pct board minutes 26 mar by nBU3p5


									         Minutes of the Board Meeting Held in Public on
                  Wednesday 26th March 2008 at
       Braintree District Council, Causeway House, Room 1

David Barron                -   Chairman
Sheila Bremner              -   Chief Executive
Adrian Marr                 -   Director of Finance and Performance
Maria Stripe                -   Executive Board Clinical Member and
                                PCT Board Nurse Representative
Donald McGeachy             -   Strategic Lead for Primary Care
David Bagnall               -   Non Executive Director
Leo Bishop                  -   Non Executive Director
Cllr Lady Patricia Newton   -   Non Executive Director
Clare Morris                -   Commercial Director
John Niland                 -   Project Director Provider Services
SarahJane Relf              -   Director of Corporate Development & Governance
Bryan Spencer               -   Clinical Chair Executive Board

In attendance
Chantelle Lillie            -   Board Secretary
Melanie Crass               -   Assistant Director of Commissioning
Alison Manton               -   Interim Strategic Lead for Estates
Martin Cresswell            -   Communications Advisor

Members of the Public
Russell.Gates               -   EC Harris
Simon Moul                  -   Essex LPC
Ken Edwards                 -
Eunice Legerton             -   Maldon Wycke WI
Jean Healey                 -   Maldon Wycke Wi
Doreen.Warwick              -   Maldon Wycke WI
J.Doghan                    -   Farleigh Hospice
Barbara.Cooper              -   Maplin WI
A.Yewlett                   -   Maplin WI
M Nutt                      -   Maplin WI
Maureen Henes               -   Mid Essex PPI Forum
Sue Jayasekara              -   Maplin WI

Mid Essex PCT
Minutes Board Meeting – 26th March 2008   -1-
J.Grant                    -      Essex Chronicle
Anthony Shelton            -      Braintree District Council
Alan Phipps                -      Nexus

1     Apologies for Absence

      Malcolm Jacobs, Alan Hubbard, Sallie Mills-Lewis

1.1   Chairman’s Report
      David Barron welcomed everyone to the third meeting of 2008 of the Board of the
      Mid Essex Primary Care Trust. David Barron began by thanking Braintree for the
      use of the Meeting Room at Causeway House and welcomed the public. Members
      of the public were advised that this was not a public meeting but a Board meeting
      held in public and that there would be an opportunity to ask questions or make
      comments after item 5.3 on the agenda, prior to the Board taking a vote on this
      item. Members were asked to sign the attendance register. David Barron reminded
      the Press that the CEO and he would be available to meet with them briefly during
      the break if there were any matters requiring fuller detail or clarification. David
      Barron reminded the Public that any issues relating to individual cases, patients,
      carers or members of staff should be raised directly with the Director involved at the
      PCTs offices at Swift House in Chelmsford. Details of which could be obtained from
      the Board Secretary.

      David Barron reminded the Board that the Patient and Public Involvement (PPI)
      Forum is to be disbanded on 31st March. David Barron paid formal tribute to
      Malcolm Jacobs and his colleagues for the diligent and effective work they have
      carried out. David Barron has received and responded to the letter of resignation
      from Malcolm Jacobs. David Barron and SarahJane Relf, are working with existing
      members of the PPI forum to establish interim arrangements until such time as
      Local Involvement Networks (LINKS) is formally established. David Barron
      expressed the PCT’s commitment to having patient and public consultation and
      input as central to its work.

      David Barron confirmed that he and Alan Hubbard had attended the Annual
      Meeting of the Community Pharmacists. He had participated in 2 Infection
      Prevention Training Sessions.

1.2   Chairman’s Action:

1.3   Chief Executive’s Report
      The PCT are currently developing a range of plans to include the Financial
      Framework, Talent Plan, Operating Plan and the Business Plan. There had been

Mid Essex PCT
Minutes Board Meeting – 26th March 2008      -2-
      an intention to bring the Business Plan to the meeting, but deemed further input
      was required to be able to present a more detailed report at the next meeting.

