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DRAFT MINUTE of MEETING of the
AREA PARTNERSHIP FORUM
Board Room, Assynt House /16 March 2007 – 10.30 am
PresentMr Ray Stewart, Employee Director (Joint Chair)
Dr Roger Gibbins, Chief Executive (Joint Chair)
Dr Eric Baijal, Director of Public Health
Mrs Sheena Craig, General Manager, North Highland CHP (by VC)
Ms Diane Fraser, RCN
Mrs Anne Gent, Director of Human Resources
Mr Malcolm Iredale, Director of Finance
Mr Nazir Lalmahamode, RCN
Ms Margaret MacRae, RCN
Ms Kate McAulay, Argyll and Bute CHP
Mrs Phyllis McRae, RCN
Mr Adam Palmer, UNISON
Mr Douglas Seago, Head of Facilities
Mr Hamish Stewart, SoCP
In
AttendanceMrs Margaret Aburn, Personnel Support Officer
Mrs Ruth Cleland, Head of Internal Communication
Mr Tony Cowan-Martin, Service Development Manager (OH and H &S)
Mrs Pamela Cremin, Workforce Planning Manager
Mr John Huband, Head of Employment Services and Recruitment
Ms Heidi May, Director of Nursing
Mrs Caroline Parr, Partnership Support Officer
Ms Linda Rawlinson, Senior Nurse Manager, Occupational Health
Mr Philip Walker, Head of Personnel and Staff Development
Mr Brian Mitchell, Board Committee Administrator
1APOLOGIES
Apologies were received from Fiona Dane, Helen Duthie, Jessie Farquhar, Aileen Gardner, Derek Leslie, Catherine Mackay, Nigel Small, Christine Stewart, and Andrew Ward.
2MINUTE OF MEETING HELD ON 19 JANUARY 2007
The Minute of Meeting held on 19 January 2007 was Approvedsubject to the following amendments:
- Add Tony Cowan-Martin to list of Apologies.
- Add Margaret MacRae to list of Apologies.
The Committee agreed to take the following Items at this point in the meeting
4REVIEW OF NURSING IN THE COMMUNITY
Ms May advised that NHS Highland had been accepted as an Early Implementer Site, following a review by the Chief Nursing Officer. The review had been undertaken as a result of population profile changes, the implications of implementing Delivering for Health, sustainability issues, and changes in community nursing. In Highland in particular there existed an older profile among nursing staff, especially in respect of community nurses. The findings of the review had indicated that the range of roles that existed, especially in urban areas led to rigidity among staff and the work undertaken leading to delays in access to appropriate care professionals, confusion for patients as to who to approach, a level of uncoordinated care and Health promotion activities, and a reactive care environment as opposed to one that was proactive. The outcome was the proposed creation of a single Community Health Nurse (CHN) role, with the exception of the Community Psychiatric Nurse role which would continue, and NES were scoping the necessary competencies required and appropriate training needs. The proposed service model showed CHNs undertaking the majority of work supported by Community Staff Nurses, Health Care Support Workers, and appropriate administrative support. Mr Palmer queried as to whether the role of Health Care Support Worker would be appropriate and provide opportunities for staff from GlencoeHospital and Ms May confirmed that would be considered. The issue of a progression model for staff was being considered with the Workforce Planning Team. Ms May added that a Practice framework would encompass the core components of the proposed role, which would be a skilled generalist one, providing a first point of contact for the public and based on health care rather than illness, and caring for families as opposed to individuals. In terms of opportunities for the organisation there would be a single point of access to a flexible and responsive service, building on current practice; that promoted a public health approach, provided an improved career structure, and helped develop whole systems thinking. The key challenges that would face Ms May, as Director of Nursing, were in relation to helping staff buy-in, joint working arrangements, training requirements, the overall task in NHS Highland given the size of the organisation, liaising with the Nursing and Midwifery Council, and maintaining all other duties. Mr R Stewart emphasised that local involvement would be key to driving the project forward.
Mr R Stewart queried as to the total number of Community Health Nurse posts that would be created given that that Community Staff Nurses would be undertaking a proportion of the workload. In response Ms May advised that matters such as Out of Hours provision would have an effect on numbers as would the issue of role extension and as such this was not yet quantifiable. Mr H Stewart raised the matter of increased paperwork and was advised that this was why administrative support would be available. Mr Palmer raised the issue of resourcing the Review and was advised that whilst finances were available for the project the matter of staff training would require to be costed. Mrs Cremin stated that these costings required to be robust given the financial implications involved.
Ms May also confirmed that she would be seeking staff side involvement in the local implementation group and would contact Mr R Stewart with regard to this.
The Forum Noted the position.
