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					                                                                          Enclosure B4




                             Strategy Board Meeting
           Minutes from a meeting held 9.30 am – 1.00 pm, Tuesday 22 April 2008
                                    Room 5, Southside



Present
George Greener, Chair
Dawn Stephenson, Non-Executive Director
Nick Ville, Non-Executive Director
Mike Bell, Non-Executive Director
Timothy Walker, Non-Executive Director
Mike Spyer, Non-Executive Director
Ruth Carnall, Chief Executive
Trish Morris-Thompson, Chief Nurse
Paul Corrigan, Director of Strategy and Commissioning
Paul Baumann, Director of Finance and Performance
Dr Simon Tanner, Regional Director of Public Health
Anne Rainsberry, Director of People and Organisational Development
Malcolm Stamp, Chief Executive, Provider Agency
Stephen Webb, Director of Communications

In attendance
Lord Warner, Chair, Provider Agency
Julia Grimshaw, Chief of Staff
Kevin Jarrold, Director of the London Programme for IT (item 4)
David Sissling, Director of Healthcare for London (item 5)
Jonathan McKee, Board Secretary and Business Manager


Action
         1 Apologies for absence

         None


         2 Minutes of the last meeting

         These were accepted as a true record
        3 Matters arising

                 a) Commissioning
                 Paul Corrigan had previously circulated a number of conference
                 presentations from Local Authority leaders describing recent approaches
                 to progress, these were helpful. Paul accepted an invitation to join a
                 London local authority board (Capital Ambition) which resources this.
                 This should be helpful in realising NHS London’s objectives.
                      There is a correlation between local authorities in difficulty and the
                        PCT with co-terminus boundaries with that borough also having
                        difficulties

                 b) Leadership development
                 Ann Rainsberry reported that:
                     A Leeds based consortium had been appointed to run the
                       programme
                     35 high-calibre people had been accepted onto the programme
                     Despite an apparently equitable recruitment process, the number
                       of BME applicants was low and this would be the subject of
                       consideration prior to the next round of recruitment
                     The programme will be launched early June

                 c) Estates Strategy
                 The board noted that:
                     Ruth Carnall and Malcolm Stamp will prepare a briefing for
                       Ministers

        4 The London Programme for Information Technology –Update

        Kevin Jarrold gave a presentation; the following issues were highlighted and
        discussed:

        Procurement
                The programme involved £6.4b of public money
                The cost of any delays would be met by the suppliers
                Greater engagement of clinicians is indicated
                The programme team had had their employment transferred to NHS
                 London

        Progress
                There were no problems with the national applications
                There were challenges with care records
                The programme had been broken down into constituent parts and the
                 best available application will be used in each case
                GPs in London were more willing to engage once they understood their
                 current systems would be suitable for integration
                Information added will be available almost instantly
                Patients have the right to opt-out


SB mins Apr 08                                                             Page 2 of 8
        Acute
            Least progress had been made in this area
            Barts and the London is a complex trust and success here will bode well
              for the programme
            There is anecdotal evidence that introducing the new system in A&E had
              already yielded some improvement in flow through the departments

        PCTs
                Good progress has been made in PCTs
                20 were live so far
                There had been some problems with Child health Interim Applications
                 [CHIA] in NE and NW London; the problems should be resolved when the
                 systems are migrated to RIO.

        Mental health
                6/10 trusts were live; 2 trusts were being added
                Oxleas is already using the system with patients during treatment reviews

        Primary care
                A national approach is being taken in this area
                CfH is leading this work
                96% of existing systems are ready to be connected with the national
                 system

        Stakeholder survey results
        It was noted that LPfIT concerns were ranked 4 th on the list of importance and
        difficulty. The following actions, taken as a result of the feedback, were noted:

                The development team was now located in trust premises in order to
                 facilitate clinical engagement
                A more incremental approach had been adopted
                Ruth Carnall had met with trust CEs and BT managers to facilitate
                 development of successful outcome measures
                A new support team will be established
                Implementation will reflect user priorities and Healthcare for London aims

