Cowal Locality Public Partnership Forum

13th November 20132pm

NOTE OF MEETING

Present: / Evelyn Hide / Chair, CLPPF
Aileen Hoey / Hunter’s Quay Community Council/CCCF
Bruce Marshall / Argyll & Bute Council
Eileen Lea / CLPPF member
Fulton McInnes / Hunter’s Quay Community Council
George Allan / CLPPF/PCIG
Heather Grier / 24/7 OOH/CLPPF member
Iain MacNaughton / Sandbank Community Council
Ian Brown / Dunoon LINK Club
Lorna Ahlquist / Cowal Community Care Forum/PCIG
Peter Galliard / Dunoon & District MS Society
Raymund Madill / Justice of the Peace, Dunoon
Viv Hamilton / NHS Highland
Wendy Thomson / British Red Cross
Susan McFadyen / Cowal Community Care Forum, Administrative Support

Apologies:Alison McCrossan, Jimmy Bell, Ellis Henderson, Sue Clarke, Tom Law, Eleanor Stevenson

  1. WELCOME

Evelyn welcomed everyone to the meeting and all attendees introduced themselves. Evelyn asked attendees to encourage members of their groups to attend in the future.

  1. ADMINISTRATION

Lorna is going away on 5th February for at least 6 months. Susan will take over the administration of the CLPPF on behalf of Cowal Community Care Forum.

  1. CLPPF, an overview of what it does

Evelyn explained that the PPF comes under the auspices of the Scottish Health Council for which Alison McCrossan is the local officer. She shared the Scottish Health Council leaflet which describes what a PPF is – 12 pages long. Susan has summarised this into 2 pages. Bruce asked if this could be sent to Shirley MacLeod for forwarding to Community Councils and other relevant community groups. Ian thought that it should be suggested to community councils that this is made an agenda item. Action Susan.

There is an Argyll and Bute PPF and several locality PPFs of which the CLPPF is one.

The chair and vice chair of CLPPF and usually Lorna attend the A&B PPF.

Iain asked if there are representatives of the CLPPF on the Community Health Partnership (CHP). Evelyn replied that the chair and vice chair of Argyll and Bute PPF attend the CHP. Viv is also part of the CHP. Evelyn did not feel that the lack of direct representation was a failing. Iain was concerned that issues raised would not be communicated to the CHP. Lorna explained that issues are raised directly with the relevant people e.g. recently issues about mental health were raised with John Dreghorn. Heather agreed with Iain and felt that local groups are underrepresented and that we need to make sure that our voice is heard.

Viv felt that Iain had raised a valid point and explained that the issue of local representation at higher levels is currently being looked at nationally. Cowal is the most active area in the CHP in terms of public involvement and this is recognised. Cowal is currently helping Islay and sharing experiences of best practice in involving the local community. Viv expects this to be extended across the whole organisation. Viv agreed that people need to feel that their voice is heard at a higher level. She noted that at the local level there is public representation on the Joint Locality Management Group whichcovers Cowal, Bute, Helensburgh and Lomond – this is a regular quarterly meeting.

Health and Social Care Integration

Lorna felt it was important that we look at how public involvement can be taken forward to ensure local representation, particularly with Health and Social Care Integration being imminent. She noted that it is senior management who are discussing Health and Social Care Integration with no public involvement and expressed concern about this.

Viv said that because it is a politicised process the meetings between the NHS and Council Chief Executives cannot be made public. She felt that there needs to be a process for community engagement. There are currently 2 models being considered. Most local authorities are choosing the Corporate Body model but this is not the model which has been adopted by NHS Highland.

Evelyn expressed the opinion that having discussed the issue of public involvement with Derek Leslie, it was the Local Authority which was against this rather than the NHS. Bruce assured the meeting that he was for public involvement and would communicate this to Dick Walsh. Bruce felt that the previous administration did not take this forward as a priority and that it should be a priority.

Aileen raised the issue that the process of Health and Social Care Integration does not seem to have moved forward for over a year. Bruce responded that this was not the fault of the present administration and summarised that the issue here is whether there will be public engagement going forward – he would say that there will be. Bruce felt that the current negotiations are strategic and that the public should be involved at the next stage, while others felt strongly that the public should be involved from the start.

Eileen gave an example of an elderly person’s care. It used to be that an hour was allocated to each person, maybe up to 3 times per week. Now with agencies taking over the care you are lucky if they attend for 8 to 12 minutes at a time. Sandwiches are being made for lunch at 7:30 in the morning. Lorna said that Dunoon Community Council have invited Cath McCloone to speak about this issue so it would be really worthwhile for people to participate in the Community Council Meeting. Action Susan to send out details of meeting.

