APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on Tuesday 5 November 2013 at 10.00am

in Sheddocksley Baptist Church, Eday Walk, 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
Dr Roelf Dijkhuizen / Medical Director
Mrs Sharon Duncan / Non-Executive Board Member
Mr Alan Gray / Director of Finance
Professor Mike Greaves / Non-Executive Board Member
Mrs Jenny Greener / Non-Executive Board Member
Mrs Linda Juroszek / Non-Executive Board Member
Mrs Christine Lester / Non-Executive Board Member
Mr Terry Mackie / 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
Mrs Elinor Smith / Director of Nursing and Quality
By / Cllr Lesley Dunbar / Aberdeen City Council (item 2 only)
Invitation / Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Dr Annie Ingram / Director of Workforce
Ms Heather Kelman / General Manager, Aberdeen City CHP (item 2 only)
Mr Jonathan Lofthouse / General Manager, Acute Sector (item 3 only)
Mr Graeme Smith / Director of Modernisation
Dr Pauline Strachan / Deputy Chief Executive
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wells / PA, Board Secretariat
Item / Subject
1 / Apologies
Apologies were received from Councillor Barney Crockett, Dr Lynda Lynch, MrCharlesMuir and Mr Mike Scott.
2 / Integration of Adult Health and Social Care in Scotland – Aberdeen City (Risk 586)
Mr Carey welcomed Cllr Lesley Dunbar, Vice-chair of the Social Work and Health Committee at Aberdeen City Council and Ms Heather Kelman, General Manager, Aberdeen City Community Health Partnership. He explained that the paper was being presented at today’s meeting, following agreement on the arrangements for Aberdeenshire and Moray at the Board meeting on 30 September 2013. The paper recommended the arrangements for the establishment of a Transitional Leadership Group (TLG) to be responsible for producing the Aberdeen Integration Plan and the arrangements for the appointment of the Chief Officer. This key post would lead the organisations towards integration by April 2015.
Ms Kelman pointed out that, unlike Aberdeenshire, Aberdeen TLG did not propose to have subgroups and intended to hold alternate meetings and workshops.
The paper proposed the body corporate model and a programme to prepare the process for appointment of the Chief Officer with input from HR colleagues in both organisations.
Cllr Dunbar welcomed the opportunity for both organisations to work more closely together, to integrate services for better outcomes for service users.
It was noted that the proposal was for six members of the TLG from NHS Grampian Board. The Chairman advised that there were enough Board members to populate the TLGs for the three areas. Ms Kelman advised that the number of members would be subject to review before the permanent Joint Integrated Board was in place from 2015.
Following discussion, the Board agreed to:
  1. accept the Body Corporate/Integration Joint Board model as the proposed model of integration for Aberdeen City
  2. the proposal for establishment of a joint Transitional Leadership Group to progress the implementation of health and social care integration, including production of the Aberdeen Integration Plan
  3. the nomination of six Board Members to the Transitional Leadership Group, namely Richard Carey, Mike Greaves, Jenny Greener, Charles Muir, Mike Scott and Elinor Smith
  4. the Transitional Leadership Group preparing a detailed scope of the services and budgets to be included, in accordance with emerging financial guidelines
  5. the Transitional Leadership Group making recommendations on the arrangements for the appointment to the post of Chief Officer by the partners
  6. accept a future report on the proposed Integration Plan for Aberdeen

