Highland nhs board 2 October 2007 Item 3(a)

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Highland NHS Board

2 October 2007

Item 9.3(a)


South East Highland

Community Health Partnership

Alder House

Cradlehall Business Park



Tel: 01463 706948

Fax: 01463 794712


Board Room, Assynt House,

Beechwood Park, Inverness

Thursday 12 July 2007 – 2.00pm

Present Mr Ian Gibson, Chair and Non Executive Director

Dr Ian Scott, Clinical Director

Mrs Jo Veasey, Assistant General Manager

Mr Jean Pierre Sieczkarek, Assistant General Manager

Mr David Garden, Head of Finance

Mrs Fiona Grant, Clinical Lead, Badenoch & Strathspey

Mr Campbell Mair, General Manager, Nairn & Ardersier GPs

Mr John Holden, Council Representative

Mrs Liz Macdonald, Council Representative

Mrs Margaret Davidson, Council Representative

Mr Douglas Johnston, Personnel Manager

Mrs Ailsa MacInnes, Optometry Representative

Mrs Tina Morrow, Voluntary Sector Representative

Mr Hamish Wood, Public Patient Forum Representative

In Attendance Mr Garry Coutts, Chair, NHS Highland

Dr Roger Gibbins, Chief Executive, NHS Highland

Ms Allison Meek, Scottish Health Council

Mrs Anne Mackenzie, Primary Care Advisor

Mr Colin Yau, PA to General Manager & Clinical Director (Minutes)
Apologies were received from Mr Nigel Small, Mrs Gillian McCreath, Ms Ros Philip, Ms Alex Fraser, Ms Cathy Lush, Ms Jackie Agnew, Mrs Cathy Steer, Mrs Hilda Hope, Mr Thomas Ross, Mrs Katie MacDonald, Dr Freda Charters and Dr Adrian Baker.
Hamish Wood informed Committee members that since the last meeting he has had a change in circumstances and is in now a Councillor for a particular party. However, he assured the Committee that he would still represent patients and the public as an individual, and will declare any interests, if appropriate to do so.
The Chair asked for any outstanding forms to be returned to CHP HQ as soon as possible.


  • The Committee Approved the minutes of the last meeting held on 5 April 2007.

4.1 Dental
Hamish Wood informed the Committee that as a member of a working group for dental, he’d attended a useful meeting of all dental representatives recently with another one scheduled to take place in the autumn.

4.2 Highland Council Representation

The Chair informed the Committee of the five newly elected Highland Councillors welcomed onto the Committee – Mrs Margaret Davidson, Mrs Liz MacDonald, Mr John Holden, Mr Jimmy MacDonald and Mr Graham Marsden.

He mentioned that the Assistant General Managers, Jean Pierre Sieczkarek and Jo Veasey had attended Highland Council ward forums/partnerships, and although there is currently no Councillor for Badenoch and Strathspey on the Committee, there is a Councillor on the Badenoch and Strathspey Locality Group. However, there is still no Partnership rep for staff-side, but the General Manager, Nigel Small, has been liaising with Ray Stewart, Employee Director, about this.
Budget Setting 2007/08 & Finance Report to 31 May 2007
Dave Garden talked to his ‘Finance’ report.
The report outlined the budget setting process for 2007/08, high-lighted the CHP savings target and achievement to date for 2007/08, and provided detail of the current forecast out-turn for the year, based upon information as at 31 May 2007.
He stated the budget setting process for 2007/08 had been robust and detailed at both NHS Highland level and within the CHP. However, the financial challenges facing the CHP are primarily due to the requirement for recurring savings in both general CRS and prescribing are significant. Recognising these challenges, the CHP expects to break-even in 2007/08 based on the information currently available.

The Committee:

  • Endorsed the CHPs budget setting process for 2007/08.

  • Noted the 2007/08 savings targets and progress made towards achievement.

  • Noted the forecast of break-even as at 31 May 2007.

Finance Report to 31 March 2007
Dave Garden talked to his ‘Finance’ report.
The previous report that went to the Committee in April forecast the financial out-turn based on February information. The purpose of this report is to up-date the Committee on the actual final position for 2006/07.
He stated the out-turn for 2006/07 was a small underspend of £51,000 compared to £118,000 in the previous month, showing an adverse movement of £67,000.
He stated the most significant reason for the adverse movement was the actual costs in respect of enhanced service payments, which were £50k higher than previous estimates. Additional minor expenditure around estates costs and equipment purchases made up the balance of the movement within localities, which were offset by additional income within Dental. Mental Health increased marginally but remained within budget for the third successive year.

