Minutes of Better Health, Better Care, Better Value

Cowal 24/7 New Model Operational Sub Group

10am, Wednesday 30thOctober 2013

Meeting Room A01,Cowal CommunityHospital

1. Present:Lorraine Paterson, Chair & CSM

Sheila McKechnie, Community Nursing Team Lead

Karen McMillan, Senior Charge Nurse, Casualty

Susan Wilson, Rehab Team Lead

Evelyn Hide, CLPPF Representative

Mhairi Cossar, Interim RotaAdministrator

Kate Stephens, Kyles Community Council

Andy Brady, Scottish Ambulance Service

In Attendance:Alison McCrossan, Scottish Health Council

Lorna Ahlquist, CLPPF

Michelle Lauffer – Minute Taker

VC:Charlotte Percival, NHS24 on behalf of William Togneri

2. Apologies:Kathy Graham, Senior Charge Nurse, Wards

Kirstin Parker, Service Planning & Contracts Manager

Caroline Cecil, Planning & PublicInvolvement Manager

Clare Rumgay, OOH Hub

Gaye Boyd, Personnel Manager, HR

William Togneri, CSM, NHS24,

North Highlands & Islands.

Lorraine welcomed everyone and introducedCharlotte Percival to the group, who joined the meeting via video conference.

Topic / Action
3. Previous Minutes
Page 1 – Move Lorna Ahlquist to ‘In Attendance’ and amend spelling of surname.
Page 2 – Matters Arising, Public Events paragraph 2. Delete NHS24 from the sentence as they did not attend the Tighnabruaich event.
Page 4 – paragraph to be added to show that the model that was agreed was that a Doctor would be in the Hospital at all times.
Page 4 – Extended Roles, Nurse Practitioner. Senior Charge Nurse to be amended to Senior Staff Nurse.
Page 5 – Extended Community Care Team. Delete sentence “Sheila said it is hoped the ECCT hours…” / ML to make all amendments to minutes.
4. Matters Arising
SAS, ‘treat & refer’
Andy has not yet provided Karen with the list of conditions as requested but he explained that there are currently 6 or 7 conditions that are being re-evaluated regarding risk levels, so once that work is complete he will provide the information to Karen.
Public Events
Strachur Event – Lorna confirmed this was well attended.
Falls/Unscheduled Care Event - Lorraine advised the group that Susan Wilson was involved in a public event due to take place on the 6th December in the Queens Hall. Susan explained this event was about getting public opinion falls and treating people at home. A poster is due to go out at the end of this week noting all confirmed speakers. The event is for all – public, NHS, private sector, voluntary agencies, SW, SAS etc. 2 Adverts will be placed in the local paper 2 weeks prior to the event. Susan advised the group that the Bute event was a very positive day and that she hoped to set up a joint working group on a falls network after this event.
The group asked if anything could be done about the title ‘unscheduled care’, like give an explanation of what that is on the poster. Susan will look into this.
Alison McCrossan said she was heartened that locally we were pushing for public involvement
Evelyn Hide said more people are not buying the local paper anymore so it can be difficult to get information out to the public. Alison asked if we should consider having a checklist of how we get information out. Who, where, links with paper etc. It is everyone’s responsibility. Lorraine said if the information is sent out to our public representatives then we would hope they use their avenues to get the message out to the public where they can. Lorraine added that discussions with the local paper are ongoing.
Monitoring Reports
Lorna had asked at the previous meeting if it would be possible to have public involvement with the monitoring reports. Lorna said one option could be to have the public involved with the patient satisfaction feedback to help combat public cynicism. Lorraine said it may be possible to have volunteers involved with verbal face to face feedback.
Lorraine advised the group that she was looking into a pilot scheme for recording patient/family/carers satisfaction via touch screen using emoticons. Specific questions would be developed for this.
Communication & e-links
Charlotte said both NHS24 & ‘Know who to turn to’ Campaign & NHSINFORM e-links would be useful to have on the Cowal 24/7 page. Michelle will ask David to add these e-links.
Lorna highlighted that the link to the CHP Decision document links to a 120 page document. The CLPPF have taken the most relevant information and linked to that.
Alison said that Cowal was fairly advanced in communication but it should continue to be reviewed and improved. Alison & Lorna to discuss possible communications checklist with David Ritchie.
Home Visit Data
Lorraine advised the group that she had just received the home visit data from Tracy Ligema’s office and that Karen McMillan had quickly done a paper exercise to extract some numbers:
PCEC OOH Dunoon & South Cowal
Jan to Sept 2013 – 360 Home Visits (approx 30/40 per month)
PCEC OOH Rural
Jan to Sept 2013 – 43 Home Visits (approx 1 a day)
(highest number of visits was 8 in May and lowest was 1 in January)
Emergency Admissions for 65+ Common Themes data
Michelle has started this, it is in progress.
GMS OOH Response Data – C Rumgay
Lorraine said this could be in the data provided by the Hub today. / ML to ask DR to add
e-links to Cowal 24/7 page.
Communications Group & DR to discuss.
5. Terms of Reference
The group discussed the latest draft terms of reference.
Andy Brady asked if Mark Benton could be removed from the membership.
