PART 1

DRAFT MINUTES OF THE FINANCE, PERFORMANCE AND RESOURCES COMMITTEE MEETING HELD ON tuesday 26 JULY 2016 at 0900HRS IN the activities room, playfield institute, stratheden HOSPITAL

Present:

Mr S Little, Non-Executive Director (Chair) / Mr P Hawkins, Chief Executive
Mrs W Brown, Non-Executive Director / Ms H Paterson, Nurse Director
Mr A Burns, Chairman / Mr J Paterson, Non-Executive Director
Dr K Cheshire, Non-Executive Director / Mrs C Potter, Director of Finance
Dr F Elliot, Medical Director / Councillor A Rodger, Non-Executive Director
Dr M Hannah, Director of Public Health
In Attendance:
Professor S McLean, Chief Operating Officer, Acute Services
Mrs C Dobson, Divisional General Manager (West Fife)
Miss S Laird, PA to Director of Finance (Minutes)
133/16 / APOLOGIES FOR ABSENCE
Apologies were received from Mr S Riddell
134/16 / DECLARATION OF INTERESTS
There were none.
135/16 / MINUTES OF MEETING HELD ON 31 MAY 2016
The minutes were agreed as an accurate record of the meeting with the exception of an additional word on page 7, paragraph 1, “recognise that the savings proposals may not be achievable”
136/16 / MATTERS ARISING
Mrs Brown queried whether the amended Private minutes of the meeting held in April had been brought back to the committee for approval. Once it had been confirmed that they had not, it was noted that they would be added to the Private agenda at the next meeting. / SL
There were no other matters arising which do not appear on the agenda.
137/16 / BOARD PERFORMANCE REPORT
Executive Summary
Mr Little introduced the report.
The Committee was referred to the Executive summary on page 3 which highlighted the main points from each section
Mr Hawkins invited the Leads to provide updates on their individual areas in the first instance and then discussion would follow.
Chief Executives Performance Escalation – Acute Services
The 18 weeks Referral to Treatment performance remained above 90% for the third month with the performance of 91.8% being the highest since May 2014. Professor McLean highlighted that the key specialities which remain at risk of not meeting the 18weeks RTT are Urology, Oral Surgery and Neurology.
Treatment Time Guarantee performance showed an improvement in June with 96.6% of patients being seen within 12 weeks (a 2% increase since May). This target has not been met since November 2013. Professor McLean explained that there are numerous “at risk” specialities due to staff vacancies and the on-going demand and capacity gap, and confirmed work is ongoing with SG colleagues to resolve.
Cancer Waiting Times: 31 day cancer waiting times is showing good progress, where 96.7% patients were treated within 31 days of decision to treat. Professor McLean said that the standard has been met 14 out of the last 16 months. With regards to 62 day waiting times, performance ranges between 85% - 95% with performance at 95.1% for May. It was noted that this achievement is fragile and unlikely to be sustained in the short term.
The Outpatient Waiting Times performance is running at 96.9% with the numbers of patients waiting over 12 weeks continuing to fall. It was noted that a significant piece of work was conducted in this area and the measures put in place has enabled NHS Fife to maintain this target.
The A&E 4 Hour Waiting Times performance showed that 96.5% of patients waited less than 4 hours. This is above Standard, a position maintained since October 2015.
Professor McLean explained that there are significant and worsening issues within Diagnostics (Radiology) where 188 patients had breached the standard. He said that there are ongoing Consultant and Sonographer workforce issues which are impacting on the service. The Committee were advised that a paper is being presented to the Clinical Governance Committee on 12 August regarding this matter.
Chief Executives Performance Escalation – Health & Social Care Integration
Mrs Dobson explained that at the June census point, there was improved performance in delayed discharges where there were 58 patients in delay (80 in May) with 38 patients who have been in delay for 14 days.
Smoking Cessation saw 502 successful smoking quits in 2015/16 which was 100 short of target, but recovery actions are becoming more effective as focus continues on the 2016/17 target of 779.
Alcohol Brief Interventions continues to exceed the standard with 5,423 Interventions delivered in the year.
Mrs Dobson stated that Antenatal access performance has continued to meet the standard with over 80% of pregnant women booking antenatal care.
It is anticipated that Dementia Post-Diagnostic support will have a clear waiting list by the end of August 2016.
It was noted that Dementia Registration is above standard.
The Committee were encouraged to see improvement in performance in CAMHS Waiting Times. Mrs Dobson said that progress has continued to improve and the figure in May (86.8%) is the highest figure reported since June 2014.
Mrs Dobson stated that performance continues to improve in Psychological Waiting Times, with the percentage of patients starting treatment within 18 weeks of referral was 75.6% in May (an increase from the reported April figure). Various actions are being implemented to further improve performance in this area.
