GRAMPIAN NHS BOARDAPPROVED
Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session on Tuesday 18 January 2005 at 10.00am in the Conference Room, Summerfield House, Aberdeen
Mr Jim Royan/ Chairman
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
Dr David Cameron / Non-Executive Board Member
Mrs Anne Campbell / Non-Executive Board Member
Mr Richard Carey / Chief Operating Officer
Mr Alan Gall / Director of Finance
Mr Angus Gordon / Non-Executive Board Member
Mrs Elizabeth McDade / Non-Executive Board Member
Mr George McIntyre / Non-Executive Board Member
Professor Val Maehle / Non-Executive Board Member
Mr Alex Smith / Interim Chief Executive
Mr Tony Ward / Non-Executive Board Member
Dr Stuart Watson / Non-Executive Board Member
Professor Jamie Weir / Non-Executive Board Member
By Invitation / Mrs Linda Bamford / General Manager, Scottish Ambulance Service
Mr Peter Baxter / Associate Medical Director, NHS 24
Dr George Crooks / Director of Primary Care
Mrs Laura Gray / Director of Corporate Communications
Mrs Judith Hendry / Chair, Allied Health Professions Committee
Ms Susan Jappy / Assistant Director of Public Health
Mr Andrew Kane / Auditor, Audit Scotland
Mrs Sue Kinsey / Chair, Grampian Local Health Council
Miss Jennifer Mack / Organisational Development Manager
Mr John Miller / Corporate Communications Officer
Mr Gordon Morrice / Director of Human Resources
Mr Geoff Pearson / Performance Management, SEHD
Dr Gordon Peterkin / Medical Director – Cross System (deputising for Dr Roelf Dijkhuizen)
Mrs Amanda Powe / Associate Director of Operations and Nursing, NHS 24
Mr Alan Reid / Head of A&E Services, Scottish Ambulance Service
Mr Ewan Robertson / Board Secretary/Director of Performance Improvement
Ms Anne Ross / Head of Performance and Quality Improvement
Mr David Sullivan / Director of Corporate Planning
Attending / Miss Lesley Hall / Assistant Board Secretary
Ms Glenys Wren / Personal Assistant, Board Secretariat
Please note that agenda items were taken out of sequence
Item / Subject /
Action1 / CHAIRMAN’S WELCOME AND ANNOUNCEMENTS
The Chairman welcomed everyone to the meeting and in particular, Dr David Cameron, the recently appointed Non-Executive member and Mr Geoff Pearson, Performance Management, Scottish Executive Health Department (SEHD).
He also welcomed colleagues from the Scottish Ambulance Service and NHS 24. He referred to the Board Seminar held in December 2004 at which the themes outlined in the Health Plan 2005/06 consultation paper had been debated. He referred to the letter dated 21 December 2004 from the Health Minister which had been circulated with the papers, focussing on the Minister’s expectation of Chairs to drive performance. The Chairman reminded the Board that NHS Grampian was a corporate Board with responsibility for delivery of health services. He stressed that, with performance as a top priority, the Performance Governance Committee had a critical role to play. He emphasised the importance of Board Committees and for lead Directors and Non-Executive Chairs contributing more positively to the way NHS Grampian carried out its business.
He referred to the Scottish Executive publication “Fair To All, Personal to Each” which had been distributed to Board Members. This reiterated the fundamental principles of health care in Scotland, emphasising the importance of waiting times targets and investment and reform being taken forward to ensure delivery of change.
He referred to the National Framework for Change event held on 15 December 2004 and stressed the need for NHS Grampian to contribute to that agenda. This was highlighted in the Health Department Letter HDL 2004(46) on Regional Planning which raised expectations for the development of regional approaches to service improvement.
He emphasised the major sustained investment in the NHS through the new Consultants’ contract, Agenda for Change and the new GP Contract.
With regard to funding, he stressed NHS Grampian’s commitment to a recovery plan with the resources at its disposal and advised that there would be an opportunity for discussion around the process for resource allocation under the Arbuthnott review.
