Highland NHS Board
11 August 2009
Item 3.5
South East Highland
Community Health
Partnership
Alder House
Cradlehall Business Park
Inverness IV2 5GH
Tel: 01463 – 706948
Fax: 01463 – 794712
www.nhshighland.scot.nhs.uk
DRAFT MINUTE of MEETING of the SOUTH
EAST HIGHLAND COMMUNITY HEALTH
PARTNERSHIP COMMITTEE
Inshes Church, Inshes Retail Park, Inverness
28 May 2009 – 2:00 pm
Present
Mrs Gillian McCreath, Non-Executive Director, Chair
Dr Kate Adamson, Patient and Public Representative
Miss Anne Angus, Council for Voluntary Services, Inverness
Dr Adrian Baker, GP & Clinical Lead, Nairn & Ardersier Locality
Mr David Garden, NHS Highland Head of Financial Planning
Mr Ian Gibson, Non-Executive Director, Vice-Chair
Mr William Gilfillan, Corporate Services, Highland Council
Councillor John Holden
Mrs Hilda Hope, CHP Lead Nurse
Mr Douglas Johnston, CHP Personnel Manager
Dr Iain Kennedy, GP & Clinical Lead, Inverness Locality
Mrs Margaret MacRae, Staff Side Representative
Ms Rhiannon Pitt, CHP Lead AHP
Mr John Richards, Acting Assistant Community Care Manager,
Highland Council, representing Ms Frances Gair
Mr Nigel Small, CHP General Manager
Mr Hamish Wood, Patient and Public Representative
In Attendance
Mrs Sue Blackhurst, Committee Administrator
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WELCOME
Mrs McCreath welcomed all to the meeting.
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APOLOGIES
Apologies were received from Ms Jackie Agnew, Dr Eric Baijal, Cllr Margaret Davidson, Cllr
Liz MacDonald, Dr Chris MacGregor, Mrs Ailsa MacInnes, Dr Boyd Peters, Mr Thomas Ross,
Dr Ian Scott and Ms Joanna Young.
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CONFLICTS OF INTEREST
The Committee:
 Noted that no Conflicts of Interest were declared.
Working with you to make Highland the healthy place to be
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MINUTES OF MEETING HELD ON 26 MARCH 2009
It was noted that Mr Ian Gibson was erroneously reported as having been present at the
meeting. Subject to amendment of the list of attendees, the Minute was approved.
The Committee:
 Approved the minutes of the last meeting held on 26 March 2009.
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PANDEMIC ‘FLU PLANNING
Mrs Hope gave a presentation on Pandemic ‘Flu, and, in particular, the current Swine ‘Flu
situation, both nationally and locally. The total number of cases as at 27 May was noted. Mrs
Hope went through the presentation outlining the signs and symptoms, actions required to be
taken by persons who exhibit those symptoms, and the wider effect of the pandemic on the
community as a whole. It was reported that a recent Protected Learning Time Session for
GP practices (where practices are closed to patients for that afternoon) was used to
accommodate a SE Highland CHP Pandemic ’Flu workshop for all CHP staff, including GP
practices. This was held at the Caledonian Stadium and representatives from the Highland
Council also attended.
In response to a question from Mr Wood pertaining to information available for patients, in
addition to the generalised advice from NHS Scotland, delivered to all homes in the area,
Mrs Hope advised that localised information for patients would follow as and when
necessary. Mrs Hope also referred to the Health Protection Scotland website
www.hps.scot.nhs.uk which has up-to-date information on the current situation. Mr Wood
then referred to the potential for mis-information from the printed and other media streams,
which the health services would need to take cognisance of.
Mr Small reported that much work has taken place already and will continue to do so, on
such topics as:
 Distribution centres for anti-viral drugs to mitigate the symptoms, and issues such as
how these distribution centres would be staffed, their security and re-stocking of the
required drugs.
 The staffing and delivery of essential services during an epidemic, such as high
dependency units, maternity services and services for acute mental health patients.
Cllr Holden stated that the health information given so far has been of high quality and that
the CHP should be encouraged to continue in this standard of work.
Mr Gilfillan then outlined the partnership work being undertaken by the Highland Council,
Northern Constabulary and NHS Highland. He advised that his role within Highland Council
is to look at the business continuity of the Council to maintain vital services and the
redeployment of appropriate Council staff to undertake critical functions. Cllr Holden
considered that the work undertaken so far in this whole exercise would be a useful learning
opportunity should a similar situation occur again in the future.
