NHS Education for Scotland s3

IN CONFIDENCE NES/15/30

NHS Education for Scotland

MINUTES OF THE ONE HUNDRED AND THIRTEENTH BOARD MEETING HELD ON THURSDAY 12TH MARCH 2015 AT WESTPORT 102, EDINBURGH

Present: Dr L. Burley (Chair) Ms S. Douglas-Scott (agenda items 5 to 11 only) Mr M. Duncanson Ms L. Ford, Employee Director Dr C. Ferguson, Director of NMAHP Mr D. Hutchens Professor S. Irvine, Medical Director Ms C. Lamb, Acting Chief Executive Dr R. M. Parr, Pharmacy Director Dr D. Steele Ms S. Stewart Dr A. Tannahill Ms C. Wilkinson

In attendance: Mr D. Ferguson, Board Services Manager (Board Secretary) Dr D. Felix, Postgraduate Dental Dean Ms D. Wright, Director of Workforce Mrs A. McColl, Acting Director of Finance Mr D. Cameron, Acting Associate Director of Finance and Corporate Resources (primarily for agenda items 7h and 8a) Professor A. McLellan, Postgraduate Medical Dean, West of Scotland (primarily for agenda item 8d) Dr G. Walker, Programme Director (HAI) (primarily for agenda item 8d) Dr K. Long, Equality & Diversity Adviser (primarily for agenda item 8e) Ms L. Dewar, Head of Property and Facilities Management (primarily for agenda item 8c) Ms J. Thomson, Director of Psychology Training

Observer: Ms V. Millie, SGHSCD (agenda items 1 to 8b only)

1. APOLOGIES FOR ABSENCE There were no apologies for absence.

2. DECLARATIONS OF INTEREST There were no declarations of interest in relation to the items on the agenda.

1 3. CHAIR’S INTRODUCTION The Chair welcomed everyone to the meeting, especially Susan Stewart and Douglas Hutchens, who were attending their first Board meeting since being appointed as new non- executive members for a four-year period from 1st March 2015.

Members were reminded that a photo shoot would take place immediately after the meeting, when group and individual shots of the Board members would be taken.

Dr Rose Marie Parr was congratulated on receiving an Outstanding Contribution to Pharmacy award at the Scottish Pharmacist Awards on 7th March 2015.

Members were informed of the following recent appointments at the Scottish Government Health and Social Care Directorate:  Dr Catherine Calderwood, Chief Medical Officer (CMO)  Professor Fiona McQueen, Chief Nursing Officer (CNO)

It was noted that Professor Alastair McLellan and Dr Gill Walker would join the meeting for agenda item 8d (Update on the Vale of Leven Hospital Public Inquiry) and that this item would be taken immediately after item 4.

4. CHIEF EXECUTIVE’S REPORT (NES/15/14) The Acting Chief Executive introduced this report, which provided information and updates on a wide range of NES activity. The following particular items were highlighted:

 NES won the RCM President’s partnership award for its ‘One out of Four’ project.  The NES/HIS/NHS GG&C Sepsis Screening App has been longlisted for the BMJ Awards 2015 in the Patient Safety category.  Professor Gillian Needham will be retiring later in 2015 following over 15 years in post as Postgraduate Medical Dean in the North of Scotland. The Board acknowledged Professor Needham’s outstanding contribution to medical education and training and her championing of the cause of remote and rural education and training.  Christine Patch will be retiring as Head of Corporate Communications in May 2015 after some 11 years in post. Members acknowledged Christine’s valuable support to them in that role.  A Dementia Champions Graduation and Celebration Event took place on 28th January 2015.  NES will be hosting the 5th National Scottish Medical Education Conference on 27th to 28th April 2015. The Chair advised that Board members would be welcome to attend all or part of this event.  The 5th annual NES Pharmacy Conference on 25th February 2015 had been very well- attended.  The NES Digital Transfomation Programme is continuing apace. In particular, Turas version 1.1 went live on 23rd February 2015, delivering additional functionality for the management of trainees. On 25th February, representatives from Health Education England (HEE) had visited the NES offices at Westport 102 in Edinburgh to meet the Turas development team and see a demonstration of version 1.1. The HEE representatives had been very impressed by this demonsration. The product owners were commended for their excellent fielding of the questions posed by the HEE representatives.

The following points arose in discussion:

 Some discussion took place on the Dementia Champions Programme. It was confirmed that places on the programme were open to all NHS and social care staff in Scotland,

2 with a wide range of practitioners taking part. It was agred to explore the scope for volunteers to take part in the programme in future. Action: CF  The success of the recent NES Pharmacy Conference was highlighted by one of the members. It was observed that pharmacists had an important role to play in the context of health and social care integration.  It was highlighted that recruitment into GP training was likely to be particularly challenging this year. Mitigating strategies are currently under consideration, including the possibility of offering additional experience to trainees who have been narrowly unsuccessful in their applications, in order to ensure that they meet the required standard.

