Approved Board Minute 4 June

APPROVED NHS GRAMPIAN

Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session on 4 June 2015 from 10.30am in Sir Duncan Rice Library, University of Aberdeen, Old Aberdeen

Present Professor Stephen Logan Chairman Mrs Rhona Atkinson Non-Executive Board Member Mr Raymond Bisset Non-Executive Board Member Cllr Stewart Cree Non-Executive Board Member Cllr Barney Crockett Non-Executive Board Member Mrs Sharon Duncan Employee Director Dr Nick Fluck Medical Director Mr Alan Gray Director of Finance Professor Mike Greaves Non-Executive Board Member Mrs Christine Lester Non-Executive Board Member (Vice Chair) Dr Lynda Lynch Non-Executive Board Member Mr Terry Mackie Non-Executive Board Member Dr Helen Moffat Chair, Area Clinical Forum Mr Eric Sinclair Non-Executive Board Member Mr Malcolm Wright Chief Executive

By invitation Mrs June Brown Associate Director of Nursing Mrs Laura Gray Director of Corporate Communications/Board Secretary Dr Annie Ingram Director of Workforce Mr Graeme Smith Director of Modernisation Mrs Susan Webb Acting Director of Public Health

Attending Ms Julie Anderson Finance Manager Mr Paul Bachoo Clinical Director Mrs Jackie Bremner Project Director Ms Amanda Croft General Manager, Acute Mr Gerry Donald Head of Physical Planning Rev James Falconer Chaplain Miss Lesley Hall Assistant Board Secretary Dr Jonathan Illoya Consultant in Dental Public Health Dr Malcolm Metcalfe Associate Medical Director Ms Lorraine Scott Programme Manager Mr John Thomson Clinical Director Mrs Alison Wood PA

Item Subject

1 Apologies

Apologies were received from Mr David Anderson, Professor Rosemary Lyness, Mr Jonathan Passmore and Cllr Anne Robertson.

1 Item Subject

2 Declarations of Interest

There were no declarations of interest relating to specific agenda items.

3 Chairman’s Welcome and Introduction

The Chairman welcomed everyone to the meeting. He advised that he had hosted thank you events at High Hilton Church and Woodend for volunteers who had provided a significant contribution to NHS Grampian. He reported on recent meetings with MPs and MSPs and visits to Dr Gray’s Hospital and the Maggie’s Centre. He suggested it would be helpful to have a seminar to include several of the volunteer and charitable organisations that contributed to the work of NHS Grampian including Maggie’s. He acknowledged the importance of the Quality Day organised by the Quality Governance and Risk Unit which had been well attended with a high calibre of speakers.

The Chairman acknowledged the exceptionally generous donation of £10 million from the Wood Foundation for the creation of a multi-storey car park at Foresterhill which would benefit both patients and visitors.

3.1 Appointment of Chief Executive

The Chairman was pleased to announce that, following the conclusion of the comprehensive recruitment process for a new Chief Executive for NHS Grampian, Mr Wright had been offered and accepted the post of Chief Executive. Members congratulated Mr Wright on his appointment. Mr Wright stated that it had been a privilege to have been Interim Chief Executive and he looked forward to the challenge of the substantive role.

4 Interim Chief Executive’s Report

Mr Wright presented his report which highlighted a range of issues that may not be covered elsewhere on the agenda. He provided details of important meetings and events he had attended and also highlighted the revised Acute Sector management arrangements.

5 Minute of Meeting held on 2 April 2015

The minute was approved as an accurate record of the meeting.

6 Action Log and Matters Arising

As agreed at the April 2015 Board meeting, a supplementary action log had been produced to record actions in progress or completed.

With regard to the Improvement Programme, it was noted that the Executive Team was maintaining an overview of this with weekly meetings.

2 Item Subject

7 Strategic Items

7.1 Development of a Major Trauma Network (including Patient Story)

Mr Smith reported on the work across the North of Scotland to improve the major trauma service, with participation from five Health Boards (Grampian, Highland, Orkney, Shetland and Western Isles) and the Scottish Ambulance Service (SAS).

The North of Scotland Major Trauma Programme Group had developed a vision and model for major trauma care in the region, approved by the North of Scotland Planning Group (NoSPG) and endorsed at the regional major trauma event held on 13 May 2015. These were attached at Appendix 2 and 4 of the paper presented.

