Item 10.1 for 2 Apr 2013 GAPF 12 12 12

APPROVED NHS GRAMPIAN Minute of the Grampian Area Partnership Forum (GAPF) held on Wednesday 12 December 2012 at 2.00pm in Conference Room, Summerfield House Board Meeting 02 04 13 Present: Open Session Sharon Duncan, Employee Director (Chairperson) Item 10.1 Mike Adams, UCATT Jim Clark, GMB Joe Collier, Clinical Nurse Manager (deputy for Alison Hardy) Bill Cowling, Project Manager Mental Health Frances Dunne, Senior Service Manager Ian Francis, CSP Alistair Grant, RCN Eileen Grant, GHP Laura Gray, Director of Corporate Communications Annie Ingram, Director of Workforce Heather Kelman, General Manager (deputy for Pauline Strachan) Steven Lindsay, UNITE Martin Mackay, UNISON Sandra-Dee Masson, BAOT Deirdre McIntyre, SOCAP (VC) Fergus McKiddie, HPA Mike Ogg, Assistant General Manager Aberdeenshire (VC connection did not work and Mike had to leave the meeting early) Clark Paterson, Senior Finance Manager (deputy for Alan Gray for item 6a) Stewart Rogerson, Head of Soft Facilities Management, Decontamination Lead and Nominated Officer Fire for NHS Grampian (deputy for Gary Mortimer) Anne Ross, Head of Performance & Quality Improvement Vincent Shields, General Manager Acute Gail Thomson, Operational Manager for Obstetrics, Gynaecology and Neonatology Services Keith Thomson, Head of Health and Safety Joan Anderson, Partnership Support Officer

In Attendance:

Nigel Firth, Equalities and Diversity Manager – for item 2 Paul Allen, Head of ITC Services - for item 7c Kate Livock, Project Manager – for item 8b

Item Subject Action 1 Apologies

Apologies were received from Gary Mortimer, General Manager Facilities and Estates (Stewart Rogerson deputised), Mike Scott, Staff Governance Committee (no deputy), Pauline Strachan, Chief Operating Officer (Heather Kelman deputising), Elinor Smith (no deputy), Richard Carey, Chief Executive (no deputy), Alison Hardy, Clinical Nurse Manager (Joe Collier deputised), Alan Gray, Director of Finance (Clark Paterson deputised for item 6a), Clare Ruxton, Deputy Director of Workforce (no deputy)

1 2 Equality Outcomes 2012 – 2016

* Nigel Firth attended the meeting to update the group on Equality and Diversity and the Equality Act (presentation attached).

There were now 9 areas defined by the Equality Act 2010 which came into being in 2010 and is a good piece of legislation.

Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012 require Health Boards to have equality outcomes by 30 April 2013. A consultation process had taken place in NHS Grampian on Equality Outcome from 15 October 2012 and 25 November 2012. A number of comments had been received and the final version is now ready (attached). * The Scottish Government are asking for this document to be complete by 30 April 2012 so NHS Grampian is ahead of target. This has resulted in a number of other Scottish Health Boards and some local authorities using the NHS Grampian template.

Work was ongoing to ensure that the correct statistics were collected and these discussions were with the staff at HR and Workforce to ensure that the aspects of the package used to collect workforce statistics was updated by the Scottish Government to include all the data required.

3 Minute of Last Meeting held on 15 November 2012

The minute of the last meeting held on 15 November 2012 was approved subject to “wa” being changed to “was” on item 6c end of first line.

4 Matters Arising

The BMA have now balloted their members on strike action and although the outcome was broadly in favour of action short of strike, the BMA have decided not to take action at this stage.

5 Mental Health and Learning Disabilities Report

Martin McKay and Julie Fletcher had been asked to give an update of the situation in Mental Health and Learning Disabilities.

Over the past few years it had been noted that there have been peaks of activity and this had been increasing. In between peaks of activity staff were finding it increasingly difficult to cope with the workload. It came to the point that partnership advised managers that either clinical activity needed to be managed or transferred elsewhere and that in the interests of staff and patients the situation was at such a stage that this position needed to be raised at higher levels. In the event they did not have to resort to closing for new admissions but introduced measures to cope with the current situation.

2  Daily meetings had been introduced to discuss staffing numbers and patients needs including the numbers of observations required.  There had been a significant increase in numbers of bank and agency nurse use.  Vacancy Control Group is now meeting weekly rather than monthly.  Fast track vacancy was being used and fast track employment for bank staff to have a bigger pool of bank staff.  Observations were being reviewed regularly.  Staff were being moved around to assist with the situation as required.  Joint meeting had taken place with the doctors and nurses.  Moray had completed a very good Risk Assessment.

