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MINUTE of MEETING of the
NHS HIGHLAND PARTNERSHIP FORUM (Strategy)
Board Room, Assynt House /21 May2010 – 10.35 am
PresentMr Ray Stewart, Employee Director (Joint Chair)
Dr Roger Gibbins, Chief Executive (Joint Chair)
Mr Ian Brown, UNITE
Ms Elspeth Caithness, RCN
Mrs Anne Gent, Director of Human Resources
Ms Georgia Haire, North Highland CHP
Ms Tracy Ligema, Mid Highland CHP
Mr David Logue, Head of Human Resources, Argyll and Bute CHP (Videoconference)
Ms Etta MacKay, UNISON (from 11.20am)
Mrs Margaret MacRae, RCN
Ms Janette McQuiston, UNISON
Mr Adam Palmer, UNISON
Ms Linda Rawlinson, Senior Nurse Manager, Occupational Health Services
Mr Bob Summers, Head of Health and Safety
Mr Alistair Wilson, MiP
In
AttendanceMr Robert Kelly, General Manager, NHS (Scotland and North England) Credit Union Ltd (Teleconference) (for Item 9)
Ms Judith McKelvie, Head of Learning and Modernisation
Mr Brian Mitchell, Board Committee Administrator
Mrs Caroline Parr, Partnership Support Officer
Dr Lesley Anne Smith, Head of Clinical Governance and Risk Management
1WELCOME AND APOLOGIES
Apologies were received from Pamela Cremin, Emma Currer, Marilyn Davidson, Jennifer Dowling, Helen Duthie, Diane Fraser, Aileen Gardner, Dawn Gillies, Brian Houston, John Huband, Malcolm Iredale,Gill Keel, Derek Leslie, Liz MacMillan, Helen Morrison, Dr Ken Proctor, Kenny Steele, Nigel Small, and Philip Walker.
2MINUTE OF MEETING HELD ON 16 APRIL2010
The Minute of Meeting held on 12 February 2010 was Approved, subject to the amendment to the List of those Present to read “Mr Ian Brown, UNITE”.
The Partnership Forum agreed to consider the following two Items at this point in the meeting.
9EXTENDING NHS CREDIT UNION SERVICES IN THE HIGHLANDS
Mr R Kelly gave a presentation to the Partnership Forum on the services provided by NHS Credit Union Ltd, including access to savings accounts through payroll deductions, access to loans, on-line account access, and access to insurance products. He outlined a summary of the key benefits, which included payroll deduction direct from source, no liability for employer bodies, establishment of Service Level Agreements containing key pledges and commitments from the Credit Union, employer facilitation only, and opportunities for personal development and volunteering. Mr R Kelly advised that the common bond area of the Credit Union had recently been extended to the whole of Scotland as well as the North West, North East, Yorkshire, and Humberside regions of England. Services would be available to all NHS employees in these areas, as well as linked family members residing at the same address. The organisational background of the NHS Credit Union Ltd was outlined and it was stated that key development issues had been identified as an increase in membership levels and associated strengthening of status, increased partnership activity with NHS Boards, offering membership and access to services to family members of NHS employees, and a strengthening of the organisation’s financial status through increased member deposits alongside a robust lending policy. Other development areas would be a development of existing and new member services, progress in relation to the Localised Champion Initiative, continuation of pilot projects for payroll deduction development, creation of active links with Unison for membership development, and member consultation and service review including Holiday Scheme partnership with the Family Holiday Association. With specific regard to establishing a partnership with NHS Highland, there was a need for an endorsement of the availability of the NHS Credit Union for all remaining NHSH staff, arrangement of linkage and administrative processes, publicity of the availability of membership, creation of links to Staffside organisation networks, and commencement of payroll deductions and administrative processes for relaying contributions to the Credit Union. In response to points raised, Mr R Kelly confirmed that agreements were between the Credit Union and individual NHS employees, with no obligation placed upon the NHS Board; that a dedicated Marketing Officer had now been employed; and that an on-line membership application was in the process of preparation. With regard to payment by family members it was stated that this could be achieved either through direct payment or via the NHS employee as appropriate.
After discussion, the Partnership Forum:
- Agreed to Endorsethe availability of the NHS Credit Union to NHS Highland staff.
- Agreed that payroll deduction and associated administrative processes be established.
- Agreed that an appropriate link to the NHS Credit Union be provided through the NHS Highland Intranet site.
