APPROVED
MINUTE of MEETING of the ABERDEENSHIRE CHP COMMITTEE held on THURSDAY 22 JUNE 2011 in the CONFERENCE ROOM, PETERHEADACADEMY, PETERHEAD from1.30 – 4.00pm
PRESENT
Professor Val MaehleNon Executive Board Member (Chair)
Mr Sandy DustanCHP General Manager
Mr Mark McEwanCHP Planning Lead
Mr Mike OggLCHP General Manager
Ms Elizabeth TaylorCHP Lead Nurse Advisor
Ms Samantha MelroseCommunity Pharmacist / APC
Dr Jennifer HallCHP Public Health Lead
Cllr Bryan StuartInverurie & District
Cllr GurudeeSalujaChair, Social Work & Housing Committee
Ms Audrey FindlayPublic representative, SA LCHP
Cllr Karen Clark (Deputising Cllr Anne Robertson)
Cllr Joanna Strathdee (Deputising Cllr Alison Grant)
Dr Bob LiddellClinical Lead, CHP
Lesley MeldrumCorporate Communications, NHS Grampian
Cllr Richard StroudChair, Education & Recreation Committee
Ritchie JohnsonDirector of Housing & Social Care, Aberdeenshire LA
Cllr Ian TaitFraserburgh & District
IN ATTENDANCE
Christopher ThirdScottish Health Council
Pat Alexander PA to General Manager, Aberdeenshire CHP
General Manager, CALCHP
Item No / Topic / Action1 / APOLOGIES
Apologies were noted from Dr Chris Allan, Ewan Black, Fiona Francey, Dr Martin McCrone, Alastair Palin, Ian Powell, Janice Rollo, Shona Strachan, Maria Walker, Steve Wilkinson, Agnes Taylor, Reita Vilar, Cllr Marcus Humphrey, Cllr Alison Grant and Cllr Anne Robertson
2 / MINUTE
Minute of Meeting of the Aberdeenshire CHP Committee held on 9 March 2011 was submitted and subsequently approved.
3 / MATTERS ARISING
3.1Guide to Improving Health and Reducing Inequalities in Aberdeenshire 2011 - 2015
Jenny Hall requested the above be added to items discussed under matters arising.
It was noted in last minute that the above paper and guidance would be circulated over a six week period to Aberdeenshire Council, Community Planning Partners, Third Sector Groups, Community Councillors and Hi-net for comment. Closing dates for comments had been 28 March 2011 and were signed off by Cllr Anne Robertson. These will be circulated. Paper to be circulated with minute of June 2011 meeting.
In response to a query about how impact would be measured, Jenny Hall advised that the document is a Guide rather than a Plan and impact would be measured through workstreams.
Cllr Saluja advised that the Change Fund would assist with better health and would be shared between Local Authority and Health. It was agreed that Item 5 would be discussed in greater detail later in the agenda.
3.2Audit Scotland Report
The Audit Scotland Report about CHPs was noted and members agreed that it was balanced and fair and far less scathing than media reports had suggested. Aberdeenshire CHP had faired well in comparison to other CHPs and was at the top end of the scale for performance. It was agreed that all weaknesses noted did not apply across the board and those that did exist had evolved due to lack of teeth in the setting up of CHPs did not allow them to address issues effectively. The report did however highlight the lack of resource available to CHPs.
Mike Ogg reported that this was a generic report which noted Aberdeenshire’s high end performance indicators. Aberdeenshire CHP has recorded improvements with Delayed Discharges, Length of Stay and has revitalised the CommunityHospital to a greater extent than the report shows. Aberdeenshire CHP has accelerated the shift in balance of care by transferring more patients from Acute to the community hospital and providing more services in the community to enable people to be looked after at home for longer.
At the last meeting there had been discussion about themed workshops and it was agreed there would be 3 workshops delivered over the next 9 months.
This would provide an opportunity to address the findings of the Audit Scotland Report.
