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MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE
Board Room, Assynt House, Inverness /8 JULY 2008 – 11.05 am
Present: / Peter Cartwright (In the Chair)Doreen Bell
Mary Burnside
Kath Clarke
Rachel Duncan
Kathryn Hamling
Nigel Hobson
Veronica Kennedy
Chrissie Lane
Jennifer Lobban
Una Lyon
Jenny MacGregor
Margaret MacRae
Heidi May
Iona McGauran
Lorraine Mckee
Ruth Miller
Helen Morrison
Patricia Morrison
Joan Philip
Pat Tyrrell
Marjory Urquhart
Angela Watt
Eric Wiseman
Sandie Young
Also Present: / Frances Hines, Research and Development Manager
In Attendance: / Brian Mitchell, Board Committee Administrator
Joan Grant
1 / WELCOME AND APOLOGIES
Apologies were received from Alan Caswell, Lynn Chalmers, Pam Garbe, Jonathan Gray, Laura Greenshields, Hilda Hope, Alison Hudson, Trisha Kelly, Alison MacLean, Gillian MacNeill, Liz McClurg, Paula McCormack, Sarah McLeod, Fiona Sharples, Helen Tissington, Mary Vance, Elizabeth Watson, Mhairi Will, Isobel Woods, and Catherine Zawalnyski.
2 / MINUTE OF MEETING OF 8 APRIL 2008
The Committee Approved the Minute of meeting held on 10 June 2008.
3 / MATTERS ARISING
3.1 Appointment of Representative to Area Clinical Forum
Ms May advised that she had written to members seeking an additional representative to sit on the Area Clinical Forum, from this Committee. This represented an excellent opportunity to influence clinical decision making within NHS Highland. Chrissie Lane expressed an interest on taking on the role.
The Committee:
· Noted the interest expressed by Chrissie Lane.
· Noted that Ms May and Mrs Lane would meet to further discuss the position.
3.2 NMAHP Strategy
Ms May advised that there had been an appreciation by the NHS Board of the range of activity undertaken by Nursing, Midwifery and AHP staff and it was important that staff at service level be aware that this was the case. There was now work underway to identify Lead Professionals for specific areas of work, much of which was underway, and the document would be brought back to the Committee for further discussion.
The Committee:
· Noted the position.
· Noted the Strategy would be submitted to the next meeting for further discussion.
3.3 Clyde Maternity Services
Pat Tyrrell advised that the closing date consultation was Friday 4 July 2008, and that a response from NHS Highland had been submitted, favouring Option 2.
The Committee Noted the position.
4 / HAND HYGIENE AUDITS
Ms May spoke to the circulated report, indicating that at May 2008 the compliance rate for NHS Highland was 93%. Whilst this was a positive audit much work remained to be done to ensure all staff/teams are properly trained and performing consistently to a high standard. The report detailed a breakdown of performance from the main staff groups. It was reported that in response to the initial audit results a Hand Hygiene Action Plan had been developed, supported by CHP Implementation Plans, and actions included targeted intensive training and re-auditing of those areas identified as non-compliant, Charge Nurses/ Sisters developing and being accountable for individual ward hand hygiene action plans and implementation of regular audits, meetings with Clinical Directors and Lead Nurses to ensure priority status for hand hygiene, appointment of Lead Nurses as local leads for infection control, display of awareness material, and progress toward provision of additional hand hygiene trainers. The key areas of future activity would be the continuation of training for all staff, provision of training in the Audit Tool to ensure all areas have one or more trained auditors, development of a rolling audit programme across all wards and teams, and enhancement of the awareness of all staff/patients/public to undertake hand hygiene on entering and leaving ward/clinical areas. Ms May thanked those present for their work in this area and advised that the most recent National Report had indicated that NHS Highland was performing well. The next audit was to take place in August 2008 and the target for November 2008 was 90% compliance. Pat Tyrrell advised that an appointment had now been made to the 0.5wte post in Argyll and Bute CHP.
With regard to Clostridium difficile (C.diff), Ms May advised that a recent report had shown that the national position was not improving and that the rate in NHS Highland was the only one that showed improvement since the last report. It had been felt that Hand Hygiene Technique training and changes in prescribing had been beneficial in this regard. A draft C.diff Action Plan had been published and was being considered.
