Minutes of the Shetland NHS Board Meeting Friday 23 June 2017, Bressay Room, Board Headquarters, Upper Floor Montfield, Lerwick

Transcription

1 Shetland NHS Board Minutes of the Shetland NHS Board Meeting Friday 23 June 2017, Bressay Room, Board Headquarters, Upper Floor Montfield, Lerwick Present Mr Ian Kinniburgh Mrs Kathleen Carolan Mrs Lorraine Hall Mr Colin Marsland Mr Tom Morton Mr Ralph Roberts Mr Ian Sandilands Mrs Marjorie Williamson In Attendance Mr Simon Bokor-Ingram Dr Jamie Hogg Mrs Yvonne Graham Ms Susan Webb Ms Karlyn Watt Mrs Carolyn Hand Chairman (by video conference) Director of Nursing and Acute Services Director of Human Resources and Support Services Director of Finance Non-Executive Board Member Chief Executive Non-Executive Board Member/Chair, Area Partnership Forum Non-Executive Board Member Director of Community Health and Social Care Acting Medical Director (NHS Grampian) Patient Travel Manager (for item 2017/065 only) Director of Public Health for NHS Grampian and NHS Shetland Manager, Deloitte LLP (for items 2017/ inc) Corporate Services Manager (Minutes) 2017/048 Chairman s Announcements 1. Mr Kinniburgh welcomed everyone to the Board Meeting. Ms Karlyn Watt as external audit representative would be joining the meeting for consideration of the Annual Accounts. Mrs Yvonne Graham and Ms Hazel Sutherland would also attend for papers later on the agenda. 2. There had been a successful recruitment round for the new Non-Executive posts and four candidates had been approved by the Cabinet Secretary for Health and Sport for appointment. Once offers had been accepted Mr Kinniburgh would be in a position to share more information. Committee membership would be reviewed at the August Board Meeting but in the meantime Board Members were thanked for being supportive during the last few weeks. 3. Mr Kinniburgh was also pleased to confirm the Board had now recruited to the Medical Director position. Mr Gilbert Ozuzu would bring considerable leadership experience to NHS Shetland, having worked as a lead clinician for ophthalmology and lead governor with the University Hospitals of Morecambe Bay NHS Foundation Trust. Mr Ozuzu would start with the Board at the beginning of October and the interim arrangements with NHS Grampian for Medical Director cover would continue until then. 4. The Board had received a very positive report earlier in the week from the Healthcare Environment Inspectorate (HEI) regarding an unannounced inspection of the safety and cleanliness of the theatres at the Gilbert Bain Hospital. This was the first inspection of the theatre department and staff were pleased that the standard of cleanliness in all areas was found to be very good.

2 The Inspectors observed lots of examples of good practice and found that theatre equipment and the theatre environment were clean and well maintained. There were also clear procedures in place for undertaking audits and learning lessons from the audit results and other forms of feedback. The Inspectors also highlighted a small number of practice points regarding the storage of sterile instrument trays, disposal of damaged equipment and the removal of drape tape residue. It was noted that some sinks in the theatre department were not compliant with current (new build) standards, but that a risk assessment was in place. There was improvement work ongoing in all of the areas listed which was being monitored through the HAI action plan. 5. Board Members were reminded that if they had not already carried out a software download on Board-owned ipads as requested by IT then they needed to do so. If anyone needed support they could drop their ipad in to the main admin office. 2017/049 Apologies for Absence Apologies for absence were received from Mr Bell and Ms Watson. 2017/050 Declarations of Interest There were no interests declared. 2017/051 Minutes of previous Board Meetings Minutes of the meetings held on 18 April 2017 The minutes of the meetings held on 18 April 2017 were confirmed as accurate records. Minutes of the extraordinary meeting held on 23 May 2017 The minutes of the extraordinary meeting held on 23 May 2017 were confirmed as an accurate record. 2017/052 Board Action Tracker No issues required discussion on the tracker. The update was noted. 2017/053 Matters Arising There were no matters arising from either of the April sets of minutes. For the May minutes Mr Marsland advised that the reduced escort fares were now available from Loganair and were in use by the Board. 2017/054 Report to Board Members from External Auditors for Financial Year 2016/17 Board Members were asked to note that an unqualified audit opinion for the 2016/17 financial statements had been issued. Seven issues had been raised for management to address, with the main one being in respect of efficiency savings and the scale of the progress required. This was applicable to all Scottish Boards and across the wider NHS.

