APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session

on Friday 4 April 2014 at 10.00am

inCLAN House, Westburn Road, Aberdeen

Present

/ Cllr Bill Howatson / Chairman
Mr David Anderson / Non-Executive Board Member
Mr Raymond Bisset / Non-Executive Board Member
Mr Richard Carey / Chief Executive
Cllr Stewart Cree / Non-Executive Board Member
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 Linda Juroszek / Non-Executive Board Member
Mrs Christine Lester / Non-Executive Board Member
Dr Lynda Lynch / Non-Executive Board Member
Mr Terry Mackie / Non-Executive Board Member
Mr Charles Muir / Non-Executive Board Member
Mr Jonathan Passmore / Non-Executive Board Member
Sir Lewis Ritchie / Director of Public Health
Cllr Anne Robertson / Non-Executive Board Member
Mrs Elinor Smith / Director of Nursing and Quality
By / Mr Gerry Donald / Head of Property and Asset Development
Invitation / Ms Fiona Francey / Divisional General Manager, Women and Children
Mrs Laura Gray / Director of Corporate Communications/Board Secretary
Dr Annie Ingram / Director of Workforce
Ms Jenny McNicol / Head of Midwifery
Ms Fiona Mitchelhill / Patient Safety Programme Manager
Ms Linda Oldroyd / Nurse Consultant, Patient Safety and Experience
Mr Graeme Smith / Director of Modernisation
Dr Pauline Strachan / Deputy Chief Executive
Attending / Miss Lesley Hall / Assistant Board Secretary
Mrs Glenys Wells / PA, Board Secretariat
Item / Subject
1 / Apologies
Apologies were received fromMr Mike Scott.
2 / Verbal Updates
  • Chairman
The Chairman reported on a well attended Grampian Area Partnership Forum (GAPF) away day held at the Aberdeen Health and CareVillage. He advised of Ministerial visits in February which included welcoming the Cabinet Secretary to AberdeenMaternityHospital and the HealthVillage, and a visit by the UK Health Minister to the JJR McLeod Centre at Foresterhill to see all aspects of the integrated diabetes service.
He stressed the importance of safety walkrounds for gaining insight into the range of frontline services and the connection they create between services and the Board. Recently he had undertaken a walkround that included the Young People’s Department at Cornhill and the Lowit Unit at Royal Aberdeen Children’s Hospital (RACH). He had supported the rollout of the Food Dudes programme, an innovative healthy eating programme aimed at increasing children’s consumption of fruit and vegetables.
  • Chief Executive
Mr Carey reported on positive feedback from the Mid Year Review with the Scottish Government. NHS Grampian had been commended on its work relating to patient safety. There were challenges around meeting the Treatment Time Guarantee and with some specialties not meeting cancer waiting times. He reported that a number of actions were in train to increase theatre capacity to address these issues. He had attended an inspirational workshop by Tommy Whitelaw who was “on Tour” in Grampian, sharing his experiences of caring for his late mother who had dementia, and reminding the Board and staff of the importance of caring, listening, improving.
He announced that NHS Grampian had been identified as one of four new specialist trauma centres in Scotland as part of an enhanced network and will enhance the role of the hospital and bring additional resources and specialist talents.
Along with other Executive team colleagues, he had met Emergency Department (ED) colleagues the previous evening to discuss the sustainability of medical staffing in the ED and the provision of training grade posts.
He had also attended an important and successful clinical event held earlier that week – CONNECT – where more than 70 GPs and secondary care clinicians had discussed how to better integrate services across primary and secondary care with a view to managing seamless patient-centred services. This linked to NHS Grampian’s intention toe develop a plan for clinical engagement by the end of April 2014.
Finally, he reported on a visit to the laundry service and instrument cleaning service. He was impressed by the dedicated staff and commended and thanked them for doing these very important jobs.
3 / Minute of Meetingheld on7 February 2014
The minutes were approved, subject to the following changes:
Item 6, Page 5: Bullet points 3 and 4 - delete “considered” and replace with “endorsed” and “acknowledged” respectively.
Item 9.1, Page7, paragraph 4: Line 5 - delete “all” and replace with “most”; Add the following to the end of the paragraph “It was noted that adult males with an IV postcode would go to the Inverness Facility.”
Item 9.1, Page 8, paragraph 4: Add “in particular those in Moray” to the end and move the paragraph to follow paragraph 4 on page 7.
4 / Matters Arising
Cllr Robertson advised that Mark McEwan had attended the last Criminal Justice Authority Meeting on behalf of NHS Grampian.
5 / Patient Story
Mrs Smith introduced Mrs Linda Oldroyd, explaining that this was a slightly different approach to a patient story, but linked to the Maternity Services Review to be discussed under item 7.1. Mrs Oldroyd gave a PowerPoint presentation on a Person Centred Project carried out in Ashgrove Ward of Aberdeen Maternity Hospital which the Senior Charge Nurse had been prepared to share. This provided information on both patient and staff experience. She explained the data collection process, the questions asked, the method and sample. The presentation showed Wordles which were pictorial representations of free text. At the end of the process, suggestions were made to improve patient and staff experience on the ward, including an improvement plan, “always events” and a commitment to ongoing real time feedback activity. It was hoped that staff would see the benefits and embed the always events into their work.
In response to a query about midwife to patient ratios, the Head of Midwifery advised that the ideal ratio was 1 midwife to 28 births, but this was a complex area, dependent on skill mix in different clinical areas. It was expected that the ratio would be 1:1 when a woman was in labour. Cllr Robertson advised that the Short Life Working Group on Workforce Resource was looking at particular issues about appropriate levels of nursing and the required skill mix. Dr Ingram advised that there were various tools for setting staffing levels looking at a range of factors such as dependency of patients and geography. She suggested that the topic be discussed at a future Board Seminar.
Dr Dijkhuizen commented on the methodology of real time feedback and how lessons could be learned and changes made quickly to make things better.
Mr Passmore suggested that the best agents of improvement were staff and that often improvements did not cost resource. He stressed the importance of empowering staff.
The Chairman thanked Ms Oldroyd for her presentation and for explaining the useful tool that could be developed to improved person centred care.
6 / Improving Health, Wellbeing and Reducing Inequalities
6.1 / Local Delivery Plan (LDP)/Property and Asset Management Plan (PAMP)
Mr Gray presented his paper seeking approval of the two documents: the Local Delivery Plan (LDP) and the Property and Asset Management Plan (PAMP). He explained that the Board had seen the draft documents at its March seminar and there were no significant changes. He advised that the LDP set out the agreement of the Board with the Scottish Government Health Directorate and how the Board will work to deliver the ambitions of the NHS Scotland 2020 routemap, covering the three main aims of: Quality of Care, Health of Population, and Value and Sustainability. The LDP also contained the Board’s 5 year financial (revenue and capital) plan, information on delivering Single Outcome Agreement commitments and improvement trajectories for the national HEAT targets and standards. He advised that the financial plan confirmed the NRAC parity uplift agreed with the Scottish Government, to increase NHS Grampian’s allocation by £43m over the next three years to bring NHS Grampian within 1% of parity by 2016/17. The plan set out the allocation of revenue to meet unavoidable cost pressures and new commitments and also the capital plan and proposed allocation of funding to meet priorities. He highlighted the challenges of dealing with cost pressures. Mr Carey stressed that the level of funding NHS Grampian received had been a bone of contention for more than 10 years, but he welcomed the clear commitment from the Government to move closer to what NHS Grampian should have received which would make a difference to sustainability over next few years.
Cllr Crockett pointed out that Grampian was still the lowest funded Health Board and expressed concern that the population was rising quickly and that this should be reflected in future funding. In response to a query from CllrRobertson about the financial implications for Health and Social Care Integration, Mr Gray advised that the detail would be worked out with the three integrated bodies.
Mr Gray explained that the PAMP set out the priorities for managing the infrastructure supporting the delivery of patient care and associated services. He stressed its importance in delivering the 2020 vision.
He highlighted recent achievements such as the new Aberdeen Health Village and Dental Centre in Fraserburgh. In 2014/15 the Forres and Woodside Practices would be replaced. Significant investment had been made to replace 3 Linear Accelerators (Linac) and essential medical equipment. Future investment included replacing Denburn and Inverurie medical centres via hubCo arrangements and further investment on the Aberdeen Royal Infirmary site. MrGray explained there would be opportunities for innovative community ownership following the Community Empowerment Bill.
It was noted that Mr Donald and his team were working with partners to look at options for disposal of surplus assets and options for affordable accommodation for staff and progress would be reported to the Board.
Mrs Duncan commended the team for getting agreement about moving towards NRAC parity, but remained concerned that NHS Grampian was still not receiving the NRAC allocation that it should.
Mrs Juroszek highlighted the need for a primary care premises strategy as GPs required investment in premises to deal with the rapidly increasing population in Grampian.
The Board approved the:
  • Local Delivery Plan (including the five year financial plan)
  • Property and Asset Management Strategy