Bruce acknowledged that since the decision to go with private carers was taken there have been issues with not enough time spent with each client.

Lorna said that the issue is also being discussed at the Reshaping Care for Older People local implementation group.

Lorna suggested that we put out a paper saying – this is what we expect to see and this this how we want to be involved.

Viv gave a reassurance that staff at the coal face are working together in an integrated way and are focussed on what the community needs. People can also see that the RCOP project is moving forward in an accelerated way. Lorna stressed that it is important that the strategic level fits into this. Bruce pointed out that Cowal is an extremely good example of how integrated working should be put into practice.

  1. Chair of CLPPF Election

Evelyn explained that she is standing down as Convener of the CLPPF. There are two candidates standing for the position, Peter Galliard and Jimmy Bell. Voting papers have been sent out and the deadline for voting is 9th December. It was clarified that only members of the CLPPF are eligible to vote. Lorna said that people have come forward who are interested in being public reps on other groups and she is talking to them and hopes that they will take part in various groups depending on their interests, e.g. the PCIG and the 24/7 Implementation sub groups. There are currently 10 to 12 subgroups with more in the pipeline. Evelyn asked anyone who has a particular interest to contact Lorna or Susan. Lorna agreed to create a list of the groups and subgroups, put it on the CCCF website and circulate it to CLPPF members. Action Lorna/Susan

  1. MINUTES OF THE LAST MEETING AND MATTERS ARISING
  • Minutes

There was discussion about the meanings of “in attendance” and “present” and who should be in each section. Action Susan/Evelyn to agree the terminology for next minutes.

The minutes of the previous meeting were agreed as accurate with one small spelling correction. Action Susan

  • Mental health

Eileen spoke about the list of questions which had been given to John Dreghorn in August. JD had said that he would speak to the Community Mental Health Team and then get back to the Link Club but they have heard nothing. Action Susan to progress this matter. It was agreed that members of the CLPPF should be invited to the meeting and that Susan would support the meeting by taking notes.

Ian said that he had raised the issue with John Dreghorn about ex armed forces personnel who are being told that they cannot be offered treatment. Peter wondered what reasons were given for refusing treatment. Ian replied that he had been told that his own personal condition was too severe to treat in this area but that he could be offered Cognitive Behavioural Therapy. Peter wondered if other paths to treatment were suggested. Ian said that he had by chance found an organisation in Ayr (Hollybush House – Combat Stress) which diagnosed him with PTSD. The idea with them is that they initiate trauma work and this is carried on by local CPNs but in Cowal the CPNs are saying that they are not qualified to do this. Peter thought that this sounded unethical and Viv felt that it was important that individual solutions were found rather than saying we can’t help you and leaving it at that. Ian said that the Link Club is planning to start a group for ex service personnel. Evelyn thought that it was important that local mental health professionals refer people onto others who can help them. Ian said he knows of about 15 ex service personnel in the local area. It was agreed that this issue could be discussed with John Dreghorn at the Link Club meeting.

  1. Cowal Services update

Viv’s report

Viv said that she will circulate a report of what is happening in the locality grouped by category and a report on the patient questionnaire regarding CowalCommunityHospital. The results of the questionnaire are predominantly extremely positive and any negative comments are being looked at with the goal of improving services.

The other really important document received recently is the Audit and Inspection report on older people’s care in acute hospitals. This included community hospitals for the first time this year. This is a very detailed and very positive report with high percentage scores achieved. The inspection team were from outwith the area. Action Viv to circulate these reports via Susan.

Bruce wondered if this report should be shared with the press. Viv said that David Ritchie (Communications Manager) has been talking to Colin Cameron of the Dunoon Observer about having a regular feature and is waiting for a response about how we go forward. Viv agreed that this report was the sort of thing that should be summarised and put into the local paper. Evelyn was concerned that the local paper are wanting the NHS to pay for articles. Bruce felt that this kind of article should be free and should be published as a good news article to balance out previous bad news articles. Heather said that part of the Comms plan being worked on is the development of a good relationship with Dunoon Observer. Evelyn, Viv and Heather all felt that this relationship had already improved. Eileen mentioned that Stewart Peterson had attended the last CLPPF and produced an article following this. She wondered if he needed permission for this article – the answer was no. Heather expressed the concern that the NHS does not always present information in a user friendly, plain English way and that this was something which we are trying to change. Viv felt that we should discuss approval of NHS related articles before publication with Dunoon Observer

  • 24.7 Implementation of Out of Hours and GP hospital Services

We have successfully recruited an additional salaried GP, started 30th September. He is part of the new model working a 1 in 3 rota which works across the hospital, the wards and casualty over a 7 day period 8am to 6pm. There are now 2 doctors in post to cover this. This is slightly different from the model approved in Dec 2013 where the CHP agreed 2 doctor cover in the wards until 1pm with one doctor after this. Heather noted that this is an enhanced service.

