Highland NHS Board 30 May 2017 Item 3.2 Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 HIGHLAND NHS BOARD Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk/ DRAFT MINUTE of BOARD MEETING Board Room, Assynt House, 28 March 2017 – 8.30 am Beechwood Park, Inverness
Present Dr David Alston, Chair Mr Robin Creelman Ms Jaci Douglas Ms Myra Duncan Dr Andrew Evennett Dr Michael Foxley Mr Alasdair Lawton Ms Melanie Newdick Mr John McAlpine Mr Adam Palmer Ms Ann Pascoe Dr Gaener Rodger Ms Sarah Wedgwood Ms Elaine Wilkinson Prof Elaine Mead, Chief Executive Ms Anne Gent, Director of Human Resources Mr Nick Kenton, Director of Finance Ms Heidi May, Nurse Director Dr Rod Harvey, Medical Director
Also present Ms Ann Clark, Non-Executive Director (pending) Ms Joanna MacDonald, Director of Adult Social Care Ms Deborah Jones, Director of Strategic Planning, Policy and Performance Mr Eric Green, Head of Estates Ms Maimie Thompson, Head of Public Relations & Engagement Prof. Hugo Van Woerden, Director of Public Health & Health Policy Ms Gill McVicar, Director of Operations, North and West Highland Mr David Park, Director of Operations, Inner Moray Firth Ms Janet Spence, Head of Care Services Improvement Ms Ruth Daly, Board Secretary Ms Margaret Brown, Business Support Directorate Dr Wendy Van Riet, Cahms Service Manager (Item 3.1) Ms Murdina Campbell, Quality Improvement Lead, Lean Team (Item 3.1) Mr Gavin Hookway, Senior Quality Improvement Lead, Lean Team (Item 3.1) Ms Helen Sikora, Principal Officer Health Inequalities Dr Helen Bryers, Head of Midwifery Dr Stephanie Govenden, Lead Doctor Child Protection and Looked After Children Ms Sally Amor, Child Health Commissioner Ms Kirsten McCulloch, Pharmacist, Raigmore (Item 3.4) Ms Amy Noble, Senior Staff Nurse, Ward 7a Raigmore (Item 3.4) Ms Kay Cordiner, Senior Charge Nurse, Ward 7a Raigmore (Item 3.4) Mr Alan Paton, Service Planning Analyst, Larch House (Item 3.4) Mr Stephen Thomas, Respiratory Consultant, Raigmore (Item 3.4)
Ms Claire Barron, Staff Nurse Ward 7a Raigmore, (Item 3.4) Cllr Bill Fernie (Highland Council) (Item 4.3) Ms Fiona MacBain, Committee Administrator, Highland Council
Preliminaries
• The Chair thanked Sarah Wedgwood, John McAlpine and Jaci Douglas for their valued contribution to the Board. Ms Wedgwood had resigned for personal reasons with effect from 31 March 2017 and Cllr McAlpine and Cllr Douglas’s terms on the Board were coming to an end due to forthcoming Local Authority elections. • Ms Janet Spence was retiring and was thanked for her work as Head of Care Services Improvement. • Ms Silvia MacKenzie, co-sponsor on the RPIW to be reported at Item 3.1, and Mr James MacNaughton were welcomed to the meeting. • The Chair drew the Board’s attention to the laminated copies of the Board compact which could be used as a referral document throughout meetings.
1 Apologies
An apology was submitted on behalf of Mr Mike Evans.
2 Declarations of Interest
There were no Declarations of Interest.
3.1 Tier 1 Report: Children and Young People Neuro-developmental Needs RPIW
Dr Wendy Van Riet, Cahms Service Manager, Ms Murdina Campbell, Quality Improvement Lead, Lean Team and Mr Gavin Hookway, Senior Quality Improvement Lead, Lean Team, presented the RPIW (Rapid Process Improvement Workshop).
