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					            MINUTES OF THE BOARD MEETING HELD ON
            THURSDAY 3RD DECEMBER 2009 AT 9.30AM
   BOARD ROOM, WHITE ROSE HOUSE, TEN POUND WALK, DONCASTER

Present:             Mr Roger Greenwood, Chairman
                     Mrs Annette Laban, Chief Executive
                     Dr Alastair Graves, Professional Executive Committee Chair
                     Dr Les Ranson, Non Executive Director
                     Mr Anthony Humphries, Non Executive Director
                     Mr Albert Schofield OBE, Non Executive Director
                     Mrs Pam Horner MBE, Non Executive Director
                     Mrs Jill Morris, Non Executive Director
                     Mrs Ann Gilbert, Non Executive Director
                     Mrs Sheenagh Powell, Executive Director of Finance &
                     Procurement
                     Ms Helen Beard, Executive Director of Performance &
                     Information
                     Mrs Julie Bolus, Executive Director of Quality and Clinical
                     Assurance
                     Dr Tony Baxter, Joint Director of Public Health
                     Mr Chris Stainforth, Executive Director of Commissioning &
                     Strategic Development

In attendance:       Mrs Debbie Hilditch, Director of Organisational Development
                     and Corporate Affairs
                     Mrs Carole Donaldson, Managing Director, Doncaster
                     Community Healthcare
                     Mr Jon Cooke, Deputy Director of Finance & Procurement
                     Mr Ian Carpenter, Assistant Director Communications
                     Mrs Margaret Shaw, Corporate Affairs Officer
                     Mrs T Slater, Assistant Director, Quality & Clinical Assurance
                     Mr M Hammonds, NHS Graduate Trainee

                                                                             ACTION
337/09     Welcome and introductions

           Mr Greenwood welcomed Mr Ed Hallam from Astra Zeneca,
           Mrs Tracey Slater and Mr Matthew Hammonds to the
           meeting.

338/09     Apologies

           Apologies were received from Mrs Joyce Parrott, LINKS

339/09     Declarations of Interest

           There were no declarations of interest.


                                           1
340/09   Minutes of the Board Meeting held on 5th November 2009

         The minutes of the Board Meeting on 5th November 2009
         were agreed as a correct record.

341/09   Matters Arising not on the Agenda

         319/09 Executive Director of Finance & Procurement
         – Vulnerable People
         Attention was drawn to the suggestion of the possibility of
         risk pooling for the above being raised with NORCOM. Mrs         Mrs Powell
         Powell agreed to pick this up.

         - Overall Position
         Mrs Bolus referred to the provision of a report on prescribing
         underspend to a future meeting and confirmed that this will
         be presented to the Professional Executive Committee in          Mrs Bolus
         January and to Board in February.

         320/09 Executive Director of Performance & Information
         Report
         - Maternity Matters
         Mrs Bolus referred to the ratio of midwifery supervisors to
         patients and confirmed that this was currently 1:13. The
         Trust are currently recruiting midwifes and training midwifes
         to become supervisors. The aim is to achieve 1:12 by the
         end of January and it was noted that an update will be
         provided at the February meeting.

         322/09 Offender Healthcare
         Mr Stainforth referred to the request at the last meeting for
         clarification on the ‘restricted route’ for procurement and
         explained the difference between the three procurement
         processes:
              Open
              Restricted
              Competitive dialogue

         The Board noted that the process in relation to the Prisons
         was in fact the ‘competitive dialogue’ procurement route. It
         was agreed that the detailed explanation would be circulated.    Mrs Shaw


         232/09 NHS Constitution
         Mrs Hilditch advised that the action plan is currently being
         developed and will be completed once the outcome of the
         consultation is concluded. Mrs Hilditch referred to the
         information in relation to patients’ rights which is now
         available on the website:
         It was agreed that the link will be circulated to Members.       Mrs Shaw




                                          2
         326/09 NORCOM Commissioning Forum Consortia
         Establishment Agreement
         Mrs Laban referred to the request for confirmation of
         lead/chair responsibility for items 11 and 12 within the
         constitution:
         Item 11 – Policy Development – Ailsa Clare is the Chair of
         the group leading on this
         Item 12 – QIPP – Barnsley leading on this, first meeting to be
         held early January to look at implications of QIPP around
         specialised services.

