Kensington Chelsea by accinent


									                       PRIMARY CARE TRUST BOARD MEETING
                                30 September 2008
                                                      AGENDA ITEM 1.3
                                                 AGENDA PAPER 08/37.01
Title                  Minutes of the Board meeting held on 22 July 2008

Presented by           Peter Molyneux                    Key Contact

Lead Director                                            Lead Non Executive
What is the decision
or action required by To approve the minutes as a true record and to consider any matters
the Board?            arising

Risk reference         Reference assessment from the Assurance Framework/Risk Register or based on the Risk Assessment
                       Matrix from the Risk Assessment Policy
level of assessment

Summary of issues
to be considered.


•   Evidence of best

•   Health

•   Race Equality

•   Disability

•   Views of users,
    patients and


Health Care

                                                                                                    Chair Peter Molyneux
                                                                                       Chief Executive: Diana Middleditch
                                                                     Chair Clinical Executive Committee: Andrew Steeden
                              HELD ON 22 JULY 2008

Peter Molyneux             Chair
Laurence Beard             Non-Executive Director
Cynthia Dize               Non-Executive Director
Andreas Lambrianou         Non-Executive Director
Sandra Mounier-Jack        Non-Executive Director
Edgar Moyo                 Non-Executive Director
Clive Pinder               Non-Executive Director
Cllr Fiona Buxton          Associate Non-Executive Director
Andrew Steeden             Clinical Executive Committee Chair
Jon Bell                   Director Finance and Commissioning
Jane Clegg                 Acting Chief Operating Officer
Diana Middleditch          Chief Executive
Melanie Smith              Director of Public Health

In attendance:
Jane Beckford              Kensington and Chelsea PCT
Yildiz Biray               Kensington and Chelsea PCT
Lesley Brown               Kensington and Chelsea PCT
Mark Creelman              Kensington and Chelsea PCT
Kate Glass                 Kensington and Chelsea PCT
David Hill                 Kensington and Chelsea PCT
Caroline Leveaux           Kensington and Chelsea PCT
Jayne Liddle               Kensington and Chelsea PCT
Frankie Lynch              Kensington and Chelsea PCT
Huw Wilson-Jones           Kensington and Chelsea PCT
Cllr Buckmaster            Royal Borough Kensington and Chelsea
C Larkin                   Kensington and Chelsea Mental Health
Robin Tuck                 Community Reference Group
Janet Mayhew               Member of the Public

60/08 Chair’s Remarks
In the light of a number of strategic papers being presented to the Board the Chair invited
members of the public to raise any points for consideration. No points were raised.

The Chair reported that the Chief Executive would be absent from the first part of the meeting.
The eight PCTs in North West London have been considering how best to collaborate to
ensure the delivery of World Class Commissioning across the sector when no one PCT has
all the skills required. Their proposals were being presented to NHS London with Diana
Middleditch, Chief Executive representing Kensington and Chelsea Primary Care Trust. The
Chair assured the Board that once a response from NHS London is received the PCT will
engage local stakeholders in the relevant developments.

                                                                                          Chair Peter Molyneux
                                                                             Chief Executive: Diana Middleditch
                                                           Chair Clinical Executive Committee: Andrew Steeden
61/08 Declaration of Interests
Members of the Board were asked to declare any interests in the agenda items for discussion.
No interests were declared.

62/08 Minutes of the previous meeting
The minutes of the previous meeting held on the 20 May 2008 were approved as a true record
and signed by the Chair.

