NHS North Somerset Board Meeting by bes0Ttrq


									 NHS North Somerset Board
 Held on 26 January 2011 at 2.00pm
 In the Boardroom, Waverley House

Present:             Stephen Harrison, Chair
                     Dr Mary Backhouse, PEC Chair
                     Chris Born, Chief Executive
                     Mary Hutton, Director of Finance and Performance
                     Graham Nix, Non Executive Director
                     Kathy Headdon, Non Executive Director
                     James White, Non Executive Director,
                     Becky Pollard, Director of Public Health
                     Jeanette George, Director of Strategic Development
                     Delyth Lloyd-Evans, Non Executive Director
                     Dr Paul Phillips, Non Executive Director

In Attendance:       Lindsey Perryman, Corporate Manager
                     Penny Smith, Associate Director for Quality and Redesign
                     Mike Lyall, Lay Volunteer, Voices for Health
                     Nick Godfrey, Local Involvement Network
                     Julie Kell (until PCT 08/11)
                     Jan Bond (until PCT 08/11)
                     Chris Morton (until PCT 08/11)
                     Thelma Howell (for PCT 13/11 and PCT 14/11)
                     Lynne Liptrott (for PCT 17/11)
                     Marcus Ede (for PCT 19/11)
                     3 members of the public (until PCT 06/11)

Apologies:           Philip Morgan, Non Executive Director
                     Julie Clatworthy, Director of Nursing, Quality and Redesign
                     Chris Creswick, Chair Weston Area Health Trust
                     Jane Smith, Director of Adult Social Services & Housing, North
                       Somerset Council
                     Penny Brown, Director of Community Services & HR

PCT 01/11        Introduction and Chair’s Comments

                 The Chair welcomed everyone to the meeting and
                 congratulated Dr Paul Phillips on the award of his OBE.

                 Introductions took place.

                                                                                Page 1 of 12
PCT 02/11   Declarations of Interest

            Kathy Headdon declared an interest in item 10, Final
            Recommendations for the Head and Neck Cancer Review,
            due to her husband being a Director at University Hospitals
            Bristol NHS Foundation Trust.

            Dr Paul Phillips declared and interest in agenda item 12,
            Partnership Plan for Children and Families 2011-2014.

PCT 03/11   Date of Next Meeting

            23 February 2011

PCT 04/11   Public Question Time

            Wrington Vale Medical Practice Development

            Mr Peter Maitland stated that he felt the PCT had a role to
            safeguard tax payers with regard to increased spending.
            Mr Maitland stated that the “do nothing “ option would
            require £124k as a one off payment with no increase in rent
            and hence he felt that this should be the benchmark against
            which other schemes were assessed but that this had been
            simply ignored.

            Mr Maitland highlighted that, with regard to better use of the
            current Wrington site, the PCT had not challenged the
            practice with regard to opening 5 days per week as
            opposed to the current 4 day per week opening. He also
            stated that he felt that the option of expanding the existing
            two sites at a cost of £155k per year extra rent was better
            value than the option being pursued.

            Mr Maitland stated that he felt that the petition and the
            public consultation had both been ignored and queried
            whether the public consultation had been undertaken
            merely to “tick a box”.

            With regard to the non financial appraisals Mr Maitland
            commented that he felt the figures had been chosen to give
            the required result. He stated that a new main surgery was
            not need to get extra services and highlighted that
            neighbouring practices had managed to do this with two

            Mr Maitland stated that in his opinion the PCT had not
            followed process.

            Mr Bill Carruthers advised that he lived in Langford and was
            concerned over the statement of Dr Tricks regarding never

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            considering building a new surgery in Wrington as the road
            system was not suitable. Mr Carruthers suggested that, if
            Dr Tricks had expressed this sentiment at the beginning of
            the consultation, the whole process would have been
            considerably reduced.