      Sheila Bremner had attended a meeting at the SHA with Adrian Marr and Sallie
      Mills-Lewis in respect of the second cut of the Operational Plan. The meeting was
      considered positive in terms of the forward plan, the detail around delivering
      pledges and local targets. There was some concern regarding the financial position
      for 07/08 where there may be a small surplus. The PCT understood the message
      to clear this and are making sure that the financial position is managed towards
      break even this year.

      In relation to commissioning health care services in the Prison and the recent
      deaths in custody, Sheila Bremner has written to the Governor to seek his
      assurance that the pending Home Office Review will also look at health services.
      Sheila Bremner will be meeting with Prison Board, that afternoon, to discuss further.

      The PCT are heading towards the end of the financial year, and are working closely
      with the Mid Essex Hospital Trust to achieve the targets for the year end with regard
      to 18 Week and 4 hour A&E waits.

      Sheila Bremner commented on the changes to the District Nursing Services,
      following the approval and implementation of the Turnaround plan. At that time, the
      PCT received some feedback and criticism, which prompted Sheila Bremner to
      commission an external, independent review. The PCT had received the results of
      this external review and accepted the recommendations it presented. Sheila
      Bremner will be writing to relevant staff and colleagues to outline the
      recommendations in the review.

      With regard to the Commissioning Arm of the PCT, it has been 18 months since
      establishment of the new structure for the PCT. In view of the recent guidance
      around World Class Commissioning, the PCT are looking again at each of the
      directorates, to ensure the PCT is fit for purpose moving into the future. Mid Essex
      PCT are delighted to welcome Jan Yates as Director of Public Health, starting on
      May 1st. The Board would like to formally thank Donna Telfer for her contribution in
      the recent months.

2.    Declaration of Interests
      Lady Patricia Newton declared an interest in the proposals for Braintree Community
      Hospital and discussions around proposed Health Care Centre for Witham.

3.    Minutes
3.1   To approve the minutes of Board Meeting held on Tuesday 26 th February, 2008.

Mid Essex PCT
Minutes Board Meeting – 26th March 2008     -3-
      The minutes were approved as a true and accurate record subject to the following

      Page 1 – Please note Bryan Spencer as ‘attending’
      Page 7, item 4.2 – last sentence should read ‘in North Chelmsford’, not ‘Beaulieu
      Page 9 – first bullet point should read ‘draft LAA’, not ‘draft Essex Strategy’.

      Clare Morris also confirmed that the press had misquoted her at the previous
      meeting as stating that the proposed health centre would cost £7m, when in fact
      she had stated ‘several’ million, which would also include ‘Out Of Hours’.

3.2   Matters arising from the Minutes not addressed elsewhere on the agenda


3.3   Action points from previous meetings

      Sheila Bremner gave response on behalf of Sallie Mills-Lewis. The base line
      assessment for end of life has now been completed, and priorities noted. This was
      therefore removed from the action list.

4.    Finance and Performance Monitoring
4.1   To receive the Finance Report for Month 11 (Adrian Marr)
      Adrian Marr reported that as at M11 the PCT was forecasting a year-end under
      spend of £4.5m.

      This was an increase in the month of £1m and mainly related to an increased under
      spend in Specialist Commissioning of £700k and a further improvement in high cost
      drugs of £300k, hosted by North East Essex PCT.

      The main risk to the PCT was that it was now £4m above the StHA set control total
      surplus of £0.5m. The threat from the StHA was that we could lose all or some of
      the £4m additional under spend, in terms of carrying it forward to 2008/09. The
      PCTs current working assumption was that the PCT would carry forward £2.5m.

      In terms of capital, the PCT was forecasting an under spend of £51k, thus
      remaining within its capital resource limit.

      The PCT was also forecasting to remain within its cash limit and not to significantly
      under spend, thereby protecting the cash position into 2008/09.

Mid Essex PCT
Minutes Board Meeting – 26th March 2008      -4-
      David Bagnall requested some clarification from the SHA on status of the PCT
      under spend. Adrian Marr confirmed that he is still awaiting the final outcome.
      Sheila Bremner further highlighted that half of the under spend had arisen from
      items outside of the PCT control, namely a significant under spend in the Specialist
      Commissioning budget which was managed centrally for East Of England and
      greater than anticipated windfall from market forces factor.

