Minutes - Kirklees Community Healthcare Services

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 Minutes of the Kirklees Community Healthcare Services Board (The KCHS Board)
                              held on 30 April 2010 at
                  08:30 – 12:00 in Beckside Court Meeting Room 2

                      Suzy Brain England OBE, (Chair) (SBE)
                      Robert Flack, Director of KCHS (RF)
                      Tina Quinn, Clinical and Operations Lead of KCHS (TQ)
                      Munir Ahmed, Non Executive Director (MA)
                      Patricia Drake, , Non Executive Director (PD)
                      Barry Lane, Assistant Director of HR (BL)
                      Helen Rees, Finance Manager (HR)

In attendance:        Lyn Milnes - Minute Taker (LM)

                      Apologies for Absence

                      Apologies for absence were received from:

                      Gwen Ruddlesdin – Head of Integrated Governance (GR)
                      Janice Boucher – Finance and Performance Lead (JB)

                      Declaration of Interest

                      Declarations of Interests are recorded and held with The KCHS Board

KCHSB 10 146b         Minutes of The Previous Meeting

                      The minutes of the Kirklees CHS Board meeting held 26th March 2010
                      were agreed as a true and accurate record and were signed by the Chair.

KCHSB 10 146c         Matters Arising

                      Matters arising were recorded on the attached action sheet.

                      A discussion took place about how the KCHS Board demonstrate how
                      clinical governance processes support staff.

                      TQ informed the KCHS Board that a flow chart to show what happens on
                      the ground, up to The KCHS Board is in process of being developed,
                      which will answer any queries the KCHS Board have.

ACTION                Action 1 - demonstrate clinical governance on a daily basis in flow chart.

                      Presentation by Elaine Gomersall and Mark Marshall
                      The value of tough books and issues rolling them out.

                      Elaine Gomersall and Mark Marshall gave a presentation on Tough books
                      they informed The KCHS Board that KCHS has a contract with BT to roll
                      out 600 tough books to KCHS staff.

                      Patient feedback is very positive from age ranges of 30 – 80.

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          Benefits show Increase on clinical contacts and decrease in travel time.
          Flexible working for staff and flexible visits for patients reduce stress,

          Carers home care record remains as it is at the moment. Cath Smyth is
          working on home record being reviewed.

          There is still issues to resolve with staff who need supporting in the new
          ways of working.

          The KCHS Board congratulated Elaine and Mark on a job well done and
          gave their support.

          The KCHS Board RECEIVED AND SUPPORTED the presentation.

          Action 2 - The KCHS Board would like to see the evaluation of tough
          book data at the June/July Board meeting.

Tabled    Managing Directors Report

          RF presented his report to the Kirklees Community Healthcare Services
          Board (KCHSB) highlighting:

          HVMH build project

          Six potential design and building contractors have been shortlisted under
          the Procure 21 scheme. Amount of money available from the SHA is not
          yet clear, but instructions to go ahead with the full business case have
          been received.

          The KCHS Board asked if the plans will maximise use of space RF said
          the old ward will be converted into a new suit of rooms with significant
          more activities planned. A diagnostic suite is to be created to support the

          Estates rationalization

          Office space negotiations with the estates team have begun to
          understand how modern technology can help to transform our business,
          improve quality and reduce costs.

          The KCHS Board requires clarity of funding in the likelihood of project
          spilling in to 2010/11.

          Planning next stage of delivery

          T7 have spent a day putting together plans for the next 12 months.
          Project plans are currently under development to include board
          governance, clinical involvement and clear milestones.

          Tough book roll out

          BT has had all the remaining tough books delivered by Panasonic. The
          roll out to staff can now be completed. However, there will still be a short
          fall, opportunities are being explored.

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               Areas are being discussed how to save office space and mileage costs
               including reduce travel costs. Tough books will work out the cheapest
               route to follow to cut travel costs.

               Staff awards ceremony

               A plan has been agreed with the PCT which will mean that an evening of
               2 ceremonies in 1. A team, consisting of both commissioners and KCHS
               is now meeting and details will be shared with the KCHS Board shortly.