Key points from the RPIW were summarised as follows:
• The aim was to develop a standardised, multidisciplinary process for identifying, assessing and intervening with children and young people with neurodevelopmental difficulties, including the provision of timely and high quality assessments. • Targets included the reduction of the time taken from referral to completion of assessment from 760 to 182 days, and the increase of the parental satisfaction score from 1.79 to 5. • 134 wastes were identified, with 49 ideas of how they could be addressed. • Of the 31 actions generated, 8 had been completed. • Work-streams for the future as well as challenges and issues were summarised. This included dealing with the back-log of referrals in the system but it was hoped this would be cleared by the end of 2017. • Parental input and support for the RPIW had been valuable and had helped to work across traditional organisational boundaries. • It was positive that the RPIW had effectively redesigned a new pathway.
The Board thanked the team for the excellent outcomes of the RPIW and noted the Tier 1 Report to the Board.
3.2 Minute of Meeting of 31 January 2017 and Action Plan
In relation to Item 2, Declarations of Interest, Ms Jaci Douglas had declared a non-financial interest in Item 4.6 as member of the Board of Inverness College UHI, however Dr David Alston and Dr Michael Foxley had declared non-financial interests as members of the Court of UHI. In relation to Item 4.6, reference to ‘ragged reports’ should be ‘rag reports.’ The Board approved the minute, subject to the above amendments. 2
3.3 Matters Arising
Item 4.9 of the January meeting related to the Local Patient Access Policy which had been deferred. It was suggested that the Policy should be incorporated in the rolling action plan together with the item on financial assistance to patients. It was clarified that the Access Policy was included later on the agenda within the CE Report (Item 4.13) and would be submitted to the Area Clinical Forum and thereafter the Board in May 2017. In this connection, it was also clarified that an update on Caithness maternity issues would be considered by the Board in May 2017.
Discussion took place on the reconfiguration of Out of Hours (OOHs) services, particularly in relation to concerns raised by the community in Glenelg who had written to the Board. The matter had been fully discussed at the previous day’s Board development session and the Chair would draft a reply to the community and circulate it to all Board members for comment before it was issued. Resulting from further discussion, consideration was given to whether it was appropriate for the Board to pause to take stock of the OOH situation in some communities, despite the general direction of travel for the OOH service having been decided, and interest in participation in a Short Life Working Group on the matter was sought.
A question was asked about the status of the work on the Performance Management Framework and a further meeting of the Short Life Working Group for that would be arranged, after its membership had been reconsidered.
A question was asked about the absence of a date for the non-executive Board members meeting, which had previously been on the action plan for March 2017. The Chair referred to the diagnostic tool that was to be considered at the Board Development session in May 2017 to facilitate Board functioning and Myra Duncan asked that a separate meeting for non-Executives also be arranged in May 2017.
The Board noted the Matters Arising and agreed the decisions made.
3.4 Value Management Presentation by Nick Kenton, Director of Finance
Nick Kenton and a team of staff associated with Raigmore Hospital Ward 7a gave a presentation on the Ward’s Value Management Programme, explaining the fit of the project with the NHS Highland Quality Approach.
Information had not been provided in a timely manner and there had been a tendency for quality and financial data to be considered separately. The Value Management approach aimed to obtain timely data in a single form to empower teams to make decisions and improve performance.
Improvement activity between October 2016 and December 2016 was summarised with a movement to a weekly box score and refined measures that had led to the creation of a visual management board, which had improved activity in capacity, safety, cost and quality. Examples were provided of how nurse time was being used more efficiently by having night-shift staff undertake certain activities to give day- shift staff more patient contact time, and how the ordering of duplicate drugs had been reduced to zero in the previous four weeks, which had previously been a challenge. It was hoped the approach could be rolled out to other wards and hospitals, although the importance of individual team ownership of any improvements was emphasised.
Board Directors thanked the team for their honest presentation and welcomed the new approach to data management. Directors were invited to visit the ward to view the Value Management Board. The improvement process had created additional work but was considered worthwhile for the long term gains from having real time data to support real time decisions.
The Board noted the presentation.
