Highland NHS Board 4 June 2013 Item 3.1
Argyll & Bute Community Health MINUTE OF MEETING OF THE Partnership ARGYLL & BUTE CHP COMMITTEE Aros Lochgilphead Argyll PA31 8LB www.nhshighland.scot.nhs.uk/
Guide Hall, Campbeltown 24 April 2013
Present Mr Robin Creelman, Chairman, Argyll & Bute CHP Mr Derek Leslie, Director of Operations, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Ms Elaine Garman, Public Health Representative, Argyll & Bute CHP Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Ms Elizabeth Reilly, Area Dental Committee Representative Ms Glenn Heritage, CVO Representative Mr Duncan Martin, Chairman, Public Partnership Forum Mr Michael Roberts, Vice Chair, Public Partnership Forum Ms Liz McMillan, Staffside Representative Councillor John McAlpine, Argyll & Bute Council Representative Jim Robb, Head of Service, Adult Care, Argyll & Bute Council
In Attendance Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Ms Christina West, Locality Manager, Mid Argyll, Kintyre & Islay Mrs Sheena Clark, PA to Director of Operations - Minute Secretary
Apologies Ms Dawn Gillies, Staffside Representative Councillor Elaine Robertson, Argyll & Bute Council Representative Councillor George Freeman, Argyll & Bute Council Representative
1. CHAIRMAN’S WELCOME
The Chairman opened the meeting by welcoming everyone to the Guide Hall, Campbeltown.
2. APOLOGIES
Apologies for absence were noted as above.
3. CONFLICTS OF INTEREST
No conflicts of interest were declared. 4. MINUTE FROM PREVIOUS MEETING
4.1 Minute of Meeting held on 20 February 2013
Page 6 – Pressure Ulcer Prevention – Ms Tyrrell requested that paragraph 3 be amended to read, “Councillor Freeman asked if the CHP receives notification of patients with pressure ulcers prior to transfer from NHS Greater Glasgow & Clyde back to Argyll & Bute. Ms Tyrrell confirmed that this does not happen in every case. Where there are gaps in communication and information sharing staff from Argyll and Bute hospitals make contact with the ward staff in NHS GGC from where the patient has been transferred to highlight the issues. In addition each of these cases is reported through DATIX and shared with the Tissue Viability staff in NHS GGC.”
The Committee Approved the content of the Minute of the meeting on 20 February 2013, with the above amendment.
5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 20 FEBRUARY 2013
Mull & Iona Primary Care Centre
Mr Martin enquired if the previously reported public concerns and issues have been resolved. Mr Robb replied as this was a new facility, with a new model of care, initially there had been some concerns around the 2 levels of overnight care but that now the majority of residents of Bowman Court are satisfied with the service provision. It has also been recognised by the public that the facility is also for community use. Mr Leslie advised that from the health perspective, the transition to the new facility is settled and community groups are engaging in its use. A full update will be included in the Director of Operations report to the June meeting.
Aortic Abdominal Aneurysm Screening
Mr Roberts asked if the local uptake figures were now available. Ms Garman confirmed that a request for data has been made to the national group and a response is awaited. She advised that uptake reporting is based on invitations to patients to attend a screening clinic, although through locality publicity a number of older patients have been attending, but not necessarily in the screening cohort of up to and including 65 years. There continues to be only one member of staff carrying out the clinics.
6. NHS Highland Organisational Issues
6.1 Meeting of Highland NHS Board Meeting Media Briefing
Mr Creelman highlighted the recently distributed media briefing, which will now be produced and issued as a summary of the Board papers.
Mr Creelman referred specifically to:
‘Highland Quality Approach’ – participation by NHS Highland in a quality improvement programme, involving learning opportunities from the Institute of Healthcare Improvement; Virginia Mason Medical Centre in Seattle’ Tees, Esk and Wear Valleys NHS Foundation Trust.
2 ‘Audit Scotland Report – Management of Patients on Waiting Lists’ – a positive report which detailed the key messages and recommendations and the position of NHS Highland regarding the recommendations and the actions taken.
‘Board Set to Achieve Financial Break-Even’ – it was noted that the CHP has consistently achieved its projected position throughout the year as an element of the corporate NHS Highland position.
The Committee Noted the previously circulated media briefing.
6.2 Director of Operations Report
Mr Leslie provided a summary of key points in the circulated report.
Major Incident – Mid Argyll, Kintyre & Islay – the content of the recently distributed staff briefing notes from NHS Highland and Argyll & Bute Council which acknowledged the positive response from staff in helping the communities affected by the recent adverse weather incident, particularly in Kintyre and Islay. Mr Leslie highlighted the considerable commitment and input by all involved which resulted in good partnership and integrated working.
Mr Martin stated that the event should be seen as a significant learning experience for the partnership and he acknowledged the outcome as a good example of joint working.
Mr Martin emphasised the requirement for a ‘common’ list of vulnerable people. Mr Robb acknowledged that there had been differing perceptions within partnership organisations of the criteria for a vulnerable person but that this would be addressed and actioned during the forthcoming final debrief session and a CHP wide list of vulnerable people will be created.