7 / Developing High Quality Care in the Right Place
7.1 / Maternity Services Review – Best Possible Start in Life Project Implementation Update
Mrs Smith reminded the Board that the Maternity Services Review had been approved in 2012 and work was underway to implement the project plan. Mrs Francey explained that the paper outlined the strategic context and the key strategic timeline including the Ministerial expectation that the recommendations of the review would be implemented by 2015. She advised of the significant progress that had been made, but pointed out the constraints which included lack of dedicated project management support, which was now in place, capacity redirected to other high priority operational areas, and the lack of detailed work on workforce implications of redesign that was now underway.
She reported that intrapartum services were currently suspended in Aboyne and Fraserburgh Birth Units because of staffing constraints. Although the implementation of alternative redesigned services were not yet in place, it was felt that the time was right for requesting that these units proceed to formal closure. In response to queries, she advised that antenatal and post natal services were not dependent on the operation of the Birth Units and that services from these facilities had been suspended since September 2013.
Mr Bisset pointed out that changes to the service had been subject to extensive consultation and had been agreed as the way forward.
The paper recommended setting up a Programme Board to oversee the programme to ensure it remained on target, with membership including the Executive Lead, the Director of Nursing and Quality. The proposal was that the Programme Board would report to the Board through the Performance Governance Committee. Mr Passmore and Mr Anderson expressed concerns about the proposed governance arrangements, suggesting they had an executive function and were not part of the Board’s governance arrangements. Sir Lewis suggested that the proposed Programme Board was analogous to the Child Health Programme Board and that Non Executive input would be helpful.
The Board:
  • Noted the draft project plan
  • Recognised the risks inherent in the delivery of the implementation
  • Supported the formal closure of the two remaining birth units (Aboyne and Fraserburgh) to allow progress to continue
  • Agreed to the Programme Board role supporting existing governance arrangements with regular updates to the Cross System Performance Review Process and hence to the Performance Governance Committee.