3 Mr Kinniburgh welcomed the unqualified audit opinion and asked if there was anything that required the Board s attention. Mr Roberts advised the financial statements had been discussed at the Audit Committee and Mrs Williamson, as acting Audit Chair, said she was comfortable with the process and that there was nothing that required to be discussed at Board level. Mr Kinniburgh thanked both staff and the internal and external auditors for their support in reaching this position. The Board noted the issues raised in the External Auditors Report to the committee entitled Final report to the Board and the Auditor General for Scotland on the 2016/17 audit for the Board of NHS Shetland and the Auditor General for Scotland. 2017/055 Notification from Sponsored Bodies: Audit Committee Mrs Williamson confirmed that there were no significant issues or incidents considered to be of wider interest to warrant notification to the Scottish Government portfolio Audit Committee. If the Board was happy to accept this notification, the letter would be signed at the end of the meeting. The Board approved the content of the letter dated 13 April 2017 regarding duties of Audit Committees of Sponsored Bodies and agreed the Board s proposed submission. 2017/056 Draft Letter of Representation to External Auditors Mr Roberts explained this was a standard letter from himself as the accountable officer which formed part of the Board s official documentation submitted alongside the statutory accounts to external audit. The purpose was to assure the Board s external auditors that the submission was made in good faith and compliant with the Board s statutory duties and obligations. Since the issue of the Board pack there had been a minor amendment to point six. The Board, subject to the amendment in point six and subsequent numbers changing, approved the letter of representation to Audit Scotland from the Chief Executive as the accountable officer. 2017/057 Statutory Annual Accounts 2016/17: Financial Statements, Strategic Report, Directors Report and Governance Statement This paper presented the Board s audited annual report and accounts which, along with the financial statements included the performance report and the accountability report. Mr Roberts felt there had been relatively good performance, though it was recognised some areas could be improved. The information had been discussed through the Audit Committee, including issues on presentation, with suggestions about visual aids being included in future years to make the accounts more readable. The Audit Scotland improvement report would be shared with the Audit Committee. There remained an issue with implementing recurrent savings; however the Board was already aware of this. Mr Roberts wished to thank the internal and external auditors, the work of the Finance team and also the hard work of people across the organisation in delivering services. There were good systems of control in place which was testament to the

4 work of staff and he was very grateful for that. Mr Kinniburgh felt all Board Members would agree with that and advised as Chair he was happy to accept and approve the annual report and accounts. The Board, following careful consideration and taking account of all evidence submitted, and to ensure the fulfillment of its obligations in respect of the Annual Report and Accounts for the period ending 31 March 2017, accepted and approved the ratification of the 2016/17 annual report and accounts for submission to the Scottish Government. 2017/058 Adults with Incapacity (Scotland) Act 2000: Annual Review of Compliance Mr Marsland advised that the Board had a requirement to report annually on the Board s management of patients financial affairs in the absence of available alternatives. The patients private funds accounts, SFR 19 in the annual accounts, had to be submitted annually for the Board to approve. For 2016/17 this was a nil balance. Mr Kinniburgh asked for views on why this was a nil return and whether there were now in place different ways of caring for the frail and elderly. Mrs Carolan felt the absence of funds being held could in part be due to the marked reduction in length of stay which was an indicator that the Board was shifting the balance of care. The Board: noted the findings of the annual review; noted that in respect of patient s funds no funds were held during 2016/17; and approved the issuing of annual Notes of Authority to the Gilbert Bain Hospital. 2017/059 Quality Report Update on Progress Mrs Carolan presented the updated Quality Report to the Board. Highlights included the completed self assessment ahead of the GMC visit in October, discussions with the PFPI Steering Group and Clinical, Care and Professional Governance Committee regarding the annual feedback and complaints report which was on the meeting s agenda, and the improvement work taking place regarding service delivery such as developing sustainable clinical services, population health and organisational development. Work had been done with the Area Medical Committee to review the delivery of emergency services out of hours, and testing was ongoing regarding the implementation of community based rehabilitation. Mrs Carolan was pleased to advise that the work of Marie Hurson, Team Lead and Cardiac Specialist Nurse had been recognised in a new publication on the impact of specialist nurses across Scotland. There had also been further discussions with NHS Grampian about the continued development of telehealth services and repatriation of services and survey results were now available regarding patient experiences when accessing care through the telehealth model.

