APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on Tuesday 1 August 2006 at 10.00am

in Committee Room 5, Woodhill House, Westburn Road, Aberdeen

Present

/

Mr Jim Royan

/ Chairman
Councillor Raymond Bisset / Non-Executive Board Member
Mrs Barbara Bruce / Non-Executive Board Member
Dr David Cameron / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Councillor Kate Dean / Non-Executive Board Member
Dr Roelf Dijkhuizen / Medical Director
Mr Alan Gall / Director of Finance
Mrs Judith Hendry / Non-Executive Board Member
Mrs Elizabeth McDade / Non-Executive Board Member
Councillor George McIntyre / Non-Executive Board Member
Professor Val Maehle / Non-Executive Board Member
Mrs Elinor Smith / Interim Director of Nursing
Mr Gordon Stephen / Non-Executive Board Member
Dr Stuart Watson / Non-Executive Board Member
By Invitation / Dr George Crooks / Director of Primary Care (item 9 )
Mrs Laura Gray / Director of Corporate Communications
Dr Helen Howie / Consultant in Public Health Medicine (item 6)
Ms Susan Jappy / Deputy Director of Public Health
Dr Robert Liddell / Clinical Lead, Aberdeenshire CHP (up to item 5)
Ms Jennifer Mack / Organisational Development Manager
Mr Ewan Robertson / Director of Performance Improvement/Board Secretary
Mr Jack Stuart / General Manager, Aberdeenshire CHP (up to item 5)
Mr David Sullivan / Director of Corporate Planning
Ms Elizabeth Taylor / Lead Nurse, Aberdeenshire CHP (up to item 5)
Dr Lesley Wilkie / Director of Public Health designate
Attending / Miss Lesley Hall / Assistant Board Secretary
Ms Glenys Wren / Personal Assistant, Board Secretariat
Item / Subject / Action
1. /

