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8 APRIL 2008–11.00 am

Present: / Peter Cartwright (In the Chair)
Helen Bryers
Alan Caswell
Kath Clarke
Lorraine Coe
Pam Garbe
Jonathan Gray
Nigel Hobson
Hilda Hope
Alison Hudson
Veronica Kennedy
Stephen Loch
Jenny MacGregor
Etta Mackay
Alison MacLean
Margaret MacRae
Heidi May
Liz McClurg
Paula McCormack
Ruth Miller
Mhairi Milne
Patricia Morrison
Joan Philip
Viv Scott
Fiona Sharples
Heather Smith
Rachel Soplantila
Marjory Urquhart
Mary Vance
Elizabeth Watson
Eric Wiseman
Isobel Woods
Catherine Zawalnyski
Also Present: / Dr Roger Gibbins, Chief Executive (Item 4)
Gill Keel, Head of Public Engagement (Item 5)
Erica Reid, Nursing Officer, Scottish Government Health Directorate
In Attendance: / Brian Mitchell, Board Committee Administrator
Apologies werereceived fromRosy Almond, Mary Burnside, Trisha Kelly, Chrissie Lane, Elaine Lang, Sarah McLeod, Gill McNeill, Lesley Randall, Linda Sinclair, Hazel Smith, Joanne Thorpe, Pat Tyrell, Angela Watt, and Mhairi Will.
At the commencement of the meeting Ms May introduced Erica Reid who had been seconded to the Scottish Government Health Directorate, under Mr Paul Martin, Chief Nursing Officer. Ms Reid advised that she would be involved in aspects of delivery relating to Delivering Care, Enabling Health. As part of her role she would be asking Board Nurse Directors how they would wish to engage in this process. In addition Ms Reid was to provide support relative to the Senior Clinical Charge Nurse Review, details of which would emerge over the next few months.
The Committee welcomed Ms Reid to the meeting.
The Committee Approved the Minute of meeting held on 11 March 2008 subject to the addition of Mary Vance to the List of Apologies.
3.1Recommendation for Training Nursing Assistants
Mr Loch spoke to a scoping report relating to the future requirement for Health Care Assistants Training, specifically identifying the number of staff who would require to undertake an SVQ Level 2 or NiCHE Training Programme. The NHS Scotland Strategy for Nursing requires that all Health Care Assistants undertake training at SVQ or equivalent level and additionally the proposed future regulation of support workers will mean that employers will be required to demonstrate that they provide this level of training. The scoping exercise had demonstrated that only 41% of Health Care Assistants had been trained raising issues of compliance with clinical and staff governance, that significant variation and inequity in take up existed between operational areas, and that the overwhelming preference was for the NiCHE programme. Action to date included the production of a comparison paper to demonstrate both programmes which was circulated, an unsuccessful bid for KSF funding, and action by Argyle and Bute and RaigmoreHospital seeking to provide some additional local support on a short term basis. In conclusion, it was recommended that Messrs Hobson and Loch explore with SVQ colleagues cross working arrangements to include both direct support of candidates and their supervisors, and the administrative and logistic systems. In addition future resources would require to be identified to roll out NiCHE training through KSF, Learning and Development and/or operational units such as in Argyll and Bute CHP. The final recommendation was that the Committee consider the results of the work to date and support innovative ways to help deliver training requirements in a way that is both manageable for the organisation and for the relevant training departments.
During discussion, and on the point raised as to the Care Commission view as to NiCHE training it was stated that both schemes were considered suitable although NiCHE was not yet accredited. The view was expressed that both training programmes were not mutually exclusive and that both were required given that NiCHE was tailored more to the technical side and SVQ to managing Long Terms Conditions etc. It was confirmed that training was to eventually become mandatory and Lead Nurses had indicated their wish that both programmes continue. Ms May requested that Messrs Hobson and Loch, in association with Lead Nurses, identify targets for training numbers and bring this back to the Committee for consideration.
The Committee:
  • Noted the position and action taken to date.
  • Agreed that cross working arrangements with SVQ be investigated.
  • Agreed that resources be identified.
  • Agreed that training targets be identified with Lead Nurses and brought back to the June meeting of the Committee.
3.2 Nurse Bank Policy
The Committee Agreed that the Committee Administrator establish whether the Policy was available for Committee sign-off.
3.3 Community Medicine Documentation
Ms May reminded the Committee that Lead Nurses, in association with Alison McRobbie lead on implementation.
The Committee so Noted.
The Committee agreed that the following Item be taken at this point in the meeting.