         Reports

342/09   Chairman’s Report

         Mr Greenwood was pleased to report that the organisation
         has recently done really well in two award categories:
         Health Service Journal Awards – the Cough Cough
         campaign came highly commended in the top 6. The award
         was won by Birmingham PCT – Gym Free.

         NHS Communications Awards – the DN1 Online Soap
         website won runner up award in the Social Media category.

         The Board note that the Doncaster Metropolitan Borough
         Council, Active Health – early access to swimming was also
         highly commended within the Yorkshire and the Humber
         ‘Making a Difference’ awards.`

         Mr Greenwood reported on an event which NHS Doncaster
         hosted ‘National Energy for Action’. Ed Milliband MP
         attended the event which showcased the work being
         undertaken in Doncaster around fuel poverty and carbon
         reduction.

         Mr Greenwood and Mrs Laban met with Ed Milliband after
         the meeting and discussed the current position and the
         challenges ahead for NHS Doncaster. The Board noted that
         as part of the constituency boundary changes Mexborough
         will be included in Ed Milliband’s constituency, constituency
         area for Geoff Ennis is Barnsley and Caroline Flint Thorne.

         Mr Greenwood reported on the following events/meetings:

               Board to Board meeting with Rotherham, Doncaster
                and South Humber Healthcare Mental Health
                Foundation Trust.
               Audit Committee
               Responsible Retailer Awards Ceremony




                                         3
         The Trust Board:
             Noted the Chairman’s update.

343/09   Chief Executives Report

         The Board received the above report updating on issues
         relating to the activity of the Trust.

         Pandemic Flu Update
         Dr Baxter updated the Board on the current position in
         relation to Swine Flu and reported that the surveillance
         system is indicating a dramatic reduction in patients
         presenting to GPs with flu like symptoms and that there has
         been a gradual reduction in hospital admissions.

         The Board noted that the vaccination programme for priority
         patient groups and staff is now underway and Dr Graves
         advised that uptake from patients for swine flu vaccine is
         lower than expected. It was noted that uptake from staff is
         also low for both swine flu and seasonal flu and that ways of
         increasing uptake are being considered.

         Attention was drawn to a problem within a specific practice
         relating to access to seasonal flu appointments outside
         normal working hours and clarification sought on whether
         this is an isolated incident or more widespread. Mrs Bolus
         reported that she was unaware of any problems but agreed
         to check with the primary care team and feedback. It was
         noted that there are issues, generally, for working people to
         access GP appointments and that a piece of work is being
         undertaken to look at ways of improving this. It was noted
         that patients experiencing problems could attend the 8-8
         Centre.

         Dr Baxter also updated on the vaccination programme for
         housebound patients and that this was being delivered by
         Doncaster Community Healthcare staff. The Board were
         also informed that it is proposed to extend the vaccination
         programme to healthy children aged between 6 months and
         5 years, further details are awaited.

         The Trust Board:
             Noted the update.

         Awards Ceremony
         Mrs Laban referred to NHS Doncaster’s awards ceremony
         taking place on 12th March 2010 which recognises the hard
         work undertaken by staff throughout 2009.




                                         4
         Developing an Integrated Lung Pathway across
         Doncaster & Bassetlaw
         Mrs Laban reported on the above event which she opened
         on 5th November.

         Kings Fund Annual Conference
         Mrs Laban reported on the above conference which she
         attended and highlighted the presentations by the keynote
         speakers: Clive Killingsworth, Chairman and Chief Executive
         Officer, Blue Cross and Blue Shield of Massachusetts Inc
         and Caroline Waters, Director, People and Policy, BT.

         Operating Framework
         Mrs Laban informed the Board that the NHS Operating
         Framework is due out next week.

         Accommodation
         Mrs Hilditch took the opportunity to advise the Board that the
         first cohort of staff will be moving into the ground floor of GE
         House on 23rd December with the rest moving into the first
         floor on 5/6th January.

