BeechwoodPark
Inverness IV2 3BW
Tel: 01463 717123
Fax: 01463 235189
Textphone users can contact us via
Typetalk: Tel 0800 959598
/
MINUTE of MEETING of the
NHS HIGHLAND PARTNERSHIP FORUM (Strategy)
Board Room, Assynt House /14 March 2008 – 10.00 am
PresentDr Roger Gibbins, Chief Executive (Joint Chair)
Mrs Ann Clarke, Chair of Staff Governance Committee (via Videoconference)
Ms Diane Fraser, RCN
Mrs Anne Gent, Director of Human Resources
Mr Malcolm Iredale, Director of Finance
Ms Margaret MacRae, RCN
Ms Phyllis McRae, RCM
Ms Heidi May, Board Nurse Director
Mr Adam Palmer, UNISON
Mr Douglas Seago, Head of Facilities
In
AttendanceMr Tony Cowan-Martin, General Manager, Occupational Health
Mrs Pamela Cremin, Workforce Planning Manager
Ms Sharon Davies, Service Planning Analyst
Mrs Caroline Parr, Partnership Support Officer
Mr Brian Mitchell, Board Committee Administrator
1WELCOME AND APOLOGIES
Apologies were received from Ruth Cleland, Helen Duthie, Georgia Haire, Brian Houston, Linda Kirkland, Catherine Mackay, Jackie Mitchell, Helen Morrison, Mary Morton, Donald Shiach, Nigel Small, Donna Smith, and Ray Stewart.
2MINUTE OF MEETING HELD ON 15 FEBRUARY 2008
The Minute of Meeting held on 18 January 2008 was Approvedsubject to the following amendments:
- Add Phyllis McRae to the List of those Present.
- Page 2, Item 3.2, Action Point – Amend to read “The Partnership Forum Agreed, in principle, to the introduction of Long Service Awards and Noted this would be taken forward by Working Group.”
- Page 4, Item 5.3, Para.1, Line 1 – Amend to read “... during discussion at a recent meeting of Chief Executive’s on the delivery ....”
- Page 4, Item 5.3, 2nd Action Point – Amend to read “... highlighted again to managers and staff through ...”
3MATTERS ARISING
3.1Final Version of Staff Governance Annual Report
Mrs A Gent advised that the Report was to be submitted to the Audit Committee on 18 March 2008 and subsequently the NHS Board.
The Partnership Forum Noted the position.
3.2NHSH Partnership Forum Terms of Reference – Role, Remit and Membership
Mrs A Gent advised that the revised Terms of Reference would be brought to the next meeting for approval.
The Partnership Forum so Noted.
3.3Facilities Time
Mrs A Gent advised that this matter would be brought to the next meeting.
The Partnership Forum so Noted.
3.4Workforce Report
Mrs A Gent advised that in association with Mr P Walker and Mr J Mackay improvements had been identified in relation to the Workforce Report submitted to this Forum and the Staff Governance Committee. The revised report would be submitted to the next meeting.
The Partnership Forum Noted the position.
3.5Local Development Plan
Mrs A Gent advised that the HEAT Target relative to Personal Development Plans (PDPs) had been confirmed and that this would be measured against the March 2008 staff cohort, exclusive of those on secondment for over three months, Bank staff, and those on long term absence of over 3 months (including staff on maternity leave).
The Partnership Forum Noted the position.
3.6Staff Governance Action Plan
Mrs A Gent advised that the Integrated Staff Governance Action Plan would be brought to the next meeting. Mrs C Parr stated that there was a need for individuals to be identified that would progress actions for inclusion in the Action Plan for 2008/09.
The Partnership Forum:
- Noted the position.
- Noted that Mr A Palmer and Mrs D Fraser would assist.
3.7Agenda for Change Update
Mrs A Gent advised that in light of Mr Shiach’s recent absence from duty the Agenda for Change Update would be brought to the next meeting.
The Partnership Forum so Noted.
3.8New Craigs Shift Pattern
Mr A Palmer advised that the Staffside had accepted an offer by the Director of Nursing to discuss the matter at the Area Nursing and Midwifery Advisory Committee. Local issues would be referred to the Organisational Change Sub Group.
The Partnership Forum Noted the position.
