REPORT OF THE MEETING OF HIGHLAND NHS BOARD ON 1st APRIL 2008
REPORT OF THE MEETING OF HIGHLAND NHS BOARD ON TUESDAY 1st APRIL 2008 IN INVERNESS
Re-appointments
The Board welcomed the Cabinet Secretary's decision to re-appoint Dr Vivian Shelley and Pam Courcha as Non Executive Directors, along with the re-appointment of Garry Coutts as Chair of NHS Highland.
DENTISTRY
The Board received a Report by Dr Ken Proctor, Associate Medical Director, on progress with the development of primary care dental services (PCDS) and the impact on access to NHS dental care for patients.
During 2008/9 new dental premises will open in Invergordon, Inverness and Grantown. Recruitment of staff is underway for Inverness and Grantown and the projected impact on access is an additional 8,000 registrations by 2010/11. The new Inverness Dental Centre in the Centre for Health Sciences is the largest of the Teach and Treat Centres and is due to open in Inverness in the summer of 08. Plans are already in place for the first group of dental students to receive some of their training in the new facility from September 2008, and it is hoped that this initiative will help with the recruitment and retention of the future workforce in Highland. Recruitment is underway for Senior Dental Tutors and Therapist Tutor posts.
During an extensive discussion, the Board noted the progress made but emphasised that access to NHS dentistry was a high priority for the Board and the public. It was agreed that the Chair and Chief Executive establish a Leadership Group to take a strong oversight of this important area and to provide assurance to the board. This Leadership Group would report back to the Board. The paper also recommended the prioritisation of an integrated service strategy for dentistry and it was agreed that this will be pursued through the Leadership Group.
PAYMENTS TO VOLUNTARY ORGANISATIONS
The Board discussed this paper on Voluntary Organisation funding, which requested approval from the Board to apply a 2% uplift to those organisations funded via the “Voluntary Organisations” Budget. It also considered the need for broader consideration of the commissioning of services from the Voluntary Sector in a more strategic manner.
NHS Highland continues to work with partners in joint commissioning and has engaged with The Highland Council and Voluntary Sector in exploring the development of a compact.
The Board agreed that the voluntary sector played a hugely important role and approved the proposed 2% uplift and roll forward of allocations within the voluntary organisations budget. It was agreed that that the budget be delegated to CHP level from the 1st April to enable local discussions and oversight of commissioning and compliance. Reports would be submitted to the Board from the CHPs on how this responsibility is being discharged.
STRATEGY FOR CARE OF OLDER PEOPLE
The Board approved a draft Strategy For Care Of Older People in The Highland Council area. This document has been written by the Highland Community Care Partnership of NHS Highland and the Highland Council. This strategy brings together several themes to provide a framework to act as a guide and focus for the provision of health and social care services for older people in the Highlands. The Board also agreed that consultation on the draft Strategy for Care of Older People is undertaken.
The Board discussed the proposed approach towards defining the extent to which the “Balance of Care” in the Highlands should be moved from institutional and residential care to community based services. The Board agreed the shift of 5% in the balance of care to be achieved by 2010. It was agreed that this target would be re-visited in the future.
Separate work is underway with Argyll & Bute Council.
CLINICAL GOVERNANCE COMMITTEE
The Board noted the draft minute of the Committee. Ian Gibson highlighted the discussions regarding the Scottish Patient Safety Programme. Considerable work had been done to identify what programme support structures were required within Highland. This had focused to date on RaigmoreHospital. Work was now underway to establish the programme in the Rural General Hospitals (Caithness General, Belford, and Lorn & Isles).
The Board noted the Committee's concern that clinical effectiveness arrangements should be consistent across the whole area and recommended that further work should be done to further progress the integration of the Argyll & Bute CHP. A report on this will go back to the Clinical Governance Committee.
STAFF GOVERNANCE COMMITTEE
The Board noted the minute of the last meeting.
ARGYLL & BUTE HEALTH & CARE STRATEGIC PARTNERSHIP COMMITTEE MEETING
The Board noted the minute of the last meeting.
