Item 9.7 Performance Governance Committee - 20 Nov

APPROVED

NHS GRAMPIAN Minute of the Performance Governance Committee Meeting held on Thursday 20 November 2008 in the Conference Room, Summerfield House Board Meeting 03 02 09 Open Session Present: Item 9.7

David Cameron, (Chair), Non-Executive Board Member, NHS Grampian Val Maehle, Non Executive Board Member, NHS Grampian Elizabeth McDade, Non Executive Board Member, NHS Grampian Gordon Stephen, Non Executive Board Member, NHS Grampian

In Attendance:

Richard Carey, Chief Executive Mark Clouston, Head of Performance, NHS Orkney (by video link) Laura Gray, Director of Corporate Communications, NHS Grampian Iain Lochhead, Senior Manager, Audit Scotland Ewan Robertson, Director of Performance Improvement/Board Secretary, NHS Grampian Anne Ross, Head of Performance and Quality Improvement, NHS Grampian Alan Sharp, Assistant Director of Finance (for item7.2.1 only) Glenys Wells, Personal Assistant, NHS Grampian – Minuting Secretary

Item Subject Action

1. Apologies

David Cameron welcomed everyone to the meeting and noted apologies from Barbara Bruce, Kate Dean and Roelf Dijkhuizen. Round table introductions were made for Mark Clouston and Iain Lochhead.

2. Healthstat

The Healthstat section of the meeting was covered in a separate paper (attached). AKR It was noted that Elizabeth McDade had been omitted from the attendance list of the previous note.

3. Minute of Meeting held on 23 September 2008

The minute of the above meeting was agreed as an accurate record of discussion.

4. Matters arising

5. Assurance Framework Reports from Governance Committees and PGC Feedback 1 APPROVED

5.1 Aberdeenshire CHP Val Maehle presented her report on behalf of the Committee. She believed good progress was being made with CHP Committee development including beginning to develop a joint financial framework. The report identified high risks about winter planning but Pauline Strachan assured members that there had been full involvement by Aberdeenshire CHP in the production of winter plans and she believed there were no high risks areas associated with the Plan. There was concern about capacity to keep people at home but the plan addressed this and this was reflected in Single Outcome Agreements (SOAs). Ewan Robertson suggested that SOAs should feature as a future agenda item. Anne Ross advised that the Local Delivery Plan (LDP) guidance had been received for 2009/10 and that this contained a new section relating to additional SOA commitments. Richard Carey advised that locally he expected that this would include substance misuse commitments.

5.2 Moray CH&SCP David Cameron reported in the absence of Barbara Bruce. He advised that the constitution and role and remit of the Moray Committee had been approved and that the issue of membership had been resolved.

5.3 Aberdeen City CHP

Richard Carey advised that there were some risks not currently covered by the City CHP report. Although the recent Child Protection report was complimentary of the health service, it had identified an issue about insufficient information available on the NHS Grampian website. It was agreed that PGC should be given assurance at a future meeting that the report’s recommendations were being implemented in full.

It was also noted that Woodend and children’s services should be covered VM/KD by the City CHP report and that Aberdeenshire’s report should refer to Mental Health issues.

6. PGC Draft Action Plan Members approved the Action Plan and asked for an update in a few months time. AKR

7. Delivery of Health Plan: High Level Performance According to Scorecard (incorporating LDP) Anne Ross highlighted some issues from the Overall Performance Report: - 3-5 year olds registered with NHS dentist – issues in Moray where the rate was lowest in Grampian. Richard Carey suggested that Dental Action Plan implementation be an item for the January meeting and Ray Watkins invited AKR to attend. - Cervical screening – next item on agenda. - Finance – worrying position with continued overspends. 2 APPROVED