Dr Baker highlighted that the number of available GPs could be reduced during an episode of
Swine ‘Flu. He considered that the security of anti-viral distribution centres, and the staff
working in them, was of prime importance. It was noted that the process for distributing antiviral drugs was in hand. Mr Small advised that Dr Peters was not present as he was
discussing the issues of anti-viral distribution centres in Badenoch & Strathspey that
afternoon. Mrs MacRae said that staffing during an episode of Swine ‘Flu had been
discussed at the Local Partnership Forum meeting, and that it was essential that local
managers were fully aware of their own staffing situation.
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Mr Small advised that, currently, he chairs a CHP Pandemic ‘Flu Co-ordinating Group.
Meetings of that group are currently held on a bi-monthly basis and membership is made up
of representatives from the CHP, the Highland Council and Inverness Prison.
Miss Angus enquired about information suitable for sending out to voluntary organisations.
Mr Small confirmed that the presentation given today may be sent out to all members. Mr
Wood considered that it was essential that the public be reassured with the details of the
work being undertaken locally, but not divulging too much clinical information. After
discussion it was agreed that Mr Small and Mrs Hope would review the current information
so that it may be sent out to voluntary and public bodies. However, it would be sent to Mr
Wood and Dr Adamson in the first instance.
Mr Small agreed to update the Committee on Pandemic ‘Flu at its next meeting.
The Committee:
 Noted the presentation and the subsequent discussions
 Noted the ongoing work within the CHP in relation to Pandemic ‘Flu planning.
 Agreed to receive an update on the local situation at the next meeting.
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MATTERS ARISING
6.1 Balanced Scorecard
Mr Wood enquired about the revised Balanced Scorecard, as discussed at the previous
Committee meeting. In response, Mr Small advised that Ms Brown and Mr Oliver were
working on this, but that they had been delayed in providing this information due to working
on projects required by the Board for the Annual Review. Mr Wood requested that waiting
times for access to Allied Health Professions (AHPs) and Psychology Services be included in
the SE CHP Balanced Scorecard.
6.2 Grantown
Mr Wood requested an update in relation to the possible co-location of health and council
services in Grantown. Mr Small referred to letters between the Chief Executives of NHS
Highland and the Highland Council where in Dr Gibbins stated that there was no funding
available for any potential co-location of services at present, or within the next few years. Mr
Garden confirmed that there were no capital or revenue funds available for this project.
6.3 Partnership Working
Mr Wood referred to page 4 of the minute of 26 March 2009, under 7.1 Finance, where it was
reported that ‘Highland Council could work jointly with various agencies and specialisms and
joint locations, if appropriate, to reduce costs.’ Mr Wood sought clarification of this
statement, which Mr Small agreed to provide, in conjunction with Mr Gilfillan.
The Committee:
 Noted the request for waiting times for access to Allied Health Professions (AHPs)
and Psychology Services be included in the SE CHP Balanced Scorecard.
 Noted the unavailability of funding to progress any potential co-location of services
in Grantown.
 Demitted to the General Manager and Mr Gilfillan to provide clarification on
partnership working issues.
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7
CLINICAL GOVERNANCE
7.1 CHP Infection Control
Mrs Hope requested all members to note the circulated End of Year Report for the Infection
Control Annual Work Plan for 2008/09. She currently plans to bring the Action Plan for
2009/10 to the next meeting of the Committee. Upon an enquiry by Mr Wood, Mrs Hope
confirmed that the hand hygiene compliance rating had been aggregated across all the
operational units. Mr Gibson noted that the SE CHP is now in the top quartile after a difficult
start. Mrs Hope confirmed that the community hospitals in the CHP had positive results with
one hospital consistently surpassing the compliance rate.
The Committee:
 Noted the End of Year Infection Control Work Plan for 2008/09.
 Agreed to receive the Action Plan for 2009/10 at the next meeting of the Committee.
 Noted the ongoing work in relation to Hand Hygiene.
7.2 Clinical Governance & Risk Management
Mr Small advised that Dr Scott was absent due to attendance at a pan-Highland 18RTT
meeting. Referring to the circulated Clinical Governance & Risk Management Performance
Report, Mrs McCreath enquired about violence and aggression training. In response, it was
noted that the Violence & Aggression Sub-Group is currently looking at all forms of training
and that violence & aggression training is part of the induction process for all new staff.
However, non-attendance at that training is considered to be an issue of concern.
Mr Gibson referred to response time for complaints, which is consistently going down, which,
in essence, means that responses to complaints are taking longer. Mr Small advised that this
is being reviewed and addressed, in conjunction with the NHS Highland Complaints Team.
However, a contributing factor is that the reporting system has recently changed and that the
complexity of some of the complaints is a challenge.
The Committee:
 Noted the Clinical Governance & Risk Management Performance Report.
