Minutes of the North Lanarkshire PPF Reference Group 18 th November 2014, 7.00pm Lecture Theatre, Wishaw General Present David Summers Felix Mulholland Duncan MacLeod Jean McMillan Hugh McMillan Bill Cloughley Marvyn Mackay Alasdair Moodie Carol Carter Ann Muir Ross McGuffie Craig McKay Julie Arthur Chair, NL PPF North PPF Rep Bellshill Community Forum Wishaw, Murdostoun & Fortissat Community Forum Wishaw, Murdostoun & Fortissat Community Forum Motherwell Community Forum Northern Corridor Community Forum Northern Corridor Community Forum Kilsyth & Villages Community Forum Carers Together/Speakeasy Interim Head of Planning & Performance, North CHP NHSL, Communications PFPI Project Assistant Apologies Frank Fallan, June Vallance, Laura Campbell, Gillian Ventura, Donald Masterton, Helen Reston, Pat Reilly In attendance Carrie McCulloch Acting Head of HAI (Prevention and Control) Steve McCormick - Area Antimicrobial Pharmacist 1. Welcome and apologies David welcomed members to the meeting and thanked them for their attendance. He introduced members to Carrie McCulloch and Steve McCormick. 2. Minutes of previous meeting Minutes of the meeting were approved by members and proposed by Jean, seconded by Duncan. 3. Matters Arising Increasing PPF Membership to be carried forward.
4. Healthcare Associated Infection Update Carrie McCulloch Carrie is currently Interim Head of Healthcare Associated Infection for NHSL. The previous post holder, Heather Gourlay, has moved on. The post has been advertised but is yet to be filled. She also advised that Jan Clarkson and Mary McLean from the department had retired. Carrie gave some highlights from the most recent Board Report as follows. The full report is available on request. Clostridium Difficile Infection (CDI) Quarter 1 validated report from Health Protection Scotland states NHS Lanarkshire is below the HEAT trajectory. Information is being collated on Quarter 2 and it will be validated by Health Protection Scotland in December. MRSA Screening The MRSA Clinical Risk Assessment Screening failed to reach the national 90% compliance target. Those wards who failed to reach the compliance target have improvement plans in place. Norovirus At the time of the report there was one ward in Lanarkshire closed due to Norovirus. Standard Infection Control Precautions (SICPS) The compliance target for September 2014 was 84% which was a decrease of 10% from the last reporting period of July 2014. Laundry Non compliance of Bag Labelling & Linen Segregation Laundry visits continued and further Bed Care Champions were being trained in order to improve compliance with laundry management. Work was being done to make sure practices were safe in the ward and at the laundry. Mattresses were being inspected to ensure they were fit for purpose and audits showed that results had improved dramatically. Hairmyres had been subject to an unannounced inspection in September which was followed up by another unannounced inspection in October. Further discussion then took place around the Hairmyres Inspection Felix commented on the Hairmyres inspection report and that it pointed out where there were problems at ward level. He believed there was a communication problem at ward level between ward managers and domestics. Carrie expressed her disappointment with the findings of the report and ensured that NHSL would be working closely with all concerned to make improvements. She explained that currently audits were carried out by Ward Managers by the 10 th of the month. These were then reviewed by the 15 th of the month by Senior Nurses. Quality Assurance teams then carried out follow up checks. Work was ongoing at Hairmyres to train staff around what happens in audits to ensure all bases were covered. The Action Plan which accompanied the inspection contained 7 requirements and 3 recommendations. The terms of reference of the HEI Steering Group would be reviewed to involve the right people and ensure robust reporting, discussion and actions were agreed.