Mr Smith gave an overview of the development of four major trauma centres (MTCs) in Scotland in the context of a national major trauma network. Work had been taken forward on a North of Scotland basis to develop a major trauma network and to establish Aberdeen Royal Infirmary and the Royal Aberdeen Children’s Hospital as MTCs. The major trauma pathway covered attending the scene of the incident, hospital care and repatriation of patients into the community. International evidence showed that a regionalised network approach to major trauma care improved mortality and functional outcomes and was cost- effective. Interim recommendations were for four MTCs in Aberdeen, Dundee, Edinburgh and Glasgow with three paediatric MTCs in Aberdeen, Edinburgh and Glasgow and it was noted that the Scottish Government would be reviewing the number of MTCs in the coming months.

An initial implementation plan covering all aspects of the major trauma pathway had been prepared for submission to the Scottish Government.

Further details were then provided by Ms Lorraine Scott, Programme Manager, Mr Paul Bachoo, Clinical Director, MTC and Mr John Thomson, Clinical Director, Emergency Department.

Mr Bachoo stressed the importance that clinicians put on the concept of a Major Trauma Centre as part of a network. He explained there was a major trauma presenting every three days on average in Grampian which involved every aspect of clinical care and put pressure on the whole system. He suggested the model afforded the opportunity to develop the service, enhance the reputation of NHS Grampian, to improve skills, recruitment and retention, and to provide support for education and training.

The paper outlined the key issues and challenges which were considered by the Board. The discussion highlighted the importance of a cohesive network from the scene through to rehabilitation.

Cllr Crockett referred to the previous presentation to the Board by Mr Jan Jansen, Consultant Surgeon/Intensivist at ARI and asked if four MTCs in Scotland would be sustainable. He was advised of the necessity for a critical mass and that extra demand on the system would require additional infrastructure and personnel.

3 Item Subject

Mrs Scott concurred with Mr Bisset’s comment that the pre-hospital process was important and stressed the importance of multi-agency working including SAS, police and community planning partners.

Rev James Falconer then introduced the patient story of Fiona Black who had been involved in a major car accident in which her young son had died and she had experienced serious injuries. The Board heard a recording of Ms Black’s experiences of her complex and difficult recovery. It was acknowledged that this was an extremely powerful story providing an example of a real-life experience of a major trauma patient and highlighted the importance of person-centred care.

Mr Wright concluded that the information presented provided a strong case for ARI and RACH as MTCs in the wider network.

The Board noted the progress and confirmed support for the approach to improve the major trauma system in the north of Scotland.

7.2 Health and Social Care Integration

Mr Smith presented a paper that provided an update on the actions supporting the implementation of health and social care integration following the approval of the Integrated Joint Boards’ (IJBs’) Integration Schemes by the Board in March 2015 and their subsequent submission to the Scottish Government (SG). These had been reviewed and commended for their approach and content. The SG had recommended some changes which were being considered by legal advisors before resubmission for final approval by the Board, Local Authorities and IJBs. The formulation of budgets to be delegated to the IJBs was confirmed to be at an advanced stage, with further work required. Dr Fluck stressed the importance of robust clinical governance systems and it was noted that a revised clinical governance framework would be developed. Mr Wright emphasised that NHS Grampian would continue to have legal responsibilities for clinical, staff and financial governance.

The Board endorsed the actions underway to develop the integration arrangements in preparation for the formal establishment of the IJBs by the end of March 2016.

7.3 NHS Grampian Dental Plan 2020 and the Current Challenges within Grampian

Mrs Webb provided an update to the Board on progress with the Dental Plan 2020 Action Plan and improvements to oral health and access to dental care in Grampian. Dr Jonathan Illoya, Consultant in Dental Public Health, outlined the key points and challenges in the plan which set out a wide ranging infrastructure programme to modernise dental services in Grampian, including the Aberdeen Dental School and Hospital. He advised that success was to be measured against the aims set out in the action plan:

1. Continued Improvement in Oral Health of Children and Adults. There had been significant improvement in the last eight years due to a range of interventions delivered through Childsmile, Priority Groups and the Caring for Smiles programmes. An adult oral health survey will be undertaken in 2019.

4 Item Subject 2. Continued Increase in NHS Dental Care and Services. Currently 69.9% of patients are registered with an NHS dentist which was an improvement from 35.2% in 2007. 3. Maintain and Improve the Dental Care Infrastructure in Grampian. 4. Structure and Organisation – Clinical Networks Delivering Quality Services for Dental Care. 5. Introduce a Revised Quality Framework for all Dental Practices and Services in Grampian. 6. Ensuring Good Communications and Feedback on the Dental Plan.

