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					                        KIRKLEES PRIMARY CARE TRUST

  Minutes of the Trust Board Meeting held on Wednesday 30 April 2008 at
      9.15am in Training Room 5, The Deighton Centre, Huddersfield

Rob Napier                 Chair
Mike Potts                 Chief Executive
Vanessa Stirum             Non-executive Director and Vice Chair
Rob Millington             Non-executive Director
Imran Patel                Non-executive Director
Mehboob Khan               Non-executive Director
Tony Gerrard               Non-executive Director
Valerie Aguirregoicoa      Non-executive Director
Dr David Anderson          Chair, Professional Executive Committee
Bryan Machin               Executive Director of Finance
Carol McKenna              Executive Director of Commissioning and Strategic
Sheila Dilks               Executive Director of Patient Care and Professions
Dr Judith Hooper           Executive Director of Public Health (from 9.45am)

In attendance
Helena Corder            Director of Corporate Services
Peter Flynn              Director of Performance and Information
Sue Ellis                Director of Human Resources and Organisational Development
Denise Boyd              Deputy Director Business Development and Localities
David Thompson           Observer
Helen Hyde               Assistant Director of Communications and Public Relations
Alison Fearnley          Corporate Governance Administrator
Pauline Kershaw          Executive Assistant
Three members of the public

The Chairman opened the meeting by welcoming all those in attendance. He explained
that David Thompson was in attendance as an Observer following the disbandment of the
Patient and Public Involvement Forum and that David was now the link to the Local
Involvement Network (LINks).

Questions from the public

The Chairman gave members of the public an opportunity to raise any questions.
No questions were raised.

KPCT/08/73         Apologies for Absence

                   Apologies for absence were received from Robert Flack, Director of
                   Provider Services and Sarah Brackwell, Professional Executive
                   Committee member.

                                Page 1 of 14
KPCT/08/74   Declarations of Interest

             No Trust Board members declared interests in any of the Agenda

KPCT/08/75   Minutes of the meeting held 26 March 2008

             The minutes of the Trust Board meeting held on Wednesday 26 March
             2008 were AGREED as a true and accurate record.

KPCT/08/76   Matters Arising

             KPCT/08/54 Chief Executive’s Report

             Contract Negotiation

             Carol McKenna provided a further brief update on the signing of
             contracts with the main providers.

             It was noted that the contract with Leeds Teaching Hospitals Trust had
             still not been signed.

             Denise Boyd provided a verbal update on progress with the
             development of the proposed national standard contract for community
             services. It was noted that this work was proving positive.

             KPCT/08/63 Standards for Better Health

             Sheila Dilks provided clarification that the PCT has sufficient evidence
             to support compliance against the following standards:

                   Standard 4c relating to decontamination
                   Standard 21b relating to cleanliness of estates

             The Board acknowledged that the Declaration has been submitted on
             29 April 2008.

             KPCT/08/65 Health Care Associated Infection

             Mike Potts confirmed he was engaged in discussions with the Chief
             Executives of both Calderdale and Huddersfield Foundation Trust
             (CHFT) and Mid Yorkshire Hospitals Trust (MYHT) to monitor
             performance and implement the actions plans to reduce healthcare
             associated infections.

             Sheila Dilks reassured the Board she was confident that the numbers
             are beginning to reduce and that acute Trusts are taking a rigorous
             zero tolerance approach to tackling healthcare associated infections.

                          Page 2 of 14
KPCT/08/77   Chief Executive’s Report

             Mike Potts presented his report to the Board highlighting the following:

             KPCT/08/77.1         Mid Yorkshire Hospitals NHS Trust

             Toby Lewis, Chief Operating Officer, has left MYHT to take up the post
             of Director of Strategy at University College London Hospitals NHS
             Foundation Trust on 1 April 2008.

             Angie Watson is Acting Chief Operating officer until further notice.

             John Harris is to take up the post of Chairman, on 1 May 2008.

             David Dawson is retiring from his post as Medical Director on 31
             March 2008. After a short break, David will be returning to the Trust
             part-time as part of the “Moving On Team”.

             The MYHT Board has recruited a substantive Medical Director, Dr
             Martin Wale, who started on 1 April 2008.

