CHIEF EXECUTIVE’S EMERGING ISSUES AND UPDATES REPORT
Highland NHS Board
6 November 2007
Item 6.2
1 INDEPENDENT ADVICE AND SUPPORT SERVICES (IASS)
In accordance with the terms of HDL(2006)13, NHS Highland has established an
Independent Advice and Support Service in collaboration with CABx and at an annual cost of
£104k. This collaboration is underwritten by a formal SLA.
The arrangement which is being implemented in two stages provide a service to patients, carers and others acting on the patients behalf. The service is structured in four levels as follows:
Level 1 - Directing patients to specific sources to obtain information that they require, eg leaflets, supplying details of telephone helplines or websites.
Level 2 - Exploring the options available to a patient to resolve an issue and supplying a self-help pack or referral to a case worker.
Levels 1 and 2 are already available at seven CABx located in Caithness, Dingwall, Fort
William, Skye, Nairn, Inverness and Lochgilphead.
Level 3 – Assistance and support from a case worker to raise the patients concern or complaint with the appropriate organisation.
Contacting third parties by telephone when authorised by the patient or assisting to compile letters.
Accompanying a patient to meetings or to review personal files.
Reviewing patients personal circumstances and advising on their potential entitlement to benefits, employment rights and ways of dealing with loss of income.
Level 4
– as level 3 but liaising with specialist support or independent advocacy services if the patient requires additional support (eg, signer for the deaf, interpreter, mental health worker/advocate).
Levels 3 and 4 will be accessible through new case workers based in the CABx in Argyll &
Bute, Ross & Cromarty, Inverness and Lochaber with effect from January 2008 and subject to recruitment of additional CABx case worker staff.
2 JEANNIE DEANS UNIT, HELENSBURGH - MANAGEMENT OF DISPLACED
STAFF
The Cabinet Secretary for Health and Wellbeing gave her approval to NHS Highland proposals for the redesign of services for older people in the Helensburgh and Lomond locality on 6 August 2007 which included the replacement of inpatient services at the Jeannie
Deans Unit and its consequent closure as a continuing care facility.
As a result a process of redeployment of displaced staff has been initiated. Currently, 13 members of staff (8 WTE) remain displaced and continue to be the focus of the organisational change process.

In collaboration with our Local Authority partners an innovative agreement has been reached to maintain the staff on NHS terms and conditions whilst redeploying them to provide intensive home care within the Helensburgh and Lomond locality commensurate with the principles and direction of the approved redesign of services for older people. This agreement provides employment security for all the staff concerned. An implementation plan is being finalised to ensure full staff involvement and that staff are developed and orientated appropriately in preparation for them to adopt a new role.
3 NATIONAL HAND HYGIENE PROJECT
The second round of hand hygiene audits undertaken in NHS Highland as part of the national Hand Hygiene Project is now completed and the results are being analysed. The
Scottish Government will be publishing in a benchmark report at the end of November all results pan-Scotland. At this moment in time, none of the pan-Scotland results have been made known. A full report of NHS Highland’s audit results will be brought to the Board by the
Nurse Director in December 07 for information and discussion.
4 NATIONAL REVIEW OF MENTAL
RELATIONSHIPS AND RECOVERY
HEALTH NURSING – RIGHTS
Key areas of progress
The second NHS H Action plan update for the National Implementation Group that reports to the Chief Nursing Officer and the Scottish Government has been completed. This report demonstrates that NHS Highland is on target with the majority of the actions in the work-plan.
Rights, Relationships and Recovery workshops for mental health nurses and partner professions have been held in the SE, North a nd Mid CHP’s to enable the teams in the
CHP’s to review their current practice and to develop local implementation plans.
People from community, inpatient services and carer groups are commencing the training for trainers to enable them to facilitate groups who are undertaking the values based training -
“10 Essential shared Capabilities”. All mental health nurses will participate in this training over a six month period. The aim of the training is to promote positive mental health practice and thus the experience of service users and carers.
There has been negotiation and collaboration with Stirling University to provide joint training and facilitation to meet the actions within the plan. A lecturer from Stirling University is facilitating the first group of nurses who are studying the 10 essentials Shared Capabilities and nurses from New Craigs will reciprocate by delivering training to students at Stirling
University.
A scoping exercise to review the provision of psychosocial interventions has taken place to enable a plan to be put in place to ensure that patient needs will be met. An analysis of future training needs is underway. Three nurses are currently studying the CBT course and a further four nurses will complete the DBT course in January 2008.
Mental health nurses are participating in clinical supervision in a variety of formats including
Action Learning sets, individual and peer supervision.
A mental health non-medical prescribers group has been set up with involvement of the nurses who have completed the course. Four nurses have commenced the course in
September.
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Local Implementation Group
The NHS Highland implementation group has membership from the four CHPs. Partner agencies including the Highland Council and the HEI’s. The group meets monthly to review the NHS H position with the work-plan and to develop current work streams.
One of the challenges has been to ensure equity in all CHP areas. The challenges are addressed by the implementation group. An example of this is the proposal that the values based training will be delivered on specific dates with attendance by community and inpatient staff.
5 NORTH OF SCOTLAND PLANNING GROUP
A copy of the Briefing from the North of Scotland Planning Group for June 2007 is attached as Appendix 1 to this update.
6 REVIEW OF NURSING IN THE COMMUNITY (RONC)
NHS Highland, as 1 of the 4 Development sites, has a unique opportunity to influence and shape the development of the new service model for nursing in the Community.
Whilst this is an exciting opportunity, it also brings with it challenges and uncertainty and this is recognised, as is the importance of the involvement, skill and expertise of NHS Highland’s much valued nursing workforce being key to the success of this work. So nursing staff as well as other service partners will continue to be fully involved in the development of this work. Key areas are outlined below.
