APPROVED

NHS GRAMPIAN

Minute of the Area Clinical ForumMeeting

held on Wednesday 09 November 2016at 4.30pm

in the Foresterhill House Committee Room, ARI site

Present:

Dr Helen Moffat, ACF Chair and Chair, Applied Psychologists Advisory Committee

Ms Catriona Cameron, Vice Chair, Allied Health Professions Advisory Committee

Mrs Pamela Cornwallis, Chair, Allied Health Professions Advisory Committee

Mr John Dean-Perrin, Chair, Area Optometric Committee

Mrs Jenny Gibb, Vice Chair, Grampian Area Nursing and Midwifery Committee

Mr Chris Llewellyn, ACF Vice Chair and Chair, Healthcare Scientists Forum

Dr Rebecca Riddell, Chair, Area Medical Committee

Mrs Ann Smith, Chair, Area Pharmaceutical Committee

Dr Rachael Smith, Vice Chair, Applied Psychologists Advisory Committee

In Attendance:

Ms Amy Anderson, Non-Executive Board Member

Dr Craig Beattie, Chair, GP Sub Committee

Mrs Lorraine Currie, Strategic Coordinator Child Health

Dr Howard Gemmell, Public Representative

Professor Mike Greaves, ANCHOR Centre Clinical Lead

Dr Annie Ingram, Director of Workforce

Mrs Susan Kinsey, Public Representative

Dr Mike Munro, Baird Family Hospital Clinical Lead

Mr Eric Sinclair, Non- Executive Board Member

Mr Graeme Smith, Director of Modernisation

Mrs Susan Webb, Director of Public Health

Ms Else Smaaskjaer, Minuting Secretary

Item / Subject / Action
1. / Welcome and Apologies
Dr Moffat welcomed everyone to the meeting
Apologies were noted as follows:
Mrs Amanda Croft, Director of NMAHPS
Dr Nick Fluck, Medical Director
Mr Alan Gray, Director of Finance
Ms Lynn Irvine, Vice Chair, Area Pharmaceutical Committee
Dr Alastair McKinlay, Vice Chair, Consultant’s Sub-Committee
Mrs Jenny McNicol, Chair, Grampian Nursing and Midwifery Committee
Ms Julie Mosgrove, Vice Chair, Area Optometric Committee
David Shaw, Chair, Grampian Area Dental Committee
Mrs Jennifer Tait, Vice Chair, Healthcare Scientists Forum
2. / Minute of meetingheld on 14th September2016
Mrs Catriona Cameron asked if it could be made clearer at item 5 that Mrs Christina Cameron, Programme Manager, Modernisation Directorate had provided the update on Winter Planning. TheMinute of the previous meeting was then approved as an accurate record.
3. / Matters Arising
There were no matters arising.
4. / Winter Planning - Update
Dr Moffat reported that the Winter Plan for 2016/17 had been approved by Grampian NHS Board at their meeting on 3rd November and submitted to the Scottish Government. Mr Smith confirmed that Board Members are aware that there are areas of understaffing, particularly at ARI but there is a requirement for each regional Board to submit a Winter Plan. Dr Ingram informed members that although there are staff shortages in some departments NHS Grampian now employs more staff than previously. However, she emphasised that management are not complacent and work is ongoing to review the best placement of staff to meet the demands on services. HR staff are also reviewingrecruitment processes to make certain that new employees are engaged in as short a timescale as possible.
Dr Gemmell asked if any additional financial resources had been allocated to meet the challenges in providing a winter plan. Mr Smith reported that some additional funding has been indicated but as the announcement regarding this tends to be made later in the financial year there is limited scope to incorporate it into the planning process.
Mr Dean-Perrin had noted the decrease in the uptake for the annual flu vaccine by over 65s and suggested that leaflets/posters should be sent out to Optometric Practices and other premises which are regularly attended by this age group.
Members noted the update.
5. / Corporate Parenting
Mrs Lorraine Currie outlined some of the changes to Corporate Parenting introduced in the Children and Young People’s (Scotland) Act 2014. The NHS Grampian Corporate Parenting Action Plan was approved by the Board on 6th October 2016 and Mrs Currie summarised the accountability structures for looked after children within NHS Grampian and the Health and Social Care Partnerships in Moray, Aberdeenshire and Aberdeen City. The Local Authority has traditionally been the legal corporate parent for looked after children and the new Act widens that responsibility to a number of other bodies including all NHS Boards. The Act also extends the period of corporate parenting up to 26 years old for teenagers who are looked after on their 16th birthday. Mrs Currie highlighted that the Action Plan includes an agreement to ‘develop the work experience policy to identify provision of work experience for care experienced young people within NHS Grampian’. Mrs Kinsey agreed that the extension and provision of work experience would be beneficial for young people who can often feel isolated during this period of transition.
Mr Gemmell asked if it is difficult to identify all who should be included in this group. Mrs Currie reported that there is currently a paper based system which operates between the three local authority areas but a database is being developed.
Members noted the report.
