item09 4pgc22jan09 by iqtT6177


									                                                                                  Board Meeting
                                                                                  07 04 09
APPROVED                                                                          Open Session
                                                                                  Item 9.4
                                           NHS GRAMPIAN
                    Minute of the Performance Governance Committee Meeting
                                held on Thursday 22 January 2009
                          in the Conference Room, Summerfield House


David Cameron, (Chair), Non-Executive Board Member, NHS Grampian
Barbara Bruce, 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
Rolf Dijkhuizen, Medical Director
Andrew Fowlie, General Manager, Moray CH&SCP, (for item 6.3.2 only)
Laura Gray, Director of Corporate Communications, NHS Grampian (for item 6.4.1 only)
Helen Cobb, Audit Scotland
Alan Gall, Director of Finance (for item 6.2.1 only)
Pam Gowans, Programme Manager, Long Term Conditions Management (for item 6.3.2 only)
Anne Ross, Head of Performance and Quality Improvement, NHS Grampian
Ray Watkins, Consultant in Dental Public Health, NHS Grampian (for item 6.1.1 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 Bill
       Howatson and Ewan Robertson. Audit Scotland was represented by Helen Cobb,
       Audit Manager.

 2.    Healthstat

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

 3.    Minute of Meeting held on 20 November 2008

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

 4.    Matters arising

       Richard Carey provided the following updates from the previous minute:


     Substance Misuse - progress had been made in relation to the funding for the
     Timmer Market project. Fergus Ewing MSP had commended Grampian in public
     on its improvement in substance misuse waiting times.

5.   Assurance Framework Reports from Governance Committees and PGC

     5.1    Aberdeenshire CHP
            Val Maehle reported that the CHP was closely monitoring maternity
            services to ensure they were working effectively. The birth rate had risen
            more than expected and both the Birth Units and the Aberdeen maternity
            services were being used by Aberdeenshire women. Work on the Single
            Outcome Agreement was progressing well.

     5.2    Moray CH&SCP
            Barbara Bruce highlighted the informative presentation to the CHP
            Committee by Dr Lesley Wilkie which was to be repeated at a full council
            meeting, to further promote health improvement and inequalities on the
            Local Authority agenda. There was good involvement around the Single
            Outcome Agreement.

            Following discussion around content of the assurance framework reports,
            Richard Carey suggested that the template should also incorporate areas
            of concern such as HMIE reports. He also felt that a similar report from
            the Acute Sector would be helpful. This and the templates would be

     5.3    Staff Governance Committee
            Gordon Stephen reported on the positive comments from the Cabinet
            Secretary during a recent visit relating to the efforts in meeting targets for
            sickness absence rates. The improvement in KSF was noted with 52% of
            staff having an outline as at 22 January which was an increase of 15%
            since the last report. He confirmed that work on outstanding areas
            would continue and that other AfC timescales were on track. It was
            confirmed that no other projects had been interrupted in order to meet
            these targets although sometimes there were delays in eg grievance
            hearings because of staff side availability. Richard Carey advised that
            that Grampian had performed well according to the staff survey results. A
            presentation would be made to the NHS Board in due course.

     5.4    Clinical Governance Committee
            Val Maehle reported positively on the previous committee meeting where it
            had been confirmed that HAI actions were being implemented and that
            regular monitoring was taking place. A very comprehensive plan to reduce
            decanting had been presented and the new bed management system
            would assist in this. Roelf Dijkhuizen advised that he was organising a
            presentation for OMT on microbacterial prescribing. Elizabeth McDade


             stressed it was important to ensure the public was kept informed and
             engaged around this important agenda..

     5.5     Patient Focus and Public Involvement
             Elizabeth McDade confirmed that there were no significant risks to report.

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

     Anne Ross highlighted some issues from the Overall Performance Report:

     Financial performance –Alan Gall will highlight later.
     CHI target – delivery of the target within laboratories was being sustained but the
     new HEAT target related to radiology and would be more challenging.
     Online referrals – the end march target was expected to be delivered as a
     consequence of the Hub initiative which was focusing initially on orthopaedics.
     Outpatient/Inpatient waiting times – 15 weeks had not been achieved at the end of
     December but we remained on track for 12 weeks maximum at end of March.
     Diagnostics – target reductions had been delivered on a sustained basis for several
     months, which Richard Carey commended. These needed to reduce even further
     as part of the 18 week RTT target.
     A&E 4 hour wait – the system had been under some pressure during the winter
     months but had generally managed well.
     Sickness absence – although one of the lowest rates in Scotland, NHS Grampian
     was falling short of its trajectory towards the 4% target.
     European Working Time Directive – as at November 2008 Grampian was 34%
     compliant for doctors in training

     6.1     Improving Health

             6.1.1     Dental Action Plan

                       Ray Watkins reminded members that the Plan had been accepted
                       by the Board in August 2008 and that this was the first progress
                       report on performance. A draft implementation plan had also
                       been circulated. He believed the corner had been turned on
                       registrations with 20,000 additional registrations since last year
                       across salaried dental practices and GDPs. It was noted that
                       new dentists were coming to Aberdeen rather than Moray and
                       Aberdeenshire although there were ongoing recruitment efforts
                       locally and nationally. The emergency care services had treated
                       13,000 cases last year, all seen within 48 hours. However, he
                       acknowledged that the registration waiting list continued to rise as
                       practices continued to deregister patients. The Dental School
                       admitting students and the considerable progress with the new
                       build were also reported. PGC found the reports very helpful.
                       Implementation of the Plan would continue to be monitored.


