1
APPROVED
MINUTE OF THE MORAY COMMUNITY HEALTH AND SOCIAL CARE PARTNERSHIP
FRIDAY 19 March 2010
Spynie Dental Centre, Elgin
Present
Mr C Muir (Chair)NHS Grampian
Mr Lloyd Griffiths, OpticianNHS Grampian
Mr Gordon Smart, General Dental PractitionerNHS Grampian
Mr A Fowlie, General Manager MCHSCP
Dr J Hogg, Clinical LeadMCHSCP
Mrs J Mackie, Acting Head of Community CareMCHSCP
Mr Mike Perera, Integrated Mental Health Services ManagerMCHSCP
Mr Bob Sivewright, Finance ManagerMCHSCP
Mr S Coady, LSM – NursingMCHSCP
Mrs T Gervaise, Public Health LeadMCHSCP
Mrs Elaine Brown, Service Planning LeadMCHSCP
Ms Ann Cheyne, Community Learning Disability TeamMCHSCP
Mrs S Bruce, Community RepresentativeMCHSCP
Ms B Aitken, Endoscopy Nurse PractitionerMCHSCP
Mrs E Bush, Director MVSOMCHSCP
Ms D Bosworth, Finance OfficerThe Moray Council
Anne Slee, Integrated Learning Disabilities ManagerThe Moray Council
Councillor Lee BellThe Moray Council
Councillor John SharpThe Moray Council
Councillor Anne McKayThe Moray Council
Councillor A MacdonaldThe Moray Council
In Attendance
Mr K Hamilton, Business Manager; Philip Shipman, HR Manager; Liz Tait, Clinical Governance Coordinator; Marka Rifat, Senior Communications Officer; Hazel Lawson, Northern Scot Reporterand Isla Whyte, Minuting Secretary.
Apologies
Apologies for absence were intimated on behalf of;Ms Gillian Grant, Pharmacist; Mrs Issie Graham, LSM – Acute; Miss P Freeland, Community Representative; Mr R Donald, Acting Head of Educational Support; Mr S Riddell, Director of Community Services; Mrs Sally Chisholm, Head of Community Care; Ms Helen Milnes, Interim Chief Officer; John Carney, Chief Social Work Officer and Councillor R Shepherd.
- Welcome
The Chair welcomed members to the meeting and advised the Committee that Appendix 2 (Part B titled Moray Community Nursing Strategy) was to be withdrawn from the papers. The Chair collected all copies of the withdrawn paper.
- Minute of the Moray Community Health and Social Care Partnership Dated
11 December 2009
Item 4 (Finance) was amended to readthat OT service for The Moray Council is showing an underspend of £0.046m and not £0.221m as stated.
The Minute of the meeting of the Moray Community Health and Social Care Partnership dated 11 December 2009 was then approved as an accurate record of the meeting.
- Matters Arising
There were no matters arising.
- Performance
Please see the attached balanced scorecard and traffic light system. This is used to assess health and social care service performance against 12 objectives and highlight risks to be addressed. The 12 objectives were reviewed in line with NHS Grampian, The Moray Council objectives and the Single Outcome Agreement.
Better CareWithout Delay
This area is currently assessed as a red risk. At the end of this month MCHSCP anticipate meeting all Scottish Government access targets – Andrew intimated his congratulations to staff across Moray. Current pressure in ENT where additional outpatient and theatre sessions are required to meet all the demand. There is increased demand for Ophthalmology; recently employed an optometrist and community work has increased. Chronic pain clinic will provide extra sessions for Moray – a North of Scotland approach is required to deal with this demand long term. Dental services in secondary care – lack of service availability currently at Dr Gray’s Hospital and therefore services are being provided by ARI – unable to appoint to Inverness post so far (which would cover Elgin). Scottish Government is reducing waiting times target from 12 weeks to 9 weeksfor orthopaedics.
Commissioning Services
Andrew reported positively that MCHSCP are commissioning a whole range of services to meet the needs of the Moray population. GPs and Pharmacistsare carrying out Alcohol Brief Interventions. Home Care – on target to re-commission tender service.