Councillor McAlpine commented on the decision at the recent Mid Argyll, Kintyre & Islay Area Committee to undertake a survey of vulnerable people affected by the major incident. Ms West requested that Health is involved in finalising the detail of the survey to ensure a joint and consistent approach within the CHP. Councillor McAlpine agreed on the requirement for liaison between the Council and Health in carrying out the survey.
Ms Garman advised that community resilience will be discussed as part of the debriefing and the need for any learning to be expanded to other areas.
Mr Creelman emphasised that a holistic view of events and responses should be captured to identify what went well and what did not.
Changes to Immunisation Programme - Major developments to immunisation programmes arising from recommendations from the joint committee on vaccinations and immunisations have been accepted by the department of health and are to be implemented in 2013. There is an awareness of a number of demand and capacity concerns in the delivery of the programme and a plan is being developed in NHS Highland to ensure the timely implementation of these recommendations.
Mid Staffordshire NHS Foundation Trust – the report has been presented throughout the CHP governance structure, resulting in various discussions and engagement around the review.
Locality Clinical Leadership – the criteria for eligibility of these roles has been broadened to all eligible clinicians in an effort to attract/stimulate wider interest in longstanding vacancies.
3 The Committee Noted the content of Director of Operations Report.
6.3 CHP Draft Annual Report
The report was previously circulated for information and any comments prior to being sent to NHS Highland for submission to the Audit Committee.
Councillor McAlpine enquired about the status of the integration programme. Mr Leslie reported that currently the integration process is to be implemented by 1 April 2014.
Mr Leslie and Mr Robb confirmed that the integration agenda is being taken forward operationally as a strategic partnership but governance issues remain to be agreed and clarified by NHS Highland and Argyll & Bute Council executives.
The Committee Noted and Agreed the content of the CHP Draft Annual Report.
7. Clinical Governance
7.1 Clinical Governance & Risk Management Report
Ms Tyrrell spoke to the circulated report and highlighted and summarised a number of items.
Risk Management
Incidents A total of 447 incidents were reported during quarter 4, which is a slight increase in the 438 incidents reported in quarter 3.
The top 3 categories were: o Slips, trips and falls o Disruptive, violent and aggressive behaviour o Pressure ulcers
Four incidents were graded as high, one in Cowal & Bute, two in Mid Argyll, Kintyre & Islay and 1 in Oban, Lorn & Isles.
There was also an increase in incidents relating to self harming behaviour which can be attributed to one patient.
There were six incidents recorded with a major or extreme consequence. Four in Mid Argyll, Kintyre & Islay and two in Cowal & Bute.
Pressure Ulcer Prevention Ms Tyrrell advised that the range of measures being taken to improve the identification and management of those patients at risk of developing pressure ulcers in all settings is leading to reduced numbers of hospital acquired pressure ulcers, with no grade 3 or 4 incidences reported in quarter 4 in Argyll & Bute.
Ms Tyrrell stated that reporting on the Datix system allows staff an over view of incidents.
Mr Creelman enquired if, when grade 3 and 4 incidents are discovered on admission to hospital, do staff have an understanding to carry out a root cause analysis. Ms Tyrrell replied that new tool from National Patient Safety Agency is being trialled at present and that support
4 is given to staff to carry out the root cause analysis. Ms Tyrrell also advised that there is now an increased focus on reporting of incidents from community areas, including care homes.
Mr Creelman stated that there is national guidance for independent contractors on the reporting and investigating any occurrence of untoward incidents.
Ms Tyrrell reaffirmed that effective systems are being pursued, with support from the Clinical Governance Team, to ensure the breakdown and timeous completion of audit data.
Falls Prevention As previously reported by Ms Tyrrell, a considerable amount of work continues in order to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn & Islands Hospital, Oban.
Serious Untoward Incidents
A Significant Event Review was carried out in early March into failure to adequately plan for transfer of very elderly patient from community hospital to home. This has resulted in some significant learning and the implementation of key actions to address potential shortfalls in planning systems and processes as well as communication
Complaints
Causes of complaints received in January/February 2013 can be categorised as follows: Access/Admission: 5 Communication: 1 Treatment Procedure: 1 Transfer/Discharge: 1 Attitude/Behaviour: 1 Policy: 1
As part of the Highland Quality Approach, and in response to the Patients Rights Act, NHS Highland is reviewing its overall performance in relation to complaints management. In addition, there has been a further system of scrutiny introduced within the CHP to ensure that appropriate clinical/professional leaders view complaints and draft responses prior to final sign off to ensure that all key aspects of the complaint have been investigated and that the response to the complainant is of high quality.
