Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on 6 August 2015 from 10.30am

Committee Room 5 – Woodhill House, Westburn Road, Aberdeen


/ Professor Stephen Logan / Chairman
Mrs Rhona Atkinson
Mr David Anderson / Non-Executive Board Member
Non-Executive Board Member
Mr Raymond Bisset / Non-Executive Board Member
Cllr Stewart Cree / Non-Executive Board Member
Cllr Barney Crockett / Non-Executive Board Member
Mrs Sharon Duncan / Employee Director
Dr Nick Fluck / Medical Director
Mr Alan Gray / Director of Finance
Professor Mike Greaves / Non-Executive Board Member
Cllr Martin Kitts-Hayes / Non-Executive Board Member
Mrs Christine Lester / Non-Executive Board Member (Vice Chair)
Dr Lynda Lynch / Non-Executive Board Member
Mr Terry Mackie / Non-Executive Board Member
Dr Helen Moffat / Chair, Area Clinical Forum
Mr Jonathan Passmore / Non-Executive Board Member
Mr Eric Sinclair / Non-Executive Board Member
Mr Malcolm Wright / Chief Executive
By invitation / Mrs June Brown / Associate Director of Nursing
Ms Amanda Croft / Director of Nursing, Midwifery and Allied Health Professions (Designate)
Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Dr Annie Ingram / Director of Workforce
Mr Graeme Smith / Director of Modernisation
Mrs Susan Webb / Acting Director of Public Health
Attending / Ms Christina Cameron / Programme Manager (Item 12)
Dr Tara Fairley / Consultant Obstetrician (Item 6)
Miss Lesley Hall / Assistant Board Secretary
MrChris Littlejohn / Consultant in Public Health & Head of Health Improvement (Item 7)
Mr Cameron Matthew / Divisional General Manager (Item 6)
Ms Jenny McNicol / Head of Midwifery (Item 6)
Ms Marion Beaton / PA
Item / Subject
1 / Apologies and Declarations of Interest
Apologies were received from Professor Rosemary Lyness.
There were no declarations of interest relating to specific agenda items.
2 / Chairman’s Welcome and Introduction
The Chairman welcomed everyone to the meeting, in particular Councillor Martin Kitts-Hayes as Aberdeenshire Council’s new representative on the Board, following the recent changes in the administration of the Council. He expressed the Board’s thanks and appreciation to Cllr Anne Robertson for her contribution to the Board during her term of office. He also congratulated Ms Amanda Croft on her appointment as Director of Nursing, Midwifery and Allied Health Professions from 1 September 2015.
The Chairman also drew attention to a display by THInC (Transport to Healthcare Information Centre) and explained that NHS Grampian was a partner in this jointly funded telephone information line to provide residents with detailed information, tailored to their needs, about transport options for getting to their health or social care appointments.
On 2 July the Chairman had represented NHS Grampian at the official opening of the Riverside Campus of the Robert Gordon University at Garthdee by the Princess Royal.He had also attended a number of local conferences and events including a Pain Conference hosted by Professor Chambers on 17 June and the Oral and Dental Health 2020 event on 15 June.He advised of a useful meeting with Grampian MPs and MSPs on 3 July at which there had been discussions regarding end of life care, primary care provision, TB and neuromuscular care.
Chief Executive’s Report
Mr Wright presented his report which highlighted a range of issues, some of which were not covered elsewhere on the agenda. He provided details of important meetings and events he had attended. He highlighted the revised Acute Sector management arrangements and the following points:
Mr Wright reported on progress with the Older People in Acute Hospitals (OPAH) collaborative which supported front line staff to use current improvement methodology and to promote person-centred care.
NHS Grampian’s gastroenterology servicehad gained prominence in the UK and internationally through the work of Dr Alastair McKinlay, Consultant Gastroenterologist and his team.
A new Regional Oncology Clinical Board had met for the first time in June 2015. The aim of the collaborative approach was to ensure a long term sustainable approach for clear and consistent oncology services across the North of Scotland.
Mr Wright reported high levels of engagement and response to the first cohort of the iMatter staff engagement tool.
The tremendous contribution that volunteers make to NHS Grampian was acknowledged. A celebratory reception for volunteers working at Roxburghe House, Woodend Hospital and the City Hospital had taken place in June to thank them for their sterling work for NHS Grampian.
TheBoard had previously received an update on the development of the major trauma network in the North of Scotland, including the development of Aberdeen Royal Infirmary as one of four major trauma centres (MTCs) in Scotland by the end of 2016. A review group had been established and NHS Grampian had expressed considerable concern regarding the very short timescale for developing recommendations
Mr Wright had attended the first Community Planning Aberdeen (CPA) Board meeting with Mrs Susan Webb. Community Planning aimed to engage people and communities in the decision-making process on public services and the report noted some of the successes to date.
