Fallside Road Bothwell G71 8BB Telephone:

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1 Lanarkshire NHS Board Kirklands Hospital Fallside Road Bothwell G71 8BB Telephone: Minute of Meeting of the Planning, Performance and Resources Committee held on Monday 22 nd June 2015 at 10.00am in the Boardroom, NHS Lanarkshire, Kirklands CHAIR: Mrs N Mahal, Non-Executive Director PRESENT: IN ATTENDANCE: Mrs L Ace, Director of Finance Councillor J Burns, Non-Executive Director Mr C Campbell, Chief Executive Mr P Campbell, Non-Executive Director Dr A Docherty, Chair, Area Clinical Forum Mr M Fuller, Non-Executive Director Mrs L Macer, Employee Director Miss M Morris, Non-Executive Director Dr A Osborne, Non-Executive Director Mr T Steele, Non-Executive Director Dr I Wallace, Medical Director Mr N J Agnew, Board Secretary Dr J Burns, Divisional Medical Director, Acute Services Mr C Cunningham, Interim Head of Health, South Lanarkshire Health and Social Care Partnership Ms J Hewitt, Chief Officer, North Lanarkshire Health and Social Care Partnership Mrs K Hamilton, Head of Communications Mrs H Knox, Director of Acute Services Mr C Lauder, Head of Planning and Development Dr J Pravinkumar, Consultant in Public Health Medicine Mr C Sloey, Director of Strategic Planning and Performance Mr J White, Deputy Director of Human Resources Mr D Wilson, General Manager, e-health APOLOGIES: Mrs I Barkby, Director for Nurses, Midwives and Allied Health Professionals Dr H S Kohli, Director of Public Health and Health Policy Councillor J Smith, Non-Executive Director Mr K A Small, Director of Human Resources Mr H Stevenson, Chief Officer, South Lanarkshire Health and Social Care Partnership 1

2 2015/11 WELCOME Mrs. Mahal welcomed members and attendees to the meeting. She extended a particular welcome to Mr. Lauder, Dr. Pravinkumar and Mr. White /12 DECLARATIONS OF INTEREST 2015/13 MINUTES No interests were declared. The minute of the meeting held on 29 th approval. April 2015 was submitted for 1. Approved the minute. 2015/14 MATTERS ARISING a) Action Log Consideration was given to an Action Log reflecting agreed actions arising from the meeting on 29 th April Emergency Medicine Dr. Wallace noted a question from Mr. Fuller about the progress of discussions with NHS Education Scotland and the Scottish Government about the training allocation to Lanarkshire. He explained that Lanarkshire had been allocated one additional training post. He also explained that consideration was being given to emerging Certificate of Completion of Training (CCT) holders as potential recruits to Lanarkshire. Dr. Burns reported on the likelihood of filling all trainee posts for the locum appointments. She also reported on the position with regard to the number of GP posts in Accident and Emergency and the anticipated shortfall in appointments. She acknowledged the need to evaluate the possible service and staff consequences of operating with unfilled posts. Dr. Wallace highlighted the need to appoint to all trainee posts to guarantee service continuity, and confirmed that locum appointments would be made, as appropriate. 1. Noted the update on Emergency Medicine Staffing. 2. Asked to be alerted to any potential service implications of staffing shortfalls. Dr. Wallace 2