Chief Executives Performance Escalation – Board Wide
Ms Paterson provided the Committee with an update for SABS performance and stated that for the 3rd month running, standards have been met against the new targets in place. She reported that a focussed piece of work is being undertaken by NHS Fife’s infection Control Team and Health Improvement Scotland around Vascular Access Devices.
A learning session has been organised on 10th August for Senior Charge Nurses which will provide them with an opportunity to share good work and practices.
Ms Paterson also advised that the Addiction Team were providing information cards to patients showing them how to spot an infection and directing them to the Community.
Mr Hawkins reported a slight improvement in sickness absence for NHS Fife, whereby performance has dropped in May to 5.01% (was 5.04% for the 12 months to April).
Section B - Capital Programme
Mrs Potter reported that the allocation of £11m has been received for the Capital Resource Limit (CRL) and is made up of £7m formula allocation and £3.7m which is for specific projects.
The major Capital scheme taking place in 2016/17 is the replacement telephone system at a cost of £4.3m in total.
The Committee were informed that an overarching review of all assets and estates will be taking place over the next couple of months with the view to actively seeking opportunities to accelerate any asset disposals.
Section C - Financial Position
Mrs Potter explained that at the end of June, there is a reported overspend of £4.6m (against the £9.4m gap) on the Revenue Resource Limit. The key driver of the positon is the impact of unidentified savings.
A very early assessment of the year-end forecast is showing a predicted overspend of £10.4m. Mrs Potter said that her team are looking at run rate and a detailed assessment will be undertaken following the month 4 (July) results.
Section D - Scottish Patient Safety Programme (SPSP)
Dr Elliot provided a brief update on the Scottish Patient Safety Programme and informed the Committee that the Mortality target has been met. The HSMR definition has changed and a report is being prepared for the Clinical Governance Committee to explain to them.
The Committee noted that a working group has been set up to focus on falls and harms, to scope for further improvements in this area.
Dr Elliot also advised that the Tissue Viability Group are looking closely to see what they can do to assist with patients being presented to from the community with Pressure Ulcers.
Section E – Freedom of Information
The Committee noted the update report for the month of June 2016.
Section F - Complaints
Ms Paterson explained that the 3 day acknowledgement is at 100%, and the 20 day completion target was at 72% which is a significant improvement on the April figure of 45%, however, it is still below the 75% target.
There were 7 cases put forward to the Ombudsman and 4 were not taken on.
There is a lot of work being undertaken around patient opinion and an increasing number of Senior Charge Nurses and Clinical Nurse Managers are becoming “responders” and this is resulting in concerns being addressed locally, negating the need for it to be logged via the patient relations team.
The team are reviewing the impact of this approach to ensure there is clear governance and due process, whilst supporting the principle of resolution of concerns at the point of care.
Ms Paterson stated that concerns are being input as “stage 1” to formally put them in the system.
Discussion.
Mr Little invited the Committee for questions on elements of the report.
Councillor Rodger asked Professor McLean to explain the issues in Radiology.
Professor McLean stated that the department is running with only half the required workforce and demand is increasing. Locum staff have been brought in as well as support from Consultants from Tayside and Lothian to assist. He advised that discussions have been held with Forth Valley, Lothian and Tayside to scope a regional solution and discussions are now being held with Scottish Government. Professor McLean added that a paper will be presented to the Clinical Governance Committee outlining the position and then to the Board.
Dr Elliott added that there is no patient harm at this time and is confident that any risk will be managed. She added that Scottish Government have now agreed to increase Radiology training posts.
The Committee discussed and acknowledged the position and Mr Burns said that he would raise this with Chairs and the Minister.
Professor McLean confirmed that an immediate solution has been put in place while a longer term sustainable solution is established (locally, regionally and nationally).
Mr Hawkins asked for a brief update at the next meeting. / SM
Diagnostics and Radiology is vital to Acute Services and Mr Paterson asked for an update at the August Board meeting following discussions with Scottish Government colleagues.
Mr Burns advised that it was satisfying to see many compliments being received through the Patient Opinion portal and asked for this to be acknowledged. He also commented that he had done a walk-around at the Victoria Hospital and was encouraged by what he saw.
The Committee were informed that discussions are still ongoing with Scottish Government around the Treatment Time Guarantee target.
In response to a query from Mr Burns, the Committee were advised that a winter review was undertaken and a very compelling plan is in place around Delayed Discharges to reduce the number of patients and the length of time in delay.
Mr Paterson stated that the initiatives are very clear and asked if the timescales for Community Bed Redesign in September were still achievable.
Mrs Dobson responded and said that the models are in place and the team are around two thirds of the way there. She added that the IJB investment and savings plans would hopefully be signed off in the next week and this will enable them to accelerate the plans in order to meet the September timescale.
Councillor Rodger raised his ongoing concerns around Delayed Discharges.
Mr Hawkins responded by saying that good progress has been made around Delayed Discharges and said that Fife is in a much better position than last Summer. He also added that the new Director of Health & Social Care will be commencing shortly and he will bring fresh ideas to the table.
