Highland nhs board 1 May 2007 Item 4

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Highland NHS Board

1 May 2007

Item 9.4

Alder House

Cradlehall Business Park



Tel: 01463 – 706948

Fax: 01463 – 794712



The Sanctuary, Inshes Church, Inshes Retail Park, Inverness

Thursday 15th February 2007 – 2.00pm

Present Mr Ian Gibson, Chair

Mr Nigel Small, General Manager

Dr Ian Scott, Clinical Director

Mr Dave Garden, CHP Accountant

Mrs Hilda Hope, CHP Lead Nurse

Ms Jackie Agnew, Service Manager, MH&LD

Dr Freda Charters, Clinical Lead, Inverness

Dr Adrian Baker, Clinical Lead, Nairn & Ardersier

Ms Fiona Grant, Clinical Lead, Badenoch & Strathspey

Mrs Margaret Davidson, Council Representative

Mrs Sheena Slimon, Council Representative

Ms Gillian McCreath, Council Representative

Mr Laurie Fraser, Council Representative

Mr Gregor Rimell, Council Representative

Ms Ailsa MacInnes, Optometry Representative

Ms Fiona MacFarlane, Community Pharmacy Representative

Mr Hamish Wood, Public Patient Forum Representative

Ms Tina Morrow, CHP Voluntary Sector Representative

In Attendance Mrs Jo Veasey, Assistant General Manager

Mr Jean Pierre Sieczkarek, Assistant General Manager

Mrs Anne Mackenzie, Primary Care Advisor

Ms Lisa Ross, Nurse, Homeless Persons

Mr Colin Yau, PA to General Manager & Clinical Director (Minutes)
Apologies were received from Mr Thomas Ross, Mrs Katie MacDonald, Mr Stuart Denholm, Mr Douglas Johnston, Mrs Cathy Steer and Mrs Pam Nicoll.


Lisa Ross, Nurse for Homeless Persons gave a verbal presentation to the Committee on her role. She focused on the development of her role in relation to HEAT targets i.e. Health Improvement, Efficiency & Governance, Access and Treatment, and in particular ‘Street Working’, where she took the service directly onto the streets to the client. She explained the need to have more resources in order to expand the service effectively.
Jean Pierre Sieczkarek recognised the development needs and mentioned that a ‘Visioning’ meeting will be taking place in two weeks time and would report back to the Committee.
The Committee thanked Lisa for her presentation and supported her on-going work, in particular to ‘Street Working’; and looked forward to the outcome of the ‘Visioning’ meeting.
The Chair requested that all forms from Committee members should be returned as soon as possible to ensure adherence to NHS Highland Policy.


The Committee:

  • Approved the minutes of meeting held on 21 December 2006.


    1. Exit Interviews

From the last meeting on the 21 December 2006 in which Douglas Johnston mentioned that exit interviews were not currently routinely carried out, Hamish Wood raised this point at this meeting, as he was absent at the last one. He queried whether there was a policy expectation that Line Managers carry out exit interviews. It was explained that this was good practice but not every single member of staff currently has an exit interview when they leave the organisation. Due to management capacity this was carried out but mainly on a selective basis.

The Chair will raise this with the Board.


    1. FINANCE

Dave Garden has produced a written report with the papers up to the end of December ’06. However, the latest financial information was now available so he tabled an up-to-date financial report to 31 January 2007.

He reported a £113k projected underspend for the CHP 06/07 and highlighted the only significant change in the forecast for January being the improvement in prescribing.
There had been a continued level of stability in terms of the day-to-day operational budgets within the Localities and Hosted Services. He referred to particular highlights:

  • Agenda for Change assimilations are on-going and there has been a degree of uncertainty as to the impact this may have on the CHP’s overall out-turn. This is due to the considerable amount of work required on individual pay budgets to ensure that appropriate budgets are drawn down to cover new bandings and arrears payments. During December there was a significant amount of catch-up work required due to the volume of assimilations and, once completed it resulted in a reduction of £30,000 in the forecast compared to the previous estimate.

  • The remaining £23,000 improvement related to a variety of minor movements in vacancies, reduction in locum costs, etc

  • The CHP currently has no un-funded posts.

