QUALITY ALLIANCE BOARD
                           MINUTES OF MEETING
                           MONDAY 9 MAY 2011

Derek Feeley (Chair)     Acting DG Health and Social Care & Chief Executive of
Ron Culley               COSLA
Harry Burns              Scottish Government Health and Social Care Directorates
Ros Moore                Scottish Government Health and Social Care Directorates
Fiona Mackenzie          NHS Chief Executive’s Group
Charles Winstanley       NHS Chair’s Group
Carol Haraden            Institute for Healthcare Improvement
Audrey Birt              Long Term Conditions Alliance Scotland
Liz Breckenridge         Consumer Focus Scotland
Theresa Fyffe            Royal College of Nursing
Frances Elliot           Healthcare Improvement Scotland
Brian Durward            NHS National Education for Scotland
Emilia Crichton          Academy of Medical Royal Colleges and Faculties in
Jill Vickerman           Scottish Government Health and Social Care Directorates
John Connaghan           Scottish Government Health and Social Care Directorates

In attendance
Emma Watson              Scottish Government Health and Social Care Directorates
Anne Hendry              National Clinical Lead for Quality, Scottish Government
Jason Leitch             National Clinical Lead for Quality, Scottish Government
Claire Tester            Scottish Government Health and Social Care Directorates
Colin Brown              Scottish Government Health and Social Care Directorates
Andrew Wilkie            Scottish Government Health and Social Care Directorates
                         (for Item 9, NHSScotland Event)
Ros Gray                 Healthcare Improvement Scotland
Shelley Gray             Long Term Conditions Alliance Scotland
Jennifer Ross            NHS Grampian
Jeanette Morrison        Scottish Government Health and Social Care Directorates

Anne Aitken              Scottish Government Health and Social Care Directorates
Billy Wright             Scottish Government Health and Social Care Directorates

Welcome and Introductions

1.     The Chair welcomed everyone to the third meeting of the Quality Alliance
Board, which coincided with the first anniversary of the launch of the Quality

Apologies for Absence

2.     Apologies had been received from Malcolm Wright (deputised by Brian
Durward) of NHS Education for Scotland, John Colvin (deputised by Emilia
Crichton) of Academy of Medical Royal Colleges and Faculties in Scotland and John
Gallacher of the Scottish Partnership Forum (SPF)

3.    Michael Fuller had notified the Chair after the last meeting that he had retired,
so had resigned from the Quality Alliance Board. A replacement representative was
being sought. Acting Director General for Health and Social Care had written to
acknowledge his contribution.

Minutes and Actions from the Last Meeting (Paper QAB/10 & QAB/11)

4.    The Board agreed the minutes of the meeting on 22 February 2011 as an
accurate record, with a minor amendment to the organisation title for the Institute of
Healthcare Improvement. The Board then discussed the action points from the last

Single Outcome Agreements and the Quality Strategy

5.     Ron Culley advised that a second meeting had taken place, involving Scottish
Government, Third Sector, COSLA and SOLACE representatives, to explore the
ambitions of the Quality Strategy and how they can be achieved through the Single
Outcome Agreements. To ensure that the Quality Strategy is carefully positioned
with a wide range of stakeholders, it was proposed that:

     mapping work should be undertaken to map the Quality Outcomes against
      Single Outcome Agreement indicators and identify any gaps.
     HEAT targets should be linked to the Quality Outcomes and the process of
      developing HEAT targets should be inclusive, drawing on views from across
      public and third sector services.
     a wider set of discussions should be taken forward with SOLACE and the
      National Community Planning Group.

6.    The Board agreed that:

     the mapping exercise should be carried out.
     wider public services should be involved in developing HEAT targets and
      consideration should be given to the appropriate method of achieving this.

Action point: Ron Culley was given approval to continue with this work along the
proposed lines, taking account of the discussions.

Action Point: John Connaghan and Ron Culley are to give consideration to an
appropriate system for stakeholders to contribute to the future development of HEAT

Future Membership of the Board (Paper QAB/12)

7.    The Board members considered the request from the Scottish Independent
Hospitals Association and, the National Area Clinical Forum Chairs respectively to
become members of the Quality Alliance Board.           It was agreed that both
organisations should invited to nominate a representative. Colin Brown agreed to
send to members a copy of the Chief Executive Letter (CEL) that issued last year to
NHS Boards on the role of Area Clinical Forums.

Action point: Secretariat to formally invite the Scottish Independent Hospitals
Association and National Area Clinical Forum Chairs are formally invited to become
members of the Quality Alliance Board.

Action point: Secretariat to circulate the Area Clinical Forum CEL for information.

