APPROVED

NHS GRAMPIAN

Note of the Performance Governance Committee held on

Wednesday 23 November2011at 10.30am in the SeminarRoom, Summerfield House

Present:

Bill Howatson, Non-Executive Board Member (Chair)

Val Maehle, Non-Executive Board Member

Charles Muir, Non-Executive Board Member

Gordon Stephen, Non-Executive Board Member

In Attendance:

Richard Carey, Chief Executive

Alan Gray, Director of Finance

Laura Gray, Director of Corporate Communications (item 5.1.1 only)

Anne Ross, Head of Performance and Quality Improvement

Pauline Strachan, Chief Operating Officer

Glenys Wells, Personal Assistant - Minuting Secretary

Item / Subject / Action
1. / Apologies
Apologies were received from Roelf Dijkhuizen.
2. / Healthstat – Note of meeting held on 15 September 2011
This was approved.
3. / Minute of Meeting held on 15 September2011and Matters Arising
This was approved.
Matters Arising from previous minute – item 5.1.4: Cancer Access Targets - Members noted that it was still expected that the 62 day target would be met on a sustainable basis by December. A full endoscopy service review was underway.
4 / Assurance Framework
Reports from Governance and CHP Committees:
4.1 / Patient Focus and Public Involvement Committee – 9 November 2011
Bill Howatsonreported that the Committee had discussed the Consultation on the Patient Rights (Scotland) Act 2011 and the
sustainability of cancer patient experience service improvement project. Richard advised that there had recently been a 10th anniversary meeting of the Public Forum where Roelf Dijkhuizen gave a presentation on the 2020 vision. It was agreed that wider engagement with the public on the Health and Care Framework was required to ensurefull exposure of the 2020 vision. Richard Carey agreed to review the position on the public newspaper which had ceased due to cost. / RMC
4.2 / Aberdeen City CHP – 22 September 2011
Bill Howatsonreferred to good discussions during the Seminar which had been held after the Committee meeting. The 2020 vision had been considered and wider debate was required on the Change Fund proposals outlined by Heather Kelman. Fred McBride would review the projects to be taken forward. The revised CHP Committee structure which was on hold pending the Government’s response to Audit Scotland Review of CHPs
4.3 / Staff Governance Committee – 15 November 2011
Gordon Stephenreported that the Committee had heard that a Head of Workforce would be appointed and a replacement for the Head of Health and Safety post was also being progressed. The People Strategy would be refreshed once an appointment had been made. There was ongoing dialogue with management regarding the level of service to be delivered during the proposed industrial action. Richard Carey confirmed that the two vacant Director posts had been advertised with a closing date of 19 December2011 and interviews were proposed for 10 January 2012. Non-Executives would be invited on to the interview panel.
4.4 / eHealth Committee – 11 November 2011
Richard Carey will discuss with the new NHS Grampian Chair the opportunity to review this Committee’s membership and increase Non Executive input. Given the importance of new technology in delivering the 2020 vision, he felt this Committee should be strengthened as a governance committee.
Alan Gray provided an update on Patient Management System (PMS) implementation and reported that data was now being submitted to ISD. He highlighted that Intersystems had not yet signed off the warranty. He advised of the challenges regarding the mental health module. The March deadline will be tight and any costs associated with retaining the current contract would have to be borne by Intersystems. There was a June 2012 target for implementation of the Order Comms which was linked to the Emergency Care Centre. He believed that Intersystems was not sufficiently resourced to meet requirements. It was important to have a meeting of the national Consortium Board very soon.
It was agreed that the proposed topic of PMS at the January 2012 Board seminar should be extended to eHealth generally. / AG
4.5 / Moray CH&SCP – 16 September 2011
Charles Muiradvised on progress with the building works at Dr Gray’s. Some work was required on the business plan to be signed off at the December Asset Investment Group meeting. Public Health had worked on the health impact analysis for the Ministry of Defence changes and this would remain on the agenda of the Committee. There were positive reports on the Public Partnership Forum workplan and improved access to dental services.
The Designing Assistive Living at Scale (DALLAS) project was a national initiative with Grampian being one of the pilot implementers. NHS 24 was leading this initiative and Andrew Fowlie had been freed up to participate on behalf of NHS Grampian. It was agreed to review this item again at a future Board Seminar. / AKR
4.6 / Aberdeenshire CHP
Val Maehleadvised that no meeting had been held and there were no issues of significant concern. A workshop would be held when the Government response to the CHP audit was announced. She reported on the successfultransfer of prison health care to the NHS, reviewing Out Of Hours medical care and cross sector issues. The issue of improving GP practice accommodation was a high risk issue to be reviewed.
Work on the Change Fund was moving forward and a pilot training programme was being developed to support people to stay at home. Management arrangements in Aberdeenshire were now in line with Local Authorities. A workshop on 7 December with all partners will look at future needs and the 14 December CHP meeting will consider further.
5. / November Overall Performance Report and ‘At A Glance’
Anne Ross provided a summary of the key issues not covered elsewhere on the agenda:
The second quarter data was now available for most health improvement measures and most were on or just below target.
Fluoride varnishing was a complex measure and all Boards were currently well below target. This topic would be discussed at the December Cross System Performance Review and reported onwards to the next PGC.
Alcohol and Drugs access target was not being met in full but was improving.
Emergency bed days for over 75s – this had fallen previously but was now increasing. The Grampian position was still low in Scottish terms however.
cDiff – continues to reduce.
AE attendance rate did reduceover the last year but there was now an upward trend, almost as high as in 2009, but again low in Scottish terms.
4hour A&E compliance – currently at 97.2% so not meeting 98% target.
Outpatient DNAs – fluctuates although below Scottish average and not meeting trajectory. December performance review will haveupdate report on DNAs at RACH
Delayed Discharges – low in Scottish terms with 2 over 6 weeks at end October and 30 in total. Fluctuates monthly. New HEAT measure for next yearwill be reduction to 4 weeks then 2 weeks maximum
