APPROVED
NHS GRAMPIAN
Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session
on Tuesday 6 February 2007 at 10.00am
in Committee Room 5, Woodhill House, Westburn Road, Aberdeen
Present
/Mr Jim Royan
/ ChairmanMrs Barbara Bruce / Non-Executive Board Member
Dr David Cameron / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Dr Roelf Dijkhuizen / Medical Director
Mr Alan Gall / Director of Finance
Mrs Judith Hendry / Non-Executive Board Member
Mrs Elizabeth McDade / Non-Executive Board Member
Mr George McIntyre / Non-Executive Board Member
Professor Val Maehle / Non-Executive Board Member (from 11.10am)
Mr Charles Muir / Non-Executive Board Member
Mr Mike Scott / Non-Executive Board Member
Mrs Elinor Smith / Director of Nursing
Mr Gordon Stephen / Non-Executive Board Member
Dr Stuart Watson / Non-Executive Board Member
Dr Lesley Wilkie / Director of Public Health
By Invitation
Mrs Laura Gray / Director of Corporate Communications
Ms Jennifer Mack / Organisational Development Manager
Miss Joan Milne / Unit Nurse Manager (Item 7.1.1)
Dr Susan MacPhee / Consultant in Public Health Medicine (Item 7.1.1)
Dr Melvin Morrison / Chair, Research Ethics Committee (Item 7.3.1)
Mr Ewan Robertson / Director of Performance Improvement/Board Secretary
Mr David Sullivan / Director of Corporate Planning (Item
Attending / Miss Lesley Hall / Assistant Board Secretary
Item / Subject / Action
1. /
APOLOGIES
These were received from Councillor Raymond Bisset, Ms Margaret Burns and Councillor Kate Dean.2. / CHAIRMAN’S WELCOME
The Chairman welcomed everyone to the first formal Board meeting of 2007. He particularly welcomed the two new Non Executive Board members who had been appointed with effect from 1 January 2007 – Mr Charles Muir and MrMikeScott. The Chairman advised that Councillor Bisset had undergone a minor operation the previous week and that he had passed on the Board’s wishes to him for a speedy recovery. He reported on issues discussed at the Minister’s meeting with Chairs the previous week, including Managing Medical Careers (MMC) and delayed discharges. He advised that he would circulate the Minister’s letter following the meeting to Board members for them to use.
The Chairman referred to the announcement the previous week relating to the financial allocations for 2007/08 and advised that NHS Grampian had been allocated an annual uplift of 6.74% amounting to more than £39 million. This was some £4 million more than had been planned for and had resulted from changes in Grampian's population profile. He referred to the good financial management within NHS Grampian and the helpful contribution the clinical community had made towards that. He advised that the rigour around financial management had to continue.
3. / MINUTE OF MEETING HELD ON 5 DECEMBER 2006
This was approved.
4. / MATTERS ARISING
Item 7.1 – Performance Governance Committee Report - the Chair advised that he and Mr Robertson had attended meetings regarding Citistat and, as the process developed, a report would be made back to the Board at an appropriate time. / J Royan
E Robertson
5. / PUBLIC HEALTH
5.1Director of Public Health Report 05/06
Dr Wilkie explained that the production of the report had been delayed to allow her time from her appointment in 2006 to ensure the report had local references and to ensure readability. She explained it was an independent report on the health of the people in Grampian and was a report for NHS Grampian and for the three Local Authorities, as she acted on their behalf as well. She advised that it was a team report and drew attention to the acknowledgements at the end. The report was a statutory requirement, which provided an independent assessment on the health of the people of Grampian and identified areas where action was required to maintain or improve health. She advised that a large section of the report dealt with statistics which provided information on culture, environment, people and demography. She drew attention to some significanthealth areas and highlighted firstly drug misuse as an area to address, pointing out that it was a problem of affluence as well as deprivation. She advised that under the topic of Sexual Health, reducing teenage pregnancy rates was a challenging target. She pointed out that it would be useful to have more detailed local statistics relating to breast feeding. With regard to screening programmes, although Grampian was a leader in the uptake for cervical screening, it was necessary to maintain vigilance on this and other screening programmes.