Mr Wright congratulated the Chairman on his Honorary Degree from the University of Aberdeen.
4 / Minutes of Meetings held on 4 and 29 June 2015
The minutes were approved.
5 / Action Log and Matters Arising
As agreed at the April 2015 Board meeting, asupplementary action log had been produced to record actions in progress or completed. Mrs Lester suggested that dates and action owners should be added to the log.
Review of Patient Story at Board
Mrs Gray advised that future stories would be more structured to provide an understanding of what had been learned from the patient experience. It was suggested that patient stories should link to Board agenda items and that the Board should also consider staff and carers’ experience too.
Strategic Items
6 / Maternity Services Strategy Implementation
Ms Croft presented the paper on Maternity Services and introduced Dr Fairley, Consultant Obstetrician, Ms McNicol, Head of Midwifery and Mr Matthew, Divisional General Manager.
Dr Fairley advised that the aim of the strategy was to provide the best start for children. She explained that some of the goals set out in the Maternity Service Strategy in 2010 had been aspirational. However, it had been recognised that some were unachievable and that the goals in the refreshed strategy would be more realistic, which would help to encourage staff and service users. She explained that the proposals for the development of the state of the art Baird Family Hospital had provided a significant boost to staff morale.
Ms McNicol advised that real time feedback was being gathered in a variety of ways. This was being used more effectively for training staff and would also inform the vision for the Baird Family Hospital. She explained that the Maternity Services Liaison Committee was involved in the review of the strategy and also in the planning of the new hospital facilities. Action plans to improve serves were being taken forward to ensure the service was as safe and effective as possible. National reviews and reports such as the Kirkup Report of Morecambe Bay and MBRRACE-UK Perinatal Report also informed actions to be taken. Mr Wright advised that the outcomes from consideration of these reports would be concluded by NHS Grampian’s clinical governance processes.
In response to a query about the normal birth rate trend, Ms McNicol advisedthat sometimes interventions in labour and birth were needed and explained that unnecessary interventions created risks for women and babies. Therefore, the aim was to increase the number of normal births in Grampian,with a target of 70% by 2015.
The importance of community midwifes and the development of care closerto home so woman did not have to travel so far was stressed. It was noted that the development of community maternity units had an impact on vulnerable groups.
Dr Fluck recommended that more meaningful outcome measures created at service level should be included. Mrs Webb suggested that future papers reflect appropriate performance indicators to ensure the organisation was building on good practice.
The revised Maternity Services Strategy would be presented to the Board in early 2016, following a meeting of the Maternity Services Programme Board in December.
Three new obstetric Consultants will facilitate an increase in Consultant presence in labour ward.
  1. The Board noted the work going forward in relation to progressing the maternity strategy.
  2. It was noted the progress of the Maternity Services Review (MSR) that followed on from the maternity strategy.
  3. The Board noted the maternity service responsiveness to the opportunity for the further significant service redesign as part of the Baird Family Hospital development and the key national drivers and issues.

7 / Local Delivery Plan 2015/16 Section 2(i): Health Inequalities & Prevention
Mrs Webb introduced the paper following which Mr Chris Littlejohn, Consultant in Public Health and Head of Health Improvement highlighted the main points in the paper which provided an update on progress and an assurance about governance relating to this chapter of the Local Delivery Plan.
He highlighted there had been a downturn in people stopping smoking which could be due to the introduction of e-cigarettes. He explained that there was an upwards prevalence of obesity which had implications for the NHS and its partners. It was estimated that obesity-related illness cost NHS Scotland £600 million annually and he pointed out the importance of prevention.
With regard to multiple conditions, there had been a significant increase in the number of people with chronic health conditions. Mr Littlejohn emphasised the need for anticipatory care and providing support to allow people to manage their own long-term conditions. It was noted that multi-agency input was needed to address these health concerns and that the NHS could not deal with these alone.
The alcohol brief interventions (ABI) target had been achieved the previous year. The target had been increased and the challenging trajectory had not been met in the first quarter of the current year. It was acknowledged that staff time to enable them to have conversations about alcohol in a busy clinical environment was challenging.
The role of Integrated Joint Boards (IJBs) in the prevention agenda was discussed and the need for them to consider the impact of changes to adult services on children’s services.
The Board members were pleased to note that Community Planning Partnerships were engaged in preparing prevention plans.
  1. The Board noted the portfolio of programmes which contributed to Section 2(i) of the Local Delivery Plan.
  2. The Board considered and approved the governance arrangements in place to ensure delivery against the actions as agreed with the Scottish Government.
  3. The Board noted progress to date and the areas requiring accelerated action.
  4. The Board endorsed commitment to NHS Grampian as a health improving organisation.
Mrs Webb sought feedback outwith the meeting on the content and this approach to consideration of individual chapters of the LDP.
