Highland NHS Board
2 October 2007
Item 9.3(a)
MINUTE of MEETING of the SOUTH
EAST HIGHLAND COMMUNITY
HEALTH PARTNERSHIP COMMITTEE
Board Room, Assynt House,
Beechwood Park, Inverness
Present
South East Highland
Community Health Partnership
Alder House
Cradlehall Business Park
Inverness
IV2 5GH
Tel: 01463 706948
Fax: 01463 794712
www.show.scot.nhs.uk/nhshighland
Thursday 12 July 2007 – 2.00pm
Mr Ian Gibson, Chair and Non Executive Director
Dr Ian Scott, Clinical Director
Mrs Jo Veasey, Assistant General Manager
Mr Jean Pierre Sieczkarek, Assistant General Manager
Mr David Garden, Head of Finance
Mrs Fiona Grant, Clinical Lead, Badenoch & Strathspey
Mr Campbell Mair, General Manager, Nairn & Ardersier GPs
Mr John Holden, Council Representative
Mrs Liz Macdonald, Council Representative
Mrs Margaret Davidson, Council Representative
Mr Douglas Johnston, Personnel Manager
Mrs Ailsa MacInnes, Optometry Representative
Mrs Tina Morrow, Voluntary Sector Representative
Mr Hamish Wood, Public Patient Forum Representative
In Attendance Mr Garry Coutts, Chair, NHS Highland
Dr Roger Gibbins, Chief Executive, NHS Highland
Ms Allison Meek, Scottish Health Council
Mrs Anne Mackenzie, Primary Care Advisor
Mr Colin Yau, PA to General Manager & Clinical Director (Minutes)
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APOLOGIES
Apologies were received from Mr Nigel Small, Mrs Gillian McCreath, Ms Ros Philip, Ms Alex
Fraser, Ms Cathy Lush, Ms Jackie Agnew, Mrs Cathy Steer, Mrs Hilda Hope, Mr Thomas
Ross, Mrs Katie MacDonald, Dr Freda Charters and Dr Adrian Baker.
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CONFLICTS OF INTEREST
Hamish Wood informed Committee members that since the last meeting he has had a
change in circumstances and is in now a Councillor for a particular party. However, he
assured the Committee that he would still represent patients and the public as an individual,
and will declare any interests, if appropriate to do so.
The Chair asked for any outstanding forms to be returned to CHP HQ as soon as possible.
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MINUTES OF MEETING HELD ON 5 APRIL 2007

The Committee Approved the minutes of the last meeting held on 5 April 2007.
Working with you to make Highland the healthy place to be
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MATTERS ARISING
4.1
Dental
Hamish Wood informed the Committee that as a member of a working group for dental, he’d
attended a useful meeting of all dental representatives recently with another one scheduled
to take place in the autumn.
4.2
Highland Council Representation
The Chair informed the Committee of the five newly elected Highland Councillors welcomed
onto the Committee – Mrs Margaret Davidson, Mrs Liz MacDonald, Mr John Holden, Mr
Jimmy MacDonald and Mr Graham Marsden.
He mentioned that the Assistant General Managers, Jean Pierre Sieczkarek and Jo Veasey
had attended Highland Council ward forums/partnerships, and although there is currently no
Councillor for Badenoch and Strathspey on the Committee, there is a Councillor on the
Badenoch and Strathspey Locality Group. However, there is still no Partnership rep for staffside, but the General Manager, Nigel Small, has been liaising with Ray Stewart, Employee
Director, about this.
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PERFORMANCE
5.1
FINANCE
Budget Setting 2007/08 & Finance Report to 31 May 2007
Dave Garden talked to his ‘Finance’ report.
The report outlined the budget setting process for 2007/08, high-lighted the CHP savings
target and achievement to date for 2007/08, and provided detail of the current forecast outturn for the year, based upon information as at 31 May 2007.
He stated the budget setting process for 2007/08 had been robust and detailed at both NHS
Highland level and within the CHP. However, the financial challenges facing the CHP are
primarily due to the requirement for recurring savings in both general CRS and prescribing
are significant. Recognising these challenges, the CHP expects to break-even in 2007/08
based on the information currently available.
The Committee:



Endorsed the CHPs budget setting process for 2007/08.
Noted the 2007/08 savings targets and progress made towards achievement.
Noted the forecast of break-even as at 31 May 2007.
Finance Report to 31 March 2007
Dave Garden talked to his ‘Finance’ report.
The previous report that went to the Committee in April forecast the financial out-turn based
on February information. The purpose of this report is to up-date the Committee on the
actual final position for 2006/07.
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He stated the out-turn for 2006/07 was a small underspend of £51,000 compared to
£118,000 in the previous month, showing an adverse movement of £67,000.
He stated the most significant reason for the adverse movement was the actual costs in
respect of enhanced service payments, which were £50k higher than previous estimates.
Additional minor expenditure around estates costs and equipment purchases made up the
balance of the movement within localities, which were offset by additional income within
Dental. Mental Health increased marginally but remained within budget for the third
successive year.
The Committee:

5.2
Noted the CHP financial performance resulted in a small underspend of £51,000 in
2006/07.
Performance Report
In Nigel Small’s absence, Jo Veasey talked to his ‘Performance’ report and Balanced
Scorecard. This report provided an up-date on a range of performance monitoring headings
and other matters likely to be of interest to the CHP Committee.
She asked the Committee to note the down-turn in bed occupancy and commented that
further to a review of community hospital bed occupancy in SE H CHP during the last three
years this would appear to be a seasonal variation and not an ongoing trend. With regards
to the delayed discharges, week ending Friday 29 June 2007, there were 12 DDs in total (4
at New Craigs). The range is between 5 -14 DDs.
Hamish Wood asked when the target would be reached with regards to breast cancer waiting
times. He also commented on the old data, re: smoking cessation dating back to 2005; and
would like to see a longer time period to look at with regards to the complaints because at
the moment the report only compared the current quarter with the results of the previous
quarter.
Garry Coutts replied that the smoking cessation data at this high level is gathered every two
years.
Margaret Davidson enquired why the information was so old on the Balanced Scorecard.
She would also like someone to talk to the areas highlighted in red, and wanted somewhere
to record the patient experience/satisfaction.
Garry Coutts replied that NHS Highland is currently looking into the patient experience. He
answered the reason why the data is out-of-date is because under national advice only data
that has gone through the validation process can then be published and put into the public
domain.
Jo Veasey explained that patient experience/satisfaction information is collected about
specific aspects of the service, e.g. Out of Hours, and offered to provide Margaret with
information from this part of the service as an example. Margaret Davidson suggested that
this information should be available across the range of services that are provided.
The Chair will ask Nigel Small to pick-up Margaret and Hamish’s points at the next
Committee meeting.
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The Committee:

5.3
Noted the latest performance activity for the SE Highland CHP.
CHP Delivering For Health Action Plan: Reporting Arrangements
In Nigel Small’s absence, Jo Veasey talked to his ‘CHP Delivering for Health Action Plan:
Reporting Arrangements’ paper. At the last meeting in April 2007, the Committee considered
and agreed a Draft CHP Delivering for Health Action Plan, which had also been to the Board.
The Chair had asked for this paper so that all members were clear about the monitoring and
reporting arrangements.
Margaret Davidson enquired about the reporting arrangements for health-acquired infections.
Jo Veasey agreed to provide the information by e-mail.
The Committee:

Agreed the proposed performance monitoring arrangements for the CHP Delivering
for Health Action Plan 2007-09.
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IMPROVING SERVICES & CLINICAL ISSUES - UPDATES
6.1
Long-Term Conditions Toolkit
In Nigel Small’s absence, Dr Ian Scott talked to his ‘Long-Term Conditions: CHP Self
Assessment Toolkit’ paper. A model for developing systematic support for people with a
long-term condition is set out as a key requirement within Section 2.2 of Delivering for
Health. This referred to the production of a long-term conditions toolkit, which would ensure
consistency across the whole of Scotland. Use of this toolkit is mandatory for Community
Health Partnerships. CHPs will be represented on the LTC Strategy Group and they will in
turn establish CHP LTC Action Groups. SE Highland CHP had already established a ‘CHP
Shifting the Balance Group” (previously known as the ‘CHP Community Hospitals Group’)
chaired by the Clinical Director, Dr Ian Scott. This group would be responsible for ensuring
implementation of the LTC Action Plan as well as annual completion and submission of the
LTC Self-Assessment toolkit, and as we’d only scored 74/150 in year one, there is indeed
room for improvement.
The Committee:



6.2
Agreed the completed CHP Self Assessment Toolkit and noted the Year 1 score.
Noted the requirement to establish a CHP Local Action Team.
Agreed the proposal to use the CHP Shifting the Balance of Care Group as the
CHP Local Action Team for Long-Term Conditions.
Dental
In Cathy Lush’s absence, Jo Veasey reported on Dental Services. She reported on the
performance of the SE Highland CHP with regards to the national oral health improvement
targets. The target (60% of 5 year old children with no decay experience) in the Argyll &
Bute, North & Mid CHPs had already been achieved. Within SE Highland, 48.5% of 5 year
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olds have no decay experience so there is still some work to be done however she asked the
Committee to note that we have one of the most deprived areas in Highland (and Scotland)
within the Inverness area and this undoubtedly has an effect on the figures.
NHS Highland had appointed a network of oral health promoters, aligned to the CHPs and
within SE; the post is fully integrated within the Health Improvement Team. They would be
supporting the further roll-out of the supervised tooth brushing programmes, jointly with
partners in Education.
A community development approach is to be explored, whereby 0-3 year olds are provided
with oral health education and registration in a non-surgery setting as part of a care pathway;
increasing access for pregnant & nursing mothers, as surgery space becomes available,
targeting those from deprived communities; expanding opportunities for oral health promotion
for children in transition from primary to secondary education.
Margaret Davidson enquired how local a level was the information gathered from and
queried the time, energy and money put in. Jo replied from school level in relation to tooth
decay (DMF score: decayed, missing, and filled). It was noted that Cathy would provide
more information, in particular about tooth decay, at the next meeting.
The Committee:

6.3
Noted Cathy Lush would provide more information at the next meeting, in particular
about tooth decay and the proposed milestones for improvement.
Mental Health & Learning Disabilities
In Jackie Agnew’s absence, Jean Pierre Sieczkarek reported on the following:




Difficulties in filling the vacancies in medical, nursing and clinical psychology.
The introduction of guided self-help workers to assist psychology services
The continuing training in STORM and ASSIST suicide prevention.
The re-deployment of learning disability nursing staff into appropriate posts within
the organisation.
The Committee:

6.4
Noted the following updates for the mental health services and the re-provisioning
of the learning disability services.
Nursing
In Hilda Hope’s absence, Jo Veasey talked to her ‘Review of Nursing in the Community’
paper. She asked the Committee to note the Terms of Reference for the purpose of
progressing the development of Nursing in the Community within the SE Highland CHP.
The Committee:

Noted the Terms of Reference.
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6.5
Prescribing & Pharmacy
In Thomas Ross’s absence, Dr Ian Scott talked to his ‘Prescribing and Pharmacy’ report. He
reported:


Thomas Ross’s appointment as CHP Pharmacist.
£93k had been saved from an increase in prescribing simvastatin and a decrease in
atorvastatin.
Prescribing support pharmacists have been appointed in Inverness and Nairn &
Ardersier Localities. We now have a pharmacy presence in each of our practices
every week.
A small working group, including representatives from the three localities, has been
set-up to discuss the establishment of a Quality Prescribing Framework.
Running schemes and services in the Community Pharmacy Contract - Minor Ailments Scheme.
- Public Health Service.
- Acute Medication Service.
- Chronic Medication Service.



The Committee:





6.6
Noted Thomas Ross’s appointment to CHP Pharmacist.
Noted the changes in statin prescribing and resultant savings.
Noted the update to the CHP Pharmacy Team Structure.
Noted the discussion regarding a Quality Prescribing Framework.
Noted the update on the Community Pharmacy Contract.
OOH Developments
Jo Veasey reported:


11 Badenoch and Strathspey GPs have come to an agreement to continue to provide
OOH services for a further 2 years from August 2007, at a lower cost than in the two
previous years; Nairn and Ardersier have a 3-year SLA in place.
A&E/OOH are now integrated in Inverness, functioning from the Raigmore site.
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IMPROVING HEALTH
In Cathy Steer’s absence, Jo Veasey talked to her ‘Smoking Cessation’ report.
reported:



She
Cathy Steer had been appointed as NHS Highland’s Head of Health Improvement,
however it is expected that she will continue with her alignment to SE.
A specialist smoking service was set-up in May 2006 with the appointment of 2.2 wte
smoking cessation advisors. In May 2007 an additional smoking cessation post was
created, however this post is only funded until September 2007. Smoking cessation
clinics have now been set-up in 14 locations across the CHP and include a mixture of
health service and community settings.
The CHP had developed its Tobacco Action Plan in June 2006.
Dr Scott added that, in collaboration with HUG, mental health patients are being encouraged
to access the Smoking Cessation service, accepting that help may be most beneficial after
discharge from Hospital.
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Hamish Wood enquired about school-age female smokers. Jo Veasey advised that the
Health Promoting Schools Development Officers are working with this age group on an
ongoing basis.
The Committee:



Noted Cathy Steer’s appointment as NHS Highland’s Head of Health Improvement
Noted the progress on developing a smoking cessation service within the CHP.
Noted the progress with the CHP Tobacco Action Plan.
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PARTNERSHIP
8.1
PUBLIC/PATIENT INVOLVEMENT
8.1.1
Delivering For Health: Community Council Presentations
The Chair reported on the ‘Delivering For Health: Community Council’ presentations, which
are being delivered to communities across Highland. The SE Highland CHP had already
done five with more in the pipeline. The presentations are currently under review, with a
group being set-up to look at the feedback received from the presentations.
8.1.2
Non-Target Waiting Times
Hamish Wood reported that the General Manager had produced a report at last Sept’s
Committee meeting which referred to learning disability waiting times and eating disorder
waiting times amongst other waiting times. He commented it would be useful to get an update for comparison as a means of monitoring progress. It was agreed the whole range of
waiting times should be reviewed. Dr Scott will ask Nigel Small to give an up-date on waiting
times at the next Committee meeting.
8.1.3
Cleaning Quality Inspections
Donald Macleod, Quality Assurance Manager, had invited Hamish Wood to view a cleaning
quality inspection at the RNI Community Hospital. Hamish was extremely impressed with the
quality control and wishes to share this with the Committee.
Jo Veasey advised the Committee that at the last audit each of the CHP Community
Hospitals are above average at 95%, against the Target of 90%.
8.2
Voluntary Sector Agreements
Jean Pierre Sieczkarek reported that funding had been devolved to CHPs. A re-organisation
had resulted, such that Lynda Thomson, Policy Development Manager and Caroline Tolan,
Policy Development Manager will both be devoting a percentage of their time to working at
CHP HQ. Lynda would be working with the Voluntary Sector Organisation and Caroline
would be covering Equality and Diversity. The General Manager and Assistant General
Managers have also met up with local authority colleagues - Amy Page, Contracts Officer,
Voluntary Organisations and Sarah Merriman, Acting Team Leader (Contracts), Social Work
Business Support, Highland Council.
Tina Morrow mentioned the CHP Voluntary Sector Workshop on 12 April was well received
with 25 in attendance and another session is planned towards the end of the year.
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STAFFING
9.1
HR Issues/Workforce Report
Douglas Johnston talked to his ‘Workforce’ report and confirmed that the CHP’s attendance
figures were improving with absenteeism levels going down.
NHS Highland’s ‘Promoting Attendance’ policy had been in place with a series of briefings
held, in which a total 71 managers attended. There is continuing dialogue between
managers and staff.
The Chair enquired about exit interviews, to which Douglas replied that these were not
carried out as a matter of routine with all staff. The Chair will take up this issue separately at
the Staff Governance Committee.
The Committee:

Noted the contents of the monthly Workforce Report.
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ORGANISATIONAL ISSUES
10.1
Audit Scotland: CHP Review
Audit Scotland is currently undertaking an audit programme of Community Health
Partnerships. A number of CHPs across Scotland have been selected. For NHS Highland,
SE Highland CHP and Argyll and Bute CHP are participating in the audit.
The Review will focus on 4 key findings – Financial Management, Corporate Governance,
Performance Management and Information and Data-Sharing.
An initial meeting took place on 17 May 2007 between Steven Boyle, Audit Manager, Richard
Smith, Audit Scotland, Nigel Small, CHP General Manager and Dave Garden, CHP Head of
Finance.
An initial, draft report for accuracy checking is expected to be available to the CHP General
Manager by the end of July 2007. The completed audit report will then be forwarded to the
Chief Executive.
The Committee:


Noted SE Highland CHP’s participation in the Audit Scotland review.
Requested that the final audit report be brought to the next Committee meeting for
consideration.
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AOCB
11.1
Garry Coutts, Chair & Dr Roger Gibbins, Chief Executive, NHS Highland
Garry Coutts explained that his attendance today was part of a programme of visits to the
CHPs. In looking at the 'Delivering for Health' agenda the Board wants to ensure the NHS
Highland is operating as effectively as possible with appropriate scrutiny in place. Reviewing
minutes, sitting in on meetings and speaking to members was part of that process. He was
convinced that closer working between the CHPs and the Local Authorities was a key
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component of the way forward and discussions were taking place with the new administration
in Highland.
Roger Gibbins thanked the Committee for their invitation to attend and mentioned his
particular interest in ensuring adherence to staff governance, clinical governance and
financial governance standards and that the interface between the Board and the CHPs was
best fitted to implement Health policy in general and re-design and modernisation in
particular.
Garry and Roger will reflect on their visits to all CHPs and discuss their conclusions with
Chairs and other Board members in due course.
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DATE, TIME & VENUE OF THE NEXT MEETING:
The next meeting of the Committee will be held on Thursday 6 September at 2.00 pm
in the Board Room, Assynt House, Beechwood Park, Inverness.
The meeting closed at 4:00pm
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