             A consultancy appointment in the “Moving On Team” has been made
             to support the Clinical and Corporate Directorates.

             KPCT/08/77.2         Calderdale Primary Care Trust

             Angela Monaghan has been appointed Chair as from 20 March 2008.
             Angela was previously a Non-executive Director of Calderdale PCT.

             KPCT/08/77.3         Kirklees Council

             Tony Hood, Director for Adults and Communities, is to take early
             retirement from the end of September 2008.

             KPCT/08/77.4         Health and Social Care Awards

             It was noted that the 18 week Route to a Solution project has won the
             Leadership for Innovation award at this year‟s Yorkshire and Humber
             Health and Social Care Awards. The Board congratulated all those

             KPCT/08/77.5         Queens Nursing Institute Fund for Innovation
                                  (and Partnership) Awards 2008

             The Board congratulated Jackie Hatfield, District Nurse Team Leader,
             and Tracy Conroy, Tissue Viability Nurse Specialist who have won the
             Queens Nursing Institute award for their project in setting up a drop-in
             wound care clinic for injecting drug users.

                          Page 3 of 14
KPCT/08/77.6        Health and Safety Bronze Award

The PCT has won an award from the Royal Society for the Prevention
of Accidents‟ Occupational Health and Safety Awards, for health and
safety. The Board thanked Chris Bedford, Health and Safety Risk
Manager, for all the work he has put in on behalf of the PCT, to win
this award.

KPCT/08/77.7        Electronic Staff Record (ESR)

The ESR Project Board have committed to a final agreement for
implementation for the ESR system effective from 1 April 2008.

KPCT/08/77.8        Deep Clean at Holme Valley Memorial Hospital

Following the earlier delay of the deep clean at HVMH due to an
outbreak of Norovirus, a new date has now been confirmed, spanning
25, 26 and 27 April 2008. All patient areas will be cleaned. The PEAT
(Patient Environment Assessment Team) inspection will follow this
deep clean in early June.

KPCT/08/77.9        Draft Locality Plans

Mike Potts confirmed that that Draft Locality plans had been circulated
to Board members following the Non Executive Directors‟ meeting held
on 24 April 2008.

It was noted that the plans would be refined further next year and
would be supported by clear action plans. In addition the plans would
be shared with the Council and signed off within 2 to 3 weeks. It was
recognised that approved copies would be re-circulated to Board
members when signed off.

The Board APPROVED the Draft Locality plans.

KPCT/08/77.10       Strategic Health Authority Annual Review

Mike advised the Board that the PCT had its Annual Review meeting
with the SHA last week. He reported that the review went well and
that the PCT received some good feedback on its achievements over
the last year. A formal letter from the SHA will be circulated to the
Board in due course for information.

KPCT/08/77.11       SMT & EMG Timeout

Mike provided feedback from the joint timeout with the PCT‟s Senior
Management Team and local authority‟s Executive Management
Group held on 25 April 2008. He explained that the aim of the timeout
was to look at common agendas and the principles of partnership
working. The event proved very positive.

            Page 4 of 14
             KPCT/08/77.12       Mid Yorkshire Hospitals Trust – Financially
                                 Challenged Trust Solution

             Mike reported that the SHA are engaging in joint discussions between
             the PCT, Mid Yorkshire and Wakefield PCT concerning reaching a
             solution to Mid Yorkshire‟s financial problems.

             It was AGREED that the outcome of these discussions would be
             brought back to the next Board meeting.

             The Board RECEIVED and NOTED the contents of the Chief
             Executive‟s Report.

KPCT/08/78   PEC Chair’s Report

             David Anderson presented his report to the Board highlighting the

             It was noted that regular meetings with Practice Based Commissioning
             and clinical colleagues in Secondary Care were to be reinstated with
             the first meeting planned for June. This meeting will focus on
             communication issues.

             The „Route to Solution‟ sub group has achieved a consensus of the
             model and process for the configuration of District Nursing teams with
             General Practice units of 10,000. The model will be tested once again
             with the wider clinical population in June and implemented as soon as
             possible. Sheila Dilks pointed out that a competency framework is
             being worked towards to allow flexibility.

