APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on Friday 3 October 2014 at 10.00am

in the Caroline/Rosemount Rooms, CLAN House, Westburn Road, Aberdeen

Present

/ Cllr Bill Howatson / Chairman
/ Mr David Anderson / Non-Executive Board Member
/ Mr Raymond Bisset / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Cllr Stewart Cree / Non-Executive Board Member
Cllr Barney Crockett / Non-Executive Board Member (from 11.00am)
Dr Roelf Dijkhuizen / Medical Director
Mrs Sharon Duncan / Employee Director
Dr Nick Fluck / Medical Director
Mr Alan Gray / Director of Finance
Professor Mike Greaves / Non-Executive Board Member
Mrs Christine Lester / Non-Executive Board Member
Mr Terry Mackie / Non-Executive Board Member
Dr Helen Moffat / Chair, Area Clinical Forum
Mr Charles Muir / Non-Executive Board Member
Mr Jonathan Passmore / Non-Executive Board Member
Sir Lewis Ritchie / Director of Public Health
Cllr Anne Robertson / Non-Executive Board Member
Mr Mike Scott / Non-Executive Board Member
Mrs Elinor Smith / Director of Nursing & Quality
By Invitation / Dr Kevin Carter / Clinical Programme Lead for Acute Medicine (Item 5)
Mr Jim Cannon / Director of Regional Planning, North of Scotland Planning Group
Dr Gordon Christie / Consultant, Respiratory Medicine (Item 5)
Cllr Karen Clark / Aberdeenshire Council (Item 10)
Dr Adam Coldwells / Chief Officer, Aberdeenshire (Item 10)
Mrs Amanda Croft / General Manager Acute
Ms Lorraine Currie / Strategic Co-ordinator of Child Health (Item 14)
Ms Fiona Francey / Divisional General Manager (Item 14)
Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Ms Pamela Gowans / Chief Officer, Moray (Item 10)
Dr Annie Ingram / Director of Workforce
Dr Izhar Khan / Chair, Area Medical Committee
Mr Graeme Smith / Director of Modernisation
Dr Roy Soiza / Consultant Geriatrician (Item 5)
Dr Pauline Strachan / Deputy Chief Executive
Mrs Susan Webb / Deputy Director of Public Health
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Rachael Sim / PA to Deputy Chief Executive
Item / Subject /
1 / Welcome/Introductions
The Chairman welcomed everyone to the meeting, particularly those invited to speak on specific agenda items.
The Chairman gave valedictory speeches for both Dr Dijkhuizen and Sir Lewis Ritchie who were both retiring from NHS Grampian and attending their last meeting as Board members.
He also took the opportunity to formally introduce Dr Nick Fluck, NHS Grampian’s newly appointed Medical Director, Dr Helen Moffat, the new Chair of the Area Clinical Forum, and Mrs Susan Webb, who would be stepping into the role of Acting Director of Public Health.
2 / Verbal Updates
·  Chairman
The Chairman reported that he had been involved in the process to shortlist applicants for two non-executive board members for NHS Grampian.
·  Chief Executive
Mr Carey also expressed his thanks to Dr Dijkhuizen and Sir Lewis and wished them both well on behalf of the executive team.
With regard to the Integration of Health and Social Care, he advised that the three Chief Officers had now been appointed: Judith Proctor for Aberdeen City, Adam Coldwells for Aberdeenshire and Pamela Gowans for Moray.
He reported that work was continuing to progress Clinical/Staff engagement.
3 / Apologies
These were received from Dr Lynda Lynch.
4 / Minute of Meeting held on 1 August and Matters Arising
The minute was approved as an accurate record. There were no matters arising.
5 / Unscheduled Care – To include Integrated Front Door of ARI Proposals
Dr Strachan introduced the item by advising that significant work had been done over the past few months to address the problems within the Emergency Department (ED).
Dr Fluck pointed out that the challenge of providing a ‘front door’ service was a national one. Issues included the dependency on middle grade doctors, staff recruitment and retention, funding, capacity and demand, and flow.
