APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

onTuesday 5 February 2013 at 10.00am

inthe Seminar Room, Curl Aberdeen, Eday Walk, Aberdeen

Present

/ Councillor Bill Howatson / Chairman
Mr David Anderson / Non-Executive Board Member
Mr Raymond Bisset / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Cllr Barney Crockett / Non-Executive Board Member
Dr Roelf Dijkhuizen / Medical Director
Mrs Sharon Duncan / Non-Executive Board Member
Mr Alan Gray / Director of Finance
Mrs Jenny Greener / Non-Executive Board Member
Professor Mike Greaves / Non-Executive Board Member
Mrs Linda Juroszek / Non-Executive Board Member
Mrs Christine Lester / Non-Executive Board Member
Councillor Anne McKay / Non-Executive Board Member
Mr Terry Mackie / Non-Executive Board Member
Professor Val Maehle / Non-Executive Board Member
Mr Charles Muir / 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 and Quality
By / Mr Adrian Berkeley / Chief Inspector, Grampian Police (item 5)
Invitation / Mr Simon Blake / Acting Assistant Chief Constable, Grampian Police (item 5)
Mrs Jackie Bremner / Programme Manager (item 6)
Ms Julie Fletcher / General Manager, Mental Health Services (item 8)
Mr Mark McEwan / Service Planning Manager (item 5)
Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Mr Mike Hebden / Deputy Governor, HMP Aberdeen (item 5 )
Dr Annie Ingram / Director of Workforce
Dr Alisdair Palin / Clinical Director/Consultant Psychiatrist (item 8 )
Mr Graeme Smith / Director of Modernisation
Dr Pauline Strachan / Chief Operating Officer/Deputy Chief Executive
Mr Neil Whyte / Finance Manager (item 6)
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wells / PA, Board Secretariat
Item / Subject
1 / Apologies
None received.
2 / Verbal Updates
  • Chairman
The Chairman reported on a number of events he had attended including: welcoming the First Minister to the Emergency Care Centre; the CLIC Sargent fundraising carol concert and annual carol service at Aberdeen Royal Infirmary; MPs/MSPs meeting; meeting with representatives of the Royal College of GPs. He advised that interviews for two new Non Executive Board members would take place later in February. He announced that he intended to put arrangements in place for the following Non Executive Board members to chair the new Health and Social Care Partnerships:
Moray – Christine Lester
AberdeenCity – Charles Muir
Aberdeenshire – Raymond Bisset
Also, Terry Mackie would be taking over as chair of the Staff Governance Committee from Mike Scott.
  • Chief Executive
The Chief Executive reported on some of the events he had attended recently including the charity CLAN’s 30th Anniversary. He was pleased that the National Review of Training of Doctors had visited Elgin as this had given NHS Grampian an opportunity to influence the national agenda.
He referred to the recent disappointing hand hygiene results and he was keen to ensure that the previous excellent performance continued. Hand hygiene was fundamentally important in reducing Healthcare Associated Infection (HAI).
3 / Minutes of Meetings held on 4 December 2012
These were approved.
4 / Matters Arising
In response to a query from Councillor Crockett, the Board was advised that there would be an opportunity at the next Board Seminar to discuss Health Inequalities to which reference had been made in the Director of Public Health’s report.
5 / Modernisation : NHS Grampian Forensic Healthcare (Prison and Police) Update
The Chairman welcomed Mr McEwan, Chief Inspector Berkely, Acting Assistant Chief Constable Blake and Mr Hebden to the meeting.
Mr Smith explained the importance of the work being led by Mr McEwan for NHS Grampian, along with colleagues in other agencies. He stressed the importance of partnerships in relation to healthcare responsibilities for people in police, prison and court settings and their role indealing with vulnerable groups and inequalities.
Mr McEwan highlighted the main points in his report, providing the strategic context relating to prison, police and NHS services, the challenges and opportunities and the key risks. He explained that it focused on NHS planning to support the new Her Majesty’s Prison and Young Offender Institute (HMP YOI) in Peterhead, which would be the first community prison in the UK, and new police custody arrangements, both of which were scheduled for early 2014.
He reminded Board members of the statutory transfer of responsibility for health in prisons from the Scottish Prison Service to the NHS in 2011. He advised of the proposed transfer of health services from Grampian Police to the NHS for people in police custody/care and opportunities for a regional approach to deliver the forensic element of police health services with the creation of the National Police Force for Scotland in April 2013.
Mr McEwan advised that NHS Grampian was working with partners to develop options for more integrated patient focused services in both prison and police settings. He advised of proposed changes to the future service for prisoners to help with the management of healthcare issues and “through care” experience. The rationalisation of police custody suites across Grampian would offer opportunities for new ways of delivering services and address the current inequities in service provision.
Mr McEwan highlighted the resource implications of the transfer of services and the potential for financial efficiencies.
Board members were given the opportunity to seek clarity from Mr McEwan and other colleagues in attendance about the issues presented.
Mr McEwan advised of resource and workforce implications and the work being done at both a national and local level to model and plan the future services. With the re-provision of prison services in Peterhead, some staff in HMP Aberdeen might not wish to transfer. It was noted that Grampian was well served by a small number of Forensic Medical Examiners (FMEs), but there were issues of wide geography, sporadic workload and out of hours arrangements. The important role of FMEs in supporting victims was stressed.