      The Board noted the following:
          The revenue position and forecast outturn
          The capital investment position and forecast outturn
          The cash forecast outturn position
          The risks and assumptions included in the forecast outturn position

4.2   To receive the Progress Report on Implementation of the Turnaround Report
      (Clare Morris)

      Adrian Marr presented the final report on Turnaround and confirmed that it was
      anticipated that the PCT would achieve 100% of required savings. There had been
      a significant improvement in prescribing. Outstanding issues regarding acute
      commissioning schemes would be picked up in 2008/09 contract discussions.

      David Barron wished to extend thanks and recognised the achievement in
      concluding a challenging turnaround target.

      The Board noted the progress with planned savings and the risk and assumptions
      included in the forecast outturn savings.

4.3   To receive the Corporate Performance Monitoring Report (Adrian Marr)

      Adrian Marr confirmed that there were two key areas under significant scrutiny, one
      being 18 weeks and the other, A&E performance.

      In terms of 18 weeks, the latest information suggested the PCT would meet the
      85% target, although this had required bank holiday working over the Easter period.

      The latest information on A&E was that Mid Essex Hospitals Services NHS Trust
      were meeting the 98% 4-hour wait target, with week ending 23 March 2008
      performance at 98.7%.
      The reason for the heavy StHA scrutiny is the risk that the EoE, overall, will not
      meet their key end of year targets. The PCT is being asked to over-perform on
      these targets to assist other localities.

Mid Essex PCT
Minutes Board Meeting – 26th March 2008     -5-
      Sheila Bremner noted that in relation to ‘A&E’ and the ’18 week target’, the PCT
      have been working closely and communicating daily with the MEHT. Sheila
      Bremner highlighted to the Board that there is the expectation that the PCT will
      achieve both of these at year end.

      Bryan Spencer queried whether the concentration on reaching the key targets might
      compromise other areas of commitment, such as Cancer. Adrian Marr
      acknowledged the concern regarding a shifting of focus, but reassured the Board
      that cancer targets were being met.

      David Bagnall enquired to what the figures for audiology represented and what the
      expected period between first assessment and receiving hearing equipment would
      be. Adrian Marr responded that the figures for audiology equated with the number
      of patients removed from the patient treatment listing each week. Adrian Marr
      would need to report further, outside of the meeting, on duration between
      assessment and treatment.

      The Board noted the Performance Report.

4.4   To receive update Infection Prevention within Mid Essex (SarahJane Relf)

      SarahJane Relf provided the Board with an update on current activity on Infection
      Prevention and Control across Mid Essex, confirming that the PCT continues to
      perform well on MRSA and CDiff targets.

      The report provided an update on outbreaks and the steps taken to control these,
      which endorsed the success of those procedures.

      The Panton Valentine Leukocidin (PVL) outbreak at the Mid Essex Hospital Trust
      (MEHT) Burns Unit is under control. The PCT are heavily involved with the
      Strategic Health Authority (SHA) and the Health Protection Unit to support the
      outbreak. A full report will follow at conclusion of the outbreak.

      The decontamination for Podiatry Services is now in place and there has been
      significant work with Dentists on decontamination.

      SarahJane Relf highlighted that Infection Prevention had now been added to all job
      descriptions with major ongoing programmes of training.

      The report noted major cleaning programmes for both MEHT and Provider

Mid Essex PCT
Minutes Board Meeting – 26th March 2008     -6-
      David Bagnall wished to establish how figures were achieved regarding ‘monthly
      hand clean’. SarahJane Relf responded that random audits were undertaken on

      The Board noted the update on Infection Prevention and Control within Mid Essex
      Health Economy.

5.     Items for Discussion and Decision
       To approve Financial Framework for 08/09-10/11 (Adrian Marr)

      This paper followed on from the draft Financial Plan presented to the January 2008

      Assumptions in the plan had been updated, taking into account the Health & Well
      Being Strategy, the Operating Plan, signed Service Level Agreements with the
      Acute Trusts etc.