    6.2    Finance

           6.2.1     End November 08 Financial Report and December update

                     Alan Gall presented the December financial report published
                     earlier in the day and advised on an improving position since the
                     November report with £1.4m overspend against budget for the
                     first 9 months of the year. However the year end forecast had
                     now been changed from a £2m surplus to breakeven. Alan
                     advised that price reductions in GP prescribing were not coming
                     through as forecast and that energy costs continued to increase.
                     Financial performance was enhanced by expenditure slippage
                     and new funding allocations from the Scottish Government Health
                     Department (SGHD) but this was not a sustainable position.

                     Core services remained under pressure and an essential spend
                     only message was going out to the service. in relation to new
                     investment, we continued to receive money from the SGHD which
                     created difficulties for managers to spend within the timescale.
                     To date, only 35% (£14m) of the capital programme had been
                     spent with £41m remaining. The main areas of spend were the
                     new PACS system, eHealth infrastructure, the dental school and
                     Laurencekirk medical centre

                     Alan advised on the work of the newly formed Budget Steering
                     Group, made up of senior budget managers. The financial
                     projections for 2009/2010 were particularly challenging and
                     should the cost of pay awards be fully funded, a commitment to
                     3% less expenditure than 2008/09 from budget holders will be
                     required. Finance managers were working with budget holders
                     to devise saving schemes for every operational area. It was
                     acknowledged that agreement on budgets would prove difficult. A
                     sub group of the Budget Steering Group was being established to
                     review the risks and effects across the organisation of saving
                     schemes. In general plans would have to be put in place to
                     operate with a less rich skill mix and fewer staff if savings were to
                     be delivered.

     6.3   Service Delivery and Organisation
           6.3.1     Outpatient and Inpatient Waiting Times

                     Richard Carey confirmed that NHS Grampian was on track to
                     reach the12 week target at the end of March despite being over
                     trajectory at the end of December.


                    David Cameron asked about access to Stracathro after the end of
                    the existing contract. Richard advised that high level discussions
                    would take place with Tayside and Fife but that Grampian wished
                    to secure its currently nationally funded capacity and required this
                    for long term sustainability. Roelf Dijkhuizen advised that the
                    objective in Better Care Without Delay was to reduce reliance on
                    private facilities to meet requirements and to eliminate this fully.

           6.3.2    Long Term Conditions Programme

                    Andrew Fowlie video linked for this item and introduced the
                    Programme Manager, Pam Gowans who was in attendance, to
                    the Committee. He advised that the purpose of the programme
                    was to embed within Health Boards and Local Authority areas
                    over a 3 year period the better management of long term
                    conditions. A long term was defined as one lasting for more than
                    one year. The Programme Board commenced its work last
                    summer and was currently taking forward 3 main areas of work –
                    self care (Grampian was ahead in Scottish) terms, specialist care
                    (e,g, COPD, CHD, MCN) and complex care (those with a number
                    of conditions). Pam Gowans advised that a focused approach
                    was required to ensure that the patient experience could be
                    improved. This programme was one of the six Board
                    Programmes and would be monitored in depth twice a year in
                    order to ensure ongoing progress. PGC requested that updates
                    were provided.

     6.4   People

           6.4.1    Media Performance Report
                    Laura Gray reported that this report showed that more positive
                    than negative reports had been received over the last two month
                    period. There were also a high number of neutral stories raising
                    awareness about issues. A number of stories this month were
                    outwith the control of the Communications Team, relating to
                    emergency incidents.

                    It was noted that more than 70% of Freedom of Information
                    enquiries came from the media and a lot of work was involved in
                    formulating appropriate responses. Laura advised that she
                    planned to expand the media report to cover broadcast media,
                    e.g. radio, TV and online.


                           Laura advised that the organisation had responded well around
                           some difficult issues in relation to the Auchenblae hotel incident
                           which will be reported at the next meeting. Although there had
                           been a significant amount of work for the team, this was
                           invaluable learning for the organisation in future.

      6.5         Learning and Growth

                  6.5.1    KSF Implementation update
                           This item had already been discussed.

 7    2009/10 Local Delivery Plan update

      Anne Ross reported on the timetable for the LDP draft submission by 18 February
      and the final version by 20 March. A local deadline for first submission of 23
      January had been set. She highlighted that less narrative was required this year
      but risks to delivery of all HEAT measures had to be identified with associated
      mitigating actions. There were a number of new sections and information was
      required on partnership working with Orkney and Shetland.

      The draft LDP would be discussed at the March Board Seminar with the final
      version available for the March PGC meeting and the April Board.

8.    To consider content of February 2009 Board Report

               Dental Action Plan
               Financial report
               Outpatient/inpatient waiting times
               General performance report

9.    AOCB

      None reported

10.   Date of Next Meeting

      16 March 2009, 10.30am, Conference Room, Summerfield House


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