APOLOGIESApologies were received from Councillor Kate Dean, Dr Roelf Dijkhuizen and Professor Neva Haites.
The Chairman advised that the order of first two items under Item 5 would be changed, so that the Director of Public Health’s Report, which played an important part in the cycle of NHS Grampian accountability, would be taken first.
MINUTE OF MEETING OF GRAMPIAN NHS BOARD HELD ON 2 NOVEMBER 2004The Minute of the meeting held on 2 November 2004 was approved
MATTERS ARISINGThere were no matters arising
5. / HEALTH IMPROVEMENT/HEALTH PLAN
- Director of Public Health Report
- Inequalities in Health
- Increasing older population which impacted on available workforce and on health
- Dental Health
- Vulnerable children, with 1 in 10 in Grampian at risk
- Substance use
- Mental Health, which had made an improvement towards the national target
- Communicable disease
He explained there was a need to be clear about how we measure health improvement. He also suggested it would be helpful to reduce the 40 indicators to a manageable number and advised that Directors of Public Health were working towards this.
Dr Baijal advised that personally he felt the most important areas to tackle were childhood disadvantage and poverty, because today’s children were tomorrow’s adults. He also stressed the importance of an appropriate healthy weight.
Board members discussed the role of public health in community planning and the need for all organisations to gain a better understanding. It was felt that the work of the Service Strategy and Redesign Committee (SSRC) was helpful in engaging clinicians in health improvement, as the process of redesign in Grampian was very partnership oriented. The need to improve working with Local Authority colleagues was stressed and it was pointed out that the Board was not the sole custodian of health improvement. It was noted that the new Community Health Partnerships (CHPs) were developing a collaborative approach with Local Authorities to health improvement, which would be helpful.
Mr Smith emphasised the importance of the Director of Public Health’s report as it provided an independent view. He stressed the need for an interface with Community Planning colleagues in the formal launch of the report. Dr Baijal anticipated an active dialogue with each of the Local Authorities and the CHPs, following the launch of his report.
Dr Watson reminded Board members of the robust Joint Health Improvement Plan process which was developed in partnership with Local Authorities. He referred to the work around the Health Improvement Healthfit and advised that the draft report would be produced shortly.
Professor Weir felt strongly that limited resources had to be targeted effectively into areas most affected and for which there was an evidence base.
The Chairman summarised that the discussion had highlighted a requirement for more connections between the Community Planning process, the Health Plan process and the Director of Public Health report. Mr Smith felt there was a need for the full Council of each of the Local Authorities to be engaged around this agenda.
Dr Baijal and Mr Smith agreed to put together a cohesive plan of action to take back to the Board in May.
The Board noted the Director of Public Health report and requested the plan of action to be brought back to its meeting on 3 May 2005.
- General Medical Services Out of Hours Service – initial evaluation of
progressThe Chairman invited Dr George Crooks, Director of Primary Care, to speak to the report which he had provided to the Board. Dr Crooks reminded Board members of the background to the launch of the service on 1 November 2004 and gave an update on the performance of the service since then. He advised there had been very close and co-operative working relationships with key partner agencies - Scottish Ambulance Service and NHS 24.
He advised there were a number of issues, for example patients having difficulty accessing the service with particular problems during the festive period. During the first two months, GMED had dealt with over 11,000 patient contacts. He referred to the graphs and appendices to his paper which gave a breakdown of the activity. He explained that the targets for Home Visit Response Time within an hour and within four hours (HVRT 1 and HVRT 4 respectively) were being met. He advised that further work was being done with the Simul 8 model to upload real data to compare with projected and planned activity. He reassured the Board that work was being done to drill down further than the two indicators mentioned in his report. He reported on the vehicle mileage and usage of GMED cars and patient transport vehicles. He advised that contingency plans for adverse weather conditions had been activated successfully during the festive period with a local GP in Upper Deeside and Strathdon having provided cover.