Karen McMillan asked about ‘implementation’ wording. What it means if it is to be kept in the TOR. Lorraine said she would take it back to the Implementation Governance Group for a response. / ML to amend TOR.
LP to ask Implementation Governance Group.
6. Operational Subgroup Reports
The summary report for September was distributed & discussed.
Lorraine advised the group that Dr Sabbineni is in post and that the hospital part of the model is up & running, the rural side is still under discussion. Alison said she hopes the negotiations would be complete for the end of the year. Lorraine said the integration side of things is fine but it is terms & conditions and the fact that the whole of Cowal will be expected to be covered which still requires agreement.
In the current model, the Dr from the Hospital would do allDunoon & South Cowal home visits and the rural Dr would only do rural home visits. In the new model the hospital Dr would remain in the hospital and the rural Dr would do all home visits across Cowal.
Extended roles
Lorraine explained that if an extra nurse practitioner was to be put on to allow them to do home visits at night then extra resources would be required to be moved from medical to nursing.
Lorrainesaid this was about looking to the future and future proofing. Most of Scotlandis looking at integrated models.
Lorna commented that the model explicitly states it would develop. Lorraine said there was no information on the CHP paper to say how this would be done financially.
Karen said there had been discussions around the fact that paramedic practitioners may be the best to deal with home visits as the community environment is the environment they are used to working in, while the nurses are based in the hospital. Lorraine confirmed there would be joint working with SAS.
Andy Brady advised the group that he had been set the task of delivering a presentation on all the different types of models. It was agreed it would be helpful if Andy could also deliver this presentation to the group.
Extended Community Care Team – Alison McCrossan asked about the possibility of other partners joining ECCT for extended hours. Lorraine said there was currently no move towards this from other partners. Sheila added that rather than extending ECCT hours up to 10pm, she would prefer to bring AHPs in to extended hours up to 8pm for the moment. Evelyn asked about how the Extended Community Care Team is contacted. Sheila explained that they are available between 8.30am and 8pm. They can be contacted by the one mobile number. The public should phone the usual numbers they would such as NHS24 etc. If NHS24 or SAS are called then they have the ECCT details so would be referred appropriately. Sheila said it would be helpful if there was access to local SW on weekends & public holidays for accessing care packages. / AB to give presentation re models to the group.
7. AOCB.
Paediatric Unscheduled Care–Karen McMillan advised the group that starting on the 1st November, the Casualty department would be able to contact a Paediatric Consultant direct via a dedicated NHS24 telephone linefor advice when they have a very ill child and where further advice is required. They are aiming to answer within 30 secs. The Consultant could be based in either Yorkhill or Edinburgh. The long term plan is to be able to do this consultation via video-conference but unfortunately due to technical difficulties (band width) it has been decided to try first via teleconference and hopefully progress to VC.
Charlotte advised that Grampian has good telemedicine links, they have a Dr based in ECT to avoid admissions, and it may be worthwhile linking in to them. Charlotte will email details; Andy said they had also been in discussions with Grampian regarding paramedic practitioners.
Medical Cover Rota – Mhairi advised the group that it was mostly covered. One gap in February for Ward cover. Dr Campbell & Dr Scott have both reduced their hours so there may be some further small changes.
Recruitment – Evelyn asked about doctors who had been appointed. Lorraine advised the group of 3 appointments. Dr Sabbeninistarted in September for 2 months training and will be implemented into the rota from the 4th November, he covers wards/casualty & OOH. Dr Clive Mast is due to start in March 2014, once he has fulfilled his current contract and will also cover wards/casualty & OOH. A rural fellow has been taken on, Dr Aaron Donald who will cover GP work; hospital & casualty work and is slightly different in that he is attached to rural doctor.
SAS & NHS24 Visit – Lorna advised the group that they were looking for approximately 6 members of the Strachur/Tighnabruaich communities to visit NHS24 & SAS Ambulance Control Centre, both co-located in Cardonald. The planned date is for it to take place on the 23rd November and Lorna expects there to be at least 1-2 cars travelling up.
NHS24 changing their number to 111 from next year.
Integrated Care Scottish Conference – Lorraine advised the group that herself, Sheila and a couple of other colleague's would be attending this conference on Friday, so hopefully more information can be gathered on what other models are being used in other areas. / CP to send details to ML.
Date & Time of Next Meeting
The next meeting will take place at 10am on Wednesday 27th November 2013 in Meeting Room A01. VC facilities are available.

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