With regard to making choices, she emphasised that resources for health care were limited and it was necessary to consider the overall health needs of the population and issues of equity. She cited an example of recent media interest about Herceptin drug use in breast cancer. She explained that the women with early breast cancer were highly visible, but the people who would be harmed if Herceptin were funded,because they would be deprived of care, were invisible. She referred to the section of the report on obesity and advised that NHS Grampian was taking forward a healthy weight strategy. She pointed out that it was necessary to look at people’s daily life, the environment, transport strategies and employment, and ways of changing the environment to address this key public health issue.
She advised that there was a rising prevalence of diabetes linked to the rising prevalence of increased weight. She was encouraged by the public health approach of the managed clinical network for diabetes, pointing out there was excellent work being done in Grampian. She stressed the importance of screening eyes and also the podiatry service as essential services for diabetics.
She drew particular attention to the section of the report on alcohol and suggested that further local information was required. This was a topic she wished to take back to the Board at a future date. She advised that there were difficulties in Grampian with regard to binge drinking and that Grampian was above the Scottish average for emergency admission rates for people with primary or secondary diagnosis of acute intoxication and harmful use. She pointed out that drug misuse hit the headlines more often than alcohol abuse, but emphasised the major impact of alcohol abuse on our society and advisedthat the gap was widening between Scotland and the rest of Europe. She advised that action had to be taken in response to the Alcohol Action Plan and she saw this as a particular issue for the Director of Public Health.
She highlighted the key messages from her report outlined on page 48. Appendix 1 outlined progress on recommended steps from 2004/05.
She concluded that she was confident that with partners, NHS Grampian could take appropriate action to address the health needs of the people in Grampian.
Mrs Bruce and Professor Maehle commended Dr Wilkie on the readability of the report and the examples given. Dr Wilkie agreed that it was important to have statistics on Grampian, rather than a national basis, so that issues could be dealt with appropriately locally. With regard to alcohol, Mrs Bruce agreed with the issues identified in the report and that it was necessary to look at the availability, pricing and licensing. She felt that a cultural change was required. She advised that young people received education about alcohol, but that was not completely effective. Dr Wilkie agreed that campaigns were often necessary, but not always sufficient.
Dr Wilkie advised that it was necessary to investigate anomalies in statistics as well as identifying trends.For example, an apparently poor outcome among other indicators which were good and going in the right direction.
Professor Haites queried whether the new GP contract had an adverse impact on the uptake of screening. Dr Wilkie advised that screening was effective and it was necessary to make sure that more information was given to patients to understand the importance of screening programmes such as cervical screening and colorectal screening. Dr Watson responded that he did not think the new GP contract had affected the uptake and advised that different strategies had to be used to encourage the public to participate. He pointed out that cervical screening was generally practice-based and that colorectal screening pilot was Dundee based.
Board members agreed that the information was immensely useful for planning and identifying gaps between affluent and deprived areas. They also agreed it was necessary to be careful about the interpretation of information.
In response to Mr Gall’s query about support from Local Authority colleagues, DrWilkie advised that there was considerable energy around partnership working and that she intended to present her report to Local Authority colleagues. Mr Gall felt it would be useful in the next Annual Report to have more information about the involvement of Local Authorities because of their role in the population’s health.
Councillor McIntyre advised of the involvement of public partners through Community Health Partnerships, community planning and community safety partnership, particularly around the use of alcohol and the impact and effect it has on communities at large, for example, anti social behaviour.
Mr Scott felt that the report gave him a very good introduction to the public health issues in NHS Grampian. He suggested that it would be helpful to have more information on mental health, particularly the impact of the recent Mental Health Act. Dr Wilkie agreed that this was valid, constructive criticism.
In response to a query from Mr Muir on whether there was enough strategic leadership at Local Authority level, Dr Wilkie advised that she had not found any lack of strategic leadership from Local Authorities.
Mrs McDade thanked Dr Wilkie for an excellent document which she thought was important, particularly for the people of Grampian. She felt it would be a useful document to help the public influence each other towards better health and to encourage the public to be aware of the issues affecting the population.
