MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE s1

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MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE 11 MARCH 2008 – 11.10 am 4th Floor Training Room, Raigmore Hospital, Inverness

Present: Heidi May (In the Chair) Mary Boyle Lorraine Coe Nigel Hobson Hilda Hope Alison Hudson Chrissie Lane Elaine Lang Stephen Loch Alison MacLean Gill MacNeill Margaret MacRae Liz McClurg Iona McGauran Patricia Morrison Joan Philip Viv Scott Heather Smith Rachel Soplantila Pat Tyrrell Angela Watt Faith Wilson Also Present: Eric Baijal, Director of Public Health Susan Donaldson, Colorectal Nurse Specialist Cathie Fraser, Colorectal Nurse Specialist Alison McRobbie Helen Morrison,

In Attendance: Brian Mitchell, Board Committee Administrator

1 WELCOME AND APOLOGIES

Apologies were received from Doreen Brass, Mary Burnside, Peter Cartwright, Alan Caswell, Jonathan Gray, Veronica Kennedy, Jennifer Lobban, Paula McCormack, Sarah McLeod, Ruth Miller, Mairi Milne, Lesley Randall, Fiona Sharples, Hazel Smith, Mary Vance, Liz Watson, Mhairi Will, and Eric Wiseman.

2 MINUTE OF MEETING OF 12 FEBRUARY 2008

The Committee Approved the Minute of meeting held on 11 December 2007 subject to

Working with you to make Highland the healthy place to be

the following amendment:

 Page 2, Item 3.3, Line 1 – amend to read “that the relevant Policy was in preparation and was to be ratified...”

3 MATTERS ARISING

3.1 Recommendation for Training Nursing Assistants

The Committee Noted that Mr Hobson would provide a briefing to the next meeting to be held on 8 April 2008.

3.2 24 Hour Rotational Nursing

It was advised that the Policy required to be considered by the NHS Highland Partnership Forum and would be brought to the Committee at their meeting to be held on 8 April 2008 for appropriate sign-off. Pat Tyrrell would give an update to the Committee at that meeting.

The Committee so Noted.

3.3 Review of Nursing in the Community Implementation Plan

Ms May advised that four pilot sites had now been chosen and that work with staff was ongoing with a view to preparing appropriate Implementation Plans, in association with the RONC Steering Group. Relevant needs would be drawn together and an appropriate Strategy developed.

The Committee Noted the position.

3.4 Committee Terms of Reference

Ms May advised that changes to the Terms of Reference for this group were agreed shortly after her appointment. Ms May advised that these should now be reviewed and will be brought to a future meeting.

3.5 Nurse Bank Policy

There had been circulated draft Nursing and Midwifery Bank Operational Policy in respect of which Mrs Morrison advised would require to be submitted to the Highland Partnership Forum, then DHS Management Team for final sign-off. Mrs Morrison requested that any comments be relayed to Kate Earnshaw by Friday 21 March 2008. The draft Policy would be brought back to the meeting of the Committee to be held on 8 April 2008 for appropriate ANMAC sign-off.

3.6 Project Plan for the Implementation of The Joanna Briggs Institute Web Based Evidence Based Resource Tool

Ms Tyrrell and Ms May reminded that CHP/ SSU Lead Nurses were required to nominate appropriate link personnel at an early date.

3.7 Supported Self Care

Ms Tyrrell advised that work was ongoing, in association with NES, with regard to the creation of an appropriate education Module and that Maggie Clark was leading this work. There was a requirement for link personnel from CHPs/SSU.

The Committee:

 Noted the position.  Agreed that Ms Tyrrell contact CHP/SSU Lead Nurses direct with a view to establishing link personnel.

4 DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT

Dr Baijal gave a presentation to the Committee on the 2006/07 Annual Report of the Director of Public Health and Health Policy, which gave an indication of the state of health of residents within the NHS Highland area. NHS Highland covered an area of approximately 40% of the total Scottish landmass whilst encompassing only 6% of the total population and as such particular regions were classified as areas of “super- sparsity”. One point of interest in particular was that traveling times to a GP took longer particularly when using public as opposed to private transport. The overall trend in Highland, as per the rest of the country was that there was an ageing population and this had consequences for both workforce and care issues, with a consequent rise in co- morbidity.

Dr Baijal then went on to highlight specific matters and advised that admissions for alcohol misuse were 30% higher in Highland than the Scottish average, in young people this mainly for the management of acute intoxication. Nationally there were issues relating to increased obesity rates and Health Protection issues. Identified high impact interventions for inequality related to measures to reduce infant mortality, smoking cessation, antihypertensive therapy, and statin prescribing. Dr Baijal referred in particular to the implications for public health and the impact on NHS services as a result of alcohol intake and increasing obesity levels.

