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MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE
Board Room, John Dewar Building, Inverness /

14 OCTOBER 2008 – 11.05 am

Present: / Heidi May (In the Chair)
Sally Amor (from 12.00)
Doreen Bell
Helen Bryers
Kath Clarke
Nigel Hobson
Hilda Hope
Veronica Kennedy
Jennifer Lobban
Una Lyon
Margaret McRae
Ruth Miller
Helen Morrison
Moira Paton (from 12.00)
Helen Tissington
Sheena Williamson, Stirling University
Faith Wilson
In Attendance: / Brian Mitchell, Board Committee Administrator
1 / WELCOME AND APOLOGIES
Apologies were received from Carol Bridge, Mary Burnside, Peter Cartwright, Lynn Chalmers, Lorraine Coe, Elaine Dibden, Kate Earnshaw, Alison Hudson, Jonathan Gray, Sandra Harrington, Trisha Kelly, Chrissie Lane, Stephen Loch, Jenny MacGregor, Etta Mackay, Maureen Mackay, Alison Maclean, Gill MacNeill, Liz McClurg, Paula McCormack, Sarah McLeod, Tricia Morrison, Hazel Smith, Heather Smith, Pat Tyrrell, Rachel Soplantila, Elizabeth Watson, Eric Wiseman, Isobel Woods, Sandie Young, and Catherine Zawalnyski.
2 / MINUTE OF MEETING OF 9 SEPTEMBER 2008
The Committee Approved the Minute of meeting held on 9 September 2008.
3 / MATTERS ARISING
3.1 eMail Policy – GIRFEC
Mr Mitchell advised that following advice having been taken it was confirmed that the relevant Policy was up to date and that sensitive information may be passed between nhs.net/nhs.uk addresses and gsi.gov.uk/gsx.gov.uk addresses.
The Committee Noted the position.
3.2 24 Hour Rotational Policy
The Committee was advised that a virtual group was to be convened to review and amend the relevant Policy with a view to it being submitted to the HR Sub Group and then this Committee in December. Staffside had indicated their agreement to the Policy in principle.
The Committee Noted the position.
3.3 Symptomatic Relief Policy
Ms Hope advised that the group established to consider issues raised had met and concluded their work. Reference to Care Homes had been removed. The Policy would apply to the hospital setting only, had now been ratified, and would be implementation tested at RNI. Such testing would involve issues relating to competencies and training, in association with the new kardex.
The Committee Noted the position.
4 / NON MEDICAL PRESCRIBING POLICY
Ms Hope gave a presentation to the Committee in relation to the circulated Policy and Procedure for Non Medical Prescribing, which had been affected by numerous changes in legislation. The background and aims of extending non-medical professions were outlined, as were the types of prescribers and prescribing involved. Ms Williamson advised that this reflected a staged approach to prescribing and that AHP professions were also looking to obtain Independent Prescriber status, which would allow prescribing from a limited list of specific Controlled Drugs. The organisation structures supporting and governing Non Medical prescribing within NHS Highland were outlined and it was advised that Prescribing Leads were Ms Hope (Nursing/Midwifery), Prof J Cromarty (Pharmacy), and Ms M Macleod (AHPs), who were working to achieve a generic approach. The six sections of the Policy were detailed and on the matter of Clinical Governance there was need for ongoing consideration of a relevant Database, CPD, record keeping, Rx and Dispensing Practice, monitoring and audit, financial accountability, dealing with concerns, and safety and security of Rx pads. Ms Hope advised as to the practices for course application and practice, and it was emphasised that the key element would be an identified clinical or service need for a prescribing role as agreed with the appropriate clinical team and line manager. The point was raised that this could have affect staff advancement/ succession planning and again it was emphasised that consideration was on the basis of clinical and not personal circumstances. On qualification prescribers would register with the relevant regulatory body, have their job description adjusted and KSF job profile and PDP updated. Commencement of prescribing practice would be discussed with clinical team colleagues and a mentor or buddy identified to apply clinical governance guidance. The next steps for the organisation would be the distribution of the Policy to all relevant Leads, provision of presentations to all Prescribing Leads and members of NMP on a cascade basis, consideration of feedback and identification of new issues through implementation, and subsequently the adjustment and updating of the Policy. Ms May stated that Lead Nurses should seek to take this matter to the CHP/Raigmore Clinical Governance Committees and there was a need for Operational Managers to consider the relevant planning and redesign implications emerging from the additional resource that would accrue from this development. Ms Miller raised the issue of those qualified prescribers that may not be regularly prescribing, if at all, and Ms hope confirmed that the relevant Sub Group would consider all those that had qualified in the previous five years. Ms may also raised the issue of GPs and their awareness of those able to prescribe etc and it was advised that appropriate record keeping would be vital, such as the use of pro-forma in the community setting, however a two way process would be required as well as acknowledgement that Community Pharmacists would have a major role to play.
