Mid Community Health Partnership CHP General Manager’s Office Larachan House Docharty Road Dingwall IV15 9UG Telephone: 01349 869221 Fax: 01349 865870 www.nhshighland.scot.nhs.uk

MINUTE of MEETING MID HIGHLAND CHP COMMITTEE Friday 29 August 2008 Moorings Hotel (10.00 am – 1.30 pm) Banavie, Fort William

Present: Mrs Ann Bethune (Chair) Non Executive Director, Highland NHS Board Mrs Gill McVicar General Manager, Mid Highland CHP Dr Angus Venters Clinical Director, Mid Highland CHP Dr Jim Douglas Clinical Lead, Mr Tom Slavin Head of Finance, Mid Highland CHP Mrs Alison Hudson CHP Lead Nurse Mr Okain McLennan Non Executive Director, Highland NHS Board Mr Bob Cameron Highland Council Corporate Manager, Ross, Skye & Lochaber Mrs Isabelle Campbell Local Councillor, Wester Ross, Strathpeffer & Lochalsh Mrs Margaret Paterson Local Councillor, Dingwall & Seaforth Mr Findlay Hickey Lead Pharmacist, Mid Highland CHP Mr Colin Shields Health & Safety Advisor, Mid Highland CHP Dr John May Raigmore Representative Mrs Jackie Jefferson CHP Administrator (Minutes)

In Attendance: Mr Larry Wilmot Area Community Care Manager, Highland Council Social Work Services

By Invitation: Ms Sarah McLeod Consultant Midwife, NHS Highland

Apologies: Mrs Kate Earnshaw Acting Locality General Manager, Skye & Lochalsh Mrs Theresa James Locality General Manager, Lochaber Mr Brian Murphy Local Councillor, Lochaber Mr Bren Gormley Local Councillor, Lochaber Dr Andrew Evennett Acting Clinical Lead, RC&WN Ms Kerry McLennan Voluntary Sector Representative Ms Maxine Johnston Deputy Voluntary Sector Representative Ms Tracy Ligema Out of Hours Operational and Development Manager Mr Hugh Campbell Ophthalmology Representative Ms Lyn Wormald Area Partnership Forum Representative

1 WELCOME AND APOLOGIES

The Chairman welcomed everyone to the meeting, particularly Ms Sarah McLeod, Consultant Midwife. Apologies were noted as above.

2 MINUTE OF PREVIOUS MEETING

The minute of the meeting held on 4 July 2008 was accepted as an accurate record of the meeting.

3 MATTERS ARISING

3.1 Record of Attendance at Committee Meetings At an earlier meeting it was agreed that Locality General Managers (LGMs) would restrict their attendance at Committee meetings to those taking place in their Locality. However, attendance is now audited and if LGMs do not attend, this is interpreted as “absence”. Mrs McVicar indicated that, for clarity, a formal Committee membership list would be issued and those members attending for specific issues would be noted as ‘In Attendance’. Cllr Paterson suggested that local councillors have substitute representation on the Committee. Mrs McVicar indicated that, prior to last year’s Highland Council reorganisation, this was the case. She suggested that local councillors approach the Highland Council with the suggestion that substitute members once again be appointed. The Chair suggested that the Committee take the opportunity to review and update its membership and this was agreed.

The Committee:

• Agreed that Local Councillors should revert to the Highland Council with the suggestion for substitute representation • Noted that the method of recording attendance and absence in Committee minutes is to be reviewed • Agreed that Committee membership should be reviewed and updated, noting any statutory requirements

3.2 Lochaber Review of Services for Older Adults Mrs McVicar confirmed that contractors will commence work on alterations at the Abbeyfield site on 1 September 08. The work will create space for a further six beds, with office and clinical space for community staff, both Health and Local Authority. Day-care and lunch club facilities are already in place. It is anticipated that the work will run for 18 weeks following which a phased occupation of the building will commence. With a confirmed timescale, a further meeting will be held with staff at Glencoe Hospital. A decision will also need to be taken on admissions to Glencoe to allow for transfer of patients, training and redeployment of staff etc. Once Glencoe Hospital has closed, the official Scottish Government disposal process will be implemented. A more comprehensive update report will be provided at the next Committee meeting.

