Draft Minutes of Board Meeting held on Wednesday 29th by rjt20314


									     Draft Minutes of Board Meeting held on Wednesday 29th March 2006 at 1.00 pm
                              Riverside House, Aberdeen


      Board Members
      Mr Deep Sagar                         Chairman, NHS 24
      Prof Lewis Ritchie                    Vice Chairman, NHS 24
      Mr Bert Bruce                         Employee Director, NHS 24
      Mr Hamish Guthrie                     Non Executive Director, NHS 24
      Mrs Jacqui Low                        Non Executive Director, NHS 24
      Mr Pat Kelly                          Non Executive Director, NHS 24
      Mrs Cheryl Black                      Non Executive Director, NHS 24
      Mr Stuart Smith                       Non Executive Director, NHS 24
      Mr John Rogerson                      Non Executive Director, NHS 24 (to Item
      Mr Allan Watson                       Non Executive Director, NHS 24
      Mr John McGuigan                      Chief Executive, NHS 24
      Mrs Eunice Muir                       Nurse Director, NHS 24
      Mr Bill Templeton                     Director of Corporate Services, NHS 24
      Dr George Crooks                      Medical Director

      In Attendance
      Ms Alison Boyd                        Board Secretary, NHS 24
      Mr Ian Williamson                     Scottish Executive Health Department
      Mrs Elaine Boyd                       Audit Scotland
      Mr Tom Greatrex                       Director of Corporate Services, NHS 24
      Mrs Jane McCartney                    Director of HR (Items 6 and 7)
      Dr Graham Dixon                       Director of IT, NHS 24 (Items )
      Ms Paula Speirs                       Director of Programme Office (Items


      The Chairman welcomed Board Members to the Meeting, reflecting on the new
      membership. Mr Sagar stressed the importance of democratic debate and the resultant
      strengthening of decisions thereafter. He advised that in future, to make the best use of
      the Board’s time, an increased focus would be placed on key strategic discussions,
      noting that the more functional requirements may more appropriately be placed at the
      end of Agenda, noting that if Papers are available in advance (4/5 days) there would be
      an assumption that they have been read. The Board endorsed this approach.


      The Minutes of the Meeting held on 22nd February 2006 were approved as an accurate
      record of discussions with the exception of a minor adjustment to wording on page 3.

      Ms Boyd undertook to amend the Minutes and the Chairman to sign an amended copy
      for the record.


3.1   Board and Standing Committee Meeting Schedule – 2006
      Ms Boyd advised that a schedule for Board and Standing Committee meetings to March
      07 had been drafted, with consultation to take place with Members and the Executive
      Team over the next two weeks to allow a finalised schedule to be brought to the April
      Board Meeting for approval.                                                      AB

3.2   Scottish NHS Confederation
      The Chairman advised that the Board’s decision to support the dissolution of the
      Scottish NHS Confederation had been communicated. It was noted that all NHS Boards
      had resolved, based on a request from the NHS Confederation, to continue with a signal
      subscription at circa £300-£500 per month. It was noted that this would provide access
      to publications and national information, including a Scottish Conference.

3.3   Fit Out of Satellite Sites
      Mr Rogerson queried if there would be a significant impact on the projected year-end
      outturn. Mr Templeton said that any expenditure would be accommodated within the
      Capital Resource Limit.


      Mr McGuigan presented the Chief Executive’s Report and highlighted that the Nurse
      Advisor figure contained therein had been corrected, with a projection of 338.01 whole
      time equivalent by May 2006. Noting the contents of the Report, Board Members raised
      queries under the following headings:

      Clinical Response Times – Mrs Low queried the outliers to the non-urgent responses
      commenced within one hour and Dr Crooks advised that up to 6% of responses are
      commenced within 70 minutes and any response over this timeframe is reviewed on a
      case-by-case basis.

      The Chairman recalled the need to continue to focus on the importance of call-back’s
      reducing trend whilst working at the same time to build appreciation that clinical needs of
      patients drive prioritisation of calls. Following discussion, Dr Crooks advised that work
      would continue with partners and proposals would be brought to a future Board Meeting
      outlining a whole system approach. He noted that this might include advising callers of
      appointment times for return calls, thus mirroring day-time service provision. He
      stressed that dealing with emergency, life-threatening conditions was the focus for the
      out-of-hours service.

