APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on Tuesday 4 October 2011 at 10.00am

in Committee Room 5, Woodhill House, Westburn Road, Aberdeen

Present

/ Councillor Bill Howatson / Non-Executive Board Member (Acting 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 Gray / Director of Finance
Mrs Jenny Greener / Non-Executive Board Member
Mrs Linda Juroszek / Non-Executive Board Member (until 11.30am)
Mrs Christine Lester / Non-Executive Board Member
Professor Val Maehle / Non-Executive Board Member
Mr Charles Muir / Non-Executive Board Member
Mr Mike Scott / Non-Executive Board Member
Mrs Elinor Smith / Director of Nursing and Quality
Mr Gordon Stephen / Non-Executive Board Member
Dr Lesley Wilkie / Director of Public Health and Planning
By Invitation / Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Mr Graeme Smith / Head of Service Development
Dr Pauline Strachan / Chief Operating Officer/Deputy Chief Executive
Mrs Susan Webb / Deputy Director of Public Health
Attending / Miss Lesley Hall / Assistant Board Secretary
Item / Subject
1 / Apologies
Apologies were received from Dr David Cameron, Professor Neva Haites and Mr Terry Mackie.
2 /

Chair’s Welcome

Councillor Howatson, as Acting Chair, welcomed everyone to the meeting. In particular he welcomed Mr Alan Gray to his first Board Meeting, having been appointed as Director of Finance from 23 August 2011. Councillor Howatson advised that this was Dr Wilkie’s last Board meeting before her retirement at the end of the year and he thanked her for all her support to the Board since she joined NHS Grampian.
3 / Minutes of Meetings held on 2 and 10 August 2011
These were approved.
4 / Matters Arising
There were no matters arising.
5 / Strategy and Planning
5.1 / NHS Grampian Health and Care Framework
Dr Wilkie introduced the item, welcoming Graeme Smith, Head of Service Development and Susan Webb. Deputy Director of Public Health, who were to speak to papers within the package of linked papers presented to the Board. She pointed out that the development of the Health and Care Framework (H&CF)was being taken forward in tandem with the strategic direction of the Scottish Government. The Board was advised that NHS Grampian’s 2020 vision approach had influenced the development of strategy in NHS Scotland.
The covering paper outlined the strategic context, resource implications and the key risks. The Board noted the four supporting papers which identified themain issues being taken forward within the H&DF.
Paper 1 - Development of the Health and Care Framework Process
Mr Smith advised that this reviewed how the process had been developed and set a clear and practical direction for planning and redesign. A key aim was to provide a framework clarifying NHS Grampian’s aims in terms of the health and healthcare system.
The paper summarised what the H&CF was and how it will support change, redesign and planning and included the following Annexes: Annex 1 - The NHS Grampian 2020 – A Possible Future; Annex 2- Opportunities and Constraints; Annex 3 – Primary and Acute Care Integration; Annex 4 - Strategy for Respiratory Care (a sample strategy document); Annex 5 Health and Care Framework Diagram
Paper 2 - Key Issues and Actions
This identified specific issues taken forward since previous discussion at the Board in April 2011. The action plan will continue to be developed as the main co-ordinating mechanism for all redesign and change activity to ensure consistency of approach. Major public engagement exercises were being undertaken through pathfinder projects. Community Planning processes with local authorities were being used effectively. The main areas of work over the next 6 – 12 months will focus on public engagement, 24 hour NHS care, ambulatory care, primary and acute care integration and the Change Fund.
With regard to capital funding, a major reassessment of priorities was required because of the general economic situation. This will have an impact on the pace of change.
Mr Smith gave reassurance that in rolling out pathfinder projects, consideration would be given to the needs of widely dispersed populations in rural areas.
The importance of keeping the public informed and involved was acknowledged. Mr Smith advised that NHS Grampian had a very good public involvement process and suggested that staff could be integral to this process as they too are members of the public. Mrs Gray advised of ongoing dialogue with staff and families and that community planning partners were crucial to the communication process. Mrs Smith advised that public involvement in the maternity review had been a very helpful part of the process.
Dr Dijkhuizen advised that lessons were being learned from pathfinder projects around working with local authorities, staff and the public. He suggested that investment was need in equipment and infrastructure, rather than in buildings. Mr Smith agreed that because of limited availability of capital, there had to be investment in new ways of working, with increased dependence on good communication and IT systems.
Mrs Smith stressed the importance of the Quality Strategy as a driver for the development of the H&CF to ensure safety and patient-centred care. She advised that the Scottish Patient Safety Programme had been very successful in engaging staff.
Councillor Bell emphasised the importance of partnerships between the NHS and local authorities.
In response to a suggestion from Mr Scott about realigning governance committee structures with the H&CF, Mr Smith advised that there was scope to simplify the action plan and identify which groups or committees were best placed to take forward or sponsor specific actions.
