UN/APPROVED
NHS GRAMPIAN
Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session
on Tuesday 2 August 2011 at 10.00am
in Committee Room 5, Woodhill House, Westburn Road, Aberdeen
Present
/ Dr David Cameron / Non-Executive Board Member (Chair)Mr David Anderson / Non-Executive Board Member
Councillor Lee Bell / Non-Executive Board Member
Mr Raymond Bisset / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Councillor Kate Dean / Non-Executive Board Member
Dr Roelf Dijkhuizen / Medical Director
Mr Alan Gall / Director of Finance/Deputy Chief Executive
Mrs Jenny Greener / Non-Executive Board Member
Professor Neva Haites / Non-Executive Board Member
Councillor Bill Howatson / 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
Professor Val Maehle / Non-Executive Board Member
Mrs Elinor Smith / Director of Nursing and Quality
Mr Gordon Stephen / Non-Executive Board Member
By Invitation / Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Mrs Gerry Lawrie / Workforce Development & Redesign Manager (item 7.2.2)
Mr Gary Mortimer / General Manager, Facilities and Estates (item 5.2 only)
Mr Mark Sinclair / Director of HR and Strategic Change
Mr Ray Watkins / Consultant in Dental Public Health (item 5.1 only)
Mr Andrew Wood / Risk Management Advisor (Health and Safety)(item 7 only)
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wells / PA Board Secretariat
Item / Subject
1 / APOLOGIES
Apologies were received from Mr Charles Muir, Mr Mike Scott and Dr Pauline Strachan.
2 /
CHAIR’S WELCOME
The Chairman welcomed everyone to the meeting. He advised that this was the Director of Finance, Mr Alan Gall’s last Board meeting before his retirement at the end of August. He acknowledged that Mr Gall had been instrumental in NHS Grampian being in such a good financial position. He wished him well on behalf of the Board. The Chairman also intimated that Mr Ewan Robertson, former Board Secretary /Director of Performance Improvement and currently Director of Special Projects was also retiring at the end of August. The Chair acknowledged his invaluable input to the implementation of the new Patient Management System and also wished him a long and happy retirement.The Chair advised that this year’s Annual Review, being chaired by Michael Matheson, Minister for Public Health, would take place on 1 November 2011 at a venue to be confirmed.
3 / MINUTES OF MEETINGS HELD ON 7 AND 24 JUNE 2011
This was approved.
4 / MATTERS ARISING
There were no matters arising.
5 / STRATEGY AND PLANNING
5.1 / Dental Plan 2008 – 2012
Mr Watkins explained that the report gave an update on the third year of the four year plan and highlighted significant changes and improvements in dental services. He advised that child oral health targets had been achieved, with 70% of children in Grampian starting school with no tooth decay. The number of general anaesthetic day cases for tooth extraction had reduced by 50% over five years. NHS registrations had increased and NHS Grampian was on target to achieve 124,000 registrations by 2012. He explained that there were plans to target particular groups of primary schools in Grampian where dental registration was poorest. There had been a major improvement in primary care waiting list, which was now below 19,000 for the first time in three years. The aim was to get rid of any waiting list within the next two years.
The opening of the AberdeenDentalSchool, which now had an outreach centre in Elgin, was contributing to decreased waiting lists. It was noted that the first students to graduate from the school would be in June 2012.
It was estimated that 25,000 people from Aberdeenshire travelled to AberdeenCity for dental care and it was necessary to identify local service provision.
The quality of dental premises had improved considerably, with 90% of practices achieving new decontamination standards. Councillor Bell advised that the public in Moray and Aberdeenshire still had concerns about waiting lists and about apparent inequalities regarding the cost of treatment between the city and shire. He felt that if the waiting lists were reduced this would prevent undue frustration.
In response to queries from Board members, Mr Watkins advised that Grampian was still eligible for Scottish Government grants. He advised of good partnership working between NHS Grampian and the local authorities regarding potential dental facilities in new developments. He advised that some patients had been put off attending a dentist because of the difficulty of mixing NHS services for children and private services for adults. He advised that in the last 2-3 years, dentists who had joined were offering a significant commitment of around 80% to NHS treatment. He advised that graduates were being encouraged to stay in the north-east through the vocational training scheme. Work was being done to increase the number of training practices available, with a target of 22.
Dr Dijkhuizen congratulated Mr Watkins and his colleagues for the significant achievements as evidenced by the improvement in children’s oral health and decrease in general anaesthetics for children for extraction of teeth. He suggested that health and safety inspections under Ionising Radiation (Medical Exposure) Regulations (2000) (IRMER) be taken into account in the action plan. Mr Watson responded that it was essential for dental practices using x-ray machines to be compliant with these regulations.