      It was noted that the call-back figures excluded the untriaged calls passed to partners
      and the outbound satellite site calls.

Citistat System – Mr Williamson advised that this system was in various stages of
development across NHSScotland. Mr McGuigan advised that the potential use of this
in NHS 24 was being explored with focus going forward being on best fit for the
organisation and Board’s use in monitoring performance. Mr McGuigan undertook to
seek to identify how other NHS Board’s sought to measure performance against the
national targets.                                                             PS

PFPI Events – Mr Smith expressed a wish to hear feedback from the 10 events held
across Scotland. Mr McGuigan advised that Mrs Speirs would provide an update on the
events during the strategic plan discussions to take place later in the meeting. He
further advised that Mr Greatrex would have Executive responsibility for Patient Focus
and Public Involvement.

Sickness Absence – Mrs Black noted the level of sickness absence and reflected on the
target level. Mr McGuigan advised that monitoring of short-term absences had
increased and the new Occupational Health Service provider involved more dynamically.

Mrs Black queried the potential impact of the implementation of the new workforce
management system. Mr McGuigan said that it was anticipated that this will make a
positive difference. Mr Bruce agreed with Mr McGuigan in his review of the issues and
said that continuing development of local senior managers may assist in staff access to
leave alternatives. Mrs Low advised that there had been detailed discussion of the
issues and action taken and planned at the most recent meeting of the Staff Governance
Committee when the Director of HR had reviewed the managed absence programme.

Business Continuity – Mr Guthrie asked if a risk analysis had been undertaken for each
of the NHS 24 properties. Mr McGuigan advised that a desk top exercise on business
continuity had been arranged by Dr Dixon to take place on 19th April, to which Board
Members would be invited.

Patient Satisfaction – The Chairman queried the rationale for moving from a monthly
telephonic to a quarterly postal survey. Mrs Muir advised that the postal survey allowed
callers to express more clearly what they felt and plans exist to move to a monthly postal
survey. Mrs Muir also highlighted the plans to seek patient views at focussed events,
working with NHS Boards. Prof Ritchie reflected that there had been potential for bias in
the call survey through selecting patients instead of patients randomly selecting in. Mrs
Black viewed that only those patients that feel strongly will bother to fill in a survey and
queried the changes in responses between the two. Mrs Muir advised that there had
generally been very constructive feedback received rather than criticism highlighting the
free area provided for participants to comment as they wished.

Internet Activity – In response to a request from Mr Guthrie, Mr McGuigan undertook to
have this information presented on a more appropriate scale.                    JMcG

Performance Data – Mr Rogerson highlighted the difficulty in reviewing extremes in
performance when averages are used. Prof Ritchie highlighted the comments made by
the Board in respect of the usefulness of reviewing the ranges in each of the
performance areas. Mr McGuigan advised that the Executive Team reviewed the
weekly data by week and weekend and agreed that there was a need to ensure that
outliers are monitored. Mr McGuigan highlighted that the organisation still had to
manage very tightly the resources available, noting the impact of the recent adverse

     weather on staffing and consequently performance levels. He advised that this would
     impact negatively on the March performance. Mr McGuigan advised that action to
     smooth out performance levels had included the establishment of a permanent night-
     shift. He undertook to review the levels of data considered within the Executive Team
     with the Board.                                                                 JMcG

     NHS 24 Service – Mr Watson suggested that it might be useful to redefine, with a more
     specific focus, the expectations of the NHS 24 service. Board Members noted that the
     Strategic Plan to be brought to the next Meeting and the stakeholder development
     discussions would seek to provide clarity in this respect.

     Complaints – Mr McGuigan advised that the quarterly complaints report had been
     withdrawn and would be re-distributed following the output of the review of complaints
     management currently being undertaken.