5 Mr Kinniburgh welcomed the positive feedback regarding telehealth services and noted the significant breadth of improvement work going on. In response to a query from Mr Morton about consideration of Shetland dialect and potential communication issues, Mrs Carolan answered that this had not been specifically considered. This was not an issue the survey covered, however it had also not been flagged through the responses. It was known some locums had expressed difficulty with the Shetland dialect and Mrs Carolan felt it was important for all clinicians to check that their service users understood the consultation. Dr Hogg introduced himself and advised that he was involved in a national piece of work on telehealth being taken forward by the Scottish Government. Attend Anywhere was a web-based platform that helped health care providers offer video call access to services and was used widely in Australia. This was now starting to be incorporated in to Scottish practice, and was being progressed in Aberdeen in particular with gastroenterology services. Patients were invited to join a virtual waiting room, and provided they had reasonable broadband at home, could be seen in their own environment. The doctor could see who was in the virtual waiting room. It was good for doctors as they could set aside time to see a lot of patients in a short time, and it was also very convenient for patients. Clearly some consultations were not suitable for this type of interaction, but often it was useful for follow ups or at a fixed point for someone to locally assist. Mrs Carolan explained this was being piloted for some Aberdeen provided services and was also of interest between primary care and the Gilbert Bain Hospital as both were areas of high travel demand. It had predominantly been used so far for upper gastrointestinal complaints but it was clear the service would be able to adapt and be of significant value for those with chronic pain and poor mobility. Mr Morton welcomed the innovation but felt it was very dependent on the quality of broadband provision across the isles. Whilst he recognised a lot of the kit was already installed in GP practices, it was not in use owing to failures in providing adequate infrastructure. He was however grateful for the insight into patient views and asked what staff thought about the developments. He also queried whether it was an adequately secure platform. Dr Hogg replied that the NHS had taken on licenses for Attend Anywhere and there would have been due diligence carried out with regard to security. In his experience while it worked with reasonably narrow bandwidth it was not as good as a video consultation unless there was good bandwidth available. Gastroenterology was the first specialty to be moved to electronic patient records provision and with all information on the hospital systems this should be able to be seen on the same screen as Attend Anywhere. Patients were in a better position to a get a consultation very quickly. The intention was then to widen the trial out to respiratory patients and other specialties in due course. Mr Roberts acknowledged Mr Morton s concerns about broadband provision as a fundamental issue, and advised that the Board had, and would continue to raise this as a concern through the Community Planning Partnership and the Scottish Government ehealth leads group.

6 In response to a query from Mr Sandilands about whether it was just planned for acute services, Mrs Carolan advised that primary care was one of the target groups. Unfortunately although the non doctor islands would benefit most, the broadband infrastructure on the islands would not currently support the system. It was planned to start with static sites across Shetland and bring people in to their local health centres to make use of the technology. Mr Kinniburgh commented that he was really pleased to hear about the enthusiastic users and could see it was beneficial to them. It also supported the reduction of travel costs. The Board noted the progress made to date with the delivery of the action plan and other associated work which focused on effectiveness, patient safety and service standards / care quality. 2017/060 Healthcare Associated Infection Report The Healthcare Associated Infection Report circulated to Board Members was the standard report which showed compliance with the various indicators. There were no concerns requiring discussion by the Board. In the period since the last report there had also been an unannounced inspection of the safety and cleanliness of theatres at the hospital which had been mentioned earlier by Mr Kinniburgh. Mrs Carolan and the team were pleased with the report and also the work of the multi-disciplinary team including cleaning and theatre staff who worked hard to achieve such good results. Mr Kinniburgh commended all the staff involved for their hard work. The Board received the HAI report and noted the Board s position and performance in relation to: Clostridium Difficile Staphylococcus Aureus Bacteraemias E Coli Bacteraemias Hand hygiene compliance Monitoring of cleaning services 2017/061 Annual Feedback and Complaints Report 2016/17 Mrs Hand presented the Board s Annual Feedback and Complaints Report for 2016/17 and highlighted to Board Members where there were changes in areas of concern and performance from the previous year. Board Members were reminded that the number of concerns and complaints raised was minimal in the context of the thousands of health care interactions each year. The report would look somewhat different in future iterations with the introduction of the revised Complaint Handling Procedure in April Mrs Carolan thanked Mrs Hand for the report which was a useful summary of the year s progress in this area. It was important to continue to encourage people to express their views in order to know what may not be working as anticipated and