             The PEC also spent time considering the work of the Diabetic HIT,
             received the Quality and Clinical Governance Strategic Framework, an
             update on Safeguarding Children and Young People and details of the
             Community Hospital Bid. The PEC also considered how to develop
             with colleagues in PBC in contributing to the commissioning process
             and the work of the HITs.

             It was noted that the PEC Terms of Reference were also being

             The Board RECEIVED and NOTED the contents of the PEC Chair‟s

KPCT/08/79   Finance Report

             Bryan Machin presented the Finance report which updated the Board
             on the income and expenditure position for the PCT for 2007/08.

                         Page 5 of 14
             Bryan explained that the PCT is preparing to submit the Annual
             Accounts for 2007/08 for audit on 1 May 2008. He advised the Board
             that a review of the forecast expenditure levels and the Mid Yorkshire
             SLA had led to the forecast expenditure being reduced by £1.7m from
             that reported last month, therefore the PCT‟s forecast surplus has
             increased from £2.7m to £4.4m (0.8% of resources available).

             The Board acknowledged that the draft Accounts would show that the
             PCT has achieved its revised control total of £4.4m.

             It was noted that the draft Accounts would be reviewed by the Audit
             Committee on 14 May and that the auditors would present their report
             on the Accounts at a further meeting of the Audit Committee on 13
             June 2008.

             The Board NOTED the expected income and expenditure position of
             the PCT for 2007/08.

KPCT/08/80   Performance Report

             Peter Flynn presented the Corporate Performance report to the Board.
             He highlighted current performance against key high priority targets
             and, where appropriate, action being taken to improve performance.

             It was recognised that overall the majority of targets had been met. In
             particular it was noted that the PCT had achieved the 18 week patient
             waiting time targets, but the A&E waiting time target had not been met.
             It was recognised that Mid Yorkshire have instigated an action plan the
             „Waterfall report‟ which aims to improve performance of A&E waiting
             times by August 2008.

             It was recognised that performance against a number of targets for
             Chlamydia screening had not been met. Peter clarified this was due to
             the process of data collection which had not been correctly followed.
             He assured the Board that a new process was now in place.

             There was a discussion regarding performance against Breast Cancer
             screening and the difficulties being incurred in meeting these targets.
             Dr Judith Hooper advised there were a number of issues and
             AGREED to provide a report for the next meeting.

             It was recognised that there was disparity between the South and
             North of the patch regarding performance against the 7 day target for
             Community Equipment, in particular the „joint contingency‟ figures. It
             was recognised that „joint contingency‟ is for specialist bespoke
             equipment and that the 7 day target for this equipment was
             difficult meet. It was AGREED that Sheila Dilks would do a breakdown
             of the specialist equipment figures and report back to the next

                          Page 6 of 14
             It was acknowledged that the SHA is increasing its performance
             monitoring regime and that the PCT was now receiving weekly

             The Board acknowledged that Performance is a high profile area.

             The Board RECEIVED and NOTED the Corporate Performance

KPCT/08/81   Provider Services Report

             Denise Boyd circulated the quarterly report from Provider Services to
             the Board and apologised for tabling it at the meeting.

             Denise updated the Board on the recruitment that had been taking
             place within Provider Services. It was noted that 12 new Health
             Visitors had been appointed and 15 new frontline staff to a variety of
             disciplines, noticeably District Nurses and administration support. In
             addition a recent community matron advert had generated a great deal
             of interest with approximately 60 applications for 10 posts. Interviews
             are planning to be held at the end of May.

             Denise highlighted the Team Leader development programme. It was
             recognised that feedback from this had been overwhelmingly
             positive. The Board congratulated Provider Services on this success.

             The Board received an update on progress towards meeting the 18
             week standard in Provider Services and current waiting times. A
             discussion ensued regarding disparity between Community Dental
             waiting time figures for Special Needs. It was recognised that there
             was a capacity issue locally, concerning delivering treatment for
             patients with Special Needs. Denise AGREED to provide narrative
             regarding the disparity in these figures.

             The Board RECEIVED and NOTED the Provider Services report which
             was very informative.

KPCT/08/82   NHS Review Update

             Mike Potts provided a verbal update to the Board. He advised the
             meeting that the final proofs for Lord Darzi‟s regional report for
             Yorkshire and the Humber were due to be signed off on Friday 2 May
             2008 and that the report was due to be published on 14 May 2008.
             This report will be shared with the Board at the next meeting.

