APPROVED

NHS GRAMPIAN

Minute of the Performance Governance Committee Meeting

held on Thursday 22 January 2009

inthe Conference Room, Summerfield House

Present:

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

Barbara Bruce, Non Executive Board Member, NHS Grampian

Val Maehle, Non Executive Board Member, NHS Grampian

Elizabeth McDade, Non Executive Board Member, NHS Grampian

Gordon Stephen, Non Executive Board Member, NHS Grampian

In Attendance:

Richard Carey, Chief Executive

Rolf Dijkhuizen, Medical Director

Andrew Fowlie, General Manager, Moray CH&SCP, (for item 6.3.2 only)

Laura Gray, Director of Corporate Communications, NHS Grampian (for item 6.4.1 only)

Helen Cobb, Audit Scotland

Alan Gall, Director of Finance (for item 6.2.1 only)

Pam Gowans, Programme Manager, Long Term Conditions Management (for item 6.3.2 only)

Anne Ross, Head of Performance and Quality Improvement, NHS Grampian

Ray Watkins, Consultant in Dental Public Health, NHS Grampian (for item 6.1.1 only)

Glenys Wells, Personal Assistant, NHS Grampian – Minuting Secretary

Item / Subject / Action
Apologies
David Cameron welcomed everyone to the meeting and noted apologies from Bill Howatson and Ewan Robertson. Audit Scotland was represented byHelen Cobb, Audit Manager.
2. / Healthstat
The Healthstat section of the meeting was covered in a separate paper (attached).
3. / Minute of Meeting held on 20 November 2008
The minute of the above meeting was agreed as an accurate record of discussion.
4. / Matters arising
Richard Carey provided the following updates from the previous minute:
Substance Misuse - progress had been made in relation to the funding for the Timmer Market project. Fergus Ewing MSP had commended Grampian in public on its improvement in substance misuse waiting times.
5. / Assurance Framework Reports from Governance Committees and PGC Feedback
5.1 / Aberdeenshire CHP
Val Maehlereported that the CHP was closely monitoring maternity services to ensure they were working effectively. The birth rate had risen more than expected and both the Birth Units and the Aberdeenmaternity services were being used by Aberdeenshire women. Work on the Single Outcome Agreement was progressing well.
5.2 / Moray CH&SCP
Barbara Brucehighlighted the informative presentation to the CHP Committee by Dr Lesley Wilkie which was to be repeated at a full council meeting, to further promote health improvement and inequalities on the Local Authority agenda. There was good involvement around the Single Outcome Agreement.
Following discussion around content of the assurance framework reports, Richard Carey suggested that the template should also incorporate areas of concernsuch as HMIE reports. He also felt that a similar report from the Acute Sector would be helpful. This and the templates would be reviewed.
5.3 / Staff Governance Committee
Gordon Stephenreported on the positive comments from the Cabinet Secretary during a recent visit relating to the efforts in meeting targets for sickness absence rates. The improvement in KSF was noted with 52% of staff having an outline as at 22 January which was an increase of 15% since the last report. He confirmed that work on outstanding areas would continue and that other AfC timescales were on track. It was confirmed that no other projects had been interrupted in order to meet these targets although sometimes there were delays in eg grievance hearings because of staff side availability. Richard Carey advised that that Grampian had performed well according to the staff survey results. A presentation would be made to the NHS Board in due course.
5.4 / Clinical Governance Committee
Val Maehlereported positively on the previous committee meeting where it had been confirmed that HAI actions were being implemented and that regular monitoring wastaking place. A very comprehensive plan to reduce decanting had been presented and the new bed management system would assist in this. Roelf Dijkhuizen advised that he was organising a presentation for OMT on microbacterial prescribing. Elizabeth McDade stressed it was important to ensure the public was kept informed and engaged around this important agenda..
5.5 / Patient Focus and Public Involvement
Elizabeth McDade confirmed that there were no significantrisks to report.
6. / Delivery of Health Plan: High Level Performance According to Scorecard (incorporating LDP)
Anne Ross highlighted some issues from the Overall Performance Report:
Financial performance –Alan Gall will highlight later.
CHI target –delivery of the target within laboratories was being sustained but the new HEAT target related to radiology and would be more challenging.
Online referrals – the end march target was expected to be delivered as a consequence of the Hub initiative which wasfocusing initially on orthopaedics.
Outpatient/Inpatient waiting times –15 weeks had not been achieved at the end of December but we remained on track for 12 weeks maximum at end of March.
Diagnostics – target reductions had been delivered on a sustained basis for several months, which Richard Carey commended. These needed to reduce even further as part of the 18 week RTT target.
A&E 4 hour wait – the system had been under some pressure during the winter months but had generally managed well.
Sickness absence – although one of the lowest rates in Scotland, NHSGrampian was falling short of its trajectory towards the 4% target.
European Working Time Directive– as at November 2008 Grampian was 34% compliant for doctors in training
6.1 / Improving Health
6.1.1 / Dental Action Plan