The Board:
- noted the progress, achievements and future challenges in the Dental Plan 2008 – 2012
- requested an update on progress around key risks in March 2012
- requested the next Dental Plan for consideration in October 2012
5.2 / Foresterhill Site Car Parking
Mr Gall introduced the item, with reference to his paper and attached proposals paper, explaining that the Foresterhill Transportation Partnership Group had a challenging task working up options for the rigorous enforcement of parking controls on the Foresterhill site.
He thanked the group members for their input to what was a more onerous task than first envisaged. He explained the strategic context, the process to date, membership of the group and the key risks. He advised that taking no action was not an option and the proposals being put forward offered the likelihood of significant benefit to the quality of patient care and experience. However, the proposals involved significant investment.
He highlighted 14 of the main issues which necessitated change including the number of complaints, negative media coverage, patients and clinicians being late or missing appointments, noise and emission pollution on the site.
The proposals included: reintroduction of manned barriers with permit access; increasing the number of pool cars; inter-site shuttle bus; circular site bus; the principle of additional land to increase spaces; the principle of subsidised “Park and Ride”; environmental agenda; ensuring services delivered in the right place; worksmart/agile agenda.
There were approximately 7000 staff who nominated the ARI site as their place of work. It was necessary to restrict numbers coming on to the Foresterhill site thereby managing demand for parking as increasing the supply was unlikely. Providing a multi-storey car park would not be a viable option. There was neither capital available for building such a facility, nor income from parking charges to cover recurring operating costs.
A financial deterrent had to be introduced to dissuade those who chose to abuse the facilities as advisory window stickers had not been successful. Investment in sustainable solutions was needed.
Mr Mortimer gave a presentation which highlighted the need for the review and the key issues including: car parking charging; civil penalties; multi-storey car park option; site development framework/Masterplan. Maps showed where parking for different categories would be located and he gave a breakdown of the number of parking spaces available for these categories. Currently there were 2500 spaces, with around 100 available for patients as the remainder were filled by staff by 9.00am. Different zones would be available which included areas for staff parking, general parking, medical emergencies, pool cars and outpatient parking. Seven hundred spaces would be available for outpatients with a limit of 3 hours. There were around 1500 patients per day, so with a 3 hour maximum stay there would be a high likelihood of finding a convenient parking space.
Mr Gall advised that if additional spaces were created, they would simply be filled up and existing difficulties would continue. Car ownership and desire to use cars had increased dramatically and would continue to do so.
The Chairman advised the proposals had been considered by a number of Committees and forums and that the financial implications had been considered by the Operational Management Team (OMT) and the Budget Steering Group which had concluded the cost implications could be addressed in the current financial year.
The Board was advised that it was necessary to spend to save. Although the cost of missed appointments was not available, investment in capital would save significant revenue, for example by reducing the number of DNAs (Did Not Attend). The patient experience would be enhanced.
Councillor Howatson commended the work and agreed that the complexity of a solution could not be underestimated. He was concerned that the inter-site bus proposal was not evidence based. He felt that £1m investment in additional car parking space was too costly and suggested any plans to take this forward be delayed until other proposals had been pursued.
Mr Mortimer responded to queries by advising that 3 hours parking suited the majority of patients/visitors. There would be flexibility to ensure they were not penalised inappropriately if they required parking over the time limit. More car parking spaces would become available for A& E once the Emergency Care Centre opened. There could be wider opportunities for the inter-site bus proposal by opening up discussion with partners, for example the University and local authorities. Professor Haites advised that the University used to have a 15 minute shuttle bus service which had been well-used but expensive.Mr Mortimer suggested that changes be implemented and reviewed then brought back to the Board for further consideration.
Mr Gall stressed that the demand for parking had to be sorted as the supply could not. There was no statutory obligation to provide car parking. Charging for car parking was not an option as this had been prohibited in 2008 by the Scottish Government. The organisation had to ensure the permit process was robust and transparent. It would have to be led and supported by senior management.
Mr Gall advised that any net income from enforcement income/civil penalties would be put towards sustainable solutions. He did not expect large amounts of income as this would mean the systems had failed.
Mr Mortimer advised that the regulations related to Monday - Friday core hours and that rules would be relaxed in the evenings and weekends. It was suggested that turnover of regular business would allow for sufficient spaces.
Dr Dijkhuizen referred to the public consultation on the Masterplan for Foresterhill in preparation for the Emergency Care Centre development several years ago. Car parking had been an issue then and action was overdue to address it. He suggested that use of space should be based on need rather than entitlement. The introduction of measures would require to be evaluated. It was noted that a permit would not guarantee a parking space.
Professor Maehle commended the amount of work done by the group. In response to her queries, Mr Gall advised that a capital impact assessment had not been done. The Board had approved the capital plan for 2011/12, but a substantial amount was unallocated. If the car parking proposals were taken forward, other plans would have to be reprioritised.
