APPROVED

NHS GRAMPIAN

Note of the Performance Governance Committee held on

Thursday 21 January 2010 at 10.30am in the Conference Room, Summerfield House

Present:

David Cameron (Chair), Non-Executive Board Member, NHS Grampian

Gordon Stephen,Non-Executive Board Member, NHS Grampian

Charles Muir,Non-Executive Board Member, NHS Grampian

In Attendance:

Richard Carey, Chief Executive

Pauline Strachan, DeputyMedical Director

Alan Gall. Director of Finance

Laura Gray, Director of Corporate Communications (items 5.2.1 and 5.2.2only)

Ewan Robertson, Director of Performance Improvement/Board Secretary

Anne Ross, Head of Performance and Quality Improvement

Lesley Wilkie, Director of Public Health (item 5.1.1 only)

Gillian Lewis, Public Health Specialist – Health Improvement Strategy (item 5.1.1 only)

Glenys Wells, Personal Assistant - Minuting Secretary

Item / Subject / Action
1. / Apologies
Apologies were received fromBill Howatson, Val Maehle and Elizabeth McDade. As this meeting was inquorate, the November 2009 minute would require to be submitted to the March meeting for approval. The note of the inquorate meeting would be circulated to all members.
2. / Healthstat
The Healthstat section of the meeting was covered in a separate paper (attached).
3. / Minute of Meeting held on 19 November 2009 and Matters Arising
Deferred to March meeting.
3.1 / CHP Committee Objectives and Work plan - update
Dr Cameronreported that he had met with CHP chairs in December 2009 and work was ongoing to update objectives and produce workplans.
4. / Assurance Framework
4.1 / Reports from Governance Committees and PGC Feedback:
4.1.1 / Staff Governance Committee
Mr Stephen reported a positive response to the Face2Face sessions which had been attended byaround 500 staff. It had been agreed to continue these twice per year and more sessions were being arranged for April and the autumn. The Health and Safety structure was continuing to be developedand covered both staff and patients. Roelf Dijkhuizen had asked that HAI be incorporated and this was being taken forward. It was expected to have thestructure in place by the end of March.
Sickness absence rates had been fluctuating and this was thought to be a consequence of seasonal changes as well as the Occupational Health Service’s (OHS) focus on the flu vaccination programme. Grampian’s rate compared favourably with others but there was always scope for improvement. Richard Carey suggested that rates may increase given the increasing challenges within the working environment. The comprehensive data produced by OHS was noted.
4.1.2 / Clinical Governance Committee
Mr Muir reported that CGC had received the full HEIreport and action planwhich had given the Committee assurance on progress to deliver improvements.
There was improvement towards meeting the cDiff target and comprehensive information on antibiotic prescribing which gave significant assurance.
Dr Dijkhuizen had identified an issue in relation to hand hygiene related to throughput of people and this was being addressed.
The CGC had been advised that the Child protection action plan was being implemented and updated. Mr Carey confirmed that there was a common agreement on this across public sector organisations.
Mr Robertson asked that future reports include completion of the agreed actions column.
4.1.3 / Patient Focus and Public Involvement
Mr Carey advised that a virtual network was to be established for the Wheelchair Users Group as attending meetings had sometimes proved difficult.
Charles Muir advised that the consultation exercise relating to health services for children with complex needs in AberdeenCity was progressing and would be presented to the Board in due course. The variety of views made the process complex and lengthy.
4.1.4 / Aberdeenshire CHP
David Cameron presented Val Maehle’s report in her absence. He stressed the importance of the ongoing work around Single Outcome Agreements. Richard Carey reported that he believed that the outcome from the national review of CHPs was imminent but did not know what it was likely to recommend.
4.1.5 / Moray
Mr Muir reported on the Committee’s recent meeting which had included a good discussion on adult protection and a presentation on the Health Plan.
The committee continued to monitor progress following the HAI outbreak. Mr Carey confirmed the robust surveillance arrangements put in place by Dr Dijkhuizen following the HEI report and reminded members that each CHP had its own specific action plan in relation to these. The CHP General Manager was aware of and addressing the red areas and would be expected to report on these to the Committee. There would be an announced HMIE inspection in May.
The Committee continued to track progress with the HMEI report on Child Protection.