5. MINUTES OF THE ONE HUNDRED AND TWELFTH BOARD MEETING (NES/15/12) The minutes of the Board meeting held on 22nd January 2015 were approved. Action: DJF

6. MATTERS ARISING FROM THE MINUTES a. Agenda item 9a: Developments within Health Education England (HEE)

In response to a question from one of the members, the Chair confirmed that, although NES has observer status on the HEE’s professional advisory groups, there is no intention to seek similar status in relation to HEE Board meetings.

7. GOVERNANCE AND PERFORMANCE ITEMS a. Board Committee Membership (NES/15/15) Dr Lindsay Burley introduced a paper proposing some changes in the membership of the Board’s committees to take account of recent changes in Board membership. These proposed changes were approved. Action: DJF b. Finance Report (NES/15/16)

Audrey McColl introduced a paper presenting the financial results for the period 1st April 2014 to 31st January 2015 and indicating the anticipated year-end outtun based on perfromance to date. In particular, it was noted that, as at 31st January 2015, the projected underspend for 2014-15 had been £1.4 million, against a planned underspend of £1 million. However, the draft figures to the end of February 2015 indicate that the level of underspend now projected is in the order of £750,000 to £800,000 and it is anticipated that the outturn will be broadly in line with the target figure.

Caroline Lamb commended the Finance team on their considerable efforts in managing this challenging position and ensuring that the financial target for the year would be met.

The Board noted the information in the report and the continued efforts to manage the year- end position. Members also commended the seamless nature of the cover arrangments put in place in the Finance Team as a result of Caroline Lamb’s assumption of the role of Acting Chief Executive for the period November 2014 to May 2015. c. Audit Committee: 8 th January 2015 (NES/15/17) The Board received and noted the unconfirmed minutes and a summary of this meeting, which were introduced by Carole Wilkinson. 3 Carole Wilkinson praised the seamless cover arrangements put in place to cover the Chief Executive’s (Malcolm Wright) six-month period of secondment to the post of Interim Chief Executive at NHS Grampian.

Members were informed that, following a tendering exercise, Scott-Moncrieff had been re- appointed as NES’s internal auditors for a further period. d. Staff Governance Committee: 29 th January 2015 (NES/15/18)

The Board received and noted the unconfirmed minutes and a summary of this meeting, which were introduced by Murray Duncanson. e. Remuneration Committee: 12 th February 2015 (NES/15/19)

The Board received and noted a summary of this meeting, which was introduced by Dr Lindsay Burley. f. Educational & Research Governance Committee: 17 th February 2015 (NES/15/20)

The Board received and noted the unconfirmed minutes and a summary of this meeting, which were introduced by Dr Andrew Tannahill.

Dr Tannahill reported that he would be meeting Rob Coward later in the day to finalise the revised Educational Governance Framework, which would then be circulated to members for the opportunity to comment.

In response to a point raised during the committee’s meeting and discussed susequently with the Board Chair, it was agreed to consider including in the programme for the Board Planning Day on 14th May 2015 an item on the NES contribution to reducing health inequalities, including socio-economic factors. Action: DJF. g. Finance & Performance Management Committee: 26 th February 2015 (NES/15/21)

The Board received and noted the unconfirmed minutes and a summary of this meeting, which were introduced by Dr Lindsay Burley. h. Performance Management Report (NES/15/22)

Donald Cameron joined the meeting for this item and the subsequent item. He introduced a paper providing an overview of NES’s perfomance against its Local Delivery Plan and Local Operational Plans for the third quarter of the reporting year 2014-15. The following points were highlighted:

 None of the targets currently classified as ‘Red’ or ‘Early Warning’ (‘Amber’ but highly likely to turn ‘Red’, largely due to having been overtaken by events) relate to high risk areas.  For 2015-16, the intention is to focus mainly on managing the performance of high risk targets.

It was noted that the detailed performance reports had been scrutinised by the Finance and Performance Management Committee, with no concerns raised.

The Board noted and was content with the current performance of NES.