4STRATEGIC ISSUES FOR DISCUSSION
4.1Developing the Workforce Strategy for NHS Highland
Mrs Gent spoke to the circulated document which outlined the strategic context of developing such a Strategy, indicated the relevant drivers for change involved, the implications for the NHS Highland Workforce, the proposed Strategy Framework, the roles and responsibilities of Human Resources Services, Line Management, Staffside Representatives, and individual members of staff, the existing Governance and Partnership Working arrangements, and outlined the next steps required in developing an appropriate Action Plan. Mrs Cremin stated that the document was strategic in nature and that much of the detail would emerge through development of the Action Plan, the process for which was being assisted through stakeholder groups. Mrs Gent added that the Strategy in question was being developed in light of the ongoing drivers for change and with a view to capturing in one document all the work and initiatives underway within NHS Highland. This would support the Board’s Clinical Framework and the work of the Remote and Rural Healthcare Alliance (RRHEAL) as well as capture the added value for patients and reflect the skill required in developing and managing staff effectively. With regard to the Framework itself, this was based on the PEOPLE acronym and each individual element of that was outlined in terms of current workforce initiatives, existing workforce policies, strategies and plans, future priorities in light of drivers for change, and benefits for patients, staff and the organisation. Work ongoing in this area related to Remote and Rural issues, governance and future action required in addition to inclusion of aspects relating to Medical workforce elements. Once these individual elements were complete then the overall Action Plan could then be progressed. Mrs Gent stated that whilst the document gave a clear direction of travel in this area, for the NHS Board to approve, further engagement sessions would be required.
Mrs Clarke stated that the circulated document was excellent and suggested that the Board highlight the work undertaken to those at a national level so as to inform that workstrand. Ms Fraser referred to the Appendix showing the Human Resources Service Structure and expressed concern that this did not reflect the Staffside role and in response it was agreed that the diagram be removed meantime, and replaced once complete. On the point raised with regard to the production of an Action Plan, Mrs Gent stated that this would capture that included within the Staff Governance Action Plan and that the key aspect would be how this fits with all other Strategies and the Clinical Framework. Dr Gibbins stated that in terms of presentation to the NHS Board there required to be identification of the key priorities to be considered and what would be specifically required in these areas. He stated that there was also need to consider monitoring arrangements/ performance measures and in response Mrs Gent advised that this could be through the existing Workforce Report submitted to this Forum and the Staff Governance Committee, linked to the PEOPLE acronym and listing what was required, who was to undertake this, and giving the relevant timescale for action. Dr Gibbins then raised the issue of higher level Key Performance Indicators (KPIs) for CHP areas, including those areas where this already existed, and stated that these also required to be highlighted to the NHS Board. Mr Seago referred to the issue of targets, for say timescales for recruitment after termination and in this regard Dr Gibbins stated that the key would be to identify where these Indicators would be most beneficial. In conclusion Dr Gibbins stated that workforce activity required to be embedded in existing organisational processes where possible.
The Partnership Forum:
- Noted the circulated document.
- Noted that the Human Resources Service Structure diagram would be removed as an Appendix.
- Agreed that presentation to the NHS Board should include identification of key priorities and the work specifically required in these areas.
- Noted that CHP KPIs should be highlighted to the NHS Board, including those that were already in place.
- Noted that workforce activity should be embedded in existing organisational processes where possible.
4.2 Review of the AHP Service Model
Ms May spoke to the circulated Review of Allied Health Professionals Temporary Leadership Structure, which had been undertaken by the Associate Director (Clinical Workforce Development) and which contained the following five recommendations:
- AHP Leads should be appointed to each CHP and RaigmoreHospital.
- NHS Highland AHP Professional Advisors should be appointed for each of the Professions.
- Further work should be undertaken to identify the most appropriate Governance arrangements to support Radiotherapy, Radiography, Orthoptists, Orthotics, Prosthetics and Art Therapy in NHS Highland.
- To support the appointment of an AHP Associate Director within the current year, funding should be identified.
- Implementation of the new model should be supported through a transitional project to clarify the roles, responsibilities and accountabilities of key personnel; and ensure staff, financial and clinical governance standards are met.
Ms May further advised that consultation had now been concluded in relation to the Job Descriptions for Professional Heads of Service and CHP Lead AHP positions and as such these were now ready to be banded in terms of Agenda for Change. Discussion with the Human Resources service had led to staff being advised as the process to now be followed. On the point raised regarding future reporting arrangements Ms May confirmed this would be through the new Associate Director, for which funding had been agreed, and then to the Director of Nursing. Mrs Clark welcomed the outcome of the Review and added that this gave clear management lines for AHP services. On the point raised, Ms May advised that Chaplaincy was not currently an AHP service. Dr Gibbins queried as to the next steps to be undertaken and was advised that this would be the usual Agenda for Change process of matching and banding, and thereafter appointment to the various roles with an initial anticipated timescale of 6 to 8 weeks.
The Partnership Forum otherwise Noted the circulated Review document.