     Actions – Mr Smith queried how the Board might review actions currently taken from
     Board Meetings. Mr McGuigan advised that an action note was created from each
     Meeting which was taken to the following Executive Team Meeting by the Board


     Mr Templeton presented the Financial Report which covered the period 1st April 2005 to
     28th February 2006 and advised that the financial position after eleven months reflected
     a cumulative overspend of £394k (1%) against the original phased budget and noted
     that NHS 24 remains on track to fully use the funds allocated for the year and to meet
     the annual financial target as required.

     Mr Templeton noted that there were sufficient resources remaining in-year to account
     for the estimated liability for the adjustments to salaries required under Agenda for
     Change. He said that the exact valuation of the adjustment was not known and a
     provision was included based on an estimate. He said that most Nurse Advisors had
     been paid the new rate in the March salaries, but, as agreed through Partnership, the
     backdated payments would be processed for all staff after all staff were on the new
     rates on a monthly basis.

     In response to a query from the Chairman, Mr Templeton advised that he expected to
     bring the draft year-end figures, subject to audit, to the May Board Meeting. WAT

     The Chairman queried the expenditure against the Capital Resource Limit of £4.4m for
     the year and Mr Templeton advised that this was anticipated to be circa £2.5m. Mr
     Templeton advised that the £4.4m had included £1.2m which had been “returned” to the
     SEHD in 2004/05 and then unexpectedly re-provided to NHS 24 in 2005/06.
     Mr Templeton advised that the Capital Resource Level had been set for 2006/07 and
     2007/08 at £2m per year and the use of those funds is being determined in the Budget
     work for the next financial year. He said that where new projects required additional
     capital NHS 24 could submit business cases to the Capital Investment Group at the
     SEHD for consideration.

     Mr Guthrie asked why, compared to January, the operating costs in the North and East
     Contact Centres had increased while those in the West had decreased. Mr Templeton

     explained that in Appendix 1, the budgeted Incremental Frontline Staff Costs line should
     be added to the total Contact Centre Operating Costs )including Satellite Centres) and
     then the overall actual costs were below the total budget level. He said that when the
     Budget was compiled the estimated costs of additional frontline staff were kept separate
     as there was no indication of which Contact Centre staff would be based in until the staff
     were actually required. He said that as staff establishment settles, the Operating Costs
     would be inclusive and a better comparison generated.

     The Chairman queried the potential barriers for stopping the organisation ending the
     financial year within budget. Mr Templeton advised that a reforecast exercise had again
     been undertaken in February and the organisation was on track to meet the financial
     target. However, adjustments may be required between revenue and capital through
     the year-end work being completed as some expenditure currently classified as revenue
     may be more appropriately treated as capital and, after transfer, that could use some of
     the projected underspend on the CRL and allow a useful carry forward on the RRL.


     Mrs McCartney presented the Paper which, she explained, provided the background to
     the implementation of the national pay modernisation agenda.

     The Board noted that the project had resourced according to the governance model
     agreed and that the Knowledge and Skills Framework and Job Evaluation Panels will
     continue beyond the life of the implementation programme.

     Ms McCartney advised that the required national timescales had been met with all
     matching and job evaluation undertaken, with the exception of new posts, and paid
     tribute to the staff and management for achieving this against the competing priorities.
     Mrs McCartney advised of the new target of having Personal Development Plans in
     place by April 2006, except for those on long-term sick, maternity leave, etc. Mrs
     McCartney advised that NHS 24 was currently ahead of most NHS Boards, with the
     eKSF tool currently being reviewed by the IT team for consideration if this can be
     included in the current CipHR system. Mrs McCartney stressed that partnership working
     has been key to the delivery and was evidence of how well this can function in NHS 24.

     Mrs McCartney advised that outstanding risks and issues included very aggressive
     timelines for implementation with some concerns remaining around the impact of
     Unsocial Working Hours payments, noting that a new model is being investigated
     nationally. The Board noted that NHS 24 has offered to be a pilot site to measure the
     impact of any new proposals.

     Mr Guthrie queried the potential for completion of the PDPs within timescale and the
     possible negative impact on staff of delays. Mrs McCartney advised that the issue was
     that PDPs required to be linked to the KSF and this will become an ongoing process up
     to September 06, which was outwith the target. It was noted that the Staff Governance
     Committee had been made aware of the position and was supportive of rolling this out
     across the organisation during the year. Mr Bruce reflected the challenges lay in
     allowing front-line staff time off-line to complete the PDP and the associated activities,
     noting that this might be assisted by the implementation of the Workforce Management
     System with staff eager to progress this.

