APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on Tuesday 5 February 2008 at 10.00am

in the Conference Room, Aberdeen Foyer, Marywell Street, Aberdeen

Present

/

Dr David Cameron

/ Chairman
Councillor Lee Bell / Non Executive Board Member
Mrs Barbara Bruce / 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
Mr Alan Gall / Director of Finance
Professor Neva Haites / Non Executive Board Member (from 10.30am)
Councillor Bill Howatson / Non Executive Board Member
Mrs Elizabeth McDade / Non-Executive Board Member
Professor Val Maehle / Non Executive Board Member (from 11.30am)
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 / Ms Anne Cargill / Group Nurse Manager (Item 5)
Mrs Laura Gray / Director of Corporate Communications
Ms Jennifer Mack / Organisational Development Manager
Mr Ewan Robertson / Board Secretary/Director of Performance Improvement
Mr Graeme Smith / Head of Service Development (Item 6.2)
Mr David Sullivan / Director of Corporate Planning (Item 6)
Dr David Williams / Clinical Lead, Patient Safety (Item 5)
Mr Ray Watkins / Consultant in Dental Public Health (Item 6.2)
Dr Diana Webster / Consultant in Public Heath Medicine (Item 9.4.3)
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wells / Personal Assistant, Board Secretariat
Item / Subject / Action
1 / Apologies
These were received from Mrs Judith Hendry.
2 / Chairman's Welcome and Briefing
Dr Cameron welcomed everyone to the meeting and reported that he had attended the National Chairs' meeting the previous day which had been a positive. He advised that the budget allocations for 2008/09 would be intimated by 6 February 2008.
3 / Minute of Meeting held on 4 December 2007
The minute was approved, subject to the following amendment: Item 5.2 paragraph 3 to read: "He advised that Mr Gall was leading a group in NHS Grampian discussing the potential impact of the centralisation of Tertiary Services…"
4 / Matters Arising
There were no matters arising.
5 / Scottish Patient Safety Programme
Mrs Smith introduced the item with reference to her paper which explained the work being undertaken in NHS Grampian in implementing the Scottish Patient Safety Programme.
She advised that the aims of the programme were to:
·  Reduce mortality by 15% in three years
·  Reduce adverse events by 30% in three years
She explained that the five basic programme objectives were to:
·  Reduce healthcare associated infections
·  Reduce adverse surgical incidents
·  Reduce adverse drug events
·  Improve critical care outcomes
·  Improve the organisation and leadership on safety
She advised that some of the key members of staff involved in the programme were present at the meeting – Ms Helen Robbins, Head of Clinical Governance; Mrs Jenny Ingram, Programme Leader and Dr Pauline Strachan, Deputy Medical Director.
She introduced Dr David Williams who gave a powerpoint presentation on Patient Safety within NHS Grampian. He explained how risky healthcare was compared to other activities, with 1 in 10 patients in an acute setting at risk of an adverse event. He pointed out that it was a global issue, providing statistics of comparisons with other countries. He gave information from an Adverse Events Study and pointed out that 37-51% of adverse events were preventable.
He contrasted the health service with the aviation industry, explaining that aviation expected things to go wrong and designed systems to compensate, whereas the health service expected things to go right and seldom designed in safety factors. He suggested the health service could learn from other high risk industries such as the aviation and oil industries.
He explained that healthcare professionals wanted the best for their patients and often mistakes were made because of system failures, referring to a diagram of the latent failure model of complex system failure.
He went on to explain the NHS Grampian developments including working with the two local Universities, pilot of Senior Charge Nurse Review/Quality Indicators, development of training opportunities for staff in patient safety, implementation of the risk management information system (Datix) and beginning the work of the national Patient Safety Alliance. A Patient Safety Strategy had been approved in May 2006 with a Steering Group having been set up in December 2006. Work was being carried out on key priority areas of:
·  Patient identification
·  Medication
·  Falls
·  Infection Control
The Back to the Floor initiative had been introduced in June 2007 and Patient Safety Walkround pilots had begun in April 2007. A successful meeting had been held with the Community Forum in November 2007.
He concluded that Patient Safety was already a priority for NHS Grampian; the aim was to incorporate the National Patient Safety work with current ongoing work within Grampian; and the model for improvement was different and required support from NHS Grampian.
In response to a query about the model being different, he explained that the methods being used to implement patient safety were supporting work already being done and that a number of models from the United States were being considered.
He explained that part of the national work was to undertake a survey of the culture in the NHS in Scotland, to establish the current position regarding patient safety and reporting of incidents. This would provide a baseline for measuring any change in culture.
Mr Mark Sinclair, Director of HR and Strategic Change, pointed out the importance of cultural change and the need for staff to work differently. He emphasised the need to develop work around culture and leadership, suggesting working in collaboration with the University of Aberdeen and the Institute for Healthcare Improvement (IHI).
Mrs Smith advised that she did not see any difficulty in engaging with staff in this very important area of work. She advised that a number of clinicians had attended a recent learning event and had shown great enthusiasm.
The Chairman welcomed Ms Anne Cargill, Group Nurse Manager, who gave a brief overview of the Back to the Floor initiative, which aimed to improve the patient’s experience regarding quality and safety. She explained that since June 2007 senior nurse managers in the acute sector had been spending one day per week or per fortnight supporting and coaching clinical staff in their workplace. The initiative had been evaluated by the Robert Gordon University and Ms Cargill tabled copies of the booklet 'Evaluation of Phase 1 of “Back to the Floor”: NHS Grampian Acute Sector'.