The Board noted the continued improvement in oral health and access to dental services in Grampian and endorsed and supported the continued implementation of the NHS Grampian Dental Plan 2020.

8 Items for Decision

8.1 Local Delivery Plan and Asset Management Plan

Mr Gray updated the Board on the Local Delivery Plan (LDP) which set out the annual delivery agreement between NHS Grampian and the Scottish Government Health and Social Care Directorate. He also provided an explanation of the current position with the Asset Management Plan (AMP). Mr Gerry Donald, Head of Physical Planning, had provided a briefing to the Non-Executive Board members earlier in the week on the AMP. This described NHS Grampian’s achievements during the last 12 months including:

 Backlog maintenance which had reduced by £26.2m.  Investment in medical equipment of approximately £6.95m.  Investment in IT infrastructure of approximately £5.1m.  Opening of new Primary Care facilities at Woodend and Forres.

It also set out the priorities for investment over the next five years and included:

 Backlog maintenance programme together with medical equipment replacement and IT infrastructure.  Commissioning of new health facilities within communities including Denburn Health Centre, Inverurie Care Hub, Foresterhill Health Centre, The Baird Family Centre and the Anchor Unit.

Mr Gray advised that progress with delivery of the LDP would be monitored by the Performance Governance Committee and as part of the Annual Review process.

The Board discussed the importance of investment in ehealth and noted that a review of ehealth priorities would be undertaken.

The Board approved the Local Delivery Plan (including the five year financial Plan) and the Asset Management Plan.

8.2 Infrastructure Investment

5 Item Subject Mr Gray referred to his paper which set out the programme of investment in infrastructure linked to the delivery of NHS Grampian’s Healthfit 2020 strategy. He summarised the various projects and associated investment supported by a number of key strategic commitments such as the maternity services strategy, support for Greener Scotland Initiative, investment in clinical services, and exit and disposal of surplus properties.

Mr Gray advised that the Initial Agreement for the Baird Family Hospital and ANCHOR Centre was the first phase of the business planning process for the project. The Baird Family Hospital will provide maternity, gynaecology, breast screening and breast surgery services. It will also include a neonatal unit, centre for reproductive medicine, an operating suite and research and teaching facilities. The ANCHOR Centre will provide out-patient and day-patient investigation and treatment services for patients with cancer and with blood disorders. The centre will also include pharmacy, research and teaching facilities.

With regard to the Initial Agreement for a multi-storey car park at Aberdeen Royal Infirmary, NHS Grampian had received a funding offer from the Wood Foundation of £10 million to enable the design, procurement and construction of this facility at the Foresterhill Campus for parking for patients and relatives. It was confirmed that a car park fitted strategic priorities and would be a welcome addition to the site.

The Carbon Energy Fund (CEF) was established as a partnership between the Carbon and Energy Fund and NHS Shared Business Services. The initiative was anticipated to deliver a reduction in overall carbon emissions of 16% and an annual cost saving of £0.586m which would be shared 87% NHS Grampian and 13% Aberdeen University. This was an important investment as energy costs had doubled in 5 years.

Investment in non invasive (robotic) surgery would help improve outcomes for patients.

The granting of a concessionary ground lease to the Grampian Children’s Respite Care charity was to facilitate the setting up of a specialist care centre for children and young people with special needs, referred to as Charlie House.

Given the clinical priority of diagnosing potential cancers, NHS Grampian was committed to significant recurring investment in endoscopy capacity at ARI and through opening a new service at the Aberdeen Health and Care Village.

The relocation of the Ear, Nose and Throat (ENT) and Audiology services which were the final clinical services on the Woolmanhill site was noted. A suitable site for these services had been identified within Woodend Hospital.

Following discussion, the Board approved the following infrastructure investments, with the associated capital values:

 Initial agreement – Baird Family Hospital and ANCHOR Centre - £120m

6 Item Subject  Initial agreement – Multi-storey car park (Aberdeen Royal Infirmary) - £10m  Full business case – Carbon Energy Fund project - £18.7m  Standard Business Case – Non-invasive (robotic) surgery - £1.8m  Granting of a Concessionary Lease – in support of Charlie House (Children’s Respite Care Centre)  Investment in additional endoscopy equipment - £1.1m  Investment required to relocate the Ear, Nose and Throat and Audiology services from Woolmanhill Hospital - £1.7m

9 Governance Items

9.1 Performance Report

Mr Gray referred to the Performance Report that summarised the key areas of performance for NHS Grampian including, but not limited to Health, Efficiency, Access and Treatment (HEAT) targets. He assured the Board that the Performance Governance Committee (PGC) had considered the report in detail.