The Committee:

  • Noted the CHP financial performance resulted in a small underspend of £51,000 in 2006/07.
5.2 Performance Report
In Nigel Small’s absence, Jo Veasey talked to his ‘Performance’ report and Balanced Scorecard. This report provided an up-date on a range of performance monitoring headings and other matters likely to be of interest to the CHP Committee.
She asked the Committee to note the down-turn in bed occupancy and commented that further to a review of community hospital bed occupancy in SE H CHP during the last three years this would appear to be a seasonal variation and not an ongoing trend. With regards to the delayed discharges, week ending Friday 29 June 2007, there were 12 DDs in total (4 at New Craigs). The range is between 5 -14 DDs.
Hamish Wood asked when the target would be reached with regards to breast cancer waiting times. He also commented on the old data, re: smoking cessation dating back to 2005; and would like to see a longer time period to look at with regards to the complaints because at the moment the report only compared the current quarter with the results of the previous quarter.
Garry Coutts replied that the smoking cessation data at this high level is gathered every two years.
Margaret Davidson enquired why the information was so old on the Balanced Scorecard. She would also like someone to talk to the areas highlighted in red, and wanted somewhere to record the patient experience/satisfaction.
Garry Coutts replied that NHS Highland is currently looking into the patient experience. He answered the reason why the data is out-of-date is because under national advice only data that has gone through the validation process can then be published and put into the public domain.
Jo Veasey explained that patient experience/satisfaction information is collected about specific aspects of the service, e.g. Out of Hours, and offered to provide Margaret with information from this part of the service as an example. Margaret Davidson suggested that this information should be available across the range of services that are provided.
The Chair will ask Nigel Small to pick-up Margaret and Hamish’s points at the next Committee meeting.

The Committee:

  • Noted the latest performance activity for the SE Highland CHP.

5.3 CHP Delivering For Health Action Plan: Reporting Arrangements
In Nigel Small’s absence, Jo Veasey talked to his ‘CHP Delivering for Health Action Plan: Reporting Arrangements’ paper. At the last meeting in April 2007, the Committee considered and agreed a Draft CHP Delivering for Health Action Plan, which had also been to the Board. The Chair had asked for this paper so that all members were clear about the monitoring and reporting arrangements.
Margaret Davidson enquired about the reporting arrangements for health-acquired infections. Jo Veasey agreed to provide the information by e-mail.

The Committee:

  • Agreed the proposed performance monitoring arrangements for the CHP Delivering for Health Action Plan 2007-09.

6.1 Long-Term Conditions Toolkit
In Nigel Small’s absence, Dr Ian Scott talked to his ‘Long-Term Conditions: CHP Self Assessment Toolkit’ paper. A model for developing systematic support for people with a long-term condition is set out as a key requirement within Section 2.2 of Delivering for Health. This referred to the production of a long-term conditions toolkit, which would ensure consistency across the whole of Scotland. Use of this toolkit is mandatory for Community Health Partnerships. CHPs will be represented on the LTC Strategy Group and they will in turn establish CHP LTC Action Groups. SE Highland CHP had already established a ‘CHP Shifting the Balance Group” (previously known as the ‘CHP Community Hospitals Group’) chaired by the Clinical Director, Dr Ian Scott. This group would be responsible for ensuring implementation of the LTC Action Plan as well as annual completion and submission of the LTC Self-Assessment toolkit, and as we’d only scored 74/150 in year one, there is indeed room for improvement.

The Committee:

  • Agreed the completed CHP Self Assessment Toolkit and noted the Year 1 score.

  • Noted the requirement to establish a CHP Local Action Team.

  • Agreed the proposal to use the CHP Shifting the Balance of Care Group as the CHP Local Action Team for Long-Term Conditions.

    1. Dental

In Cathy Lush’s absence, Jo Veasey reported on Dental Services. She reported on the performance of the SE Highland CHP with regards to the national oral health improvement targets. The target (60% of 5 year old children with no decay experience) in the Argyll & Bute, North & Mid CHPs had already been achieved. Within SE Highland, 48.5% of 5 year olds have no decay experience so there is still some work to be done however she asked the Committee to note that we have one of the most deprived areas in Highland (and Scotland) within the Inverness area and this undoubtedly has an effect on the figures.