Sickness absencewas 4.1% which was a very good performance.
5.1 / Delivering safe, effective & timely care in the right place
5.1.1 / Media Report (Strategic Risk 858)
Laura Gray reported a wide range of media coverage for September with recurring themes e.g. Buckie patient, Forres, pharmacy services in the Tarves area and car parking. The latter had received comprehensive coverage regarding proposed plans. There had been positive coverage regarding cancer services. For October, there had been a number of challenging stories from the Press and Journal e.g. the TB case, the work carried out on HAI improvements, visiting times and the recall of a flu vaccine. The relationship with the Evening Express remains positive, with good coverage on the Health and Care Framework and positive patient stories. A meeting has been arranged for Richard Carey to meet with the Evening Express.
A difficult story was that of a patient transfer between ARI and Aboyne, which although a Scottish Ambulance Service complaint, had resulted in questions to NHS Grampian. Practical examples of the impact of reporting included a positive story on breast cancer resulting in a number of new volunteers coming forward. The coverage on the flu vaccine recall required much hard work to reassurepeople.
5.1.2 / The Change Fund (Strategic Risk 851)
Alan Gray confirmed that many projects were now up and running and the paper from Heather Kelman outlined the financial governance arrangements that had been put in place. He advised that a £3m shortfall at the year end was expected and discussion was ongoing with Scottish Government on how to deal with the financial slippage. This was not unique to Grampian and was a consequence of the funds being made available for a full year and the complex work required with partners to establish projects. It was vital to ensure that the resource was spent appropriately. Plans for 2012/2013 were required in February 2012.and a review on how to manage the future including an exit strategy would be required.
Richard Carey advised that the Change Fund was a high risk for NHS Scotland in that the funding available was short term but the service change had to be sustainable beyond the period of the fund. The Change Fund would be a key enabler for the 2020 vision. Pauline Strachan advised that the division of the Grampian resource to the three local authority areas was currently pre determined by Scottish Government and this meant it did not necessarily relate to local needs. Efforts were continuing to obtain the right to allocate the resources locally.
5.1.3 / 18 Weeks Referral To Treatment
It was noted that the target was due for delivery by December 2011 and based on current performance it was expected that this would be delivered.Pauline Strachan advised that the capacity in Grampian had been enhanced on a sustainable basis without the use of waiting list initiatives. The position was welcomed.
5.2 / Improving Efficiency, Productivity and Sustainability
5.2.1 / End October Financial Report (Strategic Risk 851)
Alan Grayreportedon the financial position at the end of October which was showing a £1.63m net revenue overspend. Whilst the staffing position was 143 under establishment the pay cost was over budget due to skill mix and pay pointprogression. The nursing overspend (£4.4m) would be reviewed at the Budget Steering Group.
Medical locums were back within budget despite continued pressures in certain areas. The Budget Steering Group wouldalso look at mitigating actions for the challenging non pay position. Many actions were in place to manage the challenging financial position and manage pressures on saving initiatives. 2012/13 would be particularly challenging and a number of sessions on ‘big ideas’ for savings were planned.
Alan Grayreported that NHS Grampian had been assessed as 85% superior status for its national Procurement Capability Assessment.
5.3 / Involving patients, public staff and partners towards mutuality
5.3.1 / Car Parking at ARI – update
Pauline Strachan advised that the Steering Group chaired by Terry Mackie had met and that an Implementation Group wasnow meeting weekly to take forward a myriad of tasks following the Board agreement to take forward the car parking proposals. Communication was key as there were many concerns and misconceptions. Implementation was complex and would not be visible until April of next year. Currently, staffwere enforcing existing arrangementse.g. halting inappropriate parking. An update report was requested for the next PGC meeting. The PGC report to the Board will highlight the current position for information. / Jan 2012
6. / Annual Review
Richard Carey reported on a very positive Annual Review day and all staff had been thanked by the Chairman and himself for their contribution to delivering this. The formal letter from the Scottish Government was awaited.
7. / 2010/11 Annual Report Timetable
Anne Rossreported on the timetable for preparation and sign off of the Annual Report. It was hoped that the Annual Review letter from the Scottish Governmentwould be received before availability of the pdf version of the report on 8 December. Members will receive a copy at that time for comment. The Annual Report will be an agenda item for the PGC January 2012 meeting and presented to the Board in February 2012. / Jan 2012
8. / Performance Management Internal Audit Report
Anne Rossreported that the audit was generally positive and identified a small number pf medium or low risk recommendations. Actions in response to each recommendation had been agreed and were noted.
9. / Strategic Risk Control Plan
Alan Gray confirmed that the plan had been reviewed last week by the Executive Team and would be finalised on 24 November. The 16 risks had been reduced to 8 and the final plan would be made available to members. / AG
10. / To consider content of December 2011 Board Report
-Change Fund
-Car Parking
-PMS
-DALLAS
-FinancialPosition
-18 Weeks RTT
-Industrial Action
11. / AOCB
  1. Industrial Action –Pauline Strachan referred to working in partnership with staff side colleagues on preparation for 30th November. It was currently planned to continue with as many services as possible in a safe manner for patients and staff. The result of themanagement communication to staff to gauge their attendance on 30 November will enable a decision to be made regarding any curtailment of elective work. Certain core services will be maintained e.g. emergency, cancer and renal. A list of Qs & As will be included in the staff communication. Richard advised on the differing approaches being taken in other Boards e.g. cancellation of elective services.

12. / Date of Next Meeting
Friday 20 January 2012, 10.30am – 1pm, Conference Room, Summerfield Hse

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