63/08 Matters arising from the minutes
45/08 Full Business Case for the New Community Hospital at St Charles: It was noted that:
   • The full business case had been approved by NHS London.
   • Options for ownership are being explored with DTZ and will be discussed at a meeting
       in September. Options for transport are being discussed as part of the Primary Care
   • Patient involvement will continue to be a priority during the next stage of development
       including engagement with the Royal Borough Kensington and Chelsea and
       Community Reference Group etc. A newsletter is planned particularly addressing the
       issues of transport. The Board highlighted the need to assure people about the
       services planned for the site and affirm that they will continue to be able to contact
       their own GP. The Board emphasised the need for a complete communication
       strategy throughout the process and for the development of a communications
       strategy to become a priority, with additional resources invested if necessary.
   • A supervising architect has yet to be appointed but the original architect has
       expressed an interest in continuing this role to monitor plans and maintain the integrity
       of the site.
   • In response to the design issues raised earlier by the Board the main entrance has
       been redesigned. Issues relating to the link bridge have yet to be considered. Jon Bell
       agreed to check if the concerns relating to the Women’s units had been included in the
       report and to report back to Laurence Beard.
   • The rental costs for the Renal Unit have been agreed with Imperial Healthcare and are
       considered affordable.

The Chair noted the approval of the full business case and thanked the team for the
considerable worked involved in achieving this success which will now enable the PCT to
move forward towards delivering its promises. The Board asked that the governance of the
next phase of implementation be managed via the Integrated Governance Committee.

46/08 Financial Report for year ending 31 March 2008: Jon Bell confirmed that as reported in
May, PMS GP costs are not driving the Primary Care overspend and the work on
accountability will be reported in September.
53/08 APO/Alliance Governance: The Board was asked to note the tabled draft minutes of the
first Joint Provider Committee meeting held on the 2nd July 2008. Any issues arising from this
will be fed into the Integrated Governance Committee and Provider Board as appropriate.
54/08 Results of the 2007 National Staff Survey: The Board agreed that workforce issues
needed to have a greater focus at Board level as the PCT remains a Provider and must
therefore ensure the availability of a skilled workforce. The workforce strategy previously
approved by the Board is currently being updated and progress will be reported to the
September Board.

                                                                                          Chair Peter Molyneux
                                                                             Chief Executive: Diana Middleditch
                                                           Chair Clinical Executive Committee: Andrew Steeden
64/08 10 Year Primary Care Strategy
The Board was asked to approve the 10 year strategy, indicative budget and draft
implementation plan. The Board had previously received a number of presentations on the
principles informing the strategy which now:
    • Covers GPs, Community Pharmacists, Dentists and Opticians.
    • Has been informed by feedback from 2000 services users and staff, and this dialogue
       will continue.
    • Recognises that Primary Care is changing and has a greater focus on proactive
       management of long term conditions, prevention and screening, patient experience
       and integration with the Royal Borough Kensington and Chelsea where appropriate.
    • Emphasises choice, access and consistent high standards of care with higher
       benchmarks and performance management.
    • Focuses on work with GP practices to improve service and ensure high standards in
       PMS and GMS practices.
    • Draws on the hub and spoke model with St Charles as the hub in the north of the
       borough. A hub location in south has yet to be determined.
    • Includes an indicative budget and draft implementation plan and a number of work

In discussion of the 10 year vision the Board:
    • Supported the vision as a simple, understandable statement, but felt that 10 years was
        a long time, particularly when some aspects of the vision are not far from where the
        PCT is now. It would be helpful therefore to have a sense of what we propose to
        achieve in 1, 5 and 10 years.
    • Supported the inspirational vision for more integration with social care over 10 years
        and highlighted the need to work with the Royal Borough Kensington and Chelsea on
        other aspects of the strategy e.g. the hub and spoke model will provide a base for
        other social care, fitness services etc. which the borough may plan.
    • Noted that the principal target is to achieve access to responsive care across the
    • Highlighted the need for clearer links between the vision and addressing health
        inequalities to be made more explicit. The Board noted that in achieving a goal of
        equity this does not mean equal and should not stand in the way of higher aspirations
        for some practices. It was suggested that this should be made explicit in the
        document along with the goal of insisting that the performance of poorer practices is
    • Emphasised the need to be clearer about accountabilities and milestones, what is
        being promised by when; to be bolder in expressing ideas, the use of new
        technologies etc. Frankie Lynch agreed to report back with tighter timelines once the
        steering group set up.