        Healthcare for London
                A system needs to be commissioned that will cope with plurality of
                 provision, including any re-structuring as a result of changes in PCT
                 provider arms and be effective in efficiently integrating with the various
                 organisations’ interfaces
                The infrastructure will need to be developed with, and provided to, non-
                 statutory sector providers




SB mins Apr 08                                                             Page 3 of 8
          Informatics review
               A review focusing on national issues was undertaken
               No significant impact on work in London has been identified
               Integration with social care remains a challenge; Capital Ambition may
                provide a steer

          Targets
                 Contractors had been tightly managed under the national programme;
                  the challenge for NHS London is to maintain this control
                 Improvements in productivity are difficult to quantify at this stage, but
                  have been explored by the National Audit Office

          Kevin was thanked for his work.




          5 Healthcare for London –next steps

          David Sissling attended for this item. Paul Corrigan had previously circulated a
          report; Paul noted that:
              The mayoral election means that some discussions had been temporally
                  suspended
              The programme will be updated to reflect feedback from the consultation
              The programme is based on PCTs’ vision and is PCT led
              29/31 PCTs had expressed an interest in providing pilot sites for
                  polyclinics
              PCTs had various models in mind for the provision of polyclinics

          The Board thanked Paul and David for their work and noted that:
                 There is increasing political interest in this initiative; Ruth Carnall would
                  be briefing the Minister on progress to date, particularly with regard to GP
                  interests
                 London is different from other cities and rural areas. There is no agenda
                  in NHS London to extend initiatives which are specific to London outside
                  London
                 70% GPs had noted that their premises were not suitable for provision in
                  the future
                 The Local Medical Committee1 had provided a constructive response
                 The focus must remain to deliver the ideal patient pathway from the
                  perspective of the patient
                 NHS London will support PCTs in developing capability to undertake
                  reconfiguration exercises; in particular, to manage the adverse effect on
                  the workforce/service provision in organisations being reconfigured


1
    Often known as the ‘LMC’, a forum for local GPs to discuss issues


SB mins Apr 08                                                              Page 4 of 8
SW           Stephen Webb will prepare a briefing on increasing capability of PCT
              communication for the Board in consultation with the HfL communications
              team



        6 2012 Health legacy

        Dr Simon Tanner had previously circulated a paper. Simon explained that the
        International Olympic Committee (IOC) found favour with London’s vision of
        using the Olympics to deliver public health gain.

                The Department for Culture, Media, and Sport were leading this, a
                 complex programme, at national level
                The London Olympics Committee (LOC) is leading work in London
                The host country is required to provide an Olympics Health Service
                 (OHS) and the NHS in London will provide this
                The IOC have asked for the details of the OHS plan and has offered its
                 experience in past events

        Dr Simon Tanner suggested that in order to develop clear leadership and
        identify meaningful aim and propose workable projects the Board should focus
        on developing health:

            1. Services
            2. Resilience
            3. and legacy

        The SHA should also be clear what of its own funds it would devote to this task,
        and what would need to be found from other sources.

        The board noted that:
            Health professionals in the OHS will be volunteers and may be required
              for up to twelve weeks; planning is underway to ensure that there will be
              no impact on NHS services in London
            The Mayor’s office is keen to engage on legacy issues
            Links to specific health policy aims, eg obesity, are emerging and
              quantifiable targets will be set
            The national policy lead has recently been identified as David Flory,
              Department of Health’s Director General of NHS Finance, Performance
              and Operations.
            The DH had provided some funds for the initial costs of management
              preparation
            The Government Office for London had not approved Local Area
              Agreements where these did not include sufficient attention to planning
              for the Olympics
            A planning group of internal and external stakeholders was proposed;
              this is to include a diverse range of interested parties, especially from the
              voluntary sector



SB mins Apr 08                                                           Page 5 of 8
        The Board thanked Simon and Hilary Ross for the paper and accepted the need
        to implement the recommendations whilst recognising the process made to put
        the appropriate governance in place

