NHS GRAMPIAN Minute of the Grampian Area Partnership Forum (GAPF) held on Wednesday 26 October 2016 at 2.00pm in Fulton Clinic Meeting Room, Royal Cornhill Hospital Approved Present: Malcolm Wright, Interim Chief Executive (Chairperson) Sharon Duncan, Staff Side Chair/Employee Director Mike Adams, UCATT Paul Allan, General Manager, Facilities Chris Carden, Deputy Head of Health and Safety (deputy for Stephen Merchant) Caroline Clark, Interim Chief Nurse Gemma Barclay, SOR Ian Francis, CSP Alistair Grant, RCN Annie Ingram, Director of Workforce Gerry Lawrie, Staff Governance Manager Rachael Little, SOCAP Deirdre McIntyre, SOCAP Lesley Meldrum, Corporate Communications Manager (deputy for Laura Gray) Mike Park, Staff Side Health and Safety Chairperson Sandy Reid, Senior Service Manager Anne Ross, Head of Performance and Quality Eric Sinclair, Staff Governance Committee, Graeme Smith, Director of Modernisation Karen Watson, Unite Joan Anderson, Partnership Support Officer In Attendance Sue Swift Interim Divisional General Manager for item 4bi Alan Sharp, Deputy Director of Finance - for item 7a Item Subject 1 Apologies Action Apologies were received from Rhona Atkinson, Non-Executive Director, Rebecca Clark, BDA, Stephen Merchant, Head of Health and Safety (Chris Carden deputised), Mike Ogg, General Manager (no deputy), Jim Clark, GMB (and deputy Maurice Scott), Susan Coull, Head of HR, Amanda Croft, General Manager Acute (no deputy), Alan Gray, Director of Finance (Alan Sharp deputised), Tracy Miller, RCM (no deputy), Laura Gray, Communications Director (Lesley Meldrum deputised), Gary Mortimer, General Manager (no deputy), Martin McKay, UNISON (no deputy), Steven Lindsay, Unite (Karen Watson deputised), Alasdair Walker, Clinical Directorate Manager (no deputy) 2 Minute of Last Meeting held on 15 September 2016 The minute of the last meeting was approved with the addition of Alistair Grant to the apologies. 1
Item Subject 3 Matters Arising Action None 4 Treated Fairly and Consistently, with Dignity and Respect, in an Environment where Diversity is Valued a. Health and Safety Executive (HSE) Inspection Update Annie Ingram gave an update on the six improvement notices received from the HSE. NHS Grampian had requested an extension on four of the notices. These were 2 for safer sharps, 1 for falls and 1 for skin. Three had been extended to end of December. The outcome of the falls extension request was awaited. The HSE may visit at the end of October regarding falls. Annie Ingram, Morag Hives and Mike Park visited Royal Aberdeen Children s Hospital (RACH). They found a lot of good practice and some work still to do. Annie Ingram was discussing with Nick Fluck, Medical Director, issues around compliance with medical staff. The revised approach to falls and associated training appears to have gone well at Dr Gray s Hospital, but requires to be embedded. It would be rolled out from there. Other Boards had also been visited by HSE and received improvement notices and NHSG was seeking to learn from other Boards who received similar notices. At a recent meeting with the HSE, the Principal Inspector advised that the HSE have been asked to investigate suicides in hospital, with a suggestion that this might be the next issue to be raised in NHS Grampian by HSE. An Action Plan was in place to take forward the identified issues and this was managed through Datix. It was thought that some managers were keeping names of staff who had undertaken toolbox talks and would submit them when all in department were finished. A communication would go out to ask for individual names to be submitted as they complete the toolbox talks to assist the staff who were recording these. Corporate Communications The numbers of staff recorded as undertaking the toolbox talks had reduced and it was felt there may need to be another way to run these courses e.g. everyone in room together. As the AT Learning Administration Team were concentrating on recording Toolbox Training they were not able to carry out other tasks. Induction training was being updated and there is an emerging proposal that all staff would require to attend induction in first two days of employment, before being released to work in clinical areas and departments. 2
Item Subject The manual handing improvement notice stated all clinical staff in acute wards at ARI must be trained by February 2017. This was a huge task with lots of challenges, including having the festive period within this timeframe. Action One of the biggest challenges was releasing staff to undertake the training, without additional staff being available to cover. Some wards already struggling with shortages of staff. Also ensuring enough trainers was an issue. A two day key handler training course was being developed for staff who had already undergone the full training previously. This requires staff to have completed the elearning module. Sharon Duncan wanted the hard work of the Health and Safety Team noted, with a new Head of Health and Safety not long in post. A communication to staff was agreed to ensure they all understood the need to receive appropriate training. GL A bid for funding to redesign the model of health and safety and support compliance had been submitted and this needed to be considered by the Senior Leadership Team. b. Providing a Healthy and Safe Working Environment i. Sharps Caroline Clark reported that at RACH they had listed all sharps which had been in the hospital. They then looked at what they had and whether safe alternatives were available. Where safe alternatives