Item 10.10 for 1 Dec 09 PGC Min 22 Sep 09

APPROVED

NHS GRAMPIAN Minute of the Performance Governance Committee Meeting held on Tuesday 22 September 2009 in the Conference Room, Summerfield House Board Meeting Open Session 01 12 09 Present: Item 10.10

David Cameron, (Chair), Non-Executive Board Member, NHS Grampian Elizabeth McDade, Non Executive Board Member, NHS Grampian Charles Muir, Non Executive Board Member, NHS Grampian Bill Howatson, Non Executive Board Member, NHS Grampian

In Attendance:

Richard Carey, Chief Executive Roelf Dijkhuizen, Medical Director Laura Gray, Director of Corporate Communications, NHS Grampian (item 5.3.1 only) Anne Ross, Head of Performance and Quality Improvement, NHS Grampian Alan Gall, Director of Finance (item 5.5.1 only) Helen Robbins, Head of Clinical Governance and Risk Management (items 5.2.1and 6 only) Ewan Robertson, Director of Performance Improvement, NHS Grampian Glenys Wells, Personal Assistant, NHS Grampian – Minuting Secretary

Item Subject Action

1. Apologies David Cameron welcomed everyone to the meeting and noted apologies from Val Maehle and Gordon Stephen.

2. Healthstat The Healthstat section of the meeting was covered in a separate paper (attached).

Item 8 draft self assessment for Annual Review was taken at this point.

Mr Carey drew attention to some topics. He reported on the progress with cancer access times and advised that the 62 day target had been met again this quarter. There had been a small number of breaches in access time targets at Dr Gray’s, but overall we remained within trajectory. Mr Carey commended Dr Dijkhuizen for his leadership on the HAI agenda. Members were asked to submit any comments on the draft documentation to Anne Ross by the end of the week.

3. Minute of Meeting held on 21 July 2009 and Matters Arising The minute of the above meeting was agreed as an accurate record of discussion.

The following points were raised:

1 APPROVED

P4, item 5.6, final bullet point : Aberdeen City: Cllr Howatson confirmed his meeting the following week with Fred McBride and that a CHP workshop would be held in due course. Budget reports would be reviewed at future CHP meetings.

P4 item 8 final bullet point: Discharges from A&E in 4 hours: Mr Carey confirmed that a report had been received following the Performance Support Team visit. Mark Sinclair, Director of HR was leading on the action plan on what was now required. This plan and response to the report would be considered further at the Cross System Performance Review meeting on 13 October, ahead of the Annual Review on 2 November. PGC members would receive this at the next HealthStat meeting.

4. Assurance Framework Reports from Governance Committees and PGC Feedback

4.1 Staff Governance Committee Mr Carey highlighted the continued good employee relations despite the current pressure on finances and the need for savings. The current climate made it even more important to work together and he advised that there had been some issues recently which could have been dealt with better. He advised about challenges around health and safety issues and on a future meeting with the Director of Nursing, Director of HR and others to progress. He would provide an update at a future PGC meeting. RMC

4.2 Patient Focus and Public Involvement Mrs McDade commended a recent conference held for consultation on the Health Plan which had motivated the PFPI team and the agenda.

4.3 Clinical Governance Committee Mr Muir reported on the positive nature of the outcome of the recent Dr Gray’s outbreak with lessons learned from this and the ongoing improvement work. It had been suggested that an Open Day be held to view the refurbished wards.

4.4 Moray CH&SCP Mr Muir confirmed the continued monitoring in relation to child protection and that a return visit from HMIE had take place with progress noted. The CHP Committee was planning some seminar based discussions on the 12 objectives for delivery. The CHP had participated in dialogue with the reviewers leading the national review of CHPs. It was thought that an outcome from this review would be available in December.

4.5 Aberdeenshire CHP Mr Carey reported that the budget position within Aberdeenshire remained positive. The temporary closure of the Fraserburgh birthing unit was a concern. This had been closed due to safety concerns arising from staff shortages. MPs and MSPs had been fully briefed and the fact that that was not a funding issue stressed.

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5. Delivery of Health Plan: High Level Performance According to Scorecard (incorporating LDP)

Ms Ross gave a summary of the main points in the September report.

- A number of ‘H’ targets were continuing to be below trajectory – Susan Webb was to provide an update later in the meeting - Data on the electronic management of referrals was now being collected and reported. 15% of referrals were managed electronically in the first half of September. However this will not be shown in external performance reports until October. - Access Times and Day Case rates had already been discussed as part of HealthStat - There was an unexpected increase reported in the return to new outpatient attendance ratio which was not recognised in local reporting so this was being further investigated.

5.1 Improving the Public’s Health and Reducing Inequalities

5.1.1 ‘H’ Measures – Current Performance Mr Carey advised that he had spoken with Dr Kevin Woods about a number of the H measures falling behind plan. A number of other Boards were having difficulties. He was aware that the flu agenda had impacted on the public health capacity but believed that the way forward was to reinforce this as a key corporate priority. He stressed that some elements must be progressed quickly such as Alcohol Brief Interventions. He also believed that it was more important to benchmark Grampian’s performance with other teaching Boards than Boards generally.