Mr Stephen agreed that something needed to be done and a difficult situation required difficult decisions. He advised that staff wished additional space but he did not think that would solve the problem. Park and Ride should be seen as a suitable alternative and not as punitive.
Mr Anderson appreciated the work done and pointed out that plans had to be based on the strategy for the future. He suggested that it was an individual’s responsibility to get to work, not the organisation’s responsibility to get staff to work.
It was acknowledged that working practices had to change and to increase the use of telephone and videoconferencing facilities for meetings, to avoid intersite travelling.
Mr Mortimer explained the proposals were to bring the number of pool cars to 60 to be reviewed annually. No specific provisions had been made for staff on site late at night as a result of being held back to deal with emergency clinical activity. Mr Gall advised that the BMA had raised the issue and this would have to be dealt with in a pragmatic way that would ensure staff safety.
The Board agreed that action must be taken to improve the current car parking arrangements at Foresterhill and that improvement to patient and visitor experience was essential.
Mr Carey assured the Board that the financial implications of the proposals had been discussed at senior level. With the exception of proposal 4 (additional spaces on converted land), they were manageable and affordable. It was recognised that if money was invested in this, it would not be available for other things, but for such an important issue, investment was justified. He did not think that £1m of capital investment for additional car parking space was feasible. He advised that the major beneficiaries of the restrictions would be patients and visitors, which was as it should be. He warned the Board not to underestimate how unpopular and contentious the proposals would be with staff who did not meet eligibility for parking permits. He stressed the need for a fair and robust system and suggested any panel be chaired by a non executive Board member. Although proposals 2, 3 and 5 in the paper were not evidence-based, it was suggested they be piloted and evaluated and if not successful, they could be discounted.
Mr Carey thanked all the people on the group, particularly Mr Gall as chair, who had done a thorough and professional job. He stressed that whatever arrangements were put in place, they had to be fair and robust to make them work.
Councillor Dean declared an interest. She advised that if there was a planning application for the site to the west of existing car parking facilities, she would not be part of the Council Committee determining that.
The Chairman concluded that the status quo was not an option. Self-regulation was ineffective, so controls were required. Evaluation of any proposals implemented would be needed. He suggested a 6 month rolling evaluation, followed by a report to the Board.
Mr Carey suggested that if the Board approved the proposals, that it instruct the Board Executive Team to start as soon as possible within the current financial year.
Following the comprehensive discussion which covered every aspect of the proposals, the Board:
- agreed to the main proposal summarised in section 6 of the proposal document.
- agreed to the introduction of an inter-site shuttle bus service - for example between sites such as WoodendHospital, Summerfield House, Woodhill House, Foresterhill, RoyalCornhillHospital, WoolmanhillHospital - for a pilot period of 6 months. This will involve an estimated annual recurring revenue investment of £140,000
- agreed to the introduction of a Foresterhill site circular shuttle service, to drop off and pick up at a variety of points around the site -for a pilot period of 6 months. This will involve an estimated annual recurring revenue investment of £100,000
- agreed to the principle of developing a subsidised staff park and ride services, to encourage greater use of the existing Park and Ride schemes. This will involve an estimated annual recurring revenue investment of £100,000
It was agreed that the new scheme would be fully evaluated and that the outcome of the evaluation would be discussed by the Board.
In relation to the recommendation about the principle of developing land to the west of the existing parking facilities on the site to create additional parking spaces, the Board agreed to keep this suggestion on the table meantime and to review it in the light of the full evaluation of the new arrangements.
6 / CORPORATE GOVERNANCE
6.1 / Staff Governance
6.1.1 / Workforce Projections 2011
Mr Sinclair introduced the item explaining that the projections for the next five years provided in the report had to be viewed in conjunction with the Workforce Plan 2011 which was approved by the Board on 7 June 2011. Ms Lawrie advised that the timescales for preparing the projections for submission to the Scottish Government had been extremely tight, with a great deal of complex information to be provided, which would be useful to the organisation and the Government. The projections identified the direction for the future workforce in NHS Grampian and showed changes to skill mix, with the aim of achieving the best blend of staff within multi-disciplinary teams. She advised that staff turnover varied between different staff groups. Mr Sinclair advised that in future the projections would be an annex to the Workforce Plan which used the six step methodology. Mr Carey advised the Board of sensitivities around workforce numbers because staff costs were 70% of NHS Grampian’s overall budget. He advised that in progressing the Safe Affordable Workforce agenda, all opportunities available were being taken to manage the workforce. There were increases to the Allied Health Professions (AHP) workforce which related to the Change Fund. Mr Sinclair advised that the most significant decrease in staff related to administration and management.