3 2015/15 FINANCE The Committee considered a Finance Report for the period ended 31 st May Mrs. Ace explained that at the end of May 2015, the Board was reporting a 0.110m underspend which, despite high levels of hospital activity, including a reported overspend within the Acute Division of 0.604m to date, was ahead of expectations. Mrs. Ace noted issues raised in discussion about the overspend on medical budgets for the period, relative to the same period in She explained the contributory factors, and the required change to reverse the trend. Mrs. Ace also noted issues raised about budgets for the Integration Joint Boards within the context of the totality of the NHS Board budget. She outlined underspends within the component of the budget that would be the responsibility of Integration Joint Boards, a significant proportion of which related to Childrens Services. She emphasised that the presented report did not include the Prescribing figures, which were not currently available, and therefore the totality of the Integration Joint Boards Budgetary position was not fully known at this stage. She explained the position with regard to the element of hospital budgets which would not be managed by the Integration Chief Officers, and emphasised that a number of issues in relation to the IJB budgetary position remained to be worked through in detail. Mrs. Ace noted an issue raised about the reported increase in agency spend. She explained the reporting and scrutiny that was in place, which included a key role for the Acute Divisional Management Team. Mrs. Knox endorsed this position. She explained that, recently, the Divisional Management Team had considered a paper and proposals for the authorisation of agency and locum staff, the use of which was closely tracked on a week by week basis. Dr. Wallace noted a question about the achievability of the target prescribing saving of 3.6m for the year. He emphasised the extent of the endeavour on the delivery of this target, with particular regard to Primary Care, and explained that there was a need for additional GP capacity to review individuals on medication in order to maximise efficiency savings. The Committee would give more detailed consideration to the issue of Prescribing at its next meeting in September Mrs. Ace acknowledged the potential implications of the reported overspends for the forecast for the year, and confirmed the intention to consider the issues in further detail with relevant Executive Director colleagues. Mrs. Mahal welcomed the confirmation that more detailed consideration of Prescribing would be included in the agenda for the meeting of the Committee in September. She emphasised the requirement for adequate scrutiny of expenditure generally, and highlighted the need to test assumptions in order to inform the forecast position for the year. 3

4 1. Noted the actual revenue underspend of 0.100m as at 31 st May 2015, slightly ahead of trajectory. 2. Noted that 2.129m of the minimum 9.452m budget releasing efficiency savings had been released to date the schemes for delivering the remainder had been identified, though still carried risk. 3. Noted that some progress had been made in closing the 6.324m gap from the 3% efficiency and productivity target in the opening Local Delivery Plan ( m), but that there was still 4.187m to find, and a risk profile associated with delivery. 4. Noted the Capital Programme of m, and the reliance of 4.840m of capital receipts to deliver the Plan. 5. Noted the risks highlighted within the report. 6. Agreed to consider the issue of Prescribing in further detail in September /16 WAITING TIMES REPORT Mrs. Knox explained that the paper provided an update for Members on performance in the delivery of key Scheduled and Unscheduled Care Waiting Time targets; highlighted areas of pressure and challenge; and described the actions being taken and planned, aimed at delivering sustained improvement. She explained that the Board continued to perform well in relation to scheduled care activity. However, there continued to be a significant focus on Unscheduled Care, which remained challenging, with Improvement Plans in place on all three Acute sites. She highlighted the particular endeavour around reducing the longest waits, and reported on the focus of Improvement Leads activity on the Wishaw General Hospital site. Mr. (Philip) Campbell emphasised that Acute waiting times activity was extensively considered by the Acute Operating Management Committee, with a particular focus on actions to address 8 and 12 hour waits in the Emergency Departments. Mrs. Knox noted a question about the impact to date of changes to hospital services in Glasgow on activity at Hairmyres Hospital. She explained the additional number of patients being seen at Hairmyres Hospital and advised that this remained within the predicted increased levels of activity. She also noted a question about the implications for Lanarkshire of new Scottish Government Outpatient Performance Guidance, confirming the need for Boards to improve the 12 weeks outpatient performance to achieve a minimum 95% standard, and to eradicate waits of over 16 weeks. She explained the position within the context of a performance of 95.2% for the previous week, but emphasised the need to sustain performance and improve the position further. 4