         High Impact Actions for Nursing and Midwifery
         Mrs Bolus advised that she had attended the Chief Nursing
         Officer Conference where the above actions were launched
         and was proud to report that a number of the actions are in
         the Yorkshire and Humber area and will be replicated
         nationally.

         The Trust Board:
             Noted the Chief Executive’s Report.

344/09   Professional Executive Committee (PEC) Chair Report

         Dr Graves reported on discussions from the Clinical
         Leadership Forum which was attended by some of the Trust
         Board Non Executive Directors.

         Primary Care Capacity Challenges
         Dr Graves advised that recent guidance from the Department
         of Health around continued delivery of primary care services
         during times of short staffing and increased demand has
         been received. In response to this a planning and decision
         making group has been established to enable rapid response
         to services.

         The Board noted that if an emergency planning situation is
         declared this group will form part of the command and
         control response and will formally report to the Chief
         Executive who will then report to the Trust Board.



                                          5
         Access to GP Services
         Dr Graves referred to previous discussions around access to
         GP services and reported that a group has been established
         to look at innovative ways of improving access.

         Attention was drawn to discussions around how Doncaster
         practices are performing and it was noted that Doncaster is
         in the bottom 10-49% for both 48 hour access and
         advance/future bookings. The Board noted that this formed
         part of the Quality and Outcomes Framework targets for
         access to services and that where the standard is achieved
         an incentive payment is made to the practice. Dr Graves
         drew attention to the information included in the Primary
         Care Performance Report which was circulated to Members
         prior to the meeting and highlighted the relevant section.

         Mr Greenwood referred to the wide ranging figures of
         between 10-49% and it was noted that these are taken from
         national and regional work rather than Doncaster specific.
         The Board noted that a new survey is being undertaken in
         January and it was agreed that the figure would be clarified
         at a future meeting.                                             Mrs Bolus


         The Board also requested feedback on the outcome of the
         sub group looking at GP access issues.                           Dr Graves

         The Trust Board:
             Noted the PEC Chair’s update.

         Delivering an Improved Health System

345/09   Quality, Innovation, Productivity and Prevention

         Mrs Laban updated the Board on progress relating to the
         above and advised that the next meeting of the health
         community QIPP Performance and Delivery Group is
         imminent and that Tim Leader, the newly appointed Director
         of Resources at the Local Authority has been invited to sit on
         the group. The Board noted that the Local Authority are
         enthusiastic about working with the health community on this
         agenda, particularly around back office functions.

         Partners are working together on the financial strategy and
         Doncaster & Bassettlaw Hospitals Foundation Trust is giving
         a presentation on the programme management approach
         they are using with a view to this approach being utilised for
         joint projects.

         The Board noted that discussions are being finalised
         internally around ‘big ticket’ items which will then be signed
         off at the Board.


                                          6
         Mrs Laban informed the Board that Doncaster have been
         asked to be a national pilot site for innovation and
         implementation of QIPP.

         Mr Stainforth referred to the programme budgeting work
         which is ongoing in support of the QIPP agenda and the
         recent redesign of the pathway for the Vascular programme
         which has proved really successful. It is proposed that this
         approach will be used in other areas around the QIPP
         agenda.

         The Trust Board:
             Noted the update and that a written report will be
               provided for the January meeting.

346/09   Executive Director of Finance & Procurement Report

         The Board received the above report updating on the
         2009/10 position in relation to both the Commissioner and
         Provider as at October 2009 and noted that the position is
         similar to that of last month in terms of pressures on
         contracts.

         Commissioner
         Mrs Powell summarised the potential cost pressures set out
         in the report including: Doncaster & Bassetlaw Hospitals
         Foundation Trust Contract; Continuing Care; Vulnerable
         People and Specialised Services.

         The Board noted that significant work is being undertaken
         looking at the detail of overspends and measures to manage
         and reduce these. The Board were advised that the position
         is monitored on a weekly basis by the Senior Management
         Team and that NHS Doncaster is confident of reaching its
         financial control total although there are risks which were
         outlined in the report.

         Attention was also drawn to A&E performance and that
         although the target for October was met, performance is still
         a cause for concern. An action plan is in place to improve
         the position.