4.1 Appointments
The Board appointed the following:
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• Robin Creelman as Chair of Argyll and Bute Integration Joint Board • Ann Clark as Chair of Mid Ross Local Community Planning Group • Ann Pascoe as Chair of the Endowment Funds Committee [Post meeting note: Chair of Endowment Fund Committee requires to be determined by Endowment Fund Trustees]
4.2 Equality Outcomes and Mainstreaming Report Helen Sikora on behalf of Hugo van Woerden, Director of Public Health and Health Policy and Elaine Mead, Chief Executive
Helen Sikora highlighted the information that NHS Highland, as a listed public authority, was required to publish in April 2017 under the Scotland Specific Duties of the Equality Act 2010. This comprised:
• Progress on equality outcomes set in 2013 • Mainstreaming equality • Refreshed equality outcomes for 2017 to 2021 • Employee information • Gender pay gap • Succession planning – a new requirement introduced in 2017
It was anticipated that socio-economic duty in relation to the impact of Board decisions was likely to be included in the near future.
The equality outcomes proposed for 2017-2021 were:
1. Increasing the diversity in leadership and workforce participation. 2. Identified groups have improved experiences of accessing services and information. 3. Identified groups of children and young people will benefit from improved access to mental health services and support. 4. People better recognise and understand prejudice-based incidents and hate crimes and feel confident reporting them. 5. In Highland, all individuals are equally safe and respected, and women and girls live free from all forms of violence and abuse and the attitudes that help perpetuate it. 6. As a Community Planning Partnership, work towards addressing socio-economic disadvantage as set out in the Local Outcome Improvement Plan.
Reference was made to the case studies in the report, succession planning and the gender balance of the Board, engagement undertaken, and how to support young people with care experience considering the role of NHS Highland as corporate parent.
Comments made during discussion included:
• Cognisance should be taken of the relationship between the Out of Hours service changes and socio economic issues, noting however that that part of the legislation had not yet been enacted. • It was clarified that the Argyll and Bute Community Planning Partnership had been involved, and reference was made to the equality outcome that had focused on the role of the Partnership. The Local Outcomes Improvements Plan (LOIPs) and Locality Plans should also be investing in equalities. With this in mind, Outcome 6 should be plural rather than singular. • Outcome 2 was welcomed, especially in relation to the local access policy. In response to a query about timescales it was explained that national discussions were taking place but work was also being done to make improvements locally. • The importance of supporting Looked After Children into work was emphasised. • In order to mainstream and embed this outlook, underpinning statements about equality issues should be contained within the financial decision making process. It was explained that equality impact assessments were undertaken for all decisions. • The addition of socio economic impacts in the future was particularly welcomed for remote and rural areas in which living expenses were significantly higher. 4 • A statement about the outcome of all equality impact assessments should be included in all reports, rather than simply a statement saying an assessment had been done.
The Board:
• Note the content of the report in relation to meeting the Scottish Specific Duties of the Equality Act 2010 • Agreed the equality outcomes proposed for 2017-2021 as detailed. • Agreed to further consider the inclusion of an equality impact assessment statement into future Board reports.
4.3 Future roles of the Board and the Highland Health and Social Care Committee Ruth Daly, Board Secretary, on behalf of David Alston, Chair
Ruth Daly introduced the report which described possible options for the future of the Highland Health and Social Care Committee (HHSCC) for the Board’s consideration as follows:
Option one: to maintain the status quo Option two: to replace HHSCC with an intermediate stage Governance Integration Committee (with a review after 2 years) Option three: to dissolve the current HHSCC and remit its responsibilities back to the Board Option four: to increase delegation of responsibility to HHSCC.
The Board was invited to take a decision on the four options available, with a recommendation that Option four be pursued. Prior to considering the report, and responding to queries raised by Ms Duncan, the following areas were clarified:
• Option 1 – the report should describe the Health and Social Care Committee’s referral of issues back to the Board for reasons of its current decision making power rather than through established culture; • Clinical Governance Committee considers Argyll and Bute in the same way as north Highland however spends more time reflecting on North Highland because it receives 3 sets of SAERs; • If the Board were to pursue Option 4, proposed Terms of Reference and membership would come to the May Board meeting.