Dr Fluck advised that the paper presented had been developed in consultation with the associated clinical services. It set out three service developments that aimed to deliver the greatest impact to ensure appropriate care for patients who presented acutely to the ARI ‘front door’. These developments were oriented around acutely presenting ‘medical’ patients, representing the largest group that fit within the core remit of the Emergency Department. He welcomed clinical colleagues who were leading the three service developments.
Dr Fluck asked the Board to acknowledge that the plans presented were the first steps in the overall improvement plan, and that other wider operational issues would be considered at the next Rapid Improvement Event being held in November.
Dr Carter, Clinical Programme Lead for Acute Medicine, reported that the proposal for Acute Medicine had 3 Phases.
Phase 1: provision of a 7 day (09.00:20.00) ambulatory rapid medical assessment clinic. This would be a consultant delivered service with nurse and diagnostic support. This would draw patients from ED, Acute Medical Initial Assessment (AMIA) and short stay environments with an aim to deliver full assessment, investigation and treatment on an outpatient basis.
Phase 2: provision of a 7 day (12.00:20.00) acute care medical consultant who would offer rapid support and direct assessment of patients and have the ability to stream cases to the ambulatory medical service and have strong links to other specialties.
Phase 3: provision of additional assessment capacity within AMIA allowing, at certain times, (09.00:23.00) an overlap of consultants to be present during peak activity times.
Dr Soiza, on behalf of the Acute Care of the Elderly – Enablement Team, advised of the development of a team that would be available to see patients within the ED or other ward locations to provide timely assessment and support to help enable the safe discharge of an elderly frail person home. It would be a 7 day service and would provide support to many clinical services.
Dr Christie, Clinical Lead for Medical High Dependency Care, reported that the Emergency Care Centre provided the opportunity to open a Medical High Dependency Unit at ARI. A mixed staffing model would be progressed to develop a unit providing the highest care 24/7 for critically unwell patients to be delivered as soon as possible. The opportunity to further develop the role of Physician Associates would also be available.
Mr Passmore thanked his colleagues for their explanations about the service developments. He was reassured that the work undertaken had continued to keep the hospital safe through recent difficulties. He sought further assurance that the quality of patient care would remain if patients were to be treated on an outpatient basis and asked how this would be delivered given the current issues in recruitment.
Dr Carter advised that outpatient care would only be offered to those presenting who were physiologically well and able to return to hospital for treatment on a day to day basis for as long as required. He also informed that the unit was based in ward 101 which made the transfer of patients easy should it be necessary.
Dr Fluck commented that although recruitment has been difficult, the three proposal areas had a good record of staffing levels along with scheduled plans in place for the recruitment of trainees.
Professor Greaves welcomed the proposals and asked about the further use of Physician Associates and specialist nurses. Dr Soiza responded that medical support nurses had been involved and the use of Physician Associates would be explored further.
Mr Anderson noted that the information presented provided evidence of progress. He sought further assurance that other departments were supportive of these proposals and requested some clarity on the funding of these proposals. Dr Fluck confirmed that all the teams involved were behind the proposals.
Mr Gray confirmed additional NRAC parity allocation of £4 million had been agreed with the Scottish Government for 2015/16. However, this funding would require to be prioritised against a number of service pressures and further discussion would be necessary with the Board regarding the financial plans for the next year.
Mrs Smith reported that the Nursing Directorate also welcomed the plans and highlighted that resulting improvements in flow would mean nurses could work more effectively.
Dr Khan suggested some reflection on the process of how these proposals were presented in Acute, highlighting that they had not gone through the advisory structure. He also queried how much of a contribution the ED staff had made to the proposals. Mr Carey appreciated the concerns raised but advised that the engagement from clinical staff on the proposals had been excellent, although there were always opportunities for more engagement.
The Chairman thanked Dr Carter, Dr Soiza and Dr Christie for their presentations. He welcomed the work which provided a clear indication of engagement to bring about tangible benefits and was a good starting point for future developments and improvements.
The Board:
1.  Noted the current staffing position within the Emergency Department.
2.  Approved the plan to enhance and stabilise front door services at Aberdeen Royal Infirmary.
3.  Noted that a rapid improvement initiative to further shape and support the patient pathway of care for unscheduled presentations would be conducted in November, with the appropriate consultation in advance.