After discussion, the Committee:
·  Noted that Ms Hope would liaise with Lead Nurses in taking the presentation to Operational Clinical Governance Committees.
·  Noted that Ms Hope would be invited to address the NHS Board Clinical Governance Committee.
5 / REVIEW OF NURSING IN THE COMMUNITY
Ms May advised that Pat Tyrrell had taken on the role of Project Lead, on a three day per week basis, and that backfill arrangements were being made in respect of her Lead Nurse role. She stated that the Review was now entering the implementation phase, with appropriate plans in place at the relevant sites. Relevant Key Milestones for implementation sites are currently being established. On a national level there was discussion as to appropriate evaluation of the proposed model. It was advised that the Programme Board wish to extend the timescale of the pilot and are to apply to the Health Secretary in this regard. There was a desire to ensure consistency wherever possible. In conclusion, Ms May stated that anxiety among staff remained and as such there was to be a series of Roadshows, in association with Human Resources, to canvass staff concerns.
The Committee Noted the position.
6 / GIRFEC UPDATE
There had been circulated October 2008 GIRFEC Local Update advising as to recent issues relating to training, guidance and procedures, managing change, and other associated matters. Ms Hope advised that implementation was proceeding according to plan and that GIRFEC had received all party support at political level. The GIRFEC Team should be congratulated on the work to date, this already having a positive impact in the Highland area.
The Committee Noted the position.
7 / PERINATAL MENTAL HEALTH GUIDELEINES
Sally Amor spoke to the circulated Guidelines which she advised had been widely consulted upon and which were to be submitted to the Clinical Policy Ratification Group the following week. Ms May advised that the Ratification Group would require an appropriate checklist and associated training/rollout plan. It was stated that CHP Leads would require to establish the necessary links and consider matters relating to design issues; Lead Nurses would require to cognisant of these points at a local level. Mrs Bryers emphasised the importance of dissemination of the relevant pathways and Ms may suggested that there be consideration of an audit in 6/9 months.
The Committee Noted the circulated revised Perinatal Mental Health Guidelines.
The Committee agreed to consider the following Item at this point in the meeting.
12 / SINGLE OUTCOME AGREEMENTS
Ms Paton spoke to the circulated paper outlining the opportunities and challenges posed by Single Outcome Agreements (SOAs), these being one aspect of the Concordat between Scottish Government and Local Authorities and based on 15 National Outcomes, also reflected in local outcomes. SOAs were to ‘support progress at national level through improvements in outcomes at local level’ and would ‘set out the outcomes which each Local Authority is seeking to achieve with its Community Planning Partners’. The 15 National Outcomes included focus on a range of subjects, as outlined and it was stated that HEAT, and other NHS targets could be nested within local outcomes where appropriate. SOAs were to be supported by appropriate and robust systems for governance, scrutiny and performance management and reported through established mechanisms for local performance reporting. Overall this would provide joint accountability top Government, public and local communities. Ms May advised that the NHS Board felt that SOAs could help to align Health and Social Services together and as such there was a need for this Committee to be aware of the various elements. Ms Paton confirmed that there would be a series of CHP briefings given and the key message was the need for agencies, including Police, Highlands and Islands Enterprise, and the voluntary sector to work in partnership to meet the Outcomes. There was a process for joint agreement on Outcomes; agencies would be held jointly and severally responsible for achievement; and there would be need to consider matters relating to performance monitoring. The opportunities and challenges for Nursing and Midwifery staff were that SOAs would provide a mechanism to drive greater focus on shared local outcomes, would focus on outcomes rather than inputs/outputs and be a driver towards better joint working. The challenge would be in seeking to deliver joint governance, accountability & scrutiny as a driver towards earlier and quicker spotting and resolution of issues and problems, and for the next iteration of SOA provide potential for increased focus on ‘at risk’ children and young people, employability, inequalities in health and mental health and wellbeing.
