nursing & Quality regarding the Clinical Champions Review, which was a work in progress.
She had met with the Clinical Psychologists and they were looking at forming a professional committee and are producing a Constitution.
The Health and Care Framework was now a much more detailed Action Plan which had been discussed at the last Board Meeting. Mrs Juroszek queried how delivering care more effectively and working differently could be communicated down the line, and asked for ideas.
The Executive Team had set up a Clinical OMT, Chaired by the Chief Operating Officer which had met for the first time earlier in the day. The focus was on quality and patient safety. There was an opportunity for the ACF to feed into the meeting and Mrs Juroszek would circulate the agenda in advance. There was good representation from all Sectors, but membership was large and this may prevent good discussion. Every second meeting of the OMT would be a Clinical one.
Terry O’Kelly had tabled the Consent Policy at the Clinical OMT where it was agreed this would be circulated via the advisory structure for information. The policy had been 4 years in the making and new forms have been ordered. Mr O’Kelly will be happy to receive comments once the forms had started being used. The consent forms could be used within both hospital and General Practices, and are available in both paper and electronic forms. It was highlighted that the correct use of consent documentation is key to protecting the professional.
11 / ACF Letter to the Board
Mrs Juroszek suggested that there should be a link around the Health and Care Framework and other Strategies and make messages to the workforce simpler. IT issues should also be raised.
However, it was felt that lack of support for IT was a resource issue and the Executive Team was mindful to reserve monies, on a non-recurring basis, for IT projects arising from the Health and Care Framework
12 / Reports
12.1 / eHealth Committee – No Minute
12.2 / Others
13 / Minutes
13.1 / OMT – Minutes of 29 June and 31 August 2011
ACF Constituent Committees
13.2 / Area Medical Committee – Minute of 6 June 2011
13.3 / Area Pharmaceutical Committee – 28 June 2011
13.4 / Area Optometric Committee – No Minute
13.5 / Allied Health Professionals Committee –Minute of 30 June 2011
13.6 / GANMAC – Minute of 12 July 2011
13.7 / Area Healthcare Science Forum – No Minute
13.8 / GP Sub Committee – Minute of 15 August 2011
13.9 / Consultants Sub Committee – Minutes of 11 August and 8 September 2011
The above Minutes were noted.
14 / Items for Noting
14.1Guidance for Health Care Staff within NHS Grampian on Working with the Pharmaceutical Industry and Suppliers of Prescribable Health Care Products
15 / Other Competent Business
15.1Role of the ACF
On behalf of the Consultants’ Sub-Committee, Dr Khan queried the role of the Area Clinical Forum and its relationship to the Board. He understood that the ACF Chair presented the views of the various professional advisory committees to the Board, rather than presenting the views of the Board to those committees.
Mrs Juroszek confirmed that her role was to convey the views of the advisory structure to the Board to assist them in making decisions. However, it was pointed out that there were instances when the advisory structure was not consulted, eg car parking, which had major implications across the areas.
Dr Khan asked for assurance that the ACF engaged with the business of the Board, and that advice generated by the advisory committees was presented to the Board.
In discussion that followed, Dr Dijkhuizen suggested that there was a need for a Management link to each of the constituent committees. It was noted that Dr Nick Fluck was the Management link with the Consultants’ Sub-Committee and GANMAC was represented by the Director of Nursing & Quality. People needed to know that there was an advisory structure and a management structure which were both different, and the committees had to be active and proactive in seeking advice.
Mrs Juroszek had a meeting with the Chief Executive the following day and would raise the issues discussed.
Copies of a paper prepared by Dr Dijkhuizen some time ago would be circulated . / RD
16 / Date of Next Meeting - 7 December 2011
1