Raymund asked if the 1 doctor on duty overnight for the hospital could be called out to home visits. Viv said yes and that this was no change to the current situation. She pointed out that there would be a nurse practitioner and senior nursing staff on duty at the hospital overnight. It is hoped as part of the new model that there will be a rural doctor available overnight to support the doctor at the hospital, ensuring that there is always a doctor at the hospital, but this has not yet been agreed as negotiations are ongoing with rural doctors. Heather felt that the issue of a doctor being on duty at the hospital at all times is an important part of the model and hopes to have a meeting with Dr Paterson and Viv to discuss this, looking at past statistics.

Rural doctors and Out of Hours service – Viv is still in negotiations.

Eileen raised the issue that there is no Place of Safety at the hospital after 6pm and at weekends. Viv said that this was not strictly true and that the doctor attending could decide that a place of safety was either at the patient’s home with appropriate support or at the hospital. She agreed that there is sometimes a gap in the service and said that this can be due to staff issues – CPNs not being available or limited staff cover at the hospital. There is also an issue with transport to the Argyll & Bute Hospital. John Dreghorn is looking into this.

Argyll and Bute are providing a retrieval service commencing in Dec/Jan which means that from 10am to 10pm 7 days per week there will be a dedicated mental health retrieval service from Lochgilphead to the localities with escort.

With regards to OOH mental health services Viv reported that mental health crises out of hoursremain low in number but complex to address

A rural fellow has been recruited – Dr Aaron Donald will be half funded by the NHS and half funded by NHS Education Scotland. He is a qualified doctor who wants to develop his skills in rural medicine. He started 2nd September and has been working at the hospital and at Kames Medical Centre. He is settling in very well and will be here for 11 months.

2 public events were held recently at Tighnabruaich and Strachur to update rural patients on the progress of the Implementation.

Eileen noted that the psychiatrist who took over from Dr Sandler is leaving and asked if his job has been advertised. Viv said yes we are actively recruiting and that she has an update from Dr Ferguson Action Viv to circulate this response via Susan.

  • Cowal CommunityHospital Update
  • Everything is fine in the wards and hospice with regards to admissions.
  • Several nursing staff retirals this year; all posts have been or are in the process of being recruited to and the skill mix will not be changed.
  • About to set up touch screen booths –to record patient satisfaction – asked if we want to trial it for free by local development company. There are also tablets that can be used in the ward with patients. Evelyn wondered if this could be used to collect patients’ stories – Viv thought this was a good idea and will look into it. Action Viv
  • Reshaping Care for Older People

The extended community care team are working from 8am to 8pm seven days a week; predominantly nurses and technical assistants. Looking at extending physiotherapy and occupational therapy to a seven day service, looking at this on the ward in the first place. Rapid response mobile phone number is now available for access to the extended community care team – number is available through casualty staff, GPs, Scottish Ambulance Service and Social Work staff. Number is for use by statutory services, not general public.

Introduced the Community Ward for patients receiving a high level of care in the community. Patients are monitored twice weekly with multi-disciplinary meetings. This is an exciting development as very few people are doing this across Scotland and we are one of the first to be testing it out.

Training underway at the moment around patients who need additional fluids – instead of bringing patient into hospital for an intravenous drip fluids can be administered in the community through a subcutaneous drip while patient sleeps.

Also training underway in IV antibiotics – giving nurses training to give IV antibiotics at home.

Bed occupancy and length of stay statistics – January 2012 average length of stay was 19.1 days and in September 2013 was 8.5 days. A lot of factors have contributed to this including the “patient at a glance” noticeboard work.

Aileen wondered if patients who are getting out of hospital more quickly are receiving adequate care in the community. Bruce reassured the meeting that the 8-12 mins spent with the client is not the norm. Aileen accepted this but stressed that there is an issue with quality of care and time of care in some instances. There was some discussion around this and it was felt that in Cowal the process of discharging patients and ensuring continued care is done well in general. Viv pointed out that the ECCT are available to step in for a period of 6 to 8 weeks after discharge as appropriate based on individual assessment.