Dr Ingram recommended linking with Regional Clinical Lead for the Medium Secure Facility in Perth and also with the service manager for Children and Adolescent Mental Health Services. Dr Dijkhuizen advised that the work being taken forward provided opportunities to improve services for vulnerable groups who were part of the Grampian population.
It was important to ensure that prisoners received health services at the right time and in the right place. The design of the new prison was more user-friendly. The aim was to make it a community prison with access to services, a visitor centre and to address health inequalities by providing a facility with wider opportunities for family involvement. There was a unique opportunity for all parties, the public, private and third sectors to work together. Councillor Roberston commended the work of the Community Planning Partnerships that had been involved in the design of the facilities and the work of the Community Justice Authority to progress this very important agenda.
As female offenders would be a new inclusion in the facility, there was close working with Cornton Vale Women’s Prison. A special mother and baby unit would be provided and there would be an opportunity for any baby to stay with its mother for a period.
It was noted that joint governance arrangements would be required. A separate Health Custody Board had been established and this would provide assurance to the various organisations involved.
Board members were advised that there would be an opportunity for them to visit the new prison later in 2013.
The Board:
  1. Noted the progress outlined in the paper
  2. Approved the approach being developed to integrate Prison and Police forensic healthcare for the Grampian population that aimed for equity of service regardless of setting
  3. Requested an update in approximately 6 months before the opening of the new facility in March 2014.
The Chairman thanked Mr McEwan, Chief Inspector Berkely, Acting Assistant Chief Constable Blake and Mr Hebden for the work done so far in progressing this very important area of work.
6 / Forres, Woodside, Tain (FWT) Bundle Project – Full Business Case
Mrs Bremner reminded Board members of the process to date and explained that the aim was to deliver the projects as a hubCo Design Build Finance Maintain (DBFM) 25 year Service Concession Contract. She advised that this was the first DBFM covering two Health Board areas. Amendments were required to the Standard Form Contract and an Interface Agreement was required between NHS Grampian and NHS Highland. The Full Business Case (FBC) was being presented earlier than normal to allow Financial Close in March 2013, in agreement with the Scottish Government Health Directorate (SGHD). Approval was being sought on a “not to be exceeded unitary charge” which was the same as the sum approved in the Outline Business Case (OBC). Financial Close was to be completed by 31 March 2013 assuming by then an acceptable stage 2 submission from hubCo and a formal Stage 2 Key Stage Review approval from Scottish Futures Trust (SFT). The sub–debt will be paid by the SGHD if Financial Close was completed in March 2013. This would allow work to start on site on 15 April 2013, with a completion date of April 2014. Both the Asset Management Group and Operational Management Team had approved the FBC on 28 January 2013.
Mr Whyte explained the financial aspects and identified the financial risks. The capital costs for Forres and Woodside were unchanged from OBC at £1.577m. The net additional recurring revenue cost to NHS Grampian has been revised downwards to £0.118m in the FBC. The Unitary Charge was unchanged from the OBC and remained at a £1.852 and in the FBC was to be regarded as a “not to be exceeded” figure. The non-recurring revenue was now estimated at £0.343m.
Mr Whyte advised that, with reference to affordability and value for money, the capital and revenue consequences had been reflected in the Board’s financial plans and Local Delivery Plan. He advised that section 5.3 of the FBC document explained the financial deal for the project and that the proposed deal from Aviva was supported by financial advisers and SFT.
Mr Whyte summarised that there was no change in capital from the OBC; recurring revenue had reduced and was expected to reduce further; non-recurring revenue was expected to increase because of advisors’ fees; current modelling indicated a 90% government contribution to the unitary charge.
Mrs Bremner highlighted the following key risks and advised how these were being managed: replacement of Forres Football pitch; BREEAM very good rather than excellent rating; non cash limited dental funding; Tain land acquisition; inability to recruit a general dental practitioner for additional space in Tain. She explained the importance of the provision of dental services to meet the oral health needs of vulnerable groups in the locations where new practices were being built.
Mr Carey advised that the bundle project was the first of its kind in the UK. The contract was over 25 years during which time NHS Grampian would get additional revenue benefit of 90% contribution from the SGHD. The Government was confident that NHS Grampian can deliver because of the talent and capabilities of the team involved.
The Chairman concluded that the proposals were supportive of NHS Grampian’s 2020 vision. He thanked Mrs Bremner, Mr Whyte and their team for the work done in connection with this significant programme.
Following consideration and discussion, the Board:
  1. Approved the Forres, Woodside, Tain (FWT) Bundle Full Business Case (FBC), noting that this had been approved by NHS Grampian’s Asset Management Group and Operational Management Team on 28 January 2103.
  1. Acknowledged that the FWT Bundle FBC was based on a ‘predicted maximum unitary charge’ based on the financial model developed at Outline Business (OBC) Stage. This sum will be regarded by the FWT Project Board as a not to be exceeded sum at the conclusion of Stage 2 and Financial Close.
  1. Requested that the FWT Bundle FBC be forwarded to the Scottish Government Health Directorate (SGHD) Capital Investment Group (CIG) with a recommendation for approval.

