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MINUTE of MEETING of the AREA NURSING, MIDWIFERY and ALLIED HEALTH PROFESSIONS ADVISORY COMMITTEE
Board Room, Assynt House,Inverness /
27 JANUARY 2015 – 12.30 pm
Present: / Dr Derek Brown (In the Chair)Dr Helen Bryers
Mary Burnside
Allan Gowie
Sandra Harrington
Alison Hudson
Stephen Loch
Margaret MacRae
Heidi May
Margaret Moss
Evelyn Newman
Susan Russel
Amanda Trafford
Beatrice Wood
In Attendance: / Brian Mitchell, Board Committee Administrator
1 WELCOME AND APOLOGIES
Apologies were received from Sharron Humfrey, Joanna Macdonald, Kerrie Maclean, Iona McGauran, Sarah McLeod, Sarah Muir, Susan Smith, Caroline Tait, Pat Tyrrell and Mary Wilson.
2 MINUTE OF MEETING HELD ON 25 NOVEMBER 2014
The Committee Approved the Minute and Action Plan of the meeting held on 25 November 2014.
3 MATTERS ARISING
3.1 NMAHP Advisory Committee Membership
At their meeting held on 25 November 2014 the Committee had agreed to a Test of Change in relation to establishing and adopting a Core Group.
The Chair advised that an initial test of this approach had produced encouraging results, with responses having been received in relation to a report that was due to be considered by the NHS Board in relation to the Highland position on the National Learning Disability Strategy. It was suggested that a further test of this approach be conducted prior to agreement this be adopted as standard practice. On the point raised, it was advised that individual Leads would have the discretion in relation to the dissemination/consultation approach adopted for their respective area.
After discussion, the Committee:
· Noted the encouraging results from the initial Test of Change approach.
· Agreed there be a further Test of Change in relation to the NHS Board paper on Principles for Delivering Out of Hours Unscheduled Care prior to agreement as standard practice.
4 REVIEW OF COMMITTEE TERMS OF REFERENCE
There had been circulated copy of the existing Committee Terms of Reference and members were advised that all Committees had been requested to review these, at this time, by the Board Secretary. The Chair advised that any changes to structure and membership of the Committee arising from previous and future decisions would require to be reflected accordingly. It was acknowledged there had been no agreement at this time to proceed formally with the Core Group approach previously suggested.
The Committee Agreed the existing Terms of Reference document be updated and circulated to members for comment.
5 NURSE DIRECTOR AND LEAD NMAHPs REPORT
5.1 Nursing & Midwifery Council Local Supervising Authority Reviews 2014-2015
The circulated report outlined the purpose of the Local Supervising Authority (LSA) review, which was to assess the function of the LSAs and verify that they are meeting the midwives rules and standards for supervision of midwives. Review also enabled the exploration of any issues or concerns that may have an impact on the safety and wellbeing of women and babies and to identify and note good practice. Overall the review had been positive in nature however reviewers had determined that the North of Scotland Consortium had not met the standards outlined in relation to standards 7 and 9. A draft report would be issued to LSAs for comment, the final version of which would be submitted to the NMC for publication. An action plan would also be developed to address the matters raised by the review, be notified to and ratified by the NMC, and taken forward through the NMAHP Leadership Committee.
5.2 Appointment of Deputy Director of Nursing and Midwifery
It was advised that Pat Tyrrell, Lead Nurse for Argyll and Bute CHP had been appointed to this role, with a start date in April 2015. Arrangements would be made in relation to appointing a replacement for the Argyll and Bute vacancy.
