APPROVED
NHS GRAMPIAN
Minute of the Grampian NHS Board Meeting
held in Open Session on Tuesday 7 August 2007 at 10.00am
in Committee Room 5, Woodhill House, Westburn Road, Aberdeen
Present: / Mr Jim RoyanMrs Margaret Burns
Dr David Cameron
Mr Richard Carey
Councillor Kate Dean
Mr Alan Gall
Professor Neva Haites
Councillor Bill Howatson
Mrs Elizabeth McDade
Professor Val Maehle
Mr Charles Muir
Mr Mike Scott
Mrs Elinor Smith
Mr Gordon Stephen
Dr Stuart Watson
Dr Lesley Wilkie / Chair, NHS Grampian
Non Executive Board Member, NHS Grampian
Non Executive Board Member, NHS Grampian
Chief Executive, NHS Grampian
Non Executive Board Member, NHS Grampian
Director of Finance, NHS Grampian
Non Executive Board Member, NHS Grampian
Non Executive Board Member, NHS Grampian
Non Executive Board Member, NHS Grampian
Non Executive Board Member, NHS Grampian
Non Executive Board Member, NHS Grampian
Non Executive Board Member, NHS Grampian
Nurse Director, NHS Grampian
Employee Director, Non Executive Board Member
Non Executive Board Member, NHS Grampian
Director of Public Health, NHS Grampian
By Invitation / Mr Nigel Firth / Equality and Diversity Manager (item 7.2.2 only)
Mrs Laura Gray / Director of Corporate Communications, NHS Grampian
Dr Melvin Morrison / Chair, Grampian Ethics Research Committee (items 7.1.1 and 7.1.2 only)
Mr Graeme Smith / Head of Service Development (item 5.2 only)
Dr Pauline Strachan / Deputy Medical Director (deputising for Dr Roelf Dijkhuizen)
Mr David Sullivan / Director of Planning, NHS Grampian (item 5 only)
Mrs Susan Webb / Deputy Director of Public Health, NHS Grampian (item 5.4 only)
In Attendance / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wells / Secretary, Board Secretariat
Item
/Subject
/Action
1. / ApologiesThese were received from Councillor Lee Bell, Mrs Barbara Bruce, DrRoelfDijkhuizen, Mrs Judith Hendry and Dr John Reid.
2. / Chairman’s Welcome
The Chairman welcomed everyone to the meeting and complimented Aberdeenshire Council on the work done to refurbish Committee Room 5 at Woodhill House. He particularly welcomed Councillors Dean and Howatson to their first formal Board Meeting since their respective reappointment and appointment to the Board. He also congratulated a member of the audience and regular attendee at Board meetings,Mrs Mary Rasmussen (member of Community Forum) and her dog Campbell, winner of the Scottish Regional final of guide dog of the year and wished them best of luck in the national final.
He reported from the recent Chairs’ meeting and advised that the Cabinet Secretary was keen to share her thanks to health service staff who had been involved in dealing with the recent terrorist incident at GlasgowAirport. He advised there was an ongoing review ofrecruitment of staff following what had happened which Audit Scotland would review. He advised of the ongoing work of the National Resource Allocation Committee (NRAC) with a report expected from the Committee in September. A new government policy “Kerr Mark 2” was being developed. Key themes would include an 18 week target between referral and treatment, an emphasis on quality and safety and directly elected Health Boards. A consultation document was expected in mid August and Boards were being asked to ensure that it was circulated to patient forums and public sector partners for feedback. It was anticipated that the policy would be launched around Christmas-time. Other items which he highlighted were a report on Healthcare Associated Infection after the spending review, a new e-Heath Directorate was being set up, Senior Executive Pay, Independent Scrutiny, Delivering for Mental Health.
He advised that the minutes of Chairs’ meetings would be made public and shared with Board Members.
3. / Minutes of Meeting held on 5 and 28 June 2007
These were approved.
4. / Matters Arising
There were no specific matters arising.
5. / Planning
5.1 / Position Statements on Specialist Services
Dr Wilkie introduced the item referring to the report she had written with Dr Dijkhuizen, Medical Director and Mr David Sullivan, Director of Planning in the context of the strategy for NHS Scotland as set out in “Delivering for Health”. The purpose of the report was to inform the Board about services where there was a degree of vulnerability of risk and she explained that decisions made in isolation about services could have an effect on other services. The Board was asked to consider and approve a series of position statements on these services.
She stressed that NHS Grampian’s overarching concern was to ensure that the population of Grampian, and in some instances the North of Scotland, receive equitable access to high quality services with optimum clinical outcomes.