Mrs Juroszek encouraged engagement with professionals and independent contractors through the clinical advisory structure.
Mr Smith concluded that although the action plan was very ambitions it was achievable. Work was already underway and the plan would continue to evolve as priorities changed.
Paper 3 - Improving Health and Wellbeing Framework
Mrs Webb advised that the framework set out the guiding principles for health improvement policy and practice. The aim of the framework was to improve the health of everyone in Grampian,with a particular focus on those who are more vulnerable or who have a higher risk of serious preventable ill health. She explained the context including reports which looked at inequalities in health, early intervention and the organisation of public services. She made reference to life expectancy rates and increased expenditure on acute health care in the more deprived quintiles. The Board noted that 40% of the public service budget was spent on preventable negative outcomes. Mrs Webb cited estimated costs to the NHS of obesity, smoking and alcohol related illness and she stressed that the prevention and early detection of illness was embedded in the H&CF.
It was important to tackle inequalities and staff had to be supported to change their style and way of working. It would be necessary to work with partners and strengthen the approach to community asset building.
The paper provided illustrations of current projects and programmes producing positive outcomes such as the Huntly Kitchen,Well North and the Health Promoting Health Service.
Board members emphasised the importance of involving communities and of getting young people involved. Mrs Webb advised that the early years agenda was a priority and that the family context was important. In response to a query about what was being done regarding mental health, Mrs Webb advised that the way services were planned and delivered to ensure that individuals were supported would help tackle mental health issues.
Professor Maehle suggested that the Curriculum for Excellence and the Healthy University Initiatives would have an impact, the ripple effect of which could be substantial. Dr Wilkie advised that the partnership with the RobertGordonUniversity to involve nursing and allied health professions students in the health improvement agenda was encouraging.
Mrs Gray responded to Mr Anderson’s concern about a quarterly review of progress of health impact assessment screenings of all strategy/policy decisions, by assuring that work would be done with Mrs Webb to address this issue.
The Board agreed with the actions required identified in the paper.
The Acting Chair suggested it would be helpful for the Board to devote time in seminar mode todiscuss further the Improving Health and Wellbeing agenda.
Paper 4 –Decision making framework
Mr Gray explained that this framework provided the tools to guide and support managers to allocate resources within a finite financial envelope. The paper outlined the process by which the framework had been developed. It outlined the process for decision-making and provided guidance on using the framework. He advised that the tool would provide a structure to support decision-making but would not make the decisions. Mr Anderson commended the process as a supporting tool.
The Board accepted the recommendations in the paper, to:
Continue to support the development of the Health and Care Framework (H&CF) as the mechanism for coordinating, planning, redesign and change activity for NHS Grampian.
Consider the current key issues and endorse the H&CF action plan
Actively support the proposed approach to the improvement of health and wellbeing in Grampian
Approve the Decision Making Process for application to decision-making in NHS Grampian.
The Acting Chair concluded that the Health and Care Framework and today’s discussion had sent a very positive signal about NHS Grampian’s aspirations and he was keen for implementation to be taken forward at an increased pace. Mr Carey concurred with this and stressed that it was now important for the organisation to focus on implementation.
7 / Risk Management – Analysis of Strategic Risk 1115 – Alignment of Service Delivery to Health and Care Framework
The Chairman agreed to move item 7 up the agenda as it related to the Health and Care Framework discussed under Item 5. The strategic risk was “There is a risk that services and departments to not have an understanding of, or sufficient participation in the Health and Care Framework process.
The paper highlighted that at the outset of the H&CF process it had been acknowledged that there was a risk that multiple initiatives could take the organisation in a direction other that that determined by the Health Plan and H&CF. This would lessen the effectiveness of having agreed priorities and a way forward. Controls had been put in place to ensure a staged development of the H&CF with involvement of services. Gaps had been identified and action taken to address these.
The framework process, as discussed previously at the Board and under item 5 above, resulted in a clear articulation of the future direction. This framework has been reviewed at all levels of the organisation.
The risk continued to be reviewed by Dr Wilkie as the risk owner, and because of the controls which had been put in place, the risk had reduced from high to medium as reflected in the Datix extract in the Appendix to the paper.
Dr Wilkie concluded that risk controls were in place and adequate. These needed to be continuously reviewed as the Action Plan implementation progressed in the context of the local organisation, the wider public sector and resource-constrained environment.
The Board noted the paper and the controls in place to manage this strategic risk.
