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APPROVED

MINUTE OF THE MORAY COMMUNITY HEALTH AND SOCIAL CARE PARTNERSHIP

FRIDAY 16th March 2012

Spynie Dental Centre, Elgin

Present

Mr Charles Muir (Chair)NHS Grampian

Mr A Fowlie, General Manager MCHSCP

Mrs J Mackie, Head of Community CareMCHSCP

Mrs Elaine Brown, Service Planning LeadMCHSCP

Mrs Tracey Gervaise, Public Health LeadMCHSCP

Dr Jamie Hogg, Clinical LeadMCHSCP

Mr James Walker, Community RepresentativeMCHSCP

Mr Sandy Henderson, Community RepresentativeMCHSCP

Mr Bob Sivewright, Finance ManagerMCHSCP

Mr Ken Hamilton, Business ManagerMCHSCP

Councillor Lee BellThe Moray Council

Councillor Anne McKayThe Moray Council

Councillor John SharpThe Moray Council

Deborah O’Shea, Finance OfficerThe Moray Council

Christine Lester, Non Exec Board MemberNHS Grampian

Ali Walker, Clinical Directorate Services ManagerNHS Grampian

Mr Simon Cole, Clinical DirectorDr Gray’s Hospital

In Attendance

Liz Tait, Clinical Governance Coordinator; Sandy Thomson, Lead Pharmacist; Lorna Campbell, Clinical Manager Women and Children’s Health; Elinor Smith, Director of Nursing and Quality; John Campbell, Drug and Alcohol Services; Karen Birse, Area Service Manager SAS; Jill Fletcher, Area Service Manager SAS; Anne McKenzie, Lead AHP; Emma Pettis, Corporate Communications Officer and Isla Whyte, Minuting Secretary.

Apologies

Apologies were intimated on behalf of Ms Brigid Aitken, Endoscopy Nurse Practitioner; Ms Anne Cheyne, Community Learning Disability Team; Mr Sandy Riddell, Director of Community Services; Helen Milnes, Interim Chief Officer, Mr Sean Coady, Community Health Services Manager; Mr Lloyd Griffiths, Optometrist; Mrs E Bush, Director MVSO; Councillor Ron Shepherd; Mrs Amanda Croft, Hospital Manager; Councillor Anita McDonald, Ian Francis, Senior Partnership Rep and Dr Graham Taylor, GP.

  1. Welcome

The Chair welcomed all to the meeting. He advised that December’s meeting was cancelled due to forecasted adverse weather conditions and that items due to be discussed will be covered in today’s agenda. Mr Muir welcomed colleagues from Scottish Ambulance Service (SAS) and Anne McKenzie, Lead AHP, to their first MCHSCP Committee meeting. Mr Muir also welcomed members from the local press and advised that the Committee meeting would finish by 11.45am as Board Members will be video conferencing to a specially convened meeting in Aberdeenat 12noon.

  1. Minute of the Moray Community Health and Social Care Partnership Dated
    16th September 2011

It was highlighted that Dr Jamie Hogg was recorded twice under present and that Deborah O’Shea was present at the meeting but not recorded as attending. Minute will be updated accordingly.

The Minute of the meeting of the Moray Community Health and Social Care Partnership dated 16th September 2011was then approved as an accurate record of the meeting.

  1. Matters Arising

a)Community Care Redesign

Jane Mackie provided a brief update following the paper presented at September’s committee – work has been ongoing for sometime now and is due to complete for 1st April 2012. The 4 community teams have been reconfigured and areas will now be covered by 3 Team Managers - Moray East (Buckie, Keith, Speyside), Moray West (Forres, Elgin, Lossie) and Access Care Team.