5.3 North of Scotland Major Trauma Rehabilitation and Repatriation Task and Finish Group (MTR&RG)
Margaret Moss, Group Lead, spoke to the circulated report and advised there was an initial intention to develop four Major Trauma Centres within Scotland in Edinburgh, Glasgow, Aberdeen and Tayside. Later review would determine whether that number could be reduced to one or two Centres if the four Centre model was not viable. It was confirmed that both Raigmore and Belford Hospitals would have a role to play in any future arrangements, initially linked to the Centre in Aberdeen. Several task and finish groups had been established to address all aspects of Major Trauma from post trauma pre-hospital care to discharge with ongoing support and care. MTR&RG had established North of Scotland Board membership, relevant Terms of Reference and key deliverables. Stated aim was to ‘ensure people who experience MT receive the care that they require throughout the rehabilitation process, from the right people at the right time and close to home as possible’. Clear, person-centred pathways and protocols would support rehabilitation from the earliest acute stage through to ongoing care and rehabilitation and eventual discharge. Ms Moss advised scoping work to date had indicated rehabilitation and repatriation pathways were patchy across North of Scotland Boards, with work required to map details of current service access. Pathway development would support person-centred, well coordinated care delivered as locally as possible. Need for repatriation and ongoing care/support with appropriate communication and funding structures for ongoing rehab. The expected impact of this activity included improved rehabilitation outcomes, reduced long term disability and improved quality of life with associated return to recreational activities and work. Next steps would include rehab service mapping and establishment of a multidisciplinary rehab/care pathway. There was an expectation that service improvements would be cost neutral.
On the point raised in relation to emergency retrieval, it was stated that this would relate to MT for adults and children however it was unknown if the same would apply in relation to neonatal cases and this would require to be clarified. On the question of a centralised approach being adopted it was advised that overall the aim would be to ensure patients were transferred to a Major Trauma Centre within a 45 minute timeframe and as such a number of issues would required to be considered at this time.
The Committee:
· Noted the activity being undertaken.
· Agreed that the position in relation to neonatal cases be clarified.
5.4 Seven Day Allied Health Profession Service
Amanda Trafford advised a workshop event had been held in December 2014 after which a draft Action Plan, as circulated, had been developed to support the roll out of the flexible, “Extended Services” across NHS Highland Operational Units. Key activity at this time would include establishing levels of demand for weekend and evening working and consideration of what services would be within service scope. Not all services were likely to be provided within all areas. Evidence showed that provision of an AHP front door approach would help to reduce levels of hospital admissions. It was noted that Staffside representatives were actively involved in speaking to relevant staff to help mange any concerns in relation to future service requirements and associated impact.
5.5 Vale of Leven Report
Heidi May advised the Vale of Leven report had been published in late 2014 and had included a total of 75 Recommendations for NHS Boards in Scotland in relation to Infection Prevention and Control. All NHS Boards had been instructed to conduct an appropriate Gap Analysis against the recommendations, the outcome of which was circulated, and these were due for submission on 19 January 2015. The Infection Prevention and Control Manager would now develop an appropriate Action Plan to address the identified gaps. This Action Plan would be agreed by the Control of Infection Committee, be sighted on by the Clinical Governance Committee, and supported by the Area Clinical Forum.
5.6 Introducing the New NHSH Adult Inpatient Nursing Assessment and Care Record
Alison Hudson advised that revised documentation was available to be ordered via PECOS and would be in use for all new admission across NHS Highland from 2 February 2015. She advised that this followed extensive development and testing of standardised documentation. There would be continued development of this documentation and this would be supported by a governance framework that would include an NHSH Adult In-Patient Nursing Documentation Policy. Relevant eHealth links had been established to seek relevant solutions. Work was underway in relation to a review of the existing array of ‘care bundles’ and risk assessment tools. Practice Education Facilitators were leading on training activity and this was aided by development of a FAQ sheet and Manager’s Briefing. She advised a further two phases of activity remained outstanding in relation to assessment, and care and comfort rounding with all activity due to be completed by July 2015.
Members were advised the Care Planning template related to both the short and longer term, with appropriate training being given. Key elements related to the ‘getting to know you’ and ‘Five Must Dos’ aspects that helped to inform development of associated Care Plans. Heidi May stated the recent OPAH visit had highlighted the importance of these aspects in terms of being able to appropriately evidence Care Planning activity. There had been a large amount of work undertaken by the team involved and NHS Highland was now helping to advise other NHS Boards undertaking similar activity.