ST           Simon will report back with a detailed plan

ST           Key FTs will be added to the membership of the planning group

PC           Paul Corrigan will provide a briefing to the Board on related Public
              Service Agreements 2 targets


        7 Updates and forthcoming issues

                 a) Finance and performance
                 Paul Baumann had previously circulated a report; the Board noted the
                 following:

                 A&E
                        That the target of 98% was missed overall but that more trusts had
                         reached the target than in previous months
                        PCTs had become more involved in managing performance in
                         through commissioning
                        The figures were now more reliable and indicate steady
                         improvement compared with previous months

                 The following was agreed:
MS,               Malcolm Stamp and Paul Baumann will review resources and
PB                 underperformance and present a full report to the June NHS London
                   Board meeting

                 HCAIs
                        The MRSA target has been reached
                        Trusts have set themselves tougher targets on MRSA
                        NHS London will continue to pursue Cdiff with vigour
                        Monitor is taking a tough line with FTs
                        16 trusts have been the subject of sustained attention from NHS
                         London

SW                Stephen Webb will produce a press release




2
 Often abbreviated to ‘PSA’, these set out the Treasury’s expectations of what the public will get in return for
expenditure


SB mins Apr 08                                                                        Page 6 of 8
                 18 weeks
                       There had been improvement but the 85% target was missed by
                        3%
                       It was noted that tertiary treatment centres cited that they were
                        often in a difficult position as by the time they had received
                        referrals, the ‘clock’ had already been ticking for some time;
                        however, the target would not be relaxed at this stage
                       There have been further improvements to the figures since
                        publication

                 Finance
                       There is uncertainty as to how the Audit Commission/DH will
                        interpret rules on partially completed spells; an adverse ruling
                        would add £25m to the surplus which might breach the control
                        limit.

PB                Paul will pursue with Audit Commission/DH colleagues
NV/               Nick Ville and/or George Greener will consider raising the matter
GG                 formally with Audit Commission

                 b) Referral by Joint Overview and Scrutiny Committee of Barnet,
                 Enfield and Haringey Clinical Strategy Proposals to Secretary of
                 State
                 Paul Corrigan outlined the main objections. NHS London had made a
                 response to the DH as outlined above. Paul reported the PCT’s 50-page
                 response to the Secretary of State also refuted these accusations. A
                 response from DH is expected imminently, it may set-aside the objections
                 or refer to an independent review panel (such a review would take up to
                 six months).

                 c) Reputational and institutional risk management
                 Nick Ville had found an article in a local government journal in which the
                 author had been critical of NHS London. There had been an exchange of
                 emails on the specific article, but the Board wished to consider the wider
                 issues.

                 In considering risk, everyone noted improvements in the approach taken
                 to management and review of performance and risk, but whilst noting the
                 desirability to be able to foresee all adverse incidents also acknowledged
                 that:
                      Risks can be minimised and mitigated, not eliminated
                      Risks management systems were the subject of ongoing review
                      Many simultaneous initiatives add complexity to the management
                        of risk
                      Effective management of relationships with stakeholders was
                        critical to generating ‘soft’ intelligence as part of mitigating risk


SB mins Apr 08                                                             Page 7 of 8
                 It was agreed that:
NV                The Audit Committee will undertake a review of risk management
                   systems
ST                Simon Tanner will report on the findings of recent SUIs in order to
                   capture organisational learning to the May Strategy Board

                 d) Progress on the development of the Patient Safety and Clinical
                 Quality Strategy
                 Trish-Morris Evans advised the Board that she and Dr Simon Tanner
                 were exploring options

TME               Trish Morris-Evans and Dr Simon Tanner will present the options for
ST                 consideration at the NHS London Board in June

                 e) NHS London Staff Structure
                 This was tabled for information as requested.


                 f) Operational Plans
                 Paul Baumann advised the Board that only six plans are outstanding; an
                 update was tabled.
All               Any comments to Paul




        8 Date of next meeting
        This will be 9:30, Wednesday 28th May




SB mins Apr 08                                                           Page 8 of 8

				
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