AREA CLINICAL FORUM
The Board noted the minute of the last meeting. Quentin Cox highlighted the absence of a clear Board policy on anonymous complaints. It was noted that the Complaints procedure would be reviewed and reported back to the Board. Okain MacLennan advised that the audit committee was looking at the Whistle Blowing policy.
ENDOWMENTS COMMITTEE
The Board noted the minute of the last meeting. Ian Gibson advised that, since the meeting, new investment advisors had been appointed. Concern was expressed regarding the lack of progress on Long Service Awards for staff.
JOINT COMMITTEE ON CHILDREN AND YOUNG PEOPLE
The Board noted the minute of the last meeting. It was agreed that the Annual Report of the Highland Child Protection Committee would be submitted to a future Board meeting.
LOCAL HEALTHCARE BILL – SCOTTISH GOVERNMENT CONSULTATION
The Board discussed in detail the NHS Highland response to this consultation. The majority of the Board did not support the principle of direct elections to NHS Boards. The full formal response will be published through the NHS Highland website.
SINGLE OUTCOME AGREEMENTS
The purpose of Single Outcome Agreements (SOAs) is to agree the outcomes which each local community planning partnership (CPP) will contribute towards the achievement of national outcomes, within the context of local circumstances, and reflecting local priorities. They herald a move towards focusing on what is to be achieved, rather than how it is to be achieved, and over time should result in a significant reduction in the burden of reporting to Government. They are underpinned by the removal of ring-fenced funding to Local Authorities, leaving them free to prioritise and manage spend across all aspects of their work.
The Board noted the scope and implications of the Single Outcome Agreements and the draft SOAs for The Highland Council & Argyll & Bute Council.
ROLE AND REMIT OF JOINT PERFORMANCE BOARD
The Board discussed the role and remit of the proposed Joint Performance Board across NHS Highland and The Highland Council. The Board agreed the development of a Joint Leadership and Performance Board and a Stakeholder Forum for Community Care. The Board agreed the proposed core membership as follows:
Co-Chairs:Sandy Park (Convener, The Highland Council) and
Garry Coutts (Chair, NHS Highland)
NHS Highland: Ian Gibson (Vice Chair)
Roger Gibbins, Chief Executive
The Highland Council Jean Urquhart, Vice-Convener
John Finnie, SNP Group Leader
Dr Michael Foxley, Liberal Democrat Group Leader
Jimmy Gray, Labour Group Leader
Alistair Dodds, Chief Executive
In relation to Community Care, the above membership to include:
The Highland Council Margaret Davidson, Chair, Housing and Social Work
NHS Highlanda Chair of a Community Health Partnership (to be agreed)
MCNs/LONG TERM CONDITIONS
Dr Dennis Tracy presented a paper on Managed Clinical Networks (MCNs) and Long Term Conditions (LTC). The paper described relevant recent national developments, updated on progress on determining a local response and described the proposed content of a Long Term Conditions strategy for NHS Highland.
Dr Tracy indicated that the Long Term Conditions Strategy is work in progress. A framework has been agreed and is being developed into a draft which will go for consultation to relevant stakeholders in May. A final draft will be presented to the Health Board at its August meeting. The aim is to keep the document relatively brief so as to be as accessible as possible to a wide range of staff and other stakeholders. Its purpose is to identify the key strategic themes and broad supporting activities, but not detail the actions which should appear in CHP, Raigmore, MCN and Corporate/Departmental workplans.
The Board noted the progress made and endorsed the proposed content and timetable for agreeing the Long Term Conditions Strategy.
DEVELOPING A WORKFORCE STRATEGY FOR NHS HIGHLAND
The development and implementation of the Workforce Strategyfor NHS Highland will enable the Board’s vision for how it intends to support, develop and manage its staff - now and in the future, in a coherent and integrated way - to be realised.
The Board noted the developing Workforce Strategy and endorsed the direction of travel. It also noted that an Action Plan will be developed to confirm priorities, lead responsibilities and timescales and this will be presented to the Board at its June Meeting.
