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Argyll & Bute CHP Committee th 26 July 2007 Item 3.0

MINUTE OF MEETING OF THE ARGYLL & BUTE CHP COMMITTEE Village Hall, Craignure, Isle of Mull Present

14th June 2007: 11.00am

Bill Brackenridge, Chairman, Argyll & Bute CHP Fiona Ritchie, Argyll & Bute CHP General Manager Robin Creelman, Chairman, Public Partnership Forum Elaine Garman, Public Health Rep. John Herrick, Area Dental Committee Rep. Donald McIntosh, Argyll & Bute Council Rep. Fiona Thomson, Area Pharmaceutical Committee Rep. George Freeman, Argyll & Bute Council Rep. Kate MacAulay, Staffside Rep. Pat Logan, CVO Rep. Pat Tyrrell, Lead Nurse, A&B CHP Jim Robb, Head of Integrated Services Argyll & Bute Council Stephen Whiston, Head of Planning and Performance, A & B CHP George Morrison, Head of Finance, A & B CHP David Logue, Head of HR, A&B CHP David Whiteoak, Locality Manager, Oban, Lorn & The Isles, A&B CHP Viv Shelley, Non-Executive Director David Ritchie, Communications Manager, A&B CHP Christine Gosman, Executive Assistant, A & B CHP

In Attendance

Item 1.0 Chairman’s Welcome The Chairman welcomed everyone to the meeting at Craignure, the first one to be held in public. Introductions were then made from everyone present. Item 2.0 Apologies Apologies for absence were received from: Ann Clark, Non-Executive Director Evelyn Hide, Vice Chairman, Public Partnership Forum Dougie Philand, Partnership Forum Rep. Tricia Morrison, CVO Rep. Additional Item Bill Brackenridge stated that he wished to begin with an important news release from NHS Greater Glasgow & Clyde, which detailed a full review of breast cancer services at Inverclyde Royal Hospital in Greenock. Fiona Ritchie proceeded to read out the full press release, which detailed the review of services and the actions taken to contact the patients identified (198 in number) who will be recalled for further consultation to ensure that their original diagnosis was correct.

Item 4.0 Matters Arising Mr McIntosh enquired as to the dentistry presentation to the Committee, as detailed under item 6.1 in the previous Minute. Bill Brackenridge stated that a presentation on dentistry would be included on the July agenda. The Committee agreed to the inclusion of a dentistry presentation on its July 2007 agenda.

Item 5.0 NHS Highland Health Board Meetings Item 5.1 NHS Highland Health Board Meeting of 1st May 2007 Bill Brackenridge spoke to a previously circulated paper, which outlined the Minute from the meeting. He highlighted a couple of areas which held specific interest for Argyll & Bute CHP:  Allocation of Funding to voluntary and independent sector organisations Bill Brackenridge informed the Committee that Argyll & Bute CHP held delegated responsibility for allocating funding for the Voluntary sector, unlike the rest of NHS Highland. Pat Logan asked what the proposals within the CHP were for this. George Morrison stated that the Finance team were currently identifying the current allocation, in conjunction with Local Authority partners, to the voluntary sector. Once these figures had been verified, these would be presented to the CHP Committee.  NHS Highland Financial Position for the period to 31st March 2007  Agenda for Change George Freeman asked why NHS Greater Glasgow & Clyde held the responsibility for Agenda for Change assimilation for Argyll & Bute CHP and Not NHS Highland. David Logue informed the Committee that the payroll agents for Argyll & Bute CHP remained with NHS Greater Glasgow & Clyde post dissolution due to systems compatibility and it was deemed impractical to move the AfC assimilation at that point in time. Item 5.2 NHS Highland Health Board Meeting of 5th June 2007 Bill Brackenridge gave a verbal update to the Committee on the events of the Board meeting, which took place on 5th June 2007. The Committee noted the contents of the Minute and the verbal update.

Item 6.0 Clinical Governance Pat Tyrrell spoke to a previously circulated paper, which summarised the activities and key priorities for the Argyll & Bute CHP in Clinical Governance and Risk Management. She gave the Committee further details on items such as the CHP Risk Register, audit, incident reporting, complaints, training and external inspections. Pat Tyrrell concluded her presentation by stating that the action plan to address the main recommendations of the HMIe Child Protection Inspection report was signed off on 7th June by the Argyll & Bute Child Protection Committee and the progress reports, expected on a six monthly basis would be presented to future meetings of the CHP Committee. The Committee noted the contents of the paper and agreed the key priorities for Clinical Governance and Risk Management within the CHP.

