South East Highland
Community Health Partnership
Alder House
Cradlehall Business Park
Inverness IV2 5GH
Tel: 01463 – 706948
www.nhshighland.scot.nhs.uk
MINUTE of MEETING of the SOUTH
EAST HIGHLAND COMMUNITY
HEALTH PARTNERSHIP COMMITTEE
Inshes Church, Inverness
26 November 2009 – 2:00 pm
Present
Mr Nigel Small, CHP General Manager, Chair
Miss Anne Angus, Council for Voluntary Services, Inverness
Dr Adrian Baker, GP and Clinical Lead, Nairn & Ardersier Locality
Ms Marie Close, Local Officer, Highland, Scottish Health Council
Mr William Gilfillan, Corporate Services Manager, Highland Council
Dr Robert Henderson, Consultant in Public Health Medicine
Mrs Hilda Hope, CHP Lead Nurse
Mr Douglas Johnston, CHP Personnel Manager
Councillor Liz MacDonald
Ms Emily Macintyre, Community Pharmacy Representative
Mr Adam Palmer, Staff Side Representative
Ms Rhiannon Pitt, CHP Lead AHP
Mr John Richards, Acting Assistant Community Care Manager,
Highland Council, representing Ms Frances Gair
Mr Kenny Rodgers, CHP Finance Manager, representing Mr David Garden
Mr Thomas Ross, CHP Lead Pharmacist
Mr Hamish Wood, Patient and Public Representative
In Attendance
Mrs Sue Blackhurst, CHP Committee Administrator
Ms Leighanne Morrison, Administration Assistant, SE CHP HQ
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WELCOME
Mr Small welcomed all to the meeting. It was encouraging to note that a member of the
public had attended the meeting. Mr Small had agreed to chair the meeting in the absence
of Mrs McCreath, who was unwell, and Mr Gibson, who was in Edinburgh.
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APOLOGIES
Apologies were received from Dr Kate Adamson, Ms Jackie Agnew, Mr David Garden, Mr
Ian Gibson, Cllr John Holden, Dr Iain Kennedy, Mrs Gillian McCreath, Dr Chris MacGregor,
Mrs Ailsa MacInnes, Mrs Margaret MacRae, Dr Boyd Peters and Dr Ian Scott.
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CONFLICTS OF INTEREST
The Committee:
 Noted that no new conflicts of interest were declared.
 Noted that due to the absence of Councillor Holden there was no information
regarding the status of his declaration at the previous meeting.
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MINUTE OF MEETING HELD ON 1 OCTOBER 2009
Cllr MacDonald, who had attended the Raigmore Hospital Governance Committee meeting
referred to in Item 10.1, General Manager’s Report, stated that the issue of the said
Committee not having formally agreed the closure of Ward 2C at Raigmore Hospital, was not
included in the reporting of that item.
The Committee:
 Noted the comment made by Cllr MacDonald around the issue of the Ward 2 closure.
 Approved the remaining minute of the last meeting held on 1 October 2009.
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MATTERS ARISING
5.1 Pandemic ‘Flu Planning
Mr Ross gave an update on the Pandemic ‘Flu planning within the CHP.
There had been a considerable recent increase in activity, both in relation to seasonal ‘flu
and swine ‘flu. Practices had been very busy dealing with ‘flu which had been producing
irregular patterns of activity and staff sickness. Raigmore Hospital was currently also very
busy with ‘flu related activity, to the extent that bed management meetings were taking place
twice daily. Mr Small said that a whole system approach to hospital beds was required at this
time. He added that the SE CHP is rising to the challenge of freeing up beds in community
hospitals to allow more beds in Raigmore Hospital to be used during the current increase in
‘flu related activity. There was much multi-agency working on this issue and Mr Richards
advised that the Highland Council had made many more home care packages available to
facilitate increased care in the community, with the aid of district nursing teams.