The Access Care Team provides a quicker more responsive service for all adult community care. All partners will be given new contact details and information as to why changes are being made. All teams are working hard to ensure a smooth transition. The Access Care Team will be moving into the new Moray Council Annex shortly; a very central location. Final arrangements for re-ablement will be put in place soon. Christine Lester asked when changes will actually happen. Jane confirmed new processes will start on2nd of April 2012.

b)Assistive Technologies –DALLAS

Andrew advised there has been a lot of progress made around assistive technologies – specifically for Moray. The Lifescience Centre has recently been granted permission to build and will be called The Alexander Graham Bell Lifescience Centre, it will be the UK’s, and potentiallyEurope’s first, Lifescience Centre for assistive technologies. The centre will create new jobs in the area and potentially bring new companies. STV have agreed to make two new television programmes about assistive technologies - they are here in Dallasthis morning filming and will be in Dr Gray’s Hospital this afternoonmaking Vox Pops(short films) on patients’ views around assistive technologies - thesewill be screened later this year. A number of projects are running concurrently around telehealth/telecare ie invisible body worn technologiesfor management of COPD. ‘NoDelays’ - an approach that seeks to move away from referral based health care (GP to Specialist) to a more real time decision making system. Within Grampian a proposal to try out (test of change) the process with G.I. Medicine at ARI / Dr Gray’s Hospital has been developed Virtual Ward – apply geomapping to sequence and optimise primary care team support, decision making and resource allocation. Moray CHSCP recently entered a competition for Delivering Assisted Living Lifestyles at Scale – 148 entered the competition and MCHSCP are down to final 7, a decision will be made in May 2012. Two projects are in place at the moment the first is called Living It Up (all about connecting via TV / mobile phones etc to health and care services in your area. The 2nd project is called Year Zero – which is around digitalising the red book which is issued to parents shortly after birth of baby.

  1. Performance

a)CHSCP Performance

A colour coded performance and risk table updated for March 2012 was issued with papers. Red shows areas with significant risks that CHSCP are working on to reduce. Amber represents a moderate risk and green areas depict the CHSCP are performing well against targets.

Integrated Care & Supporting Independent Living – on track in terms of redesigning services to ensure target continues to be met. Introduction of self directed support where clients determine their own care needs / care package. A resource allocation system has been designed to establish what budget clients will receive – this will be enacted and improved by next Summer. Continuing extensive home care training. Continuing with roll out of telecare to support individuals to be more independent. Older people’s pathway of preventative and anticipatory care successfully rolled out. The Chair asked members if there were any questions. Jill Fletcher advised that the SAS are keen to get involved in anticipatory care to reduce hospital admissions.

Effective Care Pathway– 7Clinical Pathways are now agreed between primary and secondary care. Two are in relation to orthopaedics, 1 in relation to GI services and 1 in relation to each of the following - older people, heart failure and COPD. The 7th pathway is for those who attend A&E departments – for moray this is Dr Gray’s Hospital. How people use the hospital will be established and a review of access to day time services will take place. A pathway can then be designed which begins to help meet peoples’ needs in a different / more effective way.

Better Care Without Delay – BCWD describes the process in which the public access services. Challenge for Moray is similar across Scotlandand is around orthopaedics – dealing with as well as we can. Jill Fletcher said she will liaise with Jamie Hogg to ensure SAS are part of any discussions. Jim Walker asked if there is an orthopaedic review taking place in Grampian and if so are patients involved, he added he is aware there are issues around the type of knees and hips that are used and the complexity of nursing involved. Andrew confirmed there is a review taking place which is being led by Dr Pauline Strachan, Chief Operating Officer for NHS Grampian, and has a number of areas of focus and the public have been involved in a number of aspects via public reps. One of the key national programmes is the development of a National Musculoskeletal Programme which aims to bring about significant service redesign to improve the delivery and outcome of musculoskeletal services across Scotland. The redesign focuses on improving access to services by establishing a centralised self referral triage system utilising the technology within NHS 24, which is the national telephone and web based advice service for NHS Scotland. The aim is also to develop tele-rehabilitation opportunities as well as specific web based rehabilitation resources. Anne describedthe MSK Hub within Physiotherapy – there is pathway for GPs to refer to this process, physio are working in conjunction with orthopaedic surgeons. Patients can be referred for x-ray on same day and decision made and GPs can refer urgently directly to surgeon if required. Good success since starting in February 2012 and Anne confirmed they will now carry out an assessment of patient satisfaction. Simon Cole advised Dr Gray’s Hospital have appointed another orthopaedic surgeon and a new technique that involves an image guided implant is being used in Dr Gray’s with success for last 13 months. Joint replacements – knee and hip are procured NHSG wide. Emma Pettis confirmed NHS Grampian do not use metal implants. Anne confirmed self referral to physiotherapy is still available for patients – all information is available in GP waiting rooms.

