APPROVED
GRAMPIAN NHS BOARD
Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session on Tuesday 4 May at 11.30am in the Conference Room, Summerfield House, Aberdeen
Present
/Mr Jim Royan
/ ChairmanCouncillor Edward Aldridge / Non-Executive Board Member
Dr Eric Baijal / Director of Public Health
Mr David Benton / Director of Nursing
Councillor Raymond Bisset / Non-Executive Board Member
Mrs Barbara Bruce / Non-Executive Board Member
Ms Margaret Burns / Non-Executive Board Member
Mrs Anne Campbell / Non-Executive Board Member
Mr Alec Cumming / Interim Chief Operating Officer
Dr Roelf Dijkhuizen / Medical Director
Mr Alan Gall / Director of Finance
Mr Angus Gordon / Non-Executive Board Member
Professor Neva Haites / Non-Executive Board Member
Professor Val Maehle / Non-Executive Board Member
Mrs Elizabeth McDade / Non-Executive Board Member
Mr Alex Smith / Interim Chief Executive
Dr Stuart Watson / Non-Executive Board Member
Mr Tony Ward / Non-Executive Board Member
By Invitation / Dr George Crooks / Director of Primary Care
Mrs Maggie Emslie / Grampian Local Health Council
Mr Alan Gray / PricewaterhouseCoopers
Mrs Laura Gray / Director of Corporate Communications
Dr Annie Ingram / North of Scotland Planning Group
Ms Susan Jappy / Assistant Director of Public Health
Ms Jennifer Mack / Organisational Development Manager
Mr Gordon Morrice / Director of Human Resources
Mr Ewan Robertson / Board Secretary/Director of Performance Improvement
Ms Anne Ross / Head of Performance and Quality Improvement
Miss Kathleen Simcock / Assistant General Manager - Medicine and Surgery
Mr Gordon Stephen / Co-ordinator, Grampian Partnership Forum
Dr Lesley Stewart / Vice-chair, Area Clinical Forum
Mr David Sullivan / Director of Planning
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wren / Personal Assistant, Board Secretariat
Item / Subject /
Action
8 / CHAIRMAN'S WELCOME/ANNOUNCEMENTSThe Chairman welcomed everyone to the first formal open meeting of the new NHS Grampian Board. He advised that the Minister had confirmed the appointment of Mr Alan Gall and Dr Roelf Dijkhuizen as Director of Finance and Medical Director respectively.
He wished to thank all the staff of NHS Grampian following the transfer to a single system of NHS Grampian, and Alex Smith and Calum Campbell for leading the single system integration work.
He advised that he had attended a meeting of NHS Board Chairs with the Minister at which there had been wide ranging discussions on the development of a modern healthcare system. There had been a recent meeting between NHSG and local MSPs and it was hoped to develop these further over time.
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APOLOGIES
Apologies were received from Councillor K Dean, Professor S Logan and Professor J Weir.10 /
MINUTE OF MEETING OF GRAMPIAN NHS BOARD HELD ON 2 MARCH 2004
Minute of Meeting of Grampian NHS Board held on 2 March 2004 The minute was approved, subject to the following amendment:Item 6.2a - Staff Governance, final sentence to read "He reported that an employee relations strategic review was to be held on 3 March to review the new employee relations structure in keeping with the single system organisation".
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MATTERS ARISING
There were no matters arising.12 /
HEALTH IMPROVEMENT
12.1a Grampian Health Plan 2004/05 including 2004/05 Strategic objectivesThe Board considered the paper prepared by Dr Baijal, in particular the six Strategic Objectives detailed in Appendix 1: Involving People; Health Improvement; Planning for a progressive health system; Staff Capacity; Capability and Commitment; Property and Resources; Performance and Development.
The Board endorsed the Grampian Health Plan 2004/05, subject to the caveat that further financial work had to be done.
The Board noted and confirmed its support for the strategic corporate objectives drawn from the 2004/05 Health Plan and requested the Remuneration Committee to endorse these.
The Board agreed that the Health Plan be disseminated and implemented subject to completion of the Financial Plan. / G Morrice
E Baijal
12.1b Grampian Health Plan Planning 2005/06 Planning Cycle
The Board noted the paper, which outlined the component parts of the planning cycle and proposed a timetable for completing the Health Plan 2005/06 by March 2005. Board members were advised that further proposals would be made in due course. Dr Baijal wished to acknowledge Ms Susan Jappy's immense effort in the process.
Board members noted that their individual objectives would be underpinned by the Strategic Objectives of the Health Plan and if they had any queries about this to contact Ms Jappy directly.
The Board approved the planning cycle for 2005/06. The Board endorsed the focus on strategic plans and processes for the June Board Seminar. / D Sullivan/
S Jappy
12.2NHSG Communication Strategy
Mrs Gray presented her paper, which explained the background and the work done to develop the communication strategy in the context of a single system. She felt it was symbolic to be presenting this after the approval of the Health Plan and at the first formal meeting of the Board under the new single system in Grampian.
