Draft Minutes of Board Meeting held on Wednesday 26th by rjt20314


									      Draft Minutes of Board Meeting held on Wednesday 26th April 2006 at 9.30 am
                       Deaconess House, NHS Lothian, Edinburgh


      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 (from Item 4)
      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
      Mr Allan Watson                      Non Executive Director, NHS 24
      Dr George Crooks                     Medical Director (Also for Chief Executive)
      Mrs Eunice Muir                      Nurse Director, NHS 24
      Mr Bill Templeton                    Director of Corporate Services, NHS 24

      In Attendance
      Ms Alison Boyd                       Board Secretary, NHS 24
      Mrs Elaine Boyd                      Audit Scotland
      Mr Tom Greatrex                      Director of Corporate Affairs, NHS 24
      Mrs Jane McCartney                   Director of HR
      Ms Paula Speirs                      Director of Programme Office (from Item 4)

      Mr John McGuigan                     Chief Executive, NHS 24
      Mr Ian Williamson                    Scottish Executive Health Department


       The Minutes of the Meeting held on 29th March 2006 were approved as an accurate
       record of discussions with the exception of minor amendments to the references to
       business continuity and Agenda for Change progress. Ms Boyd undertook to amend the
       Minutes and the Chairman to sign an amended copy for the record.              AB


3.1   Agenda for Change
      Mrs McCartney advised that further advice had been received as follows:

         •   On-Call arrangements - interim arrangements to remain in place

         •   Out of Hours arrangements – implementation to be deferred until April 07, with
             clarification being sought around the effective date of the new arrangements and
             confirmation of no backdating of payments. Mrs McCartney advised that detailed
             modelling on NHS 24 shift patterns would be undertaken, highlighting the
             difference with the NHS Boards. It was noted that an update will be provided to
             the Board together with the details of correspondence with SEHD.          JMcC

3.2   Variation Order
      Mrs McCartney advised that a Variation Order for the Easter period had not been
      submitted, in acceptance of the views of partner NHS Boards. Mrs McCartney advised
      that the new Recruitment and Retention Premia was being explored as an interim
      measure until April 07 when the new Out of Hours arrangements under Agenda for
      Change were scheduled to be implemented.

3.3   Determination of the FAI
      The record of discussions around the outcome of the Fatal Accident Inquiries was
      redacted as a consequence of the requirement to await the publication of the findings.

3.4   Actions from Board Meetings
      Noting the listing of key matters arising to be brought to future Board Meetings, Mr
      Rogerson queried how an audit trail of actions would be maintained for those not
      explicitly referenced on this listing, e.g. outlier data. The Board supported the
      Chairman’s proposal to work within the current process and keep this under review, with
      the Board Secretary to continue to collate the matters arising and co-ordinate the
      management actions arising from Board Meetings.                                    AB


      Dr Crooks presented the Chief Executive’s Report which sought to inform the Board of
      the performance of the operation of the service in March 06 and development activities
      being undertaken, noting that performance levels remained high in March despite
      challenges to the service. The Board noted:
         • average time to answer was 6 seconds, against 52 seconds in March 05
         • access level average 92%, against 54% in March 05
         • clinical indicators of 95% of urgent call responses within 20 minutes and 94% of
             non urgent call responses within 60 minutes
         • the number of calls answered by the core service was lower than same period
             the previous year, noting that reasons for this included the relatively mild winter
             free from major viruses, the use of user messaging and Easter falling in March in
         • Internet activity to be given a more prominent focus in reporting, noting that the
             operational performance reporting was currently under consideration            GC
         • A&E referral levels with work underway with the Scottish Ambulance Service to
             consider this on a case by case basis to ensure appropriateness of 999 usage,
             with both organisations recognising the change in patient health seeking
             behaviours and illnesses. It was noted that a request had been made to the
             SEHD to have the Unscheduled Care Collaborative consider differences in OOH
             demand since the nGMS Contract was implemented. Dr Crooks advised that
             NHS 24 Nurse Advisors are working alongside SAS colleagues in Edinburgh

       where they deal with Category C calls in addition changes to internal processes
       to allow 999 call transfers from NHS 24 to be on a Category A or B basis.

