Item 17 on the Agenda)

Mid Highland Community Health Partnership CHP General Manager’s Office Larachan House Docharty Road APPROVAL Dingwall IV15 9UG Telephone: 01349 869221 Fax: 01349 865870 PENDING www.nhshighland.scot.nhs.uk MINUTE of MEETING MID HIGHLAND CHP Friday 28 October 2011 GOVERNANCE COMMITTEE (10.00 am – 2.00 pm) The Moorings Hotel Banavie, Fort William Present: Mr Okain McLennan (Chair) Non Executive Director, Highland NHS Board Mrs Gill McVicar CHP General Manager Mr Tom Slavin CHP Head of Finance Mrs Alison Hudson CHP Lead Nurse Mrs Margaret Moss CHP Lead, Allied Health Professions Mr Findlay Hickey CHP Lead Pharmacist Mr Colin Shields CHP Health & Safety Manager Mrs Tracy Ligema Locality General Manager Lochaber/Out of Hours and Unscheduled Care Development Manager Dr Jim Douglas Clinical Lead, Lochaber Dr Brian Tregaskis Clinical Director, Belford Hospital (from 11.15 am) Mrs Isabelle Campbell Local Councillor, Wester Ross, Strathpeffer & Lochalsh Mr Hamish Fraser Local Councillor, Skye Mr Bren Gormley Local Councillor, Fort William & Ardnamurchan Mr Brian Murphy Local Councillor, Lochaber Mrs Margaret Paterson Local Councillor, Dingwall & Seaforth Ms Sarah Wedgwood Non Executive Member Highland NHS Board Ms Mandy Sillars Area Partnership Forum Representative Mr Gavin Hogg Patient/Public Representative Mr Alan Knox Scottish Ambulance Service Representative In Ms Joanna Hynd Assistant Area Community Care Manager (Ross, Skye Attendance: & Lochaber) By Invitation: Ms Claire Savage CHP Learning & Development Facilitator Ms Michelle Duffy COPD Clinical Practice Educator (tbc) Ms Theresa James Community Care Manager, NHS Highland Ms Tina Morrow Service Development Manager, Connecting Carers Apologies: Dr Donald Mowat CHP Clinical Director Mr Michael Macmillan Patient/Public Representative Mr Johnson Swinton Voluntary Sector Representative (deputy) Ms Margaret Ryan CHP Personnel Manager Mrs Annie Macleod Patient/Public Representative Ms Lyn Wormald Area Partnership Forum Representative Mrs Sue Restan CHP Communications Officer 1 WELCOME AND APOLOGIES The Chairman welcomed everyone to the meeting, particularly Mr Gavin Hogg who was attending his first Governance Committee meeting as a Patient/Public representative. Apologies were noted as above. 2 DECLARATIONS OF INTEREST None declared. 3 MINUTES 3.1 CHP Governance Committee Meeting – 19 August 2011 The minutes were approved as an accurate record of the meeting. 3.2 CHP Health & Safety and Clinical Governance Meeting – 7 September 2011 The minutes of the meeting were noted. 3.3 NHS Highland Improvement Committee Assurance Report – 5 September 2011 The contents of the report were noted. Governance Committee: Approved the minutes of the CHP Governance Committee meeting dated 19 August 2011. Noted the Mid Highland CHP Health & Safety and Clinical Governance Meeting minutes dated 7 September 2011. Noted the NHS Highland Improvement Committee Assurance Report dated 5 September 2011. 4 MATTERS ARISING 4.1 West Ardnamurchan Unscheduled Care Mrs McVicar referred Committee to her paper (Item 17 on the agenda). 4.2 Glenelg & Arnisdale Mrs McVicar reported that one of the local Glenelg GPs has accepted a prestigious secondment with Scottish Government for the next two years. As with all vacancy situations the CHP is taking the opportunity to ascertain whether or not services can be provided differently. There are 3 groups looking at in-hours primary care, out of hours primary care and emergency and urgent responses. The latter is the responsibility of the Scottish Ambulance Service (SAS). An interim report will be submitted to the CHP Management Team on 2 November. Mrs McVicar indicated that the report does contain some recommendations for change, due to the low activity in the area. The community, who is well engaged with the process, has highlighted its concerns. In the meantime the CHP continues to work closely with SAS, RNLI and Fire & Rescue on a community resilience approach to support the community regardless of the outcome of the review. A report will come to the December meeting of the Governance Committee. 4.3 Broadford Medical Practice The development continues and despite bad weather the project is still expected to complete on time. Cllr Fraser raised concerns around disabled access and Mrs McVicar confirmed that she will liaise with the project team in this regard. 2 4.4 Ross Memorial Hospital Working Group A very successful and well-attended open workshop event ‘Designing Services for Older Adults’ was held on 26 October. This was to look at services for older people in Dingwall and the surrounding area. Cllr Paterson, who is the chair of the steering group, reported that some 60 people attended including members of the public, healthcare professionals and managers. Although there is an understanding of the need to prevent hospital admissions unless absolutely necessary and of the financial challenges, concerns around the future of Ross Memorial Hospital continue. Mrs McVicar acknowledged these concerns but reiterated that the hospital is an ageing facility which, because of its layout, cannot be brought up to current environmental healthcare standards. There are tight timescales attached to this project but some changes identified, for example to ways of working, will be implemented immediately as good practice. A follow-up meeting is to be held on either 28 November or 8 December. A report will come to the next Governance Committee meeting in December. 4.5. Dingwall Dental Services Cllr Paterson reported that the local community are delighted with this brand new facility. It is easily accessible and with convenient evening opening hours. Dental Services will provide a full report to the December meeting of the Governance Committee. 4.6 Adverse Incident Management A conservative estimate of the cost to the CHP of reported adverse incidents is around £600,000 per annum. Mr Shields’ report provides a comprehensive description of proactive and reactive approaches to managing risk, how incidents are reported, how incidents are graded and dealt with, incident management and audit and the future management of adverse incidents. Mr Shields advised that he has already trained over 380 staff in the CHP in risk assessment and adverse incident management. Both subjects will shortly be available to staff via the Learn-Pro online training system. On the subject of risk, Cllr Fraser expressed his concern about the availability of Mental Health Officers and places of safety, particularly in Skye and Lochalsh. (Under the Mental Health Act 1983, a mentally ill person may be removed by the police to a “place of safety” for their own protection or for the protection of others). Dr Douglas indicated that this was an extremely difficult issue which often hinged on the availability of transport. Joanna Hynd indicated that a pan- Highland review is taking place and Mrs McVicar Gill, agreed to find out what stage the process was at to try to ensure that the CHP could be consulted. The Chairman emphasised the importance of everyone’s views being taken into account. In response to a point raised by Cllr Fraser, Mrs McVicar confirmed that an update report on MacKinnon Memorial Hospital will come to the December meeting of Governance Committee. There was a brief discussion around how political involvement and public engagement could cause delays in making changes in the CHP which often had a direct effect on budgets particularly when savings are required. Mrs McVicar acknowledged that change can cause communities to feel threatened and that their views were extremely important. She emphasised that the CHP’s role is to present the facts, listen to all of the voices and where necessary, to help people understand that any proposed changes will not be detrimental to patient care. She stressed that quality of care is key. 3 Governance Committee: Noted that a report on Glenelg and Arnisdale will come to the December meeting of the Governance Committee. Noted that a report on Designing Services for Older Adults will come to the December meeting of the Governance Committee. Noted that Dental Services will bring an update to the December meeting of the Governance Committee. Noted that a report on MacKinnon Memorial Hospital will come to the December meeting of the Governance Committee. Remitted to the General Manager to ascertain the stage of the review of Mental Health Officers 5 NHS HIGHLAND BOARD UPDATE The Chairman gave a verbal update from the NHSH Board Meeting on 4 October 2011. Items of note: 5.1 Tissue Viability (Pressure Ulcer Prevention) Report by Pat Tyrrell, Lead Nurse, Argyll & Bute CHP, on behalf of Heidi May, Board Nurse Director The Board was asked to note the current status of pressure ulcer incidence across NHS Highland and the actions in place to improve care. The Chairman outlined the contents of the report which indicates that the Board is working towards a zero tolerance approach to pressure ulcer prevention. Mrs McVicar shares the concerns expressed and her General Manager’s report emphasises the clear need to ensure robust reporting and an avoidance of over-reporting which may be happening in some areas. Apart from the significant human cost and suffering for patients, staff are being made aware of the financial cost, estimated at between £1,000 and £24,498 per ulcer. With the support of link nurses across the CHP, the aim is to embed improvements in practice to ensure a sustained reduction in the numbers of reported pressure ulcers across the CHP by the end of 2011-2012. A proposal to increase awareness-raising training amongst all staff and partner agencies is in train. Home carers are key to the early prevention and diagnosis of pressure ulcers. 5.2 Infection Prevention & Control in the Community Report by Abhayadevi Tissington, Nurse Consultant Health Protection, on behalf of Heidi May, Board Nurse Director National policy, guidance and supporting materials on Healthcare Associated Infection (HAI) produced in the last decade by the Scottish Government Health Directorate, National Services Scotland and other stakeholders has focussed primarily on acute care.

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