With regard to MRSA infection, NHS Highland had maintained a stable, low rate since 2003 although the recent HEAT target had sought a reduction of 30% by 2010. Ms May advised that it would be difficult to meet this target. The relevant Action Group was to encompass matters relating to MRSA and SSSA and Dr Andrew Hay would be contacted regarding the date of the next meeting, at which a draft Action Plan would be considered. There was a need for staff to be aware of all patients with MRSA, how this had been contracted, and the availability and occupation of isolation wards. Moving forward CHPs and Raigmore would be asked to prepare relevant Action Plans and, therefore, work in this area should be commenced.
The Committee:
· Noted the results from the Hand Hygiene Audit Summary.
· Agreed to support the development and implementation of Hand Hygiene Action Plans.
· Agreed to support the implementation of a rolling Hand Hygiene Audit programme throughout NHS Highland.
· Noted the position in relation to C.diff and MRSA.
5 / REVIEW OF NURSING IN THE COMMUNITY IMPLEMENTATION
Ms May spoke to the circulated Implementation Plan, which had been agreed by the NHS Board at their meeting held on 3 June 2008. The project was moving to the stage of development of the overall model and as such impact etc would need to be considered. CHPs would be required to sign-off relevant Local Implementation Plans. Ms May also advised that she acted as Chair of the Review of Nursing in the Community Steering Group.
There had also been circulated paper incorporating the relevant update information that was to be published in the next issue of the Team Update Staff Notice and this included AFC Banding, KSF Outlines, Education, Evaluation arrangements, information on Patient Information Leaflets, and relevant forthcoming events.
The Committee Noted the position.
6 / GIRFEC
There was no discussion in relation to this Item.
7 / AAHP PROFESSIONAL LEADERSHIP
Ms May advised that the proposed new AHP Leadership Structure for NHS Highland had been approved by the Board Partnership Forum (HPF) at their meeting held on 14 March 2008. The recommendations accepted at that meeting were that AHP Leads be appointed to CHPs and Raigmore on the basis of a minimum 4 days a week, that AHP Professional Advisors be appointed for each of the five professions on the basis of a minimum of one day per week, that work be undertaken to identify most appropriate governance arrangements to support the remaining AHP Professions in NHS Highland, that the appointment of an AHP Associate Director within the current year be supported, and that implementation of the model be supported through a transitional project. Following the meeting of the HPF, Professional Heads of Service (PHOS) and CHP Lead AHP roles job descriptions had been submitted for Agenda for Change banding, and arrangements for the three current PHOS had been agreed. In addition, two year funding for the Associate AHP Director role had been secured, with the relevant job description being finalised and submitted for grading. Overall these proposals would ensure that a full structure would be in place and consideration was being given to education and training needs for those staff new to roles. On the point raised by Pat Tyrell it was confirmed that the Associate Director post would be full-time and that funding had been initially secured for a two year period.
The Committee Noted the position.
8 / CHARGE NURSE REVIEW UPDATE
Mr Hobson advised that in terms of implementation of ‘Better Care’ there was new focus on the very important role of Charge Nurses in terms of delivering safe and effective care, management of teams, improving the patient experience, and contributing to Board Objectives. One particular area of focus would be the use of information/data to lead teams and drive up levels of quality, reduce incidents at ward level, and provide back-up to the Clinical Leadership Programme. The Project Lead job description had been submitted for AFC grading and once that had been confirmed a secondment appointment would be sought. The relevant Steering Group had met the previous month and would continue to meet on a monthly basis moving forward. Mr Hobson stated that there was to be an audit to establish the number of hospital based Charge Nurses that would be involved in the programme, on behalf of the National Steering Group, and as such Lead Nurses had been requested to identify relevant numbers. In this regard there were issues as to who exactly would be involved and Mr Hobson stated that in his opinion all Charge Nurses should be. A relevant Implementation Plan was in preparation and would be submitted to the next Staff Governance Committee meeting for approval, including a mapping of the structure, as per the RONC Project Initiation Document. The project itself was to commence in September 2008 and run to 2010, from when the new job description would apply, and overall would incorporate a range of ambitious challenges for NHS Boards. Mr Hobson added that he was to visit Cupar, in Fife, to establish how the NHS Board in that area had met the requirements and that Fiona Gray, NHS Grampian, has been invited to address the Steering Group. Pat Tyrrell emphasised the importance of appropriate linkages with RONC, especially with regard to education and development issues. Mrs Morrison sought clarification as to whether Mental Health Teams and other groups such as MacMillan Nurses would be involved and Mr Hobson advised that initially this would be restricted to hospital based staff as the relevant Clinical Indicators related to that area although it was hoped that this would be extended to the other groups/areas at a later date, in respect of which those Indicators were in preparation. Margaret McRae sought advice as to the staff who would decide on Charge Nurses designation and Mr Hobson advised that this decision would initially be taken by Lead Nurses although, as an indication, if someone led a team then they would be involved. Mrs Morrison suggested consideration of a Steering Group to consider and address this point.