Quality Ambition Delivery Groups – Report on Progress

Mapping Key Actions Against Quality Outcomes & Indicators/ Delivery Group

8.     Jill Vickerman tabled two papers: the first mapped the key actions from each
delivery group to the quality outcomes and indicators, the second paper showed a
template for use by the Delivery Groups in updating the Board on progress.

9.     The Board discussed the papers and reflected on progress since the launch
of the Strategy a year ago. Summing up the Chair proposed that:

     an item was needed for a future Board meeting on where NHSScotland has
      reached in the process of transition to a quality focus, highlighting
      achievements to date;
     the Board needs to have quality outcomes data to consider soon; and
     a Board discussion is needed about acceleration, bringing in how we can use
      NHS Board Annual Reviews and what members of the Board are doing out-
      with the meetings to keep up the momentum.

Action point: Jill Vickerman to produce an achievements to date paper for the next

Action point: Jill Vickerman to provide a detailed update and graphs on the quality
outcomes for the next meeting.

Action point: A paper on the new arrangements for Annual Reviews and how the
Annual Reviews and Local Delivery Plans will be used to accelerate change and
maintain momentum.

Action point: Secretariat to ensure that the agenda for the next meeting includes a
discussion on how HEAT targets are aligning with the quality agenda how
development of 2011-12 targets is progressing.


10.    Jill Vickerman provided a brief verbal update on the Infrastructure Delivery
Group. She indicated that a small group has been established with senior
representation from territorial and special Health Boards. A focused initial discussion
had taken place which considered the six Action Groups that will sit under the
Delivery Group. The Action Groups are currently prioritising their key pieces of work.

11.    In the discussion it was recognised that the Infrastructure Action Groups face
a challenge to ensure that they provide support across the Quality Ambition Delivery
Groups. The Infrastructure Delivery Group agreed that it needs to ensure that
appropriate linkages are being developed, but additionally indentify a small number
of key areas for improvement that it will ensure progress on over the year ahead.

Effective Ambition

12.    Anne Hendry provided a brief update on the progress of the Effective Delivery
Group. She advised that work has taken place to establish the three Action Groups;
Reshaping Care, Improving Population Health and Children and Families, that will sit
under the Effective Delivery Group, and that the focus is now on establishing priority
areas for action and ensuring outcomes.

Safe Ambition

13.   Frances Elliot provided a brief update on the progress of the Safe Delivery
Group. She advised that group has held its second meeting and is the process of
mapping all the safe work which takes place nationally and locally and will identify
any gaps that exist.

Action point: Secretariat to circulate a copy of the completed mapping exercise on
safe activity to Quality Alliance Board members.


Quality Compact (Paper QAB/13)

14.     Jill Vickerman presented a proposal on workforce/clinical engagement, based
on the concept of a quality compact, which would be a catalyst for a bilateral
discussion and agreement about respective “gives” and “gets” between teams,
clinicians and management, organisations or even between the NHS and public.
She advised that this was drawn from the Virginia Mason model used in the USA to
effectively engage of clinicians and management to accelerate change and to
improve quality, which had been discussed at the recent IHI conference in

15.    Points raised in discussion included:

     The concept is good, and provides an opportunity to set out shared language
      about what quality care is, however it is important that this is not seen as a
      top-down approach.
     Any work should align with the existing work including the National Clinical
      Leadership Programme, Area Clinical Forums activity, the Practitioner
      Programme and work with nurses on professionalism and core values, to
      ensure there is no duplication.
     Examples of interaction between management and wider staff is important
      and has proved successful in the past.
     Learning from other countries is important.
     Any work needs to focus on the whole team rather than just doctors.
     There are a lot of initiatives already taking place to improve clinical excellence
      and communication amongst staff and this should build on, not duplicate
      these. The concept needs to ensure it is not overly bureaucratic for staff.
     The concept could encourage a change in thinking and could build on existing
      quality work on staff communications.

16.   Summarising the discussion the Chair proposed that:

     A shared language is needed on quality.
     There is a need to try and further mobilise clinical engagement and ownership
      to move the Quality Strategy forward.
     There may not be enthusiasm to pursue a ‘compact’, but unwarranted
      variation in practice should be identified and removed.
     It reinforces the importance of regular discussions and the need to build on
      what we already have.
     It is important that any development of the compact covers teams rather than
      looking at one or two individual disciplines.
     Management should be included in any work that is to be taken forward.
     The NHSScotland should be in a position to implement this work due to
      having an integrated health system and established arrangements in place.