Primary Care Contract Development and Third Party Commissioning of Services – steady progress is being made. Scottish governmentcontinue discussions around Scottish GP Contract. Contract with community pharmacists is also underexamination.

Maternity Child Health Services – substantive item on today’s agenda. Alot of work around smoking cessation in pregnancy and support for young mums (16-22yrs) is taking place. Positive feedback was received fromthe recent Child Protection Inspection – report will be published on the 14th May, can feedback at next meeting.

Mental Health Substance Misuse – substantive item on today’s agenda. Launched alot of work around dementia – increasingly a large part of Health and Care Partnership work.

Health Improvement & Health Inequalities–continue work around reducing inequalities. Work in Forres continues with health improvement and scoping work being carried out to support the area through transition of RAF to Army.

Patient & Service User Safety and Improving Quality of Care Management–work in relation to modernising our community care services underway. Recently profiled our work at National conference in south Scotland re safer processes for drugs and handling communication between GP Practices and patients. Care of older people /safety –continuing to improve quality for those in hospital. Liz Tait advised that Older People in Acute Care Standards and Dementia Standards are two different standards. Dementia Standards – have appointed a nurse consultant in Grampian for dementia and a sub group in Moray has been set up to assess against standards and develop an action plan – they are working closely with Moray council colleagues. Liz informed the committee that Alzheimer's Society has launched a leaflet called ‘This is me’ for people with dementia who are going into hospital.‘This is me’ is a simple and practical tool that someone going into hospital can give to staff to help them understand the condition. It provides a 'snapshot' of the person with dementia, giving information about them as an individual, such as needs, preferences, likes, dislikes and interests. Diane Vass, Senior Charge Nurse at Dr Gray’s Hospital, leading training for staff. The Chair confirmed the pilot is run by full health improvement Scotland team.

Cllr Bell said he felt it important to convey to the general public that pharmacists can provide good support and advice. Sandy Thomson added pharmacists are increasingly getting involved with LTC management. Diagnosis is made by GP or clinician and pharmacist can support and help manage condition.

Jim Walker asked why there was no call for input by the general public in Moray for the recent Scottish Government consultation on mental health. Jim asked how good are we performing in Moray and what feedback are we getting from those using services? Ali Walker advised there had been several local events and there may have been an opportunity missed, Jane added that service user involvement is an area the CHSCP are looking to improve.

Involving the Publicand Improving the Patient and Service User Experience– will take to a future meeting to discuss fully.

Finance – will be discussed later in the agenda.

Infrastructure – Dr Gray’s Hospital Reconfiguration on today’s agenda. Opened Child Protection Unit in Elgin recently.