            Mr John Gowar highlighted the statement made by Penny
            Hynds regarding future proofing of the practice. He advised
            that over a year ago he had tried to open a discussion with
            the practice on ways in which the partners could be relieved
            of the limitations caused by their equity holdings in the
            practice premised. He advised that he failed because, at
            that time, they would not consider anything other than a
            single surgery and that left him worried about the level of
            commitment they would bring to the branch surgery.

            Mr Gowar highlighted that at the extra ordinary Board
            meeting Barbara Hardy quoted the actual rental for
            upgrading of the two surgeries that the Project Board
            thought would be reasonable. He requested that the figure
            of £155k be added to the minutes for the meeting. Mr
            Gowar advised that within the consultation document there
            was a statement that the upgrading of the two surgeries
            would be of no interest to the developer and said that he
            considered it a disgrace that the interest of the developer
            should have a higher priority than the needs of the patients.

            Mr Maitland also queried the comment in the minutes made
            by James White regarding being saddened by the
            judgement of the GPs being questioned and continued that
            he was more than saddened that the Board had chosen not
            to question the judgement of the practice in this matter.

            Mr Maitland concluded by saying that many of the
            Practice’s patients had formed the view that the doctors and
            the PCT had conspired together to railroad their proposal
            through the decision making process.

            The Chair thanked the members of the public for their
            comments and advised that, although they had a right to
            their opinions, he felt that the Board had taken sufficient
            assurance regarding the proposal.

PCT 05/11   Minutes of the Meeting held on 24 November 2010 and
            Matters Arising

            The minutes of the meeting held on 24 November were
            approved as an accurate record of the meeting.

            Matters Arising

                                                                            Page 3 of 12
            PCT 218/10 – Midwifery Services at the Children’s Centre –
            Becky Pollard advised that she had followed up this issue
            with Weston who had acknowledged that there were
            problems with access. Becky Pollard advised that Weston
            had assured the PCT that the problems would be
            addressed. Mike Lyall advised that the Weston Partnership
            Group had called an emergency meeting with
            representatives from the council regarding all aspects of the

PCT 06/11   Minutes of the Extra-ordinary Meeting held on 17
            December 2010 and Matters Arising

            The Chair highlighted that although minutes were not
            supposed to be a verbatim account of the meeting he was
            happy to take suggested amendments from Board

            Page 6 – third paragraph – should read “…… associated
            with Option 4 were less than for option 3 but that it was felt
            that the criteria were mostly met. However the score could
            be altered to partially met and would thus score 5”.

            Page 8 – paragraph 6 – James White advised that he stood
            by his comment which related to a comment which was
            made regarding personal mortgages being paid off.

            With the above amendment on page 6, the minutes were
            approved as an accurate record of the meeting.

            There were no matters arising.

PCT 07/11   Chief Executive’s Report including North Somerset
            Healthcare 2012

            Chris Born presented this report and highlighted the
            ongoing work on the operational plan which he advised
            would be a priority for the PCT over the coming weeks.

            Chris Born updated the Board on the North Somerset
            Healthcare 2012 work and advised that a meeting had been
            held with the Strategic Health Authority on 14 January. He
            advised that the local health community needed to come to
            a decision as to whether a premium for a small district
            hospital was appropriate but, that to do this, maximum
            efficiencies would have to be met. Chris confirmed that to
            date it had not been possible to conclude a route to an
            effective high quality hospital within the finances available.

            Chris also updated the Board on proposals for clustering of
            PCTs. He advised that the operating framework had
            outlined clusters with a single executive team with further

                                                                             Page 4 of 12
            guidance to follow. He advised that the guidance had still
            not been received and that the current position was that the
            PCTs would work in partnership and identify single teams
            across BNSSG where this was appropriate.

            Chris clarified that the North Somerset Partnership had
            given funding in advance of the receipt of Performance
            Reward Grant to some organisations to help achieve
            particular Local Area Agreement targets. Chris advised that
            the recession fund had supported third sector organisations
            but that the challenge was to enable them to remain
            sustainable for the future. Chris confirmed to Mike Lyall
            that some funding had been used for the development of
            the alcohol service and also into taking the lessons about
            neighbourhood developement learnt in South Ward and
            applying them to other areas.