NHS Highland had appointed a network of oral health promoters, aligned to the CHPs and within SE; the post is fully integrated within the Health Improvement Team. They would be supporting the further roll-out of the supervised tooth brushing programmes, jointly with partners in Education.
A community development approach is to be explored, whereby 0-3 year olds are provided with oral health education and registration in a non-surgery setting as part of a care pathway; increasing access for pregnant & nursing mothers, as surgery space becomes available, targeting those from deprived communities; expanding opportunities for oral health promotion for children in transition from primary to secondary education.
Margaret Davidson enquired how local a level was the information gathered from and queried the time, energy and money put in. Jo replied from school level in relation to tooth decay (DMF score: decayed, missing, and filled). It was noted that Cathy would provide more information, in particular about tooth decay, at the next meeting.

The Committee:

  • Noted Cathy Lush would provide more information at the next meeting, in particular about tooth decay and the proposed milestones for improvement.

6.3 Mental Health & Learning Disabilities
In Jackie Agnew’s absence, Jean Pierre Sieczkarek reported on the following:

  • Difficulties in filling the vacancies in medical, nursing and clinical psychology.

  • The introduction of guided self-help workers to assist psychology services

  • The continuing training in STORM and ASSIST suicide prevention.

  • The re-deployment of learning disability nursing staff into appropriate posts within the organisation.

The Committee:

  • Noted the following updates for the mental health services and the re-provisioning of the learning disability services.

6.4 Nursing
In Hilda Hope’s absence, Jo Veasey talked to her ‘Review of Nursing in the Community’ paper. She asked the Committee to note the Terms of Reference for the purpose of progressing the development of Nursing in the Community within the SE Highland CHP.

The Committee:

  • Noted the Terms of Reference.

6.5 Prescribing & Pharmacy
In Thomas Ross’s absence, Dr Ian Scott talked to his ‘Prescribing and Pharmacy’ report. He reported:

  • Thomas Ross’s appointment as CHP Pharmacist.

  • £93k had been saved from an increase in prescribing simvastatin and a decrease in atorvastatin.

  • Prescribing support pharmacists have been appointed in Inverness and Nairn & Ardersier Localities. We now have a pharmacy presence in each of our practices every week.

  • A small working group, including representatives from the three localities, has been set-up to discuss the establishment of a Quality Prescribing Framework.

  • Running schemes and services in the Community Pharmacy Contract -

- Minor Ailments Scheme.

- Public Health Service.

- Acute Medication Service.

- Chronic Medication Service.

The Committee:

  • Noted Thomas Ross’s appointment to CHP Pharmacist.

  • Noted the changes in statin prescribing and resultant savings.

  • Noted the update to the CHP Pharmacy Team Structure.

  • Noted the discussion regarding a Quality Prescribing Framework.

  • Noted the update on the Community Pharmacy Contract.

6.6 OOH Developments
Jo Veasey reported:

  • 11 Badenoch and Strathspey GPs have come to an agreement to continue to provide OOH services for a further 2 years from August 2007, at a lower cost than in the two previous years; Nairn and Ardersier have a 3-year SLA in place.

  • A&E/OOH are now integrated in Inverness, functioning from the Raigmore site.


In Cathy Steer’s absence, Jo Veasey talked to her ‘Smoking Cessation’ report. She reported:

  • Cathy Steer had been appointed as NHS Highland’s Head of Health Improvement, however it is expected that she will continue with her alignment to SE.

  • A specialist smoking service was set-up in May 2006 with the appointment of 2.2 wte smoking cessation advisors. In May 2007 an additional smoking cessation post was created, however this post is only funded until September 2007. Smoking cessation clinics have now been set-up in 14 locations across the CHP and include a mixture of health service and community settings.

  • The CHP had developed its Tobacco Action Plan in June 2006.

Dr Scott added that, in collaboration with HUG, mental health patients are being encouraged to access the Smoking Cessation service, accepting that help may be most beneficial after discharge from Hospital.

Hamish Wood enquired about school-age female smokers. Jo Veasey advised that the Health Promoting Schools Development Officers are working with this age group on an ongoing basis.

The Committee:

  • Noted Cathy Steer’s appointment as NHS Highland’s Head of Health Improvement

  • Noted the progress on developing a smoking cessation service within the CHP.

  • Noted the progress with the CHP Tobacco Action Plan.