During discussion, the following points were raised:
• One further outstanding matter related to the existing legislative framework. It was confirmed that the Joint Monitoring Committee was a legislative requirement under the Public Bodies (Joint Working) (Scotland) Act as stated in the Integration Scheme. The Health and Social Care Committee was currently established as a Governance Committee of the Board and was governed by Health Board meetings legislation. • The view was expressed that the Board was not permitted to delegate health and social care for north Highland to a Sub-Committee of the Board. This was on the basis that Governance Committees were established to provide additional scrutiny, to question and gather information, and to deliver assurance to the Board rather than make decisions. Decision making ultimately sat with the Board. In contrast to this, decision-making powers could be delegated to Management Committees. By delegating decision making as proposed, it was feared that the Board could become too far removed from the business to maintain oversight. • In response, the concerns expressed suggested that the Board had no power to delegate its functions through Committees. Delegation did not alter what the Board had responsibility for but described a way of discharging its functions. There had been no information to suggest the course of action was inappropriate in terms of Board governance, On this point, it was requested that the advice on which the proposal was based be shared with the Board and further clarification be sought that the approach was competent. • In seeking to replicate the governance structure around the IJB in Argyll and Bute, the recommended option ignored the different relationship that the Board had with regard to the HHSCC and the IJB in Arygll in Bute; the IJB is a legal entity whereas the HHSCC is a Sub-Committee of the Board.
5 • Clarity is required regarding the purpose of the committee, whether it was a governance committee or a management committee. • It was noted that some areas of responsibility would be taken forward separately by North Highland and by Argyll and Bute, e.g. the Local Delivery Plan. However, some issues were overarching, such as capital budgets, and this required to be made explicit and taken into consideration in an overall governance framework. Areas such as payroll, could become regional or national in due course. • It was suggested that an assurance framework as well as revised terms of reference and membership of the future HHSCC be brought to the Board in May 2017. Suggestions from the Chair included a larger Non-Executive presence. • In response to the suggestion of a period of ‘shadowing’ for any new arrangement to minimize risks during a period of extreme budget pressure, and having heard that the IJB had operated as a shadow board for a year during the transition period, it was pointed out that the IJB shadowing period had largely been due to the need to develop a new working relationship with the Local Authority. • It was important that joint working with partner organisations was facilitated by whatever option chosen and a robust discussion on this with the Highland Council was proposed. • A mechanism for financial scrutiny, including options and consequences, was required and clarity was sought on the role of the Board in key decisions such as major service redesigns. • Further clarity was required on provision to escalate decisions to the Board and how the Board might challenge decisions taken by HHSCC. • The development of the regional agenda should be taken into consideration and a clearly defined relationship between the Board and North Highland was essential to improve the sustainability of the lead agency model. In this regard, the Chair summarised the current situation in relation to regional working which was a changing landscape at present. For the moment, only a decision on the direction of travel was sought, with detail to be brought back to the Board. • The principle of reducing duplication which had been part of the Polley review was referred to and it was suggested that a performance monitoring framework was required before further decisions could be made. • Other options had been suggested both during and since the Governance Review but had not been taken forward.
Following further discussion of the points raised, the Chief Executive referred to the changing environment and that she considered the lead agency model that Highland had chosen to have been effective and deserved protection. However, the setting up of the HHSCC in its current format had resulted in over-scrutiny of some of the integrated parts of the organisation and too little scrutiny of other areas, such as finances and clinical governance. Actions were being proposed to try to rebalance this and to ensure members of the committee were sufficiently aware of the entirety of their responsibilities for certain key issues, which currently were not being dealt with to the Chief Executive’s satisfaction. Prompt change was required to address the situation.
The Chair, seconded by Robin Creelman, moved that the Board agreed Option Four as the preferred option, subject to the following being brought to the next Board meeting: revised terms of reference, revised membership, assurance framework, and clarification that the proposal was within the Board’s decision-making powers.
Following a vote by a show of hands, the Chair’s motion was agreed by the Board by 16 votes to 3.
In the absence of a webcast of this meeting, votes were cast as follows:
In favour of the Motion
Dr David Alston Ms Ann Pascoe Mr Robin Creelman Dr Gaener Rodger Ms Jaci Douglas Ms Elaine Wilkinson Dr Andrew Evennett Prof Elaine Mead, Chief Executive Mr Alasdair Lawton Ms Anne Gent, Director of Human Resources Ms Melanie Newdick Mr Nick Kenton, Director of Finance Mr John McAlpine Ms Heidi May, Nurse Director Mr Adam Palmer Dr Rod Harvey, Medical Director
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Against the Motion
Ms Myra Duncan Dr Michael Foxley Ms Sarah Wedgwood
4.4 Finance – Highland Financial Position as at February 2017 Nick Kenton, Director of Finance
Nick Kenton summarised his report and praised the team effort that had facilitated the forecast break- even position (subject to audit) during a challenging situation which had involved difficult decisions, such as the one-off capital to revenue conversion. Of ongoing concern was there having been too many one- off and non-recurring savings.