      An internal ‘star chamber’, made up of members of the PCTs Executive Board had
      reviewed business cases from directorates and the results were included within the
      Financial Plan.

      In respect of 2008/09, it was the PCTs proposal to lodge a deposit with the StHA of
      £11.1m. This was due to the significant headroom afforded by paying off the one-
      off debt in 2007/08 with recurrent resources, as well as receiving cash uplift for
      2008/09. Feedback from the StHA suggested this deposit would be acceptable for

      In respect of 2009/10 onwards it was likely that growth would reduce significantly,
      therefore this paper suggested a further deposit in 2009/10 and a slight withdrawal
      of a deposit in 2010/11. This strategy would enable the PCT to smooth funding
      investments rather than creating a stop/go strategy, which would occur if the PCT
      matched its spending directly with its available income in each year. Smoothing the
      resource availability would also improve the VFM of purchasing services.

      In 2008/09 it was proposed that the PCT held £3m of earmarked reserves and £4m
      of general contingency. Given the position in 2007/08, the StHA were requesting
      back-up spending plans if these contingencies were not utilised in the early months
      of 2008/09.

      There was also an uncommitted sum of £2.7m, some of which was likely to be used
      on redesigning care pathways and moving the PCT towards becoming a World
      Class Commissioner.

Mid Essex PCT
Minutes Board Meeting – 26th March 2008    -7-
      Due to the protection of cash in 2007/08, the cash position for 2008/09 should be

      The proposed capital plan was attached and had been considered by the Estates,
      IT & Capital Planning Committee.

      David Bagnall voiced reservations around the amount of the proposed reserve to be
      lodged with SHA and sought assurance that this would be safe. Adrian Marr
      responded that the process required a balanced approach; and highlighted that the
      PCT had also created its own contingencies. He noted that there might be a
      greater risk that expenditure would be lower than planned rather than higher.

      Sheila Bremner commented that there would be more detailed work in the
      implementation of both the East of England Strategic Pledges and our own
      proposals, and for the first time the PCT is in a position where forward financial
      planning is to be based on quantifiable targets. The money is not available to
      spend instantly, and the PCT needs to be clear about the consequence of any
      investment decisions. A meeting was held with the SHA in relation to the Operating
      Plan, and they have made it very clear that all PCTs will be required to deliver their
      plans into the future. If Mid Essex were to deviate from this plan, they might find
      themselves with a greater surplus and be at a greater risk of losing it. Adrian Marr
      further commented that a planned lodging of the reserves at the beginning of a
      year, rather than changes to policies mid way through the year, will give greater
      security. The SHA have been reviewing the Year 2 figures in detail, but the Year 3
      figures are indicative for planning purposes, and can be reviewed.

      Bryan Spencer asked if the prescribing uplift was purely to accommodate inflation,
      and, if there would be pressure in the future for costs for new/updated drugs.
      Adrian Marr responded that there is significant investment for year 1 and future
      drugs, and the PCT are following the national guidelines as part of their

      Sheila Bremner reassured the Board that as a consequence of an operational
      planning meeting with the SHA recently, she wrote to their Director of Finance and
      Performance highlighting the PCT’s plan and received a positive response, noting
      that the Mid Essex approach was consistent with their requirements. Sheila
      Bremner noted that it was not unreasonable to feel a degree of nervousness when
      handing over large sums of money to a third party, with an anticipation of having it
      returned. Sheila Bremner concluded that the Mid Essex PCT approach was
      correct, as it was detailed and planned.

      Leo Bishop asked if the SLA could give some focus to the anticipated additional
      costs that may accrue in the next three years in specialist health. He otherwise felt
      the planned approach was positive.


Mid Essex PCT
Minutes Board Meeting – 26th March 2008     -8-
           The Board noted the updates on progress with the 2008/2009 Budget and the
           Forward Financial Plan. The Board approved the 2008/09 Budget; the Forward
           Financial Plan, the 2008/09 Capital Plan and noted the risks and assumptions
           included in the Financial Plan.