         Reference was made to the underspend of £7M in relation to
         LDP and spotlight initiatives and whether or not the agreed
         number of staff are still in post. Mrs Powell reported that
         where staff were taken on they are still in post but that lead
         in times and the fact that projects have not needed the extent
         of investment approved has resulted in slippage within the
         programme. The Board noted that management costs were
         currently under review with a proposal to reduce over the
         next 3 to 4 years.


                                         7
         Provider

         The Board received the finance position as at end of October
         for the provision arm of NHS Doncaster.

         Mrs Donaldson highlighted the key points from the above
         report including an increase of £2M in turnover due to taking
         on additional work. The Board noted that DCH is on target to
         reach the yearend forecast.

         Attention was drawn to the number of vacancies and Mrs
         Donaldson explained that substantial recruitment was
         ongoing but that some vacancies relate to areas which are
         currently covered by agency staff due to time limited
         contracts. Mrs Donaldson confirmed that service delivery
         was not affected by these vacancies.

         Clarification was sought on the current position regarding
         recruitment against the drive to reduce management costs.
         The Board noted that in order to tighten up on the
         recruitment process all Directorates will have to prepare a
         business case for replacement posts which will be
         considered by the Senior Management Team.

         Mrs Donaldson referred to paragraph 7 relating to community
         contracts 2009/10 and advised the Board that these issues
         have now been resolved.

         The Trust Board:
             Noted the current position and updates in relation to
               both the Commissioner and Provider financial
               positions.

347/09   Executive Director of Performance & Information Report

         The Board received the monthly performance and
         information report comprising:
              Monthly performance and information update
              Quarter 2 Business Plan update
              2010/11 Business Planning process
              CQC Forecast
              LAA Quarter 2 Performance report

         Ms Beard highlighted the following:

         Monthly Performance & Information Report
         Breastfeeding – Quarter 2 below target - work is ongoing to
         check data to ensure it is being captured correctly.

         A&E – 4 hour maximum wait - November target failed – key
         issues relate to staffing and access to beds.


                                         8
Yorkshire Ambulance Service (YAS) – The Board noted that
the Doncaster position appears to be improving reaching
69%. Questions in relation to significant outliers have been
raised and a response is awaited.

Mrs Laban reported on a meeting between PCT Chief
Executives and the Chief Executive of YAS where it was
agreed that NHS Bradford would continue with the lead
commissioner model. Operational meetings between NHS
Doncaster and the YAS team continue and PCTs have
agreed to data sharing of ambulance turn around times. A
time out is planned to look at a strategic commissioning plan
for the ambulance service.

Mrs Bolus referred to previous discussion around patient
safety concerns and confirmed that no significant incidents or
complaints have been received.

Mr Greenwood confirmed that he has discussed with other
PCT Chairs the issue of demand in other areas affecting the
performance in Doncaster.

Unplanned Care
Mr Greenwood suggested that it would be useful to have the
more detailed information available prior to the official
opening of the centre. Mr Stainforth agreed to ensure that
this is provided.
                                                                  Mr Stainforth

Quarter 2 Strategic Business Plan Report
The above report gave a summary overview of quarter 2
performance against the 2009/10 Strategic Business Plan.

Clarification was sought on actions traffic lighted red in
relation to Public Health and it was noted that this was partly
as a result of staff working on the Swine Flu Pandemic. The
Board noted that additional tutorials on the Covalent system
are also being provided to achieve the best out of the
system.

2010/11 Business Planning Process
The timetable and process was reviewed and approved. The
Business Plan will be presented to Trust Board at the April
meeting.

LAA Quarter 2 Performance Report
Ms Beard presented the above report giving an overview of
progress against the LAA targets.

Mr Greenwood drew attention to the referrals to children’s
social care and that this has moved from rated green in
September to red. The Board noted that this may have


                                 9
         related to the backlog of cases and Mrs Bolus confirmed that
         these have now been cleared.

         The Trust Board:
             Noted the information provided in the above reports.

