Community Health Partnership
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DRAFT MINUTE of MEETING of the SOUTH EAST HIGHLAND COMMUNITY HEALTH PARTNERSHIP COMMITTEE
InshesChurch, InshesRetailPark, Inverness / 29 January 2009 – 2:00 pm
Present Mr Ian Gibson, Non-Executive Director, Chair
Miss Anne Angus, Council for Voluntary Services, Inverness
Mr David Garden, NHS Highland Head of Financial Planning
Mr William Gilfillan, Corporate Services, Highland Council
Mrs Hilda Hope, CHP Lead Nurse
Ms Emily McIntyre, Community Pharmacist
Mrs Margaret MacRae, Staff Side Representative
Councillor Graham Marsden
Dr Boyd Peters, Clinical Lead, Badenoch & Strathspey Locality
Mrs Ros Philip, Primary Care Manager
Ms Rhiannon Pitt, CHP Lead AHP
Mr Thomas Ross, CHP Lead Pharmacist
Dr Ian Scott, CHP Clinical Director
Mr Jean Pierre Sieczkarek,Locality General Manager, Inverness & Nairn
Mr Nigel Small, CHP General Manager
Ms Jo Young, Communications Officer for SE CHP
Mrs Margaret Walker, Locality General Manager, Badenoch & Strathspey
In AttendanceMrs Sue Blackhurst, Committee Administrator
Dr Trevor Escott, Convener, Men’s Health Highland(for Item 5)
1WELCOME
Mr Gibson, Vice-Chair, welcomed all members to the meeting in the absence of Mrs McCreath, who had sent apologies due to ill health. He wished Mrs McCreath a speedy recovery.
2APOLOGIES
In addition to Mrs McCreath, apologies were also received from, Dr Kate Adamson, Ms Jackie Agnew, Dr Eric Baijal, Dr Adrian Baker, Cllr Margaret Davidson, Ms Susan Eddie, Cllr John Holden,Mr Douglas Johnston, Dr Iain Kennedy, Ms Katie Macdonald, Cllr Liz MacDonald, Dr Chris MacGregor, Mrs Ailsa MacInnes, Mr Brian Robertson and Mr Hamish Wood.
3 CONFLICTS OF INTEREST
The Committee:- Noted that noConflicts of Interest were declared.
4MINUTES OF MEETING HELD ON 6 NOVEMBER 2008
8.2Healthcare Acquired Infection (HAI) Report
It was noted that Mr Gibson had reported that, following the Highland NHS Board meeting on 2 December 2008, the Board Nurse Director had requested a revision to the item on Healthcare Acquired Infection, referring to cases of clostridium difficile. The section of the item was subsequently amended to:
“However, Ms Eddie advised of the stringent actions taken to reduce the incidence of clostridium difficile at RaigmoreHospital after several cases a short whileago and confirmed that similar actions are taking place at the present time to deal with the present cases. The former course of action was noted to reduce previous incidences of clostridium difficile significantly.”
This amendment was conveyed to the Board in response to their Action Point.
9.3The Highland Council / NHS Highland Single Outcome Agreement
Mr Gilfillan reported that the Highland Single Outcome Agreement is produced in partnership with other agencies as well as health and council services.
The Committee:- Approved the minutes of the last meeting held on 6 November 2008 subject to the amendments noted.
- Noted the Board’s request and subsequent action taken.
5MEN’S HEALTH HIGHLAND
Dr Trevor Escott, Convener, Men’s Health Highland (MHH), gave a presentation on the work of MHH. Cllr Marsden, Secretary of MHH, circulated copies of the GP Survey 2007-8 to which Dr Escott referred to in his presentation. Dr Escott began by advising the Committee that MHH was set up in 1989 in response to concerns around the poor health of men in Highland, particularly in relation to the high suicide rate amongst men. MHH have regular stands in public places in Highland, e.g. in the Eastgate Centre in Inverness. In conjunction with nurses, blood pressure and other similar checks are carried out on men (and sometimes women) who visit the MHH stand. There are also regular talks in the Town House in Inverness, which has an average attendance rate of 50. Topics for these talks include heart and stroke issues and mental health. As well as three GP surveys undertaken in past years, MHH have produced an information leaflet that has been distributed to 76,500 households. Dr Escott outlined pertinent issues in the survey, which requires around 12 months to compile the questions. The last survey undertaken in 2007-08 had a response rateof 70%. In relation to mental health, it was noted that there was a significant difference in the suicide rate between the population of ‘old’ Highland and the Argyll & Bute CHP area.
