APPROVED
NHS GRAMPIAN
Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session
on Tuesday 1 April 2008 at 10.00am
in Committee Room 5 Woodhill House, Westburn Road, Aberdeen
Present
/Dr David Cameron
/ ChairmanCouncillor Lee Bell / Non-Executive Board Member
Ms Margaret Burns / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Councillor Kate Dean / Non-Executive Board Member
Dr Roelf Dijkhuizen / Medical Director (from item 6)
Mrs Judith Hendry / Non-Executive Board Member
Councillor Bill Howatson / Non Executive Board Member
Mrs Elizabeth McDade / 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
Mr Mark Sinclair / Director of HR and Strategic Change
Mrs Elinor Smith / Nurse Director
Mr Gordon Stephen / Non-Executive Board Member
Dr Lesley Wilkie / Director of Public Health
By Invitation / Mr Bill Boyes / Assistant Director of Finance
Mrs Laura Gray / Director of Corporate Communications
Mr Gary Mortimer / Head of Estates (Item 5)
Mr Ewan Robertson / Board Secretary/Director of Performance Improvement
Mr Graeme Smith / Head of Service Development (Item 6.2)
Dr Pauline Strachan / Deputy Medical Director (up to Item 6)
Mr David Sullivan / Director of Corporate Planning (Item 6)
Attending / Miss Lesley Hall / Assistant Board Secretary
Dr John Reid / Chair, Area Medical Committee
Mrs Glenys Wells / Personal Assistant, Board Secretariat
Item / Subject / Action
1 / Apologies
These were received from Mrs Barbara Bruce, Dr Roelf Dijkhuizen (for items 1-5, Dr Pauline Strachan deputising), Mr Alan Gall (Mr Bill Boyes deputising) and Professor Neva Haites.
2 / Chairman's Welcome and Briefing
Dr Cameron welcomed everyone to the meeting and reported that NHS Grampian had been designated as one of three Boards, along with Western Isles and Ayrshire and Arran, to run a pilot MRSA screening programme and wished to thank the staff who would be involved in the challenging work around this agenda.
He commended Mrs Laura Gray and the Corporate Communications team for the work put into responding to the Local Healthcare Bill consultation, which had closed that day. He also thanked Board members, staff and public for their involvement in the consultation process.
3 / Minute of Meeting held on 5 February 2008
The minute was approved.
4 / Matters Arising
Item 7.1 – Dental Action Plan Consultation: Councillor Bell advised that he had had a meeting with the Regional Manager for Scottish Water to discuss fluoridation. Dr Wilkie advised that historical data might be available and she would ask the Consultant in Dental Public Health to investigate any effect of fluoridation on oral health. / LW
5 / Carbon Management Programme
Mr Carey introduced the item by explaining NHS Grampian’s responsibility to minimise its carbon footprint and referring to the involvement in the NHS Carbon Management Programme in association with the Carbon Trust. He advised that the energy resources consumed by NHS Grampian were equivalent to the town of Inverurie and therefore there was scope for more effective and efficient carbon management.
He introduced Mr Gary Mortimer, Estates Manager, who was leading the work for NHS Grampian.
Mr Mortimer referred to his paper which gave an update on the work being done. He gave a powerpoint presentation during which he explained the Programme overview, targets and work streams, the current focus and benefits and challenges. He explained that the background to the Programme was the Environmental Policy for NHS Scotland issued in April 2006. He referred to the five stage programme from mobilisation of the organisation to implementing the plan. He referred to graphs showing business as usual compared to following the carbon management plan, which over 10 years indicated potential savings/cost avoidance of £15.44 million and potential savings of 103,686 tonnes of carbon emissions. He advised of initiatives including recycling at Dr Gray's hospital, installation of low energy lighting, and the replacement of domestic hot water systems to reduce energy use and improve control of legionella. He also advised of the Travel plan review.
He reported on progress with the Outline Business Case relating to the replacement energy centre for the Foresterhill campus, explaining the potential carbon savings of the two main options. He explained the importance of carbon management in new builds and refurbishments. According to The Carbon Trust, investing an additional 3 -10% on capital build cost could achieve reductions of 5 - 25% in operational costs.
He concluded his presentation by highlighting the key benefits and challenges.
Key Benefits:
· Cost savings/avoidance
· Corporate responsibility and reputation
· Mitigation of regulatory impacts
· Organisational engagement
· Wider public and private sector opportunities
· Peace of mind
Key Challenges:
· Maintaining momentum and enthusiasm
· Whole system capacity
· New ideas generation and not just traditional forms of energy savings
· Ownership and deliverables beyond Estates and Facilities
Following his presentation, Board members congratulated Mr Mortimer and his team for their accomplishments.
In response to queries about what the Board could do to support the work, Mr Mortimer stressed the importance of providing appropriate resource to fund the programme and of including carbon management in senior executives’ objectives. He was pleased to have had the opportunity to present to the Board at this meeting and sought support to maintain momentum. He explained that momentum was being kept up throughout the organisation for example in Team Brief articles.
Mr Mike Scott declared an interest in respect of his directorship of Aberdeen Heat and Power Ltd and also being on the Board of SCARF (Save Cash and Reduce Fuel). In that capacity he wished to offer the support of a Sustainable Energy Forum which was being set up.
Councillor Dean declared an interest as the Council’s representative on the Energy Renewable Group.
Councillor Bell stressed the benefits and cost savings over time of the work being done by Mr Mortimer and his team.
Dr Wilkie suggested that another key benefit could be the long term benefit to public health.
In response to a query form Mrs Hendry about the use of disposable instruments to prevent cross-contamination, Mr Mortimer responded that there had been an increase in the tonnage of waste as a result of this. One steam of work was waste management and it was necessary to see if there were opportunities to reduce waste to make savings.