KPCT/08/83   Urgent Care Procurement Update

             Carol McKenna introduced the Urgent Care Procurement update
             report to the Board. She advised that the report updates the Board on
             how the urgent care procurement process is progressing and to
             formally sign off the consultation document before formal consultation
             commences on 6 May 2008.
                         Page 7 of 14
             Carol explained the background to the re-design and procurement of
             urgent care services and gave an update on the current position. She
             explained that the evaluation panel met in March to assess the outline
             solutions and short-listed 3 bidders to go forward into the next phase
             of the process. These are: Primecare, Local Care Direct and Care UK
             who have formed a partnership with Calderdale and Huddersfield NHS
             Foundation Trust. Local service specifications have been updated and
             sent out to the remaining bidders who have to submit detailed
             solutions in July 2008. These will be evaluated in August where one of
             the bidders will be eliminated and the remaining two bidders will go
             forward to the final tender process. Final solutions will be submitted in
             September and evaluated in October with the preferred bidder
             identified and contract awarded in November. Transition period then
             begins with the new service and contract commencing from April 2009.

             The Board reviewed the Consultation document. There was a
             discussion regarding the partnership that Calderdale and Huddersfield
             Foundation Trust (CHFT) has entered into with Care UK, prior to the
             commencement of the Consultation, and the commercial advantage
             this would give Care UK in delivering the solutions required in the
             PCT‟s specification ie urgent care centres co-located with A&E
             departments. The other issue was the capacity of acute providers to
             work with bidders within the tight timescales of the procurement
             process to enable them to deliver a co-located solution.

             Vanessa Stirum asked if there was a risk of overprovision of services
             in conjunction with the Primary Care procurement process to extend
             primary care services 8am to 8pm. Carol McKenna confirmed it was
             difficult to establish a definitive figure on unmet demand as present.

             The Board APPROVED the Consultation document but acknowledged
             that if the issues highlighted above which were being discussed by the
             Programme Board that evening, that the Programme Board may
             consider the issues to be too high a risk which may mean that the
             scope of the tender would have to be reduced, and co-location of
             urgent care centres be taken out of the procurement process which
             would involve a lesser form of formal engagement.

KPCT/08/84   Review of PCT Committee Structures

             Helena Corder presented the Review of PCT Committee Structures
             report to the Board. She explained that due to changes in legislation
             and national policy direction that impact on PCT governance
             arrangements, it has been necessary to review the PCT‟s Committee
             Structures and Standing Orders and Scheme of Delegation, to make
             sure the PCT has in place robust governance arrangements. The key
             changes are reference to the NHS Act 2006.

             The Board reviewed the Standing Orders, Reservation and Delegation
             of Powers. It was suggested to add the following to Helena Corder‟s
             role outlined in Appendix B:

                          Page 8 of 14
                    Health and Safety
                    Equality and Diversity

             There was a discussion regarding the timescales for dispatching the
             Agenda and supporting papers for Board meetings as outlined in
             paragraph 3.3 on page 12 of the document. It was NOTED that this
             discussion would be picked up at the Board Timeout on 19 May 2008.

             It was recognised that the PEC Terms of Reference were currently
             being reviewed and that these will be brought back to the Board in July
             for approval.

             It was PROPOSED and AGREED that the PCT should formally review
             its governance arrangements annually and that a sub group of the
             Board is established to do this each March prior to the submission of
             the PCT‟s Statement of Internal Control (SIC) as part of the internal
             control mechanisms.

             The Board RECEIVED and AGREED the Standing Orders,
             Reservation and Delegation of Powers.

KPCT/08/85   Mental Capacity Act – Deprivation of Liberty

             Sheila Dilks introduced the Mental Capacity Act – Deprivation of
             Liberty report to the Board. She explained that the introduction of the
             deprivation of liberty safeguards is adding to the Mental Capacity Act
             2005 important protections for people who lack capacity to consent to
             arrangements made for their care and treatment and who need to be
             deprived of their liberty in their own best interests in order to keep
             them safe.

             It was recognised that the deprivation of liberty safeguards legislation
             contains detailed requirements about when and how deprivation of
             liberty may be lawfully authorised, and that the PCT will be the
             authorising body for the NHS provider Trusts.