Ms Cargill advised that initial concerns such as the clinical competence of participants, role clarity, workload and uniforms had largely been overcome. From a personal perspective, she reported that she had found it enjoyable and valuable. As well as aiming to improve patient safety, it provided an opportunity to see the good work being done by staff and to give positive feedback, which was highly motivating.
She advised that the initiative would continue, with a formal remit and in conjunction with the Charge Nurse Review which had started at the same time. She reported that other disciplines thought the process was valuable and were looking at doing something similar.
Mr Scott warned that staff could be overwhelmed by the number of audits undertaken and suggested it was important to ensure they were properly managed. He asked if there would be any benefit in Non-Executives participating as he would be interested in doing so. Ms Cargill advised that Board Members were welcome to accompany any Back to the Floor visit as staff welcomed them spending time in clinical areas and showing an interest in what they were doing. Dr Williams stated that Board Members were also welcome to participate in the Patient Safety Walkrounds.
In response to a query from Dr Wilkie about similar initiatives in Primary Care, Ms Cargill advised that the plan was to include the whole of NHS Grampian and it had started in the Acute Sector because it had been easier to organise. Work had begun in Primary Care with senior nurses working with District Nurses, but the wide dispersal of services in Primary Care made it more difficult to organise.
Mr Carey explained that he was delighted that NHS Grampian was talking about Patient Safety at a strategic level. It gave him an opportunity to remind people of the core purpose of the NHS to deliver safe and effective clinical care. As far as he was concerned Patient Safety and Back to the Floor were what NHS Grampian did as part of its embedded activity. He hoped the public was reassured that work was being undertaken with clinical leadership to continue to improve services to patients.
The Board acknowledged the progress to date with Patient Safety, including Back to the Floor, and supported the continued implementation of this priority area.
6 / Strategy and Planning
6.1 / Better Health Better Care Action Plan Update
Mr David Sullivan, Director of Planning, referred to his paper and advised the Board the aim was to formally present the Scottish Government’s “Better Health Better Care: Action Plan” to the Board. He advised that the Action Plan had been launched by the Cabinet Secretary on 15 December 2007.
The Action Plan comprised three main sections;
·  Towards a Mutual NHS
·  Improving Scotland’s Health
·  Improving Quality
The key themes had been set out in the template attached to his paper. He stressed the importance of not creating a separate industry in responding to the Action Plan and to capture where work was already ongoing and to relate this back to Better Health Better Care.
He advised that the completed template would be presented to the Operational Management Team (OMT) and thereafter the Service Strategy and Redesign Committee (SSRC). The Board would be given reassurance through the Performance Governance Committee (PGC).
Mr Sullivan advised that a workshop was being arranged for 19 March 2008 to reflect on the progress made in implementing NHS Grampian’s Healthfit strategy in the context of Better Health Better Care. He advised that the completed template would form part of the background information to underpin these discussions.
Mr Gall suggested there were centralised issues in the Action Plan and it was necessary for NHS Grampian to work with the Scottish Government Health Directorate to contribute to national initiatives. Mrs Smith stressed the need to continue to work with the Scottish Government with regard to items 1.4.b and 1.4.e of the template i.e.
·  Expand the coverage of MCNs and strengthen them, as appropriate, to implement improvements in neurosurgery, laboratories and specialist children’s services
·  Assess 4 pilots of a new model of nursing in the community and make a decision about the roll out in Spring 2009
Dr Dijkhuizen pointed out the need to include community planning partners in the process. Dr Wilkie emphasised that joint working around the Single Outcome Agreements in local authorities was essential, particularly where staff posts were jointly funded.
Ms Burns emphasised the importance of the Board being kept informed of actions being taken forward. Professor Haites suggested that the OMT should agree the response prior to formal presentation to the Board.
Following the discussion, the Board:
1.  Noted the Better Health Better Care: Action Plan launched by the Cabinet Secretary in December 2007
2.  Agreed to set out how the aims of the Action Plan will be taken forward in NHS Grampian using the suggested template and building on existing activity wherever possible
3.  Agreed that implementation of actions required will be managed by the OMT and that progress will be updated and monitored by the SSRC and PGC, with direct reports being made to the Board.
6.2 / Health Campus Programme
Mr Sullivan introduced the item and asked Mr Graeme Smith, Head of Service Development and Mr Ray Watkins, Consultant in Dental Public Health, to lead the discussion on the items under this heading.
6.2.1 / Revised Initial Agreement for Health Campus Programme
Mr Smith gave a powerpoint presentation in support of his paper which explained that the Health Campus Programme was a major component of the Change and Innovation Programme. He advised that the original Programme Initial Agreement had been approved by the Board in December 2006 and amended to take account of the outcome of the Foresterhill masterplan process and more detailed planning in connection with current high priority projects. He explained the various influences relating to the programme, activity shifts, CHP developments and the anticipated investment requirements. The draft Initial Agreement document, which accompanied his paper, had been approved by the Health Campus Programme Board and the Asset Investment Group.
He advised that the concept had been shaped through public and staff consultation, and outlined the various groups which had been consulted
The formal approval of the Initial Agreement was necessary before any of the Programme's Outline Business Cases could be approved. He gave a summary of the four current high priority projects, indicating the interlinks between them, namely: Aberdeen Dental School, Emergency Care Centre, Aberdeen Health and Care Village and MRI/Outpatients/Endoscopy Centre.