PCT 08/11   Tender for alcohol Intervention Services, Process
            followed to reach a recommendation of Preferred

            Julie Kell present this report on the process followed to
            prepare a recommendation for the Board for the preferred
            provider which she advised would be presented in closed

            Discussion took place regarding the decision not to pursue
            a joint tender for both drug and alcohol services due to
            differences in timing and the process.

            Dr Mary Backhouse highlighted the prevalence of alcohol
            abuse and advised that in the past the joint monies had
            been used for funding drugs only.

            Kathy Headdon reported that the procurement group had
            been acutely aware that although they could have pushed
            harder to work with the council the outcome to patients was
            felt to be key.

            The Board noted the content of the process paper which
            supported the recommendation paper to be received in
            closed session.

PCT 09/11   Final Recommendations for the Head and Neck Cancer

            This report was presented by Mary Hutton who advised that
            when considered by the Professional Executive Committee
            concerns had been raised about the spoke system and that
            they had been assured that the proposal supported the care
            closer to home concept.

                                                                           Page 5 of 12
            The Board revoked the previous Bristol Health Services
            Plan decision to centralise adult ENT services at

            The Board agreed the proposed clinical service model for a
            centralised hub for all inpatient and day case head and
            neck cancer, ENT and OMF services with satellite and
            spokes providing diagnostic, follow up and less complex

            The Board agreed for the centralised hub to be located at
            the BRI and hub services to be provided and managed by
            UH Bristol and for UH Bristol to proceed with
            implementation planning for May 2012.

            The Board agreed for UH Bristol to work with local
            commissioners and providers from across the network to
            ensure there is good access to spokes across the network

PCT 10/11   Findings from a Review of Health Inequalities Work in
            North Somerset undertaken by a Department of Health
            National Support Team

            Becky Pollard presented this report and highlighted the
            positive outcome.     Becky highlighted that there were
            challenges around maintaining the focus during a period of
            financial challenges and focusing on those at high risk.

            Becky advised that a list of recommendations had been
            received with the PCT would now prioritise and produce a
            detailed action plan.

            The Chair reported that he felt proud of what had been
            achieved within the limited resources available.

            The Board noted the key findings.

PCT 11/11   Partnership Plan for Children and Families 2011 2014

            The Chair highlighted the changes in legislative
            requirements on page 4 and Chris Born advised that this
            was one of the reasons it was agreed to set up the
            partnership early. Chris advised that the partnership would
            review the plan after 12 months due to the cuts in both
            council funding and other budgets.

            Discussion took place regarding the lack of dates and
            responsibilities on the action plan and the lack of real
            measures of success.

            Kathy Headdon highlighted the rise in teenage pregnancy

                                                                          Page 6 of 12
            figures. Becky Pollard undertook to clarify the information      BP
            on teenage mums/teenage pregnancy with regard to exactly
            what was being counted but advised the Board that the
            action plan had been reviewed and that best practice was
            being followed.

            Chris Born confirmed that in terms of performance
            management there was a system which lay behind the
            partnership which was supported by the council and he           CB
            undertook to ensure that this was continuing.

            It was also agreed to see if additional work with regard to    BP/CB
            learning disabilities/disabilities could be included.

            The Board ratified the plan and gave their support to its

PCT 12/11   The Pharmaceutical Needs Assessment for NHS North
            Somerset 2011

            It was noted that the Board members had discussed the
            Pharmaceutical Needs Assessment in detail during the
            morning seminar session.

            The Board considered the assurance statements shown in
            Appendix 2 and the PNA itself and approved the NHS North
            Somerset Pharmaceutical Needs Assessment for
            publication on 1 February 2011.