were available these had been introduced and risk assessments for both the safer sharps and those identified as non-safe sharps undertaken for them. Some risk assessments covered a number of similar sharps rather than multiple individual risk assessments. Work was ongoing with staff, explaining what the issues were and why they needed to be involved to achieve compliance. Staff recognised that it was an organisational failing rather than individual and this assisted with getting them onboard. Health and Safety notice boards were being established to display information on Toolbox Talks, risk assessments and other necessary health and safety information. The Standing Operating Procedures (SOP) would all be completed by the end of October, during November there would be face to face discussions with staff and in December would be management walk rounds to gather evidence of compliance. RACH were commended for the huge amount of work they had undertaken and it was hoped that others would learn from them. 3
Item Subject Sue Swift reported that most of the work from RACH would be able to be translated to adult and community areas. Action It was noted that if any member of staff required a different piece of sharps equipment they would need to complete the necessary risk assessment and have good clinical reasons for this. It was noted that one of the contraventions referred to exposure of porters to needlestick injuries. All porters had been trained on what to do with the sharp equipment when identified in waste and following a needlestick injury by 12 October 2016. ii. Falls and iii. Bed Rails A new Policy for the Prevention, Reduction and Management of Patient Falls in Hospital and a separate Bed Rails Policy had been developed and gone through a consultation process. The consultation on these ended on 19 October 2016 and would be presented to GAPF in November for approval. As there had been two preliminary consultations on the Falls Policy and an urgent need to improve processes to comply with the requirements of the Improvement Notice, it had been been rolled out in Moray. Joan Anderson was asked to circulate the Falls Policy to GAPF members for any final minor comments to be sent to Jane Ewen to allow for quicker approval in November. JA The two draft polices on Falls and Bed Rails had been shared with the HSE who confirmed it could be used. iv. Skin A wet worker was someone who washed their hands or used hand gel at least 20 times a day. NHS Grampian had around 11000 wet workers. Out of these, it was estimated that up to 20% may go on to develop a skin condition. The risk assessment for domestic staff at Aberdeen Maternity Hospital was complete. All staff had been reviewed and a small number seen by the Occupational Health Service (OHS). These positive identifications would be datixed in future; i.e. when someone was referred to OHS with a possible skin condition. Gloves suitable for all domestic staff had been sourced in response to another contravention. Managers should hold basic health records for staff e.g. if they were a wet worker or night worker, and information on what needed to be done for these type of staff. This would require to be rolled out across NHS Grampian, as it was not current practice. Wet workers hands had to be checked visually and not just a questionnaire completed. 4
Item Subject Action OHS had an upgrade to their system which allowed them to improve reporting and support the system. Latex was not to be supplied routinely in NHS Grampian. All latex had been removed from the ordering catalogues. If an individual required latex gloves, the requirement would be risk assessed and prescribed individually and only for the use of that individual. To date only four people in NHS Grampian have had latex gloves prescribed. Overall it was felt that NHS Grampian was on target for the end of December 2016 for compliance on the immediate improvement notices. The current hard work would have to keep going and there would still be challenges regarding recording, medical staff, etc. Manual Handing training was going to be a challenge to complete by end February 2017 and an extension may be requested. The GAPF were assured that work to date was going well. Malcolm Wright commended all those involved in the massive work that was going on around this and thanked everyone including Health and Safety Representatives. He acknowledged that this was one of the organisations top priorities. There was a need to focus on the future and Partnership working was essential to this. There was a need to look at resources both recurring and non-recurring to assist to achieve targets. The improvements being worked on as a result of the HSE improvement notices would have to be rolled out to the whole organisation. HSE could return at any time to inspect. 5 Appropriately Trained and Developed Induction Eric Sinclair noted that these improvements discussed earlier in the meeting, needed to be embedded into the organisation and induction for new staff was a good way to start. Induction was a huge challenge as there was approximately 2500 new staff every month. The Induction Group, which was a Partnership one, was working on a new process to ensure all new staff received a standard minimum. Statutory and mandatory items were included in Corporate Induction along with specific information. A paper would be going to the Expert Group for approval and then to GAPF as soon as possible. This would be discussed at the Senior Leadership Team too. 5