             Sheila highlighted the implications for the PCT and care homes.
             Concerning this, it was noted that the PCT will need to establish
             systems and processes to ensure the assessment of the patient is
             undertaken within the required timescales, by appropriately trained
             and competent staff. In addition it was recognised that there is no
             continuing funding at this time.

             Finally it was noted that this is not yet in statute and that further
             information will be shared with the Board in due course.

             The Board RECEIVED and APPROVED the Deprivation of Liberty
             report and await further information.

                           Page 9 of 14
KPCT/08/86   National NHS Staff Survey 2007

             Sue Ellis presented the National NHS Staff Survey 2007 report to the
             Board. She explained that all NHS organisations are required to
             conduct a National Staff Survey on an annual basis which was
             conducted between October and December 2007. It was recognised
             there had been a high response rate to the survey of 69%, which was
             in the highest 20% of PCT‟s in England. In addition, the PCT was
             either above average or in the highest 20% of PCTs in the following
             key score areas:

                   Flexible Working: 85% of staff at the PCT said that they had
                    taken advantage of at least one of the flexible working options
                    that the PCT offers.

                   Training and Development Opportunities: 82% of staff at the
                    PCT said that they had received training, learning or
                    development in the pervious 12 months.

                   Percentage of staff working in a Well Structured Team
                    Environment: 56% of staff reported that they worked in a team
                    of 15 or fewer people that have clear objectives.

             The areas in which the PCT was rated within the worst 20% of PCTs in
             England were:

                   Appraisals: Percentage of staff having appraisals that are well
                    structured, and develop personal development plans (low)

                   Quality of Job Design: (clear job content, feedback and staff
                    involvement) (low)

                   Health and Safety Training (low)

                   Percentage of staff suffering work related stress (high)

                   Percentage of staff witnessing and reporting errors, near misses
                    or incidents (low)

                   Percentage of staff experiencing harassment, bullying or abuse
                    from patients or relatives and percentage of effective action
                    from the PCT towards violence and harassment (high)

             A summary of the results was circulated and reviewed by the

             There was a discussion regarding work related stress and how the
             staff survey results compared with staff sickness absence recorded in
             the PCT. Sue explained that the PCT does not record people‟s reason
             for sickness but the information from the survey will be used internally.

                         Page 10 of 14
             Sue also explained that the PCT is preparing an action plan to meet
             the Health and Safety Executive Stress Standards. Each Directorate
             will have a Staff Survey action plan which will be monitored by the
             Senior Management Team (SMT) and the Investors in People Steering
             Group (IIPSG).

             It was AGREED that the IIPSG would feedback progress
             on the Staff Survey action plan regularly to the Board and that the first
             update would be received in July.

             In addition it was recognised that Health and Safety was a high profile
             area and there needed to be greater emphasis on embedding this
             within the Trust. Dr Hooper also pointed out there needed to be
             greater emphasis on a healthy workplace and environment.
             Helena Corder advised that a Health and Safety Annual Report was
             currently being produced.

             Finally it was acknowledged that things had moved on significantly
             within the PCT since the survey was undertaken and that these results
             fall on the back of the reconfiguration.

             The Board RECEIVED and NOTED the report and await feedback
             from the IIPSG in July on progress with the action plan.

KPCT/08/87   Local Area Agreement (LAA) Final Working Draft

             Dr Judith Hooper presented the Local Area Agreement Final Working
             Draft to the Board. Judith explained this was a final opportunity for the
             Board to comment on this document. Judith highlighted the mandatory
             indicators and some minor amendments which had just been received.

             The Board AGREED to delegate the Chief Executive and Director of
             Public Health responsibility for agreeing any final alterations to the
             final version of the LAA.

KPCT/08/88   Local Involvement Networks (LINks) and NHS Complaints

             Helena Corder introduced the Local Involvement Networks (LINks) and
             NHS Complaints Processes report to the Board. She explained that
             the Local Government and Public Involvement in Health Act contains
             important new duties for health service organisations in terms of
             patient and public involvement and engagement. The Board received
             a letter that outlines the role and activities of the LINk and NHS
             providers are under a duty to allow LINks to enter and view certain
             health and social care facilities. The PCT‟s are required to respond to
             reports and recommendations made by the LINk within a prescribed

                         Page 11 of 14
             It was noted that new legislation is due in 2009 which will impact on
             the PCT complaints processes particularly in respect of the provider
             arm of the PCT. The PCT is aware of these changes and is making
             sure it is up to date with what is happening in early adopter sites.