External Reviews
Joint Inspection of Children’s Services in Argyll and Bute
The on site inspection, led by the Care Inspectorate, with inspectors drawn from range of partner organisations, commenced in March 2013 and is due to conclude at the end of April. This is a pilot inspection which is seeking to test the inspection methodology prior to carrying our inspections across all Local Authority areas in Scotland. Verbal feedback will be provided to members of Community Planning Partnership on 3 May. The written report will be published in June 2013. Ms Tyrrell commented that this was a useful inspection and staff were well engaged in the whole process.
CPA Surveillance Inspection of LIH, Oban Laboratories
A follow up inspection will take place in April 2013.
5 National Plans for Joint Inspection of Adult Services
A joint approach to the inspection of adult services is being undertaken by Healthcare Improvement Scotland in conjunction with the Care inspectorate to examine the effectiveness of collaborative working, primarily between health, social work and social care services for adults. The inspection will mirror the approach to the Children’s Inspection process and aim to build on the previous experience of multi-agency inspections and the proposals for the integration of health and social care systems. The model and methodology for scrutiny and improvement is currently being developed and will consider how well strategic partners work together to deliver support that maintains people in the community at home or in a homely setting.
The inspection model has been produced by bringing together the most relevant elements from the Care Inspectorate and Healthcare Improvement Scotland into an improvement model for services for adults, 65 years and over.
The model will look at 6 key themes: jointly meeting needs through person centred approaches key outcomes for people and carers joined up delivery of services management of whole systems and partnership approach leadership and direction capacity for improvement.
Following a request from Healthcare Improvement Scotland, a request for clinical experts to join the inspection teams has been sent to a number of staff in Argyll & Bute.
Scottish Patient Safety Programme
Acute Services Ms Tyrrell referred to the latest information in relation to SPSP across NHS Highland Acute Hospital sites, which is presented in different format from the previous dashboard and allows comparison across the four hospital sites.
The reported figures have been scrutinised through the mortality monthly audit by senior nurses, consultants and managers and there are no identified adverse events.
Mental Health The roll out of SPSP in mental health is underway, with the team from Argyll and Bute Hospital having attended two of the national learning set events in Glasgow.
Using the improvement methodology the main focus is on reducing risk by improving communication; this will also include improving risk assessment and medicines management.
Daily Board Rounds at the hospital have helped with internal clinical communication. The implementation of new care plans, which are currently being rolled out, will help to address the issues in communication between inpatient and outpatient care since the same plan will be continued.
Primary Care The Scottish Patient Safety Programme in Primary care was officially launched on 14/15 March by the Cabinet Secretary for Health and Wellbeing and the Chief Exec of NHS Scotland. Joyce Robinson, Primary Care Manager represented Argyll and Bute CHP at the launch.
6 Two elements of the Primary Care Safety Programme are included in Quality and Outcomes Framework (QOF) of the GMS contract this year:
o The Safety Climate Survey, and o Structured case note review using the Primary Care trigger Tool.
Training for the GP practices in Argyll & Bute is being arranged for early June with Dr Kirsty Vickerstaff, who was involved in the Safety Improvement in Primary Care Pilot Programme for NHS Highland.
Francis Report of Public Inquiry into Mid Staffordshire Hospitals
The CHP Clinical Governance Group, Partnership Forum and Management Team have reviewed the findings of the Mid Staffordshire public inquiry, which will be presented at the next CHP Committee Development Session. The recommendations of the report will have implications for all organisations and the CHP will continue to work with people who use services and with staff to highlight and address areas for improvement.
Mr Creelman referred to the RCN National Survey of staff, which reported that 29% (of those interviewed) felt that they had been discouraged or told directly not to raise concerns about patient safety. Within Argyll & Bute CHP, Mr Creelman acknowledged the strong management structure, professional and leadership structure and professional accountability but he emphasised the need for systems and processes to be evidenced to give staff a degree of confidence to highlight and report to management any areas of concern around patient care. He asked for an assurance to the Committee that this was the case in the CHP.
Ms McMillan responded that Staffside felt that this was the case and she believed that there is an assurance and support for staff around the openness and management structure for reporting concerns.
Mr Leslie agreed with Ms McMillan’s comments but stated that it is not possible to give 100% assurance to the Committee that staff will report their concerns to management but he believed that there is a CHP management culture of encouragement to do so.
Mr Creelman asked about the interaction between nursing staff and charge nurses around patient care. Ms McMillan responded that it was her understanding that communication between staff and senior ward staff has significantly improved.
Ms Garman commented there is a need for evidence of management investigation and the resolving of concerns and issues raised. Mr Morrison queried if this could be evidenced as part of the staff survey. Mr Leslie replied that as a result of a national staff survey, a local staff survey group was set up to produce a local action plan to consider and address the staff comments and concerns. Mr Creelman suggested that there should be Staffside input into discussions to consider a general level of evidence that staff concerns are being addressed. It was agreed that Ms Tyrrell and Ms McMillan will discuss this further outwith the meeting.
Supplementary Staffing
The utilisation of bank and agency staff continues to be reviewed by managers in an attempt to keep the level below 10% of supplementary staffing in nursing and midwifery services. This is noted as a quality marker and ensures a better continuity of staff and quality of care.
