Mr Alastair Robertson, Chair of Kirkcaldy and Levenmouth CHP

MINUTE OF THE KIRKCALDY AND LEVENMOUTH CHP COMMITTEE MEETING HELD ON TUESDAY 12th MARCH 2013 AT 1:30PM WITHIN THOMSON HOUSE, METHIL

PRESENT:

Mr Alastair Robertson, Chair of Kirkcaldy and Levenmouth CHP

Mrs Mary Porter, Acting General Manager

Mr Harry Blyth, Non Executive Board Member / Vice Chair of Kirkcaldy and Levenmouth CHP

Mrs Moira Dunsire, Registered Allied Health Professional Representative

Mr Peter Adams, Non-Executive Board Member
Mr Stephen Rogers, Registered Medical Practitioner (non-primary care) Representative

Mrs Samantha Allen, Registered Nurse Representative

Mr Simon Fevre, Area Partnership Forum Representative

Mr Simon Little, NHS Fife Non-Executive Board Member

Councillor Lawrence Brown, Council Representative

Mrs Nicky Connor, Acting Associate Nurse Director

Mr Jim Bett, Voluntary Sector Representative

Dr Brian Wilson, Registered GP Representative

IN ATTENDANCE

Mr Andrew McCreadie, Assistant Director of Finance

Ms Barbara Anne Nelson, Deputy Director of Human Resources

Mr Alasdair MacLeod, Service Manager, Fife Council

Mr Danny Cepok, Area Service Manager, Fife Council

Mrs Cheryl Easton, Head of Podiatry Services

Mr Graeme Pettigrew, Business Manager, NHS Fife

Mrs Brenda Ward, Corporate Services Administrator (Minute)