5 Mrs. Knox reported on the funding shortfall within the Capacity Plan. She confirmed that provision for a substantial proportion of the shortfall had been made within the Board s Financial Plan, and highlighted the potential for a further allocation to Lanarkshire from the Scottish Government. Mrs. Knox noted issues raised about the management of patients in delay and the use of the independent sector. She reassured colleagues about the prioritisation process around patients in delay. She explained the approach to the use of the independent sector which, typically, followed the consideration of capacity in-house and at the Golden Jubilee National Hospital. She noted emphasis placed by Mrs. Mahal on the need for the Acute Operating Management Committee to give further detailed consideration to the protocol and indicators for use of the independent sector. She also noted an issue raised by Dr. Docherty about the pressures on Consultant staffing within medical receiving at Wishaw General Hospital, and reassured members that the Site Director met with relevant medical colleagues on a weekly basis to review the position. Ms. Hewitt confirmed the progress that had been made in reducing delayed discharges. However, she highlighted the consequent pressures on social care, and the need to carefully monitor the associated healthcare and social care budgets. Mrs. Knox 1. Noted the Waiting Times Report, and confirmed that it provided assurance about the delivery of waiting times targets to date, and about the actions being taken and planned to address areas where performance was off target. 2. Agreed to consider a further report in September, with a more detailed articulation of the risks to delivery of the waiting time targets and the mitigation current and planned. Mrs. Knox 2015/17 HEALTHCARE STRATEGY a) Development of Healthcare Strategy Consideration was given to a report on the development of the Healthcare Strategy. reminded members that the Healthcare Strategy would replace A Healthier Future in describing the basis for delivering the strategic objectives of NHS Lanarkshire within the context of the integrated approach to Health and Social Care provision. He explained that the presented paper and Annex provided a summary of the current status of the ongoing work to prepare an NHS Lanarkshire Healthcare Strategy. He advised that members were invited to note the individual elements of this work, and the key milestones which had been agreed so far. He noted the need, highlighted by Mrs. Mahal, to develop further clarity about the milestones for further Board involvement in the next steps described, and undertook to provide this information for the next meeting. 5

6 also noted issues raised in discussion about the need to align the development of the Healthcare Strategy with other strategic commissioning plans, viz: those for the NHS Board and the Integration Joint Boards, including clarity about timescales and the wider stakeholder engagement. He confirmed that these issues would be addressed in the planning for the next steps in the development of the Healthcare Strategy. This would also take due account of the route map to the NHS Board and to the Scottish Government. Mr. (Calum) Campbell reassured members that the Integration Chief Officers, and the Integration Joint Boards understood the requirement for strategic alignment. 1. Noted the work and progress and milestones set out. 2. Agreed to receive reports on progress at subsequent meetings, including further clarity and assurance about the key milestones for Board involvement, and the processes to ensure strategic alignment between the NHS Board, the Local Authorities and the Integration Joint Boards. b) Orthopaedic Services Consideration was given to a report on the progression of the Review of Orthopaedic Services, including a report on a Stakeholder Event held on Monday 23 rd March Mr. Lauder and Dr. Burns gave a presentation highlighting the key issues. They reminded members of the drivers for change. They explained the current status of the review and potential changes to orthopaedics, and the impact on the configuration of other specialties, and described the Programme Plan and the proposed way forward. Mr. (Calum) Campbell highlighted the need to consider carefully any implications for Accident and Emergency Services, taking account of the prevailing clinical views, both locally and nationally. He also suggested that it may be appropriate to consider commissioning external scrutiny and validation for proposals arising from the review. acknowledged the need for additional clarity about the timescales and key milestones for Board involvement in the progress of the Programme Plan, and undertook to provide this. Members acknowledged the Healthcare Improvement Scotland Rapid Review recommendation that there required to be a more fundamental review of the distribution of Orthopaedic Services across NHS Lanarkshire. Discussion highlighted the need to fully understand the continuing challenges which orthopaedic services faced, and to articulate fully and clearly the benefits of any service change proposals, as well as any implications for other services as 6