The areas highlighted in the report covered the following areas:  Delayed Discharge  Cancer Access standards – 62 day Referral to Treatment standard  Treatment Time Guarantee (TTG) and 18 weeks Referral to Treatment standard (RTT)  Access to Psychological Therapies  A&E 4 Hour Standard (Grampian wide)  Access to Child and Adolescent Mental Health Services (CAMHS)  Access to stroke unit  Smoking cessation

Mr Gray advised that there was also a standing item in the report regarding the Board’s financial position. He reported that, subject to audit, the Board had achieved its three financial targets for the year ended 31 March 2015 by operating successfully within:  Revenue Resource Limit  Capital Resource Limit  Cash Requirement

Mr Gray recognised the efforts of all staff to achieve these challenging targets. The Board acknowledged the work done by Mr Gray and his Finance team colleagues to complete the year-end accounting processes.

Mr Gray advised of progress to reduce delayed discharges and of ongoing detailed discussions with the three Chief Officers and the General Manager of Acute to deal with the associated challenges.

Progress had been made with cancer access standards with a General Surgical Locum consultant having been appointed which released colorectal surgeon capacity. Progress was also being made towards achieving the 18 week referral to 7 Item Subject Treatment Time Guarantee (TTG).

Access to Child and Adolescent Mental Health Services (CAMHS) remained a challenge as the service was currently 9% below capacity with 6.2 whole time equivalent (WTE) clinical posts unfilled or vacant. Efforts to fill vacancies, engage locums and provide temporary cover arrangements were ongoing. The Scottish Government had been kept well-briefed on the situation.

The increase in drug costs was highlighted as a particular pressure.

Stroke Unit access showed that the standard of 90% was not being achieved due to capacity issues although the trend showed improvement. However, it was noted that the mobile stroke team dealt with all admissions wherever they were received in the system.

Following discussion and review, the Board noted the performance report for May 2015 and the actions being taken to address those areas where performance was not in line with agreed trajectories.

9.2 Workforce Report

Dr Ingram presented the NHS Grampian Workforce update to the Board and highlighted the key workforce challenges and risks. She advised that recruitment remained a challenge across different professions and grades. There had been an increase in both numbers and whole time equivalents (WTEs). Nursing vacancies were still at an unacceptable level although the number had reduced. There had been an annual increase of 3.8% in the number of consultants, with 470.1 WTE at 31 March 2015. It was noted that vacancy figures included posts where an appointment had been made, but the person had yet to take up the post.

The total bank spend for the year to date had increased with Nursing/Midwifery continuing to have the largest bank spend. Agency usage has also increased.

Total sickness absence for March 2015 was 4.71%. The annual sickness absence rate has increased slightly to 4.66% compared to 4.62% at the same point last year. NHS Grampian continued to perform better than the other large territorial Boards in terms of absence, with a particular difference in relation to long term absence. This can be attributed to helping staff back into the workplace on supported rehabilitation programmes.

At 1 May 2015 the Job Plan submission rate for 2014/2015 was 85.6% which was a significant improvement on last year’s position.

It was noted that employer contribution costs had increased as a result of changes to the NHS Pension Scheme for Scotland. In addition, the number of staff who were members of the scheme had increased from 75% to 92% which resulted in additional increased contributions from NHS Grampian.

Dr Ingram explained that the Staff Governance Committee had received and

8 Item Subject discussed a more detailed report. She agreed to circulate the Year End Workforce Staff Governance Report to Board members.

The Board noted the Workforce update.

9.3 Improvement Programme

Mr Gray assured the Board that the Executive Team had a formal meeting on a weekly basis to review progress against the detailed recommendations in the three reports. This formed the basis of reporting on progress to the Board. Monthly meetings were also held with colleagues from the Scottish Government to report on progress. The Chief Executive of NHS Scotland and the Director of Scrutiny and Assurance, Health Improvement Scotland, had confirmed their support for the actions being taken and the progress made to date.