348/09   Doncaster Community Healthcare (DCH) Performance
         Report, Managing Director, Doncaster Community
         Healthcare

         The Board received the above report setting out progress
         against key performance indicators relating to the following:

               Smoke Free – accumulated number of quitters – On
                target
               Continuing Care Review Team – Issue with data
                quality in October, work ongoing to resolve this
               Cardiac Rehabilitation – on target
               Dental Access and Out of Hours – Investigative
                project to be carried out to understand the problems
                around incoming calls.
               Breast Feeding – Work is underway to more
                accurately record the way data is collected, along with
                clarification of the criteria
               8 – 8 Centre – It was noted that the service is
                currently exceeding the Quality & Outcomes
                Framework indicators. Information is also being
                collected from patients who access the service.

         The Trust Board:
             Noted the report.

349/09   Personalisation/Personal Health Budgets Pilot

         Mr Stainforth presented the above paper and updated the
         Board on the position in relation to Doncaster becoming a
         pilot site for Personal Health Budgets.

         Discussion followed on the provision of the budgets and
         whether the financial impact would be greater than before. It
         was noted that the cost of the current care provided is known
         and that this can be benchmarked against the cost of the
         pilot to identify any increase/decrease in costs. The pilot will
         be independently evaluated with outcomes being measured
         as well as the financial impact. The Board noted that the
         package will cover both health and social care needs and
         that consideration is being given to the category of patients
         that would most benefit from this package.

         Mrs Bolus supported the introduction of the personal health
         budgets and highlighted the clinical risks and others that


                                          10
         needed to be taken into account when moving forward with
         this project. The Board noted that a risk policy is being
         developed and that a representative from Quality & Clinical
         Assurance has been involved in that process.

         The Trust Board:
             Noted the progress on the pilot.

350/09   Sustainability and Sustainable Development

         Dr Baxter presented the above paper outlining the
         background, structure and process to delivering a
         sustainable organisation.

         Mr Greenwood referred to the Regional Sustainability Group
         which he sits on and the need to embed sustainability into
         the organisation. He expressed concern regarding the
         number of Committees within the reporting process and
         suggested that reporting should either be straight to Board or
         through the Integrated Governance Committee.

         Mrs Hilditch referred to the requirement to undertake
         environmental impact assessments for all policies and
         practices and that a statement will be included in all new
         contracts.

         The Trust Board:
             Noted the update and that a report setting out
               baselines for the organisation and an action plan for
               implementation will be presented to the February
               meeting.

351/09   Patient Insight Themes Report

         The Board received the above report and Mrs Hilditch
         highlighted the key successes from ‘You said we did’
         together with the key themes for development.

         Members noted that the revised website and proposals for
         the elephant kiosks in the 8-8 centre and other areas will
         help to support the organisation in the patient experience
         agenda.

         Mr Greenwood referred to the importance of feeding back to
         members of the public and sought clarification on proposals
         for taking this forward. The Board noted that options include
         newsletters for key stakeholders, staff and public.

         Attention was drawn to key themes for development and in
         particular ‘early diagnosis of dementia’. It was noted that this
         is being taken forward via the spotlight initiatives and that the


                                          11
         Clinical Leadership Forum has already held an event on
         dementia and that the patient experience before and after
         service design will be evaluated. Mr Stainforth stressed the
         importance of including carers in the process.

         The Trust Board:
             Noted the update

         Corporate Assurance

352/09   Annual Audit Letter & Use of Resources report

         The Board received the Annual Audit Letter and the Use of
         Resources Final Report and Action Plan. Mrs Powell
         highlighted the key points outlined in the Annual Audit Letter
         and informed the Board that action plans are in place to
         address the issues outlined in the letter.

         Mrs Powell drew attention to the Use of Resources report
         and action plan. The Board noted that work has already
         commenced to ensure that full engagement with the Audit
         Commission is achieved throughout the process, which,
         along with the implementation of the action plan should
         enable a higher score to be achieved.

         The Board noted that an event has been arranged with all
         assessors to demonstrate the PCT’s position and
         commitment to the assessment. In addition joint meetings
         between the Steering Group and assessors are also being
         arranged.

         The Trust Board:
             Noted the Annual Audit Letter and the Use of
               Resources Final Report and progress to date.

353/09   Workforce Report

         Mrs Hilditch presented the above report highlighting a
         number of workforce metrics which have been developed by
         the PCT to provide assurance to the Board regarding
         workforce matters.