APOLOGIES

These were received from Ms Margaret Burns, Professor Neva Haites and Mr Tony Ward.
2. / CHAIRMAN’S WELCOME
The Chairman welcomed everyone to the meeting, explaining that this was a regular Board meeting held in public, not a public meeting, the main item of which was the Aberdeenshire Community Health Partnership’s Change and Innovation Plan. He welcomed members of the Scottish Health Council who were in attendance. He advised that a number of letters received in connection with the Aberdeenshire consultation had been tabled for Board Members that day. He also explained that prior to the meeting, Board Members had access to all the feedback from the consultation which included a DVD from Save Aboyne Maternity (SAM), a letter from Aberdeenshire Council, an email from Councillor Tait and a letter from SAM. For the benefit of members of public present, the Chairman introduced each member of the Board outlining their roles and responsibilities. He explained that the three Boards Members who were not in attendance had previously given their views to him on the various items of the agenda.
3. / MINUTE OF MEETING HELD ON 29 JUNE 2006
The minute was approved.
4. / MATTERS ARISING
There were no matters arising.
5. / THE CHANGE AND INNOVATION PROGRAMME
5.1The Aberdeenshire CHP Change & Innovation Plan: Older People’s Services, Diagnostic & Treatment Services and Maternity Services in Aberdeenshire – Report on Formal Consultation
5.2Supporting Information
Mr Carey introduced this item and welcomed those who had come to the meeting to listen to the debate. He explained the background of the consultation process, advising on specific issues addressed in the Supporting Information paper, which had been circulated prior to the meeting. He advised that the Aberdeenshire Community Health Partnership (CHP) had developed a series of proposals to redesign local services which had been subject to a consultation process for more than two and a half months. During that period, there had been a range of public meetings and documents produced with an opportunity for feedback on the proposals.
At its meeting on 4 April 2006, the Board had asked for the whole process to be reviewed by the Scottish Health Council, with a report to be available for the Board meeting on 6 June 2006. At the meeting on 6 June 2006, the Board had agreed to a six week consultation period from 7 June to 19 July 2006 and for the feedback from this formal consultation, together with all feedback received, to be submitted to the Board at its meeting today, to enable the Board to take a decision on the CHP’s recommendations.
The overview of the process was outlined in the report on the formal consultation prepared by the Director of Corporate Communications. As part of the process, there had been an event at Inverurie on 7 July 2006 which had been well received and comprehensive in engaging with stakeholders.
Mr Carey explained that all parts of the consultation process would be independently assessed by the Scottish Health Council who would report directly to the Minister for Health and Community Care. As Accountable Officer, he was satisfied that there had been a comprehensive and robust consultation on the redesign of Older People’s Services, Diagnostic and Treatment Services and Maternity Services. He highlighted some specific issues which had arisen from the process, including the importance of carers and the requirement to engage even more with them to provide support to this role. He pointed out that the importance of communicating effectively had been highlighted with a requirement to clarify that the proposals related to the proposed closure of the maternity part of Aboyne Hospital, not Aboyne Hospital itself. The process had also highlighted issues about choices and priorities and emphasised the need for change. In conclusion, he commended the consultation to the Board for noting and endorsement.
The Chairman also agreed that he was satisfied with the process that had been undertaken. He went on to outline some of the key issues in the CHP proposals which had been comprehensively developed, relating to enhanced Older People’s Services, reconfiguration of inpatient capacity at community hospitals and chronic disease management, Diagnostic and Treatment Services and Maternity Services. He reminded the Board that the proposals were designed as an overall package of care with a number of complex interdependencies. The Supporting Information paper outlined NHS Grampian’s investment plans as well as contentious resource shifts and financial implications of the proposals. He explained that resources related to available physical accommodation, staff and finances. He advised that staffing resources would be redirected to create capacity within the community midwifery service, shifting resource from under-utilised units to provide midwifery support for mothers in the community and particularly those who were socially disadvantaged.
With regard to feedback on services for older people, he explained that people generally wanted, as far as possible, to be in their own homes or supported in a community setting. The package of proposals suggested converting existing long stay beds into slow stream rehabilitation beds. With regard to Diagnostic and Treatment Services, with developments in technology, it was increasingly possible to provide services in local communities rather than having people travel to Aberdeen. The proposals were to move services and care to local communities where technology and resources would allow. He explained the specific issues relating to maternity services and why these proposals were contrary to the plans to devolve other services to communities. He informed members of the different issues relating to maternity services, explaining that the clinical sustainability of services in local communities was an issue because of midwifery cover out of hours and the restrictions under the European Working Time Directive. If staff were only dealing with a small number of deliveries, there was a risk of them becoming de-skilled. He explained that value for money was a factor and, although cost was not the main driver, he pointed out that it was a consideration and NHS Grampian had a responsibility to make the best use of taxpayers’ money and to use facilities and resources for priority services.
At this point the Chairman introduced Mr Sullivan, Dr Liddell, Mr Stuart and Ms Taylor and explained that the discussion around the proposals would be structured into three key themes:
  • Maternity Services
  • Older People’s Services
  • Diagnostic and Treatment Services
Maternity Services
Councillor Bisset explained that it was incumbent on him to refer to the Notice of Motion which had been passed by Aberdeenshire Council’s Vacation Committee. He explained that he had declared an interest at the Committee meeting because he had not wanted to compromise his own position as a Board member. The Notice of Motion took a holistic view of health service provision which acknowledged the importance of allowing freedom of choice. Mr Carey responded that the proposed services for older people and diagnostic and treatment services provided a developing agenda for expansion of choice, although he acknowledged that there would be a reduction in maternity care at community hospitals. This would allow opportunities, with the redeployment of resource, to give choices to other people. However complete freedom of choice was not possible. He suggested that the choices associated with intrapartum care be set against the choices made available by the redeployment of the midwifery resources. He confirmed that the Notice of Motion from the Council would go with all the other feedback to the Minister, whatever the decision of the Board.
Dr Dijkhuizen explained that the CHP’s proposals were in line with the Grampian Health Plan and also the NHS in Scotland’s “Delivering for Health” strategy for devolving services to communities wherever this could be done, provided they were safe, sustainable and of high quality.