The Board also discussed the service performance over Easter (to appear in the April MI
report ):
   • clinical indicators of 94% of urgent call responses within 20 minutes and 93% of
        non urgent call responses within 60 minutes
   • average time to answer of 13 seconds, comparing with the 2005/06 festive period
        of 44 seconds
   • access level of 88%, comparing with the 43% of Easter 05. Dr Crooks
        highlighted that this was below the 90% target as a consequence of the peaks in
        call demand, e.g. between 8.30 and 10.30 am on the Friday, Saturday and
        Easter Monday
   • daily conference calls had been held and a wash up session with partners held to
        consider the challenges over the period, with a further internal event planned for
        May 06 to include reflections on the impact of the different approaches by NHS
   • telephony failure at the East Contact Centre on the Sunday morning had been
        managed effectively and safely with no degradation of the access level. A
        number of Call Handlers were moved from the East to West to maximise this
        resource and a significant event had been raised internally and with BT. Whilst
        noting that the Executive Team considered IT and telephony performance on a
        weekly basis, Prof Ritchie asked that consideration be given to information
        governance in the context of e-health and electronic record development. Mrs
        Black highlighted the potential value of reviewing IT/telephony performance on a
        four hourly basis during the OOH period.                                   GC/AB

The Chairman recorded his thanks to the management team and staff for the
performance over Easter, noting the Minister’s recognition of the NHS 24 and NHS
Board achievement at the most recent Chairs’ Meeting. He reflected on the leadership
shown by the Chief Executive, Medical Director and Nurse Director in working in the
Centres at various points over the period. Prof Ritchie advised of the high level of staff
morale in the North Contact Centre on Easter Monday and views expressed around the
improved management of the service.

In response to a query from Mr Kelly around the accuracy of the demand modelling, Dr
Crooks noted the high level of accuracy of the average call demand but current inability
to take account of the impact of queue management. Dr Crooks noted its value in
using with NHS Boards in order to assist in their resource level planning.

Mrs Black queried the impact of the marketing campaign and the information available
from call type analysis, e.g. had patients sought prescriptions in advance. Dr Crooks
advised that 12% of calls on Good Friday were from people requiring a repeat
prescription. Mr Greatrex undertook to bring the impact analysis of the awareness
campaign to the next Meeting in addition to undertaking to monitor web-site activity
around pharmacy opening times.                                                    TG

In response to a query from Mr Smith, Dr Crooks advised that the difference in level of
no partner action was multi-factoral, with discussions taking place internally and with
partners to identify the key causes and any potential mitigating actions.

     Mr Guthrie noted the trends in front-line staff levels and requested further analysis
     around future requirements, noting discussions would take place later in the meeting and
     that work was currently ongoing in this respect. The Board noted the current system
     capacity to deal with up to 540 calls at any one time, inbound and outbound mix, with
     ongoing monitoring of the telephony specialists.        The Chairman asked for the
     organisation to keep its focus on reducing call-back/outbound calls but also to examine
     how access can increase to almost 100%. He asked for nurse advisor recruitment to be
     focused on how to get to target.

     In answer to a query from Mr Smith, Mr Templeton advised that NHS 24 does not gain
     financially from the usage volume of the 0845 number in that a standard price is paid for
     registering the number. He said that the caller is charged at their standard local rate by
     BT (with additional costs for calls from mobiles). Mrs Black looked forward a Board
     debate around telephone number arrangements at a future date.

     The Board noted the detail of the report and above discussions.


     Mr Templeton presented the Financial Report which covered the period 1st April 2005 to
     31st March 2006 and advised that the full year-end information could not be placed into
     the public domain until released by Parliament.