In discussion on the model and implementation plan the Board:
    • Were assured that the Hub and Spoke model did not mean that bureaucratic borders
       were created and there would be fluidity of access e.g. patients could use St Charles if
       they desired or another GP offering a particular service. The model is based on what
       is known about distances people are willing to travel but does not exclude patients
       travelling longer distances.
    • Highlighted the absence of any focus on children’s needs and services and maternity.
       It was reported that a number of pieces of work are underway relating to midwifery
       which will be built into the implementation plan.

                                                                                          Chair Peter Molyneux
                                                                             Chief Executive: Diana Middleditch
                                                           Chair Clinical Executive Committee: Andrew Steeden
   •   Noted the need identified for an additional 20 GPs and 5 nurses to cover the increased
       workload created by extended hours and increased community based initiatives to
       prevent hospital admissions etc., and the plans to ensure that there was sufficient
       capacity to meet the demand and changing expectations. However the Board also
       expressed support for any proposals to over provide and ensure that the PCT is ahead
       of the anticipated need and enable choice. Whilst any increase in GPs will be based on
       the redistribution of services, a strong business case and tendering process, with the
       provider being responsible for deciding the exact staffing needed, the Board
       recommended that the workforce planning needed to be further developed.
   •   Asked that the need to ensure a wider range of providers when commissioning for
       choice is made more explicit.
   •   Agreed that given the PCT’s resourcing position access to dentistry was not sufficiently
   •   Agreed that a 1-2 page summary document which could be widely communicated
       would be produced which would include reassurance that people will be able to stay
       with their GP and explain the need for extending the market.

The Board approved the strategy as a draft and requested more clarity on priorities and what
will be achieved by when. Board members were asked to submit any further comments direct
to Frankie Lynch and Andrew Steeden for an updated document to be circulated to Board
members in early September. A decision will then be made as to whether there is a need for
it to return to the September Board for a full discussion or not.

65/08 End of Life Strategy
The Board was asked to approve the strategy including the outcome measures, action plan
and timescales and community engagement report. The Board had previously seen the draft
strategy in January 2008 and had requested more work, particularly to include the views of
users and carers and key targets. The Board noted that the strategy has an adult focus
covering three years and has direct links to the Primary Care Strategy and Carers Strategy
with the Royal Borough Kensington and Chelsea. (Children’s issues have very different
mechanisms of care). It focuses on providing a good death, early identification during the last
year of life; better and equitable high quality coordinated care with a single point of contact
supported by a specialist team. It sets a target to identify 100% of people qualifying for the
end of life care plan and with 30-35% of this population supported to die at home as
requested. Research shows this is the optimum level achievable as patient conditions
become increasingly unpredictable towards the end of life and care needs change.

In discussion the Board:
    • Highlighted the January Board recommendation to take and use the Age Concern
        statement as a model for an equivalently short, simple statement/commitment telling
        people what they can expect for the PCT and against which it can be held account.
        This statement still needs to be included.
    • Questioned the target of 35%at home if 60% of people indicate they wish to die at
        home. The national accepted target is that half will be facilitated in the first three years
        with a view to improving this beyond three years. As patients’ conditions become
        more unpredictable requirements change end of life is not always achievable at home.
        The target is that 100% of people qualifying for the end of life plan are identified.
    • Noted that the response from focus groups show a split between those who desire to
        die at home and in a hospice; none indicated a preference for hospital. However,
        there is a need for education on what is possible and practicable at home.