5.1 (ii)
           To note EoE Operating Plan Submissions for 08/09 (Adrian Marr)

           The Operating Plan, which was a requirement of the StHA, detailed the PCTs
           intentions in respect of implementing the EoE StHAs Improving Lives, Saving
           Lives strategy as well as highlighting trajectories and investments associated
           with the national Vital Signs improvements. The Board noted this 2nd cut

           A review meeting had taken place with the StHA. The conclusion was generally
           positive, although a slightly refined 3rd cut submission would need to be
           submitted by 31 March 2008. A final iteration would be concluded by the end of
           June 2008, taking into account the Local Area Agreements (LAA) as well as
           outcomes of the Darzi review.

           The key elements of the Operational Plan would be included in the PCTs overall
           Business Plan.

           David Bagnall enquired as to the process to reducing the number of people dying
           as per Page 51. Sheila Bremner responded that this was achieved through a
           combination of screening and early intervention. Bryan Spencer outlined an
           example to coronary heart disease; where we are identifying people at greater risk
           and in areas of deprivation. With clinical intervention; they were looking at bowel
           screening and obesity education etc.

           The Board noted the submission of the PCTs 2nd cut Operational Plan 08/09 to the
           Strategic Health Authority.

      Report on set-up costs for Mid Essex PCT (Adrian Marr)

           Adrian Marr presented a paper which identified the costs of PCT set-up and
           restructuring. In terms of set-up costs, this accounted to £64k, which included the
           cost of producing two sets of final accounts, changes to office accommodation.
           Restructuring costs amounted to £1572k and included redundancies, early
           retirements etc.

Mid Essex PCT
Minutes Board Meeting – 26th March 2008          -9-
      The Board noted the report, which finalised the reporting of costs, incurred directly
      as a result of setting up the Mid Essex Primary Care Trust.

      To approve Full Business Case for Braintree Community Hospital (Clare Morris)

      In introducing the item, David Barron commented that many will have been involved
      in discussions about the possibility of such a development since 2002. He believed
      that the Board needed to take a fresh and untrammelled view of the situation.

      David Barron advised that the decision needed to be taken on the basis of the
      determined health needs of the population of the Braintree area both now and in
      future years, and asked that the Board consider this during the debate. He also
      advised the board that they would be asked for their vote after the meeting is
      opened to the public for debate.

      Sheila Bremner wished to highlight that it had been some time since the Board
      discussed this proposal, and the PCT had moved on beyond the Turnaround and

      Clare Morris introduced Alison Manton, as the PCT Strategic Lead for Estates.
      Clare Morris informed the Board that they had reached this point in the project in
      record breaking time without compromising the quality of it. The Capital Team at
      the Strategic Health Authority had received the full business case document and
      that the PCT were responding to their comments and questions.

      Alison Manton proceeded to outline the key elements of the Business Plan, and
      concluded by asking the Board to consider that the strategic case fits with the
      strategic vision with the PCT; and for the Board to approve the business case.

      David Bagnall asked for clarification regarding changes to PCT accounting policies
      as a result of the introduction of International Financial Reporting Standards (IFRS)
      which could potentially lead to the PCT being double charged for both the unitary
      charge from the PFI contractor and a capital charge. Adrian Marr responded that
      the recent Budget announced by Alistair Darling has delayed the introduction of
      IFRS accounting standards until 2009/10. Therefore at this stage the risk of a
      double charge would not be relevant. Adrian Marr also commented that the
      auditors would review the PCT Business Case under the current guidance due to
      the postponement of IFRS. David Barron enquired as to the likely view of the
      external auditors in respect of producing an off-balance sheet opinion. Adrian Marr
      responded that the auditors have asked for some further information, but he did not
      see any problems in this opinion being forthcoming.

Mid Essex PCT
Minutes Board Meeting – 26th March 2008      - 10 -
      Clare Morris updated the Board with regard to the shell space area; the PCT
      lawyers were currently in meeting with Care UK lawyers in anticipation of them
      occupying this space. David Barron asked what would the position be if the
      preferred option, Care UK, did not go ahead? Did we have a Plan B? Clare Morris
      stated that despite being confident that this plan will go ahead there are several
      contingency plans should this not be possible. Any alternative solutions would be
      required to pass the test of value for money.

