UN/APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

onTuesday 2 April2013 at 10.00am

inthe Seminar Room, Curl Aberdeen, Eday Walk, Aberdeen

Present

/ Mr Charles Muir / ViceChairman
Mr David Anderson / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Cllr Barney Crockett / Non-Executive Board Member
Dr Roelf Dijkhuizen / Medical Director
Mrs Sharon Duncan / Non-Executive Board Member
Mr Alan Gray / Director of Finance
Professor Mike Greaves / Non-Executive Board Member
Mrs Jenny Greener / Non-Executive Board Member
Mrs Linda Juroszek / Non-Executive Board Member
Mrs Christine Lester / Non-Executive Board Member
Councillor Anne McKay / Non-Executive Board Member
Mr Terry Mackie / Non-Executive Board Member
Sir Lewis Ritchie / Director of Public Health
Cllr Anne Robertson / Non-Executive Board Member
Mr Mike Scott / Non-Executive Board Member
Mrs Elinor Smith / Director of Nursing and Quality
By / Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Invitation / Dr Annie Ingram / Director of Workforce
Mr Graeme Legge / Strategic Asset Manager
Mr Graeme Smith / Director of Modernisation
Ms Helen Robbins / Head of Quality, Governance and Risk
Dr Pauline Strachan / Chief Operating Officer/Deputy Chief Executive
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wells / PA, Board Secretariat
Item / Subject
1 / Apologies
Apologies were received from Councillor Bill Howatson and Mr Raymond Bisset.
2 / Verbal Updates
  • Chairman
Mr Muir advised that the appointment of two Non Executive Board members was awaited following interviews in February. He reported the Chairman’s feedback from a very positive visit by the Cabinet Secretary to NHS Grampian on 4 March 2013. This had included presentations at Turriff Health Centre and discussions aboutClinical Decision Support, NHS Grampian’s 2020 vision and patient safety. The visit had demonstrated partnership working between the health service and local authorities. He advised that the Chairman had participated in informative walkrounds to the Intensive Care Unit (ICU) and Stroke Unit at Aberdeen Royal Infirmary.
  • Chief Executive
Mr Carey advised that there had been a positive meeting with MPs and MSPs the previous week at which topics discussed had included waiting times, insulin pumps and neuro-oncology services. The results of a staff and patient survey of the new Emergency Care Centre had been presented. This showed high levels of satisfaction.
Mr Carey took the opportunity to provide an update on the situation within Mental Health Services at RoyalCornhillHospital, Aberdeenwhich had been reported in the press. He advised of unprecedented levels of clinical activity which, combined with a shortage in staffing, had led to pressures on the service. He reported there were 28 whole time equivalent (wte) nursing vacancies out of an establishment of 369.7wte and advised the steps being taken to recruit staff. Additional investment of £700k for the service had been approved. Dr Ingram advised that there was a shortage of mental health nurses throughout Scotland, with a reduction in the numbers in training. Mr Carey advised that staff side colleagues had provided significant input to assist with the current situation. Mrs Smith advised that staff remained committed to the Scottish Patient Safety Programme. She had been on recent patient safety walkrounds and had been encouraged by the enthusiastic and committed staff. Dr Strachan reassured the Board that the immediate priority was to keep the service safe. The configuration of Mental Health Services was being reviewed as part of Mental Health 2020 using the Healthfit model and that proposals would be brought back to the Board. The Clinical Governance Committee would maintain an overview of the situation.
3 / Minute of Meeting held on 5 February 2013
This was approved subject to the following amendments:
Page 1 – List of attendees. Amend Mr Mike Hebden’s designation to “Deputy Governor Designate, HMP Grampian”.
Page 3 – Paragraph 7, line 8. Replace “Criminal” with “Community”.
4 / Matters Arising
There were no matters arising.
5 / Developing and Empowering our Staff
5.1 / The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry – TheFrancis Report – Risk 853
Mr Muir explained the importance nationally of the recently published Francis Report and of the requirement for Boards to consider its recommendations. MrsSmith advised that the questions raised in the Francis Report should be used to improve service to ensure all patients receive safe, effective, and dignified person-centred care. The 290 recommendations of the report were divided into five themes: Fundamental standards of patient care; culture of openness and honesty, backed by law; support for compassionate nursing and care; better leadership; collection and use of accurate, relevant data, including inspection, monitoring and escalation.
Mrs Smith advised that NHS Grampian could demonstrate that it was undertaking a great deal of work to promote person-centred, safe and effective care. The vision and values of the organisation had been reviewed recently and “Caring, Listening, Improving” was being used widely throughout the organisation.
A number of senior groups will be asked to consider the Francis Report to feed into a collated report to be brought to a Board meeting in August or October 2013. A suggestion was made to set up a short life working group comprising chairs and executive support to governance committees to oversee the collation of the report.
Mr Scott welcomed a group to review the various mechanisms to ensure appropriate information and information flow. Dr Strachan advised that NHS Grampian was not solely target driven and that it should not compromise its values to achieve what may be unachievable targets.
Dr Dijkhuizen stressed the need to listen more to patients and the importance of engagement with staff and members of the public. Dr Ingram explained it was necessary for organisations to take responsibility and for all staff to adhere to good standards of behaviour. She suggested that having an Employee Director on the Board and full time partnership representatives promoted good relationships between management and staff.
Mrs Smith advised that the Patient Safety Walkround programme was being reviewed and would be re-launched at the Quality and Safety in Healthcare Event on 20 May 2013. Mrs Duncan advised that Non-Executive participation in walkrounds had been particularly helpful to allow staff to raise issues and to feel as if they were being listened to.
Sir Lewis reminded the Board that the report on the Vale of Leven Enquiry was due to be published later in the year and its recommendations might impact on the work of the short life working group. Dr Strachan advised that the process was not static and that it was necessary to ensure that lessons were learned from these other areas and reports
It was suggested that Local Authority and third sector partners, patients and carers be included in the Short Life Working Group.
Mr Muir concluded the discussion by advising that although much had been done to improve quality, there were continual opportunities to improve andto keep learning from our own and others’ experiences.
The Board:
  1. Noted the previous work and the key themes.
  2. Asked senior groups to consider Volume 2 of the Francis Report with a view to identifying what worked well and where improvements could be made.
  3. Agreed to the proposal to form a short life working group to ensure this work was completed and collated and a report brought back to the August/October 2013 Board meeting.
  4. Agreed to have the Quality Dashboard on the Board agenda on a quarterly basis.
  5. Asked the Director of Nursing and Quality to explore further the possibility of patients presenting their own stories at Board meetings.
  6. Asked the Chairs of Clinical Governance and Staff Governance Committees and their Executive Sponsors to consider how information from complaints and incidents may be brought to the Board.
  7. Agreed to add Executive Patient Safety Walkround feedback to the Board agenda.