8.1.1 Delivering For Health: Community Council Presentations
The Chair reported on the ‘Delivering For Health: Community Council’ presentations, which are being delivered to communities across Highland. The SE Highland CHP had already done five with more in the pipeline. The presentations are currently under review, with a group being set-up to look at the feedback received from the presentations.
8.1.2 Non-Target Waiting Times
Hamish Wood reported that the General Manager had produced a report at last Sept’s Committee meeting which referred to learning disability waiting times and eating disorder waiting times amongst other waiting times. He commented it would be useful to get an up-date for comparison as a means of monitoring progress. It was agreed the whole range of waiting times should be reviewed. Dr Scott will ask Nigel Small to give an up-date on waiting times at the next Committee meeting.
8.1.3 Cleaning Quality Inspections
Donald Macleod, Quality Assurance Manager, had invited Hamish Wood to view a cleaning quality inspection at the RNI Community Hospital. Hamish was extremely impressed with the quality control and wishes to share this with the Committee.
Jo Veasey advised the Committee that at the last audit each of the CHP Community Hospitals are above average at 95%, against the Target of 90%.
8.2 Voluntary Sector Agreements
Jean Pierre Sieczkarek reported that funding had been devolved to CHPs. A re-organisation had resulted, such that Lynda Thomson, Policy Development Manager and Caroline Tolan, Policy Development Manager will both be devoting a percentage of their time to working at CHP HQ. Lynda would be working with the Voluntary Sector Organisation and Caroline would be covering Equality and Diversity. The General Manager and Assistant General Managers have also met up with local authority colleagues - Amy Page, Contracts Officer, Voluntary Organisations and Sarah Merriman, Acting Team Leader (Contracts), Social Work Business Support, Highland Council.
Tina Morrow mentioned the CHP Voluntary Sector Workshop on 12 April was well received with 25 in attendance and another session is planned towards the end of the year.


    1. HR Issues/Workforce Report

Douglas Johnston talked to his ‘Workforce’ report and confirmed that the CHP’s attendance figures were improving with absenteeism levels going down.

NHS Highland’s ‘Promoting Attendance’ policy had been in place with a series of briefings held, in which a total 71 managers attended. There is continuing dialogue between managers and staff.
The Chair enquired about exit interviews, to which Douglas replied that these were not carried out as a matter of routine with all staff. The Chair will take up this issue separately at the Staff Governance Committee.
The Committee:

  • Noted the contents of the monthly Workforce Report.


10.1 Audit Scotland: CHP Review
Audit Scotland is currently undertaking an audit programme of Community Health Partnerships. A number of CHPs across Scotland have been selected. For NHS Highland, SE Highland CHP and Argyll and Bute CHP are participating in the audit.
The Review will focus on 4 key findings – Financial Management, Corporate Governance, Performance Management and Information and Data-Sharing.
An initial meeting took place on 17 May 2007 between Steven Boyle, Audit Manager, Richard Smith, Audit Scotland, Nigel Small, CHP General Manager and Dave Garden, CHP Head of Finance.
An initial, draft report for accuracy checking is expected to be available to the CHP General Manager by the end of July 2007. The completed audit report will then be forwarded to the Chief Executive.

The Committee:

  • Noted SE Highland CHP’s participation in the Audit Scotland review.

  • Requested that the final audit report be brought to the next Committee meeting for consideration.

  1. AOCB

11.1 Garry Coutts, Chair & Dr Roger Gibbins, Chief Executive, NHS Highland
Garry Coutts explained that his attendance today was part of a programme of visits to the CHPs. In looking at the 'Delivering for Health' agenda the Board wants to ensure the NHS Highland is operating as effectively as possible with appropriate scrutiny in place. Reviewing minutes, sitting in on meetings and speaking to members was part of that process. He was convinced that closer working between the CHPs and the Local Authorities was a key component of the way forward and discussions were taking place with the new administration in Highland.


Roger Gibbins thanked the Committee for their invitation to attend and mentioned his particular interest in ensuring adherence to staff governance, clinical governance and financial governance standards and that the interface between the Board and the CHPs was best fitted to implement Health policy in general and re-design and modernisation in particular.


Garry and Roger will reflect on their visits to all CHPs and discuss their conclusions with Chairs and other Board members in due course.


The next meeting of the Committee will be held on Thursday 6 September at 2.00 pm in the Board Room, Assynt House, Beechwood Park, Inverness.
The meeting closed at 4:00pm

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