MINUTES OF MEETING OF THE STRATEGIC STEERING GROUP

FOR THE ADMINISTRATION OF MEDICINES IN SCHOOLS

Held on Wednesday 22nd September, 2010 at 10am in the Board Room, Assynt House, Beechwood Park, Inverness

Present: Alison MacRobbie, Palliative/Community Care Pharmacist

Calum Munro, Highland Children’s Forum

Bernadette Cairns, Principal Educational Psychologist, The Highland Council

Anne Johnston, Public Health Team Leader (Inverness West)

Allan Kerr, Solicitor, The Highland Council

Andrew Stevenson, Manager - The Orchard

Shelia Watt, Associate Specialist, Community Paediatrics

Via Video link: Jamie Houston, Consultant Paediatrician, Lorn & Islands Hospital

In attendance: Helen MacDonald, Acting Community Pharmacy Business Manager

Lindsay Ross, Pharmacy Admin Assistant, NHS Highland

Apologies: Wilma Lawn, Argyll & Bute Council

Catherine Dobbie, Argyll & Bute Council

Jan Baird, Director of Community Care, NHS Highland

Glynne Williamson, Early Education Development Officer

Carol Walker, Argyll & Bute Council

Julia Nelson, Early Education Development Officer

1  / Welcome and Introduction
Alison welcomed attendees to the meeting and noted apologies. Round the table introductions were made. Alison in particular welcomed Bernadette to the Group in her new role and advised that after discussion with Carol Walker from Argyll & Bute Council more members had been recruited from within that forum, although were not available to attend today.
2 / Minutes of the Meeting held on 3rd February, 2010
The minutes of the meeting held on 3rd February, 2010 were approved with alteration in spelling to Allan’s name.
3 / Matters Arising
(a)
(b)
(c) / Chair
Alison reported that she had met with Carol Walker from Argyll & Bute Council who advised it was hoped that their new Quality Improvement Manager for Additional Support Needs, when recruited, would become chair of this group. Interviews for this job will be held shortly but, in the meantime, Alison agreed to chair this meeting.
Role of Secretary
Alison advised that there had been no interest expressed in filling this role, however, she was happy to continue in this role.
Annual Report
It was proposed the annual report be submitted to the Children’s Services Network at its next meeting in November but that Alison would circulate a copy to members of this Group in advance for their information. / AMcR
(d)
(e)
(f) / School prospectus audit – inclusion of medicines in schools information
This work will be taken forward following changes in personnel. Alison had discussed with Bernadette and Carol and it was hoped to obtain a standard form of words to be included in all school prospectus/handbooks regarding medicines in schools information for parents. This would also allow any additional individual school information to be added. Bernadette advised that the prospectus goes out with enrolments for the next year’s intake, usually in February, and that she would contact Carol in Argyll & Bute to find timescales for prospectus there and further discuss. Bernadette advised it would be easy to make the necessary changes to Highland documents and Jamie advised that within Argyll & Bute CHP hard copies were mostly used.
Alison to provide Bernadette with Carol’s contact information.
Health Guidelines availability on Argyll and Bute Council Website
Alison had not been able to check to see if the link was on the Argyll & Bute website yet following agreement with Carol Walker and IT staff, but would pursue this further.
Website Documents
Alison confirmed changes to the format of the documents on the medicines in schools NHS site had been updated and had requested the part completed templates prepared for allergy and anaphylaxis by Dr Farmer be loaded. / BC/
CW/
AMcR
4 / Workplan: Review of progress
(a) / Integrated Policy - update
Bernadette reported that this policy had been waiting for a slot on the agenda of the Highland Council LNCT agenda, which had been heavy but that no problems in its ratification were anticipated.
Calum enquired if training was causing problems with the progression of the policy in particular, he had concerns in two areas:-
o  administering medicines; and
o  intimate care, or elements of it.
Calum advised that different unions had expressed varying views and that the Group had raised its concerns previously with Stephen Iliffe with a view to resolving any issues prior to them occurring.
Bernadette reassured members of the Group that a training plan had been put in place, although she had heard that some auxiliaries had raised concerns about what was expected from them, but felt this would be addressed by consulting with and moving members of staff into areas where they felt they were working within boundaries comfortable to them.
Bernadette advised members of the Group she had not received any reports from parents advising they were unhappy with their child’s care to date.
Calum advised that he was pleased that this had been addressed and that he felt reassured by what Bernadette had said that any auxiliaries who were not happy with any of the duties expected of them would be moved to another area or work within The Highland Council where work would be more suited to that individual, diffusing any awkward situation to the benefit of the child, if required.
