NHS GRAMPIAN
Minute of Meeting of the Area Clinical Forum held
on Wednesday 27 October 2010 at 6.00pm
in the Conference Room, Summerfield House
PRESENT
Dr John Reid, Chair/Chair, Area Medical Committee
Mrs Linda Juroszek, Chair, Area Pharmaceutical Committee
Dr Izhar Khan, Chair, Consultants’ Sub-Committee
Mrs Lynn Morrison, Chair, Allied Health Professions
Mrs Jane Ormerod, Chair, GANMAC
Mrs Elizabeth Squires, Vice Chair, GANMAC
Mrs Jennie Tait, Chair, Healthcare Science Forum
BY INVITATION
Dr Roelf Dijkhuizen, Medical Director
Mrs Elinor Smith, Director of Nursing
Dr Lesley Wilkie, Director of Public Health – Item 2 only
IN ATTENDANCE
Mrs Rosie Gauld, Administrator to the Professional Advisory Committees
Ref / Item / Action1 / Chair’s Welcome
Dr Reid welcomed everyone to the meeting.
2 / Health and Care Framework Update
Copies of a paper entitled “Proposed Grampian Health and Care Framework” dated 24 September 2010 had been circulated previously with the agenda. The paper set out the rationale, scope and plans for the development of the Health and Care Framework.
Dr Wilkie was seeking to encourage all the various groups, including the advisory structure, to be involved in the process and highlighted the Desired Outcomes on page 2 of the document.
The High Level Plan for the Development of the Framework, as set out on page 7 of the document, was outlined by Dr Wilkie
Dr Wilkie asked the ACF to endorse the scope of work and to be involved in the process, either in their professional role or as a group.
Mrs Smith stated that the Quality Strategy should be embedded into the model.
Mrs Juroszek queried the involvement of pharmacy in the process and Dr Wilkie confirmed that pharmacy was a key component and there needed to be a piece of work modelled around pharmacy. Dr Dijkhuizen indicated that MCNs would make a contribution in terms of maintaining health, treating complex cases etc which would appear in the Framework, and pharmacy would be involved. Pharmacy would also be involved in terms of prescribing and the quality of prescribing, as would the GMMG. Dr Dijkhuizen also advised that CHPs had been creating Clusters to have a group of about 60,000 working together and he expected pharmacy to have made a contribution to that.
Dr Reid stated that there were two opportunities to input to the process – strategic level and criteria level. The ACF had to decide whether any of the members would wish to input to the strategic and/or criteria component and asked for names to be put forward if they wanted to be involved. Any volunteers were asked to let Rosie know by e-mail. Mrs Smith mentioned that Mr Graeme Smith, Planning Director would be writing out to all stakeholders as he and Lorraine Scott, Service Planning Lead, were leading the process.
Dr Wilkie left the meeting.
3 / Apologies
Dr David Fowler and Malcolm McPherson.
4 / Minute of Meeting held on 8 September 2010
Two amendments were made:-
(i)Under Present, Lynn Morrison should be recorded as Chair, not Vice chair
(ii)Mrs Juroszek submitted a written amendment to Item 5, which would be made to the Minute and the Minute circulated for final approval.
5 / Matters Arising
Nil.
6 / Role of Advisory Structure in Management Decisions affecting Clinical Service
Dr Khan reported that some concerns about the lack of engagement in clinical decisions had been raised at the last meeting of the Area Medical Committee. It had reached the stage that the officers of the Consultants’ Sub-Committee had considered resigning but had been persuaded by the members to continue in their role. Agenda setting meetings had been held but there had been lapses of attendance acknowledged by management colleagues.
Subsequent to that, discussion had taken place with the Chief Executive and Medical Director prior to this meeting of the ACF. The Consultants’ Sub Committee would continue to serve as an advisory committee and a proposal had been made that management colleagues would be assigned to attend the Sub-Committee. The Committee would continue in it’s role but be vigilant of lapses in clinical engagement. It was a work in progress.
Dr Dijkhuizen acknowledged that communication was often difficult and was a matter of discipline and goodwill. With regard to the advisory structure, Grampian had committed to support it and there were ideas how attendance could be ensured at agenda setting meetings.
Mrs Juroszek stated that there had to be the situation where the Directorate consults with the professions It could work provided there was free and forthright discussion. It was acknowledged that the Board would not always take the advice of the advisory structure but would not ignore it.