Mr Ross then advised that the CHP was mid-way through the vaccination programme. He
outlined the statistical issues of the programme so far for staff. Mr Palmer enquired as to the
breakdown for clinical and non-clinical staff, to which Mr Ross responding by advising that he
would send this information direct to Mr Palmer. The Public Health Team at Assynt House
were looking into additional vaccinations sessions for social care and voluntary staff. In
relation to patient groups, Mr Ross advised that all practices were well on their way to
vaccinating priority groups in Phase 1 of the Vaccination Programme. Mr Wood enquired as
to the number of doses of vaccines required for each patient. In response, Mr Ross advised
that the majority of patients would receive one dose only. Children under 10 years of age
would be given two doses, three weeks apart. Immunosuppressed patients would also be
given two doses of vaccine.
Dr Henderson enquired whether Phase 1 would be completed before Christmas 2009. In
response, Dr Baker considered this to be logistically challenging. Mr Ross added that the
nature of the vaccinations was causing a few scheduling difficulties for practices as patients
are required to be in good health before being immunised and some patients are cancelling
appointments due to ill health.
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Mr Small asked around the table if they considered that members of the public are aware of
what they should be doing to try and prevent the spread of the virus. Miss Angus offered a
non-clinically based view in that, with her considerable contact with various voluntary groups,
she believed the general public were aware of effective hand hygiene issues.
Finally, Mr Ross voted a note of thanks to all staff, both clinical and administrative staff, who
had been involved in additional work in the provision of vaccination clinics for staff, and which
was over and above their usual workload. He advised that a total of only three additional
hours have been undertaken so far, to minimise additional staff costs. This was applauded
by all, particularly Mr Small who emphasised the value of contributions made by all staff
involved with the ‘flu vaccination programme and pandemic ‘flu issues.
The Committee:
 Noted the ongoing work within the CHP in relation to Pandemic ‘Flu issues.
 Noted the considerable amount of commitment over and above usual patterns of
work by all staff involved with Pandemic ‘Flu activity.
 Noted the value of multi-agency working during this situation.
 Demitted to the CHP Lead Pharmacist to provide a breakdown of the statistical
information relating to vaccination of clinical and non-clinical staff.
 Agreed to receive an update on the local situation at the next meeting.
5.2
CHP Committee Membership
Mr Small advised that he had discussed the issue of committee membership with William
Gilfillan, who advised that a decision would be made on 18 December 2009 at a full council
meeting of the Highland Council. It was noted that the councillor vacancy, on the CHP
Committee, for Badenoch & Strathspey is under discussion.
The Committee:
 Noted that discussions are taking place to seek a nomination from the Highland
Council to replace the vacant Councillor seat on the CHP Committee.
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REPORT OF THE DIRECTOR OF PUBLIC HEALTH
Dr Robert Henderson, Consultant in Public Health Medicine, and Public Health link to the SE
CHP, gave an overview of the Report of the Director of Public Health, which had been issued
previously. Dr Henderson gave an outline of the pertinent issues and described what it
meant for the SE CHP. Essentially these centred on the following:
 Early years

Encouraging people to buy into health
 Employment
 Facts and figures

Inequalities

Longer & healthier lives
The aim would be to work more closely with social care and voluntary sector colleagues.
The community planning process should assist with the work on tackling equalities. Cllr
MacDonald enquired how the work on employment issues could affect the unemployed as
unemployment impacts upon the health of the population, particularly with mental health
issues. The Condition Management Programme (CMP) was given as an example of multiagency working; it is part of the Government's Pathways to Work Programme and is a joint
initiative between JobCentre Plus and local NHS providers, fully funded by the Department of
Work & Pensions. People on Incapacity Benefit/ Employment Support Allowance suffering
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mild to moderate conditions can volunteer to take part. Using a Cognitive Behavioural
Therapy approach, participants get one-to-one support from a health practitioner. The
programme helps individuals to better understand and manage their health condition or
disability, improve their quality of life and regain control, and return to work now or in the
future. Programmes cover stress management, confidence building, pain management,
healthy lifestyle advice, goal setting, and relaxation techniques. NHS Highland has eight
CMP practitioners operating from offices in Wick, Inverness and Fort William. Mrs Hope
commented that she had received favourable feedback on the effectiveness and success in
encouraging people back to work. Mr Wood asked how the SE CHP was performing in
relation to the themes highlighted within the report. Dr Henderson responded by saying that
the purpose of the report is to provoke discussion and critical thought within the NHS and
partner organisations, and CHP colleagues should review current activities against the
issues discussed within it. During discussion, Miss Angus stated that voluntary groups play
an important part in the health of the population. It was also reported that the new GMS
contract for GPs would be dealing with inequalities in targeting the most deprived residents,
and addressing disproportionate cardiovascular issues. Mr Gifillan said that the Single
Outcome Agreement links in with this work, and that the Chief Executives of NHS Highland
and the Highland Council meet to discuss certain issues relevant to both organisations.