In summary, the barriers and difficulties to men’s health in Highlandwere identified as:
- Men themselves.
- Surgery opening hours, particularly for men working away from home.
- Low percentage of attendance at suicide prevention training courses by healthcare professionals.
- Blood pressure issues.
- Employment issues – securing time off work to seek medical help.
- Alcohol.
- Distance to healthcare providers for me living in rural areas.
Cllr Marsden advised that, in relation to checks in the Eastgate Centre, the responses and outcomes are varied. An average of 100 blood pressure checks are carried out and approximately 25% are found to have raised blood pressure. In these case men are encouraged to contact their own GP for further investigations. During these checks other issues can be identified which may result in men being referred to any other service or agency.
It was noted that a considerable part of voluntary sector work is around alcohol abuse. Mr Small advised that the Scottish Government had made extra resources available to frontline drug and alcohol services, and outlined the work currently being taken by Mr Sieczkarekto prepare proposals for HDAAT aimed at prevention and treatment in relation to alcohol.
In relation to suicide training opportunities as part of the REACT Practice Training Sessions, Mrs Philip advised that some work has already been done on STORM training but the REACT sessions are not generally considered to be long enough for this purpose. These afternoon training sessions, when practices are closed, follow a strict pattern determined when NHS 24 is available. Mrs Philip also advised that suicide prevention training for clinical staff within General Practice is part of the Depression Local Enhanced Service. Regarding extended hours access to GPs it was noted that 15 out of 18 practices within the SE CHP had signed up to providing a service outwith the core hours of 08:00 and 18:00.
Dr Escott was thanked for an informative insight into a specific area in the health of the Highland population.
Dr Escott left the meeting
The Committee:- Noted the presentation and the subsequent discussions.
- Noted the challenges faced by a specific group of people in Highland.
- Noted several CHP actions which address issues arising from the Men’s Health Highland questionnaire.
6MATTERS ARISING
6.1Primary Care Premises Update
Mr Small wished to update the Committee on the following premises developments:
Inverness Primary Care Premises: Southside Road and Cairn Practices: Following the advertisement in the European Journal, a shortlist of bids has been established and interviews have been arranged for 31 March 2009, in order to comply with the requirements of the European Journal.
Aviemore Health Centre: A feasibility study has been conducted on potential issues for this practice and a report is awaited. It was noted that there are also localised issues to consider, which are linked to the impact of the proposed CommunitySchool on the Health Centre site. A separate meeting was arranged to discuss this matter.
Grantown:In relation to a possible co-location of social work and health services in Grantown, it has not been possible to identify the required capital until 2012, at the earliest. Astatement to the Highland Council will be forwarded as soon as practicable to set out whether NHS Highland is likely to be in a realistic position to proceed as part of a joint development.
Kinmylies Practice: A feasibility study is about to get underway looking at potential future options for the practice.
The Committee:- Noted the update to the Primary Care Premises Developments.
7PERFORMANCE
7.1 Finance
MrGarden spoke to his circulated Finance Report to 31 December 2008. He suggested that he was not expecting much to change before the end of the year, although prescribing costs are always an issue. There has, however, been an improvement in reducing cost pressures with Badenoch & Strathspey community hospital nursing costs, through effective management work undertaken locally in that area. As previously reported, there is still plenty of robust activity required to undertaken in the next year in respect of costs savings.