6 / Committee Reports
6.1 / Staff Governance Committee
Mr Mackie asked the Board to note the sections on recruitment and the staff survey. Dr Ingram reported a 31% response rate from NHS Grampian staff to date.
The Board Noted the report.
6.2 / Clinical Governance Committee
Mr Muir referred to the self-explanatory report and highlighted the item on Protecting Vulnerable Groups. Ms Duncan sought assurance that there would be sufficient staff to comply with legislation. Dr Ingram reported that a business case was being developed for Health Visitors and additional funding had been identified.
Dr Khan queried why the PwC audit report on the Feedback Service had not been widely circulated. Mrs Gray responded that there would be an opportunity to discuss this at a future meeting or seminar.
The Board noted the report.
6.3 / Spiritual Care Committee
With reference to item 3 – Access to Information, the Chair reported there would be no change to the current approach. The paper by the Information Governance Manager was also to be discussed by the Staff Governance Committee.
The Board noted the report.
6.4 / eHealth Committee
The Chairman recommended that this committee be revitalised as it dealt with issues fundamental to the work of NHS Grampian.
The Board noted the report.
6.5 / Endowment Committee
The Board Noted the report.
6.6 / Patient Focus and Public Involvement Committee
Mrs Lester advised that funding for the advocacy service would be raised with the three Chief Officers in the first instance.
She also highlighted that the Public Involvement Team was currently running a pilot Youth Forum programme in Aberdeen. Mr Passmore thanked Mrs Laura Dodds, Public Involvement Manager, for organising a recent excellent Youth Forum event.
It was noted that the Feedback Service was a regular item at this Committee and the Committee had been informed that additional funding had been provided to the service to increase capacity and staffing levels.
The Board Noted the report
7 / Healthcare Associated Infection Report
Dr Dijkhuizen advised that, although all Boards hade faced challenges dealing with Healthcare Associated Infections (HAI), significant improvements had been made since 2008 and the numbers of cases within NHS Grampian hospitals had fallen dramatically. He invited the Board to look at the overall numbers as reported in the bimonthly report. The Chairman commended the outstanding progress made in tackling HAI.
The Board Noted the report
8 / Director of Public Health (DPH) Annual Report
Sir Lewis advised that the report gave a snapshot of the health issues of the population, the challenges and priorities for public health, and provided a vision for the future. The report built on the DPH Annual Report of 2012 and highlighted improvements that had been made. The report set out the challenges faced as a result of converging pressures an ageing population, increasing multiple long-term health conditions and health inequalities. He stressed the importance of public health and its role in the integration of health and social case.
Sir Lewis stated that the work was dependent on partnership within the NHS and across agencies, patients and communities. To realise the vision of increasing healthy life expectancy between the most and least deprived, the focus must be on culture and capacity. He made specific reference to the responsibility as corporate parent and role of the NHS in “Looked After Children”. Current partnership working in Grampian provided a good basis for the progress of the Community Planning Partnerships by making public health everyone’s business, incorporating population health needs, aspirations and actions into future planning. The DPH report provided a tool to inform and support this and he agreed it would be widely circulated and presented to committees and partners to raise awareness of the public health agenda. Cllr Crockett stressed the importance of work with community planning partners to address health issues, pointing out the scale of the problem because of ethnic migration and low levels of funding.
The Board Noted the report.
9 / Protecting the Health of the Population
Sir Lewis requested the Board to note and approve the two plans, highlighting that they had been prepared in collaboration with the Environmental Services of Aberdeen City, Aberdeenshire and The Moray Councils along with all relevant clinical services.
The Board approved:
1.  The Joint Health Protection Plan 2014-16.
2.  The Infectious Diseases Incident Plan.
10 / Health and Social Care Integration – Transitional Leadership Groups’ Progress against Legislative Timetable
Mr Smith gave a brief update with reference to the supporting paper. He reported the key legislative requirements and the crucial actions that were required.
The Board agreed with the principles of the Memorandum of Understanding (MoU) between NHS Grampian and the Moray Council. However, there was a lack of clarity around aspects of the document and an acknowledgement that progress had been made since it was prepared. On that basis, it was agreed to defer approval and refer to the Chief Officer in Moray to update the document.