17.   It was agreed that a working group should be formed to take this work
forward, running alongside the work that Charles Winstanley and Fiona Mackenzie
are doing with NHS Boards. Jill Vickerman, Emma Watson, Fiona Mackenzie and
Charles Winstanley would meet to discuss it further, then develop options for

Action point: Jill Vickerman to form a working group and bring a proposal back to
the Board for the next meeting.

Note: Derek Feeley left the meeting and Dr Harry Burns, Chief Medical Officer
assumed the Chair.

Person-centred Ambition (Paper QAB/14)

18.    Ros Moore presented a paper on achieving the person-centred ambition. She
reflected that the person-centred ambition had been less developed than the others;
so much of the initial work had been about developing the process elements to

support it. She suggested that while person-centred means something to everyone,
there is no definitive problem or solution in terms of person-centred care.

19.     She indicated that meeting zero of the Person-centred Delivery Group had
taken place and the full group had been established. Four action groups have been
established - Enabling Person-centred Care, Clear Communication, Effective
Collaboration, Improving Experience and Outcomes and Supporting Staff to have the
Best Possible Experience. She sought views from the Board on membership of the
Delivery Group and the identified focus of their work, which would build on existing

20.   The following points were raised in discussion:

     ADSW should be invited to nominate a representative to become a member of
      the Delivery Group.
     For hospital based medicine, some of the representatives could cover and
      others could be brought in if needed.
     There is a need to articulate quick wins. There may be an opportunity to frame
      this in the context of social care work on personalisation and to bring these
      pieces of work together.
     Person-centred care should be relevant and beneficial to staff as well as
     The approach is welcome and the systems approach is clear. There is a need
      to explore how success would look like.
     Person-centred work should link with the work on personalisation. Work on
      person-centred care will need to be aligned to work on Self Directed Support
      as this is likely to become the default model for social care in the future.
     Work on person-centred care should be linked to the shared narrative on

21.    It was agreed that the proposed person-centred work was a good starting
point and that future work should consider what person-centred care will look like
and how progress towards that is mapped.

Safe Ambition

Medicines Reconciliation (Paper QAB/15)

22.    Jason Leitch, Jennie Ross and Ros Gray presented a proposal for a
programme of work on medicines reconciliation. They advised that it would be a six
month programme starting in the summer with involvement from four or five NHS
Boards. The aim would be to get 95% of elderly patients medicines reconciled on
admission and discharge to and from acute care and take the learning to the other
parts of the service. The project would build on projects like that for SABs and the
pockets of excellence across the country.

23.   The following points were raised during discussion:

     This work should be linked to the self-management agenda, particularly
      around patients taking their own medicines.

     It is not possible for the project to cover measurement of adverse events to
      assess progress.
     There needs to be a clear link to current medicines reconciliation work and to
      build on existing activity.
     Person-centred care needs to be more involved around the drivers, but it is
      important that the results of this work does not add more bureaucracy.
     Acute elderly physicians need to be involved in progressing the work on
      medicines reconciliation given their experience.

24.   It was agreed that the project should link to all three Delivery Groups, but that
the Safe Delivery group – through the Acute Adult Action Group – should take a lead

Action point: Jason Leitch, Jennie Ross and Ros Gray to finalise the details of the
project and take forward. A progress report should be provided through the Safe
Delivery Group at the November meeting with a full report provided early next year.

Any Other Business

NHSScotland Event (Paper QAB/16)

25.    Jill Vickerman, joined by Andrew Wilkie, presented a paper on the forthcoming
NHSScotland Event which takes place on 23 and 24 August 2011. She advised
members that the programme would be circulated shortly for comment, with a view
to going live in June 2011. It is proposed that in addition to the plenary sessions
there will be 32 breakout sessions taking place over the two days covering the three
quality ambitions plus infrastructure.

26.   The following points were made in discussion:

     The event should be used to link to the work on efficiency and productivity.
     It is important to get input and involvement from the third sector, social care
      and local authorities.

Action point: Andrew Wilkie to ensure that the NHSScotland Event programme
reflects involvement from the third sector and social care and that it links to work on
efficiency and productivity. Secretariat to circulate the draft Programme to members.

Review of Knowledge Services

27.    Colin Brown provided an update on the Review of Knowledge Services which
is currently ongoing with Healthcare Improvement Scotland and NHS Education for
Scotland. He offered to circulate more detail on the review to members.

Action point: Secretariat to circulate the Review of Knowledge Services paper for
their information.

Next Meeting

28.   The next meeting of the Quality Alliance Board will take place on Friday 23
September 2011 at 14.00 at Healthcare Improvement Scotland, Elliott House,


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