The CHSP had held a very positive workshop which was well attended and areas of common interest with the Local Authority would be taken forward. Richard Carey welcomed that the local authorities appeared more supportive of the Joint Future agenda.
4.2 / Review of Performance Governance Committee’s role in Risk Management
Mr Robertsonintroduced his paper. The 2009 QIS report had raised issues about the role of Performance Governance Committee and the Audit Committee concerning risk management. He believed that roles were clear in that the Audit Committee was to provide independent assurance around the risk management process through the SSRC. PGC provided assurance around performance and strategic objectives at risk. There was perhaps a need to more formally review the Strategic and Operational Risk Control Plans at PGC and/or when agenda setting. This had been identified as a gap by a recent review by Bannisdale Consulting. Charles Muir said the report was helpful and the proposals made risk ownership more visible.
5. / Overall Performance ‘At A Glance’
Anne Rossadvised that the ‘At a Glance’ report circulated with the papers covered only the HEAT measures. The more substantial overall performance report continued to be produced monthly and was considered in full at Cross System Performance Reviews. Her report drew on the fuller report. She highlighted:-
Cardiovascular health checks in areas of deprivation –performance remained under trajectory (which had already been revised downwards). Electronic management of referrals – well ahead of trajectory
Cancer Waiting Times - urgent referral within 62 days had bee above the 95%target for 3 quarters in a row. Performance against the new cancer target of decision to treat to treatment within 31 dayswas improving but below trajectory.
Access times were slightly off trajectory but Richard Carey confirmed that he believed the 9 weeks would be delivered by the end of march 10.
4 hour A&E wait was below 98% in October. Performance had fallen further at Dr Grays relating to the ward upgradings but was expected to be back on track by March. The ARI position was much more positive and believed to be above target on a sustainable position.
Mr Carey commended this report and suggested it be used for the forthcoming mid year review.
5.1 / Improving the Public's Health and Reducing Inequalities 12.20
5.1.1 / Report on addressing ‘H’ Measures
Dr Wilkieintroduced a report prepared in response to an action agreed at the Annual Review in November. Performance against some H targets were below trajectory and the Cabinet Secretary had sought an improvement plan by the end of January to show what action was to be taken.
Mrs Lewis advised that a more detailed report covering all H measures would be presented to the February Cross System Performance Review. The report for the Cabinet Secretary related only to those targets and initiatives which she had raised. The reports would assist in preparations for the 2010/11 Local Delivery Plan by highlighting what could be delivered by when.
H3 – Child Healthy Weight Interventions - this was an extremely challenging target to meet and the reported performance against the target itself did not show the considerable development and preparatory work that had already been done to prepare for its delivery. Scottish Government had asked all Boards to review their trajectoriesfor 2009/10 as Grampian was not alone at being behind schedule. Discussions were ongoing nationally about acceptable approaches on intervention such as the ForthValley class based model.
H4 – Alcohol Brief Interventions - detailed plans were in place, posts had been filledand previous issues about access to training had been resolved. There was however a data recording issue as not all primary care activity was being captured. This was being addressed and the true position was expected to be reflected in official reporting soon.
H6 –Smoking cessation–there had been data capture issues associated with this target but these had now been resolved and delivery was expected to be back on track by the end of March.
Counterweight – the Cabinet Secretary had asked specifically about this initiative in Grampian. Some national funding had been received to take it forward in primary care but progress had been slow due to other pressures such as H1N1. Activity was now picking up however.
Mr Carey commended the report and felt that it would be helpful to have a greater degree of specificity on what could be delivered by when. Mrs Lewis confirmed that this information would be contained within the report being presented to February’s Cross System Performance Review.
5.2 / Delivering safe, effective and timely care in the right place
5.2.1 / Media Performance Report