Mrs Dobson highlighted that Fife are not isolated in this position and the same problems are being encountered nationally. She stated that we really need to let the plans in place run, give them some time to be really effective and see what the outcome is. She is confident that the position will improve with the new implementations.
Mr Burns said that he conducted a walk-about of the new Intensive Psychiatric Care Unit (IPCU) at Stratheden. He said that it is an excellent facility and wondered if we are populating it with the correct patient mix and volumes. Mrs Dobson said she would investigate and report back to the next meeting. / CD
In response to a query from Mr Burns, Dr Cheshire stated that plans are in place to reduce the number of patients waiting for Psychiatric Therapies now that funding has been received from Scottish Government, but said that locating clinical space is an issue. Dr Cheshire to have a discussion with Mr Hawkins about this. / KC / PH
Mr Paterson asked when results will be seen around the SABs initiatives. Mrs Paterson explained that a six week intensive programme has seen improvements in the position already.
It was acknowledged that departments carry out individual risk assessments around sickness absence.
Mr Hawkins stated that the relaunch of a new OHSAS service is being constructed and this will commence very soon.
A detailed discussion was held around Prescribing as this is a key driver for the overspend position. Dr Elliot advised that a Senior Pharmacist from NHS Glasgow & Clyde is coming to Fife in August to look at cost per item, dispensing and volume to provide an external understanding of the Fife position.
Mr Hawkins stated that the new General Manager for eHealth has commenced employment today and she would be looking at the IT Strategy to see if any initiatives can be seen there.
Mrs Potter said that Andy Fairgrieve and Mark Doyle are looking at various transport initiatives and that she is working with them to identify opportunities for efficiency and improvement. Discussions are being held and Mrs Potter would report back to the next meeting. / CP
In response to a query from Councillor Rodger, Dr Elliot said that NHS Fife has received funding for Polypharmacy and have recruited to post. Mrs Potter added that Boards in Scotland will be receiving an allocation from Scottish Government for the New Medicines Fund (high cost drugs for specific patients).
Dr Elliot said that the Area Drugs & Therapeutic Committee (ADTC) are reviewing the Prescribing position around newly approved SMC drugs. Discussions are also being held with GP practices around efficiencies and targets. Detailed discussions are also happening at EDG, the Local Negotiating Committee (LNC) and with the public.
The Committee noted that processes could be tighter around Prescribing and that Dr Elliot and Professor McLean are leading on the Communication plan.
138/16 / EFFICIENCY PROGRAMME – UPDATE
Mr Hawkins shared a presentation with the Committee which provided his assessment of the current risks associated with the savings plans.
He confirmed that this would be discussed in detail at the Board Development session, but wanted the Finance, Performance & Resources Committee to be sighted on it in advance.
Mr Hawkins explained that he has met with Scottish Government colleagues and National Services Scotland (NSS) have been identified to support NHS Fife, with data analysis, programme management and other specific areas of expertise.
Mr Burns stated that NHS Fife needs to set a three-year programme which demonstrates what we are looking to achieve and how we plan to execute it. This recovery plan needs to be in place by September 2016 so we need to act quickly.
Mr Hawkins confirmed that some ideas are in the pipeline which need to be looked at in more detail. There is an Estates Rationalisation workshop taking place on 15th August and also a workshop with Staff Side early in September. He added that once the IJB savings plan is in place, this will inform the overall recovery plan.
Mr Hawkins stated that the plan needs to be with the Scottish Government by the end of September. At the next Finance, Performance & Resources Committee, he would therefore expect to be in a position to present this draft plan.
Mr Hawkins stated that while this is being developed, NHS Fife needs to continue to drive forward with current initiatives, in order to reduce the £9.4m gap.
139/16 / POST PROJECT EVALUATION (PPE) – QMH
This paper was carried forward to the next meeting in the absence of a representative from Estates & Facilities
140/16 / REVIEW OF POLICIES AND PROCEDURES
Mrs Potter introduced the report on General Policies and explained that of the 58 policies aligned to the Committee, 41 of these were up to date and the majority of these required Equality Impact Assessments (EQIA’s) completed.
The Committee were informed that a follow up procedure is being implemented to ensure that policies aligned to the Committee would be as up to date as possible.
The Finance and Resources Committee:
·  noted the status report on General Policies
141/16 / MINUTES FOR NOTING:
a) Acute Services Division Committee – 25 May 2016
b) Primary Medical Services Committee – 14 June 2016
The Finance and Resources Committee:
·  noted the above minutes.
142/16 / ANY OTHER COMPETENT BUSINESS
There was no other competent business to discuss.
143/16 / DATE OF NEXT MEETING – Tuesday 27 September 2016 at 09.00am, with the Activities Room, Playfield Institute, Stratheden Hospital

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