3.4TOBACCO POLICY
Dr Baijal spoke to the circulated revised draft Tobacco Policy, advising that implementation would require staff and management working together to bring about a culture change. The proposed Policy went beyond current legislatory requirements and would apply to everyone using NHS Highland sites including staff, patients and visitors and was to be introduced with the aim of improving the health of all. Information and support would be provided and one point that was emphasised was that approximately 85% of carcinogens contained within tobacco smoke were undetectable, and difficult to dilute, even in the open air. It was proposed that, after implementation, there be an annual review to monitor and evaluate the success of the Policy. Dr Baijal requested that any comments on the draft Policy be referred to him in early course. Mr Seago stated that one of the major issues for consideration had been in relation to those patients with long term tobacco dependency and Section 6 of the Policy, relating to exemptions now included an appropriate statement that managers could provide a suitable area which met legal requirements for vulnerable, anxious or distressed patients. Mr R Stewart expressed concern that the Policy would not be workable, especially on larger sites, and Dr Baijal stated that while people would make a choice as to whether they abided by the Policy the key aspects from an organisational view were to emphasise the principle and seek to set a standard. An implementation plan would be required and Mrs Cleland stated that there would be a need for a reasonable period of awareness raising for staff, patients and the public. Mr Lalmahamode raised the matter of psychiatric facilities and was advised that unless these were designated as such then provision of an appropriate area would require to be located outside. Ms Fraser referred to the issue of home visits and the requirement for patients to refrain from smoking 1 hour prior to such a visit, queried whether this would be enforceable, and stated that there was an issue of idealism versus pragmatism whilst getting the broad message across. Ms Fraser asked whether there would be support for staff undertaking home visits that refused to treat individuals on the basis of their smoking regimen; Dr Baijal stated that this was a matter of clinical judgement, and Dr Gibbins reminded that there existed a duty of care to patients although acknowledged that there should be a procedure and support established for those instances where a repeated problem existed. Mr Cowan-Martin stated that there was a need for the rights of staff members to be explicitly outlined in such cases and circumstances.
Mr Palmer stated that as well as having a duty of care to patients the organisation had a duty to provide a healthy and safe environment for staff. He also referred to the matter of reviewing the Policy after a year and stated that this had not occurred for the existing policy. Mr Palmer stated that the unnecessary introduction of this policy extension was likely to raise a number of issues, queried the risk level involved in smoking out of doors in terms of smoke dissolution by wind and rain etc, and stated that he saw no issue in providing discrete areas for smokers. Dr Baijal stated that the proposed extended Policy Introduction was not an arbitrary one, other NHS Boards having introduced total bans, and that the issue was making a positive step as a health care organisation. He added that the matter of smoke dissolution had been evidence based in terms of air quality etc and reminded that a review was to take place in relation to the success of the Policy. Mrs Gent emphasised the importance of learning from the Argyll and Bute CHP where a total ban had previously been introduced. Ms McAulay advised that the Argyll and Bute Local Partnership Forum had been mixed in their views and that the main issue that arose was in respect of appropriate enforcement. She suggested that the success of the policy in Argyll and Bute be evaluated prior to introduction Highland wide.
The Forum:
- Noted the revised draft Tobacco Policy.
- Noted that comments should be relayed to Dr Baijal in early course.
6CHILDCARE VOUCHER PROVISION FOR STAFF
Ms Aburn spoke to the circulated report regarding implementation of a Childcare Voucher Scheme for staff and advised that this was a cost neutral way of employers assisting employees with the costs of childcare, with NHS Highland one of the few employers who did not provide such a scheme. The scheme operated through salary sacrifice and employees could opt to do this for up to £55 per week or £243 a month of their salary, Income Tax and National Insurance free. Additional vouchers could be purchased although these would not attract Income Tax or National Insurance relief. There would be a need to provide suitable information for staff in relation to associated Tax Credits and also establish the position for those on Disability Benefit. The organisation could limit staff to taking the maximum deductible amount so as to ensure no additional work would be required in the completion of P11D forms by the Pay Unit. A Sub Group of the Area Partnership Forum had been established, had met with three providers in the forefront of Voucher provision and following presentations had established that Accor Services would be the most suitable to administer a scheme in NHS Highland. Enquiries were being made with the Finance Service as to whether the normal tender process could be waived in this respect. The report detailed the staff input required to administer the scheme along with an indication of the associated costs and it was confirmed that it would be possible to isolate the savings made from each Departmental Staffing Budget and extract this into a pool in order to cover the costs of administration, and demonstrate savings. In conclusion it was considered that the implementation of a Childcare Voucher Scheme would be of benefit to the organisation and staff and would be a cost effective manner to meet some of the requirements of the Support Work-Life Balance PIN Policy. This would promote NHS Highland as an employer of choice and aid in the recruitment and retention of staff.