The chairman welcomed Dr Malcolm Metcalfe, Associate Medical Director, Ms Amanda Croft, General Manager, Acute, and Mr John Thomson, Clinical Director, ED, to provide an update on the following aspects of the Improvement Programme:

Acute Sector Management Arrangements

The substantive appointment to the Acute Sector General Manager post had been confirmed and appointments had been made to each of the Divisional Manager posts, with each division having a medical and nurse lead. A new post of Head of Operations had been established, with responsibility for managing patient flow, fire safety and civil contingencies planning. A Head of Performance Governance had been appointed on an interim basis. Implementation of the new management arrangements will ensure effective leadership within Aberdeen Royal Infirmary and give clarity around structure, roles and responsibilities. Nursing staff, medical staff and management will have equal responsibility and accountability for performance, patient safety and staff governance.

The following new appointments were noted:

Dr Steve Wilkinson - Deputy Associate Medical Director for the Acute Sector. Mr Paul Bachoo - Divisional Clinical Director for Surgery Dr Satchi Swami - Divisional Clinical Director for Medicine

Dr Chris Hemming and Dr Rick Herriot will continue in their roles as Divisional Clinical Directors for Women and Children’s Services and Support Services respectively.

Emergency Department

Mr Thomson reported that there had been significant improvements in the last 12 months in the Emergency Department (ED), with support from management colleagues, resulting in a change in morale. Work was ongoing with clinicians to ensure improved patient flow and reduced ED waiting times. Staff now felt supported in their roles and had a clear vision for the ED. He referred to the results

9 Item Subject of the GMC trainee survey which had shown a significant improvement from the previous year. The Chairman expressed his gratitude to Mr Thomson and his team for the significant turnaround in the ED’s performance. On behalf of the Board, Mr Wright also commended the improvements within the ED as a result of clinicians, professionals and managers working well together with a clear vision. It was also acknowledged that the improvements would help with recruitment.

The Board reviewed and noted the progress in respect of the implementation of the recommendations highlighted in the three reports issued on 2 December 2014.

9.4 Healthcare Associated Infection Report

Dr Fluck highlighted the key matters from the report to the Board. He explained that the rates of Staphylococcus aureus bacteraemia (SAB) including MRSA remained stable, although there were month to month variations as shown in the funnel charts. He stressed the importance of identifying what infections were avoidable and taking steps to address this. With regard to infection rates in the community, he advised that about a quarter of these related to intravenous drug users. He reported that Clostridium difficile infections had shown an increase in 2014. However, this could be attributed to changes in diagnosis and advanced techniques being adopted. He assured the Board that improvement work was ongoing to control infection in hospitals and the community.

The Board noted the Healthcare Associated Infection Report.

9.5 Committee Reports

1. Clinical Governance Committee

Professor Greaves highlighted the notification of a Joint Medicines and Healthcare Products Regulation Agency (MHRA) Statutory Good Clinical Practice Inspection.

The Board noted the report.

2. Performance Governance Committee

No specific issues were highlighted.

3. Area Clinical Forum (ACF)

Dr Moffat highlighted discussions on agenda-setting for the advisory structure. The ACF was keen to promote wider engagement with clinicians facilitated by agendas populated with clinically relevant, future-focussed and strategic questions. She advised that the Health Promoting Health Service action plan had been discussed.

10 Item Subject

4. Grampian Area Partnership Forum (GAPF)

Mrs Duncan advised that work was ongoing to ensure policies were in line with PIN (Partnership Information Network) guidelines. A number of policies would be consulted on in the near future in the near future. She reported that GAPF would be linking with ACF to ensure clinicians were engaged in the process.

5. Spiritual Care Committee

No specific issues were highlighted.

10 Items for Noting

The following items were noted:

10.1 Haddo Medical Group Dispensing Update

10.2 Board Meeting and Seminar Dates for 2016.

The dates would follow the current pattern of the first Thursday of the month, alternating between meetings and seminars. The date for approving the Annual Accounts would be advised once agreed by the Audit Committee.

11 Approved Minutes

The following minutes were noted:

 Clinical Governance Committee – 30 January 2015  Performance Governance Committee – 10 March 2015  Patient Focus and Public Involvement – 11 February 2015  Spiritual Care Committee – 24 February 2015  Area Clinical Forum – 18 March 2015  Grampian Area Partnership Forum – 18 February 2015

12 Any Other Competent Business

12.1 Endowment Committee Annual General Meeting (AGM) - 29 June 2015

Mr Bisset encouraged all Board members, as Trustees of the Endowment Funds, to attend this important annual meeting.

13 Dates of Next Meetings

Board Meeting (to approve Annual Accounts) - Monday 29 June 2015 – Summerfield 11 Item Subject House, Aberdeen Board Meeting – Thursday 6 August 2015 – Woodhill House, Aberdeen

Signed …………………………………………………………………. Dated ……………………...... Chairman