     Mr Templeton advised that further work had determined that the financial year-end
     position reflected a cumulative underspend of circa 1.5% (£750k), noting that, as
     previously reported, the year’s accounts included a provision for the potential settlement
     of the back-dated pay adjustments under Agenda for Change.

     The Board noted the detailed breakdown of capital projects undertaken during the year
     and Mr Templeton advised that he would confirm wit the SEHD that the underspend
     could be carried forward into financial year 2006/07 when the Accounts are finalised. In
     response to a query from Mr Rogerson, Mr Templeton advised that following discussions
     with Executive Directors the current Capital Resource Limit (CRL) of £2m in 2006/07
     had been allocated to projects in the budget-setting process and any carry forward
     would allow some of the other strategic plan activities to progress. Mr Templeton
     advised that papers on individual large capital projects would require to be considered
     by the Board at future Meetings as required under the current delegated authority limits.

     Mr Templeton said that the process for the Annual Accounts completion, in the required
     format, was continuing. It was noted that the audit process would take two weeks,
     finishing on 12th May 06 and that would allow the Audited Annual Accounts to be
     presented to the June 06 meetings of the Audit Committee and Board for approval. WAT

     Following a request by the Chairman, Mr Guthrie as Audit Committee Chairman
     undertook to include in the Committee’s consideration of the Audited Annual Accounts, a
     specific review of the assessment of the provision for the potential pay settlement liability
     established in the Accounts, along with a review of the variances arising in the Capital
     Expenditure Projects over the year, noting that an analysis of that expenditure had been
     provided by Mr Templeton in the Financial Report.                                HG/WAT

     Mr Templeton provided an update on discussions being held with SEHD on the Revenue
     Resource Limit (RRL) for 2006/07. He said that a Business Case had been drafted from
     the Budget discussions earlier in the year with each Director and that assisted in
     estimating the recrurring costs for 2006/07, based on current operational performance
     levels. Mr Templeton said that any carry forward in RRL would be helpful and that the
     carry forward in the CRL would establish that for 2006/07 at almost £4m.

     Mr Watson stressed the need for budget and strategic planning activity to align and
     queried the potential for enhancement above the original level proposed. Mr Templeton
     spoke about the financial resources returned to the SEHD in past years and the
     experience gained from now running the national service for a full year in 2005/06. Mrs
     Speirs confirmed that the Strategic Plan was clear in respect of what was considered as
     core business and noted that any additional activity beyond this will require the
     submission of a service development business case for additional funds.

     Noting discussions earlier in the Meeting, Mr Templeton advised that NHS 24 is a
     member of the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS)
     established by the NHS in Scotland and operated by Willis plc. He said that, like other
     NHS Boards, any litigation settlements on NHS 24 would be met through this Scheme.
     He added that the premiums for NHS 24 would rise on future claims experience. In
     answer to a query from Mr Guthrie, Mr Templeton said that NHS 24 would be required to
     meet any associated legal costs.

     The Board noted the detail of the report.


     Dr Crooks introduced the Paper and noted the dynamic nature of the Strategic Plan for
     2006/09 which, if approved, would be used to consult widely with the service, internally
     and externally, with the expectation that it would continually evolve.

     Mrs Speirs presented the Plan and highlighted that it reflected the Board discussions
     held on 11th and 13th April and stakeholder feedback. Mrs Speirs advised that once the
     Strategy was in place key performance targets and ongoing monitoring arrangements
     would be developed with the Board (proposed quarterly) in order to provide an
     appropriate level of assurance of management delivery and that a Local Development
     Plan for 2006/07 would be further developed with associated operational level
     performance targets to be monitored by the Executive Team (proposed monthly).