      Lady Patricia Newton commented that the strategic case noted in the full business
      case had not altered significantly since the predecessor reviewed the requirements.
      She highlighted that it offered what the local people wanted and needed whilst
      being financially viable. Lady Patricia Newton is reassured, along with the public
      that the facility will be required to adopt a solid maintenance plan throughout its
      tenure and that ownership will return to the public health sector.

      Lady Patricia Newton asked for the rationale behind the reduced bed numbers and
      whether there was adequate parking. Clare Morris confirmed that the bed numbers
      were gathered using population projections, population growth and a changing
      demographic profile. The beds are configured to be flexible from a gender
      perspective and will be used more efficiently. Should there be a need the PCT can
      buy beds from the private sector when a peak of care is evident. Clare Morris
      responded with regard to the parking issue, that it was generously provided for
      above mandatory requirements. As yet there is no conclusion as to how the
      parking will be managed as considerations need to be taken in respect of the close
      proximity of a residential area. There is the potential for the parking to be filled by
      cars which may not be using the hospital or services, and a nominal cost or barrier
      may deter misuse.

      With regard to William Julian Courtauld Hospital, Clare Morris advised the Board
      that whilst the MEHT had current ownership, there were active discussions for the
      future of this site. There are no plans for the site not to be used for health care and
      there are no current plans to withdraw the maternity facilities.

      Leo Bishop expressed concern over the interface between the hospital and the
      community, and whether additional pressure would be placed on community
      services. Clare Morris responded that in terms of the relationship between social
      services and community health, she did not envisage the demand to be any
      different to how it currently is. She commented that in the early years the flow
      through the beds may be on a similar level albeit more efficient. The GPs in the
      local area are very positive that it is proceeding and view it as complimentary to the
      services already provided with primary care.


      Mr Edwards queried who specifically the loan agreement was to be signed with, to
      which Clare Morris responded that it would be signed with the Grosvenor House

Mid Essex PCT
Minutes Board Meeting – 26th March 2008      - 11 -
      The Board noted the Full Business Case for the development of the new community
      hospital under the PFI procurement route. The matter was put to the Board for
      vote, and was recorded as ‘all in favour’.

         To approve Business Case for Reprovision of Douglas Grove Surgery
         (Melanie Crass)

      Melanie Crass presented a business case for reprovision of Douglas Grove Surgery
      highlighting that existing facilities are no longer fit for purpose. A number of options
      had been considered such as relocating to existing facilities in Witham; finding a
      new location or reprovision on the existing site. The latter was considered to be the
      most workable. The proposal for reprovision would provide accessibility, meet
      infection control requirements; offer a reception area, provide additional services
      and grow with the demands of the local community. The Business Case complies
      with the Strategic Services Development Plan and the plans have received District

      David Bagnall congratulated Melanie Crass on an excellent business case and he
      felt that the doctors on this site deserved full support. He commented that whilst
      adhering to the bullet point list of provisos, he expressed slight concern or need to
      consult with neighbouring practises and whether this would cause a delay.

      Melanie Crass responded that the there was a need to get the cluster groups
      working together on a project such as this to ensure that it is future proof.

      Leo Bishop agreed that this premises clearly needed attention. He commented that
      if the Board agrees to the proposal, time will pass between its acceptance and the
      new business premises being available. He asked how this would be managed
      within the commissioning arrangements in Witham. Melanie Crass responded that
      there was sufficient capacity currently; the plan and the build would be two phased
      to enable services to continue. Lady Patricia Newton agreed that there was a need
      to start the process. Bryan Spencer acknowledged with the Board that this project
      was in line with targeting the deprived services and the ensuing population

      The Board noted the Business Case for the redevelopment of Douglas Grove
      Surgery, Witham and approved the proposed Business Case.