Dr Baijal emphasised the role of the Public Health in Health Protection and advised that this included aspects such as immunisation against childhood infections, protection of water supplies, screening programmes, surveillance and investigation of infectious diseases, and Emergency Planning.

During discussion, reference to alcohol interventions was raised and Dr Baijal advised that whilst these had been agreed as a Locally Enhanced Service for GPs in Argyll and Bute, on the basis of the Sign74 Guideline the same had yet to be achieved in the remaining three Highland CHP areas. On the issue of self harm/ suicide in Highland Dr Baijal stated that the two key elements related to the effective management of mental illness through legislation etc, and promotion of mental health and wellbeing both elements requiring incorporating capacity and resource issues. Ms May stated that services were being designed in the main relative to Long Term Conditions and as such there needed to be greater consideration of those issues that were arising among young people and the impact these would have. In this regard Dr Baijal confirmed that the Health Promoting Schools Initiative encompassed a range of issues including healthy eating, literacy outreach and matters relating to social capital among others.

The Committee otherwise Noted the Annual Report with interest.

The Committee agreed that the following Item be taken at this point in the meeting.

9 COLORECTAL/ STOMA SERVICE ANNUAL REPORT 2006

Susan Donaldson and Cathie Fraser spoke to the circulated Colorectal/ Stoma Care Department Clinical Nurse Specialists NHS Highland Annual Report 2006 and gave a presentation giving an overview of the work of the Nurse Specialist in NHS Highland, identifying service achievements, and offering a comparison of patient numbers in 2006/07. The service includes 3 full time Nurses and covers both Acute and Primary Care, incorporating advanced Nursing Practice as well as research, audit and service development, education, and providing leadership in this area. Achievements for the service included creation of a telephone proforma for the delivery of pathology results, an increased number of patients seen at Nurse led follow up clinics where radiological investigations were also organised, and ownership of the relevant budgetary function including development of guidelines for the acute sector relative to ostomy supplies through the National Procurement Group. Other achievements identified were the creation and implementation of a Patient Held Handbook, ongoing Colorectal/Stoma Department audit, National Audit in collaboration with QIS, acting as Blind Assessors in the National PROPHECI Study, and attendance at local and national meetings. For 2007/08 the identified Objectives for the service included further development of the Raigmore and outreach Nurse led clinics, continued participation in the relevant research study, continued patient audit and introduction of a peer group audit, participation in the BSc Professional Practice and Clinical Leadership Programme, and contribution to the RCN publication raising awareness of SCNS.

On the point raised by Mrs Morrison as to whether the total number of those benefiting from the service were being captured and recorded it was stated that data also included those with benign conditions, and following discussion with colleagues it was felt that no large group of patients were being excluded from this. Alison Hudson queried as to whether evidence was being collated as to the contribution the service made to waiting times, Ms May stated that quantifying this would be important in light of the 18 week targets to be introduced, and Ms Donaldson stated that one point for inclusion would be the reduced workload of Consultants.

The Committee otherwise Noted the Annual Report with interest.

5 HIGHLAND CARERS STRATEGY

The Committee Agreed that this Item be deferred to the next meeting.

6 RECORD KEEPING AUDIT

Rachel Hill and Polly Masson gave a presentation to the Committee on the Nursing Record Keeping and Care Planning Audit 2007/08, advising as to background, the plans for and results from the 2007 audit, and the identified next steps. As to background the NMC Guidelines for records and record keeping stated that good record keeping helps to protect the welfare of patients and clients by promoting high standards of clinical care, better communication and dissemination of information between of the healthcare team, an accurate account of treatment and care planning/delivery, and the ability to detect problems at an early stage. In this regard the NHS Scotland Chief Executive Officer had stated to NHS Boards that “...it is essential that staff document aspects of care and other important information, such as the views of the patient or carer in the patient’s record...It is important that you remind clinical staff that if there is no contemporaneous record of their actions, there can be no assumption later that a procedure or a discussion took place”. With regard to the 2007/08 audit, this had been undertaken in November 2007 via an electronic audit tool. As part of the process the person carrying out the audit had reflected upon the findings and completed the action plan, sent results to the Lead Nurse/ Consultant Midwife, sent this for collation and fed back results to their staff and discussed required action. A Highland wide report, and reports for CHPs/SSU were distributed to

relevant Leads in February 2008. Participation levels were outlined, for which it was stated that Raigmore had been low, and in terms of results it was noted that the six record keeping standards with the lowest scores were the same for nurses and midwives, as outlined, and the six care planning standards with the lowest scores for both nursing and midwifery were also detailed. Of those teams participating in the audit the majority had submitted an action plan, the standards which generated the most actions were highlighted, and it was noted that most teams emphasised the need to share results with team members and identify training needs and opportunities. Issues that had arisen included clarity over definition of a team, the same for a care plan, audit use for multi- disciplinary teams, wording of standards, clarification of standards for staff in different settings, and inconsistent adherance to completion guidance and timescales. Ms McNeill stated that the audit had been time consuming and in response Ms May stated that the information provided would be extremely useful. Next steps would include dissemination of findings including Lead Nurse commentaries, local action plan monitoring, resolving issues from the 2007 audit, on the 2008 audit there was a need to ensure this continued to add value, and consideration of a local record keeping link person to coordinate an area-wide audit and associated action planning.