The Chair and Chief Executive congratulated the Senior Management Team, especially the Director of Finance, and all staff who had contributed to the financial position.
During discussion the following points were made:
• Consideration was given to the 11% staff turnover rate which was increasing, although there was a similar pattern across Scotland. It was of particular concern in rural areas and was addressed on the workforce plan, although there was considerable variation across different staff groupings. It was suggested that easy-to-read language in Board papers would be helpful. • Reference in the Executive Summary to ‘January’ should be ‘February.’ • Financial plans were adapted during the year to meet changing needs and circumstances. The majority of savings measures had been delivered in the operational units.
The Board agreed it was content with the financial position as set out in the report and the actions being taken to ensure the target of break-even was delivered on capital and revenue.
4.5 Quality and Sustainability Plan – Revenue Budget 2017/18 Elaine Mead, Chief Executive and Nick Kenton, Director of Finance
The Chief Executive referred to the unprecedented level of savings being sought in 2017-18 and that the Quality and Sustainability Plan attempted to address the detail from the ten year plan to achieve a fundamental change to the model of care, that being the only way to meet the challenging financial pressures ahead while also maintaining quality of care.
In addition to the overarching fundamental re-design of service delivery, a significant number of small incremental changes would also be required. Particular challenges being faced included meeting national waiting and access times. Other key issues included meeting the needs for future generations, attention to inequalities, delaying transfer of care to keep people independent.
With regard to the structure of the Plan, initiatives were streamed into seven headings: Adult Care; Flow; New Models of Care; Realistic Medicine; Drug Costs; Re-modelling Assets; and Quality Improvements & Local Initiatives and Opportunities. Engagement would be undertaken with communities to develop local models of care.
The Chair pointed out that an updated paper had been tabled at the meeting following significant detailed consideration of the draft Plan at the previous day’s Board Development session.
During discussion, the following points were raised:
• the Plan did not clearly identify what was going to happen although it was noted that the annexes to Quality and Sustainability plan (monitoring framework) would be available for April. There had been five years of waste eradication measures and the proposals to ensure savings from waste reduction were properly utilised elsewhere were welcomed. The Chief Executive concurred that waste eradication remained a continuous process to sustain improvements and that the new models of care were far reaching. 7 • It was noted that there had been no reference to the continued Raigmore overspend and a rebasing of budgets was suggested. Further detail on the timeframe for introduction and governance arrangements for new models of care was sought and it was urged that the pace of change be increased. The Board needed to remain sighted on this. • In relation to the governance implications included in the executive summary, the role of the Clinical Governance Committee as a central role for safety was welcomed, although governance arrangements later in the Plan were contradictory and required to be developed. • It was vital that appropriate equalities impact assessments were undertaken to improve equality of access to services. • Further clarity was needed on the understanding of major service change when engaging with communities. Detail on how the Board would engage on this and how feedback from communities would be sought was requested. This was particularly pertinent for major service change in Glenelg. Liaison and relationship building with Local Authority elected members was also vital. Staff involved in community partnership work should be supported and to be empowered to contribute to the change culture. • The strategic direction was welcomed but required to be evidenced and have mechanisms to monitor agreed actions. • The description of Realistic Medicine in the Plan was considered endorsed. • It should be clarified that the statement about smaller care homes not being viable was in relation to those run by private operators, whereas the Board might have to consider them in certain circumstances. The Chief Executive pointed out that that lack of viability might not be financial but related to inability to source adequate staff in a remote area. • The move towards a three-year rolling plan was welcomed, although the Board would also welcome being shown the detail behind the Plan as soon as possible. • In section seven, Communication and Engagement, explicit mention should be made of staff and their representatives, and in addition to referencing the Area Clinical Forum, the Adult Social Care Practice Forum should be added.