             The Board RECEIVED and NOTED the report.

KPCT/08/89   Vital Signs – Key Performance Indicators

             Peter Flynn introduced the Vital Signs – Key Performance Indicators
             report to the Board. He explained that the report highlights the key
             national and local priority performance indicators detailed in the new
             Operating Framework 2008/08 against which the PCT, and health and
             social care partners, will be performance monitored during 2008/09
             and beyond.

             The national priority areas where PCTs need to explicitly plan for
             delivery in 2008/09 are:

                   Cleanliness and healthcare associated infections
                   Improving access
                   Keeping adults and children well, improving their health and
                    reducing health inequalities
                   Experience, satisfaction and engagement
                   Emergency preparedness

             Peter explained as part of the Operating Framework the Department of
             Health has introduced a new approach to planning and performance
             managing thee priorities both nationally and locally – the Vital Signs.
             The „vital signs‟ are key performance indicators considered to be „vital
             to supporting delivery of Government policy.

             Peter highlighted that the Vital Signs consists of 3 tiers:

             Tier 1 – National requirements (ie must do‟s)
             Tier 2 – National priorities for local delivery
             Tier 3 – Local Action (priorities and any corresponding targets agreed

             The Board NOTED the key performance indicators that will be
             performance monitored/managed by the Performance Team
             throughout 2008/09.

KPCT/08/90   Minutes of the Professional Executive Committee

             The Board RECEIVED and NOTED the minutes of the Professional
             Executive Committee held on the 12 March 2008.

                          Page 12 of 14
KPCT/08/91   Minutes of the Finance and Performance Committee

             The Board RECEIVED and NOTED the minutes of the Finance and
             Performance Committee held on the 20 February 2008.

KPCT/08/92   Minutes of the Governance Committee

             The Board RECEIVED and NOTED the minutes of the Governance
             Committee held on 20 February 2008. It was highlighted that the
             National Health Service Litigation Authority Level 1 assessment will
             now take place in August 2008.

KPCT/08/93   Minutes of the Estates Strategy Committee

             The Board RECEIVED and NOTED the minutes of the Estates
             Strategy Committee held on 6 December 2007.

KPCT/08/94   Minutes of the Provider Services Board

             The Board RECEIVED and NOTED the minutes of the Provider
             Services Board held on 2 November 2007, 17 January and 28
             February 2008.

KPCT/08/95   Minutes of the Yorkshire and Humber Specialised Commissioning

             The Board RECEIVED and NOTED the minutes of the Yorkshire and
             Humber Specialised Commissioning Group held 28 March 2008.

KPCT/08/96   Minutes of the Yorkshire and Humber Specialised Commissioning
             Group (North)

             The Board RECEIVED and NOTED the minuets of the Yorkshire and
             Humber Specialised Commissioning Group (North) held on 5
             December 2007, 9 January, 6 February, 5 March and 2 April 2008.

KPCT/08/97   Any Other Business

             David Thompson enquired if the Mobile Operating Theatre at Holme
             Valley Memorial Hospital had been a success and if this had been

             Denise Boyd confirmed how successful this had been and it was
             AGREED that the Communications Team would be asked to publicise

                         Page 13 of 14
KPCT/08/98          Date and time of the next meeting

                    It was AGREED that the next meeting of the Kirklees PCT Trust Board
                    would take place between 9.15am and 12.00 noon on Wednesday 28
                    May 2008 in the Seminar Room at Dewsbury Health Centre.

Questions from the Public

The Chairman gave a final opportunity for any members of the public to raise any further

A member of the public enquired why there had been a significant delay in the Estates
Strategy Committee minutes being received by the Board. Bryan Machin confirmed that
the ESC only met quarterly and that the last meeting had been rearranged, delaying the
ratification of the minutes at the subsequent meeting, before they could be presented to the

Chairman’s Signature: ………………………………….                         Date: ………………

                                Page 14 of 14

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