Felix informed members that an unannounced inspection had also taken place at Wishaw, the results of which were still to be published. Felix had been interviewed by the Inspection team, at their request, as a representative of the public. Members asked who ultimately was responsible for the cleanliness in the wards and Carrie confirmed it was the Senior Charge Nurses and they should sign off the cleaning schedules. She also advised that they would be working with Health Protection Scotland to find out what the challenges and barriers were and workshops would be held. Work would be done to identify particular wards that were not up to standard and to share good practice with them from wards that were operating well. Carrie reassured members that learning from Hairmyres would be shared Lanarkshire wide and she offered to return to a future PPF meeting to provide an Action Plan update which was welcomed. She would link with Julie to set a future date to return. Carrie advised that she would send Julie a leaflet for circulation to members which was available to the public on Healthcare Associated Infection and would be keen for comments on this to improve communication. ACTION Julie to contact Carrie to set date to attend future North PPF meeting. Steve McCormick - Area Antimicrobial Pharmacist Steve explained that he worked within the antimicrobial team which was responsible for how we used antibiotics across all Lanarkshire hospitals and in Primary Care. Today was European Antibiotic Awareness Day which was part of a full week of awareness events being held throughout NHS Lanarkshire to highlight the importance of using these important drugs more appropriately. The key messages of the campaign were to raise awareness about antibiotic overuse and the increase in antimicrobial resistance. This was a major public health issue as, without effective antibiotics, many routine treatments would become increasingly dangerous or impossible to perform safely. He explained that there had been no new antibiotics for 30 years. Steve asked for the PPFs help in sharing the Campaign Pledge by accessing the web page (link shared by Julie) and signing up to play their part in helping reduce the use of antibiotics. He informed them that there were awareness stands in all 3 acute hospitals and within health centres too. The campaign wanted healthcare professionals to consider how they prescribed antibiotics and ask the public to refrain from asking for or using antibiotics unless absolutely necessary. Ann did remind members that if they had a cough that lasted more than 3 weeks they should get this checked out. Steve explained that the campaign was not aimed at people who had conditions that did need antibiotic treatment but at those people, generally fit and well, who expected to receive an antibiotic for minor self limiting ailments that would actually go away after a few days on their own such as common colds and flu. Carol hadn t found the pledge particularly clear and also commented on the fact that she had just attended her dentist and was immediately offered an antibiotic for an infection
that she may not have. Steve advised that dentists were being targeted in the campaign as antibiotics were not always the best method of treatment. Alasdair asked why GPs did appear to over prescribe. Steve explained that some people expected or demanded an antibiotic and this expectation and pressure could be challenging to manage. A survey of GPs showed that some of them did prescribe to appease the patient despite knowing it would have little benefit on the self limiting viral ailments. This campaign was focused on trying to reset patient expectation over antibiotic benefit for such simple conditions. The message was asking patient to help their GP or prescribing nurse to do the right thing and not prescribe unless warranted. Alasdair had read an article around the introduction of a blood test that would check if someone had a bacterial infection. Steve advised that this approach was currently being used in Holland and some Scandinavian countries. Close to patient testing technologies are on the radar of national Scottish Antimicrobial Prescribing Group, a national body which links government policy around antibiotic use to local health board antimicrobial management teams. Carol commented that she knew some people who had leg ulcers and antibiotics no longer helped as they had become resistant. Steve explained that this was why the reviewing of drugs was so important so they retain their effectiveness and more importantly deciding whether to use them at all for some conditions which may not have any signs of active infection. Carol is an advocate of alternative therapies and asked why NHSL do not use these. Both Steve and Ann advised that there is no evidence to confirm their effectiveness. Members felt that this was a useful and important campaign. So far, around 3900 people had signed the pledge. Steve offered to come to a future meeting to provide a further update which was welcomed by members. 5. Integration of Health & Social Care Update Ross McGuffie Ross shared a presentation with PPF members to remind them of the reasons for Integration, highlight the Draft Regulations and Delegated Functions and show what the Transition Integration Board would look like. He explained that development sessions would take place with voting members of the Transition Board then further sessions would be held which would include the non voting members, which would include patient and carer representatives. The changes would present a huge learning curve to all involved. Ross noted that the regulations note that future performance reporting would include the need for benchmarking with other similar partnerships and involve the use of 5 years of data to show trends. Carol asked for an example of how the changes would affect patients. Ross explained that one example of integrated working was already demonstrated in Addictions between nursing and social work but there were many other services that currently worked together. Integration would bring these links even closer together.