The process for setting budgets for 2007/08 is already well underway and CHP representatives are members of the NHS Highland Financial Planning Group which meets regularly and is led by the Board’s Chief Operating Officer. NHS Highland is due to show an underspend due to the future sale of Craig Dunain. Capital and excess on this will go to revenue.

The Committee:

  • Noted the current forecast predicted an underspend of £113,000.

Ian Scott welcomed the appointment of Thomas Ross as CHP Lead Pharmacist.
Ian Scott went onto talk to a prescribing paper previously circulated to the


Data from the ISD (Information and Statistics Division) showed an overspend of £46,127 to end November 2006.
He confirmed that there are problems in monitoring due to the long delay in receiving actual prescribing information. This can sometimes be 3/4 months later.
He confirmed that prescribing budgets moved to a ‘fair shares’ basis some years ago.
Adrian Baker enquired what happens to savings made in prescribing, to which Dave Garden replied that they are then fed back into the bottom-line budget, as prescribing is part of the CHP’s unified budget and cannot be seen in isolation.
Ian Scott discussed statin prescribing developments.
He also confirmed that Thomas Ross was looking to strengthen pharmacy support across the CHP and this matter would be discussed at the CHP Management Team.
It was also confirmed that there is a delay in full implementation of the new community pharmacy contract which is being led by a NHS Highland Implementation Group. Fiona MacFarlane confirmed that the main problem was the delays in IT systems provision.

The Committee:

  • Noted the current prescribing budget and spend position, demonstrating an

overspend of £46,127 to end November 2006.

  • Noted the ongoing work in relation to statin prescribing.

  • Noted the current review of pharmacy and prescribing support across the CHP area.

  • Noted the current position in relation to the new community pharmacy contract.


Nigel Small talked to the Performance Monitoring & General Manager’s report. This report provides an up-date on a range of performance monitoring headings and other matters likely to be of interest to the CHP Committee.

He confirmed that:


Progress continues towards an integrated A&E and OOH service in Inverness.

A newsletter that had gone out to staff affected was circulated to Committee members.
Of particular note is the proposal to develop the Unscheduled Care Practitioner Role. A modular programme of training has been developed with Paisley University. This lasts 18 months and appropriate nursing staff are being identified to attend. The proposal to pay for the training, backfill, some additional staffing plus potential upgrade costs is currently being considered by the NHS Highland Planning Group. This proposal is part of the overall OOH Strategy to develop alternatives to the current “Doctor heavy” model of OOH care provision across Highland. It was confirmed that £200k has been allocated over the next 2 years to support the initiative. The aim after 2 years is to re-coup the resource via a reduction in GPs working in OOH across the wider NHS Highland area.
Margaret Davidson enquired whether there is any patient feedback on Waiting Times in the light of the A&E/OOH integration. Nigel Small replied that he understood the Raigmore Patient Council was involved. He confirmed that overall patient waiting times in A&E have improved significantly. The impact of integration on OOH waiting times would need to be carefully monitored.
Hamish Wood asked what was being done about AHP Waiting Times? Nigel Small replied that a group had been set-up, under the direction of the Nurse Board Director. The aim is to put in place a consistent process for gathering and monitoring AHP Waiting Times. Nigel Small confirmed that he had offered to be a member of the group.

The CHP General Manager is involved in the development of an options paper for the Chief Executive and Chief Operating Officer This explores the potential for collaborative contracting to be introduced within NHS Highland.

He confirmed that ‘Delivering for Health’ refers to collaborative contracting but does not enter into detail. For NHS Highland, this would potentially involve the development of a weighted capitation budget allocation to CHPs, the formation of capacity plans between CHPs and SSU, the setting of a tariff for activity, robust referral data utilised by practices and an overall environment which supports demand management and the movement of care to primary and community settings. The likelihood is that a “shadow” period will be instigated.
He confirmed that appropriate dis-aggregated information will be crucial to both collaborative contracting and monitoring of HEAT targets.
The Chair confirmed the importance of the dis-aggregation of HEAT targets and will take the matter to the Board in order to obtain data, which currently sits at NHS Highland level, to CHP level. This would support achievement of targets by assigning these to local teams and it would support collaborative contracting.