Intermediate Care
A&E 4 hour target means that patients will wait a maximum time of 4 hours from presenting at Dr Gray’s Hospital to a medical plan being put in place. Building works (refurbishment of wards) caused a dip in performance. Wards are now open and 100% 4hr target achieved. Assessment for older people – reconsideration for older people eligibility criteria, Scottish Government guidance will be sent out for next financial year.
Long Term Conditions
Substantive item on today’s agenda called Shifting the Balance of Care where a discussion on the management of those with a Long Term Condition will take place and how the MCHSCP will accelerate the pace of change.
Health Improvement and Health Inequalities
Report improvement. Looking at how to penetrate community further in terms of improving the health of the Moray population – further discussion to take place under Item 6 Shifting the Balance of Care.
Finance
Overspend projected for end of financial year. Shifting the Balance of Care agenda will be vital in improving the financial situation. Andrew confirmed there will be no immediate change for the public. MCHSCP need to become more efficient; around sickness absence levels and use of locums etc. The effects of the recession are still unknown, preparation for this is required and the Shifting the Balance of Care agenda / funding of public services will run together. Jane advised the Committee that Social Care is looking to role out enabling services across Moray, see the establishment of new home care providers and development in conjunction with partners in Hanover housing. These projects will be able to move at a quicker pace as financial situation is better than that of the NHS.
Strategic Workforce / Organisational Development
Progressing well on the whole, however, sickness absence rates are higher than they should be in some areas. Main pressure across health and care services is that change is required rapidly.
Patient and Service User Safety
Successful visit from Scottish Government’s Patient Safety Programme, held in the Eight Acres Hotel in January 2010. Favourable feedback was given to the MCHSCP’s approach to make services safer for patients. SPSP (Scottish Patient Safety Programme) initiative is to improve health care processes to ensure patient safety ie checking patients receive correct medication by ensuring nurses are not interrupted during drug rounds. Senior Charge Nurses carry out regular safety briefings with staff. A nurse facilitator has been appointed.
The MCHSCP Committee noted Cllr Bells recognition and thanks to staff for their hard work during the Cdiff outbreak at Dr Gray’s Hospital. Andrew also informed the Committee that health and care services have had to contend with a high volume of the publicpresenting athospital or primary care provider in relation to H1N1or broken bones this Winter; throughout all this levels of infection have continued to drop.
Infrastructure
There is a delay in agreeing the capital allocations from the Scottish Government to NHSG. The Scottish Government sought a reduction across health boards this year therefore NHSG has had to re-look at capital allocations. Awaiting outcome of that process which will determine timescales of ForresHospital and HealthCentre and funding for Life Science Centre in Elgin. Hope to have a decision on the Life Science Centre by the end of April as ERDF require to know by then as well.
Involving the Public and Improving the Patient and Service User Experience
There is good involvement from the public in health and care services. An Older People’s Focus Group has been set up.
Child Health
Steady progress is being made. Further discussion to take place later in the agenda - Item 7.
Mental Health
Key areas of work are depression, dementia, suicide, alcohol and drug use – steady progress is being made. Ministerial launch seminar and exhibition for tackling substance misuse in Moray to take place on 26th April.
- Joint Health Protection Plan
Tracey Gervaise, Public Health Lead, presented the Joint Health Protection Plan 2010-2012 to the MCHSCP Committee. The Committee note the contents of the report and support further development and work in this area.
- Shifting the Balance of Care
Shifting the Balance of Care brings together the majority of the work that the MCHSCP does. The demand of health and care services is growing with demographic changes having an impact on resource utilisation. It is estimated that those with a Long Term Conditions account for 80% of all GP consultations. MCHSCP is looking to move more towards planned work and make the public aware/support the public to look after themselves. MCHSCP view those who are aged 75+ as bigger users of services. Demographic changes lead to a different way of working.
The Shifting the Balance of Care Work Plan for 2010/11 is set out in attached paper – this paper is a starter for 10 to get people thinking about how health care services will work in the future. This is not just about the financial situation, the MCHSCP want to see how services can work best for the public. Local knowledge is required to ensure that those who are at high risk of an acute admission are given resources they require immediately. Would like to have more focus on patient groups / learning centres /clinics in the community / self care and telehealth care. Admissions to Dr Gray’s with diabetes as primary cause are low as there is lots of support in the community for those with diabetes in Moray.