6 / Corporate Governance
6.1 / Staff Governance
6.1.1 / Staff Governance Committee Report
Mr Scott highlighted the main points from his report. He advised that a workshop to look at issues to be included in the new People Strategy was being held in 2 months. He was pleased to note continued good performance on attendance management.
The Board noted the report.
6.1.2 / Grampian Area Partnership Forum Report
Mr Stephen referred to his report and advised of the progress with implementation of Safe Affordable Workforce (SAW). A useful workshop session had taken place to undertake a (Strengths Weaknesses, Opportunities and Threats (SWOT) analysis. The outcome of this exercise would be developed into an action plan He reported on the positive staff engagement in the change process.
The Board noted the GAPFpaper.
6.2 / Performance Governance
6.2.1 / Performance Governance Committee Report
The Acting Chair reported of concerns with cancer access targets and that the Committee would be updated at the next committee meeting. Dr Strachan advised that it had been recognised that performance against targets had dropped. An action plan had been developed and was being implemented. The September 2011 position had improved and the organisation was on trajectory to meet the cancer access requirements.
Mrs Gray advised that with reference to the disappointing outcome of parts of the Participation Standard assessment, there was an opportunity for constructive dialogue with the Scottish Health Council to understand the criteria against which the assessment had been made.
The Board noted the report.
6.2.2 / Healthcare Associated Infection Report
Dr Dijkhuizen explained that the report presented a positive position. He was pleased to advise that there had been no Clostridium Difficile (C Diff) infections since October 2010 in Dr Gray’s Hospital. Overall there was a very low rate of MRSA in NHS Grampian’s hospitals.
The report summarised incidents and outbreaks. Mr Carey pointed out that presenting such information in public was not without risk of criticism. However, as an organisation it was the right thing to do in terms of openness and accountability.
Dr Dijkhuizen advised that positive lessons learned were transferred to different areas of the service. For example, progress in reducing C Diff infections had been made by ensuring staff understood what they were aiming to achieve. Compliance with antibiotic prescribing had been the biggest driver in reduction in these infections. There had been a tremendous organisational effort to improve after the first negative report by the Healthcare Environment Inspectorate (HIE) at Aberdeen Royal Infirmary.
Dr Strachan commended the staff for their contribution to improvements made which were tremendous for patients, public and staff.
Councillor Bell asked that the Board’s congratulations should be given to staff about the standards achieved. Mr Carey responded that the senior management team regularly meet staff and make a point that they are doing an excellent job.
Mrs Smith advised that the government was introducing inspections for Care of the Elderly in Acute Settings. She advised that lessons learned from the HEI inspections and work done in connection with infection control would be used to inform the work to be done
The Board noted the Healthcare Associated Infection Report.
6.3 / Area Clinical Forum Report
The Acting Chair advised that the report appeared to be self-explanatory but if anyone had any queries to contact Mrs Juroszek, who had left the meeting earlier.
The Board noted the Area Clinical Forum Report.
6.4 / Clinical Governance Committee Report
Mr Muir pointed out the main items in the Committee’s report. He advised that dental practices had made good progress with achievement of decontamination standards, with 90% having already achieved the standard.
With reference to Adolescent Care within Acute Settings, the Committee had noted that changes would be made by 1 April 2012 to raise the age limit for admission to the Royal Aberdeen Children’s Hospital (RACH) to the young person’s sixteenth birthday. In the meantime, clinicians were willing to make flexible arrangements to suit the needs of young people and their families.
Mrs Smith advised that the Committee had been assured by the General Manager at RACH that staff always looked at individuals on a case by case basis.
The Committee will continue to receive reports on collaborative working between the Children and Adolescent Mental Health Service and RACH regarding admission of adolescents to mental health wards, as no specific facility currently existed. Mr Carey advised that it was a priority of the North of Scotland Planning Group to provide a facility for Children and Adolescent Mental Health Services and the Board would be updated on this in due course.
Mr Muir concluded that the Committee received very detailed reports on the subjects presented at its meetings.
The Board noted the Report from the Clinical Governance Committee.
8 / Items for Noting
The Board noted the following reports:
Forum Minutes
8.1 / Area Clinical Forum – 29 June
8.2 / Grampian Area Partnership Forum – 16 June and 25 August
Approved Minutes
8.3
8.4
8.5 / Audit Committee – 24 June
Aberdeen City CHP – 22 June
North of Scotland Planning Group – 29 June
8.6
8.7
8.8
8.9
8.10
8.11
8.12 / Clinical Governance Committee – 27 May
Moray CH&SCP – 17 June
Performance Governance Committee – 19 July
Aberdeenshire CHP – 22 June
eHealth Committee – 13 May
Patient Focus and Public Involvement Committee – 11 May
Spiritual Care – 6 May
9 / AOCB
There was none.

Signed ……………………………………….Date …………………………………

Chair

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