NHS GRAMPIAN

Minute of Meeting of Grampian NHS Board held in Open Session on Tuesday 2 March 2004, at 10.00am – 12.30pm in the Conference Room, Summerfield House, Aberdeen.

Present:

Mr Jim RoyanChairman (Chair)

Mrs Anne CampbellDeputy Chairman

Dr Eric BaijalDirector of Public Health

Mr David BentonNurse Director/Director of Nursing, Grampian University Hospitals Trust

Councillor Raymond BissetNon-Executive Board Member

Mr Alec CummingChief Executive, Grampian University Hospitals Trust

Councillor Kate DeanNon-Executive Board Member

Mr George EssonNon-Executive Board Member/Chair, Grampian Primary Care Trust

Mr Angus GordonNon-Executive Board Member/Employee Director

Professor Neva HaitesNon-Executive Board Member

Professor Steve LoganNon-Executive Board Member/Chair, Grampian University Hospitals Trust

Mr Ewan RobertsonActing Chief Executive, Grampian Primary Care Trust

Mr Alex SmithInterim Chief Executive

Dr Stuart WatsonNon-Executive Board Member/Chair, LHCC Professional Committee

Professor Jamie WeirNon-Executive Board Member/Chair, Grampian Area Clinical Forum

By Invitation:

Mrs Barbara BruceNon-Executive Trustee, GPCT

Mr Calum CampbellStrategy & Innovation Director

Mrs Maggie EmslieChief Officer, Grampian Local Health Council (representing Mrs Sue Kinsey)

Dr Karen FosterConsultant in Public Health Medicine (Item 7.2)

Mr Alan GallActing Director of Finance, NHSG

Mrs Laura GrayDirector of Corporate Communications, NHSG

Ms Deb GrantAssistant Chief Executive, GUHT (Item 6.3d(i)

Mr Andrew JacksonStandards Officer (Items 6.3e,f)

Ms Susan JappyAssistant Director of Public Health

Ms Jennifer MackOrganisation Development Manager

Mrs Anne McDonaldAudit Scotland

Mr John MillerCommunications Officer

Mr Gordon MorriceHR Director

Mr Mike OggGeneral Manager, Aberdeenshire Central LHCC (Item 6.3d(ii)

Mrs Sue RobertsonNon-Executive Trustee, GUHT

Mrs Elinor SmithDirector of Nursing, GPCT (Item 6.3b)

Mr Graeme Smith Head of Service Development (Item 7.1e)

Mr Gordon StephenArea Partnership Forum

Dr Lesley StewartVice Chair, Area Medical Committee

Mr David SullivanDirector of Corporate Planning

Mr David SutherlandNon-Executive Trustee, GPCT

Attending:

Mrs Marjory MainAssistant Board Secretary

Ms Glenys WrenPersonal Assistant, Board Secretariat

  1. Chairman’s Welcome/Announcements/Members’ Brief

The Chairman welcomed members of the public and press to the open session of the Board meeting. From his brief he highlighted a number of significant events, including a recent visit by HRH The Princess Royal who had performed the official opening of the Torry Neighbourhood Centre, a joint venture, providing a range of health and social services within the Torry community. An opportunity for Board Members to visit the facility will be provided in the future. The Chairman had opened a new NHS dental practice at Dr Gray’s Hospital, Elgin as part of NHS Grampian’s long-term plan for investment in dental services in Grampian. In regard to the recruitment of new NHS Board Non-Executives, the Chairman advised that he expected a Ministerial announcement to be made very shortly. Members had received copies of a number of papers from the most recent meeting of NHS Chairmen with the Health Minister for interest and information. The Chairman proposed that such briefings would be provided to Board Members in future.

  1. Apologies

Apologies for absence had been received from Councillor Edward Aldridge and Ms Margaret Burns.

3.Minute of meeting held on 20 January 2004

The minute of the open session of the meeting was accepted as an accurate record.

Note: Professor Logan subsequently asked for the following amendment to be made:

Page 6, item 15a – Dental Services, final sentence to read “For clarity, he advised that no discussions about creating such a facility had taken place; currently undergraduate facilities are provided in Dundee and Glasgow”.

4.Matters Arising

There were no matters arising from the minute.