During discussion, and on the matter of developing multi-disciplinary standards and associated tool, Ms May requested that Ms Hill take this up with the Medical Director and Head of Clinical Governance and Risk Management. Mrs Morrison queried whether there had been comparison with the findings of the 2005 audit and was advised that although this used a different methodology key themes had been extracted to provide such comparison. Ms Coe expressed concern at the findings relative to the signing of errors on patient records and Ms May stated that local action plans would address this point. On the circulation of summary results reports Ms May requested that summary reports be issued to CHP/SSU Lead Nurse and also that all be copied to her. Ms May then stated that action plans should be discussed at the Informal Lead Nurses Group and relative recommendations brought to this Committee for approval. There was also a need for the organisation to be made aware of the good work underway and it was suggested that a Briefing report be submitted to the Clinical Governance Committee.

The Committee:

 Noted the process and findings relative to the 2007/08 audit.  Agreed that development of multi-disciplinary standards and tool be raised with the Medical Director and Head of Clinical Governance and Risk Management.  Agreed that summary results reports be issued to CHP/SSU Lead Nurses and copied to Ms May.  Agreed that action plans be discussed at the Informal Lead Nurses Group and recommendations submitted to this Committee.  Agreed that a Briefing report be submitted to the Clinical Governance Committee.

7 COMMUNITY MEDICINE DOCUMENTATION (incl. Schools)

Ms McRobbie spoke to the circulated new Community Nurse Medicines Stock Record and Syringe Pump Prescription Chart forms, and Instructions for the Prescribing and Administering of Medicines via Syringe Pump, advising that the aim had been to simplify existing documents rather than create wholly new ones. It was also hoped that staff would be encouraged to increase the use of access to documentation through the Intranet. On the point raised it was stated that pilot schemes had not highlighted issues relative to training other than that required for nursing staff. On the issue of implementation and roll-out of the new documentation Ms McRobbie stated that an issue existed as to budget arrangements for printing costs and Ms May undertook to canvass Lead/Key Nurses as to whether they had any issues to be raised. Ms Hope suggested that any roll-out be on the same basis as that for the McKinley Pumps. In relation to Argyll and Bute CHP there was a need to establish key issues that existed given that NHS

Greater Glasgow and Clyde standards applied in relation to replacement pump parts and Ms Tyrrell stated that area patient pathways would also require to be considered.

The Committee:

 Noted the revised Community Medicine Documentation.  Noted the need for clarification of printing budget arrangements.  Noted that Lead Nurses would be canvassed in relation to implementation issues.  Agreed that Ms McRobbie and Ms Tyrrell outline the relevant issues relative to Argyll and Bute CHP in order that these may be identified and addressed.

8 NMAHP STRATEGY

Ms May advised that the draft Strategy had been considered by the Corporate Team, positive feedback had been received, and once comments had been incorporated where appropriate this would be circulated for comment, especially as to the direction of travel proposed. Ms May added that the current Strategy had been informed by the recently published National Strategy Review and as a result the relevant Action Plan progress report should satisfy both the NHS Board and national requirements. Ms Tyrrell stated that it was anticipated that the national Strategy would require to be amended in light of Better Health, Better Care (BHBC) and Ms May advised that this point had been recognised, however it had been considered appropriate to progress the local Strategy at this stage and review this at a later date in light of BHBC. Ms may advised that the draft strategy would be brought to the May meeting for sign off.

10 SCOTLAND/TASMANIA RESEARCH STUDY – NURSES AS SOCIAL ENTREPRENEURS

Ms Tyrrell spoke to the circulated document relating to an investigation of the potential of rural community health professionals as social entrepreneurs through a comparative study of Scotland and Tasmania, being carried out by the University of Tasmania and the University of the Highlands and Islands. The study would seek to explore the experiences of Tasmanian and Scottish rural health professionals living and working in rural areas in relation to building social outcomes for their communities, as outlined. This followed the suggestion by policy makers in both Scotland and Australia that public sector workers could act as social entrepreneurs in ways that extended their service role in communities, with the goal of developing social capital. Ms Tyrrell advised that voluntary participation in the study was required and would involve a 30 to 45 minute interview. A copy of the paper reporting the results of the work would be made available to interviewees who indicated an interest in the final outcomes.

The Committee Agreed that Ms Tyrrell contact CHP/ SSU Lead Nurses with a view to identifying appropriate potential sites for the research study.