7KNOWLEDGE AND SKILLS FRAMEWORK
Ms J McKelvie spoke to the circulated report outlining progress against the Knowledge and Skills Framework (KSF) Implementation Plan. With specific reference to eKSF implementation and the 2009/2011 HEAT target (E10) which stated that 80% of all staff were to have a development review completed and recorded on eKSF by March 2011, current data indicated that this had been achieved for 19.58% of staff compared to the trajectory figure of 27%. There are now 4 options available for staff to undertake reviews and record details on eKSF. Managers were being provided support through training, demos, development and sharing of good practice, as well as other support mechanisms. Monitoring of the HEAT target is currently being undertaken by the Improvement Committee as progress is significantly behind the trajectory and managers have been asked to develop implementation plans for their operational area detailing how they plan to meet this target. To help in this regard there had been established a new template for reports to managers. There was continued discussion in relation to IT bandwidth issues and a potential resolution on a national or local basis was hoped to be implemented in early course. Short Guidance documents have been developed and are available on the Intranet, including a new short guide to enable managers to use reports from eKSF to enable them to monitor progress in their operational area. Implementation of the All Time – Learning system continued.
During discussion, Ms J McKelvie stated that a number of staff groups had indicated that KSF had been helpful in providing role clarity and it was stated that staff had welcomed the provision of on-line information. Monitoring elements had proved useful, especially in remote and rural areas. It was anticipated that KSF would be an important aspect relating to service redesign activity. Mrs A Gent stated that with a view to meeting the relevant HEAT target in Highland it would be beneficial if Staffside representatives could assist in promoting this activity in a coordinated and concerted manner. On this point, Mr R Stewart stated that this would be a role for Learning Representatives, however emphasised that ultimately this activity was a management responsibility. He stated managers required to consider the priority given to this activity. Mrs A Gent stated that managers had been requested to provide implementation plans and as such there would be a role for Staffside representatives to raise this issue at Management Team meetings. Human Resources managers had also been requested to discuss progress with managers as appropriate. Ms McKelvie stated that it was hoped that the new reporting format would assist managers in better identifying progress against target and identify areas of concern to be addressed.
After discussion, the Partnership Forum:
- Noted the position with regard to implementation of KSF and eKSF within NHS Highland.
- Agreed that General Managers be requested to identify their respective support requirements to meet implementation plans.
3MATTERS ARISING
3.1Partnership Forum Role and Remit
Mr R Stewart advised that he was to consider issues relating to an update of the current Partnership Forum Role and Remit and would report back to a future meeting.
The Partnership ForumsoNoted.
4NHS HIGHLAND STRATEGIC FRAMEWORK
4.1Quality and Patient Safety Framework
Dr L A Smith gave a presentation to the Forum in relation to the circulated NHS Highland Quality and Patient Safety Framework. She advised that the Quality Strategy was people centred, built on the values of staff and their commitment to providing the best possible care, and was about making measurable improvement in the aspects of quality of care that patients and their families consider important. Quality healthcare can be defined as showing care and compassion, being clear in communications and explanations, effective collaboration with partner agencies, provision of clean and safe care environments, ensuring continuity of care, and reliably maintaining the clinical excellence patients have come to expect. It was stated that a Patient Priorities Survey had identified those issues considered most important and this highlighted the three main aspects as being provision of a clean ward, staff members displaying adequate Hand Hygiene procedures, and being treated quickly in an emergency. Dr Smith advised that the Institute of Medicine’s Six Dimensions of Quality underpinned the circulated Framework, as well as the associated national Strategy. She outlined what this meant for both patients and staff in terms of the patient experience, clinical effectiveness, and patient safety. In NHS Highland this would require clarity in relation to what constitutes high quality care, measurement of quality, publishing data on quality performance, recognising and rewarding quality, a raising of standards, and the safeguarding of quality. With regard to the issue of establishing success in the various aspects of this subject, there had been developed a series of hospital based quality measures in relation to adverse event rates, C.diff infections, SAB infections, Total Mortality rate, Hospital Standardised Mortality Rate, readmission rates within both 7 and 28 days, length of stay, complaint levels, and sickness absence. These measures would provide key indicators and would act as a springboard for future discussion and improvement. Future action would include the issue of a Quality Survey to all NHS Highland staff, development of an Implementation and Communication Plan for the NHS Highland Quality and Patient Safety Framework, and the identification and development of Clinical Quality Measures for CommunityHospitals, Mental Health and Primary Care. The National Quality Strategy was to be launched in June/July 2010. Dr Smith advised that a Quality Framework Implementation and Communications Planning Group had been established and sought Staffside representation on this. Ms E Caithness indicated she would like to participate in that Group.