The Committee Noted the content of the Clinical Governance & Risk Management Report
7 7.2 Infection Control Report
Ms Tyrrell advised that all NHS Highland Infection Prevention and Control notional targets have been achieved. She advised that a fourth Consultant Microbiologist is to be recruited to Raigmore Hospital which will enable additional infection prevention and control support to Argyll & Bute, together with infection control leadership from NHS Highland.
Ms Tyrrell commented on the following:
Staphylococcus aureus bacteraemia (SAB) (including MRSA) There have been no new cases of SAB in Argyll & Bute since the last report.
The focus on tissue damage has increased to ensure avoidance of infection.
Preparation for Inspection Visits Locality action plans will be submitted to the May Infection Control meeting in order to monitor progress and to ensure that all key actions are being taken to address areas of improvement.
Health & Safety Executive Joanna Hynd, District Manager in Lochaber, attended the April Infection Control meeting to inform the group of the learning and actions taken to address the requirements of the HSE Improvement Notice for Community Nursing which was issued in September 2012. A number of actions were agreed to ensure that training for CHP Community staff and adherence to Standard Infection Control precautions in community settings all meet the required standards.
2012 Staff Influenza Vaccine Uptake Uptake of the Influenza Vaccine was higher among staff in 2012 than in any other previous year due to a high profile campaign and real dedication and commitment from those identified as ‘Flu Champions’ across the CHP.
The target for the Staff Vaccine programme was to reach 50% of frontline staff; although this figure was achieved for some staff groups further awareness raising is required to improve the uptake in 2013 so that the overall target is reached.
Mr Leslie recorded his thanks to the ‘Flu Champions’ and asked that their contribution to the future campaigns is continued.
The Committee Noted the content of the Infection Control Report
7.3 Health Improvement
Ms Garman spoke to the circulated paper and annual report on the status of the implementation of the Health Promoting Health Service CEL 1, 2012, which NHS Boards are required to report on annually for three years. It is expected that the template will be refined for future reports based on feedback nationally. Ms Garman advised that the report presented today will feed into the overall Highland submission to the Scottish Government.
Although the CEL focuses on hospital settings, the CHP has extended the context to include community staff groups. This provides clarity to staff that ‘every healthcare contact is a health improvement opportunity’. A key area identified for greater attention is physical activity which needs to be linked to activity around healthy eating.
8 Ms Garman advised on the recommendation that starting in 2013/14 the CHP has greater health improvement focus on physical activity whilst maintaining momentum on other targets. In addition the work that can be done beneficially between Healthy Working Lives and the Staff Partnership Forum on improving the health of staff and specifically picking up issues from the staff survey and sickness absence are taken forward as a priority.
Mr Leslie acknowledged the good work in preparing this submission for the annual report and stated that it captures the work of the Health Improvement Team.
Ms Garman confirmed that the detail of the report will also be included in the Community Planning Partnership Single Outcome Agreement.
The Committee Noted the content and agreed the recommendations of the Health Improvement Report
8. Financial Governance
8.1 Finance Report
Argyll & Bute CHP – 2012/13 Year-end Financial Position Mr Morrison reported that for the year ended 31st March 2013, Argyll & Bute CHP recorded an underspend of £162,000, which is broadly in line with the forecast outturn position which had been estimated as a £200,000 underspend for several months. It also represents the seventh consecutive year in which Argyll & Bute CHP has achieved a year-end break-even or better position.
Mr Morrison provided a summary of budgetary performance across Argyll & Bute CHP for the year ended 31 March 2013 and referred to the more significant variances, specifically:
Oban, Lorn & Isles Locality A drugs budget overspend of £225k – this relates almost entirely to local service developments in chemotherapy and haematology. It includes charges made in March 2013 of over £100k for a years supply of cancer drugs (Rituximab and Trastuzumab) issued by NHS Greater Glasgow & Clyde to Lorn and Islands Hospital.
Cowal & Bute Locality A 136K overspend which is due almost entirely to locum cover for medical vacancies in Dunoon (casualty and out of hours services). There was an overspend of £300k on this budget and it will continue to be an issue moving into 2013/14. Mr Morrison stated that action is required to bring the spending into line.
Cost Improvement Programme 2012/13 The CHP approved budget for 2012/13 contained a requirement to achieve savings of £5m.
Several of these savings arose naturally e.g. prescribing drugs coming off-patent, restricted uplift to SLA values etc, however a balance of £1.56m was required to be delivered through management action.
It was reported that there was a shortfall of £312k against savings targets. However, budget underspends elsewhere (principally prescribing) enabled the CHP to offset this shortfall in- year.
It should be noted that the revenue budget for 2013/14 contained provision to write-off these shortfalls and absorb the impact within a new savings plan for 2013/14.
9 Outlook for 2013/14 Argyll & Bute CHP faces another challenging financial year in 2013/14. The funding uplift of 2.8% is insufficient to cover inflation, pay awards, cost pressures and agreed service developments. As a result, the CHP is required to deliver savings of £2.4m to achieve financial balance. It is expected that this will be delivered by prescribing savings and a 2% target applied to other budgets.
