ANGUS COMMUNITY HEALTH PARTNERSHIP Minute of the Meeting of Angus Community Heath Partnership Committee held on Monday, 29 August 2011 at 13:30, Lintrathen Room, Whitehills Health & Community Care Centre, Forfar Present Mr Andrew Richmond, Non-Executive Director, (Chair) Dr Charles Allison, Consultant Anaesthetist, Ms Alison Andrews, Convenor, Social Work & Health Committee, Angus Council Ms Elizabeth Forsyth, Non-Executive Director, Ms Mai Hearne, Chief Officer, Angus Association of Voluntary Organisations Ms Angela Murphy, AHP Lead, Angus CHP Mr John Patullo, Angus Public Partnership Network Dr Robert Peat, Director of Social Work & Health, Angus Council Ms Ameen Sattar, Community Optometrist Mr Ken Shaw, Staff Partnership Representative Mr Neil Shepherd, Community Dental Representative Ms Gail Smith, Clinical Services Development /Lead Nurse, Angus CHP Ms Vivien Smith, Community Planning, Angus Council Dr Rebecca Wheater, Clinical Director, Angus CHP Ms Susan Wilson, General, Angus CHP Apologies Dr Roger Blake, Lead Clinician, General Adult Psychiatry, Angus CHP Dr Gordon Crosby, General Practitioner, Carnoustie Health Centre Ms Liz Goss, Service, Older People s Services & Community Hospitals Ms Rhona Guild, Primary Care Development, CMRR Programme Lead Dr Brian Kidd, Lead Clinician, Addiction Services, NHST Mr Len McAllister, Community Pharmacist Mr Christopher Smith, Workforce, Ms Ruth Swanston, Service, Child & Family Health Services Dr John Tainsh, Consultant Radiologist, Stracathro Hospital Ms Bill Troup, Head of Integrated Mental Health Services In Attendance Ms Hilde Barrie, Corporate Services, Angus CHP Mr Alexander Berry, Accountant, Ms Anne Christie, Scottish Health Council Ms Sandra Christie, Corporate Services Assistant, Angus CHP Mr David Gill, Head of Pharmacy, Angus CHP Ms Anna Michie, Communications Team, Presenters Helen Dryden, Palliative Care Lead for item 5.3 Sheila Pudney and Darren Hogg presentation on generic rehabilitation worker Mr Andrew Richmond in the Chair NB: Generic Rehabilitation Worker presentation and item 5.3 were taken first to allow staff to return to their duties. 1.0 APOLOGIES - as above 2.0 CHAIRMAN S WELCOME AND INTRODUCTIONS Mr Richmond welcomed new members Mr Patullo and Mr Shepherd to their first meeting. HBarrie docs_088126.doc NB: All papers are embargoed until after meeting date 20
Mr Richmond also informed members that had agreed to the naming of the new mental health development at Stracathro as the Susan Carnegie Centre. [The name, chosen by service users, has local significance as Mrs Carnegie was one of the leaders behind the development of the first asylum in Scotland. Funded by public subscription it was opened in 1781 at the Links, Montrose before moving to the Hillside site in 1857.] 2.1 Declaration of Interests: None 3.0 MINUTES OF PREVIOUS MEETING 3.1 The minute was agreed. 3.2 Points Update these were noted Front-Line Staff / Service User Presentations Mr Richmond highlighted that Board held such presentations at the start of its meetings to spotlight service improvements at front line and the impacts these have on service users. He felt it would be useful to members to replicate this within the Angus CHP Committee and programme of these would be drawn up. Generic Assistant Post in Medicine for the Elderly (MFE) at Arbroath Infirmary Senior Charge Nurse Sheila Pudney reported that this was a ground up development that recognised a need within the ward and multi-disciplinary team for an increase in rehab focus and input. The introduction of a generic assistant role encompassing nursing, occupational therapy and physiotherapy was piloted for one year. The first year had succeeded beyond expectation. Staff spent less time doing to patients and were more confident in focussing on enabling ; there was also much greater communication across the whole multi-disciplinary team. Patients spent less time at their bedside and were now taking part in activities, such as day room socialisation, rehab gym and using kitchen facilities. This had resulted in decreasing length of stay and also reduced readmission rates. Darren Hogg spoke about his new post of generic assistant, his enthusiasm for the role, and the obvious difference it contributes to patients lives. He works mainly outwith normal hours, contributing to the 24/7 availability of rehab support and advice. Whilst he works mainly within the hospital setting, his counterpart, Ailsa McCabe follows patients from discharge into the community setting. This ensures that improvements are able to be maintained at home. Ms Wilson and Dr Peat were in discussion with Angus College in relation to developing education and training to support enablement roles such as SVQ/HNC qualifications. The committee were very impressed with the presentation, the clinical leadership shown to develop and introduce the role, and with the obvious enthusiasm and dedication of the staff taking part. Corporate Service 5.3 Palliative Care Services Update (ACHP 31/2011) Ms Dryden spoke to her report which detailed progress against the priorities for 2011-12, particularly highlighting: Identification of palliative care patients was the cornerstone of service provision and work continued to improve recording. Dr Wheater was working on a breakdown across CHPs of those on the palliative care register. Work to improve advance care planning and encourage public and staff to think ahead. This was especially important during transitions in provision of care. 21