7 a consequence of any staff reassignment. There was recognition of the demonstrable clinical and other benefits deriving from the creation of centres of excellence for other specialties and services in Lanarkshire over recent years. Dr. Wallace reminded members of the General Medical Council interest in Lanarkshire in response to the publication of the Healthcare Improvement Scotland Rapid Review Report, and the potential enhanced training opportunities which service reconfiguration might create. Members endorsed as key, the emphasis placed by Mrs. Mahal on the importance of the widest possible engagement with interests to ensure that the rationale for any change proposals and the benefits deriving from them are understood. 2015/18 e-health STRATEGY 1. Noted the work in progress described within the presented papers. 2. Agreed to receive further reports on progress at subsequent meetings. Consideration was given to an introductory paper and an updated e-health Strategy. explained that NHS Boards were required to prepare an e-health Strategy that described how the Organisation would use electronic systems and digital technology to support safe, effective, efficient, timely, equitable and patient-centred services. Boards were required to submit detailed e- Health Delivery Plans to the Scottish Government e-health Directorate, setting out how their e-health Programme would support the delivery of the seven strategic aims for e-health, this being a condition of the allocation of Scottish Government funding to Boards for their e-health Programme. Mr. Wilson highlighted the principal elements from the summary of key issues within the report. He emphasised that the e-health Strategy and Delivery Plan should, fundamentally, be viewed as a clinical transformation programme. noted a need, highlighted by Mrs. Mahal, for Members to have additional clarity about the way in which e-health would underpin the delivery of safe, effective, patient-centred care. He also noted observations from Mr. Steele about the need to extend the scope of the Strategy, with particular regard to the need for further clarity about the alignment of the Strategy and the Workplan, expenditure, deliverables, infrastructure and infrastructure renewal, and the development of digital technology. Mr Steele also expressed a view that, where appropriate, the relevant Executive Directors with operational responsibilities should be responsible for commissioning new development projects and for the subsequent realisation of business benefits. Mr Steele would meet with Mr Wilson to explore these issues further. Mr. Steele Mr. Wilson noted and acknowledged issues raised in discussion about the need for integrated IT in the context of Health and Social Care Integration, and the delivery of improved outcomes for individuals. He reminded colleagues that 7

8 there was an established Data Sharing Partnership in place, but highlighted the need to reflect on its fitness for purpose, moving to full Integration in April 2016, and to consider further the information needs of staff delivering services to individuals. Mr. Wilson explained that there would be a range of technical documents, including infrastructure application standards and activity plans, to underpin the e-health Strategy, and he undertook to share these documents with Mr. Steele. He emphasised that the Workplan was constructed on the basis of available funding. Mr. Wilson Mr. Wilson acknowledged observations from Dr. Docherty and Ms. Hewitt about the benefits to Integration from Local Authorities having the ability to access and use the Community Health Index (CHI) as a single point of access to three legacy systems. He confirmed that this issue could be addressed at an appropriate point in time. noted observations from Mr. Fuller about the need for the Delivery Plan to include a timetable and costs and prioritisation for the projects described, and further projects in development. He stressed that the Delivery Plan as presented was funded, and explained that any additional aspirations towards the delivery of the e-health Strategy would require additional funding to be identified. He noted the need highlighted by Mrs. Mahal for further clarity on the actions in place to mitigate the risks identified. He explained that these issues would be managed internally, and through the e-health Strategy Group, and undertook to bring further information to the next meeting of the Committee. 1. Endorsed the e-health Strategy for submission to the NHS Board for approval, subject to updating to reflect the key issues raised in discussion. 2015/19 HEALTHCARE IMPROVEMENT SCOTLAND RAPID REVIEW Dr. Wallace introduced the presented Healthcare Improvement Scotland Rapid Review stocktake report. He explained that the comprehensive stocktake report arose from revisiting the 21 recommendations from the Healthcare Improvement Scotland Rapid Review of Safety and Mortality, which reported in December He also explained that the report highlighted those actions which were closed, and provided a status report with recommendations on those actions which, although progressed, remained to be fully implemented. Mrs. Mahal emphasised the key role for the Governance Committees in continuing to exercise oversight of the delivery of the relevant recommendations and actions which remained to be fully implemented. 1. Noted progress against the 21 recommendations, with particular regard to closed actions and actions which remained to be fully implemented. 8