Item 7.0 CHP Management Team Fiona Ritchie informed the Committee that senior managers within the CHP had recently attended a performance review with NHS Highland, marking the first anniversary of the formation of Argyll & Bute CHP. Fiona outlined the robust process involved in the review and stated that very positive feedback had been received. Item 7.1 Update on meeting of 19th April 2007 Fiona Ritchie, as Chairman of the CHP Management Team spoke to a previously circulated Minute, which outlined the meeting of the Team on 19/04/07. Robin Creelman, as a member of the Management Team questioned the wording of Item 5.1 Delayed Discharge (page 5) stating that his understanding was that the „interim measure‟ would not necessarily be the patient‟s second choice of care package. Jim Robb confirmed that this was sometimes the case due to lack of availability of care home places in some areas. Fiona Ritchie agreed to amend the Minute to reflect this. Item 7.2 Update on meeting of 24th May 2007 Jim Robb pointed out an error in the wording of Item 4.0 Argyll & Bute Council/Social Work Review and Structure where the Minute indicated that he had stated that staff shortages were a cause of some of the problems encountered within children‟s services. Mr Robb stated that this was not accurate however would be pointing this fact out when the Management Team next meet and the Minutes are checked for accuracy. The Committee noted the Minute of the CHP Management Team meetings.

Item 8.0 Performance Item 8.1 Balanced Scorecard year –end 06/07 Item 8.2 Balanced Scorecard 07/08 Stephen Whiston spoke to a previously circulated document which detailed Argyll & Bute CHP‟s performance against a range of key targets and indicators within the context of the Local Delivery Plan and a number of other supplementary measures. Stephen Whiston continued to detail a number of particular areas of performance for noting: Sickness & Absence Performance this period shows a slight improvement from previous month and is the absence rate is the best monthly performance of the year. For the first time the CHP is within 1% of the NHS Boards target. The Head of HR spoke to a previously circulated document, which set out an action plan designed to address this area. Viv Shelley pointed out the difference between the text and the graphs, which would indicate an anomaly with the recording figures. Mr Logue agreed to address this issue. Some discussion then followed regarding the details of the managing absence workshops and whether it was possible to separate out different kinds of sickness absence e.g. stress related illness from the figures shown. Mr Logue stated that this was not routinely carried out however this was something NHS Highland are currently working on and it was hoped to have this kind of information for future reports.

Cancelled admissions The latest information shows procedures cancelled in Dunoon and Oban and his therefore attracts an amber rating, Locality Managers are exploring the detail of this to prevent a recurrence. Reasons for cancellations include patient decisions and equipment breakdown beyond normal trends. SMR Return rate (Standard Morbidity Recording) Latest information shows a low monthly percentage return, within the caveat that there is a 3-month lag in final coding. Dental registrations - Exception report attached - No change as this is an annual figure. Mr Whiston pointed out that a new measurement was set out in the Scorecard for 07/08. Inpatient/Day case ASCs, (Availability Status code) - This months report shows an improvement of the position compared to last month. The E-Health department are leading a project process to move the CHP onto the “New Ways” definition of recording suspension from waiting lists. An update will be presented at the next CHP Waiting Times group meeting. Other actions in hand to clear ASCs from the waiting list continue to focus on those with the longest waits. Achieving cancer targets is still challenging. The latest quarterly report attracts an amber rating (83.3%); however the disproportionate impact of small numbers has skewed the statistical return. The Bi weekly CHP and weekly locality monitoring systems continues and reports are issued to all Locality Managers and medical records departments to track patients, these reports also include look forward projections. The CHP cancer action plan also continues to be updated and monitored by the CHP waiting times group Delayed Discharges. The latest figures are reported. This shows that the CHP and council are now very close to meeting the SEHD target for delayed discharge rates and so attracts an amber rating. This is further discussed at item 8.4. Mr Whiston then spoke to the final draft version of the new score card template for 2007/08, which had been previously circulated. He stated that this report sees the introduction of a number of new targets and amendments to existing targets as reviewed previously. He stated that this draft has been populated with information for April but is not finalised, as confirmation has not been received regarding the source and frequency of information. Mr Whiston concluded his presentation by stating that the Head of E-Health will now take over responsibility for populating the score card with the information by the production deadlines and that he would be working with the target leads to manage, review and report performance within the CHP and to the NHS Board. Jim Robb stated that it would be helpful to have some Balance of Care performance recording within the new scorecard. Fiona Ritchie agreed that this would be very helpful and agreed to meet with him and Stephen Whiston outwith this meeting to discuss the appropriateness of developing the CHP‟s own version of the scorecard, including such issues to be used on a more localised basis. Fiona Ritchie agreed to report any findings back to the Committee.