The consultation on the 2 nd draft of the Capability Framework for the Community Health
Nurse (CHN) ended on 6 September. An NHS Highland collated response incorporating responses from teams throughout NHS Highland was sent to NES who aim to have the final version ready in November. NES are also looking at education requirements including transitional education. A draft job description for the CHN role is now being circulated so key stakeholders have an opportunity to comment by 7 December, the Project Manager is collating a Highland response. In terms of workforce, the next key milestone is the collection of baseline data on the demographics of the workforce, to give an indication of the numbers of staff that will be involved, their primary role/s, where they are located and which geographical areas/teams they cover.
NHS Highland RONC Steering group met on 16 October and CHP Local Implementation
Groups (LIG) continue to meet 4-6 weekly. The Project Risk Log/Register has been reviewed to ensure that all risks were identified and to assess the likelihood and impact, and risk controls and actions needed. An updated version was taken to the Steering Group along with key other project documents including an updated Communication Action plan, Gantt chart for the overall project, and a draft Change Management / Organisational Development plan that is in development. The aim of this plan is to ensure that all stakeholders are involved, engaged and supported throughout this project, for example a workshop is being held in November for the Steering group to look at “A Day in the Life of …’, similar workshops will follow in the Local Implementation Groups.
Following initial concerns raised during the May & June RONC workshops two workshops on
Children’s Services/Protection have been held focusing on understanding concerns and identifying solutions. Some key questions and answers are being developed and some key messages have been agreed. Workshops focusing on Public Health are being organised for
November/December. Review of Nursing in the Community workshops are also being planned for staff for November/December and will be led by Heidi May, Board Nurse
Director. These will cover a range of topics within RONC giving staff the opportunity to
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7 discuss the latest key developments, e.g. the job description of the CHN and be kept up-todate with the project, e.g. outputs from th e workshops on Children’s Services/Protection. A sub group of the Steering Group will meet on 25 October to focus on Patient and Public
Involvement and the Review of Nursing in the Community.
SEASONAL INFLUENZA
7.1 Last Year (2006-07)
There were considerable problems last winter with the supply of the seasonal flu vaccine which resulted in delays to the commencement of the vaccination programme. Despite this the uptake level in NHS Highland was the highest ever at 74.9% of those aged 65 and over.
This compared well with the Scottish average of 75.1%.
The incidence of flu infection was again low as it has been now for several years. See
Figure 1.
Fig. 1: Flu spotter consultation rates for influenza-like Illness (ILI)
4.2 This year (2007-08)
4.2.1 Vaccination Campaign
This year the supply of flu vaccine has been free of problems and by the 5 November 2007 the full Scottish order will have been delivered by the pharmaceutical companies. There are no known local supply issues.
The national advertising campaign on TV, Radio and Press began as scheduled in early
October. The centrally generated patient letter produced by Atos Origin on behalf of the
Scottish Government has also now been fully delivered. Highland and Argyll residents aged
65 and over received their letters within the first half of October.
This year the target for those aged 65 and over remains unchanged at 70% uptake.
However, in addition a new target of 60% uptake in non-age related at risk groups has been introduced for the first time. This reflects a change in the national campaign to encourage more people in the younger “at-risk” groups to come forward for vaccination as well as the elderly. These risk groups include those with chronic respiratory problems, chronic heart disease, diabetes, etc. In addition poultry workers have again been offered seasonal flu vaccine this year.
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4.2.2 Staff Vaccination Campaign
Occupational Health Services are leading on the NHS staff campaign and clinics have been set up in a large variety of geographical locations and all staff groups given the opportunity to attend for flu vaccination.
4.2.3 Surveillance and Monitoring
The weekly surveillance of clinical flu-like illness is ongoing again this winter and our network of 9 “spotter” GP practices report every Monday on the number of cases seen during the previous week. This data is collated nationally and reported on a weekly basis by Health
Protection Scotland. At the time of writing there is no evidence of significant influenza activity in Scotland. Due to the very small number of laboratory flu specimens processed to date it is not yet possible to say whether the strains circulating and affecting people are the same strains that are present in this year’s vaccine or not.
Vaccine uptake will be monitored monthly at the end of October, November and December by HPS following receipt of a monthly return completed by each general practice in the country. Final and validated uptake data however is not available until after the last financial payment claims are processed by Practitioner Services on 31 March 2008.
8 SCOTTISH ENHANCED SERVICES PROGRAMME FOR PRIMARY AND
COMMUNITY CARE
The Scottish Government has outlined 9 additional services that it is keen for NHS Boards and their CHPs to engage with a minimum of 3 initially as part of the enhanced services programme for Primary and Community Care. These were:
Local and Accessible Healthcare -Services for Adults with Learning Disabilities
-Care for Adults with Diabetes
-COPD/Pulmonary Rehabilitation
Improving Public Health
-Flexible GP appointment sessions
-Alcohol screening and brief interventions
-Cancer and urgent referral audits
-Services for carers
-Childhood obesity services
The Enhanced Services Programme will last initially for 18 months, beginning on 1 October
2007, with NHS Highland receiving an allocation of £1.28m on acceptance of an outline proposal. The four Highland CHPs, through DHS Operational Network discussed this issue and considered in detail the 9 services highlighted as a priority.
DHS Management Team have agreed the recommendation to participate in 3 specific areas and allocating funding to Cancer and urgent referrals (expanded to include referral management) £469,000k, COPD/Diabetes (individual CHPs to select as appropriate)
£448,000k and Services for Carers £306,00k.
In order to support these projects there are significant IM&T considerations for which a sum of £65,000k has been identified as part of the proposal.
Chief Executive’s Office
Assynt House
26 October 2007
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