PCT 13/11   Integrated business Plan for the Proposed Staff Led
            Community Services Social Enterprise

            The Chair highlighted that this proposal was one of the
            most important items on the agenda and that the Board had
            spent considerable time discussing it during the seminar
            session in the morning.

            Thelma Howell presented the paper which she advised was
            a summary of the 5 year business plan. Thelma highlighted
            that there were some key leadership posts which would
            need to be recruited to urgently.

            Thelma confirmed that there would be a community patient
            forum which would feed into the governing body.

            James White queried why the plan detailed waiting until
            year 4 for development of the commercial model when the
            income stream was static. Thelma Howell confirmed that
            the thinking on this had already been refined following the
            feedback from Finnamores and that she agreed with James
            regarding the need to diversify.

                                                                          Page 7 of 12
            The Board commented both that they felt the plan needed
            to be more ambitious and that there was a need from more
            detail regarding the transition period including costs and

            Paul Phillips highlighted the need to ensure that the ethos
            of the staff was appropriate with the understanding that this
            was a business enterprise.

            Chris Born advised that although the conditions for an
            integrated care organisation with Weston were not right at
            this time this was the first choice and that there was a need
            to maintain this option. Chris also highlighted that some
            people were suggesting that a larger social enterprise in
            conjunction with Bristol should be the way forward and
            therefore he wished to ensure that the Board were still
            supportive of the North Somerset Social Enterprise model.

            The Board supported in principle the proposal to establish
            the proposed staff led social enterprise, subject to due
            diligence and commissioning assurance requirements being

PCT 14/11   Commissioning Assurance Process of the Integrated
            business Plan for a Proposed Staff Led Community
            Services Social Enterprise

            The report was presented by Jeanette George who
            highlighted that the assurance process had been discussed
            during the seminar session together with a presentation
            from Finnamores.

            Jeanette advised that Finnamores had raised issues
            regarding business and commercial development and the
            need for a cultural change together with governance issues
            which needed to be resolved.

            It was agreed that a further report should be presented to
            the Board in February clarifying the assurance issues and          JG
            containing an action plan.

            The Board considered the content of the report and noted
            the commissioning assurance process, key outputs and

PCT 15/11   Health Inequalities in North Somerset Annual Report of
            the Director of Public Health 2010

            Becky Pollard presented the report and thanked Susan
            Hamilton and Helen Yeo for their input.

            Becky highlighted the focus on inequalities and the

                                                                            Page 8 of 12
            recommendations regarding the focus of services in the
            Marmot review.

            Mike Lyall highlighted the inequalities issues that were still
            prevalent in central ward. Chris Born advised that there
            had been improvements in health even in the more
            deprived areas but that the gap had widened.

            The Board noted the findings and recommendations set out
            in the report.

PCT 16/11   Performance Report

            Mary Hutton presented the report and highlighted the
            following key exceptions:

                  6 week diagnostic wait
                  2 week referrals for breast symptoms
                  4 hour A&E target

            Mary advised that both Weston and University Hospitals
            Bristol had achieved the 28 day target for cancelled ops in
            November and that the performance at North Bristol Trust
            had also shown an improvement.             Kathy Headdon
            highlighted the 17% of cancelled ops which were due to
            booking errors and Mary advised that Bristol PCT, as the
            lead commissioner, was following this up.

            Graham Nix expressed concern regarding the significant
            number of “red” and his disappointment in this particularly
            as a number of them referred to cancer targets. The Board
            requested the executive team consider how this might be Exec Team
            taken forward.

            Mary advised that the PCT had had its formal year end
            meeting with the SHA regarding the financial position.