During discussion, Mr R Stewart emphasised the need to provide focus on the issue of quality, as opposed to financial considerations, and Mrs M MacRae stated this was the cornerstone of what the organisation was seeking to achieve. Provision of a quality service to patients would accrue benefits in terms of efficiency, and enable associated improvements to be made. Mr A Palmer stated the key to success would be development of stated aspirations into actual service improvement. There was reference to potential utilisation of patient diaries for monitoring purposes, and Mr R Stewart questioned whether staff diaries could also be utilised. Mrs C Parr confirmed that there had been recent discussion as to the creation of a staff stories library via the SGHD and stated that real-life experiences of staff could provide good insight and help contribute to the promotion of the quality agenda. Mr A Palmer advised that NairnTown and CountyHospital had provision for staff to provide feedback at shift-end. Mrs A Gent stated, as evidence of the integration of key NHS Highland documents, that the current draft Health and Safety Policy had been created with the Quality Framework as reference. Mr B Summers confirmed the same applied in relation to work on the Staff Health and Wellbeing Strategy. Dr R Gibbins stated that it would be important to capturethe day to day activity of staff being undertaken to meet the Quality Framework, in order that this may be recognised, acknowledged and better promoted across the organisation. Mrs M MacRae referred to work in relation to Leading Better Care and stated there was a need to also consider the activity of integrated teams, and those not directly employed by NHS Highland.
After discussion, the Committee:
- Endorsed the NHS Highland Quality and Patient Safety Framework.
- Noted the National Quality Strategy was to be launched in June/July 2010.
- Noted Ms E Caithness would attend the Quality Framework Implementation and Communications Planning Group.
- Noted the position in relation to both patient and staff diaries.
The Committee Agreed to consider the following Item at this point in the meeting.
5MID STAFFORDSHIRE REPORT
Dr L A Smith spoke to the circulatedreport relating to the NHS Highland response to the Mid Staffordshire NHS Foundation Trust reports, including ‘The Francis Report’ which had been published in February 2010 and contained a number of conclusions and recommendations for both that Trust and the wider NHS Community. Following the publication of ‘The Francis Report’, the Chief Executive of NHS Scotland had requested that NHS Boards have a substantive Board level discussion on the issues identified, this discussion being informed by consideration of the Inquiry’s recommendations by the Clinical Governance Committee, Area Partnership Forum, and Area Clinical Forum. It was stated that NHS Highland had reviewed the adequacy of local arrangements to detect and act upon any shortcomings in standards of care. A subsequent report had been produced, which provided a summary of the review outcomes, described the systems in place and identified where further improvements were to be made. The circulated report outlined a summary of the findings from the Healthcare Commission report and of the Independent Inquiry; detailed the findings from the NHS Highland review, and described the plans for implementation of the circulated NHS Highland Quality and Patient Safety Framework. The report also set out the recommendations made in the Francis Report and asked that the Clinical Governance Committee, to which the report would be presented, consider whether theproposed actions adequately address these or whether additional steps require to be taken. Dr Smith advised that a key theme that emerged from the Inquiry related to the need for those involved in such situations to be able to speak openly and have their views and opinions considered. There was a need for the Partnership Forum to consider issues relating to organisational culture regarding safety and quality, enabling staff to be fully involved in decision making, and processes for enabling staff to raise concerns and have these considered.
During discussion, the view was expressed that staff on the front line did not always receive clear communication as to current organisational direction and priorities, and as a result can get the impression that finance and service change were more of a priority than providing a quality service. As a result, staff members were reluctant to suggest change ideas believing these would not be considered within the current financial climate. It was stated that the raising of concerns was an issue across the NHS, and that staff needed to be encouraged to raise issues. Mrs A Gent stated that there had recently been received, for consultation, draft ‘Voicing Concerns’ PIN Policy and this would need to be considered in the context of current discussion. It was stated that a lack of standard setting and monitoring had led to the situation arising in Mid Staffordshire, that this situation had emerged in a relatively short period of time, and highlighted the need for staff to be able to voice concerns at an early stage with a view to avoiding similar issues arising. The view was expressed that Charge Nurses had an extremely important role to play in maintaining quality standards and providing front line leadership, and Mr A Palmer added that the recent HEI Inspection at Raigmore Hospital had shown the importance of addressing matters, no matter how small at an early stage. In order for appropriate action to be taken however there was a need for respective managers to provide feedback on issues raised by staff and Dr L A Smith advised that this point had been discussed at the Clinical Governance Forum, where it was agreed that whilst appropriate systems were in place there was a need to further consider how best to provide the feedback required. Dr R Gibbins emphasised that the report on Mid Staffordshire had identified failures across the organisation at all levels and highlighted the need for a strategic overview to be maintained. There was to be discussion on these points at a forthcoming Development Session of the NHS Highland Board to establish the quality assurance systems already in place, and those that were also required. Whilst NHS Highland represented a different organisation from that in Mid Staffordshire, the circulated report had highlighted how matters can deteriorate in a short period of time and it was clear that there were important roles for the Highland Partnership Forum, and Area Clinical Forum in ensuring that issues were considered and discussed appropriately.