APPROVED

NHS Grampian

Performance Governance Committee

Wednesday 23 July 2013,

Conference Room, Summerfield House

Present

Bill Howatson, Chairman

Mike Scott, Non-Executive Board Member

Raymond Bisset, Non-Executive Board Member

Sharon Duncan, Employee Director

In Attendance

Richard Carey, Chief Executive

Roelf Dijkhuizen, Medical Director

Alan Gray, Director of Finance

Anne Ross, Head of Performance and Quality Improvement

Laura Gray, Director of Corporate Communications (Items 5.2 - 6.1)

Claire Smith, Interim Divisional General Manager (Item 5.5)

Rachael Ross, Minuting

ITEM / SUBJECT / ACTION
Apologies
Christine Lester, Charles Muir
1. / Minute of Meeting held on the 22nd May
Closed Session: Approved
Open Session: Approved
2. / Matters Arising
None.
3. / Delivering 2020
3.1 Planned Care
Mr Carey updated PGC on progress with the Planned Care programme. The No Delays approach was particularly exciting with a lot of external interest. This would feature as a Board seminar topic in due course when joint venture arrangements were further developed. The importance of engaging all disciplines of staff was key to success. The challenge of demonstrating a shift in the balance of care was complex at a time when access target delivery required further investment in hospital care. Changes within acute services, such as tele/video consultations, would shift the balance without necessarily moving financial resource. It was noted that recruitment was in hand for a Clinical Lead. Assurance was also given on the radiology action in the action plan that was currently behind schedule. Focus had been on redesign in relation to moving to the ECC.
3.2 Exception Update on Change Fund and Unscheduled Care
Change Fund
Mr Gray advised that meetings were imminent with each partnership to review the commitments over the remaining 18 months of the Change Fund. Given the delay in implementation of a number of projects it was vital that there was a clear strategy for spend and exit at the end of the period. The need to ensure effective planning time was a learning point for future integration arrangements.
The currently low level of anticipatory care plans was discussed. It was noted that these were now a GP Contract requirement although the target level remained quite low. A higher local target was a possibility.
Dr Strachan provided an update on delayed discharges. Whilst the April target had been delivered in full the position had since worsened with 51 delayed discharges of longer than 14 days in May and 42 in June. The position elsewhere in Scotland was similar. It was agreed that CHP Chairman should ensure this was raised once more at CHP Committee meetings with appropriate updates provided to the NHS Board in due course. Patient stories of delayed discharge were a powerful tool of true patient experience. Cllr. Howatson advised that he intended to raise the position in his introductory remarks to the NHS Board.
Unscheduled Care
Dr Dijkhuizen provided an update on the Unscheduled Care programme. The Decision Support to GPs element was still on target for beginning in September. Recruitment of the additional staffing was underway. There continued to be variability in performance against the 4 hour A&E standard although the aim was to deliver 100%. Direct admission to specialties since the opening of the Emergency Care Centre was contributing. This was also providing valuable information on the true demand for specific specialty bed capacity. It was noted that the level of boarding i.e. patients accommodated in other wards on a temporary basis, had reduced significantly. Implementation of the redirection policy was also working well.
3.3 Improving Health and Wellbeing – Obesity
Mr Carey highlighted that this was perhaps not the best forum for this paper to come to at this stage and it should be referred to a future Board Seminar aiding further discussion.
The members noted the report and agreed that this was an appropriate action.
4. / May Overall Performance Report and ‘At a Glance’
Ms Ross highlighted the following key points from the July monthly performance report and ‘at a glance’ not covered elsewhere in the meeting.
  • Data for Detecting Cancer Early target was available for the first time. Grampian’s performance is 20.4% diagnosed at stage 1 for the 3 cancers covered. The Scottish average is 23%. The end target is 29% by Dec 2015
  • Child Healthy weight interventions continue to be above plan. Grampian is exceeding trajectory more than any other Board.
  • Successful smoking cessation continues to be well above target
  • The CAMHS access target for end March was delivered and Grampian was one of only 3 mainland Boards delivering this
  • Access to drug and alcohol treatment targets continued to be delivered in full.
  • The target number of cardiovascular health checks was exceeded at end March. Activity for April and May has fallen slightly below plan
  • Childhood dental registrations were above 80% for first time at 81.4% for Grampian. AberdeenCity remained below at 76.4%
  • MRSA/MSSA rates continue to fall but were slightly above plan.
  • Continued fall in Cdiff over same period.
Members noted the report.
Access Times (Strategic Risk 851)
Dr Strachan updated PGC on performance against access time targets and standards. The waiting list management principles approved by the NHS Board were continuing to be applied. This meant patients were being treated in terms of clinical priority and time on list. Compliance with the 12 week treatment time guarantee was over 99% however this meant that a small number of breaches were continuing to be reported weekly. Patients continued to be fully engaged in decisions about where and when their care was provided. Breaches would reduce as the new investment in theatres and infrastructure increased local capacity. At the request of Scottish Government, work was underway to establish what could be done to expedite full delivery. This would inevitably require further resource which had not yet been identified. Mr Gray was meeting with Mr Mathieson soon. It was noted that any additional activity would have to be with the independent sector as local NHS capacity was fully utilised.
62 Day Cancer Targets (Strategic Risk 851)
An update was also provided on actions being taken to recover the position on the 95% within 62 day cancer target, performance against which which had dipped in the previous quarter. It was known that Grampian had a lower rate of exclusion from the target and this would contribute to making full delivery difficult.
Fluoride Varnishing
A written update was provided from Mr Watkins, Consultant in Dental Public Health detailing what action was being taken to improve the levels of application of fluoride varnishing. Non NHS dentists serving the more affluent population was the main area where the target was not being met. Efforts would continue to engage with this group. NHS dentists were generally now undertaking varnishing.
Members noted the report.
5. / Performance Topics
5.1 March Financial Report (Strategic Risk 851)
Mr Gray presented the financial position at the end of June 2013. An overspend of £1.62m was being reported which was similar to the position for the first quarter of 2012. There were however key differences in that the financial contingency available in 2012/13 was not available this year. There was significant overspending in both the acute and mental health sectors. There had been robust discussion at the recent Budget Steering Group and outstanding cost reduction plans were being secured as well as sector specific reviews taking place. The overspend had to be viewed in the context of overall expenditure of £300K over this period. PGC was assured that performance management arrangements were in place and cost reduction plans were being taken forward.
5.2 Media Report (Strategic Risk 610)
Mrs Gray highlighted a number of topics from the media monitoring report for May and June 2013. These included extensive coverage of
an elderly patient who was injured after leaving an Emergency Care Centre ward undetected, a Fatal Accident Inquiry into the death of a mother in Aberdeen Maternity Hospital and various unrelated issues at Cornhill Hospital. More positively there had been coverage of
the therapeutic roof garden donation following the Chelsea Flower show by the Bank of Canada and the turf cutting for the new Forres Health and Care Centre. The installation of ‘hygiene handles’ at Dr Gray’s was also well received by both newspapers and television.
5.3 The Participation Standard (Strategic Rick 851)
Mrs Gray presented the outcome of the Scottish Health Council’s annual review of public participation within NHS Boards. This year the review had focused on governance. PGC was pleased to note that the highest level of assessment (level 4) had been achieved by NHS Grampian across all elements. This was a great achievement.
5.4 Breastfeeding (Strategic Risk 851)
Dr Strachan gave a shot overview to the paper submitted and highlighted the following:
  • Breastfeeding target will remain 46% with the timescale for delivery moving to 2020 from 2015.
  • Breastfeeding trajectory for exclusive breastfeeding at 6-8 weeks only and will be reported to the system quarterly.
  • Monitoring of mixed feeding has been removed from the trajectory but will be monitored internally.
  • Performance will be reported in due course.