     Mr Rogerson queried the potential impact of this on the budget for 2006/07. Mr
     Templeton advised that £1.2m had been set aside during 2005/06 and £600k in 2004/05,
     but only the impact from the largest group affected – Nurses – was known to date (£538k
     back payment for the 18 month period to 31 March 2006). Mr Templeton advised that
     the impact for the Health Information Advisor and Call Handler roles would be known in
     April for the 19 month period. It was noted that the organisation still awaited feedback
     from SPRIG on the other roles. Mr Templeton considered that sufficient provision had
     been established.

     In response to a query from Mr Smith, Mrs McCartney advised that National Services
     Scotland (payroll provider) had advised that a timescale of three months was required for
     the payment of the initial salary, noting the complexities of changes in jobs, hours, etc.
     Mr Templeton advised that it could take up until October to resolve all posts.

     Mrs Black queried the impact of other elements of terms and conditions, e.g. sick pay,
     unsocial hours, etc. Mrs McCartney advised that changes to sick pay arrangements are
     for staff groups that NHS 24 doesn’t have, but noted the impact of enhancements being
     paid whilst off sick. It was noted that Unsocial Hours arrangements are unknown since
     the three initial models have been withdrawn. Mr McGuigan undertook to ensure that
     this was captured on the organisational risk register.

     Mr Guthrie queried what support the Board could provide. Mr McGuigan suggested that
     it might be an appropriate time to send a letter to SEHD outlining the Board’s concerns.
     The Board endorsed this approach.                                         JMcG/JMcC


     Mrs McCartney presented the report which sought to inform the Board of the detail of the
     Self Assessment Audit Tool (SAAT), updated action plans, improvements for the period
     April 2005-March 2006 and mandatory staffing statistics for the period October 2004-
     September 2005. Mrs McCartney received the Board’s endorsement for submission of
     the information to the SEHD, to meet the annual requirement contained within the Staff
     Governance Standard.

     In response to a comment from Mr Rogerson around identifying actions which involved
     staff in decisions that affect them, Mr Bruce highlighted the increased use of the local
     and area partnership forum as the appropriate body for management to engage with

     Mrs Low advised that during discussions at the Staff Governance Committee it had been
     agreed that Mr Greatrex would bring an update on internal communication activity to the
     next Committee Meeting.

     Mr Guthrie asked that, where possible, the use of the term ongoing be avoided or explicit
     reference included around the nature of this. Prof Ritchie suggested that milestones be
     included where appropriate.


     Dr Crooks gave a presentation on the planning activity undertaken to prepare for the
     Easter public holidays and highlighted:
     • the opening of some General Practices on Good Friday and Easter Monday, e.g.
        NHS Grampian covering 9.4% of the Scottish population, with 87% population
        coverage by NHS 24 on and 96% coverage on Monday 17th April.
     • the vast majority of the population are tolerant of three day closures but any days
        additional to this can pose additional challenges to the NHS 24 capacity for national
     • the anticipation that a significant number of calls will be for repeat prescriptions
     • A&E and the Ambulance Service provide a full service on these days with the patient
        transport service shutting down since the vast majority of outpatient work did not take
        place on public holidays.
     • a comparison of staff resources against projected call demand, based on previous
        years demand, had been undertaken using Simul8 in order to measure how the
        service might respond.
     • partner support had been sought for taking untriaged calls.
     • a range of support staff would be on duty, e.g. for handing over calls to partners,
        provision of management information, etc.
     • rotas for 98% of front-line staff had been agreed with 100% of required Call Handlers
        and 75% of Nurse requirements filled, with staff required to work 3 shifts over the 4
        days. It was noted that Health Information Advisors, Pharmacists and Dental Nurses
        would also be available with Call Handlers undertaking Advise and Refer duties, as
        appropriate for non-clinical staff, e.g. reporting of death, referral to district nurses.

