Nhs Argyll and Clyde

Argyll & Bute CHP

Committee Meeting 12/04/07

Item 6.1

NHS Highland

Argyll & Bute CHP Management Team Meeting

Thursday 22nd February 2007, 10.00am, Large Meeting Room, Mid Argyll Hospital & ICC


Erik Jespersen (Chair) (EJ), David Logue (DLo), George Morrison (GM), Anne Helstrip (AH) Michael Hall (MH), Moira Newiss (MN), Josephine Bown (JB), Grace Fergusson (GF), Stephen Whiston (SW), Pat Tyrrell (PT), (JH), John Lyon (JL), Robin Creelman (RC), Sylvia Moran (SM), Joyce Robinson (JR), Robbie Paterson (RP), John Dreghorn (JD), John Herrick (JH), Anne Campbell (AC), Jean Knowles (JK)

In attendance:

Christine Gosman (CG), David Ritchie (DR),



Agenda Item




By Whom


Welcome & Introduction

/ Erik Jespersen welcomed everyone to the meeting noting that in the General Managers absence, he would be Chairing the meeting. /
1.0 / Apologies / Fiona Ritchie, Viv Smith, Elaine Garman, Alan Henderson, Jim Robb, Douglas Philand, Brian McLachlan.
2.0 / Minute from Previous Meeting / EJ stated that Elaine Garman had sent some additional information to add to the Minute regarding the progress of the Local Enhanced Service for alcohol.
Subject to these additions, the Minute was agreed as an accurate recording of events. / CG
3.0 / Matters Arising /
Awaiting outcome of pilot on Bute – further feedback as appropriate.
New job description written for Lead Pharmacist, in conjunction with NHS Highland Pharmacy Team.
Establishment of Argyll & Bute ADAT
EG subsequently found out that this item did not get taken at the NHS Highland Board Meeting. Erik Baijal has agreed to make sure that this is put on subsequent agenda to be progressed. / JB
No / Agenda Item /
/ By Whom
3.0 / Matters Arising /