5.7 Musculoskeletal (MSK) Redesign in NHS Highland
Heidi May advised Katherine Sutton was leading the redesign activity and that the objectives were to develop a first class user service that would provide clarity of access and information, thereby maximising clinical capacity by providing an appropriate booking hub that used standardised and consistent administrative processes and systems. This was dependent upon the implementation of the PMS system. The National MSK Advice and Triage Service would be implemented for MSK self-referral and would interface with the booking hub. Progress to date on the range of individual elements was outlined and it was reported that MATS went live across NHSH on 12 January 2015, with referrals clinically triaged and referred to local areas as an interim measure until the central hub was functional.
5.8 NHSH Internal Audit Report 2014/15 – NMAHP Registration
Heidi May advised a recent internal audit review had assessed the effectiveness of systems for ensuring all NMAHP staff were fully registered in line with requirements and registrations were reviewed annually. The associated report had concluded that good controls and processes were in place to ensure appropriate registration however some areas had been identified where the approved policy for monitoring registration was not being applied fully and consistently. The issues raised were to be discussed at the NMAHP Leadership Group.
5.9 NMAHP Complaints Report
There had been circulated NMAHP Complaints Report for the period from June to end October 2014. There had been no significant change in the number of complaints over that period, the majority of which had been graded ‘medium’. The three highest reported issues related to staff, treatment and environment. The report would be considered by the NMAHP Leadership Group where any relevant actions required would also be agreed.
5.10 Other Matters
Heidi May advised that matters relating to Revalidation and Supervision of Midwives would be brought to the next meeting.
Heidi May and Margaret Moss left the meeting at 1.30pm
6 NHS BOARD MEETING – 3 FERBRUARY 2015
The Committee was advised there was to be held a meeting of the Area Clinical Forum (ACF) on 29 January 2015, prior to the meeting of the NHS Board on 3 February 2015.
The Committee then considered the topics and circulated reports relating to the following NHS Board Meeting Agenda Items:
Item 4.2 NHS Scotland 2014 Staff Survey - NHS Highland Results
Those present noted the results had yet to be considered by the Staff Governance Committee and Highland Partnership Forum. Initial consideration of results showed these were positive although the overall level of engagement remained relatively low.
Item 4.4 Principles for Delivering Out of Hours Unscheduled Care
Members noted the report content and Alison Hudson advised much of the initial deliberations in this area had been in relation to the North & West Operational Unit and on using a multi-disciplinary model approach. She advised the potential Rural Support Team for the West coast included a range of doctors and other practitioners to ensure a sustainable service that was not always dependent on a doctor being present at any given time. Proposals were at an early stage and relevant governance arrangements would need to be clarified. One of the key aspects of such an approach would be the ability to be able to manage public expectation and any final agreement would take time to achieve. Members suggested incorporation of a mobile skills unit as a potentially beneficial approach. Members welcomed the report, which clearly outlined the innovative approaches being considered, utilising resources from the NHS, Voluntary, Independent and Third Sectors where appropriate. The issue of Maternity Services was raised and it was agreed that a request be made for inclusion of midwifery representation on the Out of Hours Task Group.
After discussion, the Committee:
· Noted and Welcomed the report and associated activity in this area.
· Agreed that a request be made for consideration of midwifery membership on the relevant Out of Hours Task Group.
· Agreed this report be utilised for the Test of Change approach referred to earlier on the Agenda.
Item 5.4 Chief Executive’s and Directors’ Report – Emerging Issues and Updates
Members noted the report contained an update in relation to Caithness General Hospital Surgical Services, which would likely have an associated impact on relevant Obstetric Services. The issue would be raised at the Area Clinical Forum.
7 FOR INFORMATION
7.1 Draft Minute and Action Plan of Meeting of the Area Clinical Forum held on 27 November 2014
The Committee Noted the circulated draft Minute and Action Plan.
8 AOCB
8.1 NMAHP Leadership Group
There was reference to the function of the NMAHP Leadership Group and whether there was a Terms of Reference agreed. It was advised the Minutes from the Group would be submitted to this Committee. Members stated they would like to better understand the links between the two respective fora.
The Committee Agreed the linkages between the two groups be clarified.
9 DATE OF NEXT MEETING
The next meeting of the Advisory Committee was scheduled to be held on Tuesday 7 April 2015 in the Board Room, Assynt House, Inverness at 12.30pm.
The meeting closed at 1.40 pm
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