Jamie was unable to clarify the situation in Argyll & Bute but Alison agreed to follow this up with Wilma with a view to push for one document between the three organisations before the next meeting.
Post meeting note
The document is now going through some slight changes and has been passed to Argyll & Bute Council Health & Safety department to review. Wilma will be in touch in the near future.
Common Conditions Guidelines Progress
Alison thanked Calum for details of the support Groups which she had contacted but had received no further comments. All the guidelines had been progressed through the governance processes and a request had been made to IT services to load these on the website. / BC
AMcR
WL
(b) / QIS Asthma Audit
Alison reminded members of the Group that Georgina had volunteered to carry out an audit which Shelia advised she would further discuss with Jamie to take forward. Jamie advised that he would be happy to look at this with Sheila, however, nothing had progressed since the last meeting of this Group. It was understood that this overlapped with QIS Work and was agreed Alison would put this on the Workplan.
Jamie clarified that the audit carried out in Argyll and Bute had focussed on allergy and anaphylaxis and it was hoped this could be rolled out across the North Highland area.
Ann advised she was not aware of any Individual Healthcare Plans for asthma in schools in her area but felt that allergy and anaphylaxis would be more of a priority.
It was agreed as reasonable that the asthma, allergy and anaphylaxis audits be targeted first and that this be done by the end of June 2011 in conjunction with clinical governance and public health input. / SW/JH
AMcR
SW/
JH
(c) / QIS Asthma Group
Alison would check that the link from the Medicines in Schools website was linked to the QIS site. She advised that the asthma action plan had been adopted throughout the areas, was out for parents to view and would be put in the training pack and that this was hoped to be followed up through Jane Baines for The Highland Council, identified lead for school staff training in Argyll & Bute Council and the CHP Lead School Nurses with background training.
Anne advised that annual training was carried out for anaphylaxis although she found that it was difficult for staff in schools to engage with this due to difficulty in getting out of class in order to participate in this. She advised that the specialists nurses help take forward some cases but she could only speak of this in Inverness.
Alison was to take this matter further and acquire information from the school lead nurses.
It was noted that training in schools for individual children’s’ needs happens successfully. / AMcR
AMcR
AMcR
(d) / Resuscitation
Andrew advised that this item linked with 5(c) – Living and Dying Well and although his involvement had only happened recently it was noted there were links with the Children’s Hospice. He advised that Fiona Shevall, Child Protection had been on the National Group working with the DNA CPR guidance, that the consultation period had now passed but apparently there had been much response on this issue.
In particular he reported the second last sheet of the document had gone back to the national body as this could not be left to the regional councils and that, in particular, there were issues relating to:-
Family Support; and Quality of Life which he advised came back to the resuscitation issue. It had been wondered in a local authority establishment whether a Do Not Resuscitate (DNR) protocol could be implemented until arrival of NHS medical staff.
Allan advised that problems in this area may arise and it would be required to determine in any particular instance whether or not they were dealing with a terminal illness. In light of this it was the view that local authority staff should err on the side of caution in instances of these kind.
Andrew advised that Dr Debbie Shanks, had looked at this in conjunction with Shirley Jack, from The Orchard, who had spent some time looking at the Liverpool Care Pathway model as the potential way forward but that this matter had quietened for a while but was, again an issue. Andrew stated that the working group had been brought together but no final report had yet been seen by him.
Alan advised that a form of words had been written into the Medicines in Schools policy around the need for schools to put in place comfort measures until medical assistance arrived in these circumstances.
Calum felt, that a lay person, such as himself may be the carrier of a Red Cross First Aid Qualification/card and as, such, would be morally duty bound to resuscitate an individual until such time as a medically qualified person arrived. He explained that, for example, if he was a visitor at Drummond School and there was an incident then this would become an issue for him and he would be morally obligated to render first aid. DNR Certificates have never been raised with trainers at Red Cross, for example, and he is of the view that you would never be wrong in trying to save life until a health professional took over. He felt this extended to all walks of life if you have undertaken learning to enable life saving.