3.3 Control of Infection/Hand Hygiene The Lead Nurse reported that work continues in the CHP to meet targets for reducing healthcare associated infections. This is delivered through the CHP Infection Control Group which meets monthly; through regular environmental audits; informal “walk-abouts”; and through both national and local hand hygiene audits across the CHP. The results from the most recent National Hand Hygiene Audit in August showed a slight fall in compliance levels from May. An action plan is in the process of being developed although further analysis will

2 be required to fully understand the reasons behind these results. Some hospital sites have however performed very well, with 95% compliance.

A great deal of work is ongoing across the CHP to ensure that cleanliness is of the highest standard. Environmental issues are currently being addressed at Ross Memorial Hospital in Dingwall and a business case is being developed for Broadford Hospital on Skye. Infection control will be a key performance indicator in the Clinical Indicators Project over the coming year and occupies a high profile in the Senior Charge Nurse Review.

Mrs McVicar highlighted the recent NHS Highland Annual Review at which the Minister for Public Health had advised that the Scottish Government was adopting a zero-tolerance policy towards hand-hygiene breaches. The Lead Nurse acknowledged this, adding that infection control was everyone’s responsibility. In response to a point raised by Dr Douglas about consistency and the criteria used, Mrs Hudson confirmed that the auditors were all trained to the same standard by the Health Protection Unit in Edinburgh.

3.4 Managerial Changes in Skye & Lochalsh Locality Mrs McVicar advised that the proposed managerial changes in Skye & Lochalsh Locality were taking a little longer to implement than planned. She confirmed that consultation is ongoing and a report will come to Committee in due course.

3.5 Out of Hours Services and Scottish Ambulance Service Issues At the last Committee meeting Mrs McVicar had indicated that high-level discussions were taking place. The difficulties being experienced by Scottish Ambulance have been well- documented by the media and some of the local issues, including single manning, have been particularly difficult to resolve. Meetings are taking place between the Chairman of NHS Highland, and the Chief Executives of both NHS Highland and Scottish Ambulance and it is hoped progress will be achieved. Mrs McVicar assured Committee that the CHP would continue to highlight this issue at every opportunity and stressed that there were excellent working relationships with local SAS staff.

3.6 The Pines, Acharacle Mrs McVicar confirmed that Dr Rob Colebrook will take up his new post as GP at The Pines on 1 September. He is currently working in the area in a locum capacity. Mrs McVicar emphasised that Dr Colebrook would receive all support necessary to enable the process of restoring and rebuilding trust and relationships with the local community, patients and staff.

3.7 Tain Health Centre – Outline Business Case The outline business case went to an extraordinary meeting of the CHP Management on 23 July to which Committee members were invited. This was agreed at the meeting and subsequently submitted to the Board of NHS Highland on 5 August. Approval was received to move to the next stage, submission to the Scottish Government for consideration of allocation of capital.

3.8 Integrated Eye Care Service Mrs McVicar reported that there was a funding issue associated with the new Integrated Eye Care Service which could delay its implementation across Highland.

3.9 Association of Community Health Partnerships – Annual Conference Mrs McVicar indicated that the Association of Community Health Partnerships Annual Conference will take place on 9/10 September at The Thistle Hotel, Glasgow. She confirmed that places are still available for this event.

3.10 Western Isles Health Board Support from NHS Highland Following media reports of a possible collaboration between Western Isles NHS Board and Highland NHS Board, Mrs McVicar had obtained an update from the Chief Executive of NHS Highland. She confirmed that a partnering arrangement has been developed between the

3 two Boards, mainly for support and developmental matters. At the NHS Highland Annual Review the Chief Executive for NHS , Dr Kevin Woods, stated that there is no intention to dissolve Island Health Boards but there is a clear recognition that, because of their size, they need support with such issues as performance management, governance structures, CHP development etc. Support is also being sought from other Health Boards.

The Committee:

• Noted progress on the issues detailed above.

