NHS BOARD COMMITTEE ANNUAL REPORT 2014-2015 Name of : Area Clinical Forum Chair Andrew Docherty, Consultant Cardiologist Members Tyra Smyth Maureen Lees Claire James Gordon Stewart Mike Devine Mhairi Simpson Campbell Chalmers General Medical Practitioner - Vice-Chair, Area Medical Advisory Professional Lead for Dietetics - Chair, Area Allied Health Professions Advisory Podiatrist - Area Allied Health Professions Advisory General Dental Practitioner - Chair, Area Dental Advisory Director, Public Dental Service - Area Dental Advisory Nurse Consultant, Cancer Care - Chair, Area Nursing & Midwifery Advisory (From April 2014) Nurse Consultant, Stroke - Vice Chair, Area Nursing & Midwifery Advisory Frank Munro Optometrist - Chair, Area Optometric Advisory Julia Hunter Yvonne Williams Gail Richardson Paul McKenzie Optometrist - Vice Chair, Area Optometric Advisory Community Pharmacist - Chair, Area Pharmaceutical Advisory Head of Pharmacy, Wishaw General Hospital - Vice- Chair, Area Pharmaceutical Advisory Clinical Psychologist - Chair, Area Psychology Forum (till June 2014) 1
Suzanne Walton Gary Tanner Clinical Psychologist Chair, Area Psychology Forum (from February 2015) Professional Lead for Psychological Services - Area Psychology Forum Officer Attendees: Neil Agnew Pamela Milliken Iain Wallace Board Secretary Head of Clinical Governance and Risk Management Medical Director Meetings held during the year: Meetings where held on: 24 th April 2014 9 th June 2014 21 st August 2014 23 rd October 2014 18 th December 2014 19 th February 2015 The Work of the during the year 1. Annual Review 2014 : Area Clinical Forum members participated in dialogue with the Minster for Public Health when he presided over the NHS Lanarkshire Annual Review in November 2014. The focus of the discussion was the Area Clinical Forum involvement in the planning processes, and Members were able to comment positively in this regard. 2. Finance : Members considered regular reports on Financial Performance, and offered for consideration proposals for potential efficiency gains. 3. Healthcare Improvement Scotland (HIS) Rapid Review of Safety and Mortality and Hospital Standardised Mortality Ratio (HSMR) Programme Plan : Over successive meetings, Members considered progress reports on the delivery of the HIS/HSMR Programme Plan for implementation of the recommendations arising from the Healthcare 2
Improvement Scotland Rapid Review of Safety and Mortality which reported in December 2013. 4. Integration of Health and Social Care : Throughout 2014/15, work continued in response to the Public Bodies (Joint Working)(Scotland) Bill, for the Integration of Health and Social Care. The Area Clinical Forum took a keen interest in the progress of arrangements, with particular regard to the setting up of Transition Integration Boards for North and South Lanarkshire, and the appointment of Chief Officers for both Partnerships. In the latter part of the year, Members had an opportunity to engage with the Chief Officers along with members of the Scottish Government Joint Improvement Team. 5. Clinical Strategy : Area Clinical Forum Members received an update on the development of a Clinical Strategy for Lanarkshire, and the processes through which its continued development will be taken forward. Allied to this, Members also received a helpful update from the Director of Strategic Planning and Performance about Strategy and Capacity. 6. Access : Waiting Times and Unscheduled Care were the subject of reports to the Area Clinical forum, and were also considered regularly by the Area Medical Advisory. 7. Primary Care Out of Hours Services : The Area Clinical Forum received reports on the performance of the Primary Care Out of Hours Service, and the outcome of a review of the service, against a backcloth of continuing challenges associated with populating doctor rotas and maintaining safe services across the 3 Primary Care Centres and the 2 Satellite Centres. The Area Clinical Forum had an opportunity to consider the proposals for the future delivery of the service, and submitted a response to the consultation on options, as did other key Professional s. 8. Director General, Health and Social Care : The Area Clinical Forum facilitated a meeting of Senior Medical Staff Associations with the Director General, Health and Social Care and Chief Executive of the NHS in Scotland. Discussion covered a number of key areas, including: the move to Health and Social Care Partnerships, and their contribution to reducing delayed discharge; planned change based on safety as a primary consideration; recruitment of additional nursing staff for Acute services; the need to maintain safe staffing levels. 9. Health Promoting Health Service : Members considered presentations on the progress of the Health Promoting Health Service initiative in Lanarkshire, and noted the successes achieved to date and the further challenges. 3
10. Medical Staffing : Consideration was given to reports on Medical Staffing, which demonstrated areas of success and areas of continuing pressure, particularly in Emergency Medicine. It was encouraging that these pressures and challenges are reported and recognised at Board level. 11. Patient Safety Strategic Prioritised Plan : Members considered and endorsed the Patient Safety Strategic Prioritised Plan, and also received update reports on Patient safety. 12. Neonatology Services : Members were updated on the outcome of the Independent Review of Neonatology Services, and were encouraged by the confirmation which the review provided about the standards within the service. The Independent Review recommendations were noted and endorsed, with oversight of implementation by the Board s Healthcare Quality Assurance and Improvement on which the Area Clinical Forum Chair serves as a Member. 13. Quality Improvement Capacity and Capability : Members endorsed a Draft Quality Improvement Capacity and Capability Plan, recognising the need to ensure organisational capacity and capability as key to the delivery of the Board s aspirations for Transforming Patient Safety and the Quality of Care. 14. Person-Centred Health and Care : Members endorsed a Person- Centred Health and Care Plan as central to the delivery of delivering person-centred health and care, within the overall context of the Transforming Patient Safety and Quality of Care Strategy. 15. Research and Development : Consideration was given to an update on Research and Development, within the context of the Strengthening Clinical Research in Lanarkshire. 16. Internal Audit Review of Area Clinical Forum : Members considered an Internal Audit Review of the functioning of the Area Clinical Forum within the context of Chief Executive Letter 16 of 2010 The role of Area Clinical; Forums and Area Clinical Forum Chairs. A key recommendation from the review was the need to strengthen reporting from the Area Clinical Forum at NHS Board level. This has been addressed through the submission of minutes of ACF meetings to the NHS Board, supplemented by reports from the ACF Chair at Board meetings on the key issues considered by the Forum. 17. Reports from Professional Advisory s : At each meeting, members of the Area Clinical Forum received summary reports on the principal issues under consideration by the Parent Professional Advisory s. 4