- Outpatient waiting times – good progress in delivering 12 weeks, although concerns in last month as trajectory was exceededfor first time. October figures were not yet available. The Better Care Without Delay project board would be meeting soon and would be considering the current position and what more required to be done to rectify the position. - Day case rates. In relation to BADS procedures, Grampian had one of the lowest rates in Scotland but was improving - A&E – covered fully by Healthstat - Cancer – covered fully by Healthstat - Long Term Conditions – Grampian was on line to meet trajectory although there was a marked difference between sectors. Richard Carey explained that there was a more developed Community Health Care structure in Aberdeenshire. This will be replicated in the development of the new Health Village for Aberdeen City. Pauline Strachan advised that Moray was a huge outlier in the whole of Scotland in relation to chronic diseases, as well as having the lowest average income. - Staphylococcus Bacteraemia – Richard Carey reported a consistent trend of improvement and that Grampian compared favourably with other like-sized Boards. Overall, performance in hospital cleanliness was good. - CHI usage – it was noted that 100% could not be reached due to the recording process for the immigrant population and newborns who did not have CHI numbers.

Richard Carey commended the quality of reporting for this item.

7.1 Improving Health

7.1.1 Cervical Screening update Pauline Strachan spoke to a paper from Susan MacPhee which outlined the reasons for the decline in cervical screening uptake since 2001. This stemmed mainly from the issue of informed consent and the new GP contract which allowed for exclusion around informed dissent and when women failed to attend 3 times. Cultural issues relating to the immigrant population were consistent with other Boards. Although the HPV vaccine had been launched for younger women, there would still be a need for cervical screening for some time. A reversal in uptake trend was unlikely and was reflected throughout Scotland. The issue was to be reviewed further nationally by NHS Health Scotland. Richard Carey stressed that there was no complacency by NHS Grampian around this issue.

7.1.2 Substance Misuse Richard Carey commended the comprehensive report from Simon Raynor, Development Manager, Drug and Alcohol Action Team. He advised that the expanded service had already resulted in a significant reduction in the number of people on the waiting list 3 APPROVED

and the waiting time to access the specialist service and that this would be monitored regularly. He advised that it was also important to reduce the dependency on methadone and to move people towards being drug free. A significant proportion of clients could be rehabilitated with appropriate support. In this regard it was important to maintain pressure on Local Authority colleagues to put the necessary resources in place. As Chair of JADAT, he indicated that he was doing all he could to influence this agenda. The Aberdeen City budget had reduced to £300K, non recurring for this year. With the new Aberdeen City Council Chief RMC Executive in post from 1 December, there was an immediate priority to have a discussion to ensure wraparound services.

Progress had been made in relation to the Timmer Market facility for treating patients with drug misuse and it was the intention to appoint a nurse consultant for substance misuse, the first such post in Scotland. Partnership working was essential to ensure progress.

7.2 Finance

7.2.1 End September 2008 Financial Report and end October update Alan Sharp circulated a paper which outlined the finalised figures for October. He reported a year to date overspend of £2.36m on revenue and confirmed that the financial performance had not matched the forecast. Some of the reasons for the worsening position at end October were the GP prescribing budget, where assumed price reductions were 2% less than expected, the volume of prescribing, continued pressures in the Acute sector and Moray acute where efficiency targets were not being met. Slippage continued against earmarked funding. Efficiency savings of £13.6m had been achieved (mostly non recurring through vacancy management). A number of risk areas were outlined e.g. the impact of Agenda for Change (AfC) assimilations on budget, the areas where efficiency saving targets cannot be achieved and the increase in fuel costs where provision has been made with little flexibility for change. There might also be problems within the capital spend programme where some asset sales may not materialise this year because of the volatility of the property market. Alan advised that appointments would soon be made for a contract for the Emergency Care Centre (ECC) and combined heat and power schemes, under the new Frameworks Scotland which would improve Grampian’s carbon footprint. The timetable for this would be monitored by Graeme Smith and Gerry Donald.

Richard Carey confirmed the challenging times ahead but

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believed that balancing the financial position was achievable. The current overspend equated to 0.3%. The pressures were common across all Boards in Scotland. The risk in relation to AfC would be reviewed after modelling work was complete. The budget setting process would consider an apportionment of AG savings across sections of the service. A comprehensive paper on the financial position for 2009-2010 would be presented at the next Board meeting.

7.3 Service Delivery and Organisation 7.3.1 Change and Innovation Programme

Richard Carey reported on a successful Executive Team awayday where the change and innovation programmes had been reviewed. The outcome from that day would be presented initially to the Service Strategy and Redesign Committee (SSRC). A number of cross cutting themes had been identified and as a result the number of programmes had reduced to 6. In order to provide sufficient time and focus on delivery of the programmes it was being proposed that a strategic OMT meeting take place every 2 months where reports from at least 2 of the programmes would be presented.