  1. Health Improvement

5a Grampian Health Plan (GHP) 2004/05: Dr Baijal introduced a paper that provided an update on progress around development of the GHP and the proposed timetable to finalise the planning cycle. Ms Jappy expanded on work in progress in relation to finance strategy, risk assessment and prioritisation, detailed service plans to support the GHP and performance monitoring. . She advised that to date no formal feedback on the GHP had been received from the Health Department although informal feedback on specific sections had been provided. An outline of the proposed timetable for completion of specific pieces of work was noted. Mr Smith encouraged Board Members to input to the structure of the April Board workshop at which the Board will review in detail the final draft Plan.

THE BOARD

  • Noted progress on the development of the 2004/05 Grampian Health Plan
  1. Governance

6.1Clinical Governance

a. Area Clinical Forum: Professor Weir advised the Board that a joint letter, from the AFC and AMC to the NHSiS Chief Executive, was being prepared for issue. The letter would reflect the increasing concerns of clinicians about the perceived inadequacies in resourcing of the significant HR and financial challenges in implementing the three new contracts (Consultants’ Contract, GMS Contract and Agenda for Change) aimed to support a reformed NHS. Professor Weir also reported that such anxieties were shared by clinical colleagues throughout Scotland. The SCF would provide Board Members with a copy of the final letter before it was sent to the NHSiS Chief Executive.

THE BOARD

  • Noted the position.

b. Clinical Governance Committee: The Chair, Councillor Bisset, reported that the February meeting had been postponed. A rescheduled date has been agreed at which the issues to be considered by the committee would include arrangements for clinical governance in the single system, draft standards for healthcare governance, child protection and Interventional Procedures/Clinical Governance.

THE BOARD

  • Noted the position.

6.2Staff Governance

  1. Letter from Grampian Area Partnership Forum Chair: The Chair, Mr Gordon, commended the tremendous amount of work undertaken by staffside, staff and management to move to the single system. He commented on the importance of effective communication in relation to pay modernisation implementation and the significance of partnership working in developing solutions to take forward this agenda. He reported that an employee relations strategic review is to be held on 3 March to review the new employee relations structure in keeping with the single system organisation.

THE BOARD

  • Noted the position.
  1. Staff Governance Committee: The Chair, Mrs Campbell, highlighted issues which are of concern to the committee, including the progress towards NHSG achieving the bronze SHAW award, a number of trends from the most recent staff survey which gave concern and which are being pursued by management, and progress in relation to implementing PIN guidelines.

THE BOARD

  • Noted the position.
  1. New national arrangements: Both the Forum Committees had written a letter of support for raising the profile of staff governance in response to the consultation paper on amending the NHS Reform (Scotland) Bill to include staff governance. The Chief Executive advised that he was working closely with the Forum in this area.

THE BOARD

  • Noted the position

6.3Corporate Governance

a. Chief Executive Recruitment: The Chairman advised that, as a consequence of the outcome to the original recruitment strategy, the NHSG Appointments Advisory Group, following consultation with the NHSiS Chief Executive, decided it was appropriate to halt the recruitment process at this time. He reported that, following his discussions with Board Members, Mr Alex Smith had been asked (and agreed) to continue as Interim Chief Executive until March 2005; Mr Alec Cumming has agreed to undertake the role of Interim Chief Operating Officer on an acting basis from 1 April 2004 for a limited period. Alec had previously announced that he would be taking voluntary early retirement on 31 March 2004 when GUHT ceases to exist. The Chief Operating Officer post will now be advertised.

THE BOARD

  • Agreed the position.

b. Child Protection: Mrs Elinor Smith, Director of Nursing, GPCT, updated the Board on progress being made, locally and nationally, involving all the key agencies, in addressing the “Actions for Chairs” set out in the letter dated 10 December 2003 from the NHSiS Chief Executive. An action plan is being developed to ensure there is a whole system approach to child protection in Grampian.

THE BOARD

  • Agreed that the Action for Chairmen agenda was being appropriately addressed.
  • Requested regular updates are provided to future Board meetings.
  • Requested that the SEHD receive regular progress reports.

c. Pay Modernisation: Mr David Benton presented a high level integrated action plan, developed by the Pay Modernisation Steering Group (PMSG), which identified the strategic intent and leadership for implementation of the three new contracts. The action plan will be performance managed by the PMSG and Grampian Management Team (GMT).