Responding to comments, the Chief Executive suggested the Delivering Financial Balance Programme Board as an appropriate mechanism for monitoring progress. Myra Duncan asked that the role of the DFBPB and its relationship with the Board be formalised.
The Finance Director pointed out that much was already being done to reduce costs. With regard to suggestions for rebasing budgets, proposed changes were in the context of the government’s agreed direction of travel, and attention was drawn to the indicative costs associated with places of care detailed in the report, i.e. the high cost of care in an acute hospital compared to the much lower cost of a care at home package.
The importance of engagement with communities and partners was emphasised, especially given the magnitude of changes required.
The Board:
Endorsed the strategic direction set out in the plan; Noted the efficiencies identified to date and the process for addressing the unidentified savings; Approved the proposed rolling planning cycle; and Noted detailed papers to follow for 2017/18 annual plan and rolling three year plan.
4.6 Local Delivery Plan Margaret Brown on behalf of Elaine Mead, Chief Executive
At the last meeting of the Board it had been noted that guidance for the new style Local Delivery Plan had been received and this report now presented the first draft LDP for the Board’s approval prior to submission to the Scottish Government by 31 March 2017. The final draft would be submitted by September 2017.
Comments made during discussion included the following:
• The new layout was welcomed.
8 • The proposals for pharmacy assistance to GP practices were impressive and would result in saving costs on drugs and more efficient prescribing. Further, it fitted well with concerns about GP recruitment. • With reference to the target of 11% it was estimated that current progress to move resources to communities was around 8%.
The Board approved the Draft Local Delivery Plan 2017/18 for submission to the Scottish Government by the national deadline of 31st March.
In response to Matters Arising, the Board was informed that constructive feedback had been received from the Area Clinical Forum and the Area Medical Committee on the Local Access Policy. The Board agreed that on this basis it would approve the updated policy.
4.6(a) Opening Budget offer to Argyll & Bute Integration Joint Board Report by Nick Kenton, Director of Finance
An additional paper was tabled and Nick Kenton gave a summary of the rationale behind the opening offer to the IJB, explaining the reasons why Argyll & Bute was being funded at £1.2m above its fair share, this being recommended for transfer to the Highland Health and Social Care Partnership over the coming two financial years.
The Board approved the draft opening offer to the Argyll & Bute Integration Joint Board as detailed.
4.7 Risk Appetite Nick Kenton, Director of Finance
Nick Kenton explained that in addition to the formal risk management strategy, there was a need for the Board to define its risk appetite across a range of categories. The matter had been considered by the Board and at two meetings of a Short Life Working Group in the context of the Quality and Sustainability Plan, and the recommended risks had then gone to the Risk Management Steering Group. He pointed out that as the status quo itself became inherently more risky, given the economic climate, change became increasingly appealing.
During discussion, it was clarified that the risk appetite would be reviewed annually, linked to the risk register. The concept of realistic medicine had influenced the rationale for the clinical risk appetite.
The Board approved the proposed risk appetites as set out in the report.
4.8 Capital Plan 2017/18 Nick Kenton, Director of Finance
Nick Kenton summarised the report, drawing particular attention to the need to have aspirational schemes included in the plan, and the forthcoming government requirement for all capital bids to have been taken into consideration for regional working.
During discussion, the following points were clarified:
• Any tentative forward plans for Raigmore were part of due diligence in maintaining that asset. • It was important that investment in eHealth measures were given appropriate prominence. • The extent of the backlog maintenance reflected the geographic size of the Highland area.
The Board approved the five year capital plan.
4.9 Annual Local Supervising Authority Audit of Standards 2016-17 Supervision for midwives: moving from a statutory to an employer led model for Scotland Report by Dr Helen Bryers, Head of Midwifery, on behalf of Heidi May, Board Nurse Director
9 The two key purposes of the report were summarised: the LSA Audit Report for 2016-17 and the transition arrangements and anticipated timescales for the changes from statutory to employer led supervision of midwives.
With regard to the audit, eight of the nine standards had been met, and the ninth one partially, with the matter now reviewed and compliant. The changes to the statutory supervision now meant that midwives were supervised in the same manner as nursing staff. A modest cash transfer to NHS Highland was anticipated to support the changes.