7 make improvements to services. Mr Kinniburgh agreed and felt it was heartening to see the learning points identified which showed the Board as a learning organisation. Mrs Williamson reflected on Mrs Hand s comment about how complaints about staff attitude had widened from being predominantly about senior clinicians in previous reports, to now involving other staff groups including reception workers. Mr Bokor- Ingram recognised Mrs Hand s suggestion that where people were not able to access services as readily as they were used to or required to, it was understandable this created frustration and anxiety, which in turn could lead to the complaints. However, for the staff involved, there had been staff shortages, in particular at Lerwick Health Centre and with dental provision in the North Isles, and reception staff had to manage the appointment systems as best they could. Mr Bokor-Ingram felt it was also disappointing when staff suffered verbal abuse as a result of this frustration which had been seen on some occasions. Mrs Carolan spoke about how some complaints had come about from very complex interactions with families, on occasion where the Board was offering the services that were needed as opposed to the services the families wanted. Other complaints highlighted some significant communication issues and it was important to acknowledge this and make improvements. Mr Roberts said the report was one of the most important the Board received in that it showed how the organisation was learning from feedback and also felt it was encouraging that the number of issues was relatively low. It remained a challenge to collate positive feedback, not least because people were less likely to pass this through to Corporate Services, however it would be good to see this at Board level if possible. Mr Sandilands asked about systematic training for front line staff to have difficult conversations about, for example, access to services. Mrs Hand advised that dental staff had recently received NHS NES training and it had also been advised that MAPA training would be of benefit for all front line staff. Mrs Hand concluded by advising that since the move to the revised Complaint Handling Procedure, there had been good progress in local resolution of concerns, with a number of Stage 1 complaints lodged by staff groups and only six Stage 2 formal complaints for investigation. This was a low figure compared to the same period in the previous year. The Board: noted and considered the information in the report; were satisfied appropriate actions were being taken regarding feedback that was received; and did not request any changes in format or information for future iterations of the report (noting this was subject to change with the revised procedure). 2017/062 Capacity and Resilience Planning Managing Safe and Effective Care across Hospital and Community Services Mrs Carolan presented the paper on capacity and resilience planning, starting with a reminder to Board Members about the extent of the discussions on this matter

