Approved Board Minute 6 August 2013

APPROVED

NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session on Tuesday 6 August 2013 at 10.00am in Rosemount/Caroline Rooms, CLAN Aberdeen, Westburn Rd, 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 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 Sir Lewis Ritchie Director of Public Health Cllr Anne Robertson Non-Executive Board Member Mr Mike Scott Non-Executive Board Member Mrs Elinor Smith Director of Nursing and Quality

By Dr Chris Allan GP, Inverurie Invitation Mrs Laura Gray Director of Corporate Communications/Board Secretary Dr Annie Ingram Director of Workforce Mr Mike Ogg Deputy General Manager, Aberdeenshire CHP Mr Graeme Smith Director of Modernisation Dr Pauline Strachan Deputy Chief Executive Mr Ray Watkins Head of Health Improvement

Attending Miss Lesley Hall Assistant Board Secretary Mrs Glenys Wells PA, Board Secretariat

Item Subject

1 Apologies Apologies were received from Dr Roelf Dijkhuizen, Mrs Jenny Greener and Mr Jonathan Passmore.

2 Verbal Updates

 Chairman The Chairman advised of celebrations held to mark the 65th anniversary of the NHS including an event involving a group led by Fiona Black, who handed over a generous donation towards the ARI Therapeutic Roof Garden. He congratulated Roxburghe House

1 Item Subject

on being awarded the Queen’s Medal for Volunteering. He reported on a visit to the Moray CHSCP Committee and advised that he intended to visit each CHP regularly as transitional arrangements were established around health and social care integration.

 Chief Executive Mr Carey advised that his introductory remarks would relate to issues that had been in the media spotlight in recent weeks. He advised that the Board was well briefed about the significant pressures that mental health services were under and the steps being taken to recruit staff. He thanked staff in the service for all they were doing to go the extra mile to deliver good patient care.

He explained the unconnected circumstances that had led to the closure of three minor injuries units (MIUs) for one shift and assured the Board that this was not a major strategic issue. Sir Lewis advised that staff at MIUs took pride in the work that they did and that negative publicity affected staff morale.

Mr Carey advised that the most recent Healthcare Improvement Scotland Healthcare Environment Inspection (HEI) report on ARI had been published that day. The report was mainly positive, noting good compliance with standard infection and control precautions; good relationships between ward and other staff to prevent the spread of infection; improving auditing arrangements; good compliance with hand hygiene and the dress code. The shortcomings identified in the report were being addressed as a matter of urgency.

Mrs Duncan reinforced to the Board that staff and management were working very well with an unprecedented level of activity in mental health services and the Acting General Manager had brought cohesiveness to the service. Staff were aware that the management team was working to resolve the challenges faced by the service.

3 Minute of Meeting held on 2 April 2013

The minute was approved subject to the following amendments: Page 2, Item 2, Chief Executive update – line 4, amend to read: “The work of NHS Grampian and the University of Aberdeen had been recognised internationally.” Page 3, Item 5.1- line 6 insert the word “maximum” between the words “hour” and “waiting”.

4 Matters Arising

There were no matters arising.

5 Improving Health, Wellbeing and Reducing Inequalities

5.1 NHS Grampian Dental Plan 2020 – Risk 586

Mr Watkins highlighted the successes of the previous 2008-2012 Dental Plan including exceeding the targets of 60% of children with no obvious dental disease in Primary 1 and Primary 7; 120,000 additional NHS registrations between June 2007 and March 2012; reducing the waiting lists for primary care dentistry. With 2 Item Subject

modernisations to the service, waiting lists had been reduced significantly. The opening of the Dental School had been instrumental in the modernisation, with two cohorts of students having graduated.

Mr Watkins stressed the links between dentistry and NHS Grampian’s quality agenda. He emphasised the importance of consolidating the work done to date and the targeting of those in greatest need to close the inequality gap.

Mr Smith agreed that there had been a transformational change in dental/oral health over the last 8-10 years. Dental Healthfit in 2006 had visualised changes and investment in the vision, including an emphasis on prevention, had led to significant improvements in oral health.

The remuneration system was discussed and Mr Watkins advised of ongoing work nationally to extend salaried services.

There was a need to engage with elderly people, as a group, to encourage them to access dental services. It was suggested that links be made with Local Authority colleagues who had a useful insight into elderly population,

Professor Greaves advised that the establishment of the Dental School with the University of Aberdeen had been a challenging process, but it had proved to be a success and would continue to be so in the future.