The Board noted:
• the LSA Audit Report for 2016-17; • that this was the final LSA Audit report; and • the transition arrangements and anticipated timescales for the changes from statutory to employer led supervision of midwives.
4.10 Infection Prevention and Control Catherine Stokoe, Infection Control Manager and Dr Vanda Plecko, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control
Heidi May summarised the report and drew attention to the infection targets in the table below:
Group Target NHS Scotland NHS Highland
Clostridium difficile Age 15 and HEAT rate of July-Sept 2016 ⃰July – Sept 2016 Red (HPS over 32.0 cases validated) per 100,000 31.4 34.0 OBDs to be achieved by ⃰Oct – Dec 2016 Red (NHSH year ending data) 03/17 42.0
Staphylococcus HEAT rate of July - Sept 2016 ⃰July – Sept 2016 Green aureus 24.0 cases (HPS bacteraemia per 100,000 33.2 32.8 validated) AOBDs to be achieved by ⃰Oct – Dec 2016 Red (NHSH year ending data) 03/17 34.4
Hand Hygiene 95% 95% Green Cleaning 92% 95% Green Estates 95% 97% Green
Good news included there having been 402 days since the last Surgical Site Infection in Arthroplasty and 509 days in Neck of Femur repair.
The Board noted the position and progress to reduce and manage healthcare associated infections.
4.11 NHS Highland Corporate Plans for Child Protection and Looked After Children and Young People Dr Stephanie Govenden Lead Doctor Child Protection and Looked After Children and Sally Amor Child Health Commissioner on behalf of Hugo Van Woerden Director of Public Health and Executive Lead for Children and Young People
10 The Board was reminded that NHS Highland had corporate responsibilities with regard to keeping children and young people safe (Child Protection) and as a Corporate Parent for Looked after Children and Young People. Both responsibilities were detailed in Scottish Government Legislation, related policy and guidance. The Corporate Plans appended to the report set out the details of the two areas of responsibility and proposed governance arrangements for the NHS Highland Board.
Following a summary of the report, the following points were raised:
• There had been training for the Board in the past on the role of corporate parenting and the Highland Council provided training on this, which could be shared. • Reference was made to the Needs Assessment undertaken in 2013 by NHS Highland which showed that proportionally, Highland had more looked after children and young people in residential care (16% in Highland and 13% in Argyll and Bute, compared to 9% nationally) and a greater percentage of children with additional support needs compared to Scottish averages (24%, compared to 11% nationally) and this was fully discussed.
The Board:
• Noted and agreed the proposed Corporate Plan for Child Protection • Noted and agreed the proposed Corporate Plan for Looked After Children and Young People • Agreed to updates on progress to be included in the Child Health Commissioner report to the NHS Board in autumn 2017
4.12 Asset Transfer Requests under the Community Empowerment Act Helen Sikora on behalf of Hugo van Woerden, Director of Public Health and Health Policy
The Community Empowerment (Scotland) Act placed new duties on a range of public sector bodies and provided new rights for community organisations, such as to request ownership, lease, management or use of publicly owned buildings or land whether or not they were available for sale or deemed surplus to requirements. The report summarised the implications for NHS Highland including being able to respond to requests from communities for transfer of assets.
During discussion, consideration was given to how communities would find out about facilities and how they could approach organisations. It was considered important that staff were adequately trained to deal with enquiries. Alignment with other public body processes would be reassuring and Directors urged that disproportionate requirements were not made for small projects to provide extensive business plans etc. One of the major issues to be taken onto consideration was the relative risks of a project, especially in relation to health. Discussion ensued on the need to ensure equal consideration was given to project requests from all sectors of the community, not only the more affluent which tended to be more articulate in their ability to make this type of application. In Argyll and Bute the process was similarly directed through the Integration Joint Board and thereafter through the Local Authority. The scheme would be publicised through the Community Planning Partnership and elsewhere, and systems would be refined and revised in due course.
The Board noted the framework and supporting documentation developed by Public Health to enable NHS Highland to respond to Asset Transfer Requests meeting the regulations implemented under the Community Empowerment Act.
