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MINUTE of MEETING of the AREA NURSING, MIDWIFERY and ALLIED HEALTH PROFESSIONS ADVISORYCOMMITTEE
Board Room, Assynt House,Inverness /
27 MAY2014–12.00pm
Present: / Dr Derek Brown(In the Chair)Dr Helen Bryers
Catriona Dreghorn
Sharron Humfrey
Stephen Loch
Kerrie MacLean
Gill MacNeill
Margaret MacRae
Heidi May
Iona McGauran (from 12.20pm)
Sarah McLeod
Evelyn Newman
Katherine Sutton
Mary Wilson (Videoconference)
Claire Wood
In Attendance: / Brian Mitchell, Board Committee Administrator
Susan MacGregor, Occupational Therapy Manager
1WELCOME AND APOLOGIES
Apologies werereceived from Diane Brawn, Mary Burnside, Elaine Dibden, Alison Hudson, Margaret Moss, Sarah Muir, Kate Patience-Quate, Joan Grant-Reid, Jocelyn Reid, Patricia Renfrew, Susan Russel, Susan Smith,Pat Tyrrell, Angela Watt, and Brenda Wilson.
2MINUTE OF MEETING HELD ON 25 MARCH 2014
The Committee Approved the Minute of the meeting held on 25 March 2014.
3MATTERS ARISING
3.1Commissioning of Adult Services
At their last meeting members had requested clarification as to the patient qualification age relating to Older Peoples’ Services. This was currently over-65s, as determined by Scottish Government Policy. It was noted the Head of Strategic Commissioning had offered to attend and present to a future meeting.
The Committee Noted the position.
3.2Attendance at Meetings – Review of Current Membership
It was noted this matter had now been discussed for a number of meetings. The current membership List required to be updated and it was noted a number of personnel and organisational changes would require to be reflected. One such change had been the introduction of Allied Health Professions Professional Networks, the Chairs of which should become members. Ms May again emphasised the need to try and engage front line staff with the Committee and urged shadow attendance where possible.
The Committee Agreed a formal proposal relating to revised membership be submitted to the next meeting.
4NHS BOARD MEETING –3 JUNE2014
The Committee was advised that there was to be held a meeting of the Area Clinical Forum (ACF) on 29 May 2014, prior to the meeting of the NHS Board to be held on 3 June 2014.
The Committee then considered the topics and circulated/tabled reports relating to the following NHS Board Meeting Agenda Items:
Item 4.1 Highland Quality Approach – Progress Report
It was noted the circulated report made reference to a proposal to develop a physician’s/staff compact, focused on values and behaviours. Discussion at a recent Highland Partnership Forum meeting had indicated this Compact was based on learning from elsewhere in relation to staff engagement and the decision had been taken to propose development of this initially for all trained hospital doctors. The adoption of a ‘Team Highland’ approach would take time to embed and there was a view that any Compact should relate to all staff groups. Ms May stated that learning to date in this area suggested that a targeted approach would be appropriate and this would, finally, be a decision for the NHS Board to make.
Item 5.2 Argyll & Bute Health and Social Care Partnership – Scope of Service
Members noted there had been an options appraisal and assessment exercise regarding the scope of NHS services to be delegated to the Integrated Partnership within a Body Corporate model. The outcome had been considered by the Argyll and Bute CHP Core Management Team and the Senior Executive Team, and presented to the NHS Board at its development session in May 2014. The NHS Board was to be formally recommended to agree Option 3 as the preferred model and this would relate to all NHS services in Argyll and Bute (all planning, delivery and commissioned services SLA) as well as Adult and Childrens’ services of Argyll and Bute Council.
It was noted there was concern relating to the implications of a Body Corporate approach to managing hospital services, Human Resources and relevant information sharing arrangements. Ms May emphasised that there were already strong integrated arrangements within the Argyll and Bute area. There was also concern expressed in relation to the proposed membership of the shadow Integration Board and in particular the lack of overall NMAHP representation. Ms May undertook to clarify what was involved in relation to the exclusion of the SLA for specialist services.