 Noted the issues in relation to violence & aggression training.
 Noted the issues in relation to response times for complaints.
7.3 CHP Clinical Governance & Risk Management Group
The draft minute of the meeting held on 2 April 2009 was noted. Mr Wood enquired about the
report of the NHS Quality Improvement Scotland (QIS) peer review visit for Learning
Disability Services in Highland. Mrs Hope advised that it had been received in the CHP only
the day previously. Further details are available at www.nhshealthquality.org
Mr Gibson queried the use of the word ‘illegal’ in the Pharmacy report in the above minute, in
relation to the mixing of drugs in syringes. Mr Small advised that this issue has been
escalated to the Area Drug & Therapeutics Committee, who has a role in this issue.
The Committee:
 Noted the draft minute of the CHP Clinical Governance & Risk Management
Performance Group meeting of 2 April 2009.
 Noted that the NHS QIS Report on Learning Disability Services in Highland had
been received.
 Noted the issues in relation to the mixing of drugs in syringes.
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8
FINANCIAL GOVERNANCE
8.1 Finance
Mr Garden advised that it was too early in the financial year to provide any reports for
2009/10 and that his report for this meeting was simply a final report for the year just ended
(2008/09). It confirmed the 2008/09 financial information was very much in line with previous
estimate and highlighted some of the underspend issues. Mr Wood considered that the
report showed prudent financial management within the CHP and that colleagues should be
applauded for the work they had undertaken in this regard.
The Committee:
 Noted the report and the information given.
 Noted the financial challenges faced by the CHP and NHS Highland as a whole for this
and future years, and the requirement for further CHP savings in 2009/10.
8.2 CHP Change Group
Mr Small reminded members that the Highland NHS Board had tasked all operational units to
look at redesign themes. He highlighted the Terms of Reference for this group and sought
the endorsement of the Committee.
After discussion the Committee endorsed the savings plan noted in Appendix 2.
In respect of Appendix 3, regarding the letter Mr Small proposes to send to all staff in the SE
CHP advising them of the CHP Change Group plans and how the CHP can deliver services
more effectively, discussion took place on the format of the letter. It was agreed that the
letter should be modified to take into account the comments made, and be sent out.
Mr Gilfillan described an initiative within Highland Council for rewarding good ideas. It was
noted that there is currently a staff awards scheme for NHS Highland employees. Mr Small
advised that it may be possible to explore options for NHS employees in SE CHP.
Discussion then took place on sections relating to redesign plan contributions. Mr Small
outlined the issues for a whole system approach to service redesign. Mr Wood questioned
how it would impact upon patients, but Mr Small confirmed that it will be of considerable
benefit to patients by the management of services more effectively. Miss Angus enquired
whether there was a service users scheme in place. Mr Small responded by saying that,
presently, the complaints / suggestions process is mainly use for complaints, but feedback
needs to be received positively. Mr Small believed this should be brought into a wider
Highland view. It was noted that it could be well received at locality level. Mr Small also
advised that the CHP Management are currently looking at time management efficiencies,
such as planning as many meetings taking place on the same day, to make best use of time.
The Committee:
 Agreed the Terms of Reference for the CHP Change Group.
 Agreed the template for capturing the CHP Redesign Plan.
 Agreed on a revised format for the letter to be sent to all CHP staff.
 Supported the range of proposals set out in this paper.
 Requested further detailed work to firm up proposals.
 Requested regular up-dates on CHP progress towards meeting the Redesign Plan.
Mr Gilfillan left the meeting at 3:45 pm
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9
STAFF GOVERNANCE
9.1
Partnership Issues
Mrs MacRae highlighted the importance of staff side involvement with redesign work. Mr
Johnston cited an example of the value of staff side working in the recent Learning
Disabilities Service decommissioning process. Through effective partnership planning, 90
members of staff have been redeployed and only 14 people left the NHS service, due to no
suitable redeployment places being available, or who chose to leave at this time. Mr
Johnston commended the staff for maintaining services for clients at a time of change and
uncertainty and for supporting SENSE in their new role.
Mr Small advised that the Staff Survey results drilled down to CHP level had now been
received from the Employee Director, but was unable to attend today’s meeting to present
them.
The Committee:
 Noted the value of staff side working in the recent Learning Disabilities Service
decommissioning process.
 Noted the commendation of the Learning Disabilities Service staff for
maintaining services for clients and supporting SENSE in their new role.
 Agreed that the Staff Survey results pertaining to the CHP can be made
available to the localities.