            Mary advised that the acute trusts were continuing to over
            perform against contract. Mary detailed that there had been
            a significant shift from 0 and 1 day length of stay to 2 or
            more days in emergency activity since December 2009 at
            Weston. Mary advised that the PCT would be funding
            £600k for the year end due to pressures but that there
            would be no further payments for over performance. Mary
            confirmed that this was the agreed year end position

            Graham Nix queried the £1m of capital which was unspent
            at the end of December. Mary advised that she believed
            the PCT was on target to spend its capital allocation and
            confirmed that she would detail this in the next Board             MH

                                                                             Page 9 of 12
            The Board noted the performance and financial position of
            the PCT.

PCT 17/11   Patient and Public Relations Quarterly Report Quarters
            2 and 3

            Lynne Liptrott presented this report and highlighted the
            continued good relationship with the Health Overview and
            Scrutiny Committee and the successful “Your North
            Somerset” event.

            Lynne highlighted to the Board the decrease in complaints
            compared to the previous year and the increase in

            The Board noted the contents of the report.

PCT 18/11   Board Assurance Framework and Corporate Risk

            Presented by Penny Smith who advised that these reports
            reflected the position at the beginning of October.

            Chris Born highlighted that he would expect to see the
            addition of risks associated with transition in the next report.

            Kathy Headdon queried the entry regarding the breakdown
            of commissioned care package for a disabled child. Becky
            Pollard advised that the risk had been reduced but was still

            The Board noted the Board Assurance Framework and
            Corporate Risk Register and planned to receive updated
            reports at is February Meeting.

PCT 19/11   Human Resources Quarterly Report

            Marcus Ede presented this report and highlighted the
            sickness absence which was within target for both the
            commissioning and provider arms.

            Marcus provided an update on the statutory mandatory
            training as follows:

                                     Community Services    Commissioners
            Basic Life Support          67                   60
            Fire                        81                   79
            Manual Handling             70                   67

            Discussion took place regarding the level of attendance at
            mandatory training. Jeanette George queried the figures
            provided by MLE as these were not consistent with the

                                                                               Page 10 of 12
            figures she had for her directorate.

            Paul Phillips undertook to look into the accuracy of                    PP

            The Board noted the content of the report.

PCT 20/11   Use of the Trust Seal

            The Board noted the applications of the seal.

PCT 21/11   Six Monthly Update Paper for the SHA on Learning
            from Serious Untoward Incidents (1April to 30
            September 2010)

            This report was presented by Penny Smith who highlighted
            that significant work had been done with Weston resulting in
            an improvement of the quality of reports but that timescales
            were still an issue.

            The Board approved submission of the             report for
            submission to the Strategic Health Authority.

PCT 22/11   Professional Executive Committee Chair’s Report

            Mary Backhouse thanked the Non Executive Members of
            the Board for their attendance and input at PEC meetings.

PCT 23/11   Professional Executive        Committee      Minutes       –   9
            December 2010

            Received by the Board.

PCT 24/11   Community Services          Committee     Minutes      –       15
            November 2019

            Received by the Board.

PCT 25/11   South West Specialised Commissioning Group Minutes
            – 9 June 2010

            Received by the Board.

PCT 26/11   South West Specialised Commissioning Group Minutes
            – 4 October 2010

            Received by the Board.

PCT 27/11   Human Resources Committee Minutes – 30 November

                                                                                Page 11 of 12
            Received by the Board.

PCT 28/11   Governance and Risk Committee Minutes – 7 December

            Received by the Board.

PCT 29/11   Audit Committee Minutes – 12 January 2011

            Received by the Board.

            Graham Nix highlighted the report on the waiver of Standing
            Financial Instructions and the 3 audit reports all giving
            significant assurance.

PCT 30/11   Any Other Business

            There was no further business.

PCT 31/11   Motion to Exclude the Press and Public

            A motion was proposed by Graham Nix and seconded by
            James White to resolve under the provisions of Section 1,
            subsection 1 of the Public Bodies (Admission to Meetings)
            Act 1960 that the public be excluded from the meeting for
            the period that the Primary Care Trust is in committee, on
            the grounds that publicity of this item would be prejudicial to
            the public interest by reason of the confidential nature of the

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