      To receive Draft Essex Strategy (Clare Morris)

Mid Essex PCT
Minutes Board Meeting – 26th March 2008      - 12 -
      The Essex Strategy is being developed alongside the development of the second
      Local Area Agreement (LAA2) for Essex and describes the vision for Essex that
      achievement of the targets in LAA2 will deliver.

      The PCT have been invited to comment on the Essex Strategy alongside the
      consultation and on-going development of LAA2 which was presented to the PCT
      Board in February.

      It is expected that both the Essex Strategy and LAA2 will be launched in early
      summer 2008. The PCT are continuing to feedback on both documents in
      partnership (through the 3 Mid Essex LSPs) and as an independent entity, in close
      collaboration with the other Essex PCTs. The deadline for final feedback on both
      documents is the end of March.

      Clare Morris reminded that this was an opportunity to add comments and to note
      that this is being developed alongside the LAA, so it would be prudent to make sure
      they run parallel. There have been numerous detailed discussions at previous

      Leo Bishop suggested that the messages seem to be clear, but the connections
      were not.

      David Barron wanted to see action and wanted to encourage the link between
      vision and strategy.

      The Board noted the comments on the draft Essex Strategy

      To approve PCT Response for Healthcare Commission Standards for Better Health
      (SarahJane Relf)

      Sarah Jane Relf presented the proposed Health Care Commission Standards for
      Better Health return for 2007/08. SarahJane confirmed that this had been
      discussed at length at both the Integrated Governance Meeting and the Executive
      Board. Of the 49 standards the PCT are proposing to declare compliance with all
      but 5 of the standards. This is a significant improvement on last year where the
      PCT reported 10 standards as non-compliant.

      The five areas of non-compliance are
          Podiatry Services - decontamination: will meet requirements by March 2008.
          Waste Management - Policy will be developed by April 2008
          Equality & Diversity - The PCT is currently developing a Single Equality
             Scheme for approval to the Board in May 2008

Mid Essex PCT
Minutes Board Meeting – 26th March 2008    - 13 -
            Organisation and Personal Development - These were met in year, so could
             not record a full 12 month of compliant.
            Records Management – The PCT are currently undertaking a major IT
             project and will be complete by end of March 2008.

      The PCT have received a response from the PPI Forum and are supportive of this
      as a return, giving congratulations on significant progress, particularly around the
      Public and Patient Involvement.

      David Barron commented that this was a tremendous move forward from the
      previous year.

      Sheila Bremner advised the Board to the consequence of having a double weak
      rating last year, the PCT had been visited by the Health Care Commission. The
      meeting was considered useful and Sheila Bremner feels confident that this
      submission is the correct one. The feedback she received was that the self
      assessment was thorough, if not a little harsh.

      The Board approved the submission of the Health Care Commission “Standards for
      Better Health” Declaration.

      To receive Assurance Framework and Full Risk Register (SarahJane Relf)

      Earlier this year the Board approved introduction of a three tiered risk register. The
      Board have previously reviewed the corporate register which outlines the risks
      against the 5 strategic objectives. The Assurance Framework outlines how controls
      and risks are assured. The Board had also received the full Directorate level
      register. The Board will recall that these are risks being managed within and at
      directorate level where directions have escalated to Board Level should a significant
      risk have been identified.

      The NEDs had the opportunity to question the Directors on these risks at briefing
      sessions and have been given thorough assurance.

      The Board noted the contents of the full Risk Register and Assurance Framework.

      To approve amended Corporate Governance Manual (Adrian Marr)

Mid Essex PCT
Minutes Board Meeting – 26th March 2008     - 14 -
      The Corporate Governance Manual was approved by the Board in October 2006.
      However, it was good practice to review the manual on a regular basis and the
      proposed changes had recently been reviewed and approved by the Audit

      The main changes related to the increase in Non Executive Director membership
      and clarification of officer voting, a review of the Scheme of Delegation and an
      increase in the tender limit to £50k.

      One outstanding piece of work related to the Scheme of Delegation for the Provider
      Board. The Board delegated the Audit Committee to review and approve this
      documentation at their next meeting on Monday 14 April 2008, in order that
      Provider Services could move forward.

