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MINUTE of MEETING of the BOARD (PERFORMANCE)
Environmental Research Institute, North Highland College, Thurso /1 May 2007 – 9 30 am
Present / Mr Garry Coutts, ChairMrs Heather Sheerin, Vice-Chair
Dr David Alston
Mrs Ann Bethune
Mr Bill Brackenridge
Mrs Anne Clark
Ms Pam Courcha
Mr Ian Gibson
Mrs Gillian McCreath
Mr Bill McKerrow
Dr Vivian Shelley
Dr Roger Gibbins, Chief Executive, NHS Board
Ms Elaine Mead, Chief Operating Officer
Dr Eric Baijal, Director of Public Health and Health Policy
Dr Ian Bashford, Medical Director
Mr Malcolm S Iredale, Director of Finance
Ms Heidi May, Board Nurse Director
Also present / Ms Jan Baird, Director of Community Care (by VC link – Item 26)
Mrs Sheena Craig, General Manager, North Highland CHP
Mrs Anne Gent, Director of Human Resources
Mr Derek Leslie, Director of Planning and Performance
Dr Ken Oates, Consultant in Public Health Medicine (by VC link – Item 32)
Mrs Lorraine Power, Board Services Assistant
Mrs Susan Rose, Head of External Communications
Ms Lesley-Anne Smith, Head of Clinical Governance and Risk Management (by VC link – Item 29)
Mr Simon Steer, Head of Community Care Integration (by VC link – Item 23)
The Chair welcomed those attending the meeting from the North Highland CHP area and referred to the Board Development Session, which had been held the previous day in Thurso. At this session the Board had received updates on the Laboratory service, the Cataract service and Podiatry and Diabetes service within North Highland CHP. The Chair took the opportunity to thank the General Manager of North Highland CHP and the team involved in the presentations to the Board for an interesting and informative Development Session.
Apologies – Apologies were received from Mr Okain McLennan and Mr Raymond Stewart. The Chair advised that Mr Petrie’s appointment with the Board had come to an end on 30 April 2007 and that Dr Foxley was currently standing as a parliamentary candidate in the Scottish Parliamentary Elections on 3 May and had had to stand down as a Board member during the election period.
22 Minute of Meeting of 3 April 2007
Dr Shelley referred to item 10 of the minute and the issue relating to the possible change of name of the Area Partnership Forum and advised that she had been suggesting that the word ‘staff’ should form part of the name of the Forum, to highlight to staff the purpose of the Forum and that it related to staff. With regard to item 7, the Regional Transport Strategy, Mrs Clarke sought assurance that the Corporate Team would review the Highlands and Islands Travel Scheme. Dr Gibbins confirmed that this had been noted in the Action Plan from the last Board meeting and that Mr Iredale was the lead for this piece of work, which would be considered by the Corporate Team in due course. Mrs Gent advised that the item on the Gender Equality Questionnaire under AOCB should read “Equality Monitoring Questionnaire”.
The Minute of Meeting was approved, subject to the amendments highlighted.
NHS HIGHLAND
23 Allocation of Funding to Voluntary and Independent Sector Organisations Report by Simon Steer, Head of Community Care Integration
Mr Steer joined the meeting by video-conference link. NHS Highland provides a number of services in partnership with the voluntary and independent sector. The report outlined proposed expenditure including an annual uplift of 2% in funding for the voluntary and independent sector. Mr Steer advised that arrangements had been put in place to delegate the funding of voluntary organisations to a local (CHP) level during 2007. This would mean that commissioning, contracting and compliance arrangements would be locally directed. It was noted that there were some issues relating to the delegation to CHP level, which had still to be finalised as well as the need for capacity to ensure robust monitoring was in place. Mrs Clarke expressed concern that the policy did not extend to Argyll & Bute CHP and asked that this should happen to allow Argyll & Bute CHP to develop projects and deliver services. Dr Gibbins advised that NHS Highland had a very clear policy of supporting the voluntary sector and had maintained this budget in difficult circumstances. He advised that Argyll & Bute CHP already had a fully integrated budget and that it would be a choice for Argyll & Bute CHP if it wished to use some of that resource to assist voluntary and independent sector organisations as part of the developing local service plan for the area. Mr Brackenridge advised that it had not been the practice of the Argyll & Clyde Health Board to support the voluntary sector and suggested that Argyll & Bute CHP would find it helpful if there was an NHS policy as guidance, as the CHP would require to find resources from existing workstreams.
In relation to a question about the funding of the Highland Hospice, it was noted that this was reported separately, through the financial plan, as it was a sizeable amount of funding and to comply with the relevant NHS circular. Mr Brackenridge felt that it was important to ensure that there was funding for hospices across all of NHS Highland.
The Boarda / Agreed the funding proposals outlined in Appendix 1 of the Report.
b / Noted that further work was ongoing in relation to devolving the funding of voluntary and independent sector organisations to CHP level.
c / Agreed that consideration should be given to an over-arching policy in relation to funding of voluntary and independent sector organisations.
24 Local Delivery Plan 2007/08
Report by Derek Leslie, Director of Planning and Performance
The Board received a report at its meeting on 3 April 2007 confirming submission of a draft Plan to the Scottish Executive and was advised that it had been the subject of scrutiny by various Scottish Executive Health Department Policy Leads. Without exception the items requiring clarification or amendment were resolved with the final Plan submitted to the Scottish Executive in accordance with the deadline set of 27 March 2007. Mr Leslie advised that the Board had received confirmation from the Scottish Executive that the Local Delivery Plan had now been signed off and highlighted a number of observations made in relation to the Financial Plan, Sickness Absence, Cancer Waiting Times and Workforce Planning. The Board was now expected to deliver levels of performance described in each of the planned trajectories set out in the Local Delivery Plan and this would be subject to monitoring through the Balanced Scorecard and under scrutiny of the Board’s Performance Review Group. A report under the new format for the Scorecard would be submitted to the next meeting of the Board (Performance). It was noted that there would be further follow-up by the Scottish Executive on the trajectory relating to Delayed Discharge as some of this remained unpopulated in relation to data for Argyll & Bute CHP. Mr Leslie advised that Argyll & Bute performance in this area had greatly improved and work was ongoing between Argyll & Bute CHP and Argyll & Bute Council.