     The Chairman queried if capacity was sufficient. Dr Crooks advised that this was the
     position against the projected call demand and provided an example of the output of
     Simul8, predicting over 35k calls and access service level at 91% over the period. Dr
     Crooks said that predictions for the period included 77% against a target of 90% for
     responding to clinically urgent calls within 20 minutes and an overall call-back rate of
     35%. It was noted that calculations were still relatively crude and this continued to grow
     and develop, with a focus on any queues being clinically appropriate. Mr McGuigan
     noted that predictions run for the festive period were fairly accurate.

     Dr Crooks advised that a national conference call would take place with all partners on
     each of the four days to discuss how the service is going, the flow of patients, to
     consider if any service is under pressure, any issues requiring to be resolved, etc. It
     was noted that daily management information would be available to inform discussions.

     The Chairman asked what the constraints were to achieving a lower call back rate and
     Dr Crooks advised that the key dependency was the range of clinical staff available to
     take the calls handed over from Call Handlers, particularly during peak times, noting that
     on a normal Saturday most access to the service was within a 2 hour period.

     Dr Crooks advised that key performance indicators had been agreed with partners for
     the four days:
     • 120 seconds average answer time
     • 90% of serious and urgent calls responded to within 20 minutes
     • 90% of other calls responded to within 60 minutes

      The Chairman fed back main messages from the recent Chairs’ meeting:
      (a) The Minister had called on NHS 24 and NHS Boards to manage performance over
          Easter well; and
      (b) The need for all NHS Boards to sign off NHS 24’s Easter plan, similar to last

      Mr McGuigan said a Variation Order for resources should only be sought if additional
      benefits were identified. He undertook to communicate with SEHD so that they could
      coordinate the NHS Boards’ sign-off.                                         JMcG


      Mr Greatrex presented the paper which sought the formal approval of the Board for the
      costs to deliver a marketing/public awareness campaign to be run from 13th to 17th April
      06. Mr Greatrex highlighted the co-ordinating role undertaken by NHS 24, working with
      colleagues in the SEHD to develop the national campaign.

      It was noted that research would be undertaken on the impact of the campaign and
      brought to the Board (or an appropriate Committee) together with the outcome of the
      research from the winter campaign.                                              TG

      Mrs Low highlighted the potential for confusion in including the NHS 24 web-site
      reference and NHS Scotland helpline. Mr Greatrex advised that the winter campaign
      had published a web-address for self-care advice and pharmacy opening times which is
      why the details are included. Mrs Low asked that there be clarity in the communication.
      Mr McGuigan asked Mr Greatrex to investigate the potential for renaming the web-site to
      reflect more appropriately the NHSScotland campaign.

      Mrs Low queried why NHS 24 was paying for what appeared to be an NHSScotland
      campaign. Mr Williamson advised that discussions were ongoing within SEHD around
      the central co-ordination of such activity in future.

      The Board approved the proposal and the associated costs of £114,445, including VAT,
      to be drawn from the budget for 2006/07.


      Ms Boyd presented the Paper which sought to inform Members of the detail of the
      current Register of Interests for Board Members and Executive Directors. Ms Boyd
      advised that the updated Register will now be made available to the public and staff
      through the Internet and on personal application.

      Ms Boyd reminded Members of their responsibility to advise her of any changes to their
      declarable interests as they occur to ensure that the Register available to the public is
      up-to-date. It was noted that a formal review would be undertaken in February 2007 in
      addition to consideration being given to increasing the Register to staff with procurement
      responsibilities within the Scheme of Delegation.


      Ms Boyd presented the Paper which sought Board approval of the appointments to
      Standing Committees which had been prepared following discussions on 8th March 06
      and a process of individual consultation.

      Ms Boyd highlighted that membership had also been proposed for an Equality and
      Diversity Committee, the terms of reference for which would be brought to the Board as
      part of the review of the Board’s Standing Orders.

      The Board approved:
      • the appointments to Standing Committees as detailed in the Paper, following a
         period of individual consultation
      • the continuation of the appointment of Prof Lewis Ritchie as Vice Chairman.


      Dr Dixon presented the paper which sought approval of capital spend of up to £330,000
      (including VAT) and recurring revenue spend of £240,000 per annum (including VAT) to
      support the installation of wide area network data connections to the new NHS Scotland
      national network “N3”.