She went through the report highlighting the main points relating to the following specialist services:
-Children’s Services including cleft lip and palate and cancer services
-Neurosurgery
-Gynaecological Oncology
-Cardiac Services
Board members then discussed the various specialist services in turn. In response to a query about the referral patterns from Tayside and Highland to the central belt rather than to Grampian for children’s services, Mr Carey advised that the issue has been discussed by the North or Scotland Planning Group (NoSPG). He agreed there was a need to maximise appropriate referrals to Aberdeen and that he was actively pursuing this with colleagues. It was noted that referrals had historically been made to Edinburgh or Glasgow and sometimes it was easier to travel there than to Aberdeen. Dr Wilkie pointed out that it would be necessary to look at transport links between areas. Professor Haites stressed the need to create an environment where referrals were made to Aberdeen and to encourage supportive behaviour across the North of Scotland. Mr Sullivan advised that regional planning meant that the paediatric managed clinical network was working very effectively. He advised that there was a subgroup of the NoSPG focussing on children, which was engaged with senior executives and clinicians. The subgroup was supportive of changing patient flows.
Mrs Smith pointed out the wider benefits such as training paediatric nurses in partnership with the RobertGordonUniversity. She explained that any changes to services would have an impact on the broader range of services provided, nurse staffing and student nurse placements.
In response to a query about how much emphasis was placed on the number of cases dealt with, Dr Wilkie explained that it was necessary to look at the evidence underlying the numbers. Dr Strachan advised that Aberdeen provided an excellent service for cleft lip and palate, with outcomes as good and other aspects of quality higher than other areas. She stressed the importance of the professionalism of staff and team working in these specialist services.
In response to a query from Councillor Howatson regarding the comment in the paper “It is important that services delivered at Dr Gray’s are fully integrated in the configuration of secondary and specialised tertiary services in Grampian and the North East of Scotland”, he was assured that Dr Gray’s services were an integral part of the services in Grampian and that services at Dr Gray’s provide opportunities to further improve managed clinical networks in Grampian to take advantage of the having two hospital sites.
Mr Sullivan stressed the need for consistency in approach with clear criteria. He advised that if decisions were based on numbers, then there would only be one treatment centre for the whole of Scotland which would not be appropriate.
With regard to Neurosurgery, the position statement in the current report was the same statement that received Board approval in March 2006. Councillor Dean explained the public concern around potential service change and reported that reassurance had been provided by the Medical Director and Director of Corporate Communications when the subject had been discussed following a motion at Aberdeen City Council. She stressed the need to continue to reassure the public that immediate lifesaving treatment would still be provided locally. The Chairman agreed that it was appropriate for NHS Grampian to provide professional expertise whenever there were Local Authority debates on health issues.
The Board noted that there were ongoing discussions between NHS Grampian and Tayside to develop collaborative working arrangements to bring further sustainability to existing services.
With regard to gynaecology oncology, Dr Strachan explained there were a number of factors affecting the ability to recruit and she explained that having a bigger pool of sub-specialists across the north of Scotland would make it more attractive.
Discussion moved on to cardiac services and the Board was advised of ongoing discussions about the national tariff. Mr Gall, referring to the possibility of some specialist services being centralised remotely from Grampian, advised that apart from clinical and recruitment implications, there could be potential financial risks to NHS Grampian and the local Universities. He advised that, in practice, if services were to be provided to Grampian patients in Glasgow or Edinburgh for example, it could cost more through the tariff than if NHS Grampian provided services itself as Grampian’s costs were relatively low. He advised that, in addition, it would not be possible to eliminate all existing costs if services were removed from Grampian, as a number of those costs were fixed and would continue to be incurred regardless of service transfer. He stressed the need to enhance North of Scotland regional cooperation to maintain service viability as close as possible to patients’ homes.
Ms Burns wished to endorse the statement highlighted on page 1 of the paper and by Dr Wilkie in her introduction about the importance of ensuring the Grampian and North of Scotland population received equitable access to high quality services with optimum clinical outcomes, which she felt would only work if elsewhere in NHS Scotland was supportive. Mr Carey explained that discussions with Scottish Executive Health Department (SEHD) had been supportive of the positions stated in the report.
He explained that it was necessary to have an understanding of an overall picture and of the dependencies and interdependencies of services. He advised that senior staff had been involved in the discussions around the development of the statements. The Board noted that the clinical advisory structure had had input and that clinicians and services were supportive of the positions set out in the report.
Mr Carey explained that timescales were uncertain, but expected some clarity once “Kerr Mark 2” Action Plan was published.
At the end of the discussion Board members agreed that they had been given sufficient information and explanations.