4.13 Chief Executive’s and Directors’ Report Emerging Issues and Updates Report by Elaine Mead, Chief Executive
This month’s report incorporated updates on:
• Realising Realistic Medicine • NHS Highland Gaelic Language Plan • NHS Highland Local Patient Access Policy • Stonewall Update • NHS Highland staff recognised at prestigious awards 11 • Scottish Local Government Elections 2017: Guidance for NHS
Referring to the Gaelic Language Plan, the Chief Executive thanked Etta MacKay for its compilation and Dr Foxley urged movement on the action plan, pointing out that many costs related to its implementation were minimal, with replacement signage with Gaelic translation being given as an example.
The Board noted the Emerging Issues and Updates Report.
5.0 Audit Committee of 7 March 2017 (additional Item)
Due to timing, the minutes were not yet available, however areas of concern were highlighted as follows by Myra Duncan, who chaired the meeting:
In relation to the Internal Audit report on Performance Management, the committee had discussed that a Framework was not in place and stressed the level of priority given to this by the Board. Performance management activity was being undertaken, however it required further structure to improve effectiveness. The committee had discussed the timescale of 2018 for the anticipated management response and considered it too long. The development of a Performance Management Framework was a recommendation from the Governance Review. It had also discussed that the time set aside in the Internal Audit Plan to address the Assurance Framework had been deferred.
In relation to the Internal Audit on the implementation of efficiency plans, the committee had noted that adequate impact assessments had not been carried out and there were inconsistencies in methodologies. A more formalised approach was recommended. The terms of reference for the Delivering Financial Balance Board required review and this should be considered as a future Board item.
In response the Chief Executive undertook to investigate the possibility of reprioritising the issues raised within existing resources, as requested.
5.1 Highland Health & Social Care Governance Committee of 2 March 2017
There were no additional comments.
5.2 Integration Joint Board of 25 January 2017
Robin Creelman pointed out that the minutes should not have been indicated as draft.
5.3 Clinical Governance Committee of 7 February 2017
Myra Duncan pointed out that the meeting had not been quorate and drew attention to the following matters that had been considered:
• The quality dashboard was now being used and was helpful for framing the committee’s agenda. • The position on Return Outpatients was now known and focus was now on the approximate 9000 patients who were outwith the tolerances identified by clinicians. • The committee had discussed the number of and impact on patients boarding outwith their specialty ward in Raigmore Hospital and had received a level of assurance about the mitigating actions in place.
The Board Chair asked that Directors try to identify a substitute if they knew in advance that they were unable to attend a meeting.
5.4 Adult Care Practice Forum of 23 January 2017
Janet Spence drew attention to the ongoing eHealth issue of lack of access to NHS systems for Highland Council Adult Social Care staff and a firm plan and timescale to resolve this had not yet been decided. Following discussion and further concern being expressed, the Chair asked Deborah Jones to investigate and report back verbally to the Board.
12 5.5 Area Clinical Forum of 26 January 2017
There were no additional comments.
5.6 Asset Management Group of 24 January 2017 (approved) and 28 February 2017 (draft)
Following a query raised by the ACF representative at these meetings Andrew Evennett drew attention to the situation regarding the MRI Scanners at Raigmore which was detailed in the minutes of 24th January and asked for confirmation that the decision had not been altered at the February meeting. Alasdair Lawton confirmed that the decision had not been changed.
5.7 Staff Governance Committee of 14 February 2017
Alasdair Lawton reported that statutory and mandatory training was progressing. He highlighted participation rates in eKSF and that the planned switching to Oracle Performance Management System (OPM) in March 2018 had been delayed. Discussion ensued on the difficulties of access to the system for Highland Council staff who had been transferred to NHS employment, as well as general participation rates, which was a complex issue for which organisation-wide work was ongoing to improve uptake.
5.8 Health & Safety Committee of 9 February 2017
There were no additional comments.
The Board:
(a) Confirmed adequate assurance has been provided from the Governance Committees. (b) Noted the Assurance Reports and agreed actions from the Highland Health & Social Care Governance Committee and Clinical Governance Committee .
6.1 Date of next meeting
The next meeting of the Board was to be held on 30 May 2017 in the Board Room, Assynt House, Inverness.
6.2 Any Other Competent Business
6.3 The Board noted there would be a meeting of the Board In-Committee immediately following the open Board meeting.
The meeting finished at 12.50pm.
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