      Dr Dixon provided some context to the requirement for the paper, noting that NHS 24
      had been the first to use Healthnet Community (HNC) capacity for instantaneous
      transfer of data also noting that HNC connections were no longer available. He also
      advised that N3 technology provided greater opportunity in the use of supporting
      telephone technology. Members noted that the new HQ premises would be established
      using N3, with compatibility between that and HNC until the change was made.

      In response to a query from Mr Guthrie, Dr Dixon advised that any costs associated with
      hosting the application in Southampton would be neutral, noting that the costs would be
      included in any managed service.

      Mrs Black highlighted that whilst system performance was expected to be made more
      robust, the change process could be difficult and queried what was in place to ensure
      minimal impact. Dr Dixon advised that the current service would be retained until the
      organisation was content with the switch, noting the opportunity to learn from others in
      the NHS.

      Mr Rogerson queried if the move to the Data Centre in Southampton required increased
      business contingency arrangements. Dr Dixon advised that currently there was a live
      data centre with a mirrored copy made every 3 minutes and the infrastructure proposed
      by the suppliers is similar to this. Dr Dixon advised that, as an additional precaution, he
      proposed creating a third level inside NHS 24 for an appropriate period of time.

      Mrs Muir confirmed that staff were au fait with the network upgrade and associated

       The Chairman queried the potential range of the estimated costs and the lifetime value.
       Dr Dixon stressed that the costs advised were the maximum with work ongoing to
       identify the best costs for the individual elements. He expected the lifetime to be about
       five years.

       The Board approved capital spend of up to £330,000 (including VAT) and recurring
       revenue spend of £240,000 per annum (including VAT) to support the installation of wide
       area network data connections to the new NHS Scotland national network “N3”.


       The Chairman reminded Members of the briefing received on 8th March detailing that
       additional space is essential in Glasgow to allow the organisation to manage risks whilst
       undertaking business as usual activities. It was noted that Mr Smith had mentioned that
       there may be potential for using premises within other NHS Board properties in particular
       Glasgow and Clyde. Overall the Board had asked the chief executive to consider
       affordability, value for money and appropriateness of risk.            Based on these
       considerations management should be able to take the decision.

       Mr Templeton advised that contact had been made with NHS Greater Glasgow & Clyde,
       NHS Lanarkshire and National Services Scotland but there had been no appropriate
       capacity available. Mr Templeton said that the rate the additional city centre premises
       was relatively inexpensive and the project team was currently considering the potential
       use of using existing furniture.

       Mr McGuigan advised that the organisation would, in the medium to longer-term seek to
       explore all opportunities for co-location of services in line with the general strategic

       Following discussion, the Board approved the proposal to lease the 7th Floor at 9 George
       Square, Glasgow, on a three-year basis, empowering the Chief Executive to conclude
       the missives. The Board asked that the parking spaces should only be taken up if cost
       effective to do so, noting the potential for use by staff with disabilities.


14.1   Health and Safety – Role of the Board

       Mr Rogerson had asked about Board scrutiny of Health and Safety. The Chairman
       confirmed that responsibility for the oversight of Health and Safety would lie with the
       Clinical Governance Committee for matters pertaining to the public and external issues
       and with the Staff Governance Committee for matters in respect of staff and visitors.

14.2   Fatal Accident Inquiry

       Mr McGuigan advised that the Inquiry may report before the next Meeting. It was noted
       that an appraisal would be brought to the next available meeting detailing actions put in
       place with NHS Grampian.                                                      JMcG/GC

14.3    Partner Development

        Mr McGuigan advised he would bring to a future meeting a report on potential work with
        NHS Grampian, NHS Lothian and NHS Greater Glasgow.                             JMcG


        It was noted that the next meetings would take place as follows:
        Wednesday 26th April 2006 at 1.00 pm in Norseman House
        Tuesday 30th May 2006 at 1.00 pm in Clyde Contact Centre

16.     CLOSURE

        The meeting closed at 5.25 pm, all business on the Agenda having been discharged.

Board Meeting – Draft Minutes
29 March 2006


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