Patient Learning Centres in Moray – core aims are to empower patients and families to make informed decisions around their care, support patients to be knowledgeable and actively involved in their treatment / care plan and aid the MCHSCP to deliver against HEAT targets. Patient Learning Centres have worked effectively in areas of America, Canada and Scandinavia. The Committee confirmed that theysupport the proposal for new ways of working.
Changing Our Working Livesstrategic plan went to Health and Social Care Committee last year. Role of Social Work is to create a more able group of people to carry out work – capacity building for individuals or groups of people. This paper describes how we can start to work differently, it is an opportunity to work with staff, create dialogue and focus on what they can do. Page 5 of the document lays out the strategic objectives/ priorities for change and development. Organisational structure may inhibit changes. Once staff are engaged may well be able to engage success with others.
Shifting the Balance of Care needs to take all these parts in put them together. AMAU (Acute Medical Assessment Unit) has now opened at Dr Gray’s Hospital–patients can get an acute medical diagnosis and assessment right there are then; then either have care plan put in place and sent home or are admitted.
Nationally community nursing requires to be modernised. The Review of Nursing in the Community in Scotland (Scottish Executive 2006) recommends the model of a generic community health nurse to replace the role of the district nursing and health visiting. However, Moray is supported in taking forward a different strategy. The district nurses looked at skill mix, current work load, challenges and pressures,thenfrom the outcome Sean Coady and the Area Operations Managers developed a strategy – it will keep generic workforce but develop specialist teams. This links with the Shifting the Balance of Care agenda. Community nursing teams are in support.
Point 8 of the Shifting the Balance of Care paper summarises the key themes / key areasfor change. The CHSCP Committee agree to accelerate this piece of work and note contents of report.
- Child Protection – Moray Progress Update
Follow through inspection will take place week commencing 7 June 2010 and initial feedback will be given on Friday 11 June. The self evaluation report has been submitted. There are six main areas which HMIe will enquire about – these are listed in the attached report. There is also likely to be a focus on areas of national interest - the Chair asked if the Committee can take assurance that there will be leadership in Moray for these areas. Andrew advised that the MCOG which has representation from senior education, police, social work and health care officials have responsibility for attaining standards in child protection. Risk assessments for every child are carried out where there may be a child at risk. MorayInter-agency child protection IRD (Initial Referral Discussion) procedures are in place. Need to find more mechanisms to ensure that MCOG know all of the time that improvements are being made.
- HEI Update
A visit by the Healthcare Environment Inspectoratewill take place at Dr Gray’s Hospital on 7th and 8th April 2010. Liz Tait, Clinical Governance Coordinator, is leading on development for visit. There will be 5 inspectors who will walkround the whole hospital then concentrate on inspecting 4 wards and engage with staff.
Dr Gray’s Hospital has introduced MRSA screening for all planned admissions, the prescribing of drugs that can induce infection have improved greatly; now have 90% compliance. Hospitalsarecleaner and regularly audited. Staff leadership is in place with Senior Charge Nurses ensuring cleanliness on their ward. Infection trends are monitored regularly and are showing a continued reduction. Money has been spent on improving hospital environments ie new sinks,beds spaced further apart, single bed areas. Inpatient environment for Moray has greatly improved. Wards 9 and 10 have recently opened with increased bed spacing and new sinks etc. Senior Managers and Committee members have been assisting in auditing areas of Dr Gray’s Hospital and the wider community over recent months using HEI inspection tools in preparation for the visit.
- AOCB
Cllr Sharp received an email from Richard Donald asking for an update on children with diabetes / use of insulin in schools. Sean Coady advised he contacted Richard a few weeks ago to discuss education responsibilities around this. Jim Gibson, who works with Richard, has been tasked with sourcing models that are in place around Scotland. At present children are receiving the care they require - Diabetes Specialist Nurse carries out assessment of child, parents will support if insulin throughout day is required, if this is not possible they will have the support of the DN team. Until a sustainable model is put in place current processes should remain. Update will be given at the next meeting.
- Items for Noting
The Moray CHSCP Committee noted the Performance Governance Committee minute from 22 September2009 and the Healthier Strategic Group minute of 22 October 2009.
- Date of Next Meeting
The next meeting of the Moray CHSCP Committee will take place on 18th June 2010, 10:00am, Meeting Room, Spynie Dental Centre, Elgin.
1