7 / Quality : Person Centred, Safe and Effective: Patient Story
Mrs Smith read out reflections from a patient on constant observation in a secure ward. She commended Mental Health Services for taking on board the comments made when reviewing their policy.
Mrs Fletcher explained that such stories were helpful for learning and that staff should be informed of such powerful stories to prevent them becoming complacent about dealing with patients. She explained that there was a high level of observation ongoing. Dr Palin explained that close observations were required for safety, but the aim was to engender a culture to make it a more therapeutic process.
The Board noted the patient story and how such stories can be used to improve services.
Prior to the presentation on Mental Health and Learning Disability Service under the following item, there was some general discussion about Child and Adolescent Mental Health Services (CAMHS), access to psychological therapies and how staff can be trained to provide therapies to support individuals. It was noted that there was an emphasis on infant and early years in the Mental Health Strategy.
8 / Mental Health and Learning Disability Service
Mrs Fletcher thanked the Board for the opportunity to inform members of current and future issues, political drivers and for discussion of these. She outlined the history, explaining the reduction in bed numbers from approximately 2500 to 380 over the last 25 years. She referred to the continuum of care across the community, hospitals and other facilities. Work was ongoing to de-institutionalise patients and provide services at home where possible. There was a close link between mental health and inequalities as some of the vulnerable groups were closely connected because of, for example, substance misuse and use of prison services.
Dr Palin explained that NHS Grampian spend on mental health services was 11% of total expenditure, which was 1% below the Scottish average.
The Board noted the current challenges around the HEAT targets for waiting times for Child and Adolescent Mental Health and Psychological therapies; governance; workforce and finance.
With regard to recruitment and retention, it was noted that there were national difficulties recruiting to learning disabilities. In some sub-specialties such as forensic psychiatry and old age psychiatry, there were no problems with recruiting. The number of experienced doctors and nurses due to retire in the next five years was an issue to be addressed. Mental Health had taken part in the recent Healthcare Improvement Scotland Adverse Events visit and had a robust approach to patient safety. The service was signed up to and working towards the 2020 vision. As discussed in the earlier presentation, Prison Services were a significant issue for Mental Health Services. There were no inpatient beds for mental health patients in Orkney and Shetland, but a good obligate network in place.
Mrs Duncan thanked Mrs Fletcher for her recent presentation to the Grampian Area Partnership Forum (GAPF) at which it was noted that levels of activity were unprecedented and the measures being taken to address this had been welcomed. MrsFletcher advised that the service worked very well with partnership. The vacancy control panel was meeting weekly and Human Resources and Occupational Health Service colleagues assisted to prevent delays inthe recruitment process. Partnership colleagues had also offered to work shifts to cover a difficult situation which showed true partnership working.
Mrs Fletcher advised that there were 36 commitments in the Scottish Government’s Mental Health strategy and the service would have to co-ordinate with primary care, local authority and third sector colleagues to deliver these. The key themes related to how mental health was supported through promotion, prevention, treatment and care.
Board members had the opportunity to raise questions and discuss the issues raised in the presentation.
The stigma around mental health was a societal challenge, but Mrs Fletcher felt that within the NHS there was no discrimination against people with mental health issues. The Board noted that the Government’s “Choose Life” campaign was being re-launched within the next few months and would be driven through community partnerships.
It was agreed that it would be appropriate for the Performance Governance Committee to monitor the Action Plan.
The Chairman thanked Ms Fletcher and Dr Palin for attending and raising the profile of the service.
The Board noted the current and future issues within the Mental Health and Learning Disability Services.