Agreed the Audit Scotland Report would be circulated with a comments requested within 4 weeks. / PA
3.3Themed Workshops
Following discussion the following order of the workshops was agreed
- Health &Care Framework
- CommunityAssetBuilding
- Social Care and Health Integration
3.3Induction Folder
Reita Vilar to update folder as requested at last meeting. Work is nearing completion and folders will be distributed as soon as they are completed. / RV
4 / HEALTH AND CARE FRAMEWORK / INVERURIE PATHFINDER
Mark McEwan reminded the Committee that the purpose of the Health and Care Famework is to provide greater detail and direction based on the strategy set out in the Grampian Health Plan 2010-2013. Part of this work involves pathfinder projects which have been chosen to look at different communities and services in detail in order to identify the health and care needs for specific groups. Inverurie is one of the pathfinder projects.
Further to submitted paper on the Inverurie Pathfinder a further summary paper was tabled. The Committee was requested to note the update paper on progress made to date. Discussion followed about the shift in the balance of care (SBC) from Acute to the Community and the proposed developments to the infrastructure in 6 key areas:
- Provision for general practice
- Provision of Diagnostic and Treatment Services (DTS)
- Provision of community based services
- Provision of in-patient beds
- Possible provision of a Community Midwifery Unit
- Old Age Psychiatry assessment beds – on or off site
A question and answer session followed.
Ritchie Johnson found the tabled paper about the Inverurie Pathfinder to be very helpful around the complexities of the Pathfinder in each location. He highlighted the Social Work connection around the emerging experiences of patients about the service underpinning all work in progress to ensure no unintended consequences occurred.
Mike Ogg emphasised the whole system approach of the Pathfinder. The Inverurie Project had spent considerable time analysing data and making projections for the future in order to enable future modelling of services. Originally it had been intended to include Ellon but existing behaviour was acknowledged and it was agreed that the Ellon population would naturally expect to use PeterheadCommunityHospital. Given that Westhill now falls within Garioch it had been agreed to factor in Westhill and remove Ellon from calculations to give a clearer,cleaneranalysis. Discussion followed around various issues associated with the Inverurie Pathfinder. It was noted that theHealthVillage in Frederick Street, Aberdeen will be used as a community hospital for the population of AberdeenCity. It was noted also that discussion has been focussed on areas of dense population. Howeverthe health needs for the dispersed population throughout Aberdeenshire also had to be addressed in a meaningful way. Mike Ogg agreed this point should be factored into discussions. He reported that a Mapping/Scoping Service, outwith National Bus Routes, is working to ensure remote areas will have the necessary access to Diagnostic and Treatment Services (DTS) in Aberdeenshire.
Discussion followed about the delivery of service in the community and the positive trend in changing public perception around the shift of services from acute to the community. An example of this was the Diabetes Service. A further example of a CHP initiative developed locally was a recent development at Peterhead. Dr Iain Small, with the COPD, MCN developed anticipatory models, anticipatory plans and treatment plans for patients with a high rate of admissions to ARI due to exacerbation of their COPD symptoms. However there was some concern that the ARI department was not fully signed up to the agenda.
Therewas an expectation that Health and Care Framework would address the problem and that quality would be increased by the locally responsive service. Sandy Dustan is to take this forward. Liz Taylor reported on changes to the nursing service and how these had proved to be very successful with many people avoiding excessive travelling time into Aberdeen. Ritchie Johnson highlighted that the necessary skill mix would be built up over time and the process would be managed beyond the Inverure Pathfinder to become Grampian wide. This will result in issues emerging and a better feel will be gained over time.
It was agreed that members would retain Health &Care Framework papers in readiness for the All Day Event to be held later in the year.
5 / CHANGE FUND
The high level plan will be submitted to the next meeting for discussion when the document will contain more detail to enable greater understanding and enable the Committee to develop a view.
It was noted that both NHS and Local Authority will have access to this resource. The home care service will be transformed and there will be a move towards agreed personal outcomes around ‘living at home’, OT and assessments towards development of plans. AHPs, Community Nurses and GPs will become a virtual team to provide a service in a joined up way that has not previously been achieved. Individual caseload will be reviewed on a regular basis.
Reports from other areas have highlighted that savings can be made by providing greater support for rehab and enablement creating greater independence for the individual.The report suggests that after one year these individuals require 50% less care by using workforce more effectively and efficiently and also this creates a much more sustainable workforce.
In response to a query from Cllr Clark about the financial resource required for changes made to homes to allow people to stay at home longer, Sandy advised that other strategies will tie in to prompt action to ensure independence.