6. / Innovations Hub
Dr Andy Keen had been unable to attend the meeting. Mr Smith provided a brief overview of the implementation of the Innovations Hub in NHS Grampian. He explained that the hub has been introduced as an approach to encouraging, stimulating and supporting new ideas from staff throughout the organisation. An event called ‘The Big Pitch’ had recently provided a platform for staff to present their ideas to a panel. The innovations presented had included a bolus calculator for diabetes management, mousse style snacks for patients on stage C diets and ideas for children to make their own videos of their experiences at RACH which could help other young patients. It is planned that this type of event will be repeated and the use of NHS Grampian Endowment Funds explored for taking the most viable ideas forward. Mr Smith informed the Committee that more information is available on NHS Grampian Intranet on the Modernisation Directorate page.
Members noted the update and agreed that Dr Andy Keen will be invited to a future meeting. / HM
7. / Grampian Clinical Strategy – Developing the Electronic Patient Record
Mr Smith introduced a briefing paper “Development of Electronic Patient Records in Grampian”. The paper had been prepared as part of the implementation strategy for the Grampian Clinical Strategy and provides an update on progress made to date and what the key priorities should be to further progress the development of Electronic Patient Records (EPR) in NHS Grampian. Mr Smith reported that the paper had been discussed by the Senior Leadership Team (SLT) of NHS Grampian and a fully developed and costed plan will be considered in January/February 2017.
Mr Smith confirmed there is a commitment from SLT to the development of a comprehensive system for EPR in Grampian but recognisesthere are challenges in identifying the resources required to take the work forward. In addition to the specific allocation for eHealth from the Scottish Government it is intended that the development of EPR will be incorporated, as appropriate, into capital projects. This will initially focus on the Acute Sector and Community Services.
Members agreed the paper demonstrates that NHS Grampian has made a lot of progress but acknowledged there is still a great deal to do and that change to working practices will also be necessary. Mr Smith highlighted the work carried out in Gastroenterology which is viewed by other areas in Scotland as a model of effective electronic working. Dr Moffat recognised that there will besome co-dependencies in taking forwardthis project and it is important for staff to work together and for advisory committees to be kept informed.
Members noted the progress made and agreed that Mr Steve Baguley, Clinical Director eHealth and Mr Scott Sim, Interim General Manager eHealth should attend a future meeting to give a further update. / HM
8. / Baird and ANCHOR – Project Update
Dr Munro informed the Committee that the Baird Family Hospital is scheduled to open in 2020. It will be situated where the Breast Screening Service and Foresterhill Health Centre are currently sited as it is important to ensure accessibility to Royal Aberdeen Children’s Hospital and the Emergency Care Centre. Dr Munro noted that there are challenges in the timing, planning and development of all the ongoing works on the Foresterhill Health Campus and works to relocate the Foresterhill Health Centre are scheduled to start early next year.
Designs for the finished building will soon be available to the public. There had been a number of workshops and consultations regarding the design and the layout of the building. These included public and third sector groups and clinical and non-clinical staff. The plannedrooms will be single occupancy and a family hotel will be incorporated into the building. The clinical planning proposals include new service models in triage, transitional and ambulatory care. During consultations staff had been very receptive to the proposed innovations and had contributed to the review of different models of working and how they could be achieved. Dr Munro emphasised that the overarching principle is to have a family friendly hospital and all the modelling and planning had been conducted with that in mind. Dr Beattie asked whether it was realistic to guarantee that no parents will be turned away. Dr Munro responded that although there can be no guarantee,the hospital will make every effort to maintain that as standard practice.Mrs Kinsey noted that this will be a valuable improvement which will be much appreciated by families who live outwith Aberdeen City.