The performance indicators referenced at Appendix 2 for those Hospitals within the CHP responsibility were noted.


Nigel Small confirmed that Appendix 3 shows that the delayed discharge position at the CHP Hospitals as at 2 February 2007 were 10 delayed discharge patients in total. (compared to 12 at the December meeting and 10 at the September meeting). This number included 2 patients from SSU (in Badenoch & Strathspey) who we are supporting as we have the available beds and therefore shows on our statistics.


Nigel Small confirmed that the most recent and up-to-date information was contained in the Committee Paper, which came to the Committee Meeting on 21 December 2006.


Nigel Small confirmed that both initiatives are progressing well as per reports at the 21 December Committee Meeting. He suggested that if anyone wanted further information the relevant leads would provide this information.


Nigel Small reported that the NHS Highland Radiology Strategy Group had asked the Badenoch & Strathspey Locality to develop an initial proposal for the introduction of a mobile x-ray service. This is a feasibility proposal only at this stage. It will form part of the overall discussion and decision-making about the potential future x-ray provision in the locality. Further discussion will take place at the Radiology Strategy Group.


Nigel Small reported that Danny Alexander, MP for Inverness, Nairn, Badenoch & Strathspey visited the RNI Hospital over the festive period and is scheduled to visit the Town & County Hospital in Nairn on 16 February 2007, along with Nicol Stephen, Deputy First Minister and Charles Kennedy, MP.

The Committee:

  • Noted the contents of the General Manager’s report.



Nigel Small confirmed that the Board had asked for submission of a Draft Action Plan for consideration at its February meeting. The Draft Action Plan is intended to demonstrate how the CHP will implement or contribute to the following:

  • Delivering for Health

  • NHS Highland Clinical Framework

  • Local Delivery Plan/HEAT targets

  • CHP/Locality aims and priorities

Although only at Draft stage, the Action Plan is hugely important and will form the basis of the CHP’s work over the next 2/3 years.

Margaret Davidson enquired about a ‘sense of priority’ of the listed items. Nigel Small and colleagues will focus primarily on the Plan which aims to include the key priorities; anything else will not be as high a priority. There was a request for a column to be added around key milestones.
Hamish Wood enquired about ‘Obesity and Nutrition’. Jo Veasey answered that work continued in the background under ‘Health Improvement’ with Health Promotion officials etc and this was covered within the Plan.
Hamish Wood enquired about where ‘Staffing’ was included. He was re-assured that it was included under ‘Integrated Staff Governance Action Plan’.
Nigel Small welcomed views and comments from the Committee both at and outwith the meeting. He will then update the Action Plan. The document will be brought to a future meeting for ratification.

The Committee:

  • Noted the on-going work to develop an over-arching CHP Action Plan.

  • Commented and provided advice on the further development of the Plan.

  • Acknowledged that a final version of the Plan will be brought to a future Committee meeting following wider input and consultation.

  • Acknowledged that the Action Plan would be used as a working document.


Jackie Agnew talked to a paper that had previously been circulated to the Board, and now to the CHP Committee, on the Scottish Executive’s recent launch of a new Strategy for Mental Health Services.

Jackie Agnew confirmed that the new implementation plan – ‘Delivering for Mental Health in Scotland’ was launched on 5 December 2006. It contained a series of 3 HEAT Targets and 14 Commitments.
‘Delivering for Mental Health’ is part of the National Programme for Improving Mental Health, and is also a key component of the over-arching policy ‘Delivering for Health’.
NHS Highland, working alongside its partner agencies, is now expected to develop a local implementation plan to outline how services will meet the commitments and the 3 HEAT targets. Particular emphasis is placed on the relationship between NHS and Local Authority services in taking this forward.
Jackie Agnew confirmed that there was a significant amount of development work and change associated with the Strategy. She confirmed that ‘Delivering for Mental Health’ requires the introduction of an acute in-patient Forum at New Craigs Hospital. This must include representation from service providers, Highland Users Group, NSF Carers Group and Highland Council. Details of how in-patient Forums should develop have been issued from the Mental Health Division and this is being led by the Service Manager for Mental Health and Learning Disabilities.
The Mental Health Network is asking Localities to scope out what’s already available and this is work in progress.
Hamish Wood commented on the suicide rate target and whether the 20% reduction could be achieved or was testing enough. It was confirmed that latest figures from 2005 now take us closer to the Scottish average since 1998. Jackie mentioned the appointment of a full-time suicide prevention co-ordinator. Hamish commented that the figure of 50% of target staff to be trained in using suicide assessment tools/suicide prevention training programmes by 2010 was possibly low. Jackie confirmed this would be considered within the implementation of the plan.
Margaret Davidson was pleased to see commitment on Mental Health Delivery and enquired what Jackie Agnew would like to see more of? Jackie responded that she would like to see more of a ‘crisis response’ service