With regard to prevention of dental problems, queries were raised about the benefits of fluoridation of water supplies and it was suggested this could benefit oral health. Mr Watkins advised that there was no artificial fluoridation in Scotland and that there were two areas, one of which was in Moray, with natural fluoridation. He advised that there were no detrimental effects of fluoridation on public health, as evidenced by 100 million people consuming artificially fluoridated water in the US on a daily basis.

The Board: 1. Noted the considerable improvements in dental services since 2007/08 2. Endorsed the Dental Plan 2020 as a framework for continued. improvements in Oral Health and modernising dental services in Grampian. 3. Noted the developing clinical networks across the North of Scotland particularly between the three Island Boards, NHS Highland and NHS Grampian.

5.2 Tobacco Control 2020 Action Plan – Summary / Tobacco Policy Review: Heads of Agreement

The Chairman introduced the item by reminding Board members that smoking was the most important cause of preventable ill health and premature deaths in Grampian, with over 1000 deaths and 5000 admissions to hospital every year. He stressed the need for Board members to offer leadership to create a smoke-free generation. He advised that the benefits of implementing a tobacco policy in the 3 Item Subject

workplace would go wider than the workplace itself. He referred to a leader article in the local media the previous weekend which supported NHS Grampian’s attempts to ban smoking from all NHS premises and grounds in the Grampian region.

Sir Lewis echoed these sentiments and encouraged the Board to support the recommendations in the papers presented.

Dr Ingram advised that the Tobacco Control 2020 Action Plan set out local action to implement the national strategy to create a tobacco-free generation. The Tobacco Policy Review Heads of Agreement provided clear principles to underpin the proposed new policy for NHS premises, with clear implications for staff, patients and visitors.

Mr Watkins reported on progress to address smoking. He advised that smoking cessation was being delivered throughout Grampian supported by a pharmacy- based programme offered in over 138 pharmacies. This programme was performing well.

The Board noted that the Heads of Agreement document had been agreed in partnership as the basis for a new policy to be in place by 2014, with a view to NHS Grampian becoming smoke-free by 2015.

Dr Ingram advised that additional funding would be provided for facilities staff to have a role to monitor smoking, to identify areas of concern and to address issues.

Board members discussed the points in the Heads of Agreement and welcomed that risks associated with smoking would be routinely identified, managed and monitored through mandatory Health and Safety arrangements at local level.

It was noted that most staff were aware that they should not smoke in uniform and it was already policy for staff not to travel in uniform as that was an infection control risk. Staff should use changing facilities to ensure compliance with the policy. A particular challenge had been identified where staff went into homes where patients may be smoking.

Dr Ingram stressed that it was a Scottish Government requirement to be smoke- free by 2015 and a national group would encourage links with other Boards to ensure best practice was shared.

With reference to the point stating that all staff should actively implement the Tobacco Policy, Mr Carey pointed out the difficulties of doing so. He felt it would be helpful if the Government’s aim to be smoke-free were backed by legislation. Dr Ingram advised that it was possible to seek a Local Authority bylaw to underpin no smoking on sites.

It was noted that the policy would apply to devices designed to represent a cigarette i.e. electronic cigarettes would be treated as any ordinary cigarette. This would avoid any uncertainty if someone appeared to be smoking within NHS 4 Item Subject

Grampian premises and make monitoring easier. At present there was little evidence concerning the safety of some of these devices.

Professor Greaves reminded the Board that 30% of the Foresterhill was owned by the University of Aberdeen and work had to be done in partnership with them.

Mrs Juroszek advised that there was evidence of staff engaging with patients as part of a health promoting service and this would help to move forward the smoke- free agenda.

Dr Strachan advised that as well as important roles for the Board and staff to implement the Tobacco Policy there was also a key role for the public to ensure a smoke-free environment. Sir Lewis had been encouraged by the media article to which the Chairman referred in his introduction and hoped the local press would continue to support the Board.

The Board: 1. Supported and endorsed the ongoing successful implementation of the Tobacco Control 2020 Action Plan. 2. Noted and endorsed the Heads of Agreement and the proposed arrangements for delivering the new Tobacco Policy for implementation during 2014. 3. Supported the development and implementation of the new Tobacco Policy so that NHS Grampian was smoke-free by March 2015. 4. Agreed to act as advocates for Tobacco Control.

6 Delivering High Quality Care in the Right Place

6.1 Integrated Health and Social Care Hub – Inverurie Initial Agreement – Risk 851

Mr Gray advised that the initial agreement (IA) for the integrated health and social care hub set out the strategic case for the replacement of the Inverurie Health Centre and the establishment of the community maternity service at Inverurie Hospital. It also had the potential to include the replacement of the community dental facility and energy centre on the hospital site. The IA set out the case for change and the need to invest, together with sources of funding.