Ray Watkins reminded members that the Plan had been accepted by the Board in August 2008and that this was the first progress report on performance. A draft implementation plan had also been circulated. He believed the corner had been turned on registrations with 20,000 additional registrations since last year across salaried dental practices and GDPs. It was noted that new dentists were coming to Aberdeen rather than Moray and Aberdeenshire although there were ongoing recruitment efforts locally and nationally. The emergency care services had treated 13,000 cases last year, all seen within 48 hours. However, he acknowledged that the registration waiting list continued to rise as practices continued to deregister patients. The DentalSchool admitting students and the considerable progress with the new build were also reported. PGC found the reports very helpful. Implementation of the Plan would continue to be monitored.
6.2 / Finance
6.2.1 / End November 08 Financial Report and December update
Alan Gall presented the December financial report published earlier in the day and advised on an improving position since the November report with £1.4m overspend against budget for the first 9 months of the year. However the year end forecast had now been changed from a £2m surplus to breakeven. Alan advised that price reductions in GP prescribing were not coming through as forecast and that energy costs continued to increase. Financial performance was enhanced by expenditure slippage and new funding allocations from the Scottish Government Health Department (SGHD) but thiswas not a sustainable position.
Core services remained under pressure and an essential spend only message was going out to the service. in relation to new investment, we continued to receive money from the SGHD which created difficulties for managers to spend within the timescale.
To date, only 35% (£14m) of the capital programme had been spent with £41m remaining. The main areas of spend were the new PACS system,eHealth infrastructure, the dental school andLaurencekirk medical centre
Alan advised on the work of the newly formed Budget Steering Group, made up of senior budget managers. The financial projections for 2009/2010 were particularly challenging and should the cost of pay awards be fully funded, a commitment to 3% less expenditure than 2008/09 from budget holders will be required. Finance managers were working with budget holders to devise saving schemes for every operational area. It was acknowledged that agreement on budgets would prove difficult. A sub group of the Budget Steering Group was being established to review the risks and effects across the organisation of saving schemes. In general plans would have to be put in place to operate with a less rich skill mix and fewer staff if savings were to be delivered.
6.3 / Service Delivery and Organisation
6.3.1 / Outpatient and Inpatient Waiting Times
Richard Careyconfirmed that NHS Grampian was on track to reach the12 week target at the end of March despite being over trajectory at the end of December.
David Cameron asked about access to Stracathro after the end of the existing contract. Richard advised that high level discussions would take place with Tayside and Fife but that Grampian wished to secure its currently nationally funded capacity and required this for long term sustainability. Roelf Dijkhuizen advised that the objective in Better Care Without Delay was to reduce reliance on private facilities to meet requirements and to eliminate this fully.
6.3.2 / Long Term Conditions Programme
Andrew Fowlie video linked for this item and introduced the Programme Manager, Pam Gowans who was in attendance, to the Committee. He advised that the purpose of the programme was to embed within Health Boards and Local Authority areas over a 3 year period the better management of long term conditions. A long term was defined as one lasting for more than one year. The Programme Board commenced its work last summer and was currentlytaking forward 3 main areas of work – self care (Grampian was ahead in Scottish) terms, specialist care (e,g, COPD, CHD, MCN) and complex care (those with a number of conditions). Pam Gowans advised that a focused approach was required to ensure that the patient experience could be improved. This programme was one of the six Board Programmes and would be monitored in depth twice a year in order to ensure ongoing progress. PGC requested that updates were provided.
6.4 / People
6.4.1 / Media Performance Report
Laura Gray reported that this report showed that more positive than negative reports had been received over the last two month period. There were also a high number of neutral stories raising
awareness about issues. A number of stories this month were outwith the control of the Communications Team, relating to emergency incidents.
It was noted that more than 70% of Freedom of Information enquiries came from the media and a lot of work was involved in formulating appropriate responses. Laura advised that she planned to expand the media report to cover broadcast media, e.g. radio, TV and online.
Laura advised that the organisation had responded well around some difficult issues in relation to the Auchenblae hotel incident which will be reported at the next meeting. Although there had been a significant amount of work for the team, this was invaluable learning for the organisation in future.
6.5 / Learning and Growth
6.5.1 / KSF Implementation update
This item had already been discussed.
7 / 2009/10 Local Delivery Plan update
Anne Ross reported on the timetable for the LDP draft submission by 18 February and the final version by 20 March. A local deadline for first submission of 23 January had been set. She highlighted that less narrative was required this year but risks to delivery of all HEAT measures had to be identified with associated mitigating actions. There were a number of new sections and information was required on partnership working with Orkney and Shetland.
The draft LDP would be discussed at the March Board Seminar with the final version available for the March PGC meeting and the April Board.
8. / To consider content of February 2009 Board Report
  • Dental Action Plan
  • Financial report
  • Outpatient/inpatient waiting times
  • General performance report

9. / AOCB
None reported
10. / Date of Next Meeting
16 March 2009, 10.30am, Conference Room, Summerfield House

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