1. health and fitness

NHS Board Meeting
25 March 2013 Paper 18
NHS Board Meeting
Monday 25 March 2013
Subject
Minutes of the South Ayrshire Community
Health Partnership (SA CHP) Committee
Purpose
To report to the Board
Recommendation
To receive the draft SA CHP Committee minutes
of 30 January 2013
1.
Background
1.1
Committees of the Board should submit approved and draft minutes to the Board.
2.
Current situation
2.1
Attached are the draft minutes of 30 January 2013.
3.
Conclusion
3.1
The Board is asked to receive the minutes.
Councillor Hugh Hunter,
Chairman – South Ayrshire CHP Committee
4 March 2013
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South Ayrshire Community Health Partnership (SA CHP) Committee
2.00 pm Wednesday 30 January 2013
Board Room, Biggart Hospital, Prestwick
Present:
Councillor Hugh Hunter, Non-Executive Board Member - Chair
Mr Derek Lindsay, NHS Ayrshire & Arran
Councillor Nan McFarlane, South Ayrshire Council
Councillor Rita Miller, South Ayrshire Council
In
Attendance:
Mrs Kerry Gilligan, Head of Profession, Occupational Therapy – Item 7
Mr Bill Gray, Property and Design Manager, SA Council
Mrs Jean Hendry, Healthcare Manager – Items 10+11
Ms Diane Lamprell, Community Pharmacy Advisor (South) – Item 8
Mrs Lindsay Murphy, Public Health Practitioner – Item 4
Mrs Valerie Stewart, Community Planning Officer, SA Council – Item 5
Mr Phil White, CHP Facilitator
Mrs Mandy Yule, Director, Integrated Care & Partner Services
Ms Pauline Sharp (Minutes)
1.
Apologies for absence
Action
1.1
Councillor Kilpatrick, Mr Leinster, Mrs McQueen and Miss Tennant.
2.
Minutes of the meeting held on 12 November 2012
2.1
The minutes of 12 November 2012 were agreed as an accurate record of
discussions.
3.
Matters arising
3.1
Family Nurse Partnership – Recruiting the first families would start from
early February.
3.2
Waiting times for the hearing clinic – Mrs Yule advised that waiting times
were now 18 weeks and this met waiting time guarantees. Councillor
MacFarlane enquired if there was any reminder system for notifying patients
on the day of their appointment. Mrs Yule advised that a reminder system
was about to be rolled out across Outpatient Services as a whole. Mrs Yule
to provide information from Clinical Support Services regarding the plan for MY
reminder texts for patients with appointments, to the next meeting.
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3.3
CHP Committee Papers – Councillor Hunter advised the hard copy of his
papers had only been received the previous day and enquired about the
reliability of the use of second class post and the impact on patient
appointment letters etc. It was noted that this was being considered by
Clinical Support Services as part of the Out Patients Review.
4.
Scottish Index of Multiple Deprivation (SIMD)
4.1
Mrs Murphy provided a powerpoint presentation (please appendix 1
attached) on the index and its background noting that individual data zones
ranged from the lowest at one to highest at 6005. She advised caution
when interpreting the figures since the SIMD 2012 data was based on some
different measures from 2007-10. It was important to recognise that SIMD
figures give relative figures for Scotland but were not an absolute
measurement. Comparison was provided with East, North and South
Ayrshire and with the most deprived data zones in South Ayrshire. These
were broken down to the domains of Income, Employment, Crime, Access,
Education, Housing and Health.
4.2
The Committee was asked for their comments and these included:
The importance of responding to the local SIMD figures eg initiatives to
have GP surgeries located locally and improve access.
Need for evaluation work on how effective current initiatives are to help
inform future decisions.
Use good examples as models eg success in Girvan where capacity
building has started to address issues.
Family Nurse Partnership – targeted individual help, low key and
strength based approach.
Age profile – South Ayrshire slightly older on average than Scotland.
Early Years intervention – supporting tomorrow’s population.