Argyll & Bute eHealth Steering Group

EJ stated that any initiatives or ideas for projects are most welcome and should be sent directly to him or Fiona Ritchie for input into this group.
Waiting times – ENT Clinic OLI
There are hopes to recruit to a OLI//VOL post to cover 7 sessions in OLI
Developing Community Hospitals
PT confirmed she had commenced visits throughout the area.
OLI - Switchboard concerns
MN confirmed that a meting had taken place with Douglas Seago in attendance. It has been agreed to continue to monitor incident levels. It was agreed that an A&B CHP Rep. Should be regularly attending any subsequent meetings. JD agreed to progress this issue.
Dementia Services
JB and JD confirmed they would be taking a paper to the March 2007 Core Team meeting to discuss financial aspects, joint working with Local Authority etc.
Children’s Services
PT confirmed that she had received a draft copy of the visit report from HMIe for comment by 2nd March 2007. The final report will be presented to the Management Team when available.
Public Health – Sexual Health Development
It was agreed to split the allocation and distribute to localities. / ALL
AC / LMs
4.0 / Performance
4.1 Waiting Times / SW spoke to a previously circulated paper, which gave background and detail on the current waiting times position. SW stated that further to previous discussions, the transfer of responsibility for Helensburgh & Lomond patients had been made to NHS Greater Glasgow & Clyde (for their clinics). It was stated that the General Manager had accepted that this was a logical move and that the previously circulated Annexe to the Waiting Times report showed the outpatient waiting time schedule for the Clyde Acute Directorate of NHS Greater Glasgow & Clyde. SW informed the Team that he and SM were progressing the collection of data for all Greater Glasgow & Clyde waiting times to ensure that Argyll & Bute Patients are in no way disadvantaged. / SM / SW
No / Agenda Item /
/ By Whom
4.1 Waiting Times Ctd. / Some discussion followed regarding demand management information. SW confirmed that the Waiting Times Management Group are beginning to look at aspects of demand management to inform future discussion/report preparation.
More debate then took place regarding the lack of control of resources deployed to clinical workload other than the initial SLA agreement process although full responsibility for the outcome of these (possibly negative) remains with the CHP.
SW informed the Management Team that a Waiting Times Conference was being held at the Beardmore Hotel w/c 26th February and that himself and Moira Newiss were to attend and would feedback at the next MT meeting. / SW / MN
4.2 Balanced Scorecard / SW spoke to a previously circulated paper, which noted the performance of Argyll & Bute CHP against the indicators set within the context of the Local Delivery Plan and a number of other supplementary performance measures.
2.02.K Sickness and Absence
DLo highlighted the fact that performance this period shows a significant improvement from the previous month and for December we now meet the target. The MT welcomed this information.
Completed Complaints
PT indicated that A&B CHP still were 20% short of the target for this indicator although more detailed reports had been requested from NHS Highland to ensure local disaggregation of data.
Dental Registrations
SW explained the new measures being brought into place for next year. There was much discussion regarding the dental service as a whole within Argyll & Bute. JH outlined the work being done to produce business cases for dental suites in Campbeltown and Oban. It was agreed that a presentation on Dental issues to the Management Team would be welcomed in June 2007.
Non Clinical cancellations
SW confirmed that information on non-clinical cancellations would be ready for presentation to the MT at the next meeting.
Mr Whiston concluded his presentation by stating that the template for the new Balanced Scorecard would be available shortly and that he would bring this to the next meeting of the Management Team. / JH
No / Agenda Item /
/ By Whom
5.0 / Cancer Tracking / Sylvia Moran spoke to a previously circulated paper, which gave background to the targets set as part of the Scottish Executives Cancer plan. She outlined the reporting arrangements (weekly mandatory, quarterly audit and balanced scorecard reports). She reviewed the steps taken to improve information flow throughout the area and also detailed the patient flows. Mrs Moran detailed the continuous learning throughout NHS Highland commenting on the following issues:
·  Adequate resources
·  Interpretation of definitions
·  Effective multi disciplinary team working
·  Co-operation from other partner organisations
·  GPs sending urgent referrals quickly
·  Application of appropriate referral protocols
The Team agreed that this was the single biggest issue in terms of performance. Much discussion followed regarding the integrity of the figures quoted, although Mrs Moran felt sure that the clinical audit figures were accurate. The Team discussed the issue of ‘urgent’ referrals and the potential of consultant downgrading of patient status. Some debate followed regarding the differing policies of Health Boards regarding this subject and it was agreed that EJ would raise this issue with the Chief Operating Officer of Acute Services within NHS Greater Glasgow & Clyde.
MN discussed the new cancer referral guidelines stating that she had been given the lead for this within the CHP. She stated that she intended to write to GP practices to explain the targets and raise awareness of the National Referral Guidelines. SM confirmed that she would link this work into the Gpass facilitators with regard to electronic referrals/SCI. The team agreed that the data from the audit work would provide interesting reading. / EJ