The Committee noted the performance set out in the Balanced Scorecard concerning Argyll & Bute CHP, noted the areas of performance where particular improvement in performance is indicated and the actions proposed. The Committee also noted the changes to the scorecard for 2007/08. Item 8.3 National Waiting Times Targets Stephen Whiston spoke to a previously circulated paper which detailed the position at the end of April 2007 of Argyll & Bute CHP against the national waiting times targets: 2.1 Target: By December 2007 no patient will wait more than 18 weeks for a first consultant outpatient appointment in acute specialities. Performance: This target has been achieved for the majority of the clinics conducted however there remains small number of specialities where this target is currently exceeded. 2.2 Target: By December 2006 no patient will wait more than 18 weeks for admission to acute specialities. Performance: This target has now been achieved and is being maintained at the 3 hospitals were we conduct this activity (Lorn and Islands of Rural General Hospital, Rothesay Victoria Hospital, Dunoon community Hospital)
DIAGNOSTICS

Target: By December 2007 no patient will wait more than 9 weeks for eight diagnostic tests

The Chief executive of NHS Highland has requested that the whole of NHS Highland achieve this target by the end of May 2007. Performance: Overall the CHP looks like it will be able to achieve the 9-week target by May. However, this may be breached in Dunoon due to a temporary cessation of the scope/day case service in Dunoon from 31st March 2007, lasting 8 weeks. This is due to a new washer/disinfection unit being installed. To mitigate this patients are being offered appointments at Rothesay or Inverclyde 18 Week Outpatient Pathway This suggested target proposes a combined 18-week waiting time for outpatient appointments that require a diagnostic test. Locality managers are examining which specialties locally could be affected by this target, and developing proposals accordingly. The need to map referral information between different patient computer systems e.g. outpatient and X-Ray is a significant issue. An activity analysis report is awaited from the Head of E Health for the CHP both within the CHP and outwith with NHS GG&C. In addition a response from the SEHD is awaited from NHS Highland regarding how this objective can be met. Mr Whiston stated that additional recurring funding has been released to NHS Highland £568,000 recurring for Diagnostics a proportion of which is to go to the CHP. In addition the CHP has £200,000 in capital to support to support this initiative both within and outwith the area.

NHS Greater Glasgow and Clyde With regard to diagnostic services, this funding was passed completely to NHS GG&C at the start of the year for 2006/07. The CHP is still awaiting receipt of diagnostic waiting time financial plan from NHS GG&C and so this remains outstanding. No proposals have been received from NHSGG&C for 2007/08. Funding 2007/08 As previously reported the General Waiting times funding allocation to NHS Highland is a non-recurring allocation of £1.25 million and once again a proportion of this is for the CHP. In addition the CHP has carried forward £265,000 to support local bids and NHSGG&C requests. Mr Whiston concluded his presentation by stating that these are in the process of being defined and confirmed and further information will be brought back in due course. Viv Shelley suggested that the implications for Clinical Governance should be entered onto the report for future presentations. Mr Whiston agreed to action this. The Committee noted the General Waiting Times – Position at end of April 2007 Diagnostic Waiting Times – Position at the end of April 2007 and Funding allocations and process in developing plans for utilising this in 2007/08

Item 8.4 Delayed Discharge Jim Robb spoke to a previously circulated document, which detailed the delayed discharge statistics for Argyll & Bute CHP as at 15th May 2007. Mr Robb stated that the total figures note a fall from the high of 78 during August to a low of 26 at 15th May 2007 asking the Committee to note that the Scottish Executive reporting system is not based on the total figures rather the 6 weeks plus waiting time and the short stay specialist beds. He continued to state that further analysis of the figures highlight a significant reduction in clients waiting for six weeks plus from a high of 61 reported for July to a low of 5 at 15th May against the Scottish Executive target of 10. The delays in short stay specialist beds fell from a high of 12 reported to the Scottish Executive during October 2006 to a low of 0 at 15 th May against a target of 3. Mr Robb then went on to discuss the additional 11 patients that are presently blocking beds within the NHS who are not reported to the Scottish Executive; 5 coded as Adults with Incapacity and 6 out of authority placements within the Vale of Leven Hospital (4) and Dyke Hospital, Paisley (1) and the Southern General, Glasgow (1). Mr Robb stated that although not reported, the Partnership retains assessment and financial responsibility for the 11 noted. This is a significant fall in the number reported for April which stood at 20 ( 5 AWI and 15 out of area placements) Mr Robb concluded his presentation by informing the Committee that the progress being made in the reporting figures has been significant. Given the council financial allocation for care home placements and home care for 2007/08 it is projected that it is possible for the 0/0 target for March 2008 to be met by September 2007. Bill Brackenridge expressed his thanks on behalf of the CHP to all staff in both organisations who have contributed to this achievement with their hard work and commitment. Bill Brackenridge also noted the Committees thanks to both Jim Robb and Fiona Ritchie for successfully driving this important issue forward. The Committee noted the contents of the Delayed Discharge Report and noted its thanks to staff from both organisations.