9 2. Confirmed that the report provided adequate assurance on the progress made in delivering the Healthcare Improvement Scotland Rapid Review recommendations. 3. Endorsed the role for the Governance Committees in exercising oversight of delivery of the recommendations and associated actions which remained to be fully implemented. Governance Committee Chairs 2015/20 QUARTERLY LOCAL DELIVERY PLAN REPORT AND INTEGRATED CORPORATE PERFORMANCE REPORTING introduced the presented Quarterly Local Delivery Plan Report for Quarter 4, from January to March This encompassed: HEAT targets and standards traffic light schedules; notes on amber and red rates target and standards; progress against the 2020 Vision and Single Outcome Agreements sections of the Local Delivery Plan; Primary Care; Single Outcome Agreements; and the Programme of Reports for 2014/15. Mr Sloey explained that since the report was issued for the meeting, confirmation had been received that the Board had met the targets for Child and Adolescent Mental Health Services, and Fuel Consumption and CO2 emissions. introduced the presented paper on the development of an Integrated Corporate Performance Report. He explained that he had led a Working Group of Directors which had developed Plans for an ICPR, encompassing: a Dashboard/Scorecard of some 90 key performance indicators, deriving data from validated published sources through the Board s Information Systems; a suite of 21 short narrative reports for those areas that would not be well represented by individual KPI(s); the standard format for the narrative reports; and a forward programme of reports for each meeting of the Planning, Performance and Resources Committee. 1. Noted the Quarterly Local Delivery Plan Report for Quarter 4, January to March Noted that the next report for Quarter 1 of 2015/16 would form part of the new expanded Integrated Corporate Performance Report, and would come to the Committee on 30 th September /21 ASSET MANAGEMENT STRATEGY introduced the presented Asset Management Strategy Annual Report 2014/15, and accompanying report. He explained that the Asset Management Strategy and Annual Report were intended to illustrate the way 9

10 in which the Board s assets were managed to support the Healthcare Strategy, and demonstrate forward planning for at least five years. He advised that the documents identified: where the Board was now; where the Board needed to be; and how the Board would get there. He advised that the Committee was asked to note that the scope of the Strategy encompassed all material assets, including non-property items, and to endorse the NHS Lanarkshire Property and Asset Management Strategy Annual Report 2014/15. noted observations raised in discussion about the levels of annual expenditure on maintaining Monklands Hospital, pending its replacement. He emphasised that the substantial expenditure each year needed to be viewed within the context of the Board s legal duty to maintain a safe and healthy environment, and to manage the risks which were clearly articulated within the site Risk Register. noted issues raised in discussion about the identification within the Annual Report of surplus capacity within GP Practices. He explained that a substantial space utilisation survey was about to commence. He acknowledged the need, in taking the survey forward, to take account of the move to Integration, and to ensure that the necessary connections were in place between locality modelling and General Practice. He welcomed an observation from Councillor Burns about the opportunities which Integration presented to pursue innovation in the delivery of shared services, and to explore the potential to optimise efficiency in the use of Local Authority and Health premises. He confirmed that the progress of the space utilisation survey would involve linkages with Mr. Stevenson and Ms. Hewitt. endorsed confirmation from Mr. (Calum) Campbell that the combination of individual Board Asset Management Strategy Annual Reports in a single national document would include benchmarking. He explained that the Board s discussions with Health Facilities Scotland about the Annual Report would include consideration of how benchmarking might be further strengthened. He would bring back to a future meeting of the Committee a report on the key outputs from the discussion with Health Facilities Scotland. 1. Endorsed the NHS Lanarkshire Asset Management Strategy Annual Report 2014/ /22 ALCOHOL AND DRUG STRATEGY introduced the presented Alcohol and Drug Strategy 2015/2018, and a covering paper. He explained that the ADP Strategy set out the Lanarkshire Alcohol and Drug Partnership approach to tackling alcohol and drug-related problems, both of which could be inextricably linked to Health Inequalities. He advised that the national Alcohol and Drug Strategies continued to provide the Framework for delivering alcohol and drug prevention, treatment and support services in Lanarkshire, with the Lanarkshire Alcohol and Drug Partnership being responsible for implementing the national Alcohol and Drug Strategies within each of the Local Authority areas. He advised that the Strategy and the associated Delivery Plans focussed on achieving the key aims of: promoting the development of a recovery-orientated system of care within communities; safeguarding and promoting the interest of children and young people affected 10