6 / Delivering High Quality Care in the Right Place
6.1 / Quality Plan 2013 – 25 – Risk 853
Ms Robbins, Head of Quality, Governance and Risk joined the meeting for this item. Mrs Smith informed the Board of progress with the three quality ambitions of person-centred, safe and effective. The importance of quality had been recognised in the previous agenda item. The draft Quality Plan had been subject to wide consultation and the final version presented had taken comments into account. Board members discussed the importance of structured Mortality and Morbidity meetings across the whole of Grampian to provide learning opportunities.
Ms Robbins advised that key individuals were working on different parts of the Quality Plan. Measurable outcomes had been identified and progress would be monitored, with progress to be reported to the Board. It was noted that the Quality Dashboard,to which reference had been made in item 5.1,was a useful tool for reporting key quality indicators.
The Board:
  1. Approved the Quality Plan.
  2. Requested updates every six months.

6.2 / Property and Asset Management Plan– Risk 855
Mr Legge, Strategic Asset Manager, joined the meeting for this item. Mr Gray explained that NHS Grampian had to make best use of its property portfolio to provide a high quality service, by prioritising investment and disinvestment requirements. He highlighted some of the major investments during the last year including the opening of the new Emergency Care Centre which had replaced 40% of inpatient beds at Aberdeen Royal Infirmary; the replacement of Linear Accelerators and bunkers; investment of more than £12m for new and replacement medical equipment; combined heat and power plant; new patient management system; the commencement of building the Aberdeen Health and Care Village. He reported that backlog maintenance had reduced by £5.4m. The Property and Asset Management Plan provided a comprehensive plan to manage NHS Grampian’s asset portfolio to support the achievement of Healthfit 2020 – NHS Grampian’s strategy. In response to a query about the facility at Maud, Mr Smith explained that NHS Grampian had worked with the Community Trust and Local Authority to create a community facility which had replaced an outdated hospital.
Mr Smith stressed the importance of having estate and facilities which were fit for the future, by developing modern infrastructure and making more of community-based facilities.
Mr Gray advised that capital receipts for property sales did not belong to NHS Grampian, but to the Scottish Government. However, by negotiation,the benefits could come back to NHS Grampian as robust plans were in place for capital investment.
Mr Legge explained that the reason NHS Grampian appeared to have a high level of backlog maintenance was because it had carried out very detailed surveys of all its properties, compared to the level of surveys done elsewhere in Scotland.
Mr Gray advised that a wide range of interest was expected for the city centre properties at WoolmanhillHospital and Denburn which would be marketed by NHS Grampian and Aberdeen City Council. Woolmanhill was expected to be vacated and clinics relocated by the end of 2013.
The Asset Management Group was sighted on the 5 year strategy and would report regularly to the Performance Governance Committee. The Board would receive Business Cases for major investment and the annual Property and Asset Management Plan.
Mr Muir thanked Mr Legge and his colleagues for the provision of an excellent and comprehensive report.
The Board Approved the 2013/14Property and Asset Management Plan prior to it being submitted to the Scottish Government Health and Social Care Directorate as required.
6.3 / Healthcare Associated Infection Report – Risk 853
Dr Dijkhuizen reported that that performance was on target for Clostridium difficile infections and Staphylococcus aureus bacteraemia rates. He advised that hand hygiene data had improved since a dip in November 2012 and that reminders were constantly given to staff about the importance of handwashing in the control of infection. He explained the observation process by the infection control team and the public involvement in this. He praised nursing and medical staff at Dr Gray’s Hospital for the positive results achieved there.
The Board noted the report.
7 / Improving Health, Wellbeing and Reducing Inequalities
7.1 / Local Delivery Plan – Risk 851/1134