         Attention was drawn to the commissioning workforce
         numbers and it was noted that a review is being undertaken
         around funded establishment and manpower controls for
         both the Commissioner and Provider arms of the
         organisation.

         Mrs Hilditch highlighted the new Yorkshire and the Humber I-
         View system which links to the Electronic Staff Records and
         allows information to be extracted from the ESR data-


                                         12
         warehouse to enable comparisons to be made with other
         PCTs and Acute Trusts in relation to sickness absence,
         overtime and productivity etc. The Board noted that initial
         reports have identified that the following two areas of work
         need further consideration: reduction in sickness absence
         and use of staffing resources across the organisation.

         The Board were advised that targets to reduce absence
         across the organisation and to increase productivity were to
         be established.
         It was noted that the appraisal process is also being looked
         at and that this will be linked with the work around the
         Organisation Development Plan.

         Linked to the requirement to look at back office functions a
         series of ideas are being discussed across the health
         community.

         The Trust Board:
             Noted the Workforce Report and the updates
               provided.

354/09   Safeguarding Vulnerable People

         The Board received the above paper outlining the current
         position in relation to safeguarding vulnerable adults and
         Doncaster’s approach to improving the safety and quality of
         service. The paper also included a copy of the Doncaster
         Safeguarding Adults Partnership Board Annual Report for
         the period April 2008 to March 2009.

         Mrs Bolus took Members through the detail of the paper,
         including the Annual Report and the Care Home data.

         Discussion followed on Appendix 2 relating to Care Home
         data and a number of issues were raised including:
             Clarification on occupancy rates for the homes: It was
               noted that the information provided in the report
               related to total number of places and total number of
               Doncaster residents.
             Future action in relation to homes rated poor and
               poor: The Board noted that responsibility for the
               grading of the homes rests with the Care Quality
               Commission and that following an inspection an action
               plan is drawn up. Homes with a poor rating a return
               visit would normally take place within 3 months.
               Where there are Doncaster residents in these homes
               an assessment is carried out by a specialist team to
               ensure there are no concerns.




                                         13
         Mr Greenwood took the opportunity to refer to the press
         statement released today relating to the CQC rating for Adult
         services - ‘ Positive rating for Adult Services in Doncaster’.
         The Board noted the content of the statement including that:
         ‘Doncaster has been rated as ‘performing well’ for the
         second year running in the delivery of Adult services for
         vulnerable people across the borough. The positive rating is
         a result of the continuous improvement in Adult services over
         the past two years and shows that Service Leaders and
         Managers can effectively translate plans into positive
         outcomes for Vulnerable People.’

         Clarification was sought on where the duty of care sits and
         Mrs Bolus informed the Board that Doncaster MBC has the
         responsibility of ensuring that systems and processes for
         safeguarding are in place for all care homes in Doncaster
         and that NHS Doncaster contributes to that as a
         commissioner. The placing authority has the duty of care in
         relation to the individual patient.

         The Board discussed the issue of contracts in place and it
         was noted that the contracts in place are currently for the
         care home but that the intention is for a contract for each       Mrs Bolus
         individual patient to ensure they are receiving the right care.

         The Board suggested that it would be useful to have a
         separate briefing session to enable a more indepth
         discussion prior to further discussions at a future Board
         meeting.

         Mr Greenwood referred to the role of Chair of the Adult
         Safeguarding Board which is currently undertaken by the
         Director of Adult Services and questioned whether there
         should be an Independent Chair. Mrs Bolus informed
         Members that a review of effective working has been
         undertaken and one of the outcomes was the suggestion of
         an Independent Chair.

         The Trust Board:
             welcomed the reports and proactive statements and
                noted progress to date and future action.

356/09   Single Equality Scheme

         The Trust Board received the Single Equality Scheme which
         was received and approved by the Integrated Governance
         Committee on 9th November and recommended for approval
         by the Trust Board.

         The Trust Board:
             Approved the Single Equality Scheme


                                          14
357/09   Terms of Reference

         The Trust Board received, for approval, the revised Terms of
         Reference for the Audit Committee and Integrated
         Governance Committee which have been approved by the
         respective Committees.