She highlighted the three main components of NHS Grampian's activity: Change, Vision and Service Delivery. She explained the forces and drivers, objectives, principles and standards, the components of the strategy and the internal and external stakeholders. She stressed the challenge to make the words a reality and to ensure that practice was consistent with policies and other strategies and plans.
Board members gave positive feedback on the work done by Mrs Gray in preparing such a comprehensive communication strategy. They acknowledged the importance of the strategy and agreed that it was essential to give leadership. The need to prioritise internal communication was stressed. It was accepted that an evaluation of the strategy would be required.
It was suggested that the regular meetings with local MSPs be extended to include Board members in the discussion at an appropriate time.
The Board approved and agreed to take ownership of the Communication Strategy for Grampian
The Board agreed to consider ways to give leadership to the Strategy and suggested one of the meetings during the year with local MSPs includes Board Members. / L Gray
12.3GMS Contract: Out of Hours Service: consultation process
The Chairman welcomed Dr Crooks to the meeting for this item. He explained the background to the proposed changes to out of hours services and the work done to date resulting in the papers presented to the Board. He advised that the proposals had been developed over several months with input from key stakeholders, including the public. There had also been helpful pre-consultation work with Local Healthcare Co-operatives. He explained the proposed detailed consultation process which included 19 "Meeting the Community" events. It was agreed to circulate details of these meetings to Board members, who were encouraged to attend.
Board members discussed the documentation and agreed that Patient Focus and Public Involvement was fundamental to the process, with suggestions made for reaching people who may not come into contact with the health service e.g. schools, universities, libraries, supermarkets.
It was suggested that the documentation had to make it clear there was scope for flexibility and the new system required to be monitored.
The Board approved the Information and Consultation document in relation to out of hours medical services in Grampian.
The Board approved the Communication and Consultation plan for out of hours services.
The Board formally launched the consultation process.
The Board requested a full report on the outcome of the consultation process at the Board meeting in September 2004. / L Gray/G Crooks
12.4Mental Health (Care and Treatment) (Scotland) Act 2003
Mr Cumming referred to the paper prepared by the Grampian Lead Co-ordinator regarding the implementation of the above Act, most of which comes into effect in March 2005, and the resource implications.It was noted that a small multi-agency Grampian Task Group had been set up to determine actions required and had identified short term actions, ensuring involvement of users.
The Board noted progress in implementing the Act and supported the proposed process.
The Board noted the potential NHS Grampian resource implications from 2006/07.13 /
GOVERNANCE
13.1Clinical Governancea Area Clinical Forum (ACF) Update/Letter
The Board noted the letter dated 21 April 2004 from the Chairman of the ACF and the ongoing concerns around the new contracts. The Board was pleased to note that Professor Weir had been invited to provide clinical input to an SEHD Benchmarking Committee.
b Clinical Governance Committee
The Board noted the letter dated 23 April 2004 from the Chairman of the Clinical Governance Committee providing an update on the work of the Committee.
13.2Staff Governance
a Area Partnership Forum (APF) update/letterThe Board noted the letter dated 27 April 2004 from the Staff-side Chair of the Grampian Partnership Forum. Members noted that Mr Ed Rennie, Head of Partnership and Staff Governance had been appointed to the Partnership Information Network (PIN) Board and that NHS Grampian had achieved a PIN award in relation to the introduction of the Parental Leave policy and Partnership in Reality guidelines. The Chairman congratulated those involved on their achievements.
b Staff Governance Committee issues/letter/update
The Board noted there had been no Committee meeting since the previous Board meeting. It was noted that full copies of the Staff Survey had been circulated to the Committee. Anyone else wishing a copy may obtain this from Mr Gordon Morrice, or access it from the intranet.13.3Corporate Governance
a NHSG Board Non-Executive Members of Meetings
The Board considered the Board Secretary's paper, which set out the proposed chairs and membership of Board Committees and the Deputy Chair of NHS Grampian Board, subject to review in March 2005.It was agreed to add Anne Campbell to the membership of the Service Strategy and Redesign Committee. Mr Robertson agreed to arrange a meeting with the three Local Authority representatives on the Board on how to populate the NHS Grampian multi-agency fora. An executive director sponsor was sought for these fora. (Dr Eric Baijal subsequently agreed to undertake this role.)
It was noted that the Chairman had written to Professor Logan to clarify the terms of reference for the University Liaison Committee.
The Board approved the list of Board Committee chairs and members and requested a review at the end of March 2005.
The Board appointed Anne Campbell as Deputy Chair of Grampian NHS Board.