4 PRESENTATION: KEEPING CHILDBIRTH NATURAL & DYNAMIC (KCND)

The Chair introduced Ms Sarah McLeod, NHS Highland Consultant Midwife, who was giving a presentation on Keeping Childbirth Natural and Dynamic (KCND). Ms McLeod explained that she has been seconded for one year to lead the national KCND project in NHS Highland. The programme was developed following recommendations made in the Framework for Maternity Services (2001) and the Expert Group on Acute Maternity Care (2003) and is endorsed by the Scottish Government in ‘Better Health, Better Care’. KCND was established to support the implementation of NHS maternity policy by multidisciplinary working. Its key aims and objectives are to maximise opportunities for women to have as natural a birth experience as possible through evidence-based care; reducing unnecessary intervention; ensuring informed choice; and developing multi-professional care pathways.

Following the presentation, Ms McLeod invited questions from Committee. She outlined how the KCND approach differed from the current approach and there was a lengthy discussion around a woman’s choice in relation to her care and home births in particular.

The Chair thanked Ms McLeod for her presentation and the interesting debate it had stimulated.

The Committee:

• Noted the contents of Ms McLeod's presentation.

5 REVIEW OF NURSING IN THE COMMUNITY – CHP IMPLEMENTATION PLAN

The Mid Highland CHP Implementation Plan for the Review of Nursing in the Community (RONC) was circulated prior to the meeting. The Lead Nurse explained that RONC is a nationally driven project which has been developed to ensure a single Community Nursing workforce which could respond to changing demographics, manage long term conditions, provide anticipatory care and promote self care. There are five pilot sites across Highland and the Integrated Community Nursing Team in Tain is testing the model in Mid Highland. Rapid progress has been achieved towards developing the role of generic Community Health Nurse in Tain, which is already functioning as a Community Health Team.

The Plan utilises the R-A-G (Red, Amber, Green) system to denote progress. Mrs Hudson highlighted ‘Amber’ areas, namely Education, Engagement with Partners & Partner Agencies and Patient & Public Involvement. Work is ongoing around all three issues. A discussion took place about whether the new model promotes geographical or practice-based Community Health Nursing. Dr Douglas expressed concern that the practice-aligned staff system which has, historically, functioned very well could be dismantled in favour of a more complex, less efficient system. Mrs McVicar confirmed that the purpose of the pilot was to

4 test these issues but emphasised that the CHP did not propose to make changes to a system which clearly worked and already embraced the principles of RONC. She indicated that many of the recommendations made in the Review of Nursing in the Community had actually come out of Highland where staff had a great deal of experience of working in remote and rural areas. Mrs Hudson reiterated that there was no intention to dismantle effective teams. Mr McLennan, who sat on the original RONC Steering Group, indicated that the aim is not to change a system which already works; the key purpose of the model is to improve areas where the system works less well.

The Committee:

• Noted and approved the Implementation Plan for Review of Nursing in the Community (RONC) at the Tain pilot site in Mid Highland CHP

6 MANAGEMENT REPORT

The General Manager apologised for the delay in submission of her report. This was due to annual leave.

6.1 General Manager’s Overview & Update Report These were circulated prior to the meeting. The following key issues were highlighted:

♦ Delayed Discharge Mrs McVicar reported that that although targets are largely being met, there are some Health/Social Work partnership issues which are causing concern. These are mainly in connection with availability of care home beds, interim placements and speed of assessment. Appropriate action is being taken and she confirmed that an update report would be brought to the next Committee.

♦ Finance Mrs McVicar acknowledged the enormous amount of work done by local managers, budget managers and supporting accountants. This has allowed the CHP to identify schemes that fully address the Cash Releasing Savings (CRS) target for the present year on a recurrent basis. This was a considerable challenge and means that the financial position will remain extremely tight. Mr McLennan added his thanks to everyone who has worked so hard to achieve the CRS target.