Improvements overseen by the Area Clinical Forum and Matters of Concern to the Area Clinical Forum Healthcare Improvement Scotland (HIS) Rapid Review and Hospital Standardised Mortality Ratio (HSMR) : The year 2014/15 was, again, dominated by the continuing endeavour in relation to the Hospital Standardised Mortality Ratio (HSMR) and, the Healthcare Improvement Scotland Rapid Review of Safety and Mortality, Programme Plan. Area Clinical Forum Members welcomed the progress made during the year in continuing the focus on sustainable improvement. Finance : Area Clinical Forum members welcomed the opportunity to consider reports on financial performance, and noted with interest the progress in delivering the efficiency savings requirement. Whilst the pursuit of efficiency is, in itself, laudable, members were mindful that this requirement brings more substantial challenges each year, as already is apparent for 2015/16, with consequent pressures on staff and services across the system. Annual Review : Area Clinical Forum members welcomed the opportunity, once again, to participate in dialogue with the Minister as part of the Annual Review process. Members were able to assure the Minister about the extent of Area Clinical Forum involvement and influence in the planning processes. Members looked forward to that involvement and influence continuing, as the NHS in Lanarkshire faces a number of challenges, not least in relation to the Integration of Adult Health and Social Care, the development of a robust Clinical Strategy, and the continuing endeavour to transform patient safety and the quality of care. Integration of Health and Social Care : The implementation of the Public Bodies (Joint Working) (Scotland) Bill, signalled perhaps the most significant organisational change which the NHS Lanarkshire has faced, in delivering the Integration of Adult Health and Social Care. Members have been encouraged by the extent of partnership working during a year of transition, and look forward to building on this during the shadow year 2015/16, leading to full Integration from April 2016. Members will continue to seek further opportunities to contribute to this work. Clinical Strategy : Members welcomed the dates on progress in the further development of the Clinical Strategy for Lanarkshire. Against the backcloth of the unremitting staffing and service pressures in Lanarkshire, the Clinical Strategy, set in the context of A Healthier Future, is a welcome development in pursuit of the aim of delivering safe, sustainable services into the future. Access : Whilst members welcomed the confirmation of satisfactory performance across a number of areas of waiting times, including the Referral To Treatment target, the Treatment Time Guarantee and cancer, the continuing variable performance in delivering the four hour Unscheduled Care Target remains an area of concern. Encouragingly, this is the subject of an 5
intense management focus within Acute Services, with inputs from the Scottish Government Support Team. A key factor impacting on unscheduled care is flow through the hospitals. Delayed Discharges has been a challenge for Lanarkshire over a number of years, and has impacted adversely on bed availability. It is essential that this matter is addresses in a sustainable way, especially for Hairmyres Hospital, given the predicted increased flow of activity to the hospital, consequent upon changes in Glasgow hospital service in mid-2015. However, there has, over recent months, been significant progress in the management of patients in delay, with encouraging partnership working between Acute services and the North and South Lanarkshire Health and Social Care Partnerships. This is welcome, and augurs well for the future of Integration. Primary Care Out of Hours Service and Medical Staffing : Members were concerned about the continuing challenges which the Primary Care Out of Hours Service faced during the year in populating doctor rotas and maintaining services across the three main primary care centres and the two satellite centres. It is a concern that the service has been operating in Business Continuity Plan mode since mid-2014. Clearly, this position is not sustainable. Members were therefore encouraged by the NHS Lanarkshire response, and by the unstinting management efforts to maintain services, particularly at peak holiday periods. The Area Clinical Forum responded to the Out of Hours consultation, confirming support for the consultation options, with a preference for 2 centres, rather than 1 centre. However, it remains to be seen whether this model will address the fundamental issue, which is a shortage of doctors available to work in the service. It is recognised that this is a problem faced not only by Lanarkshire, but also by a number of other mainland Boards. The solution to the problem lies in the training of doctors, and the need for the training arrangements to be geared increasingly towards producing a doctor workforce to meet the needs of the service into the future, including out of hours provision in Primary Care. The shortage of doctors to sustain the Out of Hours Service, applies also to key specialties in Secondary Care, especially Emergency Medicine, where the current model of provision is becoming increasingly fragile. Again, the concerted effort to maintain safe services is commendable, but a more sustainable solution in the medium and long term is required. Members would encourage the NHS Board to do all that it can to influence matters at a national level in relation to doctor training, and achieving an equitable share of Trainees for Lanarkshire. Dr Andrew Docherty Chair Area Clinical Forum May 2015 6
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