3 / Aberdeen Maternity Hospital Healthcare Environment Inspection (HEI) Report (Risk 853)
The Chairman began discussion of this item by offering an apology to the people of Grampian in response to the criticisms from the recently published Healthcare Environment Inspectorate (HEI) Report on Aberdeen Maternity Hospital (AMH). He gave an assurance that every effort was being taken to reduce the risk of a recurrence and did not wish to minimise the scale of the task.
The Chairman referred to suggestions in the media that the Chief Executive should resign. He stated categorically that he, as the Chairman, and his Board colleagues supported the Chief Executive in taking matters forward. The Board unequivocally supported the Chairman in this view.
Mr Carey accepted that what had happened at Aberdeen Maternity Hospital was unacceptable and not in line with the normal and expected high standards. The Board Executive Team and staff at AMH were determined to put things right by strengthening internal assurance processes. He was disappointed that issues which were identified in the HEI report had not been picked up within NHS Grampian. He commended the staff of NHS Grampian who worked hard and did their best to provided good services in the face of many challenges.
Mr Carey advised that the HEI had carried out a number of inspections and the recent media coverage related to a report from an inspection in August 2013. Since then, there had been clear evidence of improvements. Although the hospital building was old and there were environment factors, these were no excuse for it not to be clean. He advised that there were future plans in the context of the Maternity Services Review to replace AMH.
Mr Carey concluded by issuing a personal apology and giving an assurance about how serious he was taking the matter and his determination to put things right.
Dr Strachan also apologised to the people of Grampian for any loss of confidence in the service and also to the staff who had lost confidence in what they did. She reiterated that the recent series of inspections had shown continued improvements. There had been a failing in the internal quality improvement system and rapid work was being done to understand what had happened, with staff working tirelessly to ensure that improvements were made.
She introduced Mr Jonathan Lofthouse, Acute Sector General Manager, who gave a presentation on the steps being taken to improve patient care and enhance patient and staff confidence. He advised that there was a complex array of national tools focusing on patient care and it was necessary to bring these together to make them simpler and to remove variation. He explained that there was a recognised need to build a positive culture with strong, visible leadership. It was necessary to challenge current practices to improve quality.
Mr Lofthouse outlined the process for a Back to the Floor programme involving ring-fenced time for senior nursing staff, allied health professionals, management and clinical managers to assess clinical environments and ensure rapid learning. He emphasised the importance of incorporating patient experience into the learning process. He advised of a patient survey tool to get feedback using the Hospedia bed system. Mrs Gray stressed that this would need to be integrated with other feedback mechanisms and in the reporting to the Clinical Governance Committee and Patient Focus and Public Involvement Committee.
Mr Lofthouse explained work to be done to achieve exemplar status and the aim of having the first exemplar ward by early 2015 then rolling the programme out across Grampian. He advised that it was necessary to clarify and reinforce the roles of senior charge nurses and therapy leads.
Mr Bisset referred to patient safety walkrounds in which he had been involved and advised of the admiration he had for hardworking staff.
Dr Strachan advised that the Board Executive Team was committed to the Exemplar Ward approach and will work with staff to ensure that processes were right as far as they were concerned.
Mrs Smith stressed the importance of effective communication to staff to ensure a consistent message and to raise awareness.
In response to a query from Mr Anderson about how the Board could contribute to the process, Mr Carey advised that the Patient Safety Walkround process, in which Non-Executive Board members were involved, was being reviewed and that Non-Executives would be important members of the walkround team.
Mrs Lester sought assurance about the management of risk and whether feedback or information from Datix had should have alerted the organisation to concerns. MrCarey advised that systems of internal assurance had not been as effective as required and stressed the important role of the Clinical Governance and Patient Focus and Public Involvement Committees
Dr Ingram explained that changes to improve the environment and safety were being taken forward in partnership with staff, rather than being imposed on staff.
Dr Dijkhuizen, as executive lead for Healthcare Associated Infection, advised that data was regularly presented to the Clinical Governance Committee. He reported that AMH compared well. Generally NHS Grampian’s record for transmission of infection was excellent. Staff at AMH took action to prevent transmission of infection by their dress code, hand-washing, protocols and procedures for treating patients. He emphasised the important work being done by the Infection Prevention and Control Team with staff to ensure good patient care and to reduce infection rates.
The Chairman asked that the Board be updated on the Exemplar Ward programme in due course.
The Chairman thanked Board Members for their input to the useful discussion on this important item. He concluded by stressing the need to strengthen internal assurance processes to meet the demands of the HEI.
4 / Date of Next Meeting
Tuesday 3 December 2013 – Committee Room 5, Woodhill House, Aberdeen

Signed ……………………………………….Date …………………………………

Chairman

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