Mr Mortimer hoped that business cases would accurately reflect whole life cycle costs, including an assessment of carbon impact by each assessed option. He explained that the aim was for the Emergency Care Centre development (which was to be discussed next on the agenda under Item 6.1) to follow the relevant guidance at the detailed design stage.
Dr Cameron concluded the item by reassuring Mr Mortimer that he had the support of the Board. He echoed the congratulations of other Board members for Mr Mortimer and his team’s achievements so far, including coming first in the NHS Scotland Energy and Environmental Awards 2007, following which the Board gave him a round of applause.
The Board noted the report and agreed to support the ongoing work.
6 / Strategy and Planning
6.1 / Emergency Care Centre Outline Business Case (OBC)
Mr Sullivan introduced the item by pointing out that the Business Case had been some time in development and referred to the input by Mr Graeme Smith, Project Director for the Health Campus Programme and Mr Milne Weir, Project Manager.
He did not wish to underestimate the extent to which the document was a key milestone in delivering NHS Grampian’s strategy. He handed over to Mr Smith, who gave a powerpoint presentation in support of his paper and highlighting the main aspects of the draft Outline Business Case and appendices. He thanked members of the team who were attending the meeting: Mrs Gerry Lawrie, Workforce Development and Redesign Manager, Mr Milne Weir, Project Manager and Mr Gary Mortimer, Estates Manager.
Mr Smith reminded the Board that it had approved the Initial Agreement for the Health Campus Programme at its meeting on 5 February 2008. The Initial Agreement had subsequently been approved in March 2008 by the Director-General Health and Chief Executive NHS Scotland, which allowed for the development of component parts of the Initial Agreement and proceed to Outline Business Case where appropriate.
He stressed the aims of the project were to integrate unscheduled care services, to put patients at the centre of services, replace outdated inpatient facilities and also to support the Grampian system.
Mr Smith explained the project in the context of the Health Campus Programme. He then advised that the influences included anticipated activity shifts, the potential for more care in local areas, the uncertain impact of increasing elderly population and technological developments and the anticipated future investment in buildings and equipment.
The aim was to redevelop Aberdeen Royal Infirmary and make Foresterhill fit for the future. He advised of the proactive and strategic approach to investment and outlined the facilities costs for 2008 – 2018 totalling over £375 million.
He referred to the significant involvement of staff and the public around the ECC in the context of the Health Campus Programme and advised that the proposals had been reviewed by Internal Audit and the Scottish Government Health Directorate.
The preferred option represented the best value for money and was part of a balanced programme which included: Diagnostic and Treatment/Intermediate Care, Primary Care Premises investment, reshaping Woodend and Dental Services.
The proposals provided a focus for unscheduled care, with patients at the centre and with better access and links.
He highlighted the key points:
o £83m capital cost + optimum bias
o £4.8m revenue
o Replacement of approximately 250 beds
o Capacity for approximately 70, 000 attendances
o Workforce plan for approximately 500 staff directly
o Target completion – end of 2011
He concluded his presentation by advising of the next steps in the process. If the Board approved the OBC, it would be referred to the Health Directorate for approval and, if approved, would proceed to Full Business Case.
Following Mr Smith’s presentation, Board members were given the opportunity to ask questions.
In response to a query from Mr Muir about support from the workforce and partner organisations, Mr Stephen advised that staff had been fully engaged in the process and were supportive of the developments. Mr Sinclair advised that it would provide a great opportunity for staff to work in a new building and for changes in culture and workforce redesign.
Councillor Howatson referred to the helpful briefings that had been given to Non-Executive Board members by Mr Smith and his team. In response to Councillor Howatson’s query about the approval process, Mr Smith and Mr Sullivan explained the involvement of the Health Directorate and advised that further discussions would be required with colleagues there about funding issues, although early indications were that there would be flexibility around capital allocations to support the project.
Councillor Howatson also raised a query about the percentage of single beds being planned at 75%, whereas the Health Directorate guidance was for 100% single rooms in new developments. Mr Smith advised that from discussions within the project and consultation with the public, 75% appeared to be a reasonable compromise to give a high degree of privacy and flexibility. This was an issue which will be subject to discussion with the Health Directorate. Dr Dijkhuizen pointed out that many patients liked to share a room and he explained there were advantages and disadvantages of having single rooms. He explained that at present there were about 20% single rooms, so there would be a vast improvement in these facilities whichever option was followed.
Mr Sinclair advised that the requirement for single rooms would not require additional workforce. He advised that the workforce plan was a key element of the OBC and would address workforce demands and training requirements.
Mrs Hendry pointed out that clinical practice would change in a different environment and it was necessary to ensure Higher Education Institutions were engaged in training people differently, with new roles being developed. She emphasised that a whole system approach involving primary care was required.
Dr Dijkhuizen stressed the importance of supporting the proposals to bring the Foresterhill facilities up to modern standards, following years of under-investment. He emphasised the need to give the project a high profile to secure funding in a highly competitive market for capital resources.
In reply to Ms Burns’ query about future-proofing the development, Mr Smith responded that it was a difficult issue to get the size of a new hospital right, because of the variables regarding capacity and demand. He explained that the staged approach gave the opportunity to take stock at various points to inform the next stages. He stressed that it was necessary to develop other parts of the Health Plan work, such as capacity in the Community Health Partnerships (CHPs). He pointed out the importance of the appropriate use of NHS Grampian services and of developing the public's knowledge and understanding of how they should access these services. He advised that a seminar on this topic was planned for 11 April 2008 at which initiatives in England would be looked at.