Councillor Dean referred to a number of questions asked by users of Aboyne Maternity Services and whether answers had been prepared to address these questions. Ms Taylor responded that because of uncertainties over the maternity unit’s future, there had been difficulties in recruiting over the past few months. She advised that no women using the service there had been turned away. Those who had been clinically assessed as requiring hospital care had been provided with this service. She explained that because of the low levels of activity in the unit, it was difficult to maintain skills. To remain skilled in intrapartum care, midwives could spend time at Aberdeen Royal Infirmary or Dr Gray’s where there were sufficient deliveries to do so. With regard to skills for home births, MrsSmith explained that midwifery supervisors were responsible for planning workload accordingly. She explained that the proposals would allow enhanced antenatal and postnatal services and care. If midwives were not required to staff underutilised units when there were no women/patients there, resource could be redistributed to areas where there were fewer midwives than there should be. If the proposed changes were made, the CHP planned to improve breast feeding support, encourage smoking cessation in pregnant mothers, provide additional support for teenage pregnancies and substance misuse mothers, over and above what was currently provided. Mrs Smith explained that the vast majority of mothers travelled to ARI and Dr Gray’s for delivery and that care provided in community hospitals was generally for low risk women.
In response to a query about transfer rates, Mrs Smith explained that figures from Aboyne showed that of the women booked there, 30% were transferred elsewhere. She explained that there was a tendency to err on the side of caution to transfer earlier rather than later and with hindsight, some of the mothers could have stayed at Aboyne.
In response to a query from Mrs Hendry about how much consideration had been given to health inequalities, as areas of deprivation were more prevalent in the north rather than the south of Aberdeenshire, Mr Carey responded that this was a key consideration when planning changes. Targeting the socially disadvantaged and addressing health inequalities was a key strategic aim of the NHS in Scotland. The gap in health inequalities between wealthy and less well off was widening and the Board needed to look at how it used its resources to address these as they were very relevant to the proposals in the current CHP package of proposals.
With regard to adverse comments about the standards and occupancy levels at Aberdeen Maternity Hospital (AMH), since the consultation a number of improvements had started and would continue. For example, all ward sisters had undertaken or would undertake the Healthcare Acquired Infection Control course. In response to a comment that care at AMH was “hit and miss”, Mrs Smith explained that it was difficult to guarantee that standards of care were the same all the time. However, there were standards and protocols to which staff were expected to work, with systems in place for critical incidents to ensure care was of a high standard throughout the hospital, not only in maternity services. Mrs Bruce sought assurance that beds would not be closed until alternatives were in place. Aberdeenshire CHP gave assurance that new resources would be in place before any units were closed. Mrs Smith advised that the CHP was looking at implementing the proposals in a phased way. MrStuart explained that it was incumbent on managers to manage the change process and that clear plans would be drawn up to ensure this was done. He expected it would take at least six months for any changes to be implemented.
The Chairman highlighted that an important part of the consultation had been bringing to the Board’s attention the deficiencies in current service. This feedback allowed the Board to exercise its role in clinical effectiveness. He explained that the consultation had been an important learning exercise which should not be underestimated.
Older People’s Services
Professor Maehle expressed concern about phasing in and asked if there would be sufficient staff and carers to support the proposals. The Chairman reiterated there was a high level of anxiety on this issue. Dr Liddell responded that the proposals would be carried out in a phased way and there would be a continuation of the process that had been taking place through joint working with Aberdeenshire Council, to ensure capacity to cope in the future. He explained that in Central Buchan there were too many patients in long stay beds at Maud Hospital, which was no longer fit for purpose. The plan was to replace this hospital with a joint health and social care facility.
Councillor Bisset made reference to the transport issues, particularly for the elderly population. Mr Sullivan responded by referring to changing patient flows and the need to separate routine transport from emergency transport. He advised that a Regional Transport Partnership had been set up to look into issues throughout Grampian.
Mrs Bruce sought assurance that there would be sufficient support for people coming out of hospital and asked if there would be enough carers. Mrs McDade pointed out the distinction between carers who were paid for work and friends/family who were unpaid carers. She stressed that for elderly services particularly, many patients would come home to equally elderly people who were expected to look after them. The Scottish Health Executive Department (SEHD) required Health Boards to produce an information strategy for carers (i.e. unpaid carers) with a minimum requirement to provide information and training to people looking after others at home. The deadline for submission of the strategy was 31 December 2006. The Chairman advised that the Health Plan process, which was supported by the population, required to specifically highlight the issues surrounding carers.
Mr Stuart explained that carers and carer assessment, training and support were major national issues. He advised that traditional care arrangements were changing, with the number of patients in long stay elderly beds reducing. He advised that an important partner was the Voluntary Sector and there was a need for appropriate care packages to suit elderly people. He explained the underpinning principle was to prevent patients from going into hospital and to get them home as quickly as possible with appropriate support, as the longer patients remained in hospital, the longer their dependency.
The importance of patient choice was highlighted and Mr Stuart explained that what was proposed was a choice of treatment and diagnosis as close to home as possible, to give a choice about not going to Aberdeen for tests and improving choice for thousands of people.
Diagnostic and Treatment Services
The Board noted that this was a critical part of the package. By moving services from ARI to the community, some social problems and the dilemma of physically getting from elsewhere in Grampian to Aberdeen would be minimised.
Councillor Dean pointed out concerns about transport, advising that it was sometimes easier to get to Aberdeen than to other places within Aberdeenshire. Mr Sullivan confirmed that discussions were ongoing with the Scottish Ambulance Service, to enhance services and to separate the emergency transport service from patient transport service. He advised there was a major strategic issue in altering the way transport systems operated. Dr Liddell advised that sometimes it was difficult to cross Aberdeenshire, therefore networks of care would be designed along main transport routes. The focus was on diagnostic and treatment services rather than centres, to minimise unnecessary movement.