9.2
Workforce Report
Mr Johnston referred to the workforce reporting figures whereby the annual sickness
absence figure has been reducing throughout the year. He reported on the heightened level
of awareness by managers in the use of the Promoting Attendance Policy and the use of the
Occupational Health Service. Mr Gibson considered that the information provided to the
Committee should be reduced in order to tie in with the control mechanism of the Board. It
was suggested that an Equality & Diversity Report should be produced just once a year. Mr
Gibson commended local managers for the target level of sickness absence and level of
completed Personal Development Plans (PDP) that have been achieved. However, he
enquired about the number of suspended colleagues and the relative length of such
suspensions. Mr Johnston and Mr Small agreed to produce an anonymised report for the
next meeting.
The Committee:
 Noted the report and discussions
 Commended achievement of the target level of sickness absence and level of
completed PDPs.
 Noted the level of detail of reporting suggested on an annual basis.
 Agreed to receive information concerning suspensions at the next meeting.
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PERFORMANCE MANAGEMENT
10.1

General Manager’s Report
RNI Redevelopment – Mr Small advised that he had finally received an architect’s
drawing of the proposed redevelopment only the day previously. This would now be
progressed.
New Nairn Hospital – A letter inviting Committee members to visit the new hospital
had been circulated with the Committee papers.

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
Enhanced Services - Mr Gibson commented on the number of alcohol brief
interventions in contrast with the Smoking Cessation Service quit rates. Dr Baker
offered a clinical view on the alcohol intervention work. Mr Small concluded by
saying that the information collected in respect of the alcohol screening is a robust
process and would allow close monitoring. Much discussion on these issues took
place.
The Committee:
 Noted the discussions that took place.
10.2 Balanced Scorecard
Mr Small outlined salient points from his report. He advised the Committee that once the
new formal Balanced Scorecard is populated, it will be distributed to all members. It was
noted that the newly reported HEAT targets will now be more relevant to the CHP. Dr
Kennedy enquired as to the ownership of HEAT targets as GPs performance management is
not measured against these targets. Dr Baker, however, considered that GPs were highly
influential in half of the HEAT. He believed that the 18RTT quality outcomes could be applied
to prescribing and unscheduled care. He concluded by suggesting that, as a Committee, we
should reward good practice. Much discussion then took place on this issue.
The Committee:
 Noted the discussions that took place.
 Demitted to the General Manager to circulate the populated revised Balanced
Scorecard.
Dr Baker and Mr Richards left the meeting at 4:30
10.3 CHP Committee Annual Report
Mr Small advised that the CHP was required to provide a CHP Committee Annual Report for
auditing purposes.
The Committee:
 Noted that a report of the Committee for 2008/09 had been prepared and submitted to
the Highland NHS Board Audit Committee.
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IMPROVING SERVICES AND CLINICAL ISSUES
11.1 Prescribing and Pharmacy
In the absence of both Mr Ross and Dr Scott, Mr Small referred to the circulated prescribing
budget update report, prepared by Mr Ross, and suggested that any comments upon this
should be directed to Mr Ross upon his return from leave. Mr Gibson raised the issue of
practices with the greatest prescribing levels, but Dr Kennedy advised that this was being
discussed locally. Mr Garden then reported that the prescribing budget formula is also under
discussion.
The Committee:
 Noted the Prescribing Budget Update Report.
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11.2
National Collaborative Programmes
 18 Weeks Referral to Treatment (18RTT)
 Long Term Conditions
 Mental Health
It was agreed to defer this item until the next meeting when further information would be
available.
The Committee:
 Agreed to receive an update on the National Collaborative Programmes at the next
meeting.
12.
PARTNERSHIP WORKING
12.1 Voluntary Sector
Miss Angus was encouraged to note the level of participation by various agencies in working
towards improving Inverness partnership working.
The Committee:
 Noted the work being undertaken in the Voluntary Sector to improve partnership
working within Inverness.
12.2 Public/Patient Involvement
Mr Wood advised that members of the public have contacted him to request that the
following issues be highlighted to the Committee:
 The pain control service is seen to be lacking in Highland, by many patients who
require this service, where as in other health board areas there are greater
opportunities to access such a service. Mr Small that this is an issue under discussion
at the Board’s Planning Group to provide a Highland-wide pain management service,
which would be funded by savings associated with the change to the prescribing
budget for pain control. There are also plans for an enhanced service in primary care
for pain management.
 Harmonisation of Highland Council and NHS boundary areas, specifically West Ness
and Drumnadrochit. It was questioned whether this issue was for discussion within this
forum, but Mr Small said that there had been some discussions in the past to re-modify
areas as some of our services work into Mid-Highland CHP area. It was a complex
issue, but which could be explored further in the future.