He highlighted the significant challenges around demand and capacity during the festive period. On two consecutive weeks over this period, general practices had been closed for business for four days due to the timing of this year’s public holidays. The contingency and escalation plan had been used to ensure the delivery of a safe service. Additional resource had allowed the triage of 1100 patients on behalf of NHS 24. He referred to Appendix 4 of his paper which showed activity around five times the normal level, equivalent to 180 contacts per hour to GMED.
He advised that 52% of Grampian GPs had worked for the service or would have done so by mid-February 2005. Eighteen percent of GPs were giving a regular commitment to the service. Plans were in place to staff the rota, which had always been clinically safe. He advised of national issues about the ability of NHS 24 to deal with the demand of an unprecedented number of incoming calls.
Mrs Bamford from the Scottish Ambulance Service (SAS) advised that the model had fitted in with their service delivery arrangements. Mrs Powe from NHS24 confirmed that the festive period had posed a significant challenge.
Dr Crooks advised that more detailed information was available, which would be provided to the Performance Governance Committee. The Simul 8 model was being updated to look at the whole patient journey which would be broken down into component parts.
In response to questions posed, Dr Crooks explained that the current level of GP involvement would be sustained until Autumn 2005, when he anticipated that there would be a decrease in the number of doctors involved. He stressed that GPs would not be the sole mainstay of the service, as paramedics, pharmacists, nurses and others would be able to deliver appropriate advice and an appropriate service. Training was planned for 30-40 health professionals to work along with GPs who would still be available to provide a service. NHS 24 acknowledged there were challenges around demand and capacity, particularly at weekends and on Saturday mornings, but plans were in place to increase capacity to deal with that.
Dr Crooks explained there were relatively few complaints, so it was difficult to find any consistency. However, he felt that complaints were an important way to inform development of the service. He advised that NHS Grampian was to be the first Board area to be visited by NHS QIS (Quality Improvement Scotland) to pilot standards for out of hours services.
Grampian Local Health Council was undertaking a patient experience survey and an external evaluation of the service was being carried out through the University of Aberdeen.
Professor Weir advised there had been much discussion at the Area Clinical Forum and Area Medical Committee around capacity and demand issues, where it had been agreed that systems required to be robust enough without depending on the goodwill of staff. Both Committees had suggested an audit of NHS 24 and its protocols, to ensure the service was robust and effective.
Mrs Powe advised that NHS 24 had recruitment difficulties, although it had a good level of staff retention. They seek nurses with a minimum of 5 years experience for the challenging role in the service. Working predominantly out of hours can prove unpalatable, so NHS 24 was pursuing different models of working including shared posts and rotational working. In response to concerns about NHS 24’s ability to cope with demand, Mrs Powe explained that more staff were being recruited and there were only small areas of Scotland still to be integrated into the system.
The Board noted that NHS 24 would bear the cost of extra doctors brought in for triage purposes over the festive period.
Mr Royan extended thanks to Dr Crooks and his staff who had dealt with a very difficult period. He advised that the Clinical Governance Committee and Performance Governance Committee would play a major role in monitoring the service and asked for both Committees to come back to the Board with regular monitoring reports.
The Board noted the report on GMED service and requested regular monitoring reports from the Clinical Governance Committee and the Performance Governance Committee
3. Health Plan 2004/05 update
Mr Smith referred to the letter dated 17 January 2005 from Peter Collings, Director of Performance Management and Finance, at the SEHD. He explained that the Board had been briefed on a regular basis about the ongoing work to complete a financial plan to underpin the Health Plan. He explained the importance of the letter which covered the five year period from 2004/05 to 2008/09. It highlighted one issue around how asset sales were to be dealt with for 2006/07. Both the Performance Governance Committee and Audit Committee would be required to play a part in reviewing the overall financial planning arrangements.
Mr Smith advised the Board that it could accept the letter as the completion of the work on the financial plan for the current year.