/ ACTION /
58/12 / WELCOME AND INTRODUCTION
The Chair opened the meeting and welcomed the Committee members and presenters to the March Committee meeting.
59/12 / APOLOGIES FOR ABSENCE
Apologies for absence were received from Dr Lynda Anderson,
Mr Ron Parsons, Professor Ian Campbell, Mr Gordon Penman,
Mr George Sime and Councillor Andrew Rodger.
60/12 / DECLARATION OF INTEREST
Item 9.1 Podiatry Single use Instrument Update Progress Report.
Mrs Moira Dunsire advised that she is a Podiatry Development
Co-ordinator within the Podiatry Service.
61/12 / MINUTE OF THE PREVIOUS MEETING
The minute of the previous meeting held on Tuesday 15th January 2013 were agreed as a true and accurate record of the meeting with the following amendments;
·  Mr Simon Fevre should be removed from the present list as he did not attend the meeting on 15th January 2013.
62/12 / MATTERS ARISING
Pharmacy Representative
Mrs Porter advised that she had written to the relevant Committee’s asking for a Pharmacy Representative after the resignation of
Mr Shields and to date has received no response. Mrs Porter agreed to follow this up and would bring back to a future Committee meeting. / MP
63/12 / GENERAL MANAGER’S UPDATE
Hospital at Home
Mrs Porter advised that Hospital at Home (H@H) will go live within K&L CHP on Monday 22nd April 2013. With almost all training complete the staff, are now gaining experience working in D&WF CHP before they return to K&L CHP on 1st April 2013. The roll out within K&L CHP will follow a similar approach to that taken by D&WF CHP. This will include close working with the Operational Divisional, for rapid discharge where appropriate. The medical model that will support H@H will continue to be developed and refined as appropriate.
Work at Cameron and Stratheden Site
Mrs Porter said that some minor work has taken place on both Cameron and Stratheden Hospitals’. The work involved upgrading of bathrooms, floor covering and decoration. The CHP has also been approached by a local gardening company who would like to work with local teenagers on the Cameron Hospital site, further discussions are taking place.
Birthday Celebrations
Mrs Porter said that a patient at Cameron Hospital was to receive flowers from the Chair of Kirkcaldy and Levenmouth CHP on Wednesday 13th March 2013 as she celebrated her 103rd birthday whilst in the Balcurvie Ward.
The Committee noted the General Manager’s Verbal Report.
64/12 / PLANNING FOR SERVICE IMPROVEMENT
Mr Cepok thanked the Committee for the opportunity to share the progress and development of Local Community Planning in the Kirkcaldy Area. Local Community Planningaims is to bring together the Council services, Public Agencies and Voluntary Agencies to work alongside the communities we serve and work together as a partnership.
The Local Community Planning Framework for Fife was approved by Fife Partnership Board (FPB) in November 2011. Local Community Planning is considered necessary as Fife is a diverse place, for example, an approach for North East Fife might not necessarily work within the Kirkcaldy and Dunfermline areas. Some areas requireparticular local solutions, and the challenge is to keep a balance by working within Fife-wide policies. The FPB agreed some basic principles andthat Local Community Planning arrangements will be based on the seven Fife Council areas which fit with the CHPs. Another important aspect was to avoid a “one size fits all” approach and to build local community planning from the bottom-up. Each area would have a Local Community Planning Group and be asked to contribute into to the development of a Local Community Plan.
Mr Cepok advised that he was a member on the Local Community Planning Development Group that advised the Fife Partnerhsip, and that Mrs Susan Manion, General Manager for Dunfermline and West Fife CHP represented the CHPs for NHS Fife.
Mr Cepok thought it was important for the Committee to understand the context and challenges that the Kirkcaldy area has; the SIMD (Scottish Index of Multiple Deprivation) has a total of 74 zones in the Kirkcaldy area with 21 of these areas being in the top 20% most deprived in Scotland, which is a quarter of all zones in Fife. Fife Council are looking to address issues in the high deprivation areas and focus the attention on targeting the zones with the two highest in Kirkcaldy being Gallatown and Sinclairtown.
In May 2012 a Local Community Planning Group for Kirkcaldy and Levenmouth was established with a total of thirteen representatives of which two are from K&L CHP (Jackie Barbour and Dr Neil Hamlet). Thegroup initially studied theSIMD data as well as health and police statistics, and four key themes were identified for the Kirkcaldy area: Economy, Employment and Learning; Neighbourhood Pride and Development Areas; Parenting, Early Years and Young People; Health and Well-Being. The next stage for the group is to develop a Local Community Plan and the Kirkcaldy Area Committee has agreed a strategy of Local Community Planning events “theme by theme” which will bring together the public sector, voluntary organisations, the business sector, community groups and other interested stakeholders. These 'kickstart' meetings provide introductory presentations followed by a very interactive session to establish what is important to the communities.This will establishwhat are the big issues as well as any quick wins that may involve a small change or additional small resource.
Mr Cepok thought that it may be useful for the Committee to see a copy of the Local Community Planning Framework Guidance and agreed to send this to Mrs Porter for distribution.
The Committee noted the Planning for Service Improvement Report
UPDATE ON THE HEALTH AND SCOIAL CARE INTEGRATION PROGRAMME IN FIFE
Mrs Porter said that the Committee had been provided with a copy of the Scottish Governments response to the consultation paper. The Health and Social Care Integration update is the standard report which is prepared by Rona Laing, Programme Manager and Susan Manion, General Manager, D&WF CHP. The report is taken to the Project Board meeting where a review takes place of the six work streams established and the next focus will be on the recruitment for a joint accountable officer.
The Committee noted the Scottish Government Response to the Consultation Paper and the update on the Health And Social Care Integration Programme in Fife Report.
65/12 / DELIVERY & EFFICIENCY
FINANCIAL GOVERNANCE
Mr McCreadie advised that NHS Fife’s draft financial framework for 2013/14 will be submitted to the Finance & Resources Committee at the end of March 2013 for consideration, and if agreed there, to a special board meeting for approval at the same time.
Mr McCreadie said that NHS Fife is expecting to deliver a breakeven outturn position in this financial year.