♦ Sickness Absence Mid Highland’s sickness absence record has in the past been good but the rate has shown an increase in recent months. This upward trend has been repeated across Highland and indeed, the rest of Scotland. The Personnel team will undertake work to explore the rates at very local level and this issue will be discussed at the Local Partnership Forum event in October. Mrs McVicar confirmed that Committee members are welcome to attend. In response to a query from Mr McLennan, Mrs McVicar indicated that although medical certificates do provide a reason for absence this information could not be made widely available. A confidential report could however be produced with assistance from Occupational Health Services. Mr Shields confirmed that the Occupational Health Department have produced statistics around referral rates but these were not robust in terms of the overall Sickness Absence position. A report will come to the next Committee meeting.

♦ Lochalsh Health Centre The Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, performed the official opening ceremony for the new facility on 26 August. Ms Sturgeon spent a considerable amount of time speaking with those present. She appeared very impressed with the range of services that will be delivered from the Health Centre and with the commitment and

5 enthusiasm of the staff she met. The facility allows for GPs, Nurses, Therapists and Dental Services to be situated under one roof, with the possibility of Partner organisations being located their in the future.

Mrs McVicar asked Committee if they wished to raise any points from her report. These are noted below:

♦ Long Term Conditions The Chair asked when the Nairn Case Finder model (a screening tool for emergency hospital admissions which was developed as part of the Nairn Anticipatory Care Project) would start to be used in Mid Highland. The early results from Nairn are very positive but Mrs McVicar explained that Nairn has very specific needs and the algorithm would first need to be tested in this CHP to see if it was effective. Alness and Invergordon GP Practice and the Integrated Teams aligned to it will be commencing this work shortly and following any necessary modifications, it will be rolled out more widely. Lochaber is very keen to begin implementation of the model and data is currently being validated to allow this to happen.

♦ – Laboratory Dr Douglas expressed concern about the proposed ‘swap’ between the Post Graduate Room and the laboratory at Belford Hospital. Mrs McVicar confirmed that she would explore the issue further and report back to him.

♦ Lone Working Pilot In response to a question from Cllr Campbell, Mr Shields provided a brief update. From October 07 to March 08 a Lone Working scheme, comprising a set of protocols and procedures for staff working alone, was piloted in Skye & Lochalsh. Following evaluation the pilot was agreed to be a great success and will now be rolled out throughout the CHP. North and Argyll & Bute CHP have also asked to be included in the roll-out. Telephone coverage remains a problem and various options have been explored including GPS phones, which are expensive either to buy or rent. The final option is the use of “roving” contracts which can utilise a number of different networks; however, this is of little use in locations where there is no signal. There was a brief discussion around the various options, all of which Mr Shields confirmed had been explored previously. Mr McLennan raised concerns about BT public payphone closures; Mr Cameron indicated that Highland Council is currently exploring this. Mr Shields confirmed that he will provide Mr Cameron with the Lone Working Pilot Report.

6.2 Appendices to General Manager’s Report

♦ Workforce/Staff Governance Report The contents of the report were noted.

♦ Performance Monitoring Report Mrs McVicar explained that current Balanced Scorecard data was not available but that up to date information will be presented to Committee at its next meeting.

♦ Clinical Governance/Risk Management Report The CHP Clinical Governance & Risk Management (CG&RM) Group met on 20 August and the minutes were not yet available. Dr Venters gave a brief verbal update. He confirmed that Infection Control issues would come to the CG&RM Group in future. Work continues on the CHP Risk Register. Risk is continuously monitored and the Register is regularly reviewed and updated by the individuals responsible for their area of risk. NHS Highland Clinical Governance Committee has extended an invitation to Mid Highland CHP to attend its next meeting on 28 October. The General Manager, Clinical Lead, Committee Chair and Lead Nurse will attend and will share details of the CHP Clinical Governance and Risk Management work.

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♦ Health and Safety Report Mr Shields reported that the Health & Safety Executive would be visiting NHS Highland next week as part of their ongoing review of stress management within the organisation. HSE will also be visiting premises in NHS Highland to look at asbestos and asbestos management; it is anticipated that they will be looking at buildings within Mid Highland CHP area. The visit will take place before the end of the financial year. Health & Safety are liaising with Estates Services in this respect.

♦ Complaints Report Once again the numbers involved are small, which tends to skew percentages. Mrs McVicar explained that the complaints which had not met their target were complex and involved a number of services.