The Board approved and supported the position as set out in relation to each of the services described, namely:
Cleft Lip and Palate
NHS Grampian proposed the retention of the full range of services in Aberdeen. Surgery should be provided on site either by a local surgeon or as a joint case model by a surgeon from Edinburgh or Glasgow supported by local surgeons with a special interest in Cleft Lip and Palate surgery
Children’s Services
It is proposed that NHS Grampian:
- Vigorously supports the local provision of children’s services (based on quality maintenance of local skills and access for patients) whilst demonstrating a commitment to participate in genuine national clinical networks in the spirit of Delivering for Health. This position should be based on clinical assurance and the evidence that equivalent outcomes for children can be achieved through this model.
- If a two centre model is to be developed in Scotland for some children’s services consideration should be given to an appropriate geographical spread rather than two central belt centres 40 miles apart.
- Support a proposal made by the Directors of Planning and Finance in the North of Scotland for a seminar involving the regional Child Health Group and Board Chairmen and Chief Executives to agree a strategy for children’s services in the North, including patient flows.
- The above to include clarification of the role and scope of children’s services at Dr Gray’s within a North of Scotland strategy.
It is proposed that NHS Grampian:
- Maintains its position taken at the Board meeting in March 2006.
- Supports the development of collaborative arrangements betweenAberdeen and Dundee to satisfy the requirements for the European working time directive.
- Considers the outcome of the patient pathway analysis (timescale, location and the clinical skills required) and the outcome of the activity vs workforce analysis when they become available from the National Neurosciences Implementation Group before the end of the calendar year.
- The provision of the service through a formalised managed clinical network should be supported.
- A robust and detailed analysis of demand and capacity should be undertaken by NOSCAN as a matter of priority.
- Opportunities to attract doctors in training to Grampian and proleptic appointments should be explored by NHS Grampian, NOSCAN and NES.
- NHS Grampian should continue to discuss sharing the costs of creating a third sub-specialist post in Aberdeen with other North of Scotland Boards.
- NHS Grampian should continue to promote the current North of Scotland Consortium arrangements for cardiac services.
- The Finance Directorate in conjunction with the Director of Regional Planning should continue to discuss the accuracy of the tariff data relating to cardiac services with the SEHD.
- There is a possibility of making an academic appointment of an additional EP Consultant. NHS Grampian should support this as part of a continuing regional approach and seek contributions from other NOS Boards.
- A systematic approach to training in relation to EP should be put in place across the NOS linked to retention of activity within the region.
- A further review of cath lab demand and capacity needs to be undertaken alongside use of other technologies.
- The service should be encouraged to continue development of robust demand and capacity plans for cardiac surgery to ensure ability to meet and sustain waiting times over the longer term.
The Board agreed to receive regular updates on the position in relation these services, with a report in 6 months. / RD/DS
LW/
5.2 / Capital programme 2007/08
The Chairman welcomed Mr Graeme Smith, Head of Service Development to the meeting. He referred to his paper and explained that the Asset Investment Group (AIG) had prepared a one-year capital plan for 2007/08 to support the implementation of the Health Plan. He advised that the ten year capital plan was the subject of a major review which had started with a Service Strategy and Redesign Committee (SSRC)/AIG seminar on 2 July which a number of Board members had attended. He explained the strategic context, the capital plan for 2007/08 as set out in the annex to his paper and highlighted a number of investment plans, including the upgrade of the Foresterhill Laundry, the Central Buchan Resource Centre and the upgrade of FraserburghHospital as part of the Aberdeenshire plan and investments in general practice centres and dental premises. He advised that upgrading medical equipment was a continuing pressure; clear links to the health plan priorities included the transfer of activity; initial proposals to redevelop the ARI and Maternity hospital sites. Initial business cases were being prepared for larger projects such as the Emergency Care Centre, AberdeenHealthVillage and redevelopment of the Anchor Unit. The paper set out the sources of funding. The main source was the formula allocation from SEHD which was supplemented by specific allocations, for example for the new Cath Lab at ARI. He advised that the formula allocation had been reduced as part of the funding mechanism for the Matthew Hay development.
In response to a query from the Chairman about the Maud development, Mr Smith explained that Maud hospital was very old and there was a need to modernise the service consistent with the Aberdeenshire plan and the Health Plan. He advised of the innovative approach to the development, by working in partnership with Maud Village Trust to create a facility on the old mart site in partnership with the Local Authority and the local GP practice.
Mr Smith advised that redevelopment of ChalmersHospital in Fraserburgh had been under discussion for several years. The AIG had accepted an amendment to the Outline Business Case to recognise the increased costs to allow backlog maintenance at the same time as the hospital development. The SEHD was considering the OBC and it was expected that there would be a tender process towards the end of the year.
Mr Sullivan warned of the challenges faced on the ARI site, but explained there was a balance to the plan with investment in health centres and in the community.
Mr Carey stressed that the proposals were very positive and felt that much of the work which related to the Aberdeenshire plan had not been adequately covered during the consultation because of the emphasis on maternity services. He advised that there were unprecedented levels of investment in Aberdeenshire and in some of the more deprived areas.