Item 9.0 Finance Item 9.1 Finance Report George Morrison spoke to a previously circulated paper asking the Committee to note that the final revenue outturn for Argyll & Bute CHP in 2006/07 was an underspend of £2.012m. Mr Morrison stated that the main reasons for this position were; underspends on hospital and community services, GMS and prescribing budgets, together with uncommitted reserves, which mostly related to unspent specific allocations. Mr Morrison continued to stated that the final revenue outturn for NHS Highland in 2006/07 was an underspend of £6.67m. The main contributing factors to this position were anticipated proceeds from the sale of the former Craig Dunain hospital site together with the A&B CHP underspend referred to above. The Board underspend of £6.67m will be carried-forward to 2007/08 and it is understood that this non-recurring funding will be managed on a Board-wide basis. Mr Morrison continued to updated the Committee on the following financial issues: Commissioning Contract with NHS Greater Glasgow & Clyde There is an estimated £4.0m gap, which exists in relation to our patients‟ services contract with NHS Greater Glasgow & Clyde. It is understood that discussions are taking place between the Boards and the Scottish Executive over how this gap can be tackled and how bridging funding can be factored into arrangements. Revenue Savings Targets 2007/08 The approved savings target for 2007/08 is £1.5m, of which £790k is recurring and £710k is non-recurring. Managers are expected to identify and implement savings within their area of responsibility and reports on progress towards achievement of savings targets throughout the course of the year. Internal Audit Services Until recently, NHS Greater Glasgow & Clyde provided internal audit services within the CHP under an SLA arrangement. That arrangement has now ceased and as a result, the Board‟s Director of Finance is looking to expand the remit of the current NHS Highland internal auditors, Deloittes, to cover the Argyll & Bute area. There is currently a gap in terms of internal audit service provision, which is a risk to the organisation, but a replacement service should be established in the near future. Mr Morrison then referred the Committee to the previously circulated timetable of Finance Papers, which would be presented to future meetings of the CHP Committee. Some discussion then took place regarding the realistic „gap‟ figure of £4m and how this would impact on services within Argyll & Bute CHP. Mr Morrison stated that he was confident of the validity of this figure and that he would expect this to be managed over a period of time. Further discussion took place regarding the waiting times funding negotiations with NHS Greater Glasgow & Clyde. Mr Morrison stated that negotiations were ongoing and further updates would be presented to the Committee in due course. Viv Shelley asked how long it would be before the internal audit service would be established. Mr Morrison stated that there was no timescale available however assurances had been received from NHS Highland that it would be soon.

Some clarity was sought regarding mental health funding. It was stated that mental health services were now managed within the localities and the budget had been devolved accordingly. Bill Brackenridge asked what was the position regarding the CHPs Mental Health Strategy. Fiona Ritchie stated that this was now at version 3.0 and that it would be presented to the Committee when finalised. The Committee noted the Finance Report.

Item 9.2 Capital Plan 07/08 George Morrison spoke to a previously circulated paper which outlined the major capital developments, minor scheme allocations e.g. replacement vehicles, minor estate upgrades etc, medical equipment replacement and property disposals. It also details the financial schedules, which capture the capital allocations and all known commitments and proposals over the next 5 years. Mr Morrison asked the Committee to note that the CHP has an allocation of £8.677 million and a current expenditure plan of £6.42 million for 2007/08. Mr Morrison concluded his presentation by stating that the CHP has undertaken an estate condition survey review, which was presented at a workshop on 23rd May 2007, where a number of scenarios were developed to inform the ongoing estate and property strategy. The findings of this will inform the final prioritisation and iteration of the plan by the CHP capital-planning group in 2007/08. The Committee noted the CHPs 5 year Capital Plan and noted that this plan was approved by the CHP Management Team at its meeting on 24th May 2007

Item 10.0 Public & Partnership Election Status Mr Whiston spoke to a previously circulated document, which gave background to the election process for the dual role of Chair and Deputy Chair of the PPF and appointment to the Community Health Partnership Committee. Mr Whiston detailed the election process in other CHPs and the Specialist Services Unit in NHS Highland, noting the differing arrangements in place. Brief discussion then took place with Mr Creelman voicing his concern over the appropriateness of this tool for Argyll & Bute PPF. The Committee noted the paper detailing the election process for the PPF for 2007.