5.5 Hospital Discharges 8pm – 8am (Strategic Risk 851)
Claire Smith was welcomed to the meeting and gave a short report regarding hospital discharges between the hours of 8pm-8am. She advised that she currently chaired a discharge planning group within the acute sector. She advised that a patient’s discharge is recorded on the Extramed computer system. The field for discharge time defaults to the time the system is updated unless manually changed to provide the true discharge time, and this is not routinely being done. It follows that the data produced which suggested c10% overnight discharges was not accurate.
The policy of NHS Grampian was not to discharge inpatients routinely during night time hours.There were, however, a number of short stay and day case units (both surgical and medical) and patients will, when appropriate, be discharged from such units during the evening. These discharges were part of the plan for an individual patient’s care.
Work was currently being done to produce an NHS Grampian-wide policy for discharging patients from the hospital setting which is relevant to all patients, including elderly patients.
If the patient is to be discharged, the time of discharge would be agreed with relatives or alternatively if the family or relatives have no transport, an ambulance is booked.
Claire offered to look into any cases where discharge arrangements had been inappropriate.
6. / Assurance Framework: Report from Governance and CHP Committees
6.1 Staff Governance Committee 30th May 2013
Mrs Duncan highlighted the following from the report:
  • The Director of Workforce presented Workforce 2020; the committee approved and was subsequently approved by the Board in June.
  • The National Staff Survey took place between 27th May and 5th July 2013. At close the participation rate of Grampian was 27% against a target of 50%. The Scottish average was 26%. The Grampian figure would rise when paper copies were included.

6.2 Clinical Governance Committee 7th June
Members noted the report in the absence of Mr Muir.
6.3 Aberdeenshire CHP – 3rd July 2013
Mr Bisset highlighted the following from the report:
  • Integration of Health and Social Care – A successful workshop had taken place and another was planned.
  • The first meeting of the Transitional Leadership Group had taken place on 3rd July and workstreams established
  • The Inverurie Pathfinder Project and the news that the development of the new GP premises would be funded under the HubCo scheme.
  • Heart Failure Nursing had been raised as an AOB. Mr Carey advised that within Grampian the function was provided within primary care and was not acute based

6.4 Aberdeen City CHP – 31st may & 28th June 3013
Members noted the report in the absence of Mr Muir.
6.5 Moray CHSCP – 14th June 2013
Members noted the report in the absence of Mrs Lester.
7. / Supporting Integration of Adult Health and Social Care – Internal Programme Board (Strategic Risk 586)
Mr Carey advised that the next meeting of the Internal Integration Programme Board would take place in August. He provided an update on the ongoing work with each Local Authority area.
8. / Strategic Risk Register and Supporting Narrative
Mr Gray informed PGC members that a Risk Management Workshop had been held the previous week and had been very successful. The paper from Andrew Wood on the risk review process was noted.
9. / Content for August 2013 Board Report
Access Times
Finance
Participation Standard
Change Fund
Delayed Discharge
10. / AOCB
None
11. / Date of next meeting:
17th September 2013 at 10:30 in the Conference Room, Summerfield House.