Alison thanked Calum and advised that it was very helpful to receive this view as potentially the DNA-CPR orders meant that non-medically qualified people were being asked to not resuscitate.
Alan advised that the extent of the illness may not be fully known until the ambulance crew arrived on the scene.
Alison felt that if an individual was not confident on making their decision then it would be prudent to wait until a child was seen by health trained staff but that this could not be viewed in black or white. The guidance was there to assist authorities in unexpected death and was not any further forward than before.
Calum felt that best advice should be recognised but that the document did not seem to pick up on this and his feelings were that the national document required the extra breadth and he hoped that revision of this was taken on board.
Bernadette and Allan felt the guidance advised clearly not to make that choice leaving to the medically qualified and, so long as parents were aware of this policy, then this should suffice.
Alison felt this was part of awareness raising and that there should be links to advise where to access this on the relevant web pages.
The group agreed they would wait on feedback from the national body before taking this any further.
Workplan – general
Calum requested that the workplan be updated with posts instead of names which Alison would update.
Role of the Group
Alison raised the question of whether the Group should continue as present or its work be transferred to Child Services Network. Calum asked if this were the case then who it would be who might sponsor the work which the group currently do if it was passed onto the Child Services Network. After some discussion, members of the Group reached the decision that in the interim, the Group should continue.
Alison to speak to Shelia outwith the Group regarding the work which Georgina had previously undertaken in relation to alternative therapies.
Alison would add the issue of care home/foster care setting to the workplan, as suggested by Andrew. Alison advised that the Symptomatic Relief Policy was still to be progressed for foster carers and residential settings.
Alison to take up any issues relating to The Highland Council’s new hostel in Mallaig outwith this Group with the CHP staff at local level. / ALL
AMcR
AMcR/
SW
AMcR
AMcR
5 / (a) / AOCB
BHF Training
The group discussed this at length and although was agreed to be an excellent way to spread good/better practice it was felt this would not be financially feasible due to current funding constraints.
There was discussion around how a course like this was of great benefit in dealing with wider issues, changing attitudes and encouraging positive thinking and this was a wonderful example of how these issues could be tackled.
Bernadette advised there had been some local training in the past but this had been costly. Calum wondered if this could be tackled by a partnership approach and suggested a voluntary organisation may be able to seek out a funder or fund raiser to enable opportunities such as this. Calum would follow this up with Bernadette outwith this meeting. Alison to put on the workplan. / CM/BC/
AMcR
(b) / NHS Highland/Highland Council folder Promoting Health and Wellbeing in 0-5 years settings.
Alison advised the guidance had been issued and a note of the link would be sent out to members of this Group. / AMcR
(c) / Living well, Dying Well
Discussed at 4 (d) above.
(d) / Transitions
Bernadette advised that there was clear guidance available on transitions but this was problematic if not implemented. In particular the preschool to primary school setting was managed best. Anne advised there were good arrangements in her area, however, involvement was not as good in secondary school.
Allan advised that by the time a child was 16 years of age, there were other issues to settle, including difficulty to consent to medical treatment. The expectations were for parents to obtain a Welfare Guardianship or for the GP to sign off as incapacitated, but, Allan, advised this could become quite an issue where there were absent parents or parents in conflict.
Bernadette advised that Social Work colleagues had been good at highlighting this in the past. Allan would prepare a paragraph which could be put into the current policy for clarification. / AK
(e) / Good Practice
It was agreed Alison would capture examples of good practice in a paper by way of highlighting these with a view to enabling confidence. All members of group to send examples to Alison
It was agreed that this also included as part of the Annual Report and Workplan and shared with wider partner agencies and on the website. / ALL
AMcR
6 / Date of next meeting
The date of the next meeting was scheduled for Wednesday, 23rd February, 2011 to be held in the Boardroom, Assynt House, Beechwood Business Park, Inverness at 10am.
The future date booked for 2011 of Wednesday, 21st September, 2011 was also approved.
Please note your diaries.

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