Item 11.0 Argyll & Bute CHP Public Partnership Forum Update Item 11.1 Minute from meeting of 20th March 2007 Mr Creelman spoke to a previously circulated Minute from the PPF Network Event, which took place on 20th March 2007. He stated that PPF meetings generally follow the outlined format and hoped that this full Minute would give the Committee a feel of the role of the PPF. Item 11.2 Update for Meeting of 22nd May 2007 Mr Creelman gave a verbal update from the latest meeting of the PPF. He informed the Committee that the issues of capacity building and identification of locality strategies was being investigated. However locality PPFs were not yet fully up and running.

Pat Tyrrell asked Mr Creelman if the PPF were looking to carry out training for its members similar to that being undertaken by the Highland Healthvoices network. Mr Creelman confirmed that this was currently being investigated and that a training needs assessment would be carried out for PPF members. The Committee noted the Minute from the PPF meeting of 20 th March 2007 and noted the verbal update given from the meeting of 22nd May 2007.

Item 12.0 Staff Governance Item 12.1 Minute from the meeting of 11th April 2007 Fiona Ritchie spoke to a previously circulated paper, which detailed the Minute from the CHP Partnership Forum, which took place on 11th April 2007. She asked the Committee to note that the format of work from the Argyll & Bute CHP Partnership is to be shared within NHS Highland as an example of good practice. The Committee noted the Minute from the CHP Partnership forum of 11th April 2007. Item 12.2 Agenda for Change Implementation David Logue spoke to a previously circulated paper, which detailed the current position on AfC implementation within Argyll & Bute. He continued to detail the position concerning progress on the payments of arrears to staff and the assimilation of bank staff on to AfC arrangements. He concluded his presentation by outlining the actions taken by the Director of HR to address the issues of concern with NHS Greater Glasgow & Clyde, who retain the work of completing the AfC implementation for Argyll & Bute CHP on behalf of NHS Highland. Some discussion followed with Kate Macaulay stating that this was a very stressful time with a large number of staff feeling that NHS Greater Glasgow & Clyde are not placing Argyll & Bute staff high enough on their agenda. Bill Brackenridge assured the Committee that both NHS Highland and the senior management of Argyll & Bute CHP view this as a very important issue and that everything was being done to ensure that implementation of AfC is progressed as a matter of some urgency. The Committee noted the current position on AfC implementation, the position concerning progress on the payments of arrears to staff in Argyll & Bute CHP and the position concerning the assimilation of bank staff on to AfC arrangements. The Committee also supported the Director of HR and her staff in making the case for priority for assimilation of Argyll & Bute staff within the NHS Greater Glasgow & Clyde arrangements. Item 12.3 Workforce Development Plan Pat Tyrrell spoke to a previously circulated paper, which gave background and summary to the Argyll & Bute Implementation Plan, which has been developed from the overall workforce plan for NHS Highland, which was submitted to the Scottish Executive in May 2007. The Committee noted the contents of the Workforce Development Plan and agreed the associated CHP Implementation Plan.

Item 13.0 Long Term Conditions Toolkit and Action Plan Pat Tyrrell spoke to a previously circulated paper, which detailed the plan to ensure services and care for long term conditions are integrated, responsive and of a high quality. She informed the Committee that the toolkit provides evidence of current performance within the CHP and identifies key actions necessary within the year 2007-08. Pat Tyrrell concluded her presentation by informing the Committee that this work would be led for the CHP by Elaine Garman and that a Long Term Conditions Manager would be in post soon.

The Committee noted and agreed the contents of the long Term conditions Toolkit and Action Plan. Item 14.0 AOCB Fiona Ritchie informed the Committee that interviews for the Argyll & Bute CHP Clinical Director take place w/c 18th June 2007.

Item 15.0 Date, Time and Venue of Next Meeting The next meeting will take place on Thursday 26 th July 2007, 9.30am, Council Chambers, Kilmory, Lochgilphead The Chairman asked the Committee to note that the public Q&A session will take place on that date between 1.00 – 1.30pm

ARGYLL & BUTE CHP COMMITTEE Village Hall, Craignure, Isle of Mull

Public Question & Answer Session 1.15 – 1.45pm

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Previous Minute and current agenda to be made available to public in advance of meeting Chairman agreed that this would be made available either via the NHS Highland website or by public application to Communications Manager.

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Format for submitting written questions to be clarified Chairman agreed that an appropriate format would be investigated and put in place prior to the next Committee meeting