APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on Friday 5 December 2014 at 10.00am

in the Caroline/Rosemount Rooms, CLAN House, Westburn Road, Aberdeen

Present

/ Cllr Bill Howatson / Chairman
/ Mr David Anderson / Non-Executive Board Member
Cllr Stewart Cree / Non-Executive Board Member
Cllr Barney Crockett / Non-Executive Board Member (from 11.00am)
Mrs Sharon Duncan / Employee Director
Dr Nick Fluck / Medical Director
Mr Alan Gray / Director of Finance
Professor Mike Greaves / Non-Executive Board Member
Mrs Christine Lester / Non-Executive Board Member
Dr Lynda Lynch / Non-Executive Board Member
Mr Terry Mackie / Non-Executive Board Member
Dr Helen Moffat / Chair, Area Clinical Forum
Mr Mike Scott / Non-Executive Board Member
Mrs Elinor Smith / Director of Nursing and Quality
Mr Malcolm Wright / Interim Chief Executive
By Invitation / Mrs Jackie Bremner / Programme Director
Ms Pam Gowans / Chief Officer, Moray
Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Dr Annie Ingram / Director of Workforce
Dr Izhar Khan / Chair, Area Medical Committee
Mr Graeme Smith / Director of Modernisation
Dr Pauline Strachan / Deputy Chief Executive
Mrs Susan Webb / Acting Director of Public Health
Attending / Miss Lesley Hall / Assistant Board Secretary
Item / Subject /
1 / Welcome/Introductions
The Chairman welcomed everyone to the meeting, in particular Mr Malcolm Wright as Interim Chief Executive for the next six months, and advised that colleagues were looking forward to working with him in this role.
2 / Verbal Updates
·  Chairman
The Chairman paid tribute to the winners from the successful GRAFTAS (Grampian Recognition Awards for Teams and Staff) awards ceremony and stated that the dedication and commitment of those shortlisted and the pride of the very worthy winners had been humbling to see. He had undertaken several patient recent patient safety walkrounds including a visit to the community-based rehabilitation facilities at Great Western Lodge.
The Chairman was pleased to announce the appointments of Rhona Atkinson and Eric Sinclair as non executive members of the Board from 1 January 2015.
There had been a useful seminar with Area Clinical Forum members, the Board and clinical leads on 7 November which gave commitment to good future clinical commitment.
He made reference to the Healthcare Improvement Scotland reports that were discussed in more detail later in the meeting and highlighted the valuable staff briefings that had been held, a number of which he had attended. He had been encouraged by staff who wished to move on from the current position in a positive manner.
The Chairman wished to record the Board’s appreciation and thanks to both Charles Muir, who was unable to attend the meeting because of illness, and Mike Scott for their significant contribution to the Board as Non-Executives over the last eight years.
Finally, as this was his last Board meeting, the Chairman wished to thank the Board for its support over the last seven years as a member of the Board and as Chairman over the last three years. Although there had been challenges, particularly in the past few months, his confidence and pride in NHS Grampian and its staff had never faltered. NHS Grampian had achieved great things including a massive capital investment programme and major progress in patient safely and person-centred care and he wished everyone the very best for the future.
Mr Wright, on behalf of the Board, offered the Chairman thanks for the time, commitment and devotion he had given to the organisation and wished him the best for the future.
·  Interim Chief Executive
Mr Wright advised that he was delighted to be working with NHS Grampian. He acknowledged the huge opportunities to move the whole healthcare system forward and highlighted that he was Interim Chief Executive for the whole of NHS Grampian including community care, primary care, mental health services and community hospitals. His role would be focused on the work from the HIS reports and acute services, but it was broader than that. From the staff briefings he had attended it was clear that there was a recognition of what was in the reports, but an overriding sense of wishing to move forward and look to the future. He explained that the Executive Team would be working in a different way and the role of the team would be developed. The team was taking a lead with the Improvement Programme with wide engagement across the organisation involving staff side and appropriate representatives. He referred to the recently published Vale of Leven report and advised that this would be discussed at the next Board meeting.
He thanked colleagues for their warm welcome and said he looked forward to working with colleagues to lead the organisation forward.
3 / Apologies
These were received from Mr Raymond Bisset, Mr Charles Muir, Mr Jonathan Passmore and Cllr Anne Robertson.
4 / Minute of Meeting held on 3 October 2014
The minute was approved as an accurate record.
5 / Matters Arising
Unscheduled Care – in response to a query from Mrs Lester, Mr Smith advised that there would be an update to the Board on the Emergency Care Centre once the post-project evaluation had been completed and been to the Asset Management Group.
Integration of Health and Social Care – in response to a query from the Chairman, it was advised that the requirement for clarification about the Memorandum of Understanding with The Moray Council had been superseded and would be dealt with under the partnership’s integration scheme.
6 / Healthcare Improvement Scotland (HIS) Report
Mr Wright referred to the three recently published reports that had been circulated with the covering paper, all of which had serious conclusions:
He advised that there had been media briefings and open meetings with staff. As advised at the start of the meeting, staff had responded by recognising the issues and showing a willingness to move forward. He highlighted that NHS Grampian had a very good patient safety record, Healthcare Associated Infection rates were good, if not better, than other parts of Scotland and patient satisfaction rates were good. The three reports had been critical of the Board, the Executive Team, management and individual departments. He apologised unreservedly to public and patients who had been affected and acknowledged that all the recommendations in the reports had been accepted. He explained that a draft integrated improvement plan had been developed. This included the range of actions that required to be implemented and demonstrated the commitment to delivering high quality patient-centred care.