                                                                                             Chair Peter Molyneux
                                                                                Chief Executive: Diana Middleditch
                                                              Chair Clinical Executive Committee: Andrew Steeden
   •    Noted that the focus group also asked what bereavement services would be available
        and raised the need for support for informal carers. A carers’ support worker has been
        appointed within the Royal Borough Kensington and Chelsea to make more links with
        informal carers.
   •    Noted that this can be an expensive stage of a patient’s life and the growing costs of
        end of life care.
   •    Emphasised the need to write a one to two page summary which can be widely
   •    Noted that the investment projections were based on national best practice and the
        steering group’s views of what gold standard care looks like. The projections are
        based on community services already in place e.g. through the Pembridge Unit and
        Trinity Hospice although services will be tendered and outcomes monitored to ensure
        quality and value for money. Services in other parts of the country had also been
        looked at and the business case reflects well against these. The Board highlighted the
        potential conflict of interests with advice having been taken from people/organisations
        who may later wish to tender for the services.
   •   Emphasised the need for more details on milestones to hold the PCT to account. The
       Board noted that the action plan is high level but more detail and timelines have also
       been worked up.
   •   Highlighted that experience shows that communication and community engagement
       takes longer than expected and stressed the need to build this up and move forward.

The Board endorsed the strategy as a very important area for service improvement and asked
that: the document makes clear this strategy relates to adults only and not all citizens; a high
level two page summary is prepared for local communication; more is included on
bereavement services and links are made both to the Mental Health and Well Being Strategy
and the Carers Strategy.

The Board thanked the team for their work

66/08 IM&T Strategy
The Board was asked to approve the direction of travel being taken in the development of an
IM&T Strategy. Due to the pace of technical change the strategy identifies priorities for action
and local projects to deliver these for a two to three year period only. It includes a summary of
the current position, other strategic influences and the strengths and weaknesses of team to

In discussion the Board requested that:
    • Clearer links to be made to Connecting for Health.
    • Engagement with users e.g. GPs to be highlighted more clearly. The Board noted that
       numerous stakeholder meetings had been held and the concern about the level of IT
       skills and systems currently being used.
    • SMART targets and timelines to be included in order to hold the PCT to account. The
       Board noted that detailed timelines for the projects lay behind the strategy map and
       implementation plan and performance will be measured via the balanced score card.
    • Issues relating to security to be profiled more clearly to provide assurance on the
       accuracy and safety of confidential information and patient records etc. The Board
       noted that data quality and security is core and applied to all aspects of the strategy
       and specific projects including the use of encryption software and other Department of
       Health requirements.

                                                                                           Chair Peter Molyneux
                                                                              Chief Executive: Diana Middleditch
                                                            Chair Clinical Executive Committee: Andrew Steeden
   •   Assurance on the PCT’s capacity and capability to deliver the strategy. The Board
       noted the concerns about management capability and need for not only good
       operational people but also high level strategic thinkers. Work is underway to develop
       both capacity and capability to bring these up to an appropriate level, including the
       appointment of a full time manager.
   •   Assurance on the level of confidence that can be placed in RIO and its impact on
       immunisations when other organisations have experienced difficulties.
   •   Further work with providers on improving the quality and flow of data.
   •   Information governance and technology to be ingrained across the organisation and
       not just seen as an IM&T department issue.

The Board approved the strategy on the basis that the issues raised would be brought back to
a future Board meeting or seminar with a better understanding provided on the
implementation plans, timelines and how the organisation will be held to account.

The Board thanked the team for their work in developing the strategy and helping to take the
PCT’s Information Management and Technology to another level.

67/08 Kensington and Chelsea Mental Health and Wellbeing Strategy
The Board was asked to approve the new Mental Health and Wellbeing Strategy 2008-2012
and to note the associated action plan. This is a joint strategy with the Royal Borough of
Kensington and Chelsea which had been approved at the Joint Mental Health and Well Being
Board with the proviso that more public engagement and action plan success measures were
included. These have now been included.