THE BOARD

  • Welcomed and endorsed the integrated action plan.

d. Performance Management Report: The Chairman announced that Mr Ewan Robertson had accepted the new post of Director of Performance Improvement. In introducing the March 2004 Performance Report, Mr Robertson reported that the Report followed the agreed format of general Performance Assessment Framework (PAF) based updates. Short presentations on three key issues would also form part of the formal report. Mr Robertson confirmed the date for the Accountability Review, i.e. Monday 26 July 2004. It is intended that the Accountability Review will follow the same format as last year. Appendix A provided an update on ongoing actions included in the 2003/04 Grampian Health Plan. Board Members were asked to note progress in a number of areas, including hospital acquired infection, estate management, breast feeding policy, public involvement in planning services and development of the Health Improvement Network (HI-NET).

THE BOARD

  • Noted the position.

Presentations on three key areas followed:

(i) Planned Care: Deb Grant, Assistant Chief Executive, GUHT, reported orally on the position in relation to performance against waiting time targets at end of March 2004. All in-patient and day cases targets continue to be met. Good progress is being made to reduce maximum wait to 6 months in several specialties. The planned reduction in orthopaedics to 8 months maximum by end of March 2004 will not be achieved due to lack of additional theatre capacity. Management and clinicians continue to work closely to ensure effective use of available resources.

THE BOARD

  • Noted the position.

(ii) Diagnostic and Treatment Centres/Services: Mr Mike Ogg, General Manager, Aberdeenshire Central LHCC, explained that development of DTC’s is part of the ongoing Healthfit process, which is developing long-term strategies for delivery of high quality local services. He reported on work underway as part of the Change and Innovation Plan to explore the feasibility and sustainability for the development and siting of diagnostic and treatment services.

THE BOARD

  • Noted the position.
  • Agreed that the development of DTCs is a major component of the Board’s strategy as set out in the Change & Innovation Plan which it is anxious to see progressed.
  • Agreed that this work be co-ordinated through the Service Strategy and Redesign Committee (SSRC).
  • Requested that regular performance reports should be presented to the Board.

(iii) Strategic Approach to Emergency Planning: Dr Baijal spoke to Appendix B of the Report, which sets out the inter-agency process currently underway to integrate existing emergency planning arrangements into the new single NHS system. Dr Baijal explained that emergency planning is an increasing national priority and, as such, is subject to increasing scrutiny and is a significant governance issue. An action plan is being completed to ensure a strategic approach to emergency planning.

THE BOARD

  • Endorsed the strategic approach being taken to emergency planning.

(iv) Finance Report to 31 January 2004 (Appendix C) : The Chairman announced that Mr Alan Gall has accepted the new unified post of Board Director of Finance. In introducing his report, Mr Gall provided a comprehensive overview of NHSG’s financial position and for each of the three legal entities within the system respectively. This high level report is consistent with the prescribed detailed monthly reporting to the Scottish Executive Health Department and the regular reporting to the Management Teams of the two local NHS Trusts. He summarised the current position:

GNHS Board: A favourable variance against plan of £196K, reflecting the impact to date of vacancy control procedures put in place to support the achievement of NHSG’s efficiency savings target. A year-end overspend of £3,400,000 is projected reflecting the repayment of 2002/03 brokerage to SEHD one year earlier than originally planned.

GUHT: An adverse variance against plan of £2,417,000 for the 10 months ending 31 January 2004. Contributory factors include cost reduction programmes yet to meet set targets, unfunded emerging cost pressures and increases in emergency activity.

GPCT: A favourable variance against plan of £2,263,000 for the 10 months ending 31 January 2004, reflecting the lower level of increase on prescribing and increasing staff cost savings as a consequence of vacancy management.

Mr Gall went on to provide summary updates on the four key dependencies.