Mrs Morrison intimated that the AHPAC now had the Director of Nursing attending meetings, but did not hold agenda setting meetings. Mrs Smith had attended the last meeting where there had been lively discussion on various topics.
Mrs Tait advised that Dr Rick Herriot was aware of what was happening within the Healthcare Scientist Committee but did not attend. She explained that although medical scientists made up the main group, there were a lot of smaller groups within the profession.
Mrs Smith said that she was streamlining the groups she chaired, eg Nursing and Midwifery Strategy Forum and the Senior Nurses Group
Mrs Squires intimated that GANMAC had held an event earlier in the year around the role of the Committee and the next meeting in November would be a whiteboarding meeting.
Mrs Ormerod agreed that communication was really important and she needed to know what the Board expected of the advisory structures in terms of communication and how do the committees know what the Board wanted.
Dr Dijkhuizen advised that, following the meeting earlier with the Consultants, he wanted to explore with Board Members how they could be involved in the advisory structure. In the past, Board Members had been part of the meetings, and this needed to be looked at again.
Dr Reid concluded that committee meetings were only one way of engagement and there were a number of other ways of communicating, ie face to face; electronically.
7 / Annual Review, 8 November 2010
Dr Reid reported that he had not received any suggestions for topics to be discussed at the Annual Review. Therefore, he was in the process of preparing a paper including the following issues: Quality; Workforce; Austerity Measures; ACF development and local clinical leadership.
The ACF session was scheduled from 9 – 9.45 am in the Conference Room. However, the Board Members’ room was available from 8.00 am for prior discussion, if required.
Dr Reid had taken the agenda as proposed by the Scottish Government but had included local issues. In past years attempts had been made to have different members speaking on different items. In terms of the Quality Strategy, this linked in to the Health and Care Framework which the ACF had had an input to. Workforce would include what happened before and after the introduction of SANE/SAW; EPMMO austerity measures. It had been agreed with the Chairman and Chief Executive that Dr Reid submit an analysis of the net operative costs from 2000 – 2008 which showed that NHS Grampian had been underfunded for a long time, eg NHSG was 16% under the Scottish average. Mrs Juroszek queried whether there had been acceptance that Health Boards would have to disinvest in services. Also, because of funding pressures of Aberdeen Council, there were empty places in Nursing Homes, which resulted in delayed discharges from hospital.
Dr Khan intimated that the ability to appoint SPRs locally had been lost as the process had now been centralised. There had been a 40% reduction in the existing number of trainees and it had still to be worked out how that service gap could be filled. The EWTD was also a big challenge for the workforce and needed addressing.
Mrs Smith stated that across Scotland there were about 1000 new nursing graduates looking for employment. Grampian had been successful in recruiting newly trained nurses to care homes and GP Practices.
Dr Khan advised that during the night there was only one qualified nurse and one non-qualified nurse on duty covering a whole ward. To this end overnight dialysis had been withdrawn.
Confirmed as attending the Annual Review from the ACF were Dr Fowler, Dr Khan, Mrs Juroszek, Mrs Morrison, Mr McPherson and Dr Reid. Jane Ormerod expressed a wish to attend and Rosie would check whether this was possible.
8 / Current Issues from the Advisory Committees:-
8.1AHPC
Mrs Morrison reported that the last meeting had been held in September. There had been a Quality Strategy and NMAHP update by Elinor Smith, Director of Nursing. Stronger links were being developed with Mrs Smith and other executive teams. Feedback from members around SAW and AHP redesign. Still at the stage of formalising arrangements around the AHP Director post. Mrs Morrison and Jane Fletcher, Dietetic lead had taken on the role of NHSG lead for AHP eHealth work, eg PMS. The Health professions Council was carrying out a review of the health proficiency standards.
8.2 / AOC
Mr McPherson had submitted a Press Release, copies of which were tabled. The Press Release stated that new IT links between high street opticians and hospitals were set to be introduced across Scotland to improve services for patients. The system would enable optometrists to send images of patients who they suspect have serious eye problems directly to hospital eye doctors. The Consultant would then decide the
same day whether or not a patient needed a hospital appointment. It was expected to reduce the average time between patients going to an optometrist and being given a hospital eye service appointment from 15 to nine weeks.
Next week Mr McPherson would be attending the Labour Party Conference to try and lobby for the Labour Party to support Optometry Scotland.
8.3 / APC
Mrs Juroszek advised that there were IT issues with regard to the community pharmacy contract in relation to the Chronic Medication Service in that the transfer of information to GPs was not working.