In discussion the Board:
    • Supported the move from Mental Illness to Mental Health and Well Being and
       suggested that ‘emotional’ might be a more acceptable word when considering mental
       well being.
    • Noted the resistance of people to seek medical treatment and highlighted the need for
       a communications strategy which would show the different ways of managing
       emotional health, help to normalise mental/emotional problems and highlight how these
       are not necessarily life long conditions (e.g. post natal depression).
    • Recognised that there will be areas of greater need within the borough and this should
       be acknowledged in the strategy.
    • Asked if BME issues around access and translation were issues within Mental Health
       services. It was reported that there were some difficulties getting people to link into GP
       services, therefore patients were presenting later, but once contact had been made this
       was not an issue.
    • Highlighted the need to address the issues of both helping people back into
       employment after an episode of care, and helping them remain in work during this time.
       The role of meaningful occupation and the place volunteering can play in providing
       meaningful but flexible occupation was emphasised.
    • Noted that dementia would be considered in the Older People’s Mental Health Strategy
       which will come to the Board next year.
    • Highlighted the need to involve Central North West London Mental Health Trust in
       discussion on the PCT’s ambition and innovations.
    • Highlighted the key issues for further consideration as, how to communicate the
       content of the strategy to a wider group and (the preparation of a 1-2 page
       communication summary was recommended) and the development of priorities,
       milestones and success measures to hold the PCT to account.
                                                                                           Chair Peter Molyneux
                                                                              Chief Executive: Diana Middleditch
                                                            Chair Clinical Executive Committee: Andrew Steeden
The Board welcomed the breadth of the strategy and asked that the document be updated to
reflect the discussion and then circulated for sign off, with a review date set on the Board
timetable when it would come back for review.

The Chair reported that at an earlier Board seminar the Board had received an overview of
Mental Health Commissioning and further discussions are planned for the autumn to ensure a
greater impact is achieved within the investment available. The areas of focus being: young
people and appropriate health messages; older people and the high incidence of depression;
BME groups; the work place CBT based mental well-being programme. The Chair asked for
a volunteer to work on the seminar design and how best to formulate the discussions.

68/08 Healthcare for London Board Report
The Board noted the minutes of the Joint Committee and formally endorsed the proposed
scope and approach to delivery of the programme in 2008/09.

69/08 Bi-monthly Financial Report
The Board was asked to note the financial position of the PCT at 31 May 2008 and current
year end forecasts. Approval was also sought to proceed with the full replacement of the roof
on the Tower at St Charles Hospital.

The PCT is currently reporting a surplus of £3.3million which is £0.9million more than planned
with a projected year end surplus of £13.1 million which is £4.4 million higher than planned for
the year. A number of factors have contributed to the increased surplus including: correction
to the Chelsea and Westminster Hospital over billing for ECG payments; the de hosting of the
GUM service and improved coding; one-off Provider Services benefits e.g. rate rebates and
staffing costs. A Health Investment plan is in place and work also underway to develop
contingencies for recovering the higher than planned surplus. All business cases for
investment will be in by September and the budget currently assumes there is no slippage on
the investment programme. A number of budget adjustments were also reported including:
Provider Services; London Ambulance Service; and HIV. These increases will come out of
the contingency plan. Jon Bell reported that the key risks will be developed into a more
meaningful report for the September Board. As agreed at the May Board, a new Finance
Dashboard is being developed and a mock-up of a new Board report format. This will be
finalised and circulate to the Board for comments by the end of August, to be used in
reporting to the September Board.

In discussion the Board:
    • Expressed concern regarding the increased surplus and noted:
           o That some savings will be recurring and therefore will be built into future
              forecasts e.g. GUM.
           o The difficulties experienced in predicting outturn due to problems of data quality
              and coding from the Imperial Healthcare Trust. The contract requires evidence
              of data and a response is awaited from Imperial on the actions proposed to
              improve their data quality.
           o The sharp increase in mental health placements and asked that action be taken
              to ensure these are valid and if necessary adjustments made to the budget.
    • Sought assurance on the level of confidence the Board could have in the investment
       plans and the PCT’s ability to create value for money investment plans which it was
       acknowledged require a new investment discipline and to manage investment projects
       at the appropriate level. The Board recommended that ongoing work and development
       work are split and managed separately and, if appropriate, outsourced to ensure a
       quick response.
                                                                                          Chair Peter Molyneux
                                                                             Chief Executive: Diana Middleditch
                                                           Chair Clinical Executive Committee: Andrew Steeden
   •   Noted that a Business Case for investment has been made to address the capacity
       issues and extra capacity is being put in. An ongoing issue has been the ability to
       recruit the right quality of staff.
   •   Recommended that investment is made into improving the areas of poor performance,
       and that resources are put in place ahead of need.