THE BOARD

  • Noted the current underspend to 31/1/04 of £42,000 and the projected year-end overspend of £6,400,000 (Table 1).
  • Noted the detail for each legal entity (Table 2).
  • Noted the key dependencies on which the projected outturn is based.
  • Noted the detail of Income Projections (Table 3), the Capital Resource Limit (Table 4) and Cash Requirement (Table 5).
  1. Single System Steering Group:

General update - Mr Calum Campbell, Strategic and Innovation Director gave a brief progress report from the SSSG and its sub-groups, including:-

Staff Employment Transfer Letter

Community Health Partnership appointments

Waiting Times Project Director post

Chief Operating Officer post

Director of Performance Improvement post

Proposal to seek a variation to the Organisational Change Policy

Information news sheet from the SSSG (3SG)

THE BOARD

  • Noted the progress report.

Proposed NHSG Committee Structure – Mr Andrew Jackson, Standards Officer, reported that the SSSG Legal Issues sub-group had reviewed the existing committees structure and had identified the 12 Committees and 2 Fora that have to be set up to meet statutory requirements or SE guidelines. Board Members had had the opportunity to comment on the proposed committees and draft remits during February. Mr Jackson said that work to identify all other sub-committees, working groups etc. that exist, and their reporting lines, had commenced but would take several weeks to complete.

THE BOARD

  • Approved the NHS Grampian Committee Structure detailed in Mr Jackson’s report.

f. Ethical Standards in Public Life (Etc.) Scotland Act 2000: Mr Jackson referred Members to the decision from the Standards Commission for Scotland relating to University appointed Members of Grampian NHS Board.

THE BOARD

  • Noted the position.
  1. Planning

7.1Corporate Planning: Service Strategy and Redesign

  1. Strategic Context: Mr David Sullivan, Director of Corporate Planning, said that NHSG was operating within significant pressures around use of capital. A lot of work remains, scrutinising projects and examining consistency of standards.
  2. Redevelopment of Banff Hospital: The Board noted the background to the recommendation from the NHSG Asset Investment Group to support development of the project from Outline Business Case (OBC) to Full Business Case (FBC). The PCT Trust Management Team had approved the recommendation at its meeting on 25 February 2004.

THE BOARD

  • Supported the development of the project from the OBC to FBC stage.
  • Noted that the NHSG Board will be responsible for future approvals and delivery of the final project, within the single system from 1 April 2004.

c. The Moray Projects: Mr Sullivan spoke to the paper prepared by the Moray Collective, which provided a model for the way NHSG may wish to redesign services in the future, drawing attention to the financial risks around the proposals. The individual projects detailed in the paper signified a package of proposals, centred around the development of Dr Gray’s Hospital, Elgin, with a series of satellite developments, including development of new and improved facilities in Elgin and new health centres provision. The package of projects is at the OBC stage with more work to be done to reach FBC stage. The recommendations detailed in the paper had received the support of the NHSG Asset Investment Group and the PCT Trust Management Team.

THE BOARD

  • Supported the recommendations detailed in the paper.

d. Tor-na-Dee site: Noted letter dated 21 January 2004, from the Minister for Health & Community Care, supporting the work done around the option appraisal and development of the Tor-na-Dee site. Mr Sullivan reported that a design brief is currently being developed and arrangements put in place for marketing the property for the purpose of health-related services to be developed on the site.

THE BOARD

  • Noted the position.

The Chairman said that the above three projects encapsulate the legacy that the new single system would inherit from the three entities. He recognised the huge amount of work that has gone into such projects and paid tribute to all those involved.

e. Integrated Capital Plan for NHS Grampian: Mr Graeme Smith, Head of Service Development, reported progress in preparation of the integrated capital plan for the NHS Board by the NHSG Asset Investment Group. A draft plan will be submitted to the Board in due course.

THE BOARD

  • Noted progress.

7.2Pre-school provision for Children with Special Needs in Aberdeen City

Dr Karen Foster, Consultant in Public Health Medicine, introduced her paper, which summarised the findings of the report of the review of pre-school services in Aberdeen City for children with special needs (full report is available on request). There followed extensive discussion on the recommendations.

THE BOARD

  • Noted the findings of the report.
  • Supported the broad thrust of the report and the processes for detailed examination of the recommendations, project leadership and co-ordination and the establishment of a Project Steering Group/Team.
  • Was particularly concerned that parents, staff and partners continue to be fully involved in each stage of the process.
  • Stressed the importance of maintaining the joint approach adopted by NHSG and Aberdeen City Council.
  • Noted that the report would be presented to the appropriate committees of the Council in due course.

7.3North of Scotland Planning Group