♦ Finance & Premises Report Mr Slavin’s report provided a high level breakdown of the CHP position but he highlighted the following points:

The year-end position for the CHP, including Hosted Services, is break-even. The position, excluding Hosted Services, continues to report a small overspend of £10k. Mr Slavin reiterated that the CHP has identified schemes to achieve the Cash Releasing Savings target of £920k on a recurring basis and that budgets have already been reduced accordingly. Out of Hours has now been devolved to CHP level and the Highland Hub and NHS 24 continue to show a break-even position. Financial pressures include Out of Hours, Prescribing, General Medical Services, locum costs at Belford Hospital, the continued costs associated with Glencoe Hospital and the cost of complex care packages. Taking these risks into account, the financial position remains challenging.

Mr Slavin reminded Committee that NHS Highland has received an increase in its recurrent allocation of £15.6m, an increase of just 3.15%. This compares with increases of between 6% and 9% over the previous three years and, given that simply funding inflation on pay, prices and drugs totals around £16m, NHS Highland undoubtedly faces a serious financial challenge in 2008/09.

Cllr Paterson queried the current position with the proposed new Dingwall Health Centre, where progress has stalled due to unforeseen site costs of £1m-plus. Mr Slavin confirmed that this has effectively rendered the project unaffordable and an alternative site will have to be identified. Work has begun to explore possibilities.

♦ Public Health/Health Improvement A Public Health report was not available. Up to date information will be provided at the next Committee meeting.

♦ Out of Hours (OOH) Services The contents of this comprehensive report were noted. Dr Douglas felt that the information contained should be made available to those working within the service. Mrs McVicar indicated that it is circulated at management level but confirmed that she would request that it be disseminated more widely. Mrs McVicar also reported that the OOH Operational & Development Manager had begun exploring alcohol-related incidents in the service.

♦ Delayed Discharge Report The contents of the report were noted. Mr Wilmot confirmed that the Council shared Health concerns around delayed discharges and continued to work closely with them to ensure targets were met. He indicated that funding is now being targeted for those at the 42 day maximum waiting time point. There were particular challenges in the Lochaber area related to a shortage of care home places. On a more positive note, the Council were inviting care homes to bid for 25 respite beds across Highland, i.e. 6 or 7 in Mid Highland. Mr Wilmot

7 explained that he is also keen to explore ways in which new Local Authority beds with nursing support can be used to prevent hospital admission. Mr Wilmot highlighted the new Strategy for Carer Support which is being developed jointly by Social Work and Highland Community Care Forum and links with Health’s Carer Information Strategy. In response to a query by Cllr Campbell regarding respite care facilities in Lochalsh, Mr Wilmot indicated that a formal decision has not yet been taken. There was a wide-ranging discussion around respite care, home care services, Guardianship and Power of Attorney issues. Dr Venters queried plans for expansion of services at Broadford and the potential for joint working. Mrs McVicar and Mr Wilmot confirmed that this has been discussed between Health and Social Work and that a meeting is planned for September.

♦ Lead Nurse’s Report Mrs Hudson highlighted key issues from her report:

ß Getting It Right for Every Child (GIRFEC) – the roll-out is due to commence across September from September 08 and should be fully implemented by March 09. ß The Emergency Care Framework – work is commencing on this project which is designed to ensure consistent emergency care for children and young people at different levels. ß Health Visiting and School Nursing – vacancies for these posts have been highlighted as an area of risk, particularly around Child Protection. ß Child Healthy Weight intervention – a new target requires child healthy weight interventions to be collated across the CHP. By November 08, P1 and P7 will have had their BMI measurements recorded.

The Lead Nurse confirmed that a detailed Mental Health report will be brought to the next Committee meeting.

♦ Lead Pharmacist’s Report Mr Hickey asked Committee to note an error in his report, where the figure for Lochaber (column 4) should have read £45,138. He went on to highlight the following issues:

ß Expenditure on prescribed medicines remains subject to pressures including Governmental action to reduce the price paid for branded medicines; potential for increase in the price of generic drugs; and changes in prescribing recommendations to practices. ß New regulations have been introduced for the safer management of controlled drugs (CDs) together with guidance on the new, strengthened governance arrangements. The Lead Pharmacist will be visiting all practices (in an advisory capacity only) to clear any backlog of CDs requiring destruction. Practices have been informed that, in the initial period, they can refer to Mr Hickey for support and advice. There was a brief discussion around how Community Hospitals might be affected and Mr Hickey indicated that the main impact would lie with Primary Care Practices.