Discussion followed about the training options for staff. It was noted that the Joint Improvement Team of the Scottish Government could introduce the Rehab/Enablement agenda through their mechanismsof sharing expertise.
Noted that the Aberdeenshire CHP High Level Plan for utilising the Change Fund had been submitted in December 2010 and had been Commended.
6 / INTEGRATED CHILDRENS’ SERVICE PLAN
6.1Getting it Right for Aberdeenshire’s Children 2011 – 2014
Ritchie Johnson reported the above paper had been well received by Council Committees and reinforced joint working of this full participative plan. The Plan reflects the emerging National agenda around priorities and not necessarily about Children with Needs but about all children. It is a comprehensive, straightforward document and the next step will be development of an Action Plan.
ValMaehle reported good progress has been made since the first inspection resulting in the second inspection in 2009 being much improved. The complexity and range of the organisation engaged with presented a huge challenge for joint working. Ritchie Johnson advised it had been not just doing the work but thinking about how to do itthat had improved working across boundaries and areas of challenge. Audrey Findlay felt the Report had been wide ranging in broad brush terms concerning complex issues.
Ritchie Johnson to forward a two page summary of the paper which he felt would be useful to members.
- Aberdeenshire CHP Committee endorsed the paper and agreed with updates on pages 23 / 35.
- Agreed summary would be useful with listed / signposted pages.
- Agreed paper to be forwarded to Community Planning Board
RJ
6.2Services Protecting Children and Young People in Aberdeenshire
LizTaylor reassured the Committee that work continues to develop around the outcomes from the 2007/9 inspection. New inspection arrangements will be in place next year and will be brought forward by a multi-agency which will be beneficial to the inspection. AberdeenCity and HIME inspection have had good reports and Aberdeenshire has been strong, embedding clinical practice throughout the organisation. The new method of inspection will be themed throughout the whole system focussing on childrens’ respective needs eg substance misuse service focussed around the child. There has been discussion around Aberdeenshire being a pilot area for the new arrangements.
Discussion followed about the difference between the old and new arrangements. Noted that the old was very inspectoral in style whereas the new is more about engaging with a change in relationship which is an ongoing and improving process supporting the service over time. Although focus is still accountability there is a better balance.
In December 2009 inspectors made the following recommendations for services to protect children in Aberdeenshire:
- Strengthen approaches to confirming the quality of services and staff performance, in order to achieve more consistent outcomes for children and families.
- Involve children, families and frontline staff more fully in reviewing the effectiveness of services.
- Continue to strengthen ways of ensuring children's health needs are considered fully when investigating concerns. Alongside these specific recommendations, the QI Group will continue to be active in improving and ensuring the scrutiny of additional areas of child protection activity.
7 / MATERNITY STRATEGY
Sandy Dustan highlighted the question of timing around the development of papers in advance of submission for approval to the CHP Committee prior to going to the NHS Grampian Board. Committee dates to be observed before papers submitted for approval.
Discussion followed about community midwifery units fitting with current arrangements and staffing a 24 hour unit given the difficulty in recruiting and operational issues.
Audrey endorsed the need for the CHP loop in advance of submitting papers to the Board and indicated Aberdeen City CHP did operate differently. It was agreed that this blank spot needs to be addressed as sequence of events is being missed.
An Aberdeenshire consultation around the proposed changes will evidence support and the paper submitted to the Board will be more refined than the seminar. Further consultation will decide what an appropriate strategy is. GP and public representation will be sought.
8 / PERFORMANCE MANAGEMENT REPORT ITEMS
Noted that Val Maehle to provide feedback on areas of discussion at the CHP Committee to the Performance Committee and that Mark McEwan compiles the report.
It was agreed the report would include the following areas of discussion:
- Health & Care Framework
- NHS / LA
- Application Model funding across Aberdeenshire / Grampian
- Change Fund – including the 3rd Sector
- Greater use of Community Planning
- Integrated Children Planning (Vulnerable Children)
- Synopsis paper re CHP/NHSG influencing decisions
- Process dealing with meetings – highlight issues
9 / INTRODUCTION OF THE HOTSPOT AND THE SOCIAL AUDIT
Due to unforeseen difficulties there was no introduction at the meeting and members made their way to the Hotspot.
10 / AOCB
11 / DATE OF NEXT MEETING
- Wednesday 14 September 2011
- Wednesday 14 December 2011
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