Ms Paton advised that there was time to influence the next SOA, this being required to be submitted to the Scottish Government by February 2009. The next SOA would apply for a two year period and it was stated that matters included must be with a view to seeking additional benefit as an outcome. Ms May advised that the Committee, and Lead Nurses, had a role to play in consideration of the next SOA, including aspects such as integration of Health and Social Services, and as such should consider the existing Agreements with Highland and Argyll and Bute Councils. Mrs Morrison queried as to the process of engagement with CHPs and was advised that this would be on a cascade model through the NHS Board and Corporate Team, with local work being fed up to that high level consideration.
After discussion, the Committee:
·  Noted the opportunities and challenges posed by SOAs.
·  Noted the need for Committee and Lead Nurse consideration of Outcomes.
·  Agreed that the Committee Administrator circulate the existing SOAs.
8 / KEEPING CHILDBITH NATURAL AND DYNAMIC
Mrs Bryers spoke to the circulated report outlining progress toward Keeping Childbirth Natural and Dynamic (KCND) Objectives, on a RAG (red, amber, green) basis in respect of which an Action Plan had been prepared. There was also circulated draft Terms of Reference in relation to a proposed NHSH KCND Steering Group, this to be a Sub Group of the Area Nursing and Midwifery Advisory Committee. She advised that Sarah McLeod had now been in place as KCND Consultant for a period of six weeks and during this time had addressed CHPs and Raigmore on this issue. Ms May referred to communication of the significant principles associated with KCND and stated that there was a need Lead Nurses and Midwives to give presentations to their local groups and appraise CHPs of the associated risks. There should also be a presentation given to the Clinical Governance Committee. On the points raised in relation to GP involvement it was confirmed that Ms McLeod was to address the GP Sub Committee the following week and that 2 GP representatives had been sought for the proposed Steering Group. Mrs Etta Mackay would be the relevant Staffside representative. Mrs Bell sought advice on the membership of Lead Midwives, and it was confirmed that deputies would be acceptable, as these were primarily as a point of contact for information dissemination etc. There would be PFPI involvement where a local issue had been identified.
Ms May referred to the issue of funding and Mrs Bryers advised that this would initially run to March 2009 and that funding at a national level had been secured for a further two year period. There was a need to consider how best to utilise this resource.
The Committee:
·  Noted the progress toward meeting KCND Objectives.
·  Agreed that Lead Nurses and Midwives should give presentation to their local groups and advise CHPs as to associated risk.
·  Agreed that a presentation be given to the Clinical Governance Committee.
·  Approved the proposed Steering Group Terms of Reference, subject to amendment of the Purpose to read “To lead the implementation and be accountable for delivery of the objectives laid down by the KCND....”.
·  Agreed that the Steering Group membership include Staffside, GP, Health Visitor and West of Scotland University representation.
·  Agreed that the Steering Group form a formal Sub Group of the Committee and as such incorporate an associated Workplan. Quarterly reports were to be submitted to the Committee and an Annual Report would be prepared.
·  Agreed that existing cost levels be discussed with Lead Nurses.
9 / POLICY FOR ADMINISTRATION OF DRUGS FOR NURSES AND MIDWIVES ACROSS NHS HIGHLAND
Ruth Miller spoke to the circulated Policy on Standards for the Administration of Drugs by Nurses and Midwives in NHS Highland, which were to apply across primary and acute care settings, and which had been based on the Standards for Medicine Management. The Policy did not include Controlled Drugs, and excluded IVs. Changes in the Policy, from that previously considered, included reference to multi-dosage systems and the British National Formulary. Helen Tissington referred to the issue of vaccinations and carers as second check/witness and was advised that there would normally be a requirement for two nurses to be involved, however this was not always possible in Highland and as such this element sought to give that second check where it otherwise may not exist. It was stated that this point related more to safety, than the issue of consent and after discussion Ms May suggested that the Paragraph on Administering to under 16 year olds be reconsidered. Ms Miller advised that this particular paragraph had been welcomed by Community Hospitals.