Workforce Planning and Support Change – ongoing across Moray.

b)Financial Performance

Bob Sivewright updated the Committee on the revenue budget reporting position as at 31 January 2012 as per the report and budget statement. Overall position to date is £1.1m overspend, management within both partner organisations are continuing to delivery services in cognisance of service delivery objectives and the overall financial position. To set the context for setting budgets next year Andrew advised that staffing budgets are set a mid pay point, however as many staff are above mid point this creates a pressure. All areas have element built in around efficiency savings. Andrew made the point that they way budgets are set is not ideal, the Budget Setting Group are meeting today to discuss further. Christine asked how bank staff are used in Moray. Andrew replied that external bank staff usage has virtually ceased. There is an internal bank of staff to cover periods of high activity, sickness / annual leave etc usage of this has also reduced. Options to manage these issues include annualised hours and part-time flexible staff. Liz advised that bank staff still need to be called in for unplanned events ie 1:1 care for a patient with dementia or support to assist with patient who is under the influence of alcohol. Senior Manager on-call has the authority to get a bank staff member in. Christine asked how often does this happen, Liz replied not often but staff on ward / Senior Charge Nurse can regularly request that bank staff support overnight unplanned events.

The Chair stated the performance standing item very useful to get aninsight into current progress and challenges and thanked all for their input.

  1. Dr Gray’s Hospital Reconfiguration

Elaine Brown informed the Committee that the AIG (Asset Investment Group) approved the funding to carry out the proposed works at Dr Gray’s Hospital in December 2011 and work started on site in January 2012. First handover takes place in 5 weeks, this is the AHP / Paediatric area situated in the old cherry tree nursery building. Overall project is due for completion in 2013 which means many staff are working in building areas for a approx 1.5 years, will ensure minimal possible disruption for staff. Alongside that there is a process around clinical changes that is being led by Dr Jamie Hogg, Mr Simon Cole and Dr David Williams. The project is very positive for Dr Gray’s Hospital and Moray. Cllr Anne McKay said she recently visited Ward 3 and had a very difficult job locating it. Elaine confirmed that a group islooking at reconfiguration of way finding with patient rep involvement.

  1. Reshaping Care for Older People / Change Fund Plan

Jane Mackie advised that Sandra Gracie was unable to be here today, she went on to say that the report describes current position with regards to reshaping care for older people / change fund. Want to move to support more people to be cared for at home and away from institutions. First year initiatives (2011/12)are at various stages of implementation. Initiatives will be evaluated before funding allocated for 2012/13. The change fund application for 2012/13 was endorsed by the governance committees and signed off by all partners, prior to submission to the Scottish Government by 17 Feb 2012. Require to have a 10year plan, 5 year plan and 1 year plan, this very detailed piece of work is underway at present. Have held a number of IPC events and public consultations and MCHSCP are on track to complete this piece of work by September; consultation will take place in June. Emerging priorities identified so far are dementia, rehabilitation and enablement, early intervention, social isolation, housing support and adaptations. The Chair asked if there were any questions. Christine asked how the change fundwill not double up work. Jane replied there has been/continues to beimmense communication around Scotland. Every area will start from different place even though all have the same goal. Jamie paid tribute to the way in which Jane and Sandra have ledthe process; he added they have laid great foundation for future. Jill commented the SAS would like to be involved in engagement and wanted to know if Falls Care Pathway involved in this. Jane confirmed it is part of this year’s change fund. Anne added that a falls lead has just been appointed. Ken commentedthat the partnership approachwas good and also recognised each CHP needs to do different things as needs are different. The Chair added that a meeting is planned for each CHP to look at all the issues encompassed by the changes that are taking place. That integration meeting will act as a platform to address thesekinds of issues. Cllr Bell agreed with what Jamie and Ken said, congratulating Jane, adding we have a template in Moray to be proud of. Jim said a Which report on home care came out this morning, challenges found there, hope challenges are not relevant to Moray / Grampian and commented there should be a degree of transparency re issues. Jane replied thatin maintaining frail and vulnerable people at home we need to be assured of quality of service and we are very aware that home care is delivered by an individual staff member in own home therefore we have taken approach of very high level training and induction process, she added we do scrutinise our services, user engagement / involvement is very important. The Chair thanked members for their input and congratulated Jane and her team and a very positive report, he reiterate that we also mustn’t become complacent.