Mrs Webb introduced Dr Wilkie’s paper. She explained the shift nationally to measuring performance on Health Improvement issues and the focus being given to ensure these measures were given similar importance and focus as other measures such as those relating to access. Locally the Health Improvement Theme Group had raised concerns that implicitly these measures were not being given equal priority. An example of this was delay in approving new posts and in securing training. In many instances national earmarked funding was being provided and lack of delivery had risks associated with retaining this. She stressed that delivery of the required improvement was a cross system issue with much of the resource now devolved to CHPs. Mr Carey acknowledged the position but stressed that there were competing priorities. He agreed that CHPs needed to reconsider to see what more could be done within available resources to deliver improvement and were not all resource related. Mr Howatson was concerned if delivery was allowed to slip and 3 APPROVED

asked that the topic be revisited at a future Board seminar. ER/AKR

5.2 Delivering safe, effective and timely care in the right place

5.2.1 Clinical Governance and Risk Management Standards – Draft report of July visit Ms Robbins summarised the outcome of the recent visit and advised that there was 3 weeks to comment on the draft report. The opportunity would be taken to address some issues raised and in particular Ms Robbins and Mrs Gray would ensure the resubmission of evidence on Communications given the HR/LG disappointing score.

5.3 Involving Patients, Public Staff and Partners towards Mutuality

5.3.1 Media Performance Report Mrs Gray reported a reduced volume of media articles over the last two months but an increase in those of a high profile such as the pest problem at RACH, cDiff, patient safety and Information Governance breaches. There had been positive coverage relating to dentistry as well as the flu situation and campaigns such as that for stroke awareness. Corporate Communications was now providing a service for Orkney and there had been a high level of media activity there. Mr Howatson asked about the briefing of reporters and Mrs Gray confirmed that where appropriate this did take place.

5.4 Developing the Workforce and Empowering Staff

5.4.1 KSF PDP Reviews – update

Ms Marsland reminded PGC that the previous KSF target about having a development plan had been delivered in full and that it had always been acknowledged that the new target relating to reviews would be more of a challenge. All Boards were experiencing technical issues with payroll systems providing the required data but this was expected to be resolved in early 2010. It was believed that 13.2% of eKSF reviews had been signed off by mid September indicating that increases were now happening and it was expected that the trajectory would be caught up with by the end of the year.

5.5 Improving Efficiency, Productivity and Sustainability

5.5.1 End July 2009 Financial Report and August oral update Mr Gall provided a summary of the August financial report which had recently been finalised. He advised the 5 months overspend was £3.1m at end August meaning a £7.5m year end forecast. Staffing was clearly the biggest expenditure and there were 4 APPROVED

currently 430 WTEs in post in excess of what was affordable. The end August overspends were mainly within Acute and Moray and there would be continued robust discussions with all budget holders.

The forecast of £7.5m overspend included all savings and windfalls. Anticipated waiting time resource had recently been reduced by £4.5m and Mr Gall would be discussing the imbalance with John Connaghan and John Matheson of the Health Directorate.

The difficulty in achieving revenue targets for 2009-2010 was acknowledged as was the efforts being made to reduce risk. A lot of work had been undertaken in relation to the additional £22m savings target in year and this would continue to be pursued vigorously. Clarity was still required around funding the vaccination programme by other than GPs. Mr Gall advised that he would present a paper to the October Board meeting which AG would outline the key challenges for 2010/11.

6. Risk Management

6.1 Corporate Risk Management Objectives Ms Robbins presented her paper which contained the existing objectives and the proposed ten new objectives which took account of the recent QIS report. Members supported the refreshed objectives which would be being discussed at the next Risk Management Group.

6.2 Corporate Risk Control Plan Ms Robbins reported on the progress made so far and the continuing evolution of Risk Control Plans throughout the system. A recent SBAR paper had highlighted the gaps in processes. The Executive Team will take forward the issue of strengthening control measures and accountability. Ms Robbins assured Cllr Howatson that he would be involved in any discussions regarding the Audit Committee. Meanwhile she was to meet with Mr Barry Jenkins, Assistant Director of Finance to discuss further.

7. Change Programmes/Projects Update Mr Robertson presented a paper outlining the performance management reporting arrangements to be implemented. Appendix 2 outlined all the projects and targets to be reported on monthly. Exception reports would be produced monthly from October and the most recent would be submitted to each PGC meeting.

8. Annual Review – draft Self Assessment See item 2 above.

9 Annual Report Ms Ross advised that the draft would be produced after the Annual Review meeting 5 APPROVED

and given current financial considerations the report would revert to its shortened form with signposting to other relevant publications. An update would be provided to PGC in November and the December Board meeting.

10. PGC Action Plan Mr Robertson presented the updated version which was based on the remit of PGC. Dr Cameron would follow up on the objectives for CHPs which had not yet been DC finalised. Cllr Howatson would discuss the key element of outcomes with Dr BH Cameron and Mr Robertson.

11. To consider content of October 2009 Board Report

- Preparation for Annual Review - ‘H’ targets in a Seminar

12. AOCB None

13. Date of Next Meeting 19 November, 2pm – 4.30pm, Conference Room, Summerfield House