The Board noted the finance report and that the PCT is likely to exceed its control total. The
Board encouraged staff to be ambitious and innovative in developing services but also
highlighted that whilst it would be uncomfortable for the PCT to exceed its control total it is
also vital for local health services that all investments are made wisely and are supported by
evidence of value for money, outcome measures etc. before projects are agreed. It was
acknowledged that this is a stringent and time consuming process.

The Board approved the full replacement of the roof on the Tower at St Charles.

70/08 Performance Management Dashboard
The Board was asked to note and comment on the PCT’s achievement against the
Performance Dashboard and the new high level dashboard linked to the corporate objectives.

Jayne Liddle reported that the PCT was green and in upper quartile in quarter 4 and achieved
the highest rate for MMR vaccinations for 2 year olds in the sector. Areas of poorer
performance continue to be chlamydia, smoking and breast screening and work is underway
to bring these up to an amber rating. Action plans are also in place to address the points
raised at the World Class Commissioning Board seminar. The external auditors had also
indicated that the PCT is expected to achieve a level 3 in the Auditors Evaluation, and a score
of ‘good’ for use of resources. This is an improvement on past years where due to the
historical financial position the PCT was only able to achieve a rating of ‘weak.’ The Board
noted that next year two declarations will be required, one for Provider Services and another
for Commissioning.

In discussion the Board:
    • Commented on the helpfulness of the new high level report.
    • Recommended that the dashboard include the annual forecast against target.
    • Highlighted the inconsistencies between the amber ratings for service improvements
        on the Dashboard but green against the corporate objectives. Jayne Liddle agreed to
        address this and reported that in future, to aid understanding, the report would include
        the calculations behind the rankings.
    • Identified the need to capture the top ten risks for the Board and Management Team
        and be able to monitor the performance that relates to these. These may have a
        different slant and not be the same as the top performance targets. For example
        whilst workforce scores green on the performance dashboard there are clear issues
        relating to skills gaps in the PCT which could be seen by the PCT as a priority. It was
        agree this should be discussed further at the Integrated Governance Committee.
    • Expressed concern about the PCT’s inability to achieve a green rating in some areas
        when it has the resources to invest. The Board recommended further investment,
        supported the proposals to increase the number of service providers to achieve the
        Chlamydia target, and asked that milestones be set and monitored for achieving
    • Received further information on the areas of poor performance.
            • Smoking: With the agreed investment and action plan in place the PCT expects
            to be green. The Board noted that the Smoking Advisors will report directly to
            Melanie Smith, Director of Public Health until the manager post is filled.
                                                                                           Chair Peter Molyneux
                                                                              Chief Executive: Diana Middleditch
                                                            Chair Clinical Executive Committee: Andrew Steeden
          • Breast Screening: A key issue is that due to the national model insufficient
          women will receive a call for screening for the PCT to achieve its target in 2008/09.
          The PCT has previously challenged the model but been overruled. Meanwhile work
          is ongoing with practices to improve recording. The Board noted that whilst the PCT
          is not achieving the target it has a low level of mortality from breast cancer.
          Following discussion the Board requested that the Clinical Executive Committee be
          asked to recommend what position the Board should take; should the Board accept
          the red position or if the PCT is to achieve green how this should be done and what
          investment should be made and to clarify the difficulties relating to the national
          • Choose and Book: The PCT is achieving 85% against target and continuing to
          improve and is ranked fifth in London. Achieving target is a systems problem for all
          PCTs in London, however, a Choose and Book Strategy and business case has
          been presented for investment. The Board noted that as a result of the policy and
          the way Choose and Book is designed it is not possible to make a referral to a
          particular consultant.
          • Chlamydia: The Trust Management Team has agreed additional investment and
          will be increasing the range of service providers to improve the offer to young
          people. It is anticipated that this will become amber/green. One remaining difficulty
          is the mobility of the target group which means that our residents may be accessing
          services elsewhere while our service is used by those coming into the borough for
          work or leisure. As numbers increase the impact on mobility becomes easier to