Mr Small considered that as Mrs McCreath was chair of the CHP Health Improvement
Group, the Director of Public Health’s report could be taken to the CHP Health Improvement
Group. Mr Small agreed to discuss with Mrs McCreath
The Committee:
 Received the report of the Director of Public Health.
 Noted the related discussions.
 Demitted to the General Manager to discuss with the Chair of the CHP Health
Improvement Group how the report can be made relevant to the CHP.
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ORGANISATIONAL ISSUES
7.1 Highland NHS Board Meeting on held on 6 October 2009
Due to absence of both Mrs McCreath and Mr Gibson, there was no report.
The Committee:
 Noted the position.
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PARTNERSHIP WORKING
8.1 Voluntary Sector
Miss Angus reported that the Highland Compact was launched on 23 November 2009. The
Compact is an agreement with the public sector organisations and the Third Sector, made up
of voluntary, charitable and community organisations, aiming for a higher standard of good
working practice with each other. Miss Angus also mentioned the Third Sector resilience
payments, a short term offer of one-off payments to organisations who were feeling the
financial effects of the recession. The offer was only open for four weeks, finishing the week
following the meeting.
Dr Baker referred to the Richmond Fellowship, a charity providing high quality community
based services for people who require support in their lives. He cited an example of one of
his patients receiving assistance for their special needs from the Richmond Fellowship,
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where the fees for such assistance had risen substantially from £20 a month to £18 an hour.
Mr Richards agreed to look into whether home care funding could be suitable for this patient.
Mr Small asked whether there could be an amalgamation of voluntary organisations as the
current unfavourable economic climate has the potential for some organisations to cease to
exist due to a lack of funding. Finally, Mr Small considered that there was a good link
between the CHP and the voluntary sector, and highlighted the importance of the Highland
Compact.
The Committee:

Noted the launch of the Highland Compact.

Noted the value of the Third Sector in complementing health services.

Noted the strong link between the Voluntary Sector and the CHP
8.2 Public/Patient Involvement
Mr Wood advised that he had no issues to report.
The Committee:

Noted the position.
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IMPROVING SERVICES AND CLINICAL ISSUES
9.1 Prescribing and Pharmacy
Mr Ross referred to his circulated report and outlined the issues in relation to the CHP
prescribing budget. He advised that the CHP Change Group had discussed the same report
in detail at their meeting the previous week. He is looking at how the Scottish Government’s
Information and Statistics Division weight allocations for the drug budgets. Work is also
ongoing to explore which areas of prescribing there is significant change of trends. Another
issue is the impact of secondary care patients being discharged earlier from hospital than
previously, with the resultant requirement for medication from GPs. Upon enquiry by Cllr
MacDonald, Mr Ross confirmed that he was working with the practices that were
overspending. Mr Palmer considered that patient knowledge and information was crucial in
dealing with long term conditions. Mr Small said that an element of the long term conditions
work was around self care management. Mr Wood asked if the recession was causing more
prescriptions to be prescribed. Mr Small believed that saving money on drugs didn’t
necessarily equate to lower quality patient care.
The savings achieved so far for statins were noted. Mr Ross gave an example of further
efficiency savings in the use of wound care dressings. A Primary Care Development Funded
project, initiated by a District Nursing Team Leader, showed a saving of £1,800 in one visit to
a nursing home by simply changing the wound care dressings to more appropriate products.
This project is also aiming to improve the wound care in the private sector by discussions
with District Nurses and care home staff. Mr Palmer asked if there was more prescribing due
to the increasing number of nurse prescribers. Mr Ross did not believe so and considered
that most nurses were highly skilled in wound management and therefore the most
appropriate person to prescribe these products.
