APPROVED
NHS GRAMPIAN
Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session
on Tuesday 3 June 2008 at 10.00am
in Committee Room 5 Woodhill House, Westburn Road, Aberdeen
Present
/Dr David Cameron
/ ChairmanCouncillor 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
Mrs Judith Hendry / Non-Executive Board Member
Councillor Bill Howatson / 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
Dr Lesley Wilkie / Director of Public Health
By Invitation
Mrs Laura Gray / Director of Corporate Communications
Dr Annie Ingram / Director of Regional Planning & Workforce Development, North of Scotland Planning Group
Mr Ewan Robertson / Board Secretary/Director of Performance Improvement
Attending / Ms Deb Hoad / Assistant Board Secretary
Mrs Glenys Wells / Personal Assistant, Board Secretariat
Item / Subject / Action
1 / Apologies
These were received from Professor Neva Haites, Mrs Elizabeth McDade and Mr Gordon Stephen.
2 / Chairman's Welcome and Briefing
Dr Cameron welcomed everyone to the meeting and provided an update from the Chairs meeting he had recently attended.
Work had been carried out on the 2009/10 HEAT targets and the Cabinet Secretary had informed that any changes required would be minimal.
Single Outcome Agreements (SOAs) have been agreed with the 32 Local Authorities and would be signed off at the end of June. The Local Authority would need to move quickly around community planning in the current year and involve partner organisations with regard to the 09/10 SOA. However, it was felt that Grampian was well placed to achieve good outcomes.
Extra monies should be available to assist with Smoking Cessation activities which would help the work ongoing to make smoking less acceptable.
A Drug Strategy had been launched the previous week which aimed at helping users to become drug free. Dr Cameron highlighted that there had been a drop in waiting times for drug users seeking help within North East Scotland.
The MRSA Pilot, in which NHS Grampian is one of the pilot Boards, was launched on 2nd June and the Cabinet Secretary had commented that this would involve both screening patients on admission and ensuring that hospitals were cleaner in general.
The Local Delivery Plans had all been signed off and Dr Cameron thanked everyone who had been involved for their efforts and outlined that the Chief Executive for NHS Scotland had commented that he personally appreciated the efforts of all staff who had been involved in the LDP process.
3 / Minute of Meeting held on 1 April 2008
The minute was approved subject to the following amendment:
Mr Gall outlined that under item 6.1 the first key point on page 4 should read “£83m capital cost plus optimism bias.”
4 / Matters Arising
There were no matters arising.
5 / North of Scotland Planning Group (NoSPG)
Dr Cameron welcomed Dr Annie Ingram, Director of Regional Planning and Workforce Development for NoSPG, who addressed the Board via video link. Mr Carey outlined the background of NoSPG, explaining that NHS Grampian did not operate in isolation and co-operated with other Boards to optimise health benefits for patients across Scotland. He continued that there was added value in Boards co-operating in this way, citing the improvement of provision for eating disorders in NHS Grampian as an example, and that NHS Grampian had a long history of working with other Boards to provide support, in particular with Highland. Mr Carey expressed the importanceof supporting the NoSPG.
Dr Ingram commenced by explaining that regional working should be considered as just another way in which NHS Boards carry out their business. She had three main issues to present to the Board:
- The NoSPG Annual Report for 2007/08
- The revised workplan for 2008/09
- A revised Constitution which had been necessary due to a number of changes in membership of NoSPG since the previous Constitution had been approved.
Much of the information outlined in the Annual Report and workplan was similar to the previous year’s report but that this was reflective of the fact that much of the work of NoSPG was long term. There had been some particular successes during the year, in particular the developments around cardiac services and the North Region was the only region that had a Cardiac Plan, both at regional and individual Board levels. Waiting times monies were distributed in the main to one Board at a time and this had worked well.
The main areas of work over the year were:
Electrophysiology: there was a development plan for this yearto develop an electrophysiology service and NHS Grampian will become the regional centre.
Mental Health: an eating disorders inpatient unit has been set up within NHS Grampian which had resulted in better links between clinicians and care pathways being agreed. Savings of £900k to £1m were projected.
Child and Adolescent Mental Health Services: this was an area currently being looked at with a plan to develop services in Perth. This topic will be brought back to the Board next year.
Dentistry/Oral Health: there had been very recent developments that would result in significant changes from the position outlined in the Annual Report. This will be reported to the Board next year.
Cancer: there had been significant waiting time achievements over the year.
Public Health Network: much work was ongoing behind the scenes to support this function, especially in the more remote areas.
Delivering Rural Healthcare: information had been launched by the Cabinet Secretary that provides a framework for rural healthcare.
The changes to the NoSPG Constitution were:
- A proposal for an Integrated Planning Group covering service, workforce and financial planning jointly
- Gordon Stewart had been employed as a Director
- A framework of accountability outlining specific roles and responsibilities had been included
- A Medical Directors Group had been approved
- Approval had been granted for a representative from the Nurse Directors Group to be a member of NoSPG
Mrs Smith asked if there was anything the Board could do to assist in moving forward the work around Child Protection (CP) and Dr Ingram responded that she had attended a CP meeting the previous week and as a result was going to reconstitute the CP Group. She was hoping to take this work forward over the next year and welcomed any support that could be provided.
Councillor Howatson queried if the NoSPG met in public, especially as Board Chairmen were involved. Mr Carey explained that the NoSPG was not a board of governance and was therefore not a public body but that all their work was in the public domain.
Councillor Dean noted that the Arbuthnott formula was used to calculate funding allocations and queried if any other methods were being considered. Mr Carey and Dr Ingram outlined that there were no plans currently to change the method of funding allocation and that all involved Boards were in agreement with the current arrangements.
Dr Cameron thanked Dr Ingram for her presentation.
The Board approved the Annual Report, 2008/09 workplan and the changes to the Constitution.
6 / Public Health
Dr Wilkie offered apologies to the Board that a written report had not been provided, explaining that there were specific reasons for this. A verbal report would be given with a subsequent written report being presented to the Board at a future meeting.
A multidisciplinary group, including support from Community Dieticians, was working to develop the Healthy Weight Strategy (HWS) which comprises three main components:
- Prevention: this was being developed with the three local CHPs by looking at the national proposed model aimed at helping local areas consider the impact of environmental and planning issues on healthy weight and to identify the key criteria.
- Treatment and prevention: this component related to persons already in the obese category and considerable work was already underway to develop effective Integrated Care Pathways between Primary and Secondary care and a pilot was planned.
It was expected that in the near future the Scottish Government would publish a strategy requiring Boards to develop a HWS. Grampian had anticipated this. Finance should be attached to this requirement and this issue will be brought back to the Board in the future.
- Surveillance and Monitoring: A robust monitoring system needed to be in place. This was already being implemented for children and survey information will be available in the summer in respect of the 11-25 lifestyle group.
Professor Maehle queried how the surveillance and monitoring aspect would be achieved and whether baseline data would be available to be used. Dr Wilkie explained that this would be essential, especially with regard to child Healthy Weight. For adults,some measurement data was available within Primary Care and the Scottish Health Survey.
Ms Burns requested that information be provided to the Board relating to background costs relating to obesity and weight issues and the balance of benefits in investing money compared with the costs of not doing so. It was agreed that this would be a useful approach and would be further explored.
In response to a query from Mr Muir it was explained that the government Healthy Eating Strategy for children in schools, Hungry for Success, had been implemented and had evaluated well nationally. The scheme was embedded across the three local authority areas across Grampian. Funding had now ceased but there was a legacy of improvements, although it was acknowledged that work would be required to maintain the progress achieved. Mrs Bruce commented that it was important not to overstate the Hungry for Success achievements as whilst the work had been successful in Primary Schools this had not been replicated in the Academies.
Dr Cameron thanked Dr Wilkie for her report indicating he appreciated why it had been a verbal report. Dr Cameron felt the debate had confirmed that working towards a healthier population was not just about weight and that other issues had to be considered.
The Board noted the update on the Healthy Weight Strategy. / LW
LW
7 / Draft Patient Safety Strategy
Mrs Smith presented a paper, explaining that a strategy had been brought to the Board in 2006 but changes had been required as a result of the Scotland Patient Safety Programme 2007, which had featured in the March Healthfit event. NHS Grampian had been part of the overall Scottish programme and had been recognised nationally for its work. A key risk was sustainability and spread but NHS Grampian had adopted the patient safety agenda with enthusiasm and members were asked to consider the suggested amendments and submit comments by 20th June, following which Mrs Smith would submit a final document to the August Board for approval.
Mr Scott queried if the responsibilities of patients was taken into account and Dr Cameron replied that the Patients’ Rights Bill takes into account patients’ rights and responsibilities.
Dr Dijkhuizen emphasised that there was considerable enthusiasm and support for patient safety initiatives across the Grampian clinical community and that Sir Graham Teasdale from theBoard of NHS Quality Improvement Scotland had commented positively on the local methodologies being used. Dr Cameron commented that staff enthusiasm was a key issue in ensuring spread and sustainability and must be capitalised upon.
Professor Maehle requested that a more specific reference to The Robert Gordon University be mentioned in section 4 of the paper which covers working with partner organisations. Mrs Hendry queried if the patient safety agenda covered Primary Care and it was acknowledged that patient safety was system-wide and this area would need to be worked upon in the future along with Child Health, Mental Health and Learning Disability.
Dr Cameron thanked Mrs Smith for her presentation and asked Board Members to ensure any further comments were forwarded to her by 20th June 2008.
The Board noted the update on the Patient Safety Strategy and the request for comments. / ES
8 / Performance Governance
8.1 / Performance Governance Committee Report
Dr Cameron referred to the committee report, highlighting the main topics for discussion.
At the census date of 15th April 2008 there had been no delayed discharges and thanks were offered to everyone involved. The opening of Tor na Dee had been significant and an integrated approach with partner organisations would be required to ensure continued success.
There had been a reduction in length of stay and ARI was considered efficient when compared with other teaching hospitals. This was not the case with community based hospitals and work needs to be done to address this.
The current targets for health improvement/inequalities emphasise the need for partnership working and this needs to be encouraged. The importance of targeting resources to improve health inequalities was highlighted. The non recurrent nature of funding was felt to hamper progress in this area.
A financial under spend had been achieved over the year and thanks were offered to all the staff involved. The Scottish Government Performance Review Team had undertaken a review of performance under the Better Care without Delay programmeandwhilst NHS Grampian was acknowledged to be moving in the right direction some recommendations were made to improve target delivery, especially when taking into account the forthcoming 18 week referral to treatment targets. This had been considered at the Audit Committee and Internal Audit were confident that the management team were addressing the issues.
More work needed to be undertaken to promote staff wellbeing to assist delivery of the sickness absence targets. There should be a focus on Healthy Working Lives and the early intervention of Occupational Health to ensure timely return to work. Mr Scott outlined that this was a priority area for the Staff Governance Committee.
The Board noted the Performance Report May 2008.
8.2 / Local Delivery Plan
Mr Robertson gave a verbal report highlighting that there were two outstanding issues, access and finance. The Performance Support Team had reviewed the work around access targets and it was felt that targets of 15 weeks for inpatients or day cases, 15 weeks for GP referral to a first outpatient appointment and 6 weeks for diagnostic tests would be achieved by 31st March 2009. The Board would endeavour to work towards exceeding these targets.
Mr Gall explained that he had been working with the Health Directorate with regard to the LDP and it had been indicated that the Grampian financial plan needed only minor changes and agreement of the plan was imminent. There were plans to apply for an additional £20m over the next five years although evidence would be needed to support this.