MrGarden then tabled a paper on Cash Releasing Savings (CRS) on the 2009/10 Savings Targets and Plans. This highlighted the previously reported figure of a requirement for £36M in savings for NHS Highland over four years, with £17M savings required in 2009/10. MrGarden outlined the specific initiatives identified to be used in the financial recovery plan. This would involve a blanket 1% savings target applied to virtually all parts of NHS Highland, the CHP’s share of which is £695,000. In addition to this, for the Board to fully comply with the implementation of the European Working Time Directive for junior doctors, further resources were required, which the Board has agreed would be spread as additional CRS across all operational units. The CHP’s share is £172,000, giving a recurrent target, at this point in time, of £867,000. This needs to be fully identified and taken out of budgets by 1 April 2009.
Mr Small advised that a considerable amount of work had already been undertaken so far in indentifying savings, but much work still has to be done. Cllr Marsden enquired about the annual uplift, to which Mr Garden responded by saying that the inflation uplift was 3.15%, but that the Board was required to find a further £3M over and above this to simply fund inflation. Following an enquiry, it was noted that fuel costs are shown within the Facilities budget, but there is a current £1M overspend on energy costs. MrGarden advised that the Board is currently on a fixed price energy contract, and that next year they would be moving to a consortium arrangement.
Discussion took place on how savings could be made and various suggestions were mooted. One main factor discussed was the uncertainty of the prescribing budget, due to various factors outwith the Board’s control.
Mr Small confirmed that the £867,000 CRS figure was the CHP’s share of the first tranche of required savings. He highlighted that NHS Highland had a second phase of savings to find during 2009/10 and the CHP would need to work hard to contribute.
Mr Small proposed that the CHP Finance Group be translated into a CHP Change Group which was thought to be more effective in bringing about savings through working differently and system change. It was noted that finance issues are robustly discussed at CHP Management Team and Locality meetings. Mr Small advised that he is in the process of preparing terms of reference for this new group. It was also noted whether the Highland Council and the Health Board could be brought together for the purpose of budget and savings issues, but Mr Small advised that that he was unaware of any formal process at present. MrGarden thought that this could be explored through the Chief Officers Group.
After discussion it was agreed to sign off the CHP CRS savings plan, as presented to the meeting, and note that the balance of £103,000 of savings is still to be identified. An update on progress to identify the remaining amount would be required at the March Committee meeting, along with a progress report on the second tranche of required savings.
The Committee:- Noted the report and the information given.
- Noted the financial challenges faced by the CHP and NHS Highland as a whole.
- Commended the work undertaken so far, particularly in Badenoch & Strathspey, in reducing costs pressures.
- Agreed to sign off the existing CRS savings plan.
- Noted the balance of £103,000 of savings is still to be identified and Requestedthat a plan to achieve this amount be brought to the next meeting of the Committee.
7.2Clinical Governance & Risk Management
Dr Scott advised that there was noClinical Governance & Risk Management Performance Report available due to timing difficulties with NHS Highland’s Clinical Governance & Risk Management Department. Dr Lesley Anne Smith had apologised for this delay.
The Committee:- Noted the position.
7.3CHP Clinical Governance & Risk Management Group
It was noted that an Incident Review in Highland is taking place following discussions at the DHS Management Team in November 2008. The community hospital environment audits referred to in Item 7.1 of the minute were commended for their compliance rating. Mr Ross outlined the work around antibiotic prescribing in relation to healthcare acquired infection. He confirmed that feedback on high prescribing is given to the prescribers concerned and that much work has already be done in identifying ‘at risk’ patients
The Committee:- Noted the minute of the CHP Clinical Governance & Risk Management Group meeting of 2 December 2008.
- Commended the Community Hospital Environment Audit compliance rating.
- Noted the position regarding work on antibiotic prescribing.
7.4Performance Report
As part of the Performance Report, the inadequacies of the Balanced Scorecard for CHP purposes were noted following discussion by members at the previous meeting, in that the information was not always up-to-date or pertinent to the CHP. Mr Small had convened a meeting with Gillian McCreath, Hamish Wood and Margaret Brown, Head of Service Planning, the latter having taken over responsibility for production of the Balanced Scorecard, to discuss more appropriate ways of reporting performance information. It was agreed at that meeting to revise the reporting presentation to be more meaningful and ‘user-friendly’. This would reflect more appropriately the CHP’s performance against HEAT targets and separate HEAT targets directly and indirectly applicable to the SE CHP. It was noted that the previous reporting periods were unclear and will also be revised. Mr Gibson agreed that Ms Brown should be invited to the next meeting of the Committee to launch the revised format.