The regulations regarding Control of Entry where new pharmacies want to open new premises had changed. The National Appeal Panel did not have to take patient information into consideration, whereas the Board did. A copy of the document was available on request to Rosie. It was suggested that the 2009 Regulations may be another issue raised at the Annual Review.
8.4 / GANMAC
Mrs Ormerod reported that the last meeting had been held on 14 September 2010 at which Helen Robbins had presented on the Quality Strategy and work around Better Together and the role of the Senior charge Nurse. This would be a standing item on the agenda.
The Constitution was being reviewed along with the membership. It had been agreed that the membership should include newly qualified staff; Mentor of the Year and Early Career Fellow. It had also been suggested that a member of the Staff side attend, and contact had been made with Gordon Stephen, Employee Director.
There was considerable concern around the SAW/SANE arrangements.
Mrs Ormerod advised that work was ongoing at the moment in terms of training, with colleagues from CSI and Governance. Sessions had been arranged for nurse managers/locality managers to support Senior Charge Nurses principally. The Quality Strategy was linked into that. Mrs Squires intimated that Sean Coady had incorporated the Framework into a pack for community nursing in Moray and was piloting the portfolio.
8.5 / Healthcare Science Forum
Jennie Tait reported that the next meeting was scheduled for 12 November. Alison Farrow had been appointed Healthcare Scientist Lead and would cover NHSG/Highland.
She had spoken to a member of staff in one of the smaller departments who had advised that they were to be receiving training to do very simple tasks, ie cardiac implants. However, this was now unlikely due to a member of staff leaving. Of 24 Biomedical Scientists trained, only two have been employed, none in Aberdeen. It was hoped to have a re-launch of healthcare scientist next year and get to know another profession.
8.6 / AMC
The main issues discussed at the meeting on 4 October 2010had been the Health and Care Framework and the Advisory Structure.
8.6.1GP Sub-Committee
There had been a short meeting on 25 October. The significant issue was the AberdeenHealthVillage in terms of funding. It would have a major financial impact on other developments and there were a number of conflicts in terms of the budgetary situation. New premises were costing 10 times more and there was likely to be a hit in the revenue budget of £2.6m from the health village which would take away resources for other developments.
8.6.2Consultants’ Sub-Committee
Dr khan reported that the meeting on 14 October had discussed the Advisory structure; PMS; short presentation by Prof Webster on the Consultant Award system; ECC was a standing agenda item. Mr Graeme Smith had invited colleagues to ECC site visits, and if any members of the ACF wished to attend, they should let Rosie know and arrangements would be made for a group visit.
9 / Chair’s Report
Dr Reid reported that discussion at the AIG meeting had included the capital plan which would be curtailed further. A letter would be issued later this month and it was suspected that all significant capital developments would now go through the Centre. This would impact on NHS Grampian in that all developments above £750k would go through the Hub process, ie using internal/external capital for developing premises. This would be discussed at the Board Seminar on 2 November 2010, as well as the HealthVillage in terms of the Business Case.
10 / ACF Letter to the Board
Copies of the letter dated 28 September 2010 had been circulated previously with the agenda.
Issues suggested for the next letter included a request for guidance from the Board as to what items would be relevant; Board Members’ engagement in the advisory structure; members of the advisory structure joining members of the Board.
11 / Reports
11.1 / eHealth Committee – No Minute
11.2 / Others
12 / Minutes
12.1 / OMT – No Minute
ACF Constituent Committees
12.2 / Area Medical Committee – 7 June and 2 August 2010
12.3 / Area Pharmaceutical Committee – 29 June 2010
12.4 / Area Optometric Committee – No Minute
12.5 / Allied Health Professionals Committee – 8 July 2010
12.6 / GANMAC – 13 July 2010
12.7 / Area Healthcare Science Forum – No Minute
12.8 / GP Sub Committee – 21 June and 16 August 2010
12.9 / Consultants Sub Committee – 12 August 2010
Copies of the above Minute were noted, having been previously circulated with the agenda.
13 / Items for Noting
Nil.
14 / Dates of ACF Meetings in 2011
Dates were noted as follows:
8 December 2010
23 February 2011
27 April
29 June
31 August
26 October
15 / Other Competent Business
Nil.
16 / Date of Next Meeting -
The next meeting had been arranged for Wednesday 8 December 2010 at 6.00 pm in the Conference Room, Summerfield House.
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