The Committee:

  • Noted the introduction of the Scottish Executive’s Plan ‘Delivering for Mental Health’.

  • Noted the work undertaken to date to identify the likely requirements within NHS Highland to successfully implement the plan and meet the 3 HEAT targets.

  • Endorsed the proposal that this work be progressed by the multi-agency Mental Health Network.

It was noted that Cathy Steer was not available due to ill health.
A paper on health improvement had been circulated to Committee members before the meeting.
Jo Veasey asked the Committee for any comments on the format or specific details on the paper. She also commented that Cathy Steer had been a valuable addition, working on a weekly basis at the CHP Office, as a member of the CHP Management Team.
Jo Veasey commented that within the smoking cessation service, 2.2 wte cessation advisers were now managing a large client base of 160.

The Committee:

  • Noted the progress in relation to developing a monitoring framework for Health Improvement in the CHP.

  • Noted the progress in relation to the CHPs smoking cessation service

Cathy Steer not available to discuss the paper.
A paper on migration had been circulated to the Committee members before the meeting.
There was some discussion that figures could well be underestimated, but one thing that could not be denied was that migration will play a major part in the growth of the population of the Highlands, in particular, the ever growing Polish population.

The Committee:

  • Noted for information migration figures and associated services.



No specific issues were raised.


Tina Morrow informed the Committee of a forthcoming CHP Voluntary Sector Workshop that she and Katie MacDonald had planned. This will happen on the 12 April 2007 in the Inshes Church, Inshes Retail Park, Inverness. Flyers/invites will be sent out shortly. The Workshop will be an informative event, which will enable discussion on the Voluntary Sector within the CHP.

The Committee:

  • Noted the date of the Voluntary Sector Workshop.


    1. HR ISSUES

Douglas Johnston not available to comment.


A report had been circulated prior to the meeting. Nigel Small observed from the Workforce Report that the sickness rate was showing signs of improvement (4.3%). He confirmed a lot of work has gone into this e.g. interviewing staff on return to work.

It was observed that the staff turnover rates seem reasonable at 0.99%. Hopefully this will stabilise.


Nigel Small confirmed that all NHS Boards are required to have a Local Partnership Forum. This will be a smaller version of the existing Area Partnership Forum. The first meeting was held on the 11 December 2006 with the next one in a week’s time.

The LPF will be a useful forum to discuss any major service changes.
The role and remit had been circulated to Committee members prior to the meeting.

The Committee:

  • Endorsed the role and remit of the CHP Local Partnership Forum.


  • The Chair pointed out that this would be the last meeting to be held in private. The next meeting in April will be opened up to members of the general public.


  • Gregor Rimell asked what the impact of Council changes would be on service provision and the Committee. It was confirmed that with the following Council elections and changes to Council structure, there would be a requirement to wait until after these events before changes to the Committee would be clear. Concerns regarding who would pick up elements of work effected by the changes were being raised with the Chief Operating Officer.

  • Gregor Rimell raised concerns about potential withdrawal of ambulance transport in the Badenoch & Strathspey Locality. Jo Veasey confirmed that she was trying to work as closely as possible with SAS colleagues to find out about any changes and their impact.


  • Jean Pierre Sieczkarek thanked Laurie Fraser and colleagues for their support in the Mental Health Team’s move to Corsee.


The next meeting of the Committee will be held on Thursday 5th April 2007 at 2:00pm – Inshes Church, Inshes Retail Park, Inverness*
The meeting closed at 4.20pm
*Apologies received from Hamish Wood

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