Mrs Grayreported that the previous 2 month period had been dominated by the HEI report with a total of 420 stories. This was a significant increase from the previous period and meant a high level of negative coverage. There were other stories however including alcohol minimum pricing and executive salaries. Members were reminded that this report did not take into account broadcast or online media.
5.2.2 / Communication and Media Management of HEI Report:
Mrs Gray advised that thishad been a major issue for the organisation and the communications function. Given the high level of media coverage, it was important to reflect and consider whether things could have been done differently or more effectively and to identify any lessons to be learned. The report provided the timeline of events. Mrs Gray reminded members that the organisation had seen the HEI report prior to publication so the media and public reaction could have been predicted. Various courses of action had been discussed prior to publication but none taken forward which may or may not have been the correct course of action. In addition to the media management there was also a lot of work involved in communicating with staff and Scottish Government. Dr Cameron and Mr Muir were very supportive of the extraordinary efforts of Mrs Gray and her team under these extreme circumstances.
5.2.3 / Access Times
This had been discussed earlier in the meeting. Mr Carey advised that discussions were ongoing with Scottish Government about additional resource for theatre sessions.
5.3 / Improving Efficiency, Productivity and Sustainability
5.3.1 / End November 2009 Financial Report and December oral update
Mr Alan Gall provided an oral update on the financial position as at the end of December 2009. Pay costs were being kept under control by budget holders with a £300K underspend being reported for the month and a number of sectors were showing an improving budget position. However unexpected retrospective charges relating to cross border prescribing meant the net result for December was £458K over budget. The report forecast a year end breakeven which meant a £3.6m deficit had to be recovered over the remaining 3 months through rigorous pay control, elimination of discretionary spend and delay in earmarked spending. Prescribing costs and earmarked funding expenditure were identified as high risks in the last 3 months of the financial year.
Capital spending was no longer identified as a significant risk but much work remained for project managers..
The overall financial position including plans for 2010/11 and beyond would be discussed in full at the March Board seminar.
6. / CSI Performance Report
Ms Rosspresented the monthly CSI performance report which included performance traffic lights submitted by each programme. Where reds were reported, a short narrative was provided to the CSI Leadership Group. December’s report was disappointing given the increased number of reds being reported, however the January report, currently being pulled together, would show an improved position.
7. / Annual Reviewletter and effectiveness of arrangements
Dr Cameronreported a satisfactory outcome and commended Ms Ross and Mrs Gray for the work involved in the late change of arrangements. Mr Carey confirmed that all the action points were being taken forward.Generally it was agreed that the process had been satisfactory.
8. / Annual Report
Ms Rossreminded PGC that they had seen the draft Annual report and had had the opportunity to make contributions. The report was later than usual because of the late Annual Review. The report would be presented at the February Board meeting but in the meantime was approved by PGC.
9. / 2010/11 Local Delivery Plan (LDP)update
Ms Ross advised that the first draftof the LDP was being produced and would be submitted to Scottish Government by 19 February, A major issue was the viability of the financial plan. The LDP would be refined over the next 2-3 weeks and circulated to the Executive Team and OMT prior to submission. There would be a presentation on the main issues at the March Board Seminar with final submission of the LDP on 19 March. The final version would also be available for PGC on 18 March and thereafter the April Board meeting.
10. / PGC Evaluation Plan 2009/2010
PGC reviewed the action plan and noted that all the actions for 2009/10 had been completed. A 2010/11 plan would be presented at the next meeting. The Committee self evaluation would be deferred until later in 2010.
11. / To consider content of February 2010 Board Report
  • Finance
  • Assurance framework – generic statement on topics
  • H measures
  • Annual Report – (on Board agenda as a separate item)
  • Access times – update
  • At a Glance report

12. / AOCB
None
13. / Date of Next Meeting
18 March 2010, 10.30am – 1pm, Conference Room, Summerfield House

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