8. STRATEGIC ITEMS

4 a. Draft Local Delivery Plan 2015-16 (NES/15/23) Donald Cameron introduced a paper presenting the NES Local Delivery Plan (LDP) for 2015-16. The following points were highlighted:  The 2015-16 LDP (previously known as the Corporate Plan) represents the second year of NES’s refreshed strategic framework for 2014-19 and is presented in a format prescribed by new LDP guidance for Scottish Government which supports NHSScotland’s six strategic priority areas.  There is an emerging focus on ‘planned impact’ and the aim is to improve this year-on- year, as the approach to impact assessment is developed.  The deadline for submission of the final draft LDP to Scottish Government is 20th March 2015.  The final LDP will be designed and published online.  Detailed comments will be welcomed offline. Discussion of the paper generated the following main points:  Members commended the considerable improvements in presentation which had been achieved in recent years.  The inclusion of a section on Modern Apprenticeships was welcomed.  It was confirmed that there would be a final check on ‘readability’, including the use of acronyms.  It was suggested that every opportunity should be taken to highlight NES’s collaborative work with non-NHS partners.  Primary care might be referenced more strongly in the paper.  The clear alignment of the targets to NHSScotland’s six strategic priority areas was welcomed, although it will be worth checking that the correct boxes have been ticked in every case.  Consideration might usefully be given to widening the definition of the category currently referred to as ‘Dementia’.  One member asked about the mechanism for applying to undertake the Planning Partnerships training referred to on page 35 of the paper. It was suggested that this should be taken up with Judy Thomson, Director of Psychology Training, outwith the meeting.  It was confirmed that the LDP provided the basis for organisational and personal performance management within NES. Subject to taking account of the points raised in discussion and any detailed coments provided by members offline, the draft LDP for 2015-16 was approved for final submission to the Scottish Government. Action: DC Donald Cameron was thanked for his helpful paper. b. Draft NES Budget for 2015-16 and beyond (NES/15/24) Audrey McColl introduced a paper presenting the draft NES Budget for 2015-16 and the three- year Financial Plan. The following points were highlighted:

 An early draft of this paper was submitted to SGHSCD on 13th February 2015.  The current draft takes account of any comments raised by the Executive Team and the Finance and Performance Management Committee.  The final submission requires to be submitted to SGHSCD by 13th March 2015.

5  A number of measures have required to be adopted to enable the funding gap of £3.6 million between the uplift and the pay pressures to be covered for 2015-16. These include additional efficiency savings, deletion of agreed vacant posts and a reduction of 1% to the ACT budgets.  Further recurrent savings will be required to close the funding gaps in 2016-17 and future years. It is clear that, in the longer term, it will be necessary to address the underlying recurrent revenue position and that, without an uplift sufficient to cover the removal of the NI rebate in 2016-17, plus other pay pressures, it is highly unlikely that NES will be able to develop a balanced budget for 2016-17 and beyond.

Members discussed the paper and the following main points emerged:

 Members were pleased to note that there is an increasing recognition at SGHSCD and among territorial NHS Boards that NES should be regarded as a patient-facing NHS Board.  The Scottish Government’s Living Wage Policy does not currently represent an area of risk to NES’s finances. That may change in the future if austerity cuts require NES to commission more services from the Third Sector.  No provision has currently been made for income-generation, although this is under consideration and any proposals in this regard would be brought to the Board in due course.  NMAHP Directorate are currently in discussion with SGHSCD regarding a proposed move to a funding model based on outcomes, which would allow greater flexibilty in the use of limited resources.  Some discussion took place on the proposal to impose a 1% reduction in Medical and Dental ACT funding. It was highlighted that ACT forms part of NES’s baseline funding. Members agreed that the proposed reduction was reasonable in the present circumstances, given that uplifts had always been passed on in full during less financially-constrained times. It was noted that this principle had been accepted by the Medical ACT Working Group.

Following discussion, the Board approved the draft NES budget for 2015-16 and beyond for submission to SGHSCD. Action: AMcC

Audrey McColl was thanked for her helpful paper.

c. NES Property and Asset Management Strategy (Annual Review) (NES/15/25) Linda Dewar joined the meeting for this item. She introduced a paper presenting a draft of the updated Property and Asset Management Strategy (PAMS) for 2015, with a view to receiving comments and approval to enable the document to be submitted to Scottish Government by the end of March. The paper outlined changes and updates since the approval of the strategy in 2010, with the main updates since last year’s paper relating to the successful rationalisation of NES’s office accommodation in Glasgow. It was noted that the main priorities for the coming year would be consideration of the options in relation to NES’s offices in Aberdeen, given that a break in the lease for Forest Grove House would be reached in 2017, and a review of the accommodation in Inverness. The Board approved the paper for submission to Scottish Government. In doing so, Linda Dewar was commended on the excellent quality of the information included in the paper and the clarity of its presentation. Action: LD d. Update on Vale of Leven Hospital Public Inquiry Report (NES/15/26) Professor Alastair McLellan and Dr Gill Walker joined the meeting for this item.

6 A paper had been circulated to update the Board on the key issues related to the Vale of Leven Public Inquiry Report published on 24th November 2014.