Item 5.3 Financial Position for 2013/14, and
Item 5.4 NHSH Revenue Budget 2014/15 - Update
It was noted NHS Highland, subject to audit, was to report anout-turn for 2013/14 of a £72,000 underspend. This was following agreement with Scottish Government for brokerage of £2.5m. The level of savings required for 2014/2015 would be in the region of £21m. In terms of Financial Plans for 2014/15 and beyond, Ms May advised Directors of Operations were fully engaged in developing Plans. There was agreement that system-wide working was required, with savings tackled in a ‘matrix’ approach, all in the context of the Improvement and Co-production Plan being presented to the NHS Board in August 2014. The savings programme would be overseen by a Programme Board, with focus on those elements that require working across several part of the organisation. There would be far-reaching change required whilst maintaining a focus on quality, within respective spend limits. The focus on quality to date was welcomed by members.
Item 5.8 Chief Executive’s and Directors’ Report
Members noted the report without comment.
5OCCUPATIONAL THERAPY SERVICE INTEGRATION
Ms MacGregor gave a presentation to the Committee on her research project “The Integration of Health and Social Care Occupational Therapy (OT) Provision: The Complexity of Change”. This was to be presented to the College of Occupational Therapists the following week. The aim of research in this area was to explore the outcome of a change management process to integrate Health and Social Care OT provision, with a view to informing future practice. The presentation went on to outline the reasons for integration of services, including the avoidance of duplication, and the application of appropriate Change Management process, this being similar to the Lean approach adopted by NHS Highland. There was a clear link between change management, stress and job satisfaction as outlined in a diagram illustrating the process of transition. Ms MacGregor highlighted the research questions asked, and the respective methodology and survey response rate and findings. Appropriate data analysis had led to identification of relevant barriers and critical success factors, as well as the effect of integration on Waiting Lists. There had been a series interviews undertaken with both Health and Social Care staff and these had raised a number of issues in relation to IPA Superordinate Themes of Communication and Professional Practice. There had been a view expressed that OT service provision could be diluted as result of integration and one Social Work staff member had said they felt “swallowed up by Health”. A number of recommendations emerging from the research were outlined and in conclusion it was stated the knowledge generated will help inform future OT practice and change management, address existing gaps in OT research and that shared learning had been identified as fundamental to the sustainability of integrated services.
There followed discussion, during which there was recognition that professional leadership would be key in ensuring successful service integration through among other things, fostering an integration culture. Overall the research findings provided learning for all managers and leaders involved in activity relating to integration and as such this would be shared with Chief Executive and other senior staff.
The Committee:
- Noted the presentation content.
- Thanked Ms MacGregor for sharing her research findings with members.
6NURSE DIRECTOR AND LEAD NMAHPs REPORT
6.1Safe Staffing for Nursing in Adult Inpatient Wards in Acute Hospitals
Ms May spoke to her circulated report relating to the Draft NICE Safe Staffing Guideline Consultation document, response in relation to which was to be submitted by 6 June 2014. The Draft Guideline made recommendations on safe staffing in adult inpatient wards in acute hospitals specifically and it was likely that future recommendations would be published addressing other areas/staff groups. NICE would offer a separate endorsement process to assess whether submitted toolkits for informing staff requirements comply with guideline recommendations and would award an endorsement mark, as a seal of approval, to toolkits which meet the criteria. This would have an impact on the NHS in Scotland. The view was expressed the draft document could be more comprehensive in relation to aspects concerning Allied Health Professions and ensuring an integrated community setting workforce. Members were invited to consider the guideline to ensure all relevant factors are addressed by the recommendations and that the guideline is practical to use.
The Committee:
- Noted the draft Safe Staffing Guideline Consultation document.
- Noted comments were to be submitted by 6 June 2014.
6.2NMAHP Quarterly Incident Report
Ms May spoke to her circulated report giving a summary of all NMAHP Incidents reported via DATIX from 1 April to 31 December 2013, with a view to identifying any trends or issues, and agree what action can be taken to reduce the risk of future incidents from taking place. These reports had previously been considered by the NMAHP Leadership Committee however would now be submitted to this Committee for consideration. The report outlinedthe summary of incidents within the reporting period, broken down into groups relating to Nursing, Midwifery and AHPs. The key areas highlighted had related to slips, trips and falls and disruptive, violent and aggressive behaviour.
During discussion, it was stated that staff availability remained an issue to be considered as did ensuring feedback on submitted DATIX reports. There was a suggestion that the guidance given to staff members in Argyll and Bute CHP in relation to completion of DATIX reports may vary from that adopted elsewhere within the organisation. Ms May emphasised that where an issue arose this should always be reported to enable appropriate investigation and subsequent shared learning.
The Committeeotherwise Noted the circulated NMAHP Quarterly Incident Report.