The Board noted the sponsoring director for each Committee. / E Robertson
E Robertson
b Single System Issues
The Board noted Calum Campbell's paper, which provided an update on the ongoing work on the development of reporting lines and organisational charting within the new single system, which was expected to be completed mid-May.The Board noted the progress:
- in mapping the management reporting line arrangements
- mapping the configuration of groups/committees within the system
c Corporate Governance Protocols
Non-executive directors had been asked to review individual protocols and reported on progress, as follows:- Standing Orders
- Standing Financial
- Schedule of Reserved
- Fraud Policy
- Standards of Business
- Register of Interests
Register to be reviewed every 6 months.
- Insurance Arrangements
- Banking Arrangements
Chairman to sign mandate.
- Board Committee Remits
The need to ensure staff were aware of and followed procedures e.g. SFIs was stressed. It was agreed this should be part of the communication strategy. / A Gall/
L Gray
The Board noted that all the protocols would be presented in full to the Board at its July 2004 meeting for final endorsement of the recommendations made by the non-executive directors.
/ E Robertson/A Gall
d Chief Operating Officer
The Board noted that the post had been advertised with a closing date of 5 May. The recruitment committee will meet on 11 May to discuss applications and communicate in due course to the Board.e Risk Management
The Board noted that the Statement of Internal Control was subject to external audit. Work was ongoing with the Risk Management Strategy, which will be presented to the Board at its July meeting. / E Robertsonf Pay Modernisation Report
Mr Benton presented a quarterly report of progress against the Pay Modernisation Integrated Action Plan covering the three strands of GMS contract, Consultant Contract and Agenda for Change.Considerable work had been ongoing and the need to mitigate risks was continuously being addressed.
Feedback from a forthcoming meeting between NHSG and the HR Director at the SEHD will be given to the Board at a future meeting. / D Benton
g Performance Management
(i) Directorate of Performance ImprovementMr Ewan Robertson, Director of Performance Improvement gave a detailed presentation explaining the role and function of this new Directorate. He explained the aim was to create a new performance culture within the single system and to ensure that continuous improvement of performance was high on everyone's agenda. He also explained the importance of the role of the Performance Governance Committee and the key relationship between the Directorate and that Committee and its chair. He also highlighted the relationship with the NHSG Board and other Committees.
He advised that workshop events were being held during May with operational managers to agree initial performance management processes and reporting within the system. He was keen to obtain views of Board members on his paper "Taking Performance to a New Level" prior to these events.
During discussion, it was clarified that the proposed framework aimed to help operational management, but would not take responsibility away from the line management system. It was acknowledged that the Performance Governance Committee would provide an internal check within the system. Board members were supportive of the suggested approach to encourage and improve performance and recognised the challenge faced by the Directorate in fulfilling the proposed function.
The Board supported the proposals for NHS Grampian performance arrangements in principle and recognised that further work required to be done. / E Robertson
(ii) Performance Management Report
Ms Anne Ross, Head of Performance and Quality Improvement introduced the May 2004 Performance Report, explaining that the format would change once the Performance Governance Committee was up and running.She reported on the 2003 Accountability Review process, which had been generally positive, and explained the progress being made with preparation for the 2004 Accountability Review. The main documentation to be produced for this was a Performance Assessment Framework (PAF) based self-assessment report on which work was underway.
The PAF itself was partially updated at the end of February and March, with a final update to be done at the end of May 2004.
Ms Ross highlighted the day case data, which was detailed in an Audit Scotland report issued the previous week. She explained that the rate for selected procedures was 52.3%, which was lower than the Scottish average of 69.4%. A number of actions have been taken to understand and improve the situation.
Short presentations were made on the following topics:
- Healthcare Acquired Infection – Mr Cumming explained that with a considerable amount of effort and expenditure, the acute services are planned to be compliant later in the year. Compliance in the primary care setting remained an issue, as significant investment was required. However, this was the lower of the two priority areas and did not present a significant risk. He advised that clinical advice was being sought and discussions with the SEHD were ongoing. Proposals will be brought back to the Board in due course.
- Finance Report – Mr Gall reported on the financial performance for the year to 31 March 2004. He outlined the revenue performance, explaining there had been an overspend of £0.7m compared to the projection of £6.4m. The improvement was due to a combination of borrowing repayment being rephased and additional SEHD funding. He highlighted the financial challenges faced in 2003/04, including EU working time directives, waiting times targets, Healthcare Associated Infection (HAI) provision and new drug technologies. He explained some benefits to 2003/04 performance such as cost efficiency achievements, disposal of surplus property and organisational integration. The Capital Resource Limit for the year to 31 March 2004 was achieved with a total capital spend of £12.1m. These figures were subject to External Audit Review and Estate Revaluation completion.
- Emerging Issues – Mr Smith reported that with careful control, emerging issues had been effectively managed. A contingency had been identified for 2004/05.
- Efficiency Project – Mr Cumming reported that the measures introduced had been effective and NHSG was on target to meet the financial savings target by 31 March 2004. The aim was now to consolidate good business practices into ongoing management. During discussion it was noted that a material amount had been saved on external training expenditure, but assurances were given that core training had not been compromised.
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PLANNING