8 through various committees and groups. Board Members had been previously aware that owing to recruitment difficulties the decision had been made to temporarily close Ronas Ward. This had seen minimal impact in terms of bed occupancy. Feedback from staff and patients on this change in the delivery of care had been positive overall. The Board was now being asked, based on the information in the report, to support the decision to permanently close the stand alone Rehabilitation Unit located on the ward. This would allow the staff affected to have new work arrangements formalised, and also support the full implementation of the community based rehabilitation model. Mr Kinniburgh commented that this was an excellent report which was packed full of data and explanation of the rationale behind the change. He asked if management was confident, should the Board agree the proposal, that it did not warrant a major consultation process. He was advised the Scottish Health Council had not felt it required a major service change consultation. Mr Roberts said it was an extension of the way the service had been evolving, and greater details about this had been added following discussion at the Integration Joint Board. Mr Bokor-Ingram assured Board Members that staff in community services were fully supportive of the direction of travel and were really excited to support people to live independently. It was right to get people home wherever possible. The projects in this regard had just received national recognition through a poster award at the NHS Scotland annual event and were seen as groundbreaking across Scotland in shifting the balance of care. The work had been going on for a number of years and this was necessary to protect the services the Board wanted to keep providing, as without the change it would become more challenging to be able to continue increasing community based care. Mr Morton commented that from discussions at the Integration Joint Board there was a degree of public concern over the closure of Ronas Ward and in his view this was driven by a need to save money and a perceived need to implement Scottish Government policy whether it was the right thing to do or not. He asked if the report fully acknowledged the views of medical colleagues and whether there were concerns in the change from what had been a consultant led service. Mr Kinniburgh replied that while the Board was challenged regarding the financial position, the proposal was part of work that had been ongoing over a number of years to keep people out of hospital where it was safe to do so, and was nearer an end point than previously possible. He felt the positive feedback was an endorsement of the direction of travel. Mrs Williamson said from a personal perspective she had seen relatives on Ronas Ward and it was found to be quite an empty and lonely environment as there were not enough people for interaction. The Board had been working for some years to change the model of service delivery to keep people at home. The concerns flagged by the Integration Joint Board had been reasonable at the time as they had felt information was missing, however the report was now more robust and ultimately supported people in their own homes which was what they wanted. In her view it was good news, and endorsed by the national direction of travel, and agreed completely with the proposal.

9 Mr Sandilands advised that staff affected had felt well supported by Mrs Carolan and Mrs Mustard, with only one or two not happy with role changes. He felt it was critical to act promptly with the vacancies left in the new team to ensure the right level of therapy input. Mr Bokor-Ingram referred to the point prevalence study and said there was nobody waiting to go home because of a lack of support. Only two people were waiting for discharge and this was due to requiring adaptations or re-housing which was a different issue. Mrs Carolan accepted resources were an issue as they would be in any pathway redesign. One of the Board s aims was to provide care in the community if it was safe to do so. In her view it would be wrong to continue to invest in unused beds when the resources could be better placed elsewhere. In response to Mr Morton s request for assurance there was no medical unease, Mr Roberts said he had discussed the matter at the Consultants Group meeting and no concerns had been raised beyond the fragility of all services. The physicians had been clear they felt it was important to have the right level of therapy staff in place to support the changes. In Mr Roberts view, there was always potential nervousness about changes in service delivery but it was incumbent on the Board to make the best use of the resources it had. Mr Roberts felt this was absolutely the right thing to do in that it was an extension of community services and reflected what patients advised they wanted in being cared for at home when that was safe and appropriate. Whilst it was consistent with national policy, this did not make it the wrong thing to do. Dr Hogg said doctors had come to realise that admitting elderly patients to hospital for any length of time reduced their independence at a frighteningly quick rate, with muscle rate reducing on average by 12% in a 48 hour period. He had worked in a unit which had once had 36 slow stream rehabilitation beds with one patient there for 13 years. This same unit now had six beds as the vast majority of people preferred to be at home. In his view most doctors would support the proposal for these reasons. In response to a query from Mrs Williamson about whether the proposal would impact upon the emergency plan or services in the outer isles, Mrs Carolan explained the hospital would retain surge capacity beds and the plan would not change appreciably. The plan would need updating but the change was not expected to put the Board at risk. In terms of the outer isles, there was a wide geographical demand for care outside of Lerwick and the north and south teams for Occupational Therapy focused on localities and would be out at least once a week to support carers. Mr Bokor-Ingram felt it was right to extend the success seen in keeping people out of hospital as much as possible and the reduction in delayed discharges. In the previous evening s bed statement, there had been 30 empty beds and 15 care home places available. Mr Roberts continued that as a Board, the average occupancy in recent years had been 60% and in the last two years averaged 50%. In his view the Board could not justify continuing to run at this level when the average for a Scottish Board was greater than 80% bed occupancy. He believed that most Boards would certainly be comfortable with 75% occupancy across a hospital and it was not sustainable to continue to manage the hospital at under 50% occupancy when the