During discussion it was advised that NHS Highland collaborated with Accor in relation to the provision of eye care vouchers. With regard to the proposed scheme it was confirmed that childcare would relate to children of school age, the vouchers would be non-transferable, the scheme would be overseen by Customs and Excise, and that vouchers would be applicable for after school care providing the childcare provider in question accepted these. Mr Iredale stated if that agreement was given to proceed there was a need for monitoring and evaluation of the administration involved given the other schemes in operation and advised that in terms of implementation the biggest issues would arise in relation to exceptional cases.
The Forum:
- Approved the implementation of a Childcare Voucher scheme for staff.
- Approved the selection of Accor as the service provider.
- Noted that advice as being sought in relation to the tender process.
Margaret Aburn, John Huband, and Philip Walker left the meeting at 12.15 pm
10HEALTH IMPROVEMENT
10.1Pandemic Flu Report
Dr K Oates spoke to the Committee and advised that NHS Boards had been asked to plan for a pandemic flu outbreak that would affect 25% of the population and result in a 0.5% death rate. He stated that Avian Influenza was still a matter of concern and that to date there had been 278 cases worldwide, with a 60% mortality rate. Experts predict that a strain of the disease would turn pandemic in nature and would take six to eight weeks to reach the UK. With regard to mortality in such cases it was reported that as the disease became wider spread the associated rate would drop. Dr Oates advised that planning would be on the basis that one in four members of staff would contract the disease and that 6 – 10% would be absent from work at any one time. As staff numbers decreased patient numbers would be increasing and there was a need to consider how crucial areas of care would be delivered. In addition it was likely that schools would be closed during an outbreak and this would have an associated impact on available staff numbers. In terms of service to the public a national Flu Line would be established and anti-viral drugs, not vaccine which would take up to six months to produce, would be available for collection by the individual having received an appropriate identifier from the Line. These anti-viral treatments would not be prioritised and only be given to those displaying symptoms. Complicated cases would be referred to a GP or specific centre for assessment. In terms of existing planning arrangements training was to begin shortly in respect of the use of FFP3 masks and the first to receive this would be ICU and Paediatric staff. On a national level a Group had been established to look at workforce arrangements including flexible working, the employment of retired staff and extending existing working hours among other initiatives; a revised OK Pandemic Plan was to be issued later that day. During discussion the issue of appropriate communication was raised and Dr Oates advised that nationally a great deal of pre-planning had taken place and that locally this would be through the Intranet service,in respect of which the Highland Pandemic Influencing Committee would be involved. Mrs Cleland confirmed that there was also a local draft communication plan. On the issue of the likelihood of a pandemic occurring Dr Oates stated that whilst there was no certainty one may have been expected given the time lapse since the last big outbreak.
The Forum Noted the position.
5STAFF SCREENING POLICY
There had been circulated for approval draft Staff Screening Policy for implementation during Healthcare Associated Infection (HAI) incidents and outbreaks. Dr Oates advised that the draft Policy had been prepared following the issue of an HDL instructing NHS Boards to introduce the same. Consultation had raised no issues of concern, the Policy represented protection for staff as well as patients, and was considered an appropriate procedure.
The Forum Approved the draft Policy.
Dr Oates left the meeting at 12.40 pm
3MATTERS ARISING
3.1 Delivering for Health Clinical Framework
There had been circulated letter from the PFPI Project Officer advising that an ‘easy read’ leaflet was in the process of being developed and asking for members of the Forum to suggest areas of concern that could be addressed within that document. Mrs Cleland advised that the Clinical Framework was now available on the Intranet site and that GET WISE staff events were to be held.
The ForumNoted the position.
3.2 National Shared Services Project
There had been circulated copy letter dated 14 March 2007 from the Director of Finance to relevant staff members advising as to the current position in relation to the National Shared Services Project following consideration of the Full Business Case. Mr Iredale advised that in terms of staff there was full representation on the Project Board and the local NHS Highland Group.
The Forum:
- Noted the circulated letter.
- Agreed that relevant national information be circulated as and when any new information became available.
The Committee agreed to take the following Items at this point in the meeting
8FINANCIAL POSITION
8.1Year End Position 2006/07
There had been circulated report by the Director of Finance detailing the in year financial position for the period to 31 January 2007, which had been considered by the NHS Board at their meeting held on 6 March 2007. Mr Iredale advised that there was a projection of a £6.9m underspend for the financial year and that operationally a break even position was forecast. Accounting practice had resulted in the £4.6m non-recurrent benefit to the Board, emanating from the sale of surplus sites at Craig Dunain, being accounted for in 2006/07 and carried forward as a surplus to 2007/08. Of the reserves being carried forward this included approximately £2m from Pump-priming funds. There had been good progress made by operational units in relation to improving revenue performance and this had improved by some £670,000 on the previous month.