The Boarda / Noted the conclusion of the work to finalise the NHS Highland Local Delivery Plan 2007/08 and confirmation of agreement with the Scottish Executive.
b / Noted that a report under the new format for the Balanced Scorecard would be submitted to the next meeting of the Board (Performance).
SERVICE REDESIGN
25 Clinical Framework – Delivering Healthcare in NHS Highland – Development Plans for each CHP/SSU
Report by Derek Leslie, Director of Planning and Performance
Mr Leslie updated on the Development Plans, which were still a work in progress. All the plans reflected each CHPs/SSU interpretation of the framework and linked to the HEAT targets, Delivering for Health and the Clinical Framework. The Chair sought feedback from each of the Chairs of the CHPs/SSU on the development of the plans in their area. There was still ongoing discussion relation to the targets, although it appeared that the work was already beginning to become embedded in some areas. Mr Leslie welcomed the feedback from the Chairs and, in relation to comments about the format of the plans, he advised that the format had been debated at some length and while all the plans did not look the same, they had all been constructed around the HEAT targets. The Vice-Chair sought clarification on how the Chairs of the CHPs/SSU would use the documents and how they would be monitored. Ms Mead advised that monitoring would be achieved via the Chief Operating Officer’s meetings with General Managers which had a formal agenda focussing on the Balanced Scorecard and local issues and that the Development Plans would also be looked at in detail at these meetings. The Chair advised that the Development Plans should be live documents and that there was a need to ensure this work was core to the CHP/SSU Committees.
The Boarda / Noted the progress with the ongoing development of CHP/SSU Development Plans and the need to ensure that the work was core to the CHP/SSU Committees.
JOINT WORKING
26 Joint Inspection of Services for Children and Young People in Argyll & Bute
Report by Jan Baird, Director of Community Care
Ms Baird joined the meeting by video-conference link. As part of the programme implemented across Scotland, the Argyll & Bute partnership, comprising NHS Highland, Argyll & Bute Council and Strathclyde Police, had now received the published report. This was the first report for NHS Highland, which followed the HMIe recording format where performance was assessed on a range from Unsatisfactory to Excellent. Appendix 1 outlined the performance against the indicators and showed range from adequate to very good. It was noted that the detailed assessment highlighted areas for improvement and these had now been extracted into an Action Plan for Chief Officers. The Action Plan developed by Chief Officers and the Child Protection Committee would be monitored across the partnership by the Chief Officers and would also be presented to the Clinical Governance Committee to ensure oversight on behalf of NHS Highland. Mr Brackenridge welcomed the report on the Joint Inspection of Services for Children and Young People in Argyll & Bute and felt this was a good example of partnership working.
The Boarda / Noted the report from HMIe and the process of taking forward the recommendations.
FINANCIAL AND PERFORMANCE MANAGEMENT
27 NHS Highland Financial Position for the Period to 31 March 2007
Report by Malcolm Iredale, Director of Finance
Mr Iredale advised that the report highlighted the financial position of NHS Highland, based on data at 31 March 2007. The position was provisional at this stage pending receipt of the Final allocation Letter and the External Audit process, which was currently underway. The Consolidated Provisional out-turn was shown in Table 1, and showed an overall year end underspend of £6.957m on a budget of £535m. This was mainly the result of non recurring benefits, which were detailed in the report. The provisional out-turn had improved by £24,000 compared to the previous month, and the key movements were detailed in Section 2 and Table 2.
It was important to note that the provisional £6.9m under-spend represented the overall position, with a £1.7m recurrent overspend offset by £8.6m of non–recurrent under-spends and resources. This meant that £1.7m was in effect added to the Board’s recurrent deficit carried forward to 2007/08. The £6.9m under-spend would be carried forward to help fund the Recovery Plan commitments in 2007/08.
In setting the 2007/08 Budget, the Board noted that its original Recovery Plan had to be flexed in order to reflect the revised Arbuthnott Shares and the Argyll & Bute SLA with Greater Glasgow. The revised plan was shown at Table 4. The main recurrent savings challenge was in 2008/09 and 2009/10 and the aim in 2007/08 was to develop 2007/08 Savings Plans as early as possible, thereby allowing time to focus on the plans for subsequent years, which were likely to have a longer lead in period.
Mr Iredale advised that there were continued challenges in achieving recurrent and non-recurrent savings and that the CRES targets would continue.
The Boarda / Noted the provisional year-end position.
b / Noted the recurrent deficit and its impact on the Board’s Recovery Plan.
c / Noted the 2007/08 Financial Plan, including associated Savings targets.
28 Executive Report (Balanced Scorecard)
Report by Elaine Mead, Chief Operating Officer
Ms Mead updated on the outpatient waiting times, oral surgery and the focus to maintain the 18 week in patient target and the impact this would have on outpatient targets. It was noted that there would be additional Neurology clinics during June and July and that there would be a Locum Cardiologist for 2 months, which would allow additional clinics to be booked. In relation to urology and cancer waiting times it was noted that the team were focussed on rapid access. Ms Mead advised that the ISD data for the next quarter showed early signs of a slight improvement, although the figures had still to be validated.