      The Board approved the revised Corporate Governance Manual.

      To receive Draft Equality Scheme (SarahJane Relf)

      The Board will recall the ‘trailed’ Single Equality Scheme (SES) which will outline
      the PCTs approach to equality and diversity both externally around services
      commissioned and internally for our own staff.

      Sarah Jane Relf presented that ‘Draft’ scheme, which will be taken out to
      consultation during April and May with view to final scheme approval by the Board
      in May.

      The Single Equality Scheme brings together previous predecessor schemes around
      race, disability and gender into one Equality and Diversity document which also
      covers diversity for age, sexual orientation and religion.

      More and more organisations are moving towards SES as this ensures a more
      holistic approach to diversity. However, our scheme is also mindful of the differing
      requirements of each group within that.

      This draft scheme has been developed after a major audit and review of the
      organisations current activity around diversity and also includes feedback from a
      diversity focus group with patients and public, staff involvement and includes
      feedback fro the Health Care Commission’s review on race equality.

      The document outlines the PCTs commitments and responsibilities and areas
      where the PCT should be improving ie. around involvement of diversity groups and
      hard to reach groups.

Mid Essex PCT
Minutes Board Meeting – 26th March 2008     - 15 -
       The draft scheme also includes an action plan which will be developed during the
       consultation period. SarahJane Relf would expect the final action plan to evolve
       considerably during the consultation.

       The PCT will be establishing an Equality and Diversity Steering Group to oversee
       implementation of the Strategy which will include public and staff representation
       from diversity groups. Sheila Bremner will chair this group.

       The Board are asked to note the draft scheme for consultation and that the final
       scheme will be available in May. SarahJane Relf asked for all comments to be
       directed to her no later than the second week of May.

       The Board noted the Draft Single Equality Scheme.

      To ratify policies

       The Board reviewed the summaries of policies and ratified all.

       The Board approved and ratified the policies.

6      Provider

      To receive an update on Provider Services (John Niland)

       John Niland reported that the service level agreement has now been signed off for
       08/09, with some updating required. The Services are subject to 18 week targets
       and are currently reaching 95% of those. In discussion with Making A Difference
       Group (MAD), John Niland is hoping to monitor staff welfare and response.
       The forecast outturn was required to be revised. The additional expenditure to the
       banking agency is due to staff changes, and this needed to remain flexible. John
       Niland highlighted that the Telecare Project had commenced. John also
       acknowledged the end of year 5 Lottery Funding to support the healthy living
       initiative and that there was an event to mark these achievements on March 25th.

       The Board noted the report.

7.    Sub Committee Minutes

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Minutes Board Meeting – 26th March 2008      - 16 -
      To receive Audit Committee minutes for 11th February 2008 ( David Bagnall)

      David Bagnall presented Audit Committee minutes drawing particular attention to
      charitable funds and specialist commissioning groups and the fact that minutes of
      these meetings would be received by Audit Committee and PCT Board respectively.
      The Board noted the Audit Committee Minutes.

      To receive details of Remuneration Committee dated 4th February 2008 (Alan

      SarahJane Relf presented a summary of items discussed at the Remuneration

      The Board noted the updates to the Remuneration Committee.

8.    Any other urgent business

9.    Questions and Comments from the Public

      Eunice Legerton, on behalf of a friend, wanted to enquire on waiting times for
      physiotherapy at St.Peters Hospital. John Niland responded that the waiting time
      would vary depending upon the severity of the ailment. This would be determined
      on a priority basis. Equally it might be dependent upon where the referral has come

      Mr Edwards highlighted on page 9 of the SHA Operational Plan the figures stated
      that suicide would be ‘reduced from 7 to 7’, which did not constitute a reduction.
      Sheila Bremner responded that this will be looked at.

10.   Date of next meetings
      Wednesday 28th May, 2088. Civic Centre, Chelmsford

Signed as a true and accurate record

David Barron
Chairman            Date

Mid Essex PCT
Minutes Board Meeting – 26th March 2008     - 17 -
Mid Essex PCT
Minutes Board Meeting – 26th March 2008   - 18 -

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