Dr Allan, a GP from the Inverurie Medical Group, explained that the practice population had increased significantly over the last 10 years. The practice had 17 GPs and would struggle to provide services without changes that would allow additional services for the elderly, anticipatory care and the prevention of ill health.

Mr Scott sought clarification of the funding, particularly around the revenue element.

Mr Bisset declared an interest as a patient of the practice, but commented that the community was delighted to see the project reach this stage. He commended the partnership working with the CHP, Local Authority, local GPs, 5 Item Subject

the public, voluntary sector, community council and other groups who had input to the comprehensive document.

Mr Anderson felt this was a big step towards integration and new ways of working and sought assurance that opportunities would be taken to maximise the potential for joint working. Dr Strachan responded that Inverurie was a well- managed practice that was very engaged in the community, with forward looking and innovative partners. She advised that the practice engaged well with NHS Grampian and she was encouraged by the proposals in the IA.

Mrs Gray commended the contribution from the community in reaching this very important milestone and advised that the input from the Community Council, Friends of Inverurie Hospital and patient participation group would continue to help shape future service delivery.

The Board noted that NHS Grampian was working with the Local Authority regarding the potential for replacing inpatient facilities and the integration of services. Management was aware of the proposed new care home and was in dialogue with Local Authority colleagues about this. Opportunities would be investigated for joining up facilities and resources.

Mrs Duncan advised of staff input to the planning process and reported that the project had created a tremendous enthusiasm among the community, the public and staff. The proposals were in line with the 2020 vision and staff were very supportive.

Mr Gray advised that the Outline Business Case would be looking at a permanent solution for the Community Maternity Unit (CMU). He suggested it might be worthwhile delaying the timescale slightly to ensure the right model for a sustainable service. Mr Mackie cautioned against a temporary approach and suggested planning far enough ahead for a permanent solution for maternity services.

The Board approved the initial agreement and noted that this will be forwarded to the Scottish Government Capital Investment Group (CIG) for its approval.

The Board noted that following approval by the CIG, NHS Grampian would proceed to agree a new project request with hub North Scotland Ltd and develop the outline business case for the project. The timeline for delivery of the project was set out within the Initial Agreement.

6.2 Forres Woodside and Tain (FWT) Bundle Project Full Business Case Addendum – Risk 586

Mr Gray advised that Addendum outlined had changed since the Boards of NHS Grampian and NHS Highland had approved the Full Business Case in February 2013. He advised that the overall unitary charge had reduced at Financial Close and that NHS Grampian’s contribution was £0.054 million. He stressed 6 Item Subject

the importance of hubCo in the project and the support from the Scottish Government.

The Board noted the Full Business Case Addendum for the Forres Woodside Tain Bundle Project.

6.3 Healthcare Associated Infection Report – Risk 853

Dr Strachan highlighted the main points in this regular report to the Board. She advised that NHS Grampian was performing well, but particular attention was paid to any areas of non-compliance. Concerns were raised about hand hygiene compliance at Dr Gray’s Hospital.

The Board noted the report.

7 Involving our Patients, Public, Staff and Partners

7.1 Patient Rights (Scotland) Act 2011 – Risk 851

Mr Gray advised that the paper was presented to advise the Board about the status of investment in additional capacity to increase surgical operative capacity at Aberdeen Royal Infirmary and Woodend Hospital. The paper also restated the principles that the Board had agreed relating to the Patient Rights (Scotland) Act 2011. He advised that the aim was to continue to treat patients in Grampian on time and in terms of clinical priority.

Dr Strachan advised that there was a gap between demand and capacity and the commitment was to invest to bridge that gap to reach a position of stability by 2014. In the meantime, NHS Grampian would continue to report breaches of the Treatment Time Guarantee (TTG). She assured Board members that patients continued to be at the centre of waiting times management and were involved in decisions about being treated elsewhere if it was not possible to treat them in Grampian within the 12 weeks guarantee time. Discussions continued with Scottish Government Health and Social Care Directorate about performance against the TTG. NHS Grampian’s current performance demonstrated that in excess of 90% of patients were seen in compliance with the TTG and in line with the principles agreed.

Mr Carey pointed out that to put waiting times breaches in context, out of thousands of patients being treated, only 17 patients per week were waiting longer than the TTG. He stressed that elective waiting times were at their lowest level both in NHS Grampian and in NHS Scotland.