10 Board was trying to more effectively manage its budget and make best use of the public resources that were received. Mr Morton did not think Mr Roberts could compare the figures with urban hospitals and whilst he had found the discussion useful, in his view he did not think the safety of patients and medical approval was evident in the report. Mr Kinniburgh commented that in days gone by people had been living and dying in hospital without choice, and he was pleased the service was now in a very different place. In his view clinicians had been fully engaged with and the change had been working for a significant amount of time. Dr Hogg suggested patient safety could be measured and spoke about the ability to undertake risk stratification of patients, combining soft markers and harder data to monitor readmission rates. Mrs Williamson advised fellow Board Members that Dr Unsworth s view at the recent IJB meeting had been that this proposal was the least bad option, meaning keeping the ward open was worse. Mrs Carolan added that there had not been concerns raised about the interim arrangements and there had been no suggestion that the proposal was unsafe in terms of patient care. Mrs Hall advised of a patient safety visit to Ward 3 and speaking with clinical colleagues about the reduction in delayed discharges and readmissions. Mr Kinniburgh felt confident there was capacity in the system, and that if people needed to be in hospital then they were. There was also capacity in the care homes. Mr Roberts felt it was important to emphasise that the decisions about where people cared for in the health and care system were made by multidisciplinary clinical teams and this was the appropriate place for individual patient decisions to be made. Mr Morton asked for it to be noted that he had certain uneasiness about the proposal. The Board otherwise supported the decision to permanently close the stand alone Rehabilitation Unit at the Gilbert Bain Hospital. 2017/063 Performance Update 2016/17 (as at May 2017) Mr Roberts presented the standing report regarding performance. There was discussion about vaping in the context of smoking cessation services and the Board was advised that service users who used ecigarettes felt the smoking cessation service was not open to them. The current policy meant no staff should undertake any kind of smoking on its premises. In light of new evidence a number of Boards were likely to review their policies; however it was clear that vaping remained harmful even if it were helpful in supporting people to quit smoking cigarettes. Mrs Williamson commented that the sickness absence rates appeared to be much better now. Mrs Hall replied that it stood at just over 4% and in 2016/17 this had been the highest performance of the territorial boards. This was believed to be due to managers applying the policy and monitoring trigger points in sickness absence. Staff incidences of reporting stress and depression through Occupational Health were not work related. The Board should not be complacent however, and the respect charter was being revised.

11 Mrs Carolan drew attention to the hospital standardised mortality rates and the increase in the winter quarter. Two governance groups were looking at this to provide assurance given the ratio was slightly outside the usual parameters. The Board noted the progress against performance up to May /064 Local Delivery Plan The Board was being asked to approve the Local Delivery Plan for This was linked to item 18 on the agenda. Mr Kinniburgh noted the requirements regarding regional working and asked how this fed into the Local Delivery Plan process. Mr Roberts could provide an update but not a definitive answer in this regard. He understood part of the following year s guidance, not yet received, would be to link regional working explicitly to the LDP process. The six North of Scotland Board Chief Executives were now meeting on a monthly basis and had given a commitment to work closely together to find service solutions that worked for the North. They were also keen that the Regional Delivery Plan delivered regional priorities as well as the national Health and Social Care Delivery Plan. Meetings to develop the regional plan would take place every six weeks and Directors of Public Health were also meeting fortnightly because of the requirement for public health to support the delivery of the plan and the longer term actions. Mr Kinniburgh asked to what extent regional planning was focused on Our Islands Our Future. Ms Webb said from a public health perspective they were very much sighted on this and plans would need to be reviewed in light of the Islands Bill. Dr Hogg added that it had been discussed at the Medical Directors meeting how Boards could practically regionalise services, however there had to be some efficiencies in working towards, for example, a streamlined radiology service. Whilst the terminology in the letter referred to redesigning at pace, in reality it was recognised the pace had to be appropriate to involve clinicians and the community in service changes. The real skill would be to get the pace right but also get the process right. Mr Sandilands commented that as more practices became salaried, and with potential issues of patient safety with the continued use of locums and lack of doctor/patient continuity, it had to be a priority to the Board to redesign. Mr Roberts agreed that primary care redesign was a good case study for discussion at the Board development session. The Board also needed to discuss its risk appetite for the decision making process and the issues that would fall out of this. The Board noted the comment from the Scottish Government on the Local Delivery Plan feedback and approved the Local Delivery Plan for /065 Patient Travel Escort Criteria and Leaflets Mrs Graham was in attendance for the discussion on this item. The Board had previously asked for work to be done on the patient escort criteria in terms of firming up information for GPs and the public in this regard. Mrs Graham explained the