Ms Keel spoke to a circulated summary document listing the current NHSH Communications Strategy objectives and progress on actions. She gave a presentation on the themes of communicating with patients, and with the public/communities, and outlined some approaches to both. Ms keel emphasised the important and influential role of clinical leaders, and their ability to promote effective, appropriate communication with patients as a core part of clinical care. She also emphasised the importance of keeping communities informed about health matters, matters and local services, especially at times of change. There had also been circulated a draft Communications and Engagement document which provides step by step guidance to managers and staff on working with patients and communities.
During discussion, Mr Cartwright raised the practical difficulty of getting meaningful representation from service users, especially in relation to Mental Health services. Ms Keel advised not to consider “representation”, but to focus on the purpose of any engagement, and to target the people affected directly. This can be a real challenge, but there are individuals and groups with wide service user and community networks in existence, and advice and support available from the Public Involvement Team. Ms Hudson raised a question about the definition of “major” service change and was advised that at present there is no agreed national definition or process for assessing the scale of change. Advice is sought from Scottish Government and the Scottish Health Council on individual change projects.
The Committee otherwise Noted the circulated Communications Strategy.
Dr R Gibbins gave a presentation to the Partnership Forum on Delivering for Remote and Rural Healthcare outlining the relevant Objectives, Process, and associated challenges. The Objectives related to delivering a sustainable healthcare strategy in remote and rural Scotland, defining the role and function of a Rural General Hospital (RGH), development of a framework of generic principles of service delivery for primary care in remote settings, development of a rural education strategy, a review of the role of the Emergency Medical Retrieval Service, and development of workforce planning arrangements to support the remote and rural agenda. The Process would involve a consultative approach and a range of focus groups on issues such as RGH’s and remote primary care, consensus building, producing a Needs Assessment, an Interim Report and consultation with all rural NHS Boards, Regional Planning Groups, and Scottish Ambulance Service. With regard to the challenges to be faced these included the fragility of the existing model, differing views, uncoordinated and fragmented care, variation between centres including limited and uncoordinated support in larger units, the perception that some changes would not be career enhancing, and the lack of remote and rural specific training programmes. Aims involved production of a Policy Framework, provision of sustainable services, standardisation and consistency in treatment, high quality care provided as locally as possible, establishment of Obligatory Networks, and establishment of appropriate training pathways. Dr Gibbins outlined the emerging model of care involving the extended Primary Care team, secondary care, and Tertiary services. The emerging model for the Primary Care Framework was also outlined with particular regard to issues relating to the workforce, infrastructure, supporting networks, and community resilience supported by robust patient care pathways, good IT infrastructure, premises and diagnostics; well trained generalists multiskilling and rotating with larger centres, integrated teams networked to specialists in larger centres and the grouping of small practices. Dr Gibbins went on to address the matter of RGH’s and advised that the relevant definition of this stated that “The RGH undertakes the management of acute medical, surgical emergencies and is the emergency centre for the community, including the place of safety for mental health emergencies. It is characterised by more advanced level of diagnostic services than a CommunityHospital and will provide a range of outpatient, day case, in-patient and rehabilitation services.” The role and function of the RGH in relation to Unscheduled and Planned care was outlined as were the elements relating to diagnostic services and relevant support including eHealth links to support clinical decisions, formal networks, arrangements for patient retrieval and transfers, and Pharmacy services. The role of the RGH in the overall emerging remote and rural model was also outlined.
With regard to an Education Strategy for Rural Healthcare, NES had established a Remote and Rural Healthcare Alliance (RRHEAL) and the aim of this was to identify educational requirements and broker solutions, support strategic alliances, and act as a broker between service and education providers. In relation to training pathways a Tripartite Group, involving the Academy of Royal Colleges, NES, and the Remote and Rural Steering Group, had been established. This group involved four Sub groups of core specialities for Medicine, Surgery, Anaesthesia & Accident and Emergency, and General Practice and these had developed a range of training pathways to equip doctors with the appropriate skills to work in rural settings, including a Hybrid GP with Acute medicine. The fifth workstream related to immediate requirements for recruitment and retention, four bids in relation to proleptic appointments to non-consultant grade, and development of a training pathway for remote and rural practitioners i.e. in relation to anaesthetic skills. Dr Gibbins advised that, as Chair of the Workstream on the subject of delivering remote and rural healthcare, he had overseen the submission of the final report to the Cabinet Secretary on 30 November 2007 comprising some 60 commitments, 20 associated forward issues, and 9 Web-based Annexes; and incorporating a detailed Implementation Plan incorporating actions for the Scottish Government Health Department (SGHD), NHS Scotland, North of Scotland Planning Group, NHS Boards, and CHPs. Implementation within NHS Highland required to be considered against the Clinical Framework.