The Chairman concluded there had been positive debate around a very useful document. He suggested that with forthcoming Local Authority elections, it was important for the Director of Public Health to make contact with Local Authority colleagues early in the new administration.
The Board noted the Director of Public Health’s Annual Report. / LWilkie
6. / PERFORMANCE
6.1Performance Governance Committee Report
The Chairman referred to the report from the PGC meeting on 23 January 2007. He felt it was important to recognise and acknowledge where things were going well. He advised that Mr Richard Abel, Emergency Planning Officer, had provided a helpful report on emergency planning and business continuity. This had provided reassurance to the PGC of the steps in place to deal with emergencies such as pandemic influenza.
The financial position was encouraging, with continuing underspend and anticipation of a surplus at the year end. The Committee had noted the delayed discharges had remained a substantial risk. Mrs Smith advised of the latest figures for total delayed discharge at the end of the previous week. There had been 160 delayed discharges (made up of 45 in Aberdeenshire, 101 in AberdeenCityand 14 in Moray). It was noted that the December 2006 inpatient/day case target of no patient waiting more than 18 weeks had been delivered and was being sustained.
Mrs Smith advised that there had been a visit from SEHD colleagues regarding delayed discharges and that their findings would be presented to the Integrated Care Group later in the month. She advised that work was being done to develop the SPARRA (Scottish Patients at Risk of Readmission & Admission) model. DrDijkhuizen pointed out the relationship of admissions and readmissions of elderly and the importance of the local Change and Innovation Programme work to combine the acute assessment of the elderly at Woodend with the acute assessment at ARI.
The Committee had been advised of work being done towards eliminating Availability Status Codes (ASCs) by the end of December 2007. MrCarey advised that ASCs were assigned for legitimate reasons, for example when a patient was not fit for a procedure or was low clinical priority. Mr Carey had asked Dr Wilkie to lead a piece of work to ensure that there was local consistency with the national position on these issues. MrCarey was chairing a local group to ensure compliance with the New Ways of Defining and Measuring Waiting: Updated Definitions; Availability Status Codes.
The Chairman advised that Mr Eric Murray, Director of Facilities, had reported on NHS Grampian’s positive performance in relation to Audit Scotland’s report “Catering for Patients”. Mrs McDade pointed out that Quality Improvement Scotland standards were very demanding and that a considerable amount of hard work had been done by the Grampian Nutritional Care Group to ensure patients’ welfare in terms of nutritional care. She reported that Grampian was partially compliant with recommendations and that work was ongoing to make further improvements anyway, not just as a result of Quality Improvement Scotland (QIS) requirements.
The Chairman reported that NHS Grampian was on target to achieve the end of March targets relating to Agenda for Change.
The Board noted the report.
7. /
CORPORATE GOVERNANCE
7.1Strategies- NHS Grampian Draft Maternity Strategy
Board members were informed that there was a robust clinical risk management system at AberdeenMaternityHospital and Dr Gray's Hospital where issues were addressed on a monthly basis, with feedback and education integral to the process.
Mrs Smith explained that the strategy was not radical, but builton work already done in Grampian, taking direction from the SEHD guidance, to provide women-centred care.
Mr Stephen pointed out that the section on training and education provided reassurance of benefits realisation out of Agenda for Change.
In response to a query from Mr Scott, Mrs Smithadvised that although there was a wide range of actions coming from the national framework which informed QIS, some actions had higher priority within Grampian. The Clinical Board for Maternity Services would monitor the actions and would provide a collated report for QIS.
The Chairman requested that the governance section be reviewed to ensure that it was fit for purpose. Mrs Smith agreed to review this section
Mr Gall pointed out that two key considerations were workforce and affordability and that a costed strategy would require a detailed review of workforce to be built in to the strategy.
The aim was to finalise the strategy with input from appropriate stakeholders and to finalise the document by June 2007.
The Board considered the report and requested the final version to be submitted to the Board meeting in June 2007.
2. Nursing, Midwifery and Allied Health Professions (AHP) Strategies
Mrs Smith explained that since Autumn 2006 a number of Nursing, Midwifery and Allied Health Professions strategies had been launched by the SEHD, which she described at high level to the Board, highlighting their links to the NHS Grampian Health Plan and existing work streams.