Mrs Juroszek advised that as well as investing in additional theatre capacity, it was necessary to ensure a sufficient workforce, for example physiotherapists and carers, to deal with aftercare and rehabilitation,

The Board noted the status of the investment programme in additional staffing and theatre capacity and discussions with the Scottish Government 7 Item Subject

Health and Social Care Directorate in relation to our waiting times performance.

8 Developing and Empowering our Staff

8.1 Patient Story – Risk 853

Mrs Smith read out a patient story entitled “Little Things Matter” from the perspective of a patient’s daughter-in-law. It related to clinical and end of life treatment, highlighting the importance of communication and for family members to feel respected, valued and included.

The Board noted that patient stories were used in the training and development of staff for learning purposes.

9 Reports

9.1 Staff Governance Committee Report

Mr Mackie highlighted the main items in his report from the meeting on 30 May 2013. He advised that the Committee had approved Workforce 2020 as the workforce vision for NHS Grampian, which reflected well against the emerging national NHS Scotland Workforce 2020. Attendance management continued to maintain low levels of sickness absence.

9.2 Clinical Governance Committee Report

Mr Muir advised that the topics discussed at the meeting on 7 June 2013 had included the introduction of the Datix risk reporting system to general practices. The Committee had noted Healthcare Improvement Scotland’s (HIS) External Review of the Management of Adverse Events and endorsed the improvement plan to take forward its recommendations.

9.3 Area Clinical Forum Report

Mrs Juroszek advised that the advisory structure had considered the Francis Report and felt it was appropriate to consider this along with the recently published Keogh report. She advised of work with the Quality, Governance and Risk Unit to take forward the recommendations suggested in the HIS Adverse Event Improvement Plan and of links with the Feedback Service about follow up and reflective learning from incidents. The Routemap to the 2020 Vision for Health and Social Care in Scotland referred to a new Innovation Fund which should be an opportunity for NHS Grampian to access additional resources to develop innovative approaches to healthcare. The particular challenges of targeting the most deprived communities was discussed, both in inner cities and remote and rural areas was 8 Item Subject

discussed.

9.4 Endowment Committee Report

Mr Bisset advised that the Committee had received an update on investment performance and noted the capital growth and income generation. The Committee had agreed to the transfer of investment management to Standard Life Wealth who had acquired Newton’s private client business. A seminar for Endowment Fund Stewards (formerly known as fund managers) was being arranged for late autumn. The Annual General Meeting of the NHS Grampian Endowment Fund Trustees would take place on 24 September 2013. All Board members, as Trustees of the Endowment Funds, were asked to attend.

9.5 Performance Governance Committee Report

At its meeting on 23 July 2013, the Committee had been given assurance about progress with Planned Care. The No Delays approach had been discussed and would be subject to further Board discussion regarding joint venture arrangements with private sector partners. Delays in implementing projects associated with the Change Fund had been noted. Work was underway, in discussion with the Scottish Government, to improve performance against access standards, as discussed under item 7.1. The Committee had noted that an action plan was in place to improve the position on the cancer target of 95% of patients being treated within 62 days, which was proving challenging for all Boards.

9.6 Grampian Area Partnership Forum Report

Mrs Duncan reported from a successful away day on 18 June 2013. She thanked members of the Board Executive Team for a productive meeting with staff side colleagues to discuss a number of issues that had not been covered at recent GAPF meetings. She assured Board members that this did not reflect any failure in other formal structures and felt it was important to keep all channels of engagement open. The response rate from NHS Grampian staff to the recent staff survey appeared to be above the national average.

9 10 Items for Noting 2013

Approved Minutes

10.1 Grampian Area Partnership Forum – 17 April 10.2 Area Clinical Forum – 20 March and 22 May 10.3 Audit Committee – 26 March 10.4 Endowment Committee – 11 March 10.5 Moray CH&SCP – 15 March 10.6 Staff Governance Committee – 19 March 10.7 Clinical Governance Committee – 15 February 10.8 Aberdeen City CHP – 29 March, 26 April and 31 May 10.9 Performance Governance Committee – 22 May 10.10 North of Scotland Planning Group – 20 February

Chief Executive Letters

10.11 Chief Executive Letters received since 17 June 2013

11 AOCB

Reconfiguration of Dr Gray’s Hospital

Mr Carey advised that the work, which had resulted from £5 million of investment, was approaching completion and was a very positive development for the hospital.

12 Dates of Next Meetings

Tuesday 27 August 2013 (Development Day and Seminar) Monday 30 September 2013 (Meeting - please note change of date from Tuesday 1 October 2013)

Signed ………………………………………. Date ………………………………… Chairman