There was a need for more consistency and where more nursing staff were needed then these would be employed rather than use bank and agency nurses.

A working group were putting together an SBAR Report. The crisis remains to date and this was putting considerable strain on staff and services.

Partnership working has been acknowledged as being accommodating and professional in dealing with this situation.

GAPF were given assurances that immediate actions were being taken.

12 hour shifts were thought to have contributed to the staffing difficulties because they didn’t allow flexibility of staff handover time, time or energy to offer additional shifts or part shifts, etc. It was also reported that with the introduction of 12 hour shifts staff numbers were reduced.

There was a question about collecting information about special patients and comparing each year. This information could be collected and could be analysed if it was thought this would be useful. There were a number of other changes in the Sector which had led to the current situation e.g. the new Mental Health Act.

In terms of the 12 hour shift review, it has been agreed that this Sector should be looked at first. The e-Rostering tool had not been looked at fully because there had not been time so there was a need to ensure everyone in the pilot was trained properly to use it to see if it worked. It was noted that it would only work correctly if the staffing levels were correct.

Martin McKay was leading from Partnership but collating and conveying views of other Partnership Representatives in the Sector.

Julie Fletcher has been confirmed as interim General Manager in this Sector for the next six months and Heather Kelman’s secondment has been ended, therefore she was returning to Aberdeen City CHP but continuing with her role on integration.

3 Acute Sector Partnership Forum Presentation

Vincent Shields reported that Acute have decided that it was too much to try and fit four different Partnership Groups into one big Super Acute Group. Therefore they were in the process of setting up four separate Partnership Groups in ARI, Maternity Services, RACH and Combined Child Health and Dr Gray’s Hospital.

These four groups had one clear principle and that was they had to have an Acute focus. Annie Ingram added that the other core principle had to be that Partnership was the way of working.

All four were at different stages of development. They were all being encouraged to develop but not pushed.

Gail Thomson attended the meeting to give a overview of the Maternity Services Partnership Group she co-chairs with Kirsten Sawers, Partnership Representative.

A Partnership event had been held in June 2012 and was well attended by 70 or more staff. The event was a drop-in one and had stands and presentations from Health and Safety, Dignity at Work, etc. There was a focus on health and safety and a Health and Safety Committee was also being set up. Issues which arose from the event were being channelled through the most appropriate group either health and safety or Partnership. It was planned to hold an event annually.

Previous work had been undertaken on a Stress Survey with staff but had not come to a conclusion. There was now work ongoing to do a Dignified Workplace Survey which would be run and analysed professionally and the Partnership Group would have a clear role in this.

The Maternity Services Review would take up a lot of the agenda time with the Partnership Group having an important role.

There are a small number of regular attenders to the Partnership Group meetings and one of the important tasks was to try and encourage more staff to attend to ensure good communication and consultation with staff.

Ian Francis was working with Sandy Dustan to develop a Dr Gray’s Hospital Acute Partnership Group. Ian reported that it had been a difficult year with all the changes in Acute and now needs someone to lead the process to get both management and staff side to move these groups forward.

The Combined Child Health Group was the slowest to get started. A number of reasons were given for this. Sandra-Dee Masson asked about the Combined Child Health Group as she had not been included in an invitation to this. Vincent Shields explained that there had been a number of changes in the management of the Combined Child Health recently as follows:

4 Unit Manager - Cameron Matthews Unit Clinical Director - Dr Chris Bain Divisional General Manager - Fiona Francey Lead Nurse - Sue Swift

Vincent Shields was meeting with Partnership Reps each month to discuss how the groups were going and what needed to be done.

An internal audit had been done in Acute some time ago and highlighted the need for a Communications Strategy. Some initiatives already begun and more would be agreed in the new year once all objectives had been set.

6 Improving Efficiency, Productivity and Sustainability

a. NHS Financial Update

Clark Paterson updated the group on the financial position. At the end of October 2012 the Board was overspent by £5.6m. He was confident that with a lot of work the Board would break even by the end of the financial year.

For the next financial year there could only be “guestimates”. It was thought that there would be an increase in income to £38.7m which included an increase in the NRAC formula allowance as this was gradually being brought up to parity to where NHS Grampian should be.

The identified commitment to date was £32.5m made up from best assumptions. Then cost pressures needed to be looked at and last year these were £8.1m so the estimate for this year was £8m. Then other things need to be added and this would take it to £10-15m. Therefore taking it over the £38.7m expected income.