Dr Douglas raised the issue of supply of controlled drugs and asked if the manufacturer shortage (which had related specifically to diamorphine) had now been resolved. Mr Hickey indicated that this was an entirely separate issue but was able to confirm that production levels were approaching the levels they were previously. He highlighted the fact that despite the supply problems, no-one in clinical practice in the CHP had been without diamorphine.

The Committee:

• Noted the contents of the General Manager’s Overview and Update Report • Noted the contents of the reports to Committee

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• Noted the omission of reports for Performance Monitoring, Clinical Governance & Risk Management, Health & Safety and Public Health and that these will be submitted to the next Committee meeting

7 SERVICE IMPROVEMENT & NATIONAL COLLABORATIVES PROGRAMME

Mrs McVicar gave a brief verbal update on this important piece of work. In December 2007 three national improvement programmes were introduced: Long Term Conditions Collaborative, Mental Health Collaborative and 18 Weeks Referral to Treatment Time Improvement Programme (18RTT).

Mrs McVicar indicated that whereas waiting time targets were traditionally viewed as an Acute Hospitals issue, 18RTT took a ’whole systems’ approach. Work at local level will be vital and demand management work, which is one of the key planks of the programme, is due to commence in September. It will entail review of practice referral rates to explore any issues around community infrastructure, access to services locally etc. The 18RTT Programme is being led by Dr Ian Scott and project managed by Maimie Thompson. It will be hosted in South East CHP.

18RTT links closely to the Long Term Conditions (LTC) Collaborative where the emphasis is on helping people to manage their own long term conditions, identifying the conditions earlier (anticipatory care) and early intervention, which may prevent onward referrals and relieve pressure on specialist services. This collaborative is being clinically led by Dr Dennis Tracey, Public Health Consultant, with Maimie Thompson as the Programme Manager.

The Mental Health Collaborative is exploring patient journeys, work in Primary Care and Integrated Care Pathways. This work is being led by Dr Cameron Stark, Public Health Consultant with North Highland CHP, and project managed by Linda Forrest, Occupational Therapist in North CHP. This collaborative will be hosted in Mid Highland.

All three programmes are inter-related and are high profile and important pieces of work. The work will be overseen by a senior service improvement group and the managers and clinical directors will meet fortnightly to monitor progress.

Dr Venters reiterated the importance of the programmes and highlighted 18RTT which should lead to improved patient care. It will also provide a tool for demand management which is vital if improvements are to be made to the service.

The Committee:

• Noted the position with regard to the Service Improvement/National Collaboratives and progress in Mid Highland

8 NHS HIGHLAND ANNUAL REVIEW, 27 AUGUST 2008

Mrs McVicar reported on the Annual Review of NHS Highland’s performance, which was led by the Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon. She highlighted areas of the NHS Highland Chair’s presentation which Mid Highland CHP needed to address in the coming year in order to contribute to improvements. She confirmed that, overall, the review was a positive one; NHS Highland has shown significant improvements in some key areas.

The presentation was split into three sections: Achievements, Near Misses and Challenges.

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Achievements include delivery of access targets for general waits, cataracts, cardiac intervention, diagnostics and A&E; achieving the cancer target (treatment within 62 days of urgent referral); and significantly reducing delayed discharges.

Near Misses include MMR immunisation (with a target of 95%, NHS Highland achieved 92%); outpatients waiting over 18 weeks; same day surgery; and Community Health Index (CHI) usage.

Challenges still exist around the following: hip surgery; breast cancer treated within 31 days; sickness absence; healthcare associated infection; anti-depressant prescribing.