     Mrs Speirs reviewed with the Board the key sections of the Plan, including:
        • Chief Executive Overview and Introduction - demonstrating the alignment to
           Delivering for Health
        • Context - providing the detail of NHS 24 and its history, referencing the
           Independent Review Report, the response and improvements made
        • Vision, current services and key aims
        • Key strategic aims and associated objectives which had been based on the
           organisation’s strengths (knowledge, technology and infrastructure):

            o   Improving the core OOH service
            o   Health improvement
            o   High value services, e.g. single patient record

     The Board agreed to the proposal to focus on the key risks to achieving the Strategy in
     the Board Annual Risk Workshop scheduled to be held on 30th May 06.                PS

     The Chairman considered the Board’s role within NHSScotland and the background to
     the development of the Strategy, e.g. the Independent Review, and recommended that
     consultation take place with all stakeholders to seek wide ownership of the Plan. Prof
     Ritchie supported this noting that the document should be used for building, developing,
     and improving relationships with partners and setting patient expectations. Following
     discussion, the Board agreed to consult with the following stakeholder groups over the
     following 12 week period through an appropriate media:
         • SEHD, NHS Boards and NHS Special Boards
         • Staff
         • Wider stakeholder groups including patients, families and professionals.

     It was noted that the above timeframe would allow the Annual Review exercise in
     August to be used as a closure point for the development of the Strategic Plan for

     The Board approved, in principle, the Strategic Plan 2006/09 (Consultation Document)
     and Members undertook to make comment to Dr Crooks, Mrs Speirs or Ms Boyd by
     close of play on 28th April 06. The Chairman undertook to review the comments and
     make an appropriate response in order to finalise the document the following week. All


     Mrs McCartney presented the Strategic Workforce Plan and sought Board approval of
     the principles and associated strategic aims outlined. Mrs McCartney advised that the
     principles informed all sections of the Plan and were the basis against which NHS 24 will
     assess any proposals which affect its workforce. Mrs McCartney also asked the Board
     to endorse the vision and values, which arose from workshops with staff to establish the
     paradigm in the culture web of the organisation which they aspire to.

     Mrs McCartney advised that progress against the Plan would be reviewed quarterly at
     the Staff Governance Committee and annually with the Board. It was noted that the
     Workforce Plan had been broadly aligned with the Draft Strategic Plan for 2006/09 but
     further activity would take place over the next 12 months as key elements of the Strategy
     were further developed, e.g. the Health Improvement Agenda.

     Mrs McCartney reviewed with the Board the key headlines of the Plan:
       • Statement of Intent of the Board
       • Background – outlining the external environment and associated issues
       • Principles and Values – requesting the Board to endorse these
       • Development Plan
           o Organisation design – has commenced in the top tier of the organisation and
               will now be taken forward to the second and lower tiers. Consideration of the

            support staff structure and requirements will be undertaken through this
        o   Workforce Management and Planning – based on capacity planning and the
            work around the call flow process, e.g. to determine how many Nurse
            Advisors are required to be progressed over the coming weeks. Mrs
            McCartney advised that the staffing numbers were in the format and at the
            dates as required by the SEHD, noting the majority of these were historical.
        o   Service design – identifying new and more efficient ways of working, e.g.
            introduction of the workforce management system and capacity planning
        o   Culture development programme, Engaging People, noting the discussions
            in the Staff Governance Committee around the importance of learning and
            development in NHS 24 going forward
        o   Partnership involvement – whilst noting that this is taking place in all areas
            this was to be given particular focus in 2006/07
        o   Recruitment plan – will be developed in relation to the workforce profile

The discussion with Members raised a number of comments on the Plan which
    • the need to capture the employment issues around OOH coverage
    • the role of NHS 24 in NHSScotland be clarified in the Vision
    • the need to serve the public well be the first of the Values
    • the alignment of all sections of the Plan, e.g. consistency in respect of turnover

Mrs McCartney highlighted a number of issues around frontline and non-frontline staffing
levels, whilst noting the increase in frontline staff levels by 351 heads over the previous
    • The difference between NHS 24 and other NHS Boards and the ratio of support
        staff required to support the front-line activity. Mrs Black suggested that
        benchmark information be sought from other contact centres not solely the NHS.
        Mr Guthrie suggested that a review be undertaken of the skill sets regarded as
        front-line. Mr Kelly noted the requirement for this information in the Annual
    • Reduced dependency on external consultants, e.g. Health and Safety was
        delivered previously by an external agency but had now been brought in-house
        leading to an overall cost saving.
    • Recruitment team has increased as a consequence of the need to both recruit to
        attrition and for the additional frontline staff.
    • National agenda areas to be delivered, e.g. Equality and Diversity

Mr Templeton advised that the above issues were considered as the Draft Budget for
2006/07 was being developed.