In relation to savings initiatives within the Highland Council, Mr Gilfillan advised that budget
micro reviews had taken place. In one area £80,000 of savings had been identified by
independent validation.
Ms Emily Macintyre, Community Pharmacy Representative, then gave a community
pharmacy update, thus:
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 The Chronic Medication Service would be starting in April 2010. Good benefits had
been achieved during a trial in Fife. Upon enquiry Ms Macintyre confirmed that there
was currently no patient information available on this service.
 There was a public health national health promotion initiative for over-the-counter
treatments as part of the Minor Ailment Service to reduce GP time.
 A Chlamydia service is available at community pharmacies where samples are taken
and sent to laboratories working in collaboration with the Sexual Health Service. If
required, treatment is then available from the community pharmacy.
 Emergency hormonal contraception is available at community pharmacies.
 Nicotine Replace Therapy is available as part of the Smoking Cessation work.
 With regard to unscheduled care, a wider range of drugs can be offered without
prescriptions. There is increased communication with the Out-of-Hours Service
reducing contact with NHS24.
These schemes would allow more flexibility for pharmacists, although it was noted that the
mind set of the public needs to be changed to suggest that pharmacists could be consulted
where, traditionally, patients may have consulted their GP for minor issues. It would also
allow individuals the choice of not attending at their GP practice, as some patients may fear
the possibility of acquiring other infections there. Communication with the public on
community pharmacy issues was discussed.
The Committee:
 Noted the Prescribing Budget Update Report and related discussions.
 Noted further savings initiatives.
 Noted the Community Pharmacy update.
9.2
National Collaborative Programmes
 18 Weeks Referral to Treatment (18RTT)
 Long Term Conditions
 Mental Health
Mr Small advised that Dr Scott was unable to attend the Committee meeting as he was
attending a meeting with the national team who were visiting Highland for the mid-term
review of the 18RTT Programme. Mr Small further advised that, locally, the review of the
clinic booking process and associate systems is progressing. The Patient Focussed Booking
service, which started for x-ray appointments last year, is commencing for appointments with
the Ear, Nose and Throat Department. This is a much more patient-friendly approach where
patients are invited to contact the hospital to arrange a mutually convenient appointment.
The aim is to improve capacity in clinics and reduce the number of patients who do not
attend.
There are many strands of work progressing through the Long Term Conditions programme,
namely self-care management, anticipatory care and review of hospital admissions. Dr
Baker, who has recently been appointed as Clinical Lead for Unscheduled Care, advised that
the essence of the long term conditions work was quality care versus cost effective
treatment.
Dr Baker updated the meeting with some real examples of discharge challenges at Nairn
Hospital. He said that the average age of patients whose discharges are delayed is 87 years
and gave examples of the type of patients requiring residential care. Dr Baker also stated
that the daily cost of delayed discharges is £15,000 for NHS Highland.
There then followed robust discussion on the issue of delayed discharges. Cllr MacDonald
advised that the embargo on social care funding by the Highland Council had now been
lifted. Mr Richards said that the immediate aim was to accelerate care placements for those
patients whose discharges from community hospitals had been delayed due to care funding
issues. Some delayed discharged patients had been released due to Highland Council
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funding being released for social care funding. The value of joint funding was emphasised to
work to resolve the home care situation. Mr Wood asked about the process for calculation of
delayed discharges, which Mr Small outlined.
Cllr MacDonald requested information on delayed discharges, particularly in relation to the
RNI, in future reports to the Committee, which was agreed by Mr Small.
The Committee:
 Noted the ongoing work of the National Collaborative Programmes.
 Noted the discussions that took place.
 Demitted to the General Manager to provide regular reports on delayed discharges.
Cllr MacDonald left the meeting
9.3 Enhanced Services Provision
Mr Small referred to the circulated report prepared by Mrs Ros Philip, CHP Primary Care
Manager, detailing the enhanced services available, by practice, within the CHP. He advised
that Garry Coutts, NHS Highland Chair had requested information on the level of enhanced
services provided by each practice in the CHP.
It was noted that revisions had been made to the enhanced service extended nursing hours
to make it more attractive for staff, but it was noted that most practice nurses were reluctant
to work outwith regular hours. First Responders has been set up in rural areas that need the
service, namely Badenoch & Strathspey. Learning Disability provision stemmed from the
national review of those services.