Health warning – limits of SIMD information and importance of focusing
on assets instead of deficits.
4.3
Mrs Murphy noted the report was to go to the Directors Management Team
and then the NHS Board and that they had also been asked to supply a
report to the Community Planning Partnership (CPP) Board. South Ayrshire
Council was working on an analysis, which would include health and should
be available soon. Mr White highlighted the Health Inequality report released
by Audit Scotland late December 2012 with a report on this coming to the
Committee and Forum for their consideration at a future meeting. Mrs
Hendry advised there was an OLG event in February looking at what were
the natural localities to cluster health services around eg anticipatory care
plans. Councillor Hunter thanked Mrs Murphy for her presentation and
emphasised the importance of the CHP not losing sight of this information in
their support of service delivery.
5.
Development of Single Outcome Agreement (SOA)
5.1
Mrs Stewart tabled Paper 3 (including appendices 1 + 2) which was a draft
report to the CPP Board on the guidance for the new SOA published by
Scottish Government and Convention of Scottish Local Authorities (COSLA)
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on 4 December 2012 and proposed arrangements for developing a South
Ayrshire SOA. She picked out the salient points, noting there were six national
priorities, CPPs were to have a common focus on these key priorities with the
aim of achieving transformational and not incremental performance
improvement. The paper also included all 16 national outcomes and reflected
what was being done in relationship to these. Appendix 1 detailed the links
between the Council priorities, SOA priorities and CPP Board plans/strategies.
Appendix 2 provided an example diagram of 10 years high level outcome and
then working back through long, intermediate and short term outcomes,
outputs and firstly inputs. She noted that partnership working, community
engagement and co-production were seen as being critical to achieving the
transformational change envisaged. These would include preventative
approaches which would involve a shift in resources as well as a shift in
influence from those who provide services to those who use them.
5.2
The draft SOA had to be finalised by 1 April 2013 and it was hoped to
submit it to the CPP Board at the end of March. After 1 April there would be
a negotiating period until 28 June when it would have to be finalised and
signed off. Mrs Stewart opened the discussion out to the Committee. Items
discussed included:
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•
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Good examples of early intervention – Development of community
based interventions within Mental Health Service and within Older
Peoples Service.
Community planning context – looking at the total pot of money
available beyond organisational boundaries.
SIMD built into SOA in terms of evidence base – example of SOA on
breastfeeding going up proportionately in low 15% SIMD areas was
mentioned.
Question regarding the flexibility of the SOA indicators – Mrs Stewart
advised they required to have a discussion with Scottish Government
about the indicators and that they concentrated on those most relevant
to South Ayrshire.
The Committee raised their concern about the robustness of the
community engagement and the necessity of ensuring there was a real
community response.
6.
Early Years Collaborative
6.1
A multi agency two day national event had been held at the SECC
examining the approach, what steps could be taken to achieve the aims and
have an impact on longer term outcomes. The event was supported by Sir
Harry Burns (Chief Medical Officer), and was giving prominence to ensure
the Early Year Collaborative was a priority issue for CPPs. The ethos was
that if you get it right for prenatal and the first two years of life you reap
dividends later on. The second day of the event had concentrated on
picking outcomes and targets eg do things on a small scale and test
whether effective.
6.2
This was a quality improvement tool and a model that had been very
effectively used in the acute health sector. Two further two day sessions
would be held in May and October. It was important that 1) the Committee
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ensured that Early Years was on most agendas, 2) the CPP promote Early
Years and 3) the need to spread message through every mechanism for
prioritising Early Years.
7.
Allied Health Professions (AHPs) – Moving Forward
7.1
Mrs Gilligan provided an overview of the development and consultation
process for NHS Ayrshire & Arran AHP Action Plan 2012-2015. The
National Delivery Plan for Allied Health Professions fed into this and was for
both health and local authorities to maximise their contribution to health and
wellbeing. The aim was to make AHP accessible wherever and was very
much about communities and working with partners in developing the plan.