The Committee:- Noted the proposed revisions to the Balanced Scorecard for the SE CHP.
- Agreed to invite the Head of Service Planning to the next meeting of the Committee to launch and explain the revised Balanced Scorecard.
8PUBLIC HEALTH
8.1Smoking Cessation
Mr Gibson had reported that Mrs Walker had been congratulated on her excellent presentation to the Board’s Improvement Group (formerly the Performance Review Group) on the work of the CHP’s Smoking Cessation Service. It was noted that the CHP has exceeded its share of the the required targets for smoking cessation rates. Mrs Walker reported that there was currently a significant increase in number of referrals to the service, possibly due to the national economic situation and new year resolutions. At present, the service is also working with sections of Highland Council employees to encourage them to smoke less. Mrs Walker considered that success of the target achievement was also due to diligence on the part of GPs, as well as the Smoking Cessation service.
Mrs MacRae raised the issue of staffing within the service, wherein was noted that some staff are employed on temporary contracts due to the nature of the allocation. Mrs Walker confirmed that smoking cessation advisers are trained nurses and that any potential risk to the possible termination of the service is perceived to be low due to the success of the service within the CHP.
The Committee:- Noted the position.
- Commended further the achievements of the CHP’s Smoking Cessation Service.
9IMPROVING SERVICES AND CLINICAL ISSUES
9.1Prescribing and Pharmacy
Mr Ross spoke to his circulated Prescribing and Pharmacy Report. As requested at the last meeting, further detail on statin prescribing had been provided, particularly in relation to levels of prescribing of simvastatin 40 mg and atorvastatin 10 mg and 20 mg. It was noted that some practices within the CHP continue to have a relatively high proportion of prescribing of atorvastatin 10 mg and 20 mg as opposed to simvastatin 40 mg and that this has significant cost implications.
Mr Gibson, on behalf of the Board, requested that issues relating to practices not participating in statin savings should be robustly pursued. He was particularly concerned to see that two practices had particularly high use of atorvastatin. Mr Ross confirmed that discussions had taken place with all practices around switching appropriate patients from atorvastatin 10 mg or 20 mg to simvastatin 40 mg. Assistance from a Prescribing Support Pharmacist, to review individual patients’ medication and their suitability for changing therapy, had also been offered to help practices facilitate such a switch. Mr Gibson advised that he would advise the Board of the issue around statins at the Board meeting the following week.
Mr Ross also referred to a section of his circulated report giving a situation update on the New Community Pharmacy Contract.
The Committee:- Noted the report.
- Demittedto the CHP Management to robustly ensure that all General Practices in the SE Highland CHP are following the guidance issued in relation to statin prescribing.
- Noted theupdate on the New Community Pharmacy Contract.
9.2Healthcare Acquired Infection (HAI) Report
Mrs Hope spoke to her circulated report. It was noted that the temporary handhygiene promoters had concluded their short-term contracts and were therefore no longer in post. Their work is now undertaken by hand-hygiene link nurses in all community hospital wards as part of their general nursing role. Mrs Hope advised that all three community hospitals in the CHP were compliant in this month’s handhygiene audit. In relation to antibiotic prescribing, Mrs Hope referred to the circulated clostridium difficile alert, laminated copiesof which will be affixed to drug trolleys as an aide memoire to nurses to look out for signs and symptoms of clostridium difficile in patients receiving the drugs specified in the alert. A red dot denoting these drugs will also be placed on the patient’s drug Kardex.Mrs Hope confirmed that incident rates are reported weekly and that currently RaigmoreHospital was within the permissible banding.
Regarding visitor compliance with hand hygiene procedures, it was noted that patients’ visitors are generally compliant and there is much encouragement by staff towards visitor compliance in the use of hand-hygiene procedures. Patients who do contact clostridium difficile are usually placed in single rooms where there are hand washing facilities. In response to a query concerning the dress code, Mrs Hope further confirmed the Hand Hygiene Policy will be reviewed when the new dress code is implemented.