Ms May stated that the Steering Group required to be designated as a Sub Group of the Committee and as such would require Terms of Reference to be agreed. In terms of communication there was a need to brief the wider organisation and as such there should be discussion at the Corporate Team and DHS Management Team meetings. Lead Nurses should also brief General Managers and Clinical Directors. Pat Tyrrell confirmed that an implementation plan was to be submitted to the Staff Governance Committee, including the release of modest funds for the role of Project Manager. It was confirmed that there had been Staffside involvement to date. With regard to AFC banding for the Project Manager post, it was stated that this had yet to be confirmed and Ms May stated that this would be important with a view to attracting the best candidates. Mr Cartwright referred to appropriate training and development needs and was advised that this had yet to be scoped.
After discussion, the Committee:
· Noted the position.
· Agreed that Sub Group Terms of Reference be established and agreed.
· Noted that the Review would be highlighted to both the Corporate Team and DHS Management Team.
· Agreed that Lead Nurses brief General Managers and Clinical Directors.
· Noted that an implementation plan was to be submitted to the Staff Governance Committee, including a request for a release of funds for the post of Project Manager.
9 / RESEARCH STRATEGY IN NHS HIGHLAND
Frances Hines, Research and Development Manager gave a presentation to the Committee in relation to the current Research and Development Strategy within NHS Highland and advised that this was a combination of a number of individual strategies. The R & D Office assisted with research and development strategy writing and implementation where required. The small R & D Office team was outlined and it was stated that they provided support for all aspects of research and development as well as carry out all administrative processes and procedures for assisting researchers and developers. The level of R & D for NHS Highland was outlined in terms of the national context, and this equated to approx. £250k per annum, a relatively low level. It was hoped that greater activity would take place in the coming year, with promotion of a better research culture. Ms Hines stated that there was a desire to increase research activity in a range areas, and outwith Raigmore Hospital, and that in this regard it was hoped that a wider range of staff, including nurses, would be encouraged to undertake this. Current work by the R & D Office included a Highland wide survey to establish current activity, the analysis and final report into which was to be published in October 2008 and would serve as a benchmark for measuring future progress. It was stated that there was a relatively low level of formal networking, informal networking being more developed, and a number of national research networks were detailed, some of which were well developed, and a number of which provided direct support i.e. funding. Highland research networks were also highlighted where appropriate. In terms of R & D training, there were twelve sessions held per year, free to NHS Highland staff, and these included aspects relating to ethics, funding, statistics, critical appraisal, research question development, and quantitative/qualitative research. There was to be held a series of Roadshow events in Autumn 2008, with the aim of getting more people active in R & D across Highland, and these would include meetings with clinical/health specialists, targeted discussion with interested individuals, and open fora for those engaging or interested in getting involved in R & D. In terms of opportunities for research it was stated that Highland had a relatively untapped population, that the remote and rural aspect of the area provided special context for research, that Highland had an elderly population with specific health and care issues, that there were cultural differences from elsewhere in the UK, that areas outwith Inverness were poorly developed from a R & D perspective, and that there was practically no primary care research in the area. There was given an outline of the support, advice and guidance that was available from the R & D Office and it was stated that the overall Strategic Vision was to see substantial growth in activity across Highland; that R & D support clinical activities, address problems, generate innovations, and engage users; make R & D easier, more accessible, better supported and better promoted; and inform people as to what the R & D office can and could do.