Mr Gall explained that the Auditor General had been critical of using non-recurring revenue to support financial plans. He explained it was a huge job to convert the five-year plan into implementable solutions. He gave an explanation of the restriction around capital to revenue transfers based on the Chancellor’s “golden rule”.
Mr Royan concluded that, as the two key Executives were satisfied with the letter in response to the five-year financial plan submission in support of the Health Plan, the Board could accept the letter as conclusion of the process.
The Board accepted the terms of the letter dated 17 January 2005 from the Scottish Executive Health Department. / A Smith /
Clinical Gov Cttee/
Performance Gov Cttee
Performance Gov Cttee & Audit Cttee
4.Health Plan 2005/06 updateMs Jappy gave a brief update on the process, as the Board would be considering the feedback on the consultation in detail at its joint seminar with the Service Strategy and Redesign Committee (SSRC) on 1 February 2005. She referred to her feedback report on the Board Seminar on 7 December 2004 at which the Health Plan consultation paper had been a focus for discussion. The intention of the February 2005 seminar would be to consider the feedback on the consultation process, and the range of service modelling, CHP redesign and the work of the Performance Directorate on the balanced performance framework. The output from the seminar will inform the Health Plan development, which will be circulated in March and proposed to be presented to the Board at its meeting in May 2005, for approval.
The Board approved the feedback report of the Board seminar held on 7 December 2004 as an accurate record and agreed for it to be submitted to the consultation process.
The Board noted that it was proposed that that the Health Plan would be presented to the Board meeting on 3 May 2005 for approval.
5. Regional Planning - HDL (2004) 46
Mr Smith referred to his covering paper and the paper by Dr Annie Ingram, Director of Regional Planning and Workforce Development, North of Scotland Planning Group (NoSPG) highlighting the implications of HDL (2004) 46, which set out the framework for NHS Boards’ engagement in the regional planning of health services. He explained both the Minister and Chief Executive of NHS Scotland wanted to see the breaking down of barriers between areas. NoSPG would be addressing the issues in the HDL and a report will be brought back to the Board in May 2005.
Mr Smith explained that successful work across boundaries required behavioural change and there would be more engagement with the Board around regional working. Members discussed the financial framework and the requirement for a robust prioritisation process. The issue of patient focus and public involvement was also discussed and Mr Smith and Mrs Gray agreed to consider how to expand the arrangements currently in place in respective Boards on a North of Scotland basis. It was agreed it would be necessary for public engagement at an early stage in the process and it was noted that the public had been encouraged to attend the National Framework Change event in December 2004. Professor Maehle stressed that further and higher education required to be highlighted in the process.
The Board noted the HDL (2004) 46 and covering papers and the ongoing work with the NoSPG. The Board requested a report for the 3 May 2005 Board meeting. /
A Smith6. /
SERVICE STRATEGY AND REDESIGN
- Service Strategy and Redesign Committee Report
He advised that the Committee had taken forward a range of initiatives, projects and requirements during the year and he stressed it was important not to forget what had been achieved. Mr Sullivan explained that the proposals for the future outlined in the paper had yet to be agreed by the Committee.
The Board discussed the redesign initiatives developed in the areas of dermatology, orthopaedics, neurology, plastic surgery and ENT, which had been centrally driven by the Centre for Change and Innovation.
Support was given by members for the proposals to carry out aspects of the Committee business in seminar mode, as to date it has proved successful. It was recognised that this might not be appropriate for some business matters, so it was necessary to have the right forum for the appropriate activity.
Professor Weir acknowledged the challenging agenda and explained that the proposals had clinical backing.
The Board endorsed the process that the Committee was proposing to adopt.
Mr Royan commented that the report had been very helpful and focused. He felt this was an extremely good way of doing the business of the Board and encouraged other Committees to use this as a model.
PATIENT FOCUS AND PUBLIC INVOLVEMENT (PFPI)