Professor Greaves provided an update on plans for the ANCHOR Centre which is also due to be completed by 2020. It will be situated near to the Maggie’s Centre building on the Foresterhill Health Campus. He emphasised that it should not be viewed as a cancer centre as it will provide a broader range of care in haematology, oncology and radiology. Professor Greaves explained that the centre will provide ambulatory services for out-patients and day-patients and there will also be scope to offer complementary therapies and include services from the third sector. The centre will be more comfortable than the facilities currently available and will provide a mix of private and socialising areas. He added that the outdoor spaces at both the Baird Family Hospital and the ANCHOR Centre will be healthy spaces where patients, visitors and staff can escape from the clinical environment and relax. There are also plans to include an aseptic pharmacy, increased opportunities for clinical trials and teaching facilities for research nurses. Professor Greaves advised the Committee that the project teams are reasonably confident that the new facilities will be in a position to meet the projected increased demand for services over the coming years.
Mr Sinclair asked whether the decision to have single rooms was as a result of patient feedback. Dr Munro confirmed that this is now a Scottish Government standard for new building projects. Mr Smith noted that clinical engagement throughout the planning stages for both developments had been very helpful and would be replicated in future projects. Dr Munro agreed and reported that discussions relating to new models of working had been particularly useful and some of these had already been implemented at Aberdeen Maternity Hospital.
The Committee thanked Dr Munro and Professor Greaves for their update and welcomed the enthusiasm demonstrated by all those involved in the project.
9. / HSE Improvement Notices
Dr Ingram gave a presentation providing background to the Health and Safety Executive (HSE) Inspection in July 2016, the contraventions of legislation outlined in the Improvement Notices issued, and the remedial actions taken by NHS Grampian to date. Dr Ingram reported that following on from the inspection in July it became apparent that there were shortcomings in the understanding of the role of HSE. Staff were aware of its role in issuing guidance and practical advice but not fully aware of its wide ranging powers of inspection and its authority to enforce penalties. Improvement notices were issued to NHS Grampian in relation to falls, sharps and skin. These notices were site specific which had been helpful as it provided the opportunity to achieve the improvements required in a particular area and then replicate those on other sites.
The improvement notice for sharps was issued at Royal Aberdeen Children’s Hospital (RACH). Sharps, including needles and cannulas, are used in large volumes in NHS Grampian but Dr Ingram confirmed that unsafe needles had been removed from the catalogue and not held at RACH since August.
The improvement notice for falls was issued at Dr Gray’s Hospital in Elgin. NHS Grampian had no policy for the assessment and management of falls and insufficient staff training had been carried out. The need to arrange training of more than 2,500 staff before April 2017 had been identified and it will be necessary to ask HSE for an extension to that very challenging timeframe. Staff induction and training will be reviewed and new starts may be required to undertake mandatory elements before taking up post.
The improvement notice for skin was issued at Aberdeen Maternity Hospital (AMH). There had been insufficient identification of wet workers, insufficient training, latex gloves were in use and health surveillance was found to be reactive rather than proactive. Dr Ingram reported that since the inspection all latex had been removed and a system of risk assessment and health surveillance introduced for domestic staff in AMH. All other wet workers in NHS Grampian will be identified.
Mr Gemmell asked if there had been difficulty in persuading staff to volunteer for training to be key handlers. Dr Ingram responded that this was proving to be a significant challenge and consideration may be given to incorporating this into staff roles rather than as a voluntary ‘add on’. She also added that different methods of delivering training will be investigated as it is essential that NHS Grampian can demonstrate to HSE that there is enough appropriately trained staff in place.
Mr Dean-Perrin reported that since the inspection optometrist contractors had all been issued with new sharps but without any training or information in how they should be used. Dr Ingram agreed that there should have been some offer of training or familiarisation.
Mrs Gibb noted the challenging culture change required in persuading staff that their roleis much wider than their job description and may include corporate responsibilities. Dr Ingram agreed that this is particularly important with regard to health and safety issues which all staff should view as being their responsibility. Mrs Cameron asked if an Electronic Staff Record will be introduced to record details of training undertaken by staff along with refresher dates. Dr Ingram confirmed that this is being reviewed by Workforce staff to ensure thatcomplete and up to date records are available.