The K&L CHP Financial Report for the ten months to the end of January 2013 was showing an overspend of £47K against Managed Clinical Services and an underspend of £458k in Prescribing. The key issues of overspend are within Local Services relating to complex care packages, and within Mental Health Services for patients receiving treatment in facilities outside Fife.
Mr McCreadie advised that as part of the Financial framework in 12/13 K&L CHP had anticipated £1.27M of Efficiency Savings. For the year-to-date the CHP have achieved £1M and the CHP anticipate that the Efficiency Savings will be delivered in full by 31st March 2013.
The capital programme total allocation for K&L CHP was just over £1M with the main allocation at £700K for the low secure unit at Stratheden Hospital. The CHP are currently expecting to meet the target spend plan by 31st March 2013
Mrs Connor added that particular thanks should be passed to all the Staff and the Acting General Manager, Mary Porter for the K&L CHP achieving this excellent position.
The Committee noted the Financial Governance Report.
Monitoring of Voluntary Organisations
Mrs Porter said the Monitoring of Voluntary Organisations paper has been brought to the Committee as a part of the governance perspective. The report outlines how the K&L CHP oversee the monitoring and evaluation of Voluntary Organisations and this is currently managed on behalf of the CHP by Fife Council. As the CHP move into the new financial year a major evaluation will take place detailing the aspirations and benefits and this will be brought back to the Committee at a later date.
The Committee noted the Monitoring of Voluntary Organisations Report
66/12 / IMPROVING HEALTH
Podiatry Single Use Instrument Update Progress Report
Mrs Easton introduced the report on NHS Fife’s move to podiatry single use instrument implementation and clarified that this had been done to meet the Scottish Government’s recommendations on standards of decontamination that had to be adopted to minimise the risk of infection to patients.
In 2009 the NHS Fife Podiatry Service provided more than 100 000 treatments for approximately 35,000 patients. Forty three local decontamination units were operated by clinicians to provide reusable sterile instruments. Therefore the options for NHS Fife were to; update the local decontaminating areas, move to a central decontamination or move to using a single use instrument. After discussions it was agreed that upgrading the local decontaminating areas was not viable due to the costs involved as well as the staff training. Central decontamination using Ninewells Hospital was also not possible as there was insufficient capacity to deal with activity levels. Therefore a review took place on the use of single use instruments to evaluate the quality of instruments to ensure safe patient care and to minimise the risk of repetitive strain injuries for podiatrists. NHS Fife collaborated directly with the suppliers to improve quality and increase cost effectiveness by recommending adaptations and requesting that packs be replaced with individually wrapped items.
In 2010, NHS Fife podiatry services moved to using single use instruments for all treatments. This has facilitated increased activity as staff have been released from decontamination duties and clinical cancellation due to equipment maintenance and breakdown has been eradicated. By way of comparison in August 2009 8,500 patients received treatment and in August 2010 this increased to 10,000. Although this increase is not wholly attributable to the implementation of single use instruments usage the process has undoubtedly enabled an increase in efficiency. Additionally, this new way of working has eradicated any risk of contamination.
NHS Fife, as the first podiatry service in Scotland to wholly adopt single use instruments, is having its progress closely monitored by other NHS Boards. As other Boards are now moving to the utilisation of single use instruments a national contract is being put in place which will further improve cost effectiveness for Fife.
Until recently there was no process in place to recycle single use instruments, however we are now liaising with a waste management company and once recycling processes are in place this will release potential saving to NHS Fife as well as causing no environmental landfill damage.
The Committee noted the Podiatry Single Use Instrument Update Progress Report
Dental Services Report
Mr Pettigrew thanked the Committee for the invitation to present the Dental Services Report which provides information pertinent to K&L CHP. The Fife Community and Salaried Dental service (CDS & SDS) is a Fife Wide Service that provides Primary Care Dental Services and is complementary to those provided by the General Dental Services (GDS). The service is often described as a “safety net” service for those who may not be able to access GDS as a matter of course.
The service provides care to; children in deprived or rural areas, patients with special needs, physical disability, oral surgery services, the National Dental Inspection Programme and the oral health department which undertakes Childsmile. In K&L CHP both the SDS and CDS operate from; Kirkcaldy Dental Access at Whytemans Brae, Fife Community Dental Centre, Fair Isle Dental Clinic, Randolph Wemyss Dental Clinic and Cardenden Health Centre. These clinics are complementary to the 17 clinics provided by General Dental Services in the area.
Mr Pettigrew gave a summary on dental registration for all age groups in the K&L CHP area; with only three quarters of people being registered with a dentist, despite availability the CHP are under 70% which is below the national average of 78%. The Dental Service also operates the Fife Dental Advice Line which maintains details of NHS Fife registration and operates a system for same or next day emergency treatments for unregistered patients. Calls to the advice line are monitored and during 2012 more than half with regards to dental registration or urgent treatment were received from unregistered patients in the K&L CHP area. Mr Pettigrew said that this continues to be an issue with the number of registered patients being below the national average; although it is important to note that at present there are no areas in Fife where you cannot be seen by a dentist. During 2012/13 significant progress has been made with regards dental access and in the Levemouth area there has been a further expansion of availability. For example, the following practices are now offering NHS registration; Kirkland area of Methil, Buckhaven, Banbeath in Leven and the Willis Practice in Methil.
A dental registration drive is planned for spring/summer 2013 in the K&L area where dental health support workers will be available at local community areas to promote NHS dental registration. The registration drive follows a successful pilot that was carried out in GNEF CHP in 2012. Following the pilot dental registration enquiries increased by 78%.