         The Trust Board:
             Approved the Terms of Reference for the Audit
               Committee and Integrated Governance Committee

358/09   Governance Report Quarter 2

         Mrs Hilditch presented the Governance Report, including the
         Assurance Framework for the commissioning part of NHS
         Doncaster, which was received by the Integrated
         Governance Committee in November. The Assurance
         Framework was also received by the Audit Committee at the
         November meeting.

         The Board noted that it has not as yet received the
         Doncaster Community Healthcare Assurance Framework
         and Risk Register. Members were advised that Internal
         Audit have undertaken an audit on both these documents
         and made a number of recommendations. The report will be
         presented to the January Audit Committee and Trust Board.

         Attention was drawn to the information relating to numbers of
         serious untoward incidents and a request made for further
         information. It was agreed that a more detailed report
         covering the last twelve months will be presented to the
         February meeting.

         Reference was made to the mapping of risks to the
         assurance framework and in particular SO4 where the
         number of risks equates to 46% of overall risks. Clarification
         was sought on the implications of this to the organisation.
         The Board noted that the Quality & Clinical Assurance
         Directorate are responsible for identifying these risks and the
         reason for the high percentage is that SO4 relates to ‘design
         and invest in safe care pathways’ which also links to the
         safeguarding agenda.

         Mrs Hilditch referred to the two high risk areas of Waste
         Management and Information Technology which were
         previously reported to the Board and advised that the
         Governance Report gives assurance around action plans
         and timescales.

         Attention was drawn to page 33 of the report and the items
         under ‘incidents affecting staff’ and further clarification was


                                          15
         given regarding the item relating to selling of inappropriate
         goods at White Rose House.

         The Trust Board:
             Noted the report

359/09   Gender Dysphoria Policy

         Mr Stainforth presented the above Commissioning Policy on
         Gender Dysphoria Services for adults and advised the Board
         that the policy has been revised to ensure consistency
         across the Yorkshire and the Humber area.

         Following clarification the Board noted that the Specialised
         Commissioning Group have delegated authority to approve
         the policy on behalf of the PCTs and Members were assured
         that the policy was debated in great detail as are all
         specialised commissioning policies. Mr Stainforth informed
         the Board that the Public Health lead from the Specialised
         Commissioning Group has been invited to the next
         Commissioning Executive meeting to talk through
         commissioning of specialised services.

         Attention was drawn to paragraph 7.8 in relation to reversal
         surgery. It was noted that such surgery is not normally
         commissioned although in exceptional circumstances it is not
         totally excluded. The Board noted that this type of request
         would normally be referred to the Priorities Advisory Group.

         The Trust Board:
             Adopted the Gender Dysphoria Policy

         Minutes from Internal Trust Board Committees

360/09   Integrated Governance Committee

         The Minutes of the Integrated Governance Committee
         meeting held on 12th October 2009 were received and noted.

361/09   Doncaster Community Healthcare Executive Committee

         The Minutes of the Doncaster Community Healthcare
         Executive Committee held on 6th October 2009 were
         received and noted.

362/09   Audit Committee

         The minutes of the Audit Committee held on 22 nd September
         were received and noted.




                                         16
363/09   Commissioning Executive

         The Minutes of the Commissioning Executive meeting held
         on 27th October and 12th November 2009 were received and
         noted.

364/09   Professional Executive Committee

         The Minutes of the Professional Executive Committee held
         on 17th September 2009 were received and noted.

365/09   Minutes from External Trust Board Committees/
         Organisations

366/09   Specialised Commissioning Group

         The Minutes of the Specialised Commissioning Group held
         on 16th October 2009 were received and noted.

367/09   Discover the Spirit Board

         The Notes of the Discover the Spirit Board held on 29th
         September 2009 were received and noted.

368/09   Items for Information Previously circulated to Trust
         Board

         The Board noted receipt of the Primary Care Performance
         Report.

369/09   Any Other Business

         There was no further business.

370/09   Date and Time of Next Meeting

         The next meeting will be held on Thursday 7th January 2010,
         at 9.30am Board Room, White Rose House, Ten Pound
         Walk, Doncaster.




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