11 by substance misuse; and supporting individuals, including parents, prisoners and older people, with alcohol and/or drug-related problems. He emphasised that a key feature of the Alcohol and Drug Partnership approach involved measurement of the outcomes of the services commissioned in pursuit of these aims. Ms. Hewitt explained that the services would be hosted in one of the integrated Health and Social Care Partnerships, and she highlighted the need to report progress on delivery to the Integration Joint Boards, and to the NHS Board and the Local Authorities. reported that Maureen Watt, MSP, Minister for Public Health, had recently undertaken a visit to the Lanarkshire Alcohol and Drug Service and, subsequently, had raised the Lanarkshire Alcohol and Drug Partnership approach as an example of good practice in her report to Parliament. noted an issue raised by Mr. Fuller about Health Inequalities and the need for a mechanism to constantly review the impact of service intervention. He explained that the Alcohol and Drug Partnership had access to morbidity data, which evidenced changing patterns evident in reductions in alcohol consumption and drug misuse. He also stressed that a key element of the ADP Investment Strategy focussed on families and communities. 1. Endorsed the Alcohol and Drug Partnership Strategy 2015/2018 for submission to the NHS Board for approval. 2015/23 CORPORATE OBJECTIVES AND ANNUAL REVIEW a) Corporate Objectives 2014/15 introduced the presented year-end progress report on the Corporate Objectives 2014/15. He reminded colleagues that the Corporate Objectives 2014/15 were approved by the Board at its meeting in May 2014, with a request that progress reports be submitted at mid-year and year-end. He explained that the mid-year report was submitted to the NHS Board in November 2014, and advised that the presented report provided a summary of outturn by the agreed traffic light ratings, and set out those objectives scoring red and amber at 31 st March noted an observation raised in discussion about the red score for the lack of electronic maternity systems scoring. He explained that despite this scoring, there were no material concerns, and he reminded Members of the recent donation to contribute to the introduction of the HeRO (Heart Rate Observation) system within the Neonatal Unit. 1. Noted the year-end progress report on the Corporate Objectives 2014/15. 11

12 2. Noted that a report for the period to 30 th September 2015 (mid-year 2015/16), would come to the meeting of the Committee in November b) Corporate Objectives 2015/16 introduced the presented Corporate Objectives 2015/16. He explained that these were developed in partnership with all Executive Directors during March and April 2015, and were considered by the Corporate Management Team, and approved by the Remuneration Sub-Committee on 29 th April Noted the Corporate Objectives 2015/ Noted that a progress report against the Corporate Objectives at 30 th September 2015 (mid-year 2015/16), would come to the meeting of the Committee in November c) Annual Review Consideration was given to Annual Review Guidance and a report on preparation for the 2015 Annual Review, including a draft Programme. Mr. Agnew explained that planning for the non-ministerial Annual Review scheduled for 25 th August 2015 was underway, with a focus on maximising the presentation of achievements during the year in the areas of safe, effective, person-centred services; looking ahead, including the challenges for 2015/16; and providing progress and plans for Integration of Health and Social Care. Discussion raised issues for further consideration around the venue and the focus for the Annual Review, and further exploring the opportunities for engagement with staff. These issues would be considered further, and the Programme would be revised accordingly. 1. Noted the Annual Review Guidance and the Draft Programme. 2. Asked that further consideration be given to the Programme and arrangements for the Annual Review, having regard to the issues raised in discussion. 3. Noted that a report on the Annual Review would come to the meeting of the Committee in September 2015 including, if available, the Outturn Letter from the Scottish Government. / Mr. Agnew 2015/24 DATE OF NEXT MEETING Wednesday 30 th September 2015 at 9.30am. 12

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