The Committee:
 Noted the report on Enhanced Services within the CHP area.
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PERFORMANCE MANAGEMENT
10.1 General Manager’s Report
Mr Small referred to his circulated report, and stated that due to a wide range of discussions
that had already taken place at the meeting, he would not speak again to individual items
within his report. There were no comments from the floor.
The Committee:
 Noted the General Manager’s Report.
10.2 Balanced Scorecard
Mr Small outlined the current issues. Mr Wood asked why the alcohol targets are consistently
red, to which Mr Small advised that measurement commenced on a ‘standing start’ without
any baseline figure and thus it has taken a while to achieve the desired rating. It was also
noted that there are recording issues which are trying to be resolved.
The Committee:
 Noted the discussions that took place.
Miss Angus left the meeting
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11
STAFF GOVERNANCE
11.1 Partnership Issues
Mr Palmer advised that he is an active member of the CHP Change Group and is also part of
the Nursing Workforce Establishment Project. Partnership representatives are working
together in Nairn to build the team in the new hospital. He noted that joint working has a
positive impact on the workforce.
The Committee:
 Noted the discussions that took place.
11.2 Workforce Report
Mr Johnston spoke to his circulated report. It was noted that show sickness absence has
increased for this quarter, which could be due to Pandemic ‘Flu issues.
The Committee:
 Noted the report.
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FINANCIAL GOVERNANCE
12.1 Finance
Mr Rodgers, on behalf of David Garden, gave an overview of the financial forecast, he
advised that the CHP Management Team and Change Group are actively working towards
identifying the required savings. It was noted that, currently, £175,000 is still to be found.
Mr Ross advised that practices are looking at their prescribing budgets to attempt add to the
overall picture of the budget. Mrs Hope said that nursing budgets are also being scrutinised.
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.
 Noted the ongoing work by local Managers and Finance teams to address the required
savings.
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CLINICAL GOVERNANCE
13.1 CHP Infection Control
Mrs Hope spoke to her circulated report and highlighted the environmental audit results for St
Vincent’s Hospital which were noted to be a challenge due to the nature of the older building.
Mr Small referred to the recently published Healthcare Environment Inspectorate Report for
an Announced Inspection at Aberdeen Royal Infirmary which had an unfavourable report.
The Annual Review by the Health Minister would be taking place on 7 December 2009 and it
was believed that healthcare acquired infection will be a topic of discussion. Mrs Hope
referred to the infection control workshop that took place the previous day, which was a
useful learning and revision opportunity, with the emphasis on maintaining rigorous infection
control procedures.
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The Committee:
 Noted the Infection Control report.
 Noted that an Infection Control Workshop had taken place.
13.2 Clinical Governance & Risk Management
In the absence of Dr Scott, Mr Small referred to the regular circulated Clinical Governance &
Risk Management Performance Report and requested that if members had any questions or
queries on the report to contact Dr Scott. Mr Wood requested a comparison with last year’s
data, for the next Committee meeting.
The Committee:
 Noted the Clinical Governance & Risk Management Performance Report.
 Demitted to the Clinical Director to provide comparative data at the next meeting of
the Committee.
13.3 CHP Clinical Governance & Risk Management Group
In the absence of Dr Scott, Mr Small referred to the regular circulated Clinical Governance &
Risk Management Performance Report and requested that if members had any questions or
queries on the report to again contact Dr Scott.
The Committee:
 Noted the draft minute of the CHP Clinical Governance & Risk Management Group
meeting of 8 October 2009.
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AOCB
There was none.
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DATES OF NEXT MEETINGS
The meeting schedule for 2010/11 was agreed as follows:
18 February 2010
Board Room, NHS Highland, John Dewar Building
15 April 2010
Badenoch & Strathspey Locality, Venue to be advised
17 June 2010
Board Room, John Dewar Building
19 August 2010
Board Room, NHS Highland, Assynt House
21 October 2010
Nairn Locality, Venue to be advised
20 January 2011
Board Room, NHS Highland, Assynt House
All meetings will take place on a Thursday, starting at 2:00 pm
The meeting closed at 4:25 pm
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