In addition to the £2.4m savings target, there will be a number of other financial challenges;
Containing the cost of the NHS Greater Glasgow & Clyde SLA in the face of a claimed £5m underpayment
Managing locum costs which will be an issue in Oban, Dunoon and vacant GP practices
Controlling the cost of local service developments, particularly drugs costs.
Financial performance will be closely monitored throughout the course of the year and regular reports will be provided to the management team and committee highlighting risks and areas of concern.
Mr Leslie acknowledged and recorded his thanks for the contribution of staff and managers and the stewardship of the finance team in achieving the CHP’s financial targets.
The Committee:
Noted the 2012/13 year-end financial position. Noted the financial challenge facing Argyll & Bute CHP in 2013/14.
9. Staff Governance
9.1 PDP/R and eKSF Implementation
Mr Logue reported that currently 63.86% of all CHP staff (86.22% excluding Bank Staff) have had reviews and personal development plans signed off in eKSF. He advised that specific actions are being taken to look at the issue of missing data and details regarding a number of staff. eKSF Focus Groups have not met due to the low uptake of places but staff comments on the process have been received and noted. In general, staff have reported that regular development reviews and agreeing personal development plans has been beneficial and supports service quality, improvement, staff and clinical governance.
Three themes have been identified for the eKSF process:
o Staff to look at activity and development of practice o Tool for staff engagement o Evaluation of process
The Committee:
Noted the end of year position. Noted progress made in ensuring staff have a review and mainstreaming this within the CHP.
10 10. Partnership Working
10.1 Draft Minutes of Community Planning Partnership (CPP) Management Committee Meeting – 6 February 2013
Mr Leslie stated that the circulated Minute gives an overview of the joint working of the Community Planning Partnership and will become a focus for the wider integration agenda.
The Committee Noted the content of the previously circulated Community Planning Partnership minutes of 6 February 2013.
11. PERFORMANCE MANAGEMENT
11.1 Balanced Scorecard Summary
Mr Leslie asked the Committee to note the detail of the summary. He highlighted the current status of the heat measure for CAMHS, that by March 2013 no-one will wait longer than 26 week from referral. At present no trajectory is agreed and is currently being developed.
The Committee Noted the content of the circulated Balanced Scorecard Summary.
11.2 Delayed Discharge Report
Mr Leslie reported the current position in Argyll & Bute CHP as zero delayed discharges over 4 weeks.
The Committee Noted the verbal update.
11.3 Operational Delivery Plan (ODP)
Mr Whiston referred the Committee to the previously circulated Argyll & Bute CHP Operational Delivery Plan which feeds into NHS Highland’s Local Delivery Plan’s objectives and priorities and performance framework. It detailed how the CHP will take forward the Highland Quality Approach through various initiatives and take forward the roll out of the methodology and process in the CHP.
Mr Whiston advised that the planning priorities identified and approved by the CHP Management Team, and sit within a number of other key CHP objectives, are: o Mental Health modernisation o Reshaping Care for Older People - programme of initiatives o Sustaining our Community and Rural General Hospital core services re. acute care, trauma and out of hours services . Community Hospital strategy refresh and NHS Highland pilot - Workforce and finance modelling . Business 2 Business contract renegotiation for 01/04/14 . Implementing the outcome of the Islay Community Hospital & out of hours review o Primary Care redesign – including GMS modernisation, workforce recruitment (Inveraray, Kilmun, looking forward Kintyre Medical Group) and enhancement of roles of GMS to provide locality wide services. o Preparing for Integration – Health and Social Care Partnership o Financial balance
11 Mr Leslie credited all those who provided input into the CHP’s Operational Delivery Plan.
The Committee:
Noted the current iteration of the CHP’s Operational Unit Delivery Plan and its alignment with the targets set by the SGHD, NHS Highland LDP, NHS Highland’s Performance standards and Highland Quality Approach.
Endorsed the targets, objectives and service planning/priorities for the CHP in 2013/14.
Noted that progress against the plan will be recorded by regular updates using the traffic light system and linked to NHS Highland Improvement committee, partnership and HQA monitoring reports with formal report to the committee in November 2013.
12. Review and Redesign of Hospital, Community and Care Services in Kintyre
The previously circulated paper updated the CHP Committee on the final outcome of the 2 year process to review and redesign the hospital, community and care services within Kintyre.
The work undertaken by the Project Group has been within the national policy context of transferring continuing care provision from Hospital (institutional settings) to the community under the Scottish Government “Reshaping Care for Older People: A Programme for Change 2011-2021”
This will see the NHS, Council, Independent and voluntary sector moving towards a service that will focus on: o Care Pathways – ensuring those with complex needs are well supported by all parts of the care system; o Care Settings, which will help older people to remain at home or in homely settings; o Community Capacity, to enable older people and their communities to provide "supported self care"
Mr Whiston summarised the process undertaken and timeline of the systematic review of the hospital bed complement for GP acute and continuing care beds in partnership with all stakeholders, including local Councillors, Social Work, Scottish Ambulance Services, local GPs and the local community, including public representatives from the locality Public Partnership Forum and Community Council representatives.