Cost pressure targets deadline was 21 December 2012. Indicative savings targets had been given to sectors and the outcome was awaited on 21 December.

A very challenging financial year is expected again for 2013/14.

It was noted that some efficiency targets are not met by sectors and these are carried forward each year and the savings required to be met almost equate these carried over targets.

There are no longer any easy answers to the financial challenges. If there were any ideas for savings these discussions need to take place early in the year so as to make in-year savings.

It was noted that some areas had completed Safe Affordable Workforce (SAW) and were continuing to look at workforce regularly, and other areas had not started or completed SAW once.

The SAW Steering Group had met with the Full-Time Representatives to discuss the next phase of SAW and Clare Ruxton was drafting up a paper which would be circulated for consultation.

5 b. Partnership Reports from Sectors

It was agreed that these reports would be sent to Joan Anderson on the Friday prior to each GAPF meeting. This would mean that they would miss going with the agenda but more time was given to ensure each Sector had time to discuss at their meetings.

Aberdeen City

Frances Dunne reported that the wards move from Woodend Hospital to ARI had gone well. The staff had been “…fantastic, had worked extra shifts and went above and beyond expectations.”

Pickfords had been tremendous with the staff being very friendly and helpful.

A Partnership newsletter had continued to be circulated to staff throughout. Instead of information sessions departments requested face to face sessions so managers could speak directly to staff.

Everyone was working on the savings plans for 2013/14.

Vincent Shields explained that the move to the new Emergency Care Centre (ECC) had gone well for most and the four hour performance target had not deteriorated. Everyone had pulled together to keep things going. Pickfords had been good.

Finance/activity levels had been higher. The plan was working towards the 2020 vision with service planning and workforce planning.

Annie Ingram reiterated the thanks to all who had moved and managed to do this with no double running. Laura Gray stated there were many ways this appreciation would be passed on to the staff including the positive comments from the public.

Facilities

Partnership was working well with structures in place. Work was ongoing with individual managers regarding the cost reduction target and the cost pressure bid from Facilities would be finished the next day.

The catering facility was moving from Kittybrewster to Moray in the next few months.

A lot of work had been ongoing around fire to meet the obligations of Grampian Fire and Rescue.

The first draft workforce plan had just been completed.

Aberdeenshire

Unfortunately the video conference equipment had a technical problem and

6 Mike Ogg wasn’t able to give a report. The next Sector Partnership Forum was meeting the next week and they would be discussing health and safety structures.

Ian Francis reported that the new Health and Safety Committee for Moray CHP was to begin on Monday.

No other report was heard as no-one from Moray attended the meeting.

Mental Health and Learning Disabilities

As reported above.

7 Developing the Workforce and Empowering Staff

a. Presentation on Workforce 2020 Event/2020 workforce vision engagement

Annie Ingram explained that the paper which had been circulated had only been to one other meeting. It was written up following a Workforce 2020 event held in September 2012. It would not take away from Sector * discussions and plans (paper attached).

Documentation was expected from the Scottish Government on this issue in June 2013 but it was thought better not to wait until then before doing anything.

Comments on the paper were to be sent to [email protected] by 31 January 2013.

Anne Ross asked if this paper could be used to add information on the workforce plan into the performance plan and this was agreed.

Vincent Shields talked about the transforming of out-patients over the next 8 years and asking patients how they would like to see the process work without giving them anything written down and not getting lost in numbers and structure.

Sharon Duncan stated that it was a symbiotic relationship with staff and patients and unless it was right for both groups it wouldn’t be right for either. The Patient Experience from the Scottish Government interlinked both and don’t want one to swamp the other.

There was a discussion about integration discussions around this with local authority colleagues. Some had been at the event in September, although this event had been just about health. The paper had been looked at by a colleague with a joint health/local authority post and it was thought that the paper would make sense to partner agencies with small changes.

7 b. Policies and Procedures Sub-Group Update

Sharon Duncan explained that the group had been discussing policy process and when a policy was not a policy, e.g. local guidance.

The group had asked for sight of any corporate policies from across NHS Grampian (via the Executive Team). It was hoped this would not hold up the process but improve it instead.

From the new year all policies (except clinical)would go through the Policies and Procedures Sub-Group who would ensure they were impact assessed, properly formatted, consulted on and launched hopefully in batches.

There were 20 Partnership Information Network (PIN) Policies to launch in addition to local policies. The group would try and highlight changes in policies which had been reviewed.

The Dress Policy would be launched the next week.