MEMBERSHIP OF COMMITTEES
The membership of Committees, outlined in the published paper, was agreed.
In addition it was agreed that Margaret Davidson would join the Clinical Governance Committee. She would also join the Audit Committee, replacing Pam Courcha. It was agreed that Colin Punler would join the Joint Committee for Children and Young People.
LOCAL DELIVERY PLAN
The Board endorsed the final draft of the NHS Highland Local Delivery Plan, which had been submitted to the Scottish Government Health Directorate on 20 March 2008. It was reported that the Scottish Government Health Directorate had approved the draft Plan that day.
During discussion, it was agreed that the Performance Review Group would look at Local Delivery Plan monitoring. It would also discuss the targeted reduction of A& E admissions.
CHIEF EXECUTIVE'S REPORT
The Chief Executive's report was noted.
The Board noted that NHS Greater Glasgow & Clyde have not yet initiated the formal consultation process concerning Clyde Health Service Strategies, and in particular integrated care at the Vale of Leven Hospital, Mental Health Services and Maternity Services. Consideration is still being given to the precise nature of the proposals which will be subject to consultation following the report of the Independent Scrutiny Panel. The launch of the consultation is expected soon. NHS Highland would be commenting on the proposals once these have been published.
The Board noted that NHS Highland had been asked to participate in a TV series for Channel 5 on emergency services. Legal advice had been taken and permission had been given for the filming to commence. No staff or patients would appear in the programme without their agreement.
REVIEW OF RESIDENTIAL ACCOMMODATION (RAIGMOREHOSPITAL)
The Board discussed a paper regarding the accommodation provided at Raigmore Hospital in Inverness for patients, their escorts and relatives who stay a distance from the hospital; Student nurses and allied health professionals; Medical students; Medical staff; and Locum and on-call staff.
The Board agreed that the management of the residential accommodation on the Raigmore site should for the mean time, due to cost, remain directly managed.
The Board noted that the accommodation was hugely valued by patients' relatives but required upgrading. The board agreed to the introduction of a fully refundable charge for patients and clinically necessary escorts for the use of Kyle Court and invest this income in its refurbishment, to include ensuite accommodation.
Work will continue with strategic partners on the development of the Beechwood higher and further education campus to include residential accommodation for nursing and Allied health professional students.
FINANCIAL REPORT
An underspend of £5m is forecast for 2007/08 and will be carried forward to 2008/2009. The Board expressed their appreciation to all the staff who had been involved in ensuring that NHS Highland remained within budget.
BUDGET 2008/2009
The Board noted that 2008/09 will see a near 50% reduction, which equates to over £11m, in the uplift to the Board’s Budget and this has had a detrimental impact on the Board’s planned in-year recurrent deficit. Consequently, the objective of reducing the underlying deficit in 2008/09 has been revised so that the proposals presented in the paper deliver a balanced 2008/09 Budget that maintains the level of recurrent deficit.
The Board agreed the Budget for 2008/2009.
The budget shows an increase in recurrent commitments of £20.7m, compared to the increase in recurrent resource of £15.6m (3.15%), giving a net increase in the recurrent deficit of £5.1m.
The key areas of investment include:
- £3.6m for Prescribing / Drugs with £2.1m (3%) in GP Prescribing and £2.4m (24%) in Raigmore.
- £6.9m for Pay costs giving a total uplift of 3.01%;
- £3.4 m for Supplies, an average uplift of 2%;
- £284,000 for Cardiac Catheterisation;
- £650,000 for Lucentis;
- £750,000 for complex care;
- £601,000 for Linear accelerator;
- £370,000 for implementing the Mental Health Act.
- £233,000 for Modernising Medical Careers
DATE OF NEXT MEETING
The next meeting of the Board (Performance) will be held on 5 May 2008, in Lairg, while the next meeting of the Board (Strategy) will be held on 3 June 2008 in Inverness.
Chris Meecham
Board Secretary
2 April 2008
NB This report is intended as a summary of the meeting. A formal minute will be produced in due course. All Board papers are available from the NHS Highland website at
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