Jack Stuart provided an update on the mental health programme. He reported that the Mental Health Collaborative Board with user and carer involvement was now in place and a Programme Manager had been appointed. Dr Alistair Palin was Chair and clinical lead. The collaborative’s action plan would soon be available. There were 14 national mental health commitments against the 4 mental health HEAT targets. Non recurring funding was available over 3 years to support the approach which would be used in association with other programmes to give capacity to move the agenda forward.

Heather Kelman reported on progress with the Intermediate Care Programme focussing on 3 key areas - the relocation of acute geriatric assessment services to ARI site, the creation of Aberdeen Community Hospital at the Woodend site and the creation of safe and effective “out of hospital” initiatives. There were links to other key areas of work e.g. HAI, ECC, the Health Village project. A number of risks had been identified in several areas such as resistance to planned moves, workforce redesign challenges and meeting capital requirements. These were being addressed.

The recommendations as outlined in the paper were agreed.

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7.3.2 Online triage of referrals

David Taylor advised that there was a local target that 90% of referrals be made electronically by December 2008 and that currently Grampian was achieving 40%. He was however confident that the 90% could be delivered given the investment in new systems. In Grampian all GP practices now used Vision or EMIS. The HEAT target of managing these referrals electronically on receipt was more challenging but Grampian had now procured a system used by Lanarkshire which would be implemented in January 2009. This system dovetailed with work being undertaken by Jamie Hogg on referral management as part of Better Care Without Delay. This introduced a vetting process for referrals within acute services involving both consultants and GPs and would greatly improve this part of the patient pathway.

7.4 People

7.4.1 Media Performance Report Laura Gray reported a noticeable rise in positive media coverage since the last report. There had been positive reports for the organisation on dental services, the treatment of mushroom poisoning and the development of scarless surgery. The media report was welcomed by PGC.

7.4.2 Patient Focus and Public Involvement Laura Gray introduced her report which had been requested following the identification in the previous PFPI Committee Assurance Report of a high risk relating to capacity to provide adequate public and patient involvement and communication support around major change projects. The paper outlined the capacity currently available and how it was utilised. She advised that the change programmes were not all equally supported, depending on the stage they had reached and how they were managed. As a new strategic theme all programmes would be required to take action on PFPI. Progress was being made with the development of public Partnership but capacity to do this was varied. A discussion with Executive leads, CHP GMs and programme managers was required to identify their needs and how they could be best supported. The Committee accepted the recommendations as outlined and noted that the PFPI committee would provide the necessary assurance.

7.5 Learning and Growth

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7.5.1 KSF Implementation update

Richard Carey reported that significant improvement had been made since the last meeting but that there was still work to be done and the trajectory was not currently being delivered. He reminded PGC that the Grampian approach had focussed on ensuring AfC bandings before moving on to eKSF. There continued to be an issue around some staff access to IT but work was underway to resolve this. Gordon Stephen advised that there was a risk around the continued availability of staff-side members given current pressures to progress eKSF. Secondment opportunities and back cover would be considered in order to ensure consistency.

8 Clinical Governance and Risk Management Standards

Dianne Roberts attended and presented a progress report on action being taken to improve performance against the standards. She advised that the QIS visit to Grampian was in July 2009 and there was a requirement to submit evidence in April to demonstrate areas of improvement. Evidence was already being collated and a meeting with QIS on 28 November would provide some further clarity on what was required. An action plan had been developed following the previous assessment and named leads identified. PGC would continue to monitor progress. Ewan Robertson advised that the eHealth Committee was regularly briefed on issues relating to information governance and if required, these were brought to PGC.

An update report will be brought to the March meeting. HR

9. To consider content of December 2008 Board Report

- Substance misuse - Change programmes - HAI – public meeting - Cancer times (in Healthstat report) - Financial position - PFPI

10. AOCB

11. Date of Next Meeting

22 January 2009, 10.30am, Conference Room, Summerfield House

7 APPROVED