6.3Pressure Ulcer Prevention
There had been circulated update report in relation to Pressure Ulcer prevention, a key strand of the Older People in Hospital Standards. The circulated data related to Hospital Acquired Pressure Ulcers from 1 October to 31 December 2013. It was noted P Tyrrell, Lead Nurse for Argyll and Bute CHP would be invited to address the next meeting on this subject.
The Committee:
- Noted the circulated report.
- Noted P Tyrrell would be invited to address the next meeting.
Ms May and Mrs MacRae left the meeting at 1.40pm.
6.4MSK and Orthopaedic Quality Drive
Ms Sutton spoke to the circulated report which stated the MSK and Orthopaedic Quality Drive comprised five high impact workstreams as follows:
- AHP MSK Redesign
- Fracture Pathway Redesign
- Optimising Patient Recovery After Joint Replacement
- Hip Fracture Care Pathway
- Demand and Capacity Planning and Management
It was reported that to support governance and oversight of these five work strands an MSK and Orthopaedic Quality Drive Steering Group had been established. The Group was chaired by Associate Director for AHPs and met monthly to support driving the changes required to deliver whole scale system redesign and oversee the delivery of the metrics and outcomes of the Quality Drive. Implementation of the five work strands focuses work to address current capacity challenges within the Orthopaedic specialty and support geographical service access equality for all patients across the North Highland Health and Social Care Partnership area.
Ms Sutton highlighted that the high level of waiting times for Physiotherapy services in the community setting had an associated impact on the Waiting List for Orthopaedic services requiring whole system transformation relating to relevant pathways and GP referrals in particular. It was important to ensure the right resources were in the right place to meet demand, to become more patient-centred, and ensure appropriate patient triage. The report gave an update in relation to the AHP MSK Redesign workstream, this having been analysed using HQA methodology and which led to production of a service model to be implemented and progressed to support person-centred service delivery. The Musculo-Skeletal Advice and Triage Service (MATS) would be delivered through NHS24 as a route into the MSK and Orthopaedic pathway. Work by other early implementer sites had indicated this approach had reduced demand into Physiotherapy services by approximately 10%, by signposting patients towards self management where appropriate, subject to strict protocols. The report outlined a series of Physiotherapy waiting list pressures including appropriate utilisation of Advanced Practice Physiotherapists (APPs), eHealth and administrative requirements, and the need for development of MSK MDT through collaborative working and reshaping of patient pathways to more effectively meet patient need.
During discussion, the Chair advised he found the relevant Demand, Capacity, Activity and Queue (DCAQ) workshop enlightening and Ms Sutton advised that DCAQ training was being introduced for all relevant leaders. The test of change activity referenced in relation to Invergordon related to APP staff handling some patients that would previously have been referred to the Orthopaedic service. This had required elements of role development and improving the utilisation of existing resource. Overall the key was to accurately quantify levels of demand and take a multi-professional approach to service delivery that minimised duplication of effort and enabled resource to be released for appropriate patient care.
The CommitteeNoted the overall update in relation to the NHSH MSK and Orthopaedic Quality Drive.
7INTERNAL AUDIT – NMAHP MANDATORY TRAINING
There had been circulated report relating to an Internal Audit review originally undertaken in August 2012 relating to NMAHP compliance with Mandatory Training requirements as outlined within the NHS Highland prospectus. A re-audit of compliance levels had been undertaken and completed in April 2014, using a sample size of 10% of relevant staff. Results had indicated an overall compliance rate of 88% at that time and it was reported further work would be required with a view to meeting the target compliance rate of 95% in 2014/2015. Mr Loch stated there was a need, at that time, to further consider the existing range of required Mandatory training and suggested the Committee consider this aspect at their next meeting.
The Committee:
- Noted the current compliance rate in relation to NMAHP Mandatory Training.
- Noted the target compliance rate of 95% for 2014/15.
- Noted there was to be an annual review to monitor future compliance.
- Agreed regular updates are to be provided to this Committee and the Staff Governance Committee.
- Agreed there be a review of Mandatory Training requirements at the next meeting.
7FOR INFORMATION
7.1Draft Minute and Action Plan of Meeting of the Area Clinical Forum held on 27 March 2014
The Committee Noted the circulated draft Minute and Action Plan.
8AOCB
There were no matters discussed in relation to this Item.
9DATE OF NEXT MEETING
The next meeting of the Advisory Committee was scheduled to be held on Tuesday 5 August 2014 in the Board Room, Assynt House, Inverness at 12.00pm.
The meeting closed at 2.00 pm
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