The first bed modelling exercise took place in November 2010 to consider the results of a statistical model which analysed a number of factors including the trends in continuing care and GP acute bed occupancy over the past four years, changes in the length of stay of patients, the age of patients and also projected population increases.
There was an examination of changes in how services are being delivered locally through the development of anticipatory care, the impact of increasing the range of services in the community and more effective working with social services.
The project group considered the challenges of providing services in a very remote and rural area, particularly potential delays in patient transfer and the impact on the Scottish Ambulance Service.
12 The configuration and physical layout of the hospital wards were also considered, identifying and acknowledging constraints in the flexibility in the accommodation e.g. limited number of single rooms (3 in the GP Acute ward) with the remainder of the beds provided in bays.
Whilst undertaking this work the project group in January and February 2011 undertook a review and option appraisal exercise on the operation of the existing 2 wards. This process identified a preferred option to reduce the Acute ward to 18 beds and Bengullion to 14 beds running as a single ward team. This outcome resulted in the merger of the wards so they operated as a single unit, better reflecting the current and future NHS care needs of patients (hospital beds should be preserved for acutely ill patients). This reorganization ensured that all hospital nursing staff maintained their skills and strengthened the link to community nursing and Allied Health Professionals, continuing to support the shift of health and social care into the community.
The outcome of the initial bed modelling work and the reorganisation of the wards saw the project group agree that there should be a pause to allow time for the new hospital, community and anticipatory care arrangements and services to take affect and then assess the impact on hospital bed usage. It was therefore agreed to repeat the bed modelling exercise in about 6 months.
A number of further meetings were held through 2012 in March, August, October and December outlining the changes in community services, the impact of “Reshaping Care for Older People” and examining the trends in hospital bed use and then repeating the bed modelling exercise.
This 2 year programme has been conducted under NHS Highland’s Better Health Better Care, Better Value” initiative, the culmination of which was agreement on the future bed complement required to provide local GP acute hospital services in October 2012 with all partners.
The revised bed complement was ratified at the project group meeting on 10 January 2013. This recommended the closure of the unused and empty continuing care beds on Benguillion ward with the exception of the 2 beds for existing patients (these would close in time). The GP Acute ward bed complement would remain unchanged at 19 - total ward complement of 21 beds.
Also at the meeting a number of additional operational arrangements were clarified and confirmed notably: o Contingency arrangements to provide an additional 3 physical beds if there was an unexpected peak in demand due to e.g. a viral outbreak. o How resources from the closure of continuing care beds would be reused in the community to further develop anticipatory care services including community nursing and social work care services. . o An implementation project group would be established with appropriate representation to take forward the bed closure and redesign of services.
The culmination of this work is a further important step in NHS Highland ensuring that it has the right balance of service provision in Kintyre to make sure that hospital beds are available for those patients with acute illnesses. There has been an increase in the community services in both health and social care which is clearly helping prevent people getting ill and letting them remain in their own home. This decision to close the empty Benguillion ward will allow further development of community and social care services by transferring resources into the community. Subject to validation this is in the range of £160,000-£190,000 to be transferred into community services
13 Argyll and Bute CHP throughout the process has recognised community concerns regarding the future sustainability of hospital and care services in Kintyre and hence has taken a systematic and measured process over 2 years to get to this point. At all times it has reassured the community that it intends to maintain the 999 status of the hospital, A&E, GP Acute, GP Out of Hours and Community Midwifery Maternity Services in the hospital. Mr Whiston reported that due to an unfortunate administrative oversight the Campbeltown Community Council representatives on the project group were not invited to the ratification meeting in January 2013. This omission resulted in a breakdown in communication with the Community Council which led to a number of press articles and written/emails from the Community Council as well as local Councillors and MSPs on the closure of beds and their perceived downgrading of hospital services in the area.
To rectify this Kintyre locality management quickly put in place arrangements to have a public drop in event in the town on the 14 March 2013 to allow members of the public to meet members of the extended Community Care Team, including Occupational Therapists, Physiotherapist, Nurses and Health Care Support Workers, the Local Authority Home Care Team and Telecare Worker, the Red Cross, Carr Gomm (private home care providers and overnight response team), Argyll Voluntary Action alongside Shoppers Aid and the local Public Partnership Forum.
The Campbeltown Community Council members attended the event taking the opportunity to review the information presented, clarify the process undertaken and present their concerns.
A total of 58 members of the public attended the event. In addition the CHP established a formal feedback process around the event which saw 17 feedback forms received as at the closing date of the 29th March 2013. A full analysis of the feedback is included in the attached report. The main questions asked were:
Q3. Please tell us how you feel about the proposed changes in the way services are provided in Kintyre?