High risk areas which NHS Highland will focus on in 2008/09 include: dental registrations; alcohol brief interventions; sickness absence; financial performance; 12 weeks wait for Outpatients/Admissions and A&E attendance rate; emergency admissions; anti-depressant prescribing; and healthcare associated infection.

The Minister fed back on some of the patient concerns that had been discussed. These included communication, discharge planning, issues around young carers, cleanliness and basic care and dignity issues.

The Clinical Forum raised concerns with the Minister around how the 18RTT programme will fit with infrequent specialist clinics and the new funding mechanism, the National Resource Allocation Committee (NRAC), which will significantly impact Highland funding. The Minister was very impressed to note that patients are represented on the Clinical Forum and indeed, both representatives were present at the meeting. She indicated that this was quite uncommon and confirmed that she would be recommending this approach to other Boards.

The Partnership Forum raised issues around sickness absence.

Summarising, the General Manager set out some of the challenges ahead for Mid Highland and invited questions from Committee. There being none, the Chair took questions from the members of the public (please see Appendix 1).

9 ANY OTHER BUSINESS

♦ Health & Safety Issue Mr McLennan highlighted a situation he had been made aware of concerning the use of balloons in the workplace. The staff had been requested not to use these again as they may be injurious to health and are covered by COSHH (Control of Substances Hazard to Health) regulations. Mr Shields confirmed that latex sensitivity is a Health and Safety issue and that he will explore this further.

♦ Community Pharmacy – Fort William Dr Douglas asked when the Pharmacy Practice Committee’s decision on the Fort William pharmacy is expected. The Chair indicated that it will be sent out within 15 working days of the meeting. Dr Douglas asked if there was an official mechanism in place by which the information was made public; he felt that this should include an explanation of the decision- making process and, if necessary, the appeals process. Mr Hickey indicated that he would speak to Mary Morton, NHSH Head of Community Pharmaceutical Services and ask if it was possible to make information generally available about the community pharmacy application process. Mrs Bethune confirmed that the local community were represented at the meeting in question so they would automatically receive all the required information.

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The Committee:

• Remitted to Mr Shields to progress latex sensitivity issue • Remitted to Mr Hickey to speak to the Head of Community Pharmaceutical Services regarding the Community Pharmacy Application process

10 DATE OF NEXT MEETING

The next meeting of the Mid Highland CHP Committee will take place on Friday 31 October at MacKinnon Country House Hotel, Kyleakin, (10.00 am – 1.30 pm). Lunch will be served after the meeting.

The meeting closed at 1.20 pm

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APPENDIX 1

Questions from members of the public

Q Why do podiatrists not cut toe-nails anymore?

A Everyone of pensionable age used to have access to a podiatrist but, as the population has aged, there are no longer enough podiatrists to withstand demand on the service. A major national review was undertaken and it was decided that nail cutting was something that could be done by people other than podiatrists. Highland Council and Health podiatrists worked closely together to train Highland Council home care staff to cut nails. Patients who need nail cutting can still be referred to Home Care and receive the service. Individual cases can be notified to the CHP who can arrange for an assessment by a podiatrist and referred to the most appropriate person. In the case of medical need e.g. diabetes; the person will always be referred to a podiatrist. If required Head of Service can provide a full response.

Q Why are we not utilising Fort William HC for this meeting?

A Unfortunately rooms large enough to accommodate Committee members and members of the public are not always available at the Health Centre. We always endeavour to have meetings at the most appropriate venue available.

Q Why can’t Committee meetings be better publicised? The GP Practice didn’t know anything about it and neither did the other place (?) I was advised to phone. There should be posters in health centres, libraries etc and notices in the local papers.

A At a recent Public Involvement meeting we noted that there is room for improvement with publicity. Mrs McVicar and Mrs Jefferson, the CHP Administrator, confirmed that they would follow this up but indicated that press advertising is costly. There was a debate about the possibility of free advertising in certain Lochaber papers.

Q Why are Highland HealthVoices not represented at this meeting?

A Highland HealthVoices representatives are notified of all Committee meetings and are always invited to attend.

Referring to an earlier discussion, a Health Council member who was attending noted that the cost of obtaining Power of Attorney could be in the order of £60.00, which may prevent some people from pursuing this.

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