6.0 / Finance Report
6.1 Revenue Position / George Morrison spoke to a previously circulated paper, which detailed the financial position for the 10 months ended 31 January 2007; with Argyll & Bute CHP recording a net underspend of £579,000. He stated that this represents an increase of £245,000 on the underspend of £334,000 recorded at the end of December and is in line with the trend of an increasing underspend. He stated that the main causes of the net underspend continue to be those reported in previous months ie underspends on GMS and prescribing budgets offset by overspends on some hospital services budgets and individual care packages.
No / Agenda Item /
/ By Whom
6.2 Savings Plan
6.3 Endowments / Mr Morrison informed the Team that he was continuing to forecast an outturn of a £500,000 underspend for the CHP in 2006/07. However, as highlighted in previous finance reports, there are a number of outstanding issues to resolve which may significantly impact on this forecast. He stated that the main area of concern continues to be the outstanding agreement with NHS Greater Glasgow & Clyde for services provided by that Board. The Service Agreement with NHS Greater Glasgow & Clyde contains a large number of constituent parts and the combined total value is estimated at £41m. Until this value is agreed, this represents a significant outstanding financial risk to the CHP. However, it should be noted that if negotiations with NHS Greater Glasgow & Clyde are concluded with settlement in line with budgetary provision, it is likely that the CHP’s year-end position will improve favourably from the forecast £500,000 underspend. After some discussion regarding this last item, Mr Morrison stated that a full presentation of the management consultant’s (Tribal) report could be given at the next Management Team meeting. It was agreed that this would be very helpful.
George Morrison spoke to a previously circulated document, which detailed progress to the end of January 2007 on the achievement of the Argyll & Bute CH savings targets. In summary, of the £1.723m target, £1.637m has been declared as achieved, leaving a net outstanding balance of £86,000 to be achieved. With regard to specific targets;
§  The vacancy management target of £0.5m non-recurring has been fully achieved.
§  The slippage on developments target of £0.323m non-recurring has been significantly over-achieved. This has compensated for the non-achievement of savings on management and corporate services, albeit on a non-recurring basis.
§  The outstanding balance to be achieved is in Hospital & Community Services, with 3 localities yet to identify savings to enable full achievement of the targets set for them at the start of the financial year.
George Morrison spoke to a previously circulated document, which gave details of the Argyll & Bute CHP endowment funds to 31st December 2006. Mr Morrison stated that it was his intention to bring the production of this report ‘in house’ which would allow for some major updating of fundholders details etc. and would provide a much more relevant publication. / GM / SW
No / Agenda Item /
/ By Whom
7.0 / Reprovision of Palliative Care Services in Helensburgh & Lomond / Anne Helstrip spoke to a previously circulated document, which gave some detail to the proposed changed in the re-provision of palliative care services in the Helensburgh & Lomond Locality. Mrs Helstrip detailed the proposed plan and its relevance to the Helensburgh and Lomond Locality Community Infrastructure plan, noting the need for caution regarding fixed costs ties and the requirement for degrees of flexibility. Some discussion took place, which clarified the service framework principles and the collaborative working that would be required with Care Homes to support and improve the care for patients within that setting also the grade of staffing as detailed in the paper. AH confirmed that this was to reflect the educational role and link with acute services. The Management Team noted the changes as detailed in the document and approved the changes for implementation. / AH
8.0 / Local Transport Strategy for Argyll & Bute / Stephen Whiston spoke to a previously circulated paper, which detailed the draft strategy for Transport 2007/10 (Argyll & Bute Council). Mr Creelman stated that it was important not to underestimate the importance of this strategic consultation. EJ asked if Jean Knowles would be interested in being the Clinical Lead for this issue, liaising with SW in producing a response. JK agreed that she would be happy to be involved. RC agreed that he would lead the PPF response. EJ asked that all comments on the consultation be sent to SW by 5th March 2007 to allow a full response to be provided.
Further Transport Issues
Mr Whiston informed the Team that he was currently working with David Ross to produce an outline procedure for local transport providers to bid against capital monies within the Argyll & Bute CHP / JK / SW
9.0 / Locality Reports
9.1 Mid Argyll, Islay & Jura
9.2 Cowal & Bute / ·  Islay Health Living Centre – funding agreed in principle from within the HIF monies – agreement to forward to the Big Lottery Fund
·  Campbeltown – 2 responses for the A&E tender
·  Mid Argyll – Wendy Mowbray now Lead Nurse for Older Peoples Services, Alana Straughan is Acting Clinical Services Manager
·  Argyll & Bute Hospital – personnel issue
·  Delayed Discharges – remaining 3 in Cowal & Bute require nursing home care