Following discussion, the Board agreed to submit the Strategic Workforce Plan to the
SEHD, submit the document subject to any detailed comments being submitted by
Members close of play on 28th April 06. It was noted that detailed work would take place
to establish target figures on headings to form part of recruitment and retention to align
to the requirements of the Strategic Plan for 2006/09. The Chairman undertook to

       review comments submitted by Members and to provide a covering note for submission
       to SEHD, advising of the follow-up work to be undertaken.

       The Board agreed with Mr Rogerson’s and Mr Bruce’s recommendation that the Staff
       Governance Committee should consider the detail of the Plan and the associated
       targets and summary operational plans to be associated.


       The Board noted the details of the Minutes of the Audit Committee Meeting held on 14th
       February 06. Mr Guthrie, Audit Committee Chairman, advised that there had been
       another Meeting held on 20th April 06, the Draft Minutes of which would be brought to the
       next Board Meeting.


       The Board also noted the detail of the Draft Minutes of the Staff Governance Committee
       Meeting held on 16th March 06. Mrs Low, Committee Chairman, advised that the
       Meeting had been inquorate but had been held, in line with the agreement of the Board
       to suspend Standing Orders whilst the Board Membership was replenished.


       Ms Boyd presented the Draft Schedule of Meetings for the Board and its Standing
       Committees. It was noted that the Schedule was based on a pattern of 10 Board
       Meetings per year, held on the last Thursday morning of the month and taking place in a
       range of NHS Board venues across the country. It was noted that the venues had still to
       be confirmed with NHS Board partners and that the key agenda items would continue to
       be developed in line with the strategic planning activity and from discussions held within
       the Board, noting the stated requirement to move towards two or three key strategic
       issues for discussion at each Meeting.                                                AB

       Mr Rogerson advised of a clash of commitments on some of the Thursday mornings and
       the Board agreed that Ms Boyd should explore the possibility of holding meetings on the
       affected dates later in the day.                                                    AB

       Board Members agreed the schedule and Ms Boyd undertook to distribute a finalised
       version of times and venues as soon as available, aligning the March 07 Clinical
       Governance and Audit Committee Meeting dates.                                 AB


11.1   Partnership Working – Clinical Governance

       Prof Ritchie advised that he had attended a meeting of the NHS Grampian Clinical
       Governance Committee noting that he would seek to repeat this with other NHS Boards.
       Mr Smith advised that he had been appointed as Chair of the NHS Lothian Clinical

        Governance Committee and agreed to explore the potential of joint learning and
        development activity. The Board welcomed this approach.              LR/SS/GC

11.2    Media Article

        Mr Smith tabled a media article (The Scotsman) on recruitment to NHS 24, based on an
        interview by the Nursing Times of Mrs Muir. The Board welcomed this positive

11.3    Scottish Medical and Scientific Advisory Committee

        Prof Ritchie, as Deputy Chair of the above, reported on the most recent Committee
        Meeting which had considered the recent NHS 24 performance improvements and the
        request from Prof Ritchie that the Committee regard NHS 24 as part of the NHS family in
        Scotland and provide support as appropriate, whilst not suspending their critical
        judgement in any way.


        It was noted that the next meeting would take place at 9.30 am on Tuesday 30th May 06,
        at a venue in Glasgow, to be confirmed.

13.     CLOSURE

        The meeting closed at 1.20 pm (including a break for lunch), all business on the Agenda
        having been discharged.

Board Meeting – Draft Minutes
26 April 2006


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