 The GPAC Practice Survey results were seen as incomprehensible to some members
of the general public, with a request to provide more meaningful information in the
future. Dr Kennedy advised that this year is the last for reporting in this style. Mr Small
said that it is largely up to practices to decide how to report the findings.
 The perceived tardiness of visual screening for children. Mrs Hope reported that an
orthoptic-led service for children will be commencing in August 2009. She will ask the
Professional Lead for Children's Services, Susan Russell to provide some information
for Mr Wood.
The Committee:
 Noted the comments made by the general public and was Encouraged to note the
level of interest shown by the public in the Committee.
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13
ORGANISATIONAL ISSUES
13.1 NHS Highland Annual Event – 12 May 2009 – Proposals for the CHP Committee
At the first annual Board Development event held on 12 May 2009 attended by members of
the Board’s Governance Committees, a strong emphasis was placed on the need for
Committee members to carry out their governance role in the most correct and effective
manner, and to be clear about their role as a Committee member. In this regard, a
presentation was given at that event by Okain McLennan, Non-Executive Board member and
chair of the Audit Committee. A copy of that presentation was circulated with the paper by
Mrs McCreath and Mr Small for noting by members as part of the governance process. As
highlighted in the circulated paper, amongst other issues, it was proposed that the
Committee has a rolling programme of meetings in the community, and that the Committee’s
agenda be changed to follow the recommended agenda set by the Board. Mr Small advised
that the latter change had already been instigated with the current agenda to give Committee
Members an idea of the proposed change.
The Committee:
 Noted and Supported the Governance Guidance contained in the Audit Committee
Chair’s presentation.
 Agreed and Supported the proposals contained in Section 5 of the circulated
paper.
13.2 Highland NHS Board Meeting on held on 7 April 2009
There was no report due to time constraints of the meeting.
The Committee:
 Noted the position.
13.3 CHP Committee Members’ Appointment Letters
Mrs McCreath advised that the appointments had been sent out. Mr Small reminded
members to respond to their letters, if they had not already done so.
The Committee:
 Noted the position.
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AOCB
The following item was taken after Matters Arising to accommodate the availability of
Councillor Holden, but is noted here for ease of reference.
14.1 Inverness & District MS Therapy Centre
Cllr Holden raised the issue of funding for the Inverness & District MS Therapy Centre. He
noted the number of treatment sessions undertaken by the Centre for physiotherapy (996),
complementary therapy (720) and oxygen therapy (832). He advised that there was
currently a low level of funding from the CHP. The Centre was in need of help, both
financially and in respect of management expertise to assist the Board of Trustees, who are
mainly users of the Centre. He therefore sought additional funding from the CHP and a cooption onto the Inverness MS Therapy Centre Board. In response, Mr Small questioned why
the centre was seeking additional statutory funding. He enquired as to the exit plan for when
funding streams are due to expire. Mr Small confirmed that he had written to the Centre
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advising that CHP funding of £10,000 per annum will continue, but the CHP was unable to
increase this amount. Mr Small further advised that Rhiannon Pitt, CHP Lead AHP, had
been tasked with meeting Therapy Centre representatives to discuss the management of
patients and therapy sessions provided, and to gain an understanding of how the Therapy
Centre operates.
Referring to the request for management expertise on the MS Board, Mr Small suggested
that Cllr Holden should make a formal request in writing to the CHP, which Cllr Holden
agreed to arrange. Miss Angus advised that the present chair of the Council for voluntary
Services (CVS) in Inverness, an experienced board member, has joined the MS Board. She
countenanced that any organisational change takes time to embed. Miss Angus also said
that CVS Inverness offers training facilities for voluntary organisations and suggested that Ms
Pitt contact her in this regard as part of her review of the Centre, as noted above.
The Committee:
 Noted the discussions that took place.
 Noted the request by Cllr Holden for assistance with the Centre, and the actions
suggested.
 Noted the continuation of the CHP’s existing funding allocation to the Inverness
& District MS Therapy Centre.
 Noted that the CHP Lead AHP is to meet with representatives of the Therapy
Centre to discuss management of patients attending the Therapy Centre and the
therapy sessions provided.
Councillor Holden left the meeting at 3:00 pm
There was no other AOCB.
15
DATE OF NEXT MEETING
The next meeting of the Committee will be held on Thursday, 30 July 2009 at 2:00 pm. It
was originally scheduled to be held in the Inshes Church, Inshes Retail Park, Inverness, but,
in the light of comments above in taking the Committee out to the localities, the venue has
subsequently been changed to the Newton Hotel, Inverness Road, Nairn.
The meeting closed at 4:45 pm
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