Mr Gray explained that the Local Delivery Plan (LDP) described how NHS Grampian would deliver improvement against the key national targets and also included a five year financial plan. In response to a query about unnecessary duplication within cancer services, Mr Smith advised that there had been a recent reorganisation of cancer services with a managed clinical network which linked to the North of Scotland network. This new approach would eliminate duplication and address gaps.
Mr Gray clarified that the LDP had been submitted to the Scottish Government after discussion at the Board Seminar on 26 February 2013. A small number of changes had been made to refine the wording and to negotiate the financial plans, prior to its submission by the required date. The LDP coming to this Board Meeting for approval was a procedural matter to ensure that it was presented at an open meeting of the Board.
The Scottish Government’s letter formally approving the LDP dated 28 March 2013 was tabled. Mr Carey stressed the importance of having these documents in the public domain as they provided a source of reference about the performance of NHS Grampian. He explained that NHS Grampian was performance managed by the Scottish Government which included the Annual Review meeting in public and a mid-year review. Regular reporting on LDP items was done mainly through the Performance Governance Committee, which had a responsibility to escalate any performance issues to the Board.
Board members queried how sufficient assurance could be provided that any performance issues were being addressed, whilst acknowledging the need to delegate to governance committees where appropriate. They discussed how to achieve the appropriate balance of information to ensure sufficient knowledge and awareness of issues. It was noted that the work being taken forward following the principles of the “Intelligent Board” would help to address this.
The Board approved the Local Delivery Plan 2013/14.
8 / Involving our Patients, Public, Staff and Partners
8.1 / Patient Story
Mrs Smith explained that the patient story was an important part of the Board agenda. She read out a story of an elderly lady’s perspective about delayed discharge – the patient was unable to go home although medically fit to do so. It had been chosen as it linked to the following agenda item 8.2 on joint commissioning and also to the subject of delayed discharges to which reference was made in the Performance Governance Committee report. Mrs Smith advised that feedback would be provided to the Local Authority about the issues raised in the story. She also provided information from the Better Together 2012 survey where 1241 comments had been given about discharge and leaving hospital, 54% of which had been positive. From the story and survey feedback there were lessons to be learned for both the NHS and local authority partners. The Better Together Public Involvement Group had made a number of recommendations which would be taken forward.
8.2 / Joint Commissioning Plans – Risk 586
Mr Smith referred to the paper prepared by Mrs Heather Kelman, Lead General Manager – Reshaping Care for Older People. This explained the purpose of the three Joint Strategic Commissioning Plans and the process followed to develop these plans in partnership with local authority, third sector, independent care sector and housing colleagues. The process had also included public consultation. The plans focused on the needs of the older population of each of the three local authority areas and involved staff from many disciplines to develop strategic plans to allocate resources to best meet those needs. Mrs Duncan advised that staff had been involved in the development of the plans and it was necessary to ensure their continued involvement. The plans had been discussed very widely including detailed discussion at the Board seminar in January 2013. They had been approved by the local authorities and had been endorsed by the NHS Grampian Strategic Management Team in February 2013.
Board members discussed how the plans would be implemented and monitored and how lessons could be shared across the different local authority areas. MrSmith advised that the plans would form a critical part of an integrated health and social care system and inform the planning and business cycle, including the Local Delivery Plan. Mrs Gray advised that the three plans had been discussed at the Public Forum which had been keen for consistency around the layout and key messages in the plans.
A suggestion was made for the lead officers from each of the three areas to give an annual joint presentation on progress.