6 Involved in Decision Making a. Partnership Involvement Sharon Duncan reported that Staff Side colleagues had raised the lack of Partnership involvement at their recent meeting and also at a private meeting between the Executive Team and Staff Side Representatives. This was raised at GAPF so that managers across NHS Grampian could hear the issues and take them away to their workplaces. Partnership Representatives were increasingly concerned at not being involved, informed and communicated with. Change processes were happening without Partnership involvement and this was causing huge problems with staff. It was felt that the message that Partnership working was the way issues are progressed in NHS Grampian was not getting down from the senior management level to some middle and lower managers. Partnership involvement did not get down to departmental level in some areas. There were a number of reasons for this including new managers, disconnect, lack of understanding, and when managers don t involve Partnership there were no consequences to the manager. A few years ago, Nick Bacon undertook a study into Partnership working and NHS Grampian was reported to be very good at Partnership at that time and that was how it should still have been. The study was called Partnership in Scotland 1999-2011. Partnership working was essential to take NHS Grampian through all the challenges it currently had and those ahead. Without Partnership involvement at the beginning, issues took longer to resolve and staff could be adversely affected. It was noted that there had been a very good Partnership presentation at the Mental Health and Learning Disabilities Service Away Day that morning. Caring, Listening Improving was all about working in Partnership. There was a discussion around learning and development of staff and middle managers. It was accepted that middle managers were in a difficult situation as they were in the middle of the structure. The training for these staff could be improved. The training would be looked at to strengthen the message about Partnership involvement. It was agreed that Malcolm Wright, Annie Ingram and Sharon Duncan would have a discussion about expectations of Partnership and what needed to be done to achieve change via Partnership. There would also be a discussion at the next Senior Leadership Team meeting on how to get the message down through the direct reports and to all levels. NHS Grampian would not tolerate lack of Partnership involvement. GL MW/AI/SD Some examples of lack of Partnership involvement were discussed including where it was alleged that a manager had told staff not to report shortage of staff on datix and also that some managers had made decisions to keep Partnership out of things. Also it had been thought by some that it was quicker to do things without Partnership involvement. 6
It was noted that to be able to involve Partnership Representatives in change, representatives needed to be released from work by their manager. If a manager made this difficult for a representative there was a chance that person would give up being involved and that would be to the detriment of the organisation. Gerry Lawrie highlighted that the requirement to include Partnership involvement was an integral part of the workforce planning process. GL b. ARI Car Park Update Paul Allan updated the group on the parking at ARI. There was a Car Parking Project Board looking at all aspects of NHS Grampian car parking. An offer of 10.3m had been made by the Wood Foundation towards building of a patient and visitor multi-storey car park and the Board had accepted this extremely generous donation. The Local Authority Planning Department were happy for work to begin, with one or two small issues still to be sorted out. The work on the multi storey car park began on 24 October 2016. A lot of car parking spaces had been cordoned off for the use of the building project. These had not all be utilised to date but would be once all the safety aspects were sorted out and equipment on site. The build should be complete by July 2017. NHS Grampian was doing all it could to assist staff in alternative ways to travel to work. The park and ride buses from Bridge of Don and Kingswells were free to NHS Grampian staff. Staff had to use the park and ride car park to be able to receive the free bus travel. Many communications had gone out from Corporate Communications to staff and public in different ways including emails and signage. The staff car parks at Foresterhill had been full by 8am since the beginning of the build. There had been no reports of car parking attendants receiving any kind of abuse, which was very good news. The numbers of staff using the Kingswells park and ride had increased. It was acknowledged that there could be staff working shifts and those who had responsibilities outside work that may still have issues with parking/travel to work. The First Bus Company was originally planning to stop the Kingswells to ARI bus and NHS Grampian was in discussions with them to explain that the usage would increase during and after the car park build. If First Bus proceeds with the closure, NHS Grampian would have to discuss another solution. The numbers of staff using the shuttle buses had increased at certain times and although there were a finite number of buses available it was agreed that the timings and routes could be looked at to try and accommodate the busy times. 7 PA
