Item 9.5 for 6 June 14 ACF - 19 March

APPROVED

NHS GRAMPIAN

Minute of the Area Clinical Forum Meeting

held on Wednesday 19 March 2014 at 5.30pm

in the Conference Room, Summerfield House

Present:

Mrs Linda Juroszek, Chair, Area Pharmaceutical Committee (Chair)

Mr Norman Binnie, Chair, Consultants’ Sub-Committee

Mrs Pamela Cornwallis, Vice Chair, AHPAC

Mr David Corry, Chair, Area Optometric Committee (AOC)

Dr Izhar Khan, Chair, Area Medical Committee (AMC)

Dr Rebecca Riddell, Chair, GP Sub-Committee

Ms Ann Smith, Vice Chair, Area Pharmaceutical Committee (APC)

In Attendance:

Mr Richard Carey, Chief Executive

Dr George Dean, Professional Advisor in Applied Psychology (observer in Dr Moffat’s absence)

Mr Graeme Smith, Director of Modernisation (Item 3)

Mrs Susan Webb, Deputy Director of Public Health

Ms Tracey Leete, Minuting Secretary

Item / Subject / Action
1. / Chair’s Welcome
The Chair welcomed everyone to the meeting.
2. / Apologies
Mrs Jackie Berry, Chair, AHPAC
Dr Roelf Dijkhuizen, Medical Director
Ms Jenny Gibb, Vice Chair, GANMAC
Mrs Jenny McNicol, Chair, GANMAC
Dr Helen Moffat, Vice Chair, GAAPAC
Mrs Elinor Smith, Director of Nursing
3. / Unscheduled Care: Priorities for 2014
Mr Smith circulated a brief progress update on the Grampian Unscheduled Care (USC) Programme and sought views on the priority actions for 2014/15highlighting the following key issues:

Provision of comprehensive system of Clinical Decision Support with the aim to offer 24 hours in the future.
Developing a sustainable, flexible and Integrated USC Workforce
Patient Flow and the creation of new partnerships with local authorities.
Development of ARI as a major trauma centreby 2016.

Committee members highlighted concerns raised at recent Consultant Sub and GP Sub Committees regarding clinical pressures to provide 24 hour care and the decreasing number of A&E Consultantsdue to current vacancies and two recent resignations. The Committee were anxious about the imminent challenges in relation to both the consultant and training grade doctor workforce within the Emergency Department which will need to be addressed by August 2014 to ensure that the service is safe and sustainable.
Mr Smith confirmed that the Scottish Government has decided that ARI will be a major trauma centre therefore NHSG will needto work towards this and ensure the whole hospital is prepared and not A&E only. Mr Carey advised the national message is that nothing should happen before the referendum but clearly short-term measures are required meantime.
The Committee recommended:

The Board recognises this potential risk to patient safety if the identified medical staffing issues are not addressed.
An urgent review of patient pathways and flow at ARI, adopting a whole system collaborative approach, including primary care colleagues.
Implementation of agreed change needs to be prioritised and supported.
There is a need for further patient information and education focussing on appropriate use of ED.
Innovative approaches to recruitment and retention are urgently needed.
Investment and resource allocation to support unscheduled care across NHS Grampian, including both community and acute services must be reviewed to ensure sustainability of safe patient care.

The Chair to include in her report to the Board. / LJ
4. / Minute of meeting held on 15 January 2014
The Minute of the previous meeting was approved as an accurate record following a minor amendment.
5. / Matters Arising
Recruitment
The advisory structure welcomes the ongoing work within the Workforce Directorate to attract and recruit staff. The current situation with shortages of candidates with the right skills, abilities and experience in some NHS professions is exacerbated for NHSG because of its geographical location and the buoyant local economy. The cost of moving to Aberdeen and cost of living is becoming more of a recruitment issue for NHSG.
Dr Khan had received a response from the Cabinet Secretary which unfortunately did not address all the issues raised regarding the recruitment and retention of senior clinical posts in NHSG.
Dr Khan to discuss at next AMC meeting.
Mr Carey suggested the Board paper, where thismatter was discussed, is shared with the Committee.
Child Health 2020 Programme Board
Mrs Webb to circulate update/action plan via Ms Leete. / IK
LJ/TL
SW/TL
6. / Delayed Discharges
Heather Kelman, Aberdeen City CHP General Manager, had circulated a paper to update ACF on the present position and the efforts that are being made to improve the delayed discharge situation. The Committee were asked to consider whether there were any potential solutions which may have been overlooked, to ensure NHSG and its partners maintain the current 4 week target, which is to be reduced to 2 weeks from April 2015.
The Committee discussed delayed discharges and the main challenges including the continued shortage of care home workers particularly within Aberdeen City and increased non-routine hospital discharges and the following was highlighted:

Delayed discharges to be raised at next Board meeting.
Staff Governance paper is to be presented to the Board.
Aberdeen City Council (ACC) has written to the Scottish Government, along with NHSG and MP/MSPs.
The ACC Chief Executive has requested a meeting to formally highlight and raise this issue.
Initial meeting next week with City and Shire representatives and clinicians to look at interaction with NHSG and local authorities.
Former Ward 49 at ARI has recently been opened as a discharge lounge from 8am-8pm weekdays (and some weekend hours) to alleviate the situation and has received positive patient feedback.

The Chair to include in her report to the Board. / LJ
7. / Healthfit 2020 – Clinical Services Plan
Mr Smith circulated a discussion paper summarising the issues related to the preparation of a clinical services plan for consideration by ACF.
The ACF were supportive of the development of a Clinical Services Plan, to determine sustainable service models and the shape of services in the future. Local plans need to take cognisance of national plans around tertiary services, and these are likely to depend on population distribution. However, it is important that capacity within the community is increased to reduce the need for acute hospital care, so there needs to be a realistic appraisal of what can be delivered in the community for our population. A whole system approach is required and mental health services and paediatrics must be part of this plan. The role of public health to further develop strategies to improve the health of the population and prevent the continual rising cost of treating preventable disease should not be underestimated.
Essential to the plan will be investment in eHealth and technology. Realistic consideration as to how these can contribute to safe, effective and innovative delivery of care is important. However maintaining electronic systems and working towards improved access for all clinical staff working in the community is a priority for now.
Mr Smith to disseminate discussion paper through the advisory structure to ensure the plan is shaped properly.
The Chair to include in her report to the Board. / LJ
8. / Policy for the management of and learning from adverse events and feedback
The Chair circulated the draft NHSG policy for consultation and asked that feedback be returned to , Risk Management Adviser.
The Committee highlighted the need to include contractors in the policy and once approved to disseminate policy widely.
The Chair to issue Linda Oldroyd, Consultant Nurse Patient Safety & Experiences’ patients stories for information. / LJ
9. / Chair’s Update
The Chair gave a brief update on key events and issues since the last meeting which was highlighted in her summary paper.
Report to Board for April 2014 to include:
-Unscheduled Care
-Recruitment
-Delayed Discharges
-Clinical Services Plan / LJ
10. / Director of Public Health Report
The latest report was circulated for information.
The group working on the HPHS have been tasked with providing key consistent messages that health professionals can discuss with patients. Key messages were to be approved and taken back to ACF.
Mrs Webb to circulate paper to ACF for comment. / SW
11. / Updates from the Advisory Committees
Brief updates from the Advisory Committees covered the following areas:

AHPAC – National Delivery Plan – been asked to input targets (S.Carr to issue).

AOC – New co-ordinator for Teach & Treat Clinics (Denise Smith). SCI Gateway Referral System is now operational in all Optometry Practices albeit some outstanding IT issues. Optometry practices completed a one week audit of all Eye Health appointments at the end of February. Prescription Pads for IP Optometrists still not available despite some gaining their qualification over one year ago – The Chair to follow up.

APC – USC presentation. UTI Pilot in community pharmacy positive.

AMC – Management and clinicians attended to receive clarity re surgical reconfiguration. Email received advising that Prof Pearson to Chair SLWG re transfer. Vacancy issues – assured essential posts will not be delayed. Currently meeting with 15 Clinical Leads re current themes emerging.

GP-Sub – USC presentation. IT systems & Primary Care significant downtime and implications. Prescription for excellence – RR to meet with Medical Director & Pharmacy Director re implications.

/ LJ
12. / Minutes
Recent minutes were circulated for information.
13. / AOCB
The Chair circulated the role and remit of the Transportation Overview Group (TOG) as a request had been received for a representative from the advisory structure to join this group. Mr Carey clarified that it did not need to be an ACF member. The Chair agreed to attend the first 2 TOG meetings in the first instance.
14. / Date of Next Meeting
The next meeting will be held on Wednesday 14 May 2014 at 5.30pm in the Conference Room, Summerfield House.