7.2 / Quality Dashboard
Mrs Smith introduced the item and welcomed Ms Mitchelhill, Patient Safety Programme Manager. Mrs Smith advised that the Quality Dashboard linked to the NHS Scotland Quality Strategy and focused on five measures: inpatient mortality, adverse events, patient falls, infection data and patient experience data. Mr Carey explained the most important question to ask was whether NHS Grampian was delivering safe and effective person–centred care. He highlighted the importance of this data in terms of providing assurance to the Board and the opportunity to challenge performance against the key determinants of patient safety and person-centred care. Mrs Lester asked about Hospital Standardised Mortality Ratio (HSMR) data and was advised that this was calculated in a number of ways and was available to the public.
Mrs Smith advised that NHS Grampian was aware of the importance of data collection and the use of this data. The number of staff groups recording incidents on Datix, the electronic reporting system, was increasing. Mrs Juroszek advised that Datix was being rolled out in general practice and work was being done with the Feedback team to encourage learning from recorded incidents.
Mr Carey stressed the importance of infection data which showed very positive results. With reference to patient experience data, he advised there had been a significant increase in the percentage of complaints. He pointed out that this did not indicate there was necessarily something wrong, but reflected an organisation that was accessible and responsive to complaints. Mrs Gray said it was encouraging that people felt there was a point in complaining and stressed the importance of listening to and acting on complaints. She advised that she and Mrs Smith were considering options to bring more detailed information on complaints to the Board to seek feedback on what members felt was useful.
Mr Anderson stated that the Quality Dashboard was helpful but queried if the right things were being tracked or if it concentrated on things that could be easily measured. Mrs Smith advised that the dashboard had started with alimited number of indicators being measured, but Board members’ feedback on expanding the range of quality measures reported through the dashboard was welcomed.
Following consideration of the Quality Dashboard, the Boardwas assured on the effectiveness of the improvement activity presented.
7.3 / Healthcare Associated Infection Report – March 2014
Dr Dijkhuizen reported on a positive position in the bi-monthly report presented, advising that the number of Clostridium difficile infection (CDI) cases was lower than staphylococcus aureus bacteraemia (SAB) cases. NHS Grampian was close to being the best in Scotland.
Dr Dijkhuizen emphasised the importance of hand hygiene in achieving improvements and explained that hand hygiene was complex to measure. He stressed the importance of increasing staff awareness and the rigour required to ensure compliance as it had a huge impact on preventing the spread of HAI. Mr Muir advised that Problem Assessment Groups (PAG) were convened when hand hygiene compliance dropped below 90%, to increase awareness and discuss any underlying contributory factors.
Mrs Juroszek advised of the importance of ongoing work to reduce the use of antibiotics in tackling HAI and of the target set by the government for antibiotic prescribing. She stressed the need to reduce the variation in antibiotic prescribing which was often demand led as people did not always understand that antibiotics were not suitable treatment for some minor illnesses.
The Board noted the report.
8 / Developing and Empowering our Staff
8.1 / High Cost Area Supplement for NHS Grampian
Dr Ingram introduced the item by explaining that the issue about implementing a High Cost Area Supplement or similar scheme in NHS Grampian had been discussed at the Remuneration Committee. She advised of difficulties securing and maintaining the right number of staff in NHS Grampian at all grades and across all professions, exacerbated by the geographical location and the high cost of living which meant that staff had a lower disposable income. She stressed that there were particular professions and service areas to which it was difficult to recruit, or where there were supply issues. Therefore, it was necessary for NHS Grampian to put mitigating measures in place. She also advised that other public sector employers, particularly the Local Authorities,were often in competition with the NHS for some staff groups. She explained that the cost of moving to and living in Aberdeen was becoming a significant recruitment issue, but pointed out other issues affecting areas of Moray and Aberdeenshire, such as rurality. Low unemployment and opportunities to work for higher salaries in the oil and gas industry were factors affecting recruitment and retention.