12 proposed changes with the aim of streamlining the process and achieving greater consistency regarding the approval of escorts. Mr Kinniburgh welcomed the revised criteria and information leaflets and felt clearer guidance could only be positive. Mr Roberts also felt this was very helpful and explained it was planned implementation would take place in September to allow an opportunity for staff training and also to communicate to patients what it meant for them. In response to a query from Mr Morton about the how things would work in an urgent situation, Mrs Graham confirmed the senior manager on call would deal with these requests. It was acknowledged that the Board was responsible for ensuring discharge liaison worked smoothly, however the airports had a legal obligation to support patients where required. Mrs Carolan advised that the revised documentation had been discussed at PFPI and the view there had been that staff should be focused on the requirement for comprehensive communication in this regard. It was agreed the impact of the changes would need to be evaluated in time. The Board agreed the revised procedures and patient leaflet that would apply to all patients that required an escort. 2017/066 Local Delivery Plan 2017/18 Feedback Letter As at 2017/ /067 Verbal Updates by Committee Chairs Staff Governance Committee meeting held on 15 May 2017 This meeting had considered sickness absence, workforce projections, an equality and diversity work update, and an outline of the transformational change programmes of work. Concerns had been expressed about the capacity for people to deliver change at pace. Endowment Committee meeting held on 17 May 2017 There had been a continuing discussion about a major campaign for fund raising for an MRI scanner, and an application for a community health poly tunnel. A letter had been drafted for staff regarding fundraising ideas. Joint Audit and Committee Chairs meeting held on 17 May 2017 This was an important part of the governance arrangements in preparation of the annual report for inclusion in the annual accounts. Strategy and Redesign Committee meeting held on 23 May 2017 Much of this committee s business had been discussed earlier on the Board s agenda. The meeting had also heard about management arrangements for the strategic change programme and also some of the challenges around capacity of visiting services.

13 Clinical, Care and Professional Governance Committee meeting held on 7 June 2017 This meeting had new Council representatives who had made comment on the quantity and impenetrable nature of the papers. It had been agreed to discuss prior to the next meeting what the committee s business was all about. The committee had considered the Records Management Policy and the perceived current crisis in mental health provision. Members had been glad to receive assurance that patient safety was not in jeopardy. PFPI Steering Group meeting held on 12 June 2017 This meeting had considered the patient travel documentation and also the feedback and complaints report. Most of the meeting had been given to proposals to restructure the PPF to a more online, virtual platform with perhaps only one or two actual meetings each year. Mr Massie was taking the lead on this. Audit Committee meeting held on 13 June 2017 The meeting had essentially been to consider the Annual Accounts and the internal and external audit reports. As previously discussed, there was nothing significant to flag to the Board. A review of attendance records showed there was not an issue with lack of attendance at this meeting. Endowment Committee meeting held on 22 June 2017 The meeting had now approved the funding of specific procedure consent leaflets and also reviewed the annual accounts. It had also approved funding for Hello my name is badges. 2017/068 Approved Committee Minutes for noting Minutes of the Clinical, Care and Professional Governance Committee on 28 November 2016 Minutes of the Clinical, Care and Professional Governance Committee on 14 February 2017 Minutes of the Staff Governance Committee held on 23 February 2017 Minutes of the Endowment Committee held on 7 March 2017 Minutes of the PFPI Steering Group meeting held on 13 March 2017 Minutes of the Strategy and Redesign Committee held on 14 March 2017 Minutes of the Audit Committee meeting held on 28 March 2017 Date and time of next meeting: Tuesday 3 October 2017 at 9.30am in the Bressay Room Board Headquarters Upper Floor Montfield, Burgh Road Lerwick CH 10/08/17