During discussion the view was expressed that many national schemes established targets that were based upon an urban model and in this respect Dr Gibbins advised that part of the work undertaken in relation to service standards had been in association with QIS with a view to ensuring that these were ‘rural proof’. Ms Reid stated that the report represented a coordinated approach with clear emphasis on relevant networking requirements and provision of equity of access and provision of care standards. Reference was made to the core specialties for RGHs and the view was expressed that some Community Hospitals within NHS Highland would meet that standard. In response Dr Gibbins stated that the only real distinction was that Community Hospitals did not admit emergency surgical patients, and that for Community Hospitals in general further work was required given the variations that existed in this group.
The Committee otherwise Noted the position with regard to Remote and Rural Healthcare.
Fiona Sharples gave a presentation to the Committee advising that the main benefits for patients would be a single point of access to community nursing services, enabling the building of relationships with community nurses and teams, the building of a flexible and responsive service that anticipated healthcare needs, would build on current identified good practice, promoted a public health approach, improved the career structure for community nurses thereby improving continuity and sustainability, and help to develop whole system thinking. The various ways in which staff were involved in the process, including Trades Unions, was outlined as were the various methods for keeping staff informed and up to date. The key milestones were outlined in terms of the relevant implementation plan that would require to be signed off by the NHS Board, in terms of workload and workforce information including relevant job descriptions and organisational change polices, for education in respect of which there was to be a 5 step work based learning approach as outlined, in terms of the development of the new service model, and in respect of resources and finance including the impact on resources at service delivery level to support training needs.
During discussion Ms Sharples advised that available resource was not yet known and Ms May confirmed that this was being sought through the Finance service. It was advised that the BHBC Action Plan referred to Pilot Sites hence the change in terminology from Early Implementer Sites, these being in Tain, Thurso, Badenoch and Strathspey, and Mid Argyll.
The Committee otherwise Noted the position.
There had been circulated NHS CEL(2007)7 relating to the MAPPA requirement that NHS Boards operate as a responsible authority and with a duty to co-operate in the new arrangements to improve public protection from the risks of violent and sexual offenders. There were approximately 50 offenders in this category in Highland. NHS Boards were to become the Responsible Authority for all Restricted Patients on a Compulsion Order and who are violent or sex offenders from April 2008 and would be required to contribute to an annual report from April 2008. The respective Duty to Co-operate primarily related to information sharing and access to services and in those cases where the police share information then NHS Boards would require a clear system to communicate information on potential risk to NHS staff and patients who may encounter a MAPPA individual in an unplanned way. Links required to be established with Local Data Sharing Partnership Groups and there was a need to ensure clear guidance on MAPPA given to staff. The contact point within NHS Highland for MAPPA was Jan Baird, Director of Community Care, and there was also involvement from Dr A. Hay. The Committee was advised that there were three levels of management plans in this area including the first where the police but NHS were not involved, secondly where the NHS were involved but was mainly police led, and finally where NHS was fully involved and through Ms Baird and Dr Hay. Joint meetings had been held for a period of over one year and these had been well received to date.
During discussion concern was expressed regarding staff notification that an offender was being treated and it was confirmed that there would be no automatic formal notification that was the case. It was stated that where such information was received second hand this caused a range issues for staff. It was confirmed that all episodes of care would be managed and that any decisions relating to this would be by Ms Baird and/or the Duty Manager. Ms May emphasised that the first duty of care would be to NHS staff and as such continual feedback in this area was required.
The Committee:
  • Noted the requirements placed upon NHS Highland as a Responsible Authority.
  • Agreed that a copy of the relevant NHS Highland Protocol and associated Northern Constabulary document/ leaflet be sought.

Ms Vance advised that the Supervisor Quality Improvement Group was to meet on 28 April 2008 and would be looking at Policies, Procedures etc for Maternal Death Reporting, among other issues. A programme of local annual LSA audits would be pulled together to inform the report to the NMC and the subsequent 3 yearly review of LSAs was to include Grampian and Western Isles areas, but not Highland on this occasion. Ms May referred to Intention to Practice forms and was advised that all these for Highland had been submitted by 21 March 2008 although there had then been issues relating to data transfer thereafter in respect of which representation was to be made in writing. Mrs Mackay was to raise the matter at the NMC meeting later that week.