Mr Wright outlined the improvement plan highlighting the main issues to be addressed, under the following headings: Feedback; Older People in Acute Hospitals; Values, Culture and Behaviours; Acute Sector Management; Unscheduled Care/Winter Plan; Nurse Recruitment; Doctors in Training; Royal College of Surgeons’ report; Professional Advisory Structure; Board and Executive Development. He advised that actions would be taken forward in a focused way and it was essential to do so in collaboration with staff, the clinical advisory structure and staff side/partnership.
In reply to queries from Non Executives, Mr Wright acknowledged that it was an ambitious plan, but activities would be prioritised and initiated quickly, and that capacity was an important consideration. Offers of support had been made by HIS and the Scottish Government, but he emphasised that ultimate responsibility lay with NHS Grampian.
Mr Wright advised that there would be comprehensive communication and engagement and he had been heartened by how well staff had responded to the face to face briefings and podcasts. Mrs Gray explained the various means of communication and engagement and stressed the importance of collaborating with staff in implementing the improvement plan.
Mr Anderson welcomed the comprehensive plan and stressed the importance of leadership. He emphasised the need to be person-centred and to focus on NHS Grampian’s responsibilities to patients. Mr Wright responded that it was necessary to mobilise resources to patients needs and for divisions to be healed with high quality professional managers working with a professional range of clinicians to achieve outcomes for patients.
He advised that there would be no major structural change to the Acute Sector, but the way services in that sector were lead was crucial.
Dr Ingram stressed the need for stability and to ensure there was the right structure for clinical leadership. She and Dr Khan had done work together which would be shared with the wider organisation. In 2012 a policy on Dignified Workforce had been agreed and it was important to recognise this. Mrs Duncan reported a sense of energy and purpose from staff since the publication of the reports. However, there was concern about sustainability given the level of activity required to make progress.
Dr Fluck emphasised the importance of clinical leadership in local services and the need to identify what made a top quality functioning team and to share good practice.
On behalf of the medical community, Dr Khan welcomed Mr Wright and offered a commitment from the clinicians to work under his leadership. He commented that morale following the reports was low, but there was a recognition that the situation could only improve from the current position. The Chairman felt that morale might not be as low as suggested and reiterated the importance of looking forward rather than back. Cllr Crockett stated it was important to acknowledge that staff had been through a difficult time and it was necessary to improve staff morale and to stress that the Board was committed to making improvements.
Mr Wright commented that it was important to recognise the strong links between education, training and clinical quality.
Mr Mackie and Mr Wright both gave examples of positive staff morale and enthusiastic staff from recent visits to ward areas. Dr Ingram stressed the need to address challenges positively and for a positive focus to help with recruitment and retention of staff.
The Chairman referred to the oversight arrangements on page 2 of the covering paper and recommended the Board had overall oversight of the improvement plan and that regular reports were made to the Board.
Dr Strachan suggested forming an oversight scrutiny group, as this model had worked very well. This group would report to the Board. Dr Khan suggested a patient representative on the scrutiny group. Mrs Gray agreed that patient representation was important and recommended that the Patient Focus and Public Involvement Committee, rather than one individual, would be a useful inclusion in the process. Mr Scott recommended the short life working group method that had proved useful for the previous improvement plan. Dr Ingram suggested the new chair might have views and wish to take personal involvement.
Mr Gray explained that Executive Team members were clear of their responsibilities in terms of the improvement plan. He suggested that the scrutiny group would provide a check and balance role with involvement from Non Executives. He stressed the importance of having a clear Committee structure and membership. Mr Anderson suggested that the Committee structure needed to be reviewed to take account of the integration of Health and Social Care and overall governance arrangements.
Following the detailed discussion, the Board:
·  endorsed all the recommendations of the three reports
·  endorsed the process for development of the improvement plan
·  agreed the proposed oversight arrangements for the improvement plan
7 / Patient Story – Patient Opinion
Mrs Smith explained that Patient Opinion was an independent, open and transparent way for patients and public to share their stories and experiences of the health service. It is in the public domain and stories are vetted before being made public. They are always shared with the services concerned and where appropriate the services are asked to provide a response to supplement the initial response. Mrs Smith shared a positive story from Patient Opinion about how a member of staff promoting Carers’ Week had listened and provided appropriate information. It illustrated the value of such events and how important the simple act of listening can be.
Mrs Duncan pointed out that feedback and patient stories had been raised at recent HIS briefing sessions. Mrs Smith explained that the CBAS system was being promoted by Senior Charge Nurses to engage teams and share learning experiences to improve services.
8 / Committee Reports
8.1 / Audit Committee Report
Mr Anderson advised that the Committee had been encouraged by progress against the five year backlog maintenance plan. The Committee had considered the potential value of an annual review of the effectiveness of internal and external audit functions. The Director of Finance had been asked to consider the practical implications of applying the methodology suggested by the external auditors, particularly cost/benefit analysis. Mr Gray explained the importance of using auditors as efficiently and effectively for the organisation. For example audits on Medical Staffing and Feedback had been commissioned by the Audit Committee, not as part of the HIS review, although reference was made to these audits.
With regard to compliance with medical staffing job planning, Dr Fluck advised of steps being taken to enhance the uptake rate from 64% to the target of 85% compliance. Dr Khan pointed out that the Board had a policy that all consultants had a job plan and it was unacceptable not to have a job plan. It was stressed that the quality of job plans was important and education, training and professional development had to be incorporated into these.