There was a question about whether the Operational Management Team (OMT) would still be asked to consider any policies with financial implications and this would still happen. c. Home Computer Initiative Update/Bring your own device to work

Home Computer Initiative

980 applications had been received and agreed for the home computer initiative which amounted to 7.3% of staff. There would be a meeting with the company providing the computers Lets-Connect to see what feedback they had received from staff.

Bring your own device to work

Paul Allen explained that a global had been circulated regarding “Bring your own device to work.” Some trials had been done on this with clinicians and managers and it was felt that it was ready to roll out for staff who meet the criteria. It was purely voluntary for staff.

There was a form on the intranet to be completed by anyone wishing to apply for this initiative. It was agreed that the form would be updated to make it clearer for staff to complete.

This initiative would give staff access to NHS emails, intranet and some clinical systems e.g. PMS, and more systems were being worked on. There would be no access to documents on the server meantime.

This could only be put onto iPads at the moment not laptops. This was because of the need for protection from virus attacks.

IT would not support technical issues on an individual’s iPad if they had this service.

8 8 Delivering Safe, Effective & Timely Care in the Right Place

a. Health and Safety

Keith Thomson explained there had been two developments since last months report. The Violence and Aggression training was being reviewed throughout the organisation with a focus on sustainability of learning which is given to staff e.g. how is this information retained when staff do not have to put training into practice very often.

The second development is that a second senior tutor for Violence and Aggression training Matt Maitland had been accredited and therefore there had been a 100% increase in the number of senior tutors.

b. Emergency Care Centre

Kate Livock explained that the move to the ECC went smoothly as the meticulous plans Dianne Donald had developed. Some moved in ahead of schedule. Forward control teams worked well. Staff were all familiar with the building because of the visits they had prior to completion. The cooperation with all within the organisation was great and contributed to a good move, including Estates, IT, Domestics and Portering Staff etc. The Acute management were all supportive. At no point did they find they did not have an answer to a question.

All staff are now in the building although some were still unpacking boxes. Meetings would take place for the next three months with all specialist leads to review the situation and Kate would be involved for support.

The first three days the clinical pathway was analysed and in the main the correct pathway was used so clinically pathways were looking good. There were still some processes and system issues to be sorted out e.g. a new predictor tool from PMS was being developed over the last four year by Health Intelligence. This gives predictions of how many emergencies were expected to allow the teams to plan for these.

All the moves and amalgamations of wards meant the tool was still being embedded but within four weeks there should be accurate information from this tool.

Work will continue with work stream groups to look at pathways over the next 2 to 3 months. A lot of this work would be around changing behaviours to move to new practices. Kate Livock would be involved in discussing new policies to staff.

The group gave credit to Kate Livock, Dianne Donald and Team for the fantastic work they had done.

A number of issues had been raised at the Staff Side meeting about patient pathways. Specific examples would be discussed directly with Kate Livock. Joan Anderson was asked to request this information from staff side colleagues.

9 Bulletins had been sent to all GP Practices via General Managers from the end of October, four in total. The last one had given a special template and route by which the patient would come into the ECC and it had all the contact telephone numbers on it. It was agreed that managers in sectors would need to deal with any GP issues.

The master plan for Foresterhill Site has been in place for a long time. More stages were still to come and it was agreed to ask for a presentation from the Acute Team and/or Graeme Smith on this. A team were taking these plans forward. The plan was to close areas once staff moved out and move the funds to the new areas. If the empty areas were used for other things the funding could not then move and this would be a problem including for Facilities who would have to continue to maintain areas if they were not closed.

Funds are to be raised for a Roof Garden of approximately £500,000 to allow a structure to support shelter and access for bed bound patients etc.

9 Improving the Public’s Health and Reducing Inequalities

No items.

10 Any Other Competent Business

Annie Ingram reported that the Partnership funding for Full-Time Representatives bid had been agreed by the Executive Team and would go to Budget Steering Group the next week. The bid was for sustainable funding for the Reps.

This was Vincent Shields last GAPF meeting before he left NHS Grampian to take up a new career. Thanks were given to Vincent for all his partnership input over the years with NHS Grampian.

11 Communication to Organisation from GAPF

 Acknowledgement to staff re the cooperation and work undertaken by all over an 8/9 day period  Workforce 2020  Home computers/”bring your device to work programme”

12 Date and Time of Next Meeting

The next meeting will be held on 2pm to 5pm Wednesday 20 February 2012 in the Conference Room, Summerfield House

Joan Anderson Summerfield House Tel 558459 Email: [email protected]