Q4. What do you like about these proposed changes and why?
Q5. Do you have any concerns or comments that you would like to make regarding the future of services provided in Kintyre (For example, for people who need support with social care, in your opinion where is this best provided)?
Feedback Summary
The majority of feedback received suggests that the direction service provision is moving in is not supported by the wider community.
With the perceived level of disapproval through media, local Community Council and political interest, it is disappointing that more people didn’t attend the event on 14 March (59) and that so few feedback forms were returned (19).
There is concern that the proposed loss of beds in Campbeltown Hospital will result in patients having to go to either Oban or Glasgow to receive care, more so than before, separating them from family, carers and friends which is important to people.
Some respondees suggest that community care is a good model but that this will not be adequately resourced to meet local demand and with fewer beds in the hospital patients will not receive the care they require.
Some respondees are suspicious that the proposed reduction in beds is to save money rather than following national guidance on how care should focus less on hospitalisation but more on keeping people at home.
14 There are concerns that the proposed model will fail to be adequately resourced and recruitment to the area will be a problem compromising patient care.
To balance this view, some respondees were positive about the proposed changes, suggesting that they will result in less institutionalisation and promote independence.
Integration is a good idea resulting in a more cohesive, efficient service for patients.
The key points from the feedback can be summarised as:
Key Issues/Concerns/Comments 1 Reduction of beds at Campbeltown Hospital is not widely supported
2 Community care is a good model if correctly resourced – additional resources required, expensive model 3 Adequate beds available for those who need it, including patients waiting transfer back from Oban or Glasgow hospitals 4 Patients being separated from family, carers and friends
5 Insufficient carers available to support the proposed model
6 Recruitment and retention of appropriately trained / skilled care staff
Mr Whiston referred to the recent unprecedented winter weather experienced in March which saw wide spread failure in the power and transport infrastructure, effectively cutting off Kintyre and surrounding areas from the rest of the country. He advised that Campbeltown Hospital became a key facility and service for the local community as part of the multi-agency response.
Mr Whiston stated that it is clear that this is a function that will always be there in extremis, not only providing 24/7 clinical service but supporting the public health safety and protection role and the multi-agency review of the incident will examine how it and other facilities e.g. School, Air base, community halls, care homes etc can be used and roles strengthened for community resilience purposes.
Mr Whiston concluded that the CHP has undertaken a lengthy and systematic and considered process in reviewing, reorganising and rationalising health and care services within Campbeltown hospital with the involvement of all stakeholders and partners in the area.
The recent concerns expressed by the community relate to an unfortunate breakdown in communication but also the material step of closing empty continuing care beds as they are no longer used. In addition there seems to be concerns regarding the robustness of care and community services although performance and monitoring information show local need is being met.
Notwithstanding this and the context of the Winter Weather Major Emergency the outcome of the review process remains valid and appropriate and its is the view of the CHP Management Team that the continuing care beds should close and the resources transferred into the community to further develop services there.
The implementation team tasked with taking these changes forward must undertake a proactive and responsive PFPI and communication process with the public and politicians on the developments made and the outcomes achieved to ensure hospital and community services are meeting patient needs.
15 Mr Creelman invited the public forum representative in attendance to comment on outcome of the review as detailed.
She advised that she is supportive of the process undertaken and the outcome as reported. She stated that it was her view that the majority of the public would regard the proposals as a positive step in people having more of their care in the community.
Mr Creelman reaffirmed that the review and proposals are in line with Scottish Government policy.
Mr Martin highlighted his concern around the level of community care staffing required to deliver adequate services and the difficulties which may be incurred in providing sufficient staffing levels.
Ms Garman stated that there would be a level of risk around the community care staffing levels and there needs to be increased communication and support between stakeholders to address concerns.
Dr Hall agreed with the comments regarding community staffing difficulties and the need for assurances that this can be resolved.
In response, Mr Robb acknowledged the Council’s current recruitment problems for community staff and the issue of homecare sustainability. He agreed that the public would require evidence that care in the community does work.
Mr Creelman advised that evidence of good care in the community should be captured in terms of customer feedback. Mr Robb commented that the improved Council review process in terms of feedback from carers and clients will address this. In addition, the electronic system requires a six monthly compliance for returns which will be monitored by the Council Quality Assurance team.
Ms Tyrrell commented that the Reshaping Care for Older Peoples Services questionnaire will also provide customer feedback and will form part of the monthly Joint Performance Report.
Dr Hall advised that part of the public anxiety is around the continuance of the high standard and quality of care historically provided in Benguillion ward and the ability to mirror this into community care.
Councillor McAlpine reaffirmed the Council’s challenges in retaining staff to provide the required care as part of the agreed care packages.
Mr Leslie advised that as part of shifting the balance of care and the quality of care provided to patients, this should be fully acceptable irrespective of whether care is provided by community staff, an in-house or independent service provider.
The Committee:
Noted the back ground and process conducted within the review and redesign of services in Campbeltown Hospital.
Noted the report findings and outcome of the hospital bed modelling review process and the way forward.
Considered the feedback received from the community at the drop in event.
16 Endorsed the conclusion reached to close the continuing care beds and transfer recourses into the community.
Endorsed the implementation process.
13. Mental Health Modernisation Update
The circulated report gave an update on the implementation of the modernisation of mental health services in Argyll & Bute.
Mr Dreghorn commented highlighted a number of points.
Capital Project Stage 1 Approvals – has been delayed by approximately 12 months due to Hub issues. The revised Stage 1 submission is expected during May 2013 and the outline business case should be completed by the end of May and will be presented for approval at the CHP Management Team, the NHS Highland Asset Management Group, the CHP Committee, NHS Highland Board and the Scottish Government Capital Investment Group.
Bridging Funding – the allocation for during 2013/14 has been agreed at £500k by the CHP Management Team and is an element of the CHP’s financial plan.
Resettlement Group – this group will be re-established to lead work on the resettlement of the small number of remaining complex cases in Argyll & Bute Hospital.
New Hospital Development – the hospital floor plans were agreed at a recent meeting with the Architects and Clinical User Group.
Community Mental Health Team Bases – capital funding has been allocated for bases in Kintyre and Dunoon, with completion of works expected by end April 2013.
Supported Transfer of Detained Patients – an approved model for implementation of the service is due for agreement.
Councillor McAlpine enquired about the costs allocated to advisors. Mr Dreghorn replied that it is a Hub requirement for external technical and financial advisors to be appointed but NHS Highland advisors also contribute to the project.
The Committee Noted the current key issues and progress against the action plan.
14. Paper for Noting
14.1 Argyll & Bute CHP eHealth Steering Group – Draft Minute of 06-02-13
Mr Martin expressed his continuing concern regarding the implementation of the Patient Management System (PMS) in relation to the future clinical management of Argyll & Bute patients. He highlighted the Highland Quality Approach work which is patient focussed and suggested the Board may wish to revisit their decision around the preferred option for implementation of PMS.
Mr Leslie noted Mr Martin’s comments and reaffirmed that clinicians, planners, etc will have the opportunity to provide input into the shaping of the delivery of PMS. A technical solution is presently being explored to ensure an equity of access for Argyll & Bute patients.
17 Mr Leslie advised that an update on PMS is also due to be given by the NHS Highland Head of eHealth at a forthcoming eHealth Group meeting.
The Committee Noted the content of the circulated draft Minute.
15. AOCB
There was no other business.
16. DATE, TIME & VENUE FOR NEXT MEETING:
Wednesday 19 June 2013 in J03-J07, Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead
18 MINUTE OF PUBLIC MEETING OF THE Argyll & Bute Community Health ARGYLL & BUTE CHP COMMITTEE Partnership Aros Lochgilphead ARGYLL PA31 8LB www.nhshighland.scot.nhs.uk/
Guide Hall, Campbeltown 24 April 2013
PUBLIC SESSION
Susan Paterson, Public Partnership Forum member for Kintyre asked the Committee to give consideration to concerns raised by the Kintyre Substances Misuse Service Users Group and their families, who had a number of questions with regard to various problems arising in the South Kintyre area.
Ms Paterson read from a prepared statement :
Scottish Drug Forum was commissioned by the Scottish Government to put in place across Scotland the Take Home Naloxone Programme. This has three main strands. One, is Training of people in why, when and how to give Naloxone. Two, is arranging chains of supply and re- supply of Naloxone and ancillary equipment, such as syringes and needles. Three, is having regular data collection systems, to allow, ultimately, the Government to know what's going on, and to ensure re-supply as necessary.
1 Access to Naloxone replacement when needed as this can only be replaced through the ABAT nurse or Harm Reduction Nurse and although there is supposed to be a service Monday to Friday users often find there is no-one to do this.
Suggested solution could be issued via the Boots pharmacy or any Registered Medical Practitioner.
2. Accessing clean needles becomes a problem when the local chemist runs out and as above no access for user, this affects numbers of people at risk of blood borne viruses.
Current provision does not provide an adequate solution to this problem.
3. The Working group has not met for 8 months and Service users and the community have been left in the dark as to what is happening which is leading to concern and apathy for service users group to continue to encourage others to be involved.
Suggest a meeting be called asap to clarify what the programme entails and who are involved and reassure all that the project for a robust service for all misuse addictions to be set up with proper support and participation.
4. There is a need for more people to have formal training in various areas e.g. for people working with heroin users and people in recovery to receive training to train others in Overdose prevention and use of Naloxone.
5. Ascertain the funding situation between CHP ADP - clarify what the CHP is responsible for and what the ADP is responsible for in terms of funding.
19 Mr Leslie thanked Mrs Paterson for attending the meeting and advising the Committee of the concerns of the Kintyre Substances Misuse Service Users Group and their families. He acknowledged the concerns raised and advised that there had been progress made on the question of the management of Naloxone and he would have a full response prepared to the enquiries in due course.
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