Another was the work which has started on Locality Response. The Locality Response uses all the local staff in a Locality such as District Nurses, Social Work, Occupational Therapy, Physiotherapy, Homecare etc. who would work together in an integrated fashion to deal with urgent concerns. For example, a GP at a house call for a patient who potentially could have previously been admitted could call the Responder on duty who would then coordinate an immediate response by liasising with all local staff and identifying the best course of action. The pilot started in Airdrie and was now being rolled out across all Localities in North Lanarkshire, with the system being live in all areas by January 2015. Discussions followed around the following points. Alasdair asked what support was being given to those who were implementing this. Ross explained this was very much a bottom up approach, allowing the staff on the ground in each Locality to shape how they felt this could best work. Staff enthusiasm and support for the approach was very high. Marvyn had heard at a Local Area Partnership meeting that very few people had been referred and questioned whether all the work was worthwhile. Ross explained that the project was starting off small to ensure Locality teams could cope with the volume. At present, only GPs could access Locality Response but, in time, this will be widened out to a range of different services sych as Acess Social Work, ASSET (hospital at home team) etc. Alasdair asked how the Health Board Boundary Changes had impacted on this work. Ross advised that services involved in the Locality Response were all now provided by NHS Lanarkshire with the exception of Mental Health, so the Northern Corridor area should get the majority of the benefit. Ross noted that some services such as Mental Health and Addictions continued to be provided by Glasgow and that the Northern Corridor population would continue to access Glasgow hospitals. Carol asked if people from Kilsyth could still use Glasgow hospital services and Ross confirmed that there was no change, with around 50% of Kilsyth hospital flows going to Glasgow. 6. Out of Hours Review Update Out of Hours Review Stakeholder Event (CA) A number of members from both North and South PPFs had attended the event. An update was provided on the current issues being experienced by the service highlighting the urgency of this review. The benefits, risks and opportunities for improvement for each potential model was presented by Dr Chris MacKintosh then participants split into workshops to score the 5 proposed models. This was then reduced to 2 proposed models, which were then scored at the afternoon session. These were 1) a One Centred Model and 2) Two Centre Models. The main reasons for disregarding the Co Located models were the lack of capacity. Things to be taken into consideration during the scoring sessions were location, population, car parking, travel times, number of rooms required. Colin expressed his disappointment that the Co Located model was disregarded in the morning session. As one of the main issues currently experienced by the service was staffing, a questionnaire had been sent to 400 GPs who had previously been
involved in Out of Hours work. They were asked if it the service was located in a Health Centre, would they be more interested in working in the service. 148 had responded and 70% had said they would be involved. Louise Wheeler from the Scottish Health Council had asked to speak to PPF members who were involved in the process to gather feedback. All attendees at the event would receive the full report once prepared to check for accuracy. This would then be presented to the NHS Board on 26 th November and would be followed by discussions with the Scottish Health Council and Scottish Government before going out to a 12 week public consultation period. Marvyn asked what the current situation was with the Out of Hours Review in the Northern Corridor as he had been unable to attend the Stakeholder Events. Currently the Out of Hours service in the Northern Corridor sat under GG&C Health Board, who were also reviewing their service. It was likely that the Northern Corridor s service would move over to NHS Lanarkshire in 2015. Marvyn expressed his concerns around the process. Other members who had attended the Stakeholder Event expressed their concerns around the scoring and that none of the options on the table met the needs of all communities. Julie advised that she would feedback these concerns to Craig Cunningham. 7. Orthopaedic Service Review A request had been received inviting PPF members to attend a forthcoming Stakeholder Event in December. The service was being reviewed due to the anticipated demographic changes in future years and the purpose of the exercise was to ensure the design of the service was fit for the future and for those who used the services. The event was scheduled for Wednesday 3 rd December and it was hoped participants would help develop a short list of options which would deliver improvement and sustainability. In addition, a briefing session for PPF members would be held on Monday 24 th November at Kirklands to provide them with further information and give them an opportunity to ask questions. Dr Jane Burns would be in attendance along with Colin Lauder and Graham Johnston. Carol and Jean expressed an interest in attending so Julie agreed to provide them with further information. 8. Updates from other groups/ppf Group membership North CHP OMC o Gabe Docherty gave an update around the work being undertaken within Health Improvement, in particular on the Towers Report, Child Healthy Weight Programme and Keep Well. Although all of this was very positively received it had been noted that the DVD which had been produced on the
o Towers did not mention Mental Health which had initially been the main reason for its production. Waiting Times The majority of Allied Health Professionals services were meeting performance targets however there were some issues in Speech and Language Therapy, Podiatry, Dietetics, Paediatric and Rheumatology. Staff were working hard to overcome these issues with 95% of patients being seen on time. Food, Fluid & Nutrition Group Unfortunately Pat was unable to attend the meeting so no update was available. However Julie was able to advise that some work was being done at Hairmyres with PPF members and NHSL management and she would keep them informed on its progress. Felix advised that improving food quality in all 3 acute hospitals was ongoing. Ross informed members that were very few formal complaints on food quality in comparison to the number of meals actually served. Julie advised that she would share with members the minutes of the last Food, Fluid & Nutrition group. REPORTS TABLED HAI Comms Sub Group (Minutes) St Andrews Hospice (report BA) Health Improvement SIB (Minutes) Planned Care Quality Improvement Board (Minutes) Stakeholder Engagement Group (report JA) Lanarkshire Infection Control Committee (report SM-J) No Smoking Policy Group (report MM) NHS 24 PPF (report AM) Lanarkshire Beatson Art Strategy Group (report AM) Transforming Outpatient Services (report AM) Carers Together Conference (report AM) Seniors Together The Last Word Conference (report AM) 7. AOB Marvyn asked if NHSL would be making any comment on an audit report that was published where over 200 patients waited more than 12 hours in A&E, over half of which were in Lanarkshire. Craig advised that he would look into this and feedback. ACTION Craig to look into and feedback. Homoeopathic Review Carol asked when the review paper was going to the NHSL Board. Julie advised she would check and inform Carol. ACTION Julie to confirm when paper is going to NHSL Board. 8. Date & time of next meeting
- Tuesday 20 th January 2015, 7.00pm, Conference Room 2, Ronald Miller Centre, Wishaw General