Dr Gill Walker provided an update on progress to date, highlighting the following points in particular:

 The final report of the Vale of Leven Hospital (VoLH) Inquiry was published on 24th November 2014. The report contained 75 recommendations (65 for NHS Boards) and criticised the treatment of patients and the circumstances relating to deaths and illnesses associated with the Clostridium difficile outbreak between January 2007 and June 2008. The report also implicated personal and systemic failures.  The report recognised that there have been considerable developments in scrutiny, surveillance and education in relation to Healthcare Associated Infection (HAI) since the outbreak in 2007-2008.  The Cabinet Secretary has approved all of the recommendations in the report and has established a group to oversee the implementation of these.  NES set up a cross-directorate short-life working group to produce a NES response to the report.  The Scottish Government published its interim response on 24th February 2015 and is expected to publish a final response by Spring 2015. It is anticipated that NES will be tasked with specific responsibilities from the report in relation to the support and development of the workforce.

Professor Alastair McLellan then reported on a visit by the Scotland Deanery West Region Quality Management Team to the Vale of Leven Hospital in December 2014 to assess the quality of postgraduate medical education and training (PGMET) and of the training environment. The following points were highlighted:

 This visit was contemporaneous with, but unrelated to, the VoLH Inquiry.  The visit identified concerns regarding deviations from the GMC’s standards for PGMET and training at the VoLH was escalated to the GMC’s enhanced monitoring process in January 2015.  An action plan has been agreed with the GMC and NHS Greater Glasgow and Clyde and this will be implemented over the next six months, following which a further visit by NES and the GMC will take place. Should the required improvements not result in that timeframe, the GMC and NES will consider further action. There is however optimism that the measures outlined in the action plan will lead to the improvements sought.

Discussion of the paper resulted in the following main points:

 Some concern was expressed regarding the amount of time taken to publish the VoLH Inquiry report.  It was noted that the production by NES of robust and structured data in relation to the quality of medical education and training environments is a relatively recent development. Members were also reminded that the Board recently approved the establishment of a national information-sharing group, co-chaired by NES and HIS, which should provide early warning in relation to deficiencies in care and the standard of learning environments in future. It was also noted that work is in hand to develop data in relation to the quality of nursing and midwifery learning environments and that this is likely to have applicability to other healthcare professions. A proposal in this regard from the NES NMAHP Directorate is currently being considered by SGHSCD.  It was confirmed that serious concerns regarding education and training issues can lead to the withdrawal of trainees and even result in the closure of a clinical service. NES and the GMC would always work together with the clinical areas concerned to seek to improve matters before such serious sanctions are considered/imposed.  The success of the HAI initiatives was commended.

7  The importance of training in HAI for all healthcare staff was highlighted, as individual professions and in teams. HAI should also feature strongly in leadership and management programmes.  It was noted that the format of the template used by NHS Boards in responding to the VoLH Inquiry report had enabled the Boards to undertake gap analyses and put in place action plans to address any gaps identified.

Following discussion, the Board noted the key issues raised in the paper and agreed the following actions:

i. A report will be brought to the Board, in due course, on the development and use of data in relation to the quality of nursing and midwifery learning environments and the potential for applicability to other healthcare professions. Action: CF ii. A report will be brought back to the Board, in due course, on the success of the action plan put in place to address a range of concerns raised by NES and the GMC in relation to the quality of PGMET and the training environment at VoLH. Action: DSI and AMcL

Professor McLellan and Dr Walker were thanked for their helpful paper and contributions to the discussion. e. Equality and Diversity Strategic Action Plan Progress Report (NES/15/27)

Dr Kristi Long joined the meeting for this item. She introduced a paper setting out the plan for publication of NES’s statutory equality progress report. The following points were highlighted:

 NES is required to report on progress every two years.  The report is largely based around case studies relating to various priority areas.  It is intended to include the summary of key actions as an appendix to the report.  The report requires to be published on the NES website by 30th April 2015.

The following points were noted in discussion:

 The report has already been considered by the Staff Governance Committee, the Educational & Research Governance Committee and the Partnership Forum.  It will be necessary to remove one of the case studies from the report, in view of some sensitivities.

Subject to the removal of one case study, as agreed, and final proof-reading and typesetting, the report was approved for publication on the NES website. Action: KL

Dr Long was thanked for her helpful paper.

9. ITEMS FOR NOTING a. Training and Development Opportunities for Board Members (NES/15/28)

The Board noted a paper providing information on upcoming training and development opportunities for Board members.

The Chair encouraged members to attend all or part of the NHSScotland Event on 23rd to 24th June 2015.

Carole Wilkinson advised that the Audit Committee planned to undertake a self-assessment exercise, which may lead to some training needs being identified.

8 The Chair added that it was also intended that the Board would undertake a self-assessment exercise in due course. b. Partnership Forum: 19 th February 2015 (NES/15/29)

The Board received and noted the unconfirmed minutes and a summary of this meeting.

10. ANY OTHER BUSINESS There was no other business to consider.

11. DATE AND TIME OF NEXT MEETING It was confirmed that the next Board meeting would take place on Thursday 23rd April 2015 at 10.15 a.m.

NES March 2015 DJF