It was suggested that if the pay and display machines on public roads around Foresterhill site were upgraded to the kind that allowed online payment this may make it easier for staff and visitors. Paul Allan to enquire about this. PA The car parking/travel to work situation would be monitored closely and any improvements made where possible. Malcolm Wright thanked everyone involved for all their work on this. 7 Well Informed a. Finance Report NHS Grampian was overspent by 4.6m six months into the financial year. The overspend for September was 1.1m. This was slightly below the financial trajectory agreed with the Scottish Government but 0.5m more than at the same time the previous year. This overspend would need to be recovered over the second half of the financial year. Currently there were not enough cost reduction plans to achieve recurring savings to balance the year end position, so there would need to be reliance on slippage against earmarked funding and planned investments. There was confidence that NHS Grampian would break even by the end of the financial year. Reasons for the overspend included locum medical staff, pressure on rota for junior doctors and agency nursing costs. There was a need for more recruitment to substantive posts to mitigate these costs. The capital spend was going to plan. There would be big challenges facing NHS Grampian for 2017/18 including an increase in rates, locums and Modern Apprenticeship Levy. Malcolm Wright stressed that it was important to keep financial control and have good cost reduction and transformational programmes in place. An Audit Scotland report was to be published on 27 October 2016 and it was recommended that everyone read it as it would be very informative. The draft budget from the Scottish Government would be announced in December 2016. b. Clinical Strategy Graeme Smith reported that the Clinical Strategy had been approved by NHS Grampian Board on 4 October. The strategy was made up of 5 sections: Prevention; Self-Management; Planned Care; Unscheduled Care; Enabling System. There had been general discussion at the last GAPF and also at the Development Day in May 2016. Now the Strategy was approved it was time to discuss the operational part of it. Graeme had circulated two papers from the Clinical Strategy and it was agreed to add them to the GAPF Agenda for next and future meetings for a discussion on how to take it forward. These papers were: a. Diagnostic and Treatment Facilities Delivering a New Approach to Elective Care and b. 8
Development of Electronic Patient Records in Grampian: a Briefing Paper. a. Discussion on the first paper this set out an approach discussed at the Senior Leadership Team. There was capital available and it was hoped about 40m would come to NHS Grampian. The plan involved meeting the needs of people over the next 10-20 years. The funding could be used in a variety of ways to support the plan and the paper provided a background to this. A dedicated team would be working on this plan over the next 12 to 18 months and Steven Lindsay had been identified as the Partnership Representative for the overall group. There would be a number of sub-groups and they would also require Partnership involvement. b. Discussion on the second paper a lot of work had been ongoing on electronic patient records. Staff had fedback their frustrations on use and access of electronic devices. This paper was about implementing the use of electronic records and the future of these. There was significant work to be done following the approval of the Clinical Strategy. There could be significant financial implications to this programme and funding could come from a variety of places. The creation of electronic patient records and the use of electronic devices would be a change of practice for staff. Graeme Smith agreed to check who the Partnership Representative on this group was. GS 8 Sector Partnership Reports Sector reports were received from Aberdeenshire, Facilities, Acute and Moray. It was reiterated that Sector Reports must be submitted a week prior to each meeting. Sector Chairs 9 Any Other Competent Business None. 9
10 Communication to Organisation from GAPF The following items would be communicated to all NHS Grampian staff: a. Health and Safety of Staff was one of the top priorities for the organisation and recurring investment and change was needed to embed the model. Making good progress towards enforcement solutions and thanks to all involved including Staff Side, Annie Ingram and her team, OHS, Health and Safety Department, Health and Safety Representatives, etc b. Toolbox Talks names of those who have completed the toolbox talk to be submitted individually and not collated by teams before submitting. This to be included in a staff global email update rather than a separate email. c. Manual Handing staff to ensure their basic manual handling training was up to date. Information to be given on easy ways of booking on to training. d. Datix reminder that staff must use datix to report issues including shortage of staff. The previous message on this could be used again. e. Partnership Involvement a message to staff/managers on Partnership release and Partnership Involvement. f. Car Parking an assurance to be given to staff that NHS Grampian was dealing with all issues around car parking and travel to work. Corporate Communications Corporate Communications Gerry Lawrie Corporate Communications MW/AI/SD Paul Allan 11 Date and Time of Next Meeting The next meeting to be held on Wednesday 23 November 2016 from 1pm to 4pm. Venue to be confirmed. The Aberdeen City Away Day planned for that day had been postponed for a few months for a variety of reasons. Email: joananderson@nhs.net Telephone: (01224) 558459 10