The Board noted the performance report and actions and investment to achieve areas of poor

71/08 Infection Control Annual report
The Board was asked to note and comment on the Infection Control Annual Report and
Action Plan. The Infection Control Team supports both the provider and commissioning arms
of the PCT, with statutory obligations to comply with the Health Act for provider services and a
role in improving and assuring safety in commissioned services.

Whilst performance is currently measured against target and monitored monthly the Board
was asked to support a ‘Zero tolerance’ approach to Healthcare Acquired Infection (HCAI) to
counter any feeling that achievement of the target represents an ‘acceptable’ level of HCAI.
This approach would involve the PCT in looking at a root cause analysis to identify and
address any issues of every case of MRSA in its host Trusts and reviewing any linked cases
of Clostridium Difficile (Cdiff), as well as any that arise in the community. The PCT is
confident of the quality of its own infection control team and services but improving infection
control requires a sustained and 100% consistent chance in clinical behaviour. Two ‘saving
life’ nurses have been appointed at the Chelsea and Westminster Hospital Trust. It was noted
that the result of the analysis of the two cases of MRSA this year so far showed that one was
not associated with any failure in infection control and the second, although diagnosed at the
Chelsea and Westminster Hospital was associated with heath care at a private hospital.

In discussion the Board noted:
    • The very low rates of infection on the St Charles beds.
    • That the Chelsea and Westminster Hospital report clearly shows an emphasis on and
       satisfaction with achieving target, which implies an acceptance of incidents under
       target and not a zero tolerance approach. This is a cultural issue and needs

                                                                                          Chair Peter Molyneux
                                                                             Chief Executive: Diana Middleditch
                                                           Chair Clinical Executive Committee: Andrew Steeden
   •   That the Infection Control Team was in a good position to get a good understanding of
       the response of service providers to a PCT zero tolerance approach and whether
       incentives might need to be added next year.
   •   Work is already in progress to think through the most appropriate approach to zero
       tolerance and the processes, requirements for reporting, timescales for the route cause
       analysis etc which would be needed.
The Board noted the Infection Control Annual Report and Acton Plan and approved a zero
tolerance approach where all cases of MRSA would be examined with a root cause analysis
to highlight any healthcare links, and the review of any linked cases of Cdiff both in hospital
and the community.

72/08 Commissioning Report – Hospital Services
The Board was asked to note performance on the acute commissioning portfolio and
particularly the progress on: the sustainability of the 18 week wait target; measuring
contractual quality outcomes; World Class commissioning and financial performance to month
In discussion the Board noted:
    • That the increase in GP referrals does not correlate with the referral centre data. This
       is being investigated.
    • The change in case mix for emergency admissions demonstrated by the over
       performance in Critical Care and relatively higher cost of admissions relating mainly to
       activity at Imperial Healthcare. The Board sought assurance that that long term care in
       the community is not leading to more emergency admissions.
    • That the lack of timeliness of responses from Central North Wet London Mental Health
       Trust on CTG activity is being raised with them.
The Board noted the report and progress made and asked that the outcome of work on the
areas raised be reported at the September Board.