               The KCHS Board RECEIVED and NOTED the Managing Directors

ACTIONS        Action 3 - report back at next meeting about extra capital which may be
               available put a good business case together to buy more tough books to
               cover the short fall.

KCHSB 10 148   Finance and Performance Lead Update

               Helen Rees presented the Finance report to update The KCHS Board on
               Finance & Performance for March and expected risks to full year position.
               March financial position was £46k less than budget, including 2
               unplanned variances, and a contract variation of £155k for stock
               revaluation on KICES:
               £88k additional cost due to QOF payments - the funds were
               received earlier in the year and should have been accrued for.
               £51k benefit achieved through recharging Local Authority for the
               rental of the KICES building. This was identified as an opportunity
               through the ongoing work on KICES
               £155k Contract Variation to cover the costs of revaluing KICES
               stock to reflect realisable value, previously valued at full purchase
               Paid headcount has reduced from 946 last month to 941, and is
               now below funded by 11. Contracted headcount has reduced from
               934 to 931 (including the Corporate transfers) and is below funded
               by 21. This positions us well for the financial challenges of 2010/11
               2009/10 Year End Position
               We finalised the year at £34,987k expenditure against budget of
               £35,099k, £112k, under spend. This is offset by an income shortfall
               against the contract of £43k, resulting in net position of £69k,
               under-spent0.2% lower. This was a significant achievement
               following the predicted risk of £900k overspend earlier in the year,
               and has been achieved through vacancy controls, reduction in
               interpreter spend and tighter controls on KICES spend.
               There are challenges around service delivery KICES in terms of getting
               beds. HR assured the board JB is a high level lead on this and an action
               plan is in place.

               TQ is working jointly with the local authority and changing the
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               management structure and is writing a job description.
               The KCHSB agreed that the Vacancy control should stay in place.

               The KCHS Board RECEIVED AND NOTED the Finance report.

KCHSB 10 149   Performance Report

               Helen reported on the performance report prepared by Michael
               Crowther highlighting:

               Annual Health Check – Highlights

                     Walk-in centre achieved 100% of total wait time within 4
                     18 weeks referral to treatment – Reportable Services
                              100% achieved
                     The coverage of population for Childhood Obesity
                      measurement target was achieved for both age groups
                     The stop smoking service has achieved its monthly targets
                      for 4 week quitters and the 4 week trajectory.
                     There are no cases of MRSA or C-Diff within KCHS
                      services; we still await a final target for this measure.
                     Childhood Vaccinations and Immunisations
                           24 month cohort – 3 out 5 immunisations achieved
                             the target
                           5 Year cohort – 2 out of 4 immunisations achieved the
                     Chlamydia Screens have significantly increased in Q4 for
                      South Kirklees following a large mail out funded by
               March Performance – Exceptions

               Childhood Vaccinations and Immunisations

                     12 month cohort failed on all three vaccinations
                     24 month cohort has failed on all 2 immunisations this month
                     5 year cohort has failed on 2 immunisations this month

               There has been an error carried within the KCHS monthly
               performance report during 2009-10, the figures presented have
               actually been the achievement within a single month rather than
               cumulative achievement.

               It is now clear that even though monthly Performance was
               improving the overall 12 month achievement has fallen short of

               Action Plan
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                     An immediate review has been initiated to ensure that all
                      current information flows match the indicators that are
                      required to track KCHS Performance priorities.
                     The list of Performance priorities for 2010-11 will increase on
                      2009-10 and similar assurance will be required.
                     Michele Day, Information Manager will undertake the review
                      and will work with Performance leads within NHS Kirklees to
                      sign off current information flows and reporting processes.
                      Report to Finance, Performance and Business Development
                      Committee in May 2010.
               MC is putting an action plan in place targeting services who are not

               The KCHS Board agreed the report is nicely laid out.

               The KCHS Board RECEIVED and NOTED the performance report.

ACTION         Action 4 – MC - The KCHSB agreed that In future the report should
               also cover productivity and CQUINN

KCHSB 10 150   Clinical and Operational Leads Update

               Tina Quinn presented the following report to bring to the Boards attention
               the draft action plan developed in response to the report by Robert
               Francis QC following the Independent inquiry into the care provided by
               Mid Staffordshire NHS Foundation Trust.