Dr Ingram agreed with Dr Beattie regarding the importanceof getting the right information distributed to all the right peopleand the benefits ofcondensingit into readable summaries without losing the detail required. She also noted the importance of helping to navigate staff through all the information and to better understand the responsibilities they share in complying with health and safety requirements.
Dr Ingram concluded by informing members that since the inspections Senior Leadership Team have established an oversight group with responsibility for tracking an agreed action plan. Senior staff are meeting with HSE and work is ongoing to establish a compliant Health and Safety System for the organisation. Dr Ingram emphasised that although there is much work to complete in the coming months the inspections had identified three areas for improvement and there are many areas of good working practice throughout NHS Grampian.
Dr Moffat thanked Dr Ingram for a very helpful presentation and members agreed that it had been useful to gain a wider understanding of the actions taken since the improvement notices were issued.
10. / Staff Health and Wellbeing
Dr Moffat provided an update from the Staff Experience Sub-Committee of the Staff Governance Committee which considers matters relating to how NHS Grampian manages and looks after its employees. Dr Ingram noted that the implementation of the Innovations Hub is a good example of promoting staff engagement and further ideas for improving staff experience will be explored. Mrs Webb suggested thatraising awareness of good practice and sharing good news stories is another means of improving staff morale.
Mr Llewellyn agreed the importance of staff wellbeing but noted that workload issues and recruitment problems can prevent staff from participating in groups. Dr Ingram advised that training gaps for some groups of staff have been identified nationally and she would be willing to meet with Healthcare Scientists to explore local solutions to their specific difficulties. Dr Riddell reported that an SBAR highlighting vacancy rates had been discussed by the Consultant’s Sub-Committee and this identified where the main pressures are. She asked if more anticipatory work should be carried out to prevent problems arising. Dr Ingram responded that this would be possible in some circumstances but problems will vary between different staff groups and working environments. She advised that information is taken from a range of sources including sickness records, DATIX reports and grievance/disciplinary records but it is important to place the emphasis back on empowering managers and teams to look for the solutions which will best fit their needs.
The committee noted the update and agreed that Staff Health and Wellbeing should remain as a standing agenda item. / HM
11. / Updates from Advisory Committees, DPH and ACF Chair
Committees provided an update of matters discussed at their recent meetings and highlighted the following:
  • AMC had discussed the Baird Family Hospital and ANCHOR Centre Projects. It had also considered the implications for all professional groups by the introduction of a Statutory Duty of Candour.
  • GP Sub-Committeehad discussed the improvements to the Clinical Guidance Intranet which should be ready to progress when Aberdeenshire and Aberdeen City IJBs have confirmed the funding. It had also reviewed the situation at Northfield and Mastrick Medical Practice.
  • Consultant’s Sub-Committee had discussed Orthopaedics and an SBAR highlighting vacancy rates.
  • GANMAC had discussed the winter plan, recruitment and retention issues and problems with staff not completing the re-registration process. It had also agreed to have a workshop in December to consider how it can reach out to a wider range of nursing and midwifery staff.
  • Area Pharmaceutical Committee had discussed modernisation in Primary Care and the wider role of the increasing number of pharmacists now directly employed by GPs. It had also reviewed the requirement on community pharmacists to embed continuous improvement into working practice in line with the Scottish Patient Safety Programme.
  • Healthcare Scientists Forum had discussed the draft Professional Assurance Framework, how to develop the role of Associate Practitioners and the challenges in delivering the requirements in the Scottish Healthcare Science National Delivery Plan. Dr Ingram noted that NHS Grampian Workforce are looking at how to make use of the Modern Apprenticeship Scheme and she would be happy to discuss this further with Healthcare Scientists.
  • DPH and ACF Chair reports had been circulated before the meeting.

13. / Approved Minutes
Recent minutes were circulated for information.
14. / Items for ACF Report to the Board
  • Support from Area Clinical Forum for the ongoing work in complying with Health and Safety Executive Improvement Notices.
  • Staff Experience
/ HM
15. / AOCB
Links with Integration Joint Boards to be included on the agenda for a future meeting. / HM
16. / Date of Next Meeting
The next meeting will be held on Wednesday 18th January 2017at 4.30pm in the Committee Room, Foresterhill House, Aberdeen Royal Infirmary.

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