73/08 Commissioning Report – Out of Hospital Services
The Board was asked to note Out of Hospital Commissioning Report and particularly the
performance of GP practices against the Quality and Outcomes Framework and the
investment updates.
In discussion the Board:
    • Highlighted the improved MMR rate and suggested a review takes place to look for any
       learning from how this was achieved.
    • Noted the improvement in the disease prevalence figures but expressed
       disappointment that there still appears to be under-recording and/or under-diagnosis in
       primary care of chronic conditions and stressed the need to work with GP practices to
       improve this. The Board was assured that work is underway. There are also some IT
       issues affecting the data collection.
    • Noted the considerable rise in serious untoward incidents (SUIs) in 2006/07 compared
       with previous years. The Board was assured that these are audited and each incident
       investigated. The Healthcare Commission review of the handling of SUIs by the Central
       North West London Mental Health Trust showed this to be satisfactory.
    • The Board was assured that investment bids from the PCT’s Provider Services go
       through a rigorous business planning process which requires evidence of outcomes.
       The Board highlighted the need to also consider when a wider provider base and
       tendering of services is appropriate.
The Board noted the Out of Hospital Commissioning Report.

                                                                                          Chair Peter Molyneux
                                                                             Chief Executive: Diana Middleditch
                                                           Chair Clinical Executive Committee: Andrew Steeden
74/08 Annual Review of Board Committee Terms of Reference
The Chair highlighted the need for the Board, as a Commissioning Board, to review the Board
structure and agenda framework to ensure this focused on high level issues with the more
detailed work being undertaken by sub groups. A review of governance is underway. In the
light of this is was agreed that the existing terms of reference for Board committees should
continue until a new committee structure is in place with revised terms of reference.

75/08 Quarterly Integrated Governance Committee Report
The Board noted the report.

76/08 Financial Statements; Statement of internal Control and Annual Accounts 2007/8
Jon Bell reported that the accounts had been signed off as delegated by the Board and an
unqualified submission made. The Audit Committee will look at any issues which may arise.

The Board noted the Financial Statements and Accounts for 2007/08

77/08 Single Equality Scheme
The Board was asked to approve the Single Equity Scheme and action plan. The Single
Equity Scheme and associated action plan combines the existing Race, Gender and Disability
Schemes in to a single scheme covering 3 years. It sets out the PCT’s duties as a public
authority to promote equality and eliminate discrimination based on race, gender and
disability. The equity strands of age, sexual orientation and religion/belief have also been
included although the PCT recognises that it still has work to do to address these additional
strands, particularly age equality. A range of stakeholders have been involved in the
development of the scheme.

In discussion the Board:
    • Was assured that the PCT is meeting all its statutory obligations. Mark Hirst agreed to
       take questions outside of the meeting on how work which is beyond the statutory duty
       is prioritised in the light of other PCT priorities.
    • Noted that the tough targets included had come from directors and departments
       themselves, which demonstrates a commitment to equality.
    • Commented on the risk rating of 12 which reflected a previous lack of ownership of
       equality issues. As this has now improved the Board asked that the risk rating be

The Board approved the Single Equity Scheme and associated work plan.

78/08 Chief Executive’s Report
The Board received the Chef Executive’s Report and noted the Health Inequalities Review
chaired by Cllr Blakeman on how the Royal Borough and PCT services have responded to
health inequalities and the associate PCT action plan to address the recommendations made.

79/08 Clinical Executive Committee minutes of 29 April 2008
The Board noted the work of the Clinical Executive Committee and the minutes of the meeting
held on 29 April 2008.

80/08 Audit Committee minutes of 18 March 2008
The Board noted the work of the Audit Committee and the minutes of the meeting held on 18
March 2008.

                                                                                        Chair Peter Molyneux
                                                                           Chief Executive: Diana Middleditch
                                                         Chair Clinical Executive Committee: Andrew Steeden
81/08 Joint Health and Wellbeing Board minutes of 10 March 2008
The Board noted the work of the Joint Health and Wellbeing Board and the minutes of the
meeting held on 10 March 2008.

82/08 Any Other Business
There was no other business.

83/08 Next meeting
The date of the next meeting will be 30 September at 9.00am in The Lighthouse,
117 Lancaster Road, London W11.

                                                                                       Chair Peter Molyneux
                                                                          Chief Executive: Diana Middleditch
                                                        Chair Clinical Executive Committee: Andrew Steeden

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