11 REVIEW OF NURSING IN THE COMMUNITY

This Item had been raised under Matters Arising noted above.

12 CARE AIMS IMPLEMENTATION ACTION PLAN/ GIRFEC

Ms May stated that Care Aims outlined the methodology for introducing Care Planning and as such was integral to GIRFEC. Ms Lang advised that Allied Health Professions already operated Care Aims and a model for the same relative to District Nursing had been discussed. Ms May added that this point had been agreed with a view to ensuring Community Nurses were utilising Care Aims and on the point raised relative to non

GIRFEC patients District Nurses were involved in appropriate training. Ms Hope stated that training was being undertaken with a view to ensuring full utilisation and coverage. Mrs Morrison stated that in relation to District Nurses there was a need for a strategic approach to be taken and as such Action Plans would be required, this point being echoed by Ms May who stated that a lack of Care Plans in the community setting posed an existing risk. In conclusion Ms May stated that gaps existed with regard to implementation of Care Planning, that a whole system approach was required in this area, and as such there was a need to establish the existing position with regard to Care Aims so as to inform Care Planning introduction where required.

The Committee:

 Noted the position.  Agreed that Lead Nurses prepare an Action Plan for Care Aims rollout and that this be brought to the meeting of the Committee to be held on 13 May 2008.

13 COMPUTER ACCESS FOR STUDENTS

The Committee was advised that the Interim Head of eHealth was preparing an implementation Plan to enable this matter to be progressed.

14 LSAMO – PROPOSED PURCHASE OF DATABASE

There had been circulated report outlining a proposal for the purchase of a database for the North of Scotland Local Supervising Authority Consortium, which would enable compliance with NMC requirements in respect of midwives notification of intention to practise, would reduce duplication and provide savings in both time and administration. The database would also provide the LSAMO with real time accurate information on midwives practising within the North of Scotland, thereby enhancing the quality of information available in relation to the supervision of midwives. The data would also be utilised in the LSA’s annual report to the NMC. The initial set up cost of the database would be in the order of £3200 including implementation, training, and data conversion with annual maintenance in the region of £2500.

The Committee Agreed to the purchase of the relevant database.

15 ROLE OF INFECTION CONTROL LINK NURSE/ CLEANLINESS CHAMPION/ HAND HYGIENE PROMOTER

There had been circulated paper outlining the role of the Link Nurse for Infection Control within NHS Highland and advising as to the role profile and summary, responsibilities both organisational and professional, along with the background experience required to fulfill the role which was a minimum post registration experience of two years, excluding any post registration course. The Link Nurse acted under the supervision of the Infection Control Nurse and served as a resource and role model for colleagues. Ms Hope stated that that there was a need for clarification of the role of not only the Link Nurse but also Cleanliness Champions and Hand Hygiene Promoters, this being echoed by Ms Lane. Ms MacLean stated that the main issue related to training, advised that the Cleanliness Champion role did not necessarily require to be undertaken by a Nurse, and circulated an Information leaflet from NHS Education for Scotland (NES) regarding the necessary training requirements.

Ms May stated that the standardisation of roles and training would be beneficial and that release for training would be an issue to be considered. The role in question required to link to that for Nurses with Special Interest and as such NES were undertaking work that

may lead to the production of appropriate competencies etc. Ms MacLean stated that certain roles would be appropriate to certain areas however the key was to provide a link to the ward or clinical area. It was confirmed that Cleanliness Champions were involved in Link Nurse meetings and the aim was to have two people in each are as it was recognised that release of time for training was an issue. For Link Nurse there was a 4 day in-house training course covering not only Hand Hygiene. Ms Hope stated that there was a need for definitions as to each of the three individual roles and that these should be in terms that were commonly understood.

After discussion, the Committee Agreed:

 A report on work undertaken in relation to the role of Nurses with Special Interests be brought to the meeting to be held on 13 May 2008.  A profile be established for a generic Link Nurse role including definitions and an outline of activity and responsibility.  There be no change to the Link Nurse role at this time.

16 AOCB

Ms May advised that Dr Roger Gibbins, NHS Highland Chief Executive would be attending the next meeting of the Committee to give a presentation in relation to future Remote and Rural Healthcare in the North of Scotland, this having implications for Nursing and Midwifery staff.

Ms May advised that Linda Sinclair, Lead Nurse for North Highland CHP had resigned her post, wished to record thanks for her valuable assistance during a challenging time and on various issues, and wished her well in future endeavours. She stated that it was hoped to interview and appoint to the vacant post in April 2008 and that good succession planning had meant that the necessary skills and experience existed within the organisation.

24 DATE OF NEXT MEETING

The next meeting of the Committee would be held on Tuesday 8 April 2008 in the Board Room, Assynt House, Inverness at 11.00am.

The meeting closed at 2.00 pm