               The document was intended to stimulate a discussion designed to
               challenge and revise the draft action plan and to reach agreement on the
               first version to be implemented within KCHS.

               Actions to date
               2.1    Report produced for Board in March 2010
               2.2    Letter sent to SHA assuring development of action plan.
               2.3    Executive summary produced and circulated to Board and T7.

               A draft action plan was shared based on the 18 recommendations in the
               report. However not all recommendations are applicable to KCHS.
               Appendix 1 of the report set out the recommendations showing
               applicability and cross referencing back to KCHS Action plan.

               The KCHS Board commented that a letter has not been received
               acknowledging receipt of letter from TQ to the SHA regarding the Francis

               TQ informed The KCHS Board that many of the items on the action plan
               are happening already.

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               The Board commented that records audits need to be more dynamic. And
               were assured that this will be evidenced via the Integrated Governance

               The Board also suggested that Internal audit can be asked to look at

               The action plan will be managed through Governance but will come back
               if it needs to.

               Communication will be done through Managing Director’s Update. And
               also cascaded through T30 and T60.

               The KCHS Board RECEIVED and NOTED the Clinical and Operational
               leads report.

ACTION         Action 5 – Patient safety implications to be put on front cover sheet of
               board papers.

               Action 6 - Communication around Francis report is worked through and
               reported back, ensure that part of day job of 3 key messages.


               No Workforce report was received. There is a workforce committee
               arranged for 20 May and a number of reports will be taken there
               Staff survey, HR policies review, HR strategy, Workforce targets- e.g.

               If the above issues then need to go to Board they will follow thereafter.

KCHSB 10 151   Governance – Board Assurance Framework

               The KCHS Board Assurance framework gives an overview of the
               organisation’s potential strategic risks and provides assurance on the
               achievement of the organisation against its strategic objectives.
               The KCHS Board is aware of its key risks and can monitor them, ensuring
               appropriate controls and mitigating actions are undertaken to facilitate the
               effective delivery of services.
               The format is on the same template as NHS Kirklees.
               The KCHS Board agreed that this document has moved on has been
               really developed, we need to ensure that the document reflects the
               reporting on a year ago and what is reported on now.
               The document should be alive and interesting. The KCHS Board would
               like to know what actions are to be if there are any red ratings. The
               Ambers probably need a note.
               The KCHS Board agreed that the Governance report should contain
               analysis not data.
               The KCHS Board CONSIDERED and APPROVED The Board Assurance

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KCHSB 10 153     Strategic Business Plan

                 Attached chapters are first drafts of Section B of the Strategic Business
                 Plan. Section A is the Strategy 2010 – 2015 which is already approved
                 and published.
                 Additional Chapters to be tabled at The KCHS Board Meeting (not
                 complete in time for distribution with Board Papers):
                         Integrated Governance
                         Business Development
                         Information management and Technology
                         Performance and Quality
                         Finance
                 RF requested watertight documents for the organisational form. The
                 Business Strategy plan needs to be read and digested. TQ said not all
                 strategies are included. The KCHS Board wants a flow chart that shows
                 how The KCHS Board gets assurance.
ACTION           Action 7 – Document to be taken away and read by ALL. Feedback to
                 Robert by 14th May 2010

KCHSB 10 154     Minutes of Finance, Performance & Business Development meeting
                 held 18 March 2010

                 The KCHS Board RECEIVED and NOTED the Minutes of the
                 Finance, Performance & Business Development

                 Minutes of Workforce Committee

                 No minutes available

KCHSB 10 155     Minutes of Governance Committee meeting held 5 February 2010

                 The KCHS Board RECEIVED and NOTED the Minutes of the
                 Governance Committee

                 KEY MESSAGES

                 1. Reinforce tough books

                 2. Demonstrate what happens on clinical governance on daily basis

                 3. Linking Francis report on daily basis

                 Any Other Business

                 Action 9 - Angela Harris to be invited to do a presentation on emergency
                 care plan.

                 Date and Time of Next Meeting

                 The next meeting will be held on 24th May 2010 from 08:30 - 12:00
                 Beckside Court MR 2
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Signed by Chair of Kirklees CHS Board   Dated


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