8 / NHS Grampian Workforce Plan 2015
Dr Ingram presented the Workforce Plan 2015 for approval prior to submission to Scottish Government, as a requirement of the National Workforce Planning Framework. She advised that it had been developed from sector and service plans and described the future workforce and updates on progress from last year’s Workforce Plan.
She advisedof the changes in the overall workforce numbers over the last 12 months and highlighted that NHS Grampian employed 14,263 staff and 11,855 whole time equivalent (wte) staff which was an increase of 1.7% and 2.7% respectively. There had been an overall increase in Consultant medical staff of 27 people (22 wte) and an increase of 3.6% in nursing and midwives equating to 176 wte bringing the total to 5188 wte.
Dr Ingram pointed out the 10 priority workforce planning actions outlined on pages 32 and 33 of the report and the work to develop “Caring, Listening, Improving”outlined in the diagram on page 35.
It was suggested that the wording in the action plan should be strengthened before the document was finalised.
Mrs Duncan, on behalf of staff side, commended the work that HR recruitment had done to increase the number of vacancies being filled. The Chairman echoed this.
Subject to the amendments suggested to the action plan, the Board approved the NHS Grampian Workforce Plan 2015 and agreed to its publication and submission in the required timescale.
9 / Infrastructure Investment
Mr Gray presented his paper which set out the strategic context for the investment in infrastructure linked to NHS Grampian’s 2020 vision and the key matters relevant to the recommendations for the following three planned investments:
  • Inverurie Care Hub and Relocation of Foresterhill Health Centre Bundle Outline Business Case (OBC)
Mr Grayexplained that the OBC was being presented for approval prior to submission to the Scottish Government Capital Investment Group. He explained that the relocation of the Health Centre was a key enabling work to ensure an early start on site for the development of the Baird Family Hospital. The new Foresterhill Health Centre would provide GP services as well as a range of health and social care services. He assured the Board that pace was being maintained with the development of the Inverurie Health and Care Hub which would also provide GP facilities and health and social care services from a purpose-built facility.
The Board approved the Outline Business Case for Inverurie Health and Care Hub and the relocation of Foresterhill Health Centre for submission to the Scottish Government Capital Investment Group.
  • Carbon Energy Fund – Contractual and Legal Agreements
In order to conclude the process to progress to final close of the Full Business Case (FBC) for investment in energy efficient infrastructure which had been approved by the Board in June 2014, the Board was requested to delegate authority to the Chief Executive and the Director of Finance to finalise all outstanding matters and sign the contract documentation. The Board was also asked to approve the draft wordingto be reflected in the Boardmeeting minute, as required by the Investment Fund providing the finance for the project.
  1. The Board noted the requirement, in relation to the Carbon Energy Fund Project, to enter into certain contract and legal documents with Vital Energi Solutions Ltd, Vital Holdings Ltd and the Investment Fund and delegated authority to the Chief Executive and the Director of Finance to finalise all outstanding matters and sign the contract documentation.
  1. The Board approved the draft wording at appendix 2 of the paper (Appendix 1 of this Minute) summarising the agreement of the Board to be reflected in the Board minute, as required by the Investment Fund providing the finance to the project.
  • Backlog Maintenance Project – Phase 2
Mr Gray explained that it was necessary to maximise the benefit to the project costs through contractor continuity on site for the next stage of the backlog maintenance plan.
The Board authorised the Chief Executive and Board Chairman to agree a final target price for the second stage of the Phase 2 ARI building, not to exceed the identified budget of £8m including all risk and contingency allowance, and to sign the contract agreement with the appointed Principal Supply Chain Partner.
Operational Business
The following agenda item was taken out of order to accommodate the attendee’s availability:
12 / Grampian Winter Plan 2015/16 – Progress Update
Mr Smith introduced the paper and Mrs Christina Cameron, Programme Manager, explained the approach and progress for the development of the integrated Grampian Winter Plan in line with Scottish Government guidance and self-assessment checklist. It was acknowledged that there were key actions and a very tight timescale for submission of the plan to the Government.
The Cabinet Secretary’s letter dated 14 July 2015 had given winter planning a higher profile and placed additional emphasis on winter preparation this year, with a specific focus on the delivery of safe and effective care. The aim was to ensure that NHS Grampian, working with key stakeholders, was fully prepared to minimise any potential disruption of services. Mrs Cameron outlined the timescales for approval and submission of the plan and advised that the process would be overseen by the Operational Management Board (OMB).
Mr Smith explained the challenges relating to delayed discharges, maintenance of the 4 hour standard and surge capacity and the plans being developed to mitigate these. Concerns about the ability to achieve delayed discharge targets were discussed, noting issues with care home provision, closures of facilities and lack of carers impacting on an already challenging situation.