Improving partnerships with care homes through facilitated training. Recent meeting highlighted a number of action points, including perceived communication challenges with secondary care, especially in relation to transfers. Successful implementation of the national policy in relation to Do Not Attempt Cardiopulmonary Resuscitation. By including the form, where appropriate, in patient notes this ensures that advanced care planning is communicated across all care settings. Spiritual Care it was noted there was a need to move perception beyond religious aspects and the introduction of a person-centred approach would assist. Ms G Smith was taking forward with Ms Guild and Gillian Munro, Head of Spiritual Care. Just in Case Boxes had been very successful, especially during out of hours period with over 100 boxes in service. 1. Noted the contents of the update detailing developments, progress and service delivery issues. 2. Were reassured as the work undertaken across all settings in Angus to comply with Building on Progress: Living & Dying Well Plan. 4.0 PERFORMANCE ISSUES 4.1 Finance Report, July 2011 (ACHP 27/2011) Mr Berry highlighted the paper detailing the financial position as at 31 July 2011. Presently there was an overall underspend of 25k with a forecasted year end overspend of 243k. The committee explored the following areas: Hospital & Community Health Service Budget present underspend of 55k; this was mainly due to vacancies where it was anticipated they would be filled in the second half of the year. Prescribing - presently 29k overspend, however, year end forecast remains at breakeven. Savings Targets Only a small amount of savings ( 16.5k) has been formalised on a recurring basis. This remains a key priority area for service managers to progress and Ms Wilson and Mr Berry will continue to meet with managers to address this issue. To date it is estimated that c44% of 2011/12 s target will be met on a recurring basis from 2011/12. Supplementary Staffing Mr Berry highlighted there were some transposition errors in his paper and these were noted. [A corrected paper has been reloaded to Staffnet] Risk Assessment Uncertainties were noted around year 2 of Change Fund funding and the risks in releasing the required return on Change Fund investment at the end of the funding period. 1. Noted the financial position as detailed in report ACHP27/2011, particularly the improved position from previous years. 2. Supported the work of Ms Wilson and Mr Berry with service managers in identifying further recurring savings. 22
4.2 Angus CHP Performance Report (ACHP 28/2011) Ms G Smith provided the following updates to the report presented: Sickness & Absence Rates achieving <4% short term absences was a risk. Waiting Times separating outliers from graph was appreciated, however, it remained complex and services should be separated into two graphs. See & Treat Comparison to be annotated with start of merged service with overnight district nursing service. Post Natal Depression Scores apparent low rates are likely to be a result of lack of documentation as opposed to actual low number of offers made. Teenage Pregnancy Rates uncertainty remains in relation to authority to include unvalidated data within publicly available reports. 1. Welcomed the improvement to the format with larger graphs. 2. Noted the service performances detailed within report 28/2011 and the measures planned or taken forward to address improvement. ClincalDev Corporate Service Chairman 5.0 STRATEGIC ISSUES 5.1 Community Medicine & Rehabilitation Redesign Programme (CMRR) Ms Wilson provided a verbal update to the committee on the work of the Programme. She particularly highlighted: CMRR Programme is to be brought together with the Social Work & Health Change Programme as a single local work programme, although governance will remain within each agency. The requirements of the Integrated Resource Framework and Change Fund will be delivered through this integrated programme. Working with Orthopaedic and Surgery Directorates to identify patients presently in acute care who cannot be assisted to be discharged home directly or are better placed in community hospitals. This will inform local bed requirements which require to be established in the early part of 2012. Community Hospitals Medical Contract North West GPs meeting this week to consider and progress is hopeful. Kirriemuir GPs have chosen to withdraw and discussions are underway to agree new model. Ms Wilson gave an assurance that Kirriemuir patients would not be disadvantaged in any new pathway arrangements. North East Locality Group addressing variance issues and developing an improvement plan. North West Locality Group will be test locality for Integrated Resource Funding work as part of Integrated Health & Social Care Service. The committee 1. Were reassured by the continuing progress of the Programme as described by Ms Wilson. 2. Requested a report be submitted to the next committee detailing work to support dementia patients and care home staff. R Guild E Goss/ 5.2 Medicines Management Update (ACHP 30/2011) Mr Gill spoke to his report which detailed progress against the priorities for 2011-23
12, particularly highlighting the following within the Steps to Better Healthcare Programme: Variation Within Angus 80% of the variation in cost per patient is within three practices and work is focussed on understanding and addressing this, including exploring the possible impact of support to larger number of care homes in South Angus Polypharmacy Reviews completed within Springfield practice and being rolled out to Arbroath Medical Centre and Edzell practices, with another three north west practices indicating their interest in taking part. Non-medicines prescribing items such as dressings, stoma prescriptions and prescriptions for leg bags and catheters account for c7% of prescribing budget. This is being addressed by through engagement across the whole patient pathway including partnership working with secondary care. Prescribing Budgets in order to smooth transition towards a needs based allocation for 2011/12 it was agreed that practice budgets would be based on a combined 50% National Resource Allocation Committee (NRAC) share and 50% historic share. This has been intimated to practices and builds on work over the past three to four years to address clinical variation in prescribing. The aim over the next two to three years being to match prescribing allocations with practice need according to disease prevalence and severity, and compliance with formulary choices for prescribing Sexual Health Prescribing Youth Takin Health had indicated difficulty accessing contraceptive provision and sources in rural areas may require to be further promoted as the service for morning after contraception is available through all Angus Community Pharmacies, but the awareness of this is not high in the target populations. 1. Supported the range of actions proposed for 2011/12 detailed within Report 30/2011 2. Noted that regular updates will continue to be provided to it during 2011/12 detailing progress against agreed outcome measures. 5.4 Angus Child, Family & Public Health Service Update - Mental Health & Wellbeing (ACHP 32/2011) This report was deferred as it had not yet completed the required Community Planning Partnership governance pathway. CHP General /HIT 5.5 Adult Services Change Fund Interim Report (ACHP/33/2011) Ms Wilson advised this report had also been deferred due to requirement to complete appropriate governance reporting within the Community Planning Partnership. The Interim Report would be submitted to the next meeting. Meantime, she provided a verbal update indicating: Performance & Development Group was chaired by Ms Wilson, and there were now 9 workstreams addressing various pathways and good progress was being across these. A joint commissioning plan, including voluntary sector involvement, was required to release funding for year 2. Change Fund is a facilitating and accelerating bridging budget to address plans already established and agreed through the Social Work & Health Change Programme and the CHP CMMR Programme. It will require assessment of impact across all systems to gauge where reinvestment / CHP General 24
resource transfer should be invested. 6. Clinical Director & General s Report (ACHP34/2011) Dr Wheater spoke to report 34/2011, particularly highlighting the: Use of technology to provide support at home to patients, such as the Long Term Conditions DVD, Living Life Guided Self Help telephone service and NHS24 digital television channel. 1. Noted the general updates contained within the report. 2. Approved the wider distribution of the report as part of the CHP s communication strategy. 7. ITEMS FOR INFORMATION 7.1 Angus Child Protection Committee Annual Report 2010-11 - noted 7.2 Angus Adult Protection Committee Annual Report 2010-11 - noted 8. MINUTES OF SUB-COMMITTEE FOR INFORMATION AND CONSIDERATION 8.1 Improvement & Quality Forum, 21.04.11 noted 8.2 Angus Healthy Safe & Caring Communities, 01.06.11 noted 8.3 CMRR Programme Board, 09.06.11 - noted 9. RECORD OF ATTENDANCE noted 10. DATE & TIME OF NEXT MEETING 24 October 2011 at 1:30 pm in the Lintrathen Room, Whitehills Forfar Subject to any amendments recorded in the Minute of the subsequent meeting of the committee, the foregoing Minute is a correct record of the business proceedings of the meeting of Angus CHP Committee held on 29 August 2011 and was approved by the committee at its meeting held on 24 October 2011. CHAIR DATE 25