4.3Financial Plan 2008/09
Mr Iredale gave a presentation and spoke to a circulated report outlining the position with regard to the 2008/09 draft Budget, with particular reference to the restricted budgetary uplift of 3.2%, underlying deficit, implications of pay and price increases, and the full effect of previous and new Developments. In terms of the uplift for 2008/09 this was down on previous years from 6% to 3.2%, and took into account the decision at Government level to withhold certain funding for national level investment relative to Waiting Times and Improving Health/ Better Public Health initiatives. It was unclear as to whether, or on what basis, this additional resource would be allocated to NHS Boards and work was underway to establish this point. In terms of budget methodology work, assurance was provided that the draft budget was the result of an inclusive process involving a wide range of staff throughout the organisation, and that work was underway to move towards a system of Integrated Resource Framework that takes into account total resource and expenditure. It was noted that this was being undertaken in association with the Scottish Government Joint Improvement Team and building on the Collaborative Contracting work previously undertaken. In terms of a Budget overview for 2008/09 this would include a deficit of £10.5m from the previous financial year, development/cost pressures of £5.1m, an allocation for pay and price increases of £15.6m, £1.5m of transitional relief from Greater Glasgow and Clyde Health Board and result in required recurrent savings of £15.6m. The savings plan for 2008/09 included recurrent savings of £4.9m, non-recurrent savings of £3.5m, non-recurrent underspend of £2.9m., slippage of £2.8m plus the transitional relief referred to previously in the sum of £1.5m. There would be a requirement for savings across all operational units as outlined and the key risks for 2008/09 were identified as being the 2008/09 Pay Award, issues relating to prescribing, Agenda for Change outcomes, receipt of as yet unknown supplementary allocations for Access and Improving Health, achievement of savings targets, and potential Equal Pay Claims including associated legal costs. The Government has set a target of 2% efficiency savings across all NHS Boards and in Highland this would equate to approximately £10m which would be identified from within the savings described above. Looking forward Mr Iredale advised that there were two major factors that would impact on draft medium term plans and these were the implementation of a new national Funding Formula for the allocation of resources to NHS Boards, The NHSScotland Resource Allocation Committee (NRAC), and the introduction of the Integrated Resource Framework described above. Implementation of the new formula referred to would be incremental in order to minimise potential impact although those NHS Boards who currently received above the NRAC share, including Highland, would receive the minimum agreed uplift until such time as parity was achieved and as such planning should be on that basis. With regard to the Integrated Resource Framework, this would involve allocating the NHS Board’s recurrent resource to all CHPs on the same basis as is the case relative to Argyll and Bute CHP. Other areas such Raigmore, Facilities and Corporate Services budgets would then be based on CHP capacity plans and service agreements. In addition to the various benefits of this approach it was stated that individual CHP savings targets would be dependent on a number of variables such as the level of future recurrent commitments and the relative impact of demographic changes across CHPs and the implementation of NRAC. An agreed method of valuing hospital activity was critical for the success of this approach and that would be developed as a priority in the plan for the implementation of an Integrated Resource Framework within NHS Highland. Overall Mr Iredale stated that the reduction in the uplift to the budget of NHS Highland had a detrimental impact on the Board’s planed in-year recurrent deficit and consequently the objective of reducing the underlying deficit in 2008/09 had been revised so that the proposals to be presented to the NHS Board for approval had been revised so that these delivered a balanced budget for 2008/09 that maintained the level of recurrent deficit. The Budget proposals would be presented to the NHS Board at their meeting to be held on 1 April 2008, as would the Local Delivery Plan which included elements relating to achieving a break even position and associated efficiency savings etc.
During discussion, concern was expressed around meeting the various targets for services in light of the requirement for savings across the NHS Board and it was stated that as part of the process there would need to be consideration as to what could be undertaken more efficiently and what activities could be stopped. It was stated that all Board strategies, including the Workforce Strategy, required to be established in light of the prevailing financial position and again this would require establishing priorities and the effective use of resources, possibly through new methods of working. On the point raised as to responsibility for deciding on what activity should cease etc, Dr Gibbins advised that such decisions would require to be taken locally, in Partnership. Ms MacRae raised the issue of Integrated Resource Framework / Collaborative Contracting, advising that this was a difficult concept to get across to staff and would affect issues relating to the workforce, and Dr Gibbins requested that Paul Leak prepare a presentation to the next Strategy meeting of the Forum to be held on 16 May 2008. Mrs Clarke raised a number of issues and was advised that for following years it was likely that it would be easier to quantify costs relating to Agenda for Change. With regard to Prescribing there was to be phased reductions in prescription charges, 38% in April 2008, with NHS Boards being reimbursed from savings in the costs of generic drugs. On the issue of North of Scotland projects and associated commitments Dr Gibbins advised that for Highland this would be included within the financial plan and Mr Iredale advised that these matters were considered by the Planning Group.
The Partnership Forum:
- Noted the proposed 2008/09 Revenue budget to be considered by the NHS Board.
- Noted the impact on the Recovery Plan.
- Noted the inherent assumptions and risks in delivery of the Plan.
- Noted the proposed move towards “fully allocated” budgets in future years from 2009/10.
- Agreed that Mr Leak give a presentation on Integrated Resource Framework/ Collaborative Contracting to the meeting of the Partnership Forum to be held on 16 May 2008.
5BUSINESS ISSUES