7.2
The finalised document was to be submitted to Scottish Government by the
end of January 2013. A Programme Board, involving representation from
across all partners and including the three Local Authorities had been
established and would hold its first meeting at the beginning to mid
February 2013 to consider the strategic direction and work streams. This
would include looking at the Integration Agenda and how partners could
work better together.
7.3
The Committee raised their concern about the high level information and
the lack of detail. Mrs Gilligan assured the Committee work had already
started on this and that an updated version of the papers was available.
She advised that this was very much a direction of travel and that after the
February meeting measureable and time limited information should be
available for the Committee. Regarding the Integration of Health and Social
Care agenda, work was taking place on scoping out what Occupational
Therapy services would be like allowing this to be tested by October 2013.
There were financial and staffing issues but among the models being
looked at was seven day working. Also managers were looking at specialist
skills of staff eg AHPs and Community Nurses and the flexibility of teams to
cover East, North and South. Mrs Gilligan noted she would be happy to
come and discuss developments with any group members were involved
with.
8.
The Chronic Medication Services (CMS)
8.1
Ms Lamprell provided the SA CHP Committee with a presentation (please
see appendix 2 attached). This was part of an Ayrshire-wide engagement
on an essential service for patients with long term conditions. CMS was
one of four Core Services and had two themes 1) repeat prescribing and
dispensing element and 2) clinical element. The Scottish Government had
asked all NHS Boards to ensure all GP Practices and all Community
Pharmacies be able to produce serial prescriptions. She detailed the
different stages of the processes for implementation with training being
provided for GPs/community pharmacies. The service would be gradually
rolled out from April 2013. CMS was in the very early stages but had
potential to link in with anticipatory planning, palliative care support, Scottish
Patients At Risk of Readmission and Admission (SPARRA) patients and
other initiatives.
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8.2
The discussion was opened out to the Committee and included:
Remuneration for pharmacists.
Involvement and benefits for a GP practice.
Problems if only individual GPs within a practice sign-up.
Arrangements for different IT systems to feed in.
Plans to promote service – Ms Lamprell to send Councillors Hunter
and MacFarlane information for the “Going Out” magazine.
Responsibility of pharmacy to flag up if patient had not picked up
their prescription by a set time.
Methodology and robust checks for dispensing prescriptions and
monitoring patients’ use of medication.
8.3
Councillor Hunter thanked Ms Lamprell for her presentation.
9.
Ayrshire Healthy Weight Strategy
9.1
Mr White provided an overview of the paper supplied by Mrs Ruth Campbell
to update the Committee on work to date. He advised the Strategy title had
been changed from “Obesity” to “Ayrshire Healthy Weight Strategy” to
reflect the diverse nature of the Strategy including those underweight.
Groups had been set up across Ayrshire, containing relevant
representatives, to focus on the three key themes 1) Access and
affordability of high and low energy food and drinks, 2) Increased
awareness, knowledge, skills and empowerment and 3) Active travel and
active workplaces, the built/natural environment and physical activity for
early years, children and young people. A stakeholder event had been held
on 28 January 2013. Item 2.5 referred to work being done with Local
Authorities to develop a pan Ayrshire weight management programme. Mrs
Campbell had emphasised the importance of the CPP signing up and
supporting any initiatives for these to have a successful impact on the
health of Ayrshire. A ten year Vision document and three year Action Plan
was being developed. Mrs Campbell to attend a future SA CHP Committee
to detail further progress.
9.2
Councillor Miller noted the increasing partnership approach and support
within SA for programmes to improve people’s health and that it was
moving in the right direction. A Leisure Strategy was being developed and
representation had been made for health needs to be included. Councillor
MacFarlane noted her great concerns on the impact of high energy drinks
on pregnant women and young-ones under 18 years and the co-relation to
future drug misuse. She was working along with the Scottish Government
and the European Union to change labelling to highlight the dangers.
10.
Reshaping Care
10.1
Mrs Hendry provided the Committee with an update on progress. A very
comprehensive engagement process with staff and public on the 10 Year
Vision was underway and the report had to be with the Scottish
Government by 28 February 2013. Among the main points highlighted by
Mrs Hendry were:
DL
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The ten year vision represented a significant shift from current patterns
of service, although the change process had started.
South Ayrshire partners had held an event the previous week to
consider the impact of the Change Fund initiatives to date and it was
planned to publicise this work. Projects were being challenged to
demonstrate what difference they are making. South Ayrshire approach
was to invest in change, then embed in practice and reinvest the money
to support further change.
Page 4 detailed areas of suggested additional investment in 2013/14,
although this had not yet been considered by the OLG.
Telehealth and telecare - successful outcomes from Girvan were
highlighted.
There was very good engagement with the Third Sector interface and
voluntary groups had plans to sustain changes in the future.
It was important to encourage local GPs involvement and ownership.
10.2
As part of the engagement process the Reshaping Care for Older People in
Ayrshire & Arran (10 year Vision) booklet, the Three Year Implementation
Plan, the One Year Plan relating to the Change Fund copies of the DVD
were available, with anyone wishing a copy to contact Mr White. The DVD
could also be accessed through the Joint Improvement Team (JIT)
webpage and would be available shortly with subtitles.
8.3
The Committee discussed issues relating to slippage and work being done
along with finance colleagues from NHS and Local Authority to reduce this.
Mrs Hendry provided assurance on the use of money being reinvested with
the example of the enablement money being used.
8.4
The Committee noted and endorsed the content of the paper but requested
that an extra meeting be arranged before 28 February to allow them to
approve the final plan before it was submitted to the Scottish Government.
11.
Health and Social Care Integration
11.1
Mr Gray from SAC was in attendance to observe and get a feel for
partnership work and items discussed. He provided the Committee with an
update on work South Ayrshire are doing to plan for the Health and Social
Care Integration and the establishment of a Strategic Group of Council
Officers Offices and other partners including Mr White. Their work can only
be limited until the draft legislation was released but with its implementation
being only over a year away they considered there was a need to start
looking at issues and developing decisions. They are looking at a three
stage approach 1) Preliminary work with Council officers, 2) invite other
partners to join and explore issues and 3) when clear what Scottish
Government say then the working group would revisit areas they have
looked at. After the Strategic Group was up and running they would
establish other themed groups eg financial issues, but ensure there was no
duplication.
11.2
The Committee held a discussion and highlighted the role of the Strategic
Alliance, with the three Local Authority involvement, providing the
opportunity for dialogue on a wider context. The South Ayrshire Strategic
PS
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Group would not duplicate their work but would look specifically from a
South Ayrshire perspective and be complementary to the Strategic Alliance.
The importance of staff groups like the AHPs in the support of the changing
services for older people was again highlighted and the possibility of smaller
localities within each Local Authority being established. Mr Gray to attend
future SA CHP Committees to provide assistance. Mr White advised he
would circulate links to the Health and Social Care Integration Bill when it
was released and that it would be a standing item on the agenda.
PW
12.
SA CHP Forum Update
12.1
The SA CHP Forum had received a successful outcome and brought NHS
Ayrshire & Arran into line with other Scottish NHS Boards on the issue of
dementia prescribing raised by the Public Partnership Forum (PPF).
Councillor Hunter congratulated the Forum and thanked the PPF for raising
this.
13.
Any other competent business
13.1
Councillor MacFarlane enquired if there were alternative vaccinations for
patients who were allergic to vaccinations eg flu vaccination. She had been
advised by her GP that these could be purchased privately. Councillor
MacFarlane asked if there was information on whether this might have an
impact on older people and on increased admissions. Mrs Yule to make
enquiries to Public Health colleagues and